Health Care Reform – How Are You Affected? – Part 2

To date, little is known about specifics expected to come from the two departments. HHS will be the primary driver however, while DOL will address union and other labor issues that arise.Healthcare reforms do address a few specific areas by which employers, large and small, can plan. We do need to remember the final outcome of the law was not to reduce costs. Rather, the purpose was to increase access to health insurance.The immediate timeline related to all employer sponsored health insurance plans look like this:-By September 23, 2010, all insurance plans must offer dependent coverage to children until age 26, regardless of marital status, student status, or employment status.
-Tightly restricted annual limits on “Essential Health Benefits” are eliminated
-Waiting periods for pre-existing conditions are eliminated for children under age 19
-Lifetime benefits are eliminated
-35% tax credit (immediate for 2010) for employers who offer and subsidize health insurance for its employees.Essential Health Benefits will be better defined by HHS over time, but will certainly include mandatory wellness benefits. Health plans in effect on or before March 23, are considered “grandfathered” and thus are exempt from the following mandates. However, a change in carriers, a “substantial” change in benefits, or a substantial shift in costs of premiums to employees will result in the loss of this exemption. HHS will issue R & Rs later, further defining the parameters of “substantial change”.Grandfathered plans may enjoy the luxury of smaller premium increases over time than non-grandfathered plans because these new plans have other, stricter requirements.In the interim, grandfathered plans are exempt from:-First dollar coverage for preventive care although some grandfathered plans offer this benefit.
-Non-discrimination rules are extended to insurance plans. That is, management may not have a richer benefit plan than non-management
-Emergency care services must be treated as “in-network” without prior authorization
-Pediatricians and OB-GYNs are considered primary care providers.Insurance carriers will be required to abide by a “minimum loss ratio” (MLR). This will apply to all group insurance plans. In short, the MLR states that insurance companies must issue refunds to groups if claims are less than 85% (large groups) and 80% (small groups) of total premiums paid. The reverse is also true. Small groups in particular could face excessively high premiums after one particularly unfavorable year. Some employers who provide health insurance are now faced with some tough decisions as a result of health care reform. Non-grandfathered plans are more likely to see significantly higher premiums than grandfathered plans, as R & Rs clarify some of the uncertainty.Health Care Reform included some other obscure provisions about which employees are probably unaware. All non-grandfathered plans and employer groups with 25 or more employees (including common ownership of 2 or more small businesses) will be subjected to a number of reporting requirements in addition to the mandates listed previously. Too, health care reform will begin to count part-time employees as well through a formula called “full-time equivalent” (FTE). This could be especially troubling to employers with fewer than 50 full-time employees, but after accounting for FTE of part-time employees they could inadvertently be counted as 50+ and subject to mandates. The FTE formula will be clarified as time goes by, but by January 1, 2014, all non-grandfathered groups will be subject to these mandates.Health care reform does not require employers to offer group insurance. Nevertheless, penalties will apply to 50+ employee groups (including FTE & remember the common ownership rule) who do not offer medical insurance. For instance, an employer would face a $2000 fine per employee (31st employee and beyond) if even one employee receives a $2000 tax credit from the government toward health insurance through the Exchange (to be explained in a later column) or through Medicaid.Employers who offer health insurance must also offer a free voucher, equal to the employer’s contribution, to all employee’s whose household income is less than 400% of the federal poverty level. The employers can then purchase insurance through the Exchange. If the Exchange is cheaper than the value of the voucher, the employer is then required to pay the difference to the employee.On January 1, 2014, the IRS will get involved. Employers of 50+ and not grandfathered will be required to report the value of the health insurance on W-2′s to be issued by January 2012. Penalties will apply here as well if the reported value is greater than $10,200 for individuals or $27,500 for families. That is, insurers will be assessed an excise tax on the coverage and because of the MLR, that assessment will likely be pushed on to employees as higher premiums.If the employer’s contribution is less than 60% or the employee’s cost share of premium exceeds 9.5% of household income and an employee receives a government subsidy, then a penalty of $2,000 for each employee (31st employee and beyond) is levied..By March 2012, employers of 50+ and non-grandfathered plans must provide a 4-page pre-enrollment coverage document outlining benefits and exclusions to all new employees. Details will be forthcoming from HHS.Reading “between the lines”, it would appear the government is making it difficult for employers at or near 50 full-time employees to offer health insurance. Likewise, employers may be forced to eliminate part-time/seasonal workers and instead opt for overtime to regular/full-time employees to avoid potential penalties and the possibility of having to cover part-time employees on insurance.Health care reform includes other mandates that will trigger by January 1, 2014, but are not as likely as the above mandates to alter an employer’s basic business model on hiring practices, nor are they as apt to influence an employer’s decision on whether to offer insurance.Inevitably, many more questions will arise. As you can see, the intent with health care reform is a push toward universal coverage through employers of 50+. Next time, we’ll talk about individuals and groups under 50

Before the Affordable Health Care Act, They Were Locked Out

(Many provisions of the Affordable Health Care Act have already kicked in before full implementation of the law which takes effect in 2014.)Locked out of medical care, that is. Who? Individuals with pre-existing conditions. Now, 50,000 of them have healthcare coverage via the Pre-Existing Condition Insurance Plan (PCIP) in their state. This is a temporary high-risk health insurance program that makes healthcare not only available but much more affordable.For example, a patient named Deborah fell victim to a back injury. It left her unemployed and unable to afford health insurance premiums. However, when she discovered the Michigan PCIP plan, she was able to enroll in it, receive the back surgery she needed and get on the road to recovery.PCIP makes a difference. It has allowed many Americans to get connected to health insurance and receive the medical care they sorely need. That’s because PCIP enrollees can receive that care immediately.The way it works is that states have the option of operating this new program in their state. However, if a state has chosen not to do so, the Department of Health and Human Services has established a plan in that state. This insurance serves as a bridge to 2014. That’s when all discrimination against pre-existing conditions will be prohibited.You can see how your state administers PCIP with either their own program or one established by the Department of Health and Human Services by clicking on the link below. up to Age 26Another plus of the Affordable Health Care Act that has been in effect since 2010 is where young adults are allowed to remain on their parent’s health plan until they turn 26 (unless the young adult is offered insurance at work).Health Care Premium ExpensesEffective on January 1st, 2011, the law requires that at least 85% of the premium collected by insurance companies administering large employer plans be spent on health care services and quality improvement for health care.For individual and small employer plans, 80% of the premiums must be spent on improving health care services.It this provision is not met, rebates must be given to consumers.Discount Prescription Drugs for SeniorsAlso In 2011, seniors who reach the coverage gap will receive a 50 percent discount when they buy Medicare Part D covered brand-name prescription drugs.Over the next ten years and until the coverage gap is closed in 2020, seniors will receive additional savings on generic and brand-name drugs.

Technology and the Society – Its Facts and Controversy

Technology evolved from the society. Everything technology needed for its growth and advancement it got from the society. Many will argue that it gave everything back to the society too, and rightly so. Technology depends greatly on the society, and the society falls back to technology for its development and improvement. The relationship seems cordial, but is one party unfairly exploiting the other in any way?Technology is in the society. The society is into technology. The society contributes the human and material resources necessary for technology to blossom. There is no denying the obvious fact that technology has indeed, blossomed. The point of discourse is what technology has taken, and is still taking away from the society in its course for growth.Firstly, it should be observed that the societal utilization of technology played a large role in denting the image of technology. Some of the harmful effects of technology, which range from pollution to the obvious depletion of the world’s nonrenewable natural resources, were unintended. They came to the fore after pronounced use of technological processes. They were unforeseen and are totally regretted simply because they take as much as they offer from the society. Withdrawing these processes from the society has become near-impossible because of the total dependence of the society on technology.The major reason for technology was the simplification of human life. It had in mind the maximization of resources to ensure total control of the immediate environment and the proceedings in it. As a consequence of technology, information has become ubiquitous, communication has improved beyond comprehension and the overall quality of societal life has grown immeasurably. Sports have been commercialized and establishments have been able to expand their tentacles across continents.Different forms of danger have also resulted from technology. From the top-drawer, one could cite global warming and pollution as major issues. Then there is the little matter of all the negatives that emanate from the internet. Every new technology also seems to come with its own problems of waste which the society finds it difficult to manage. The harmful effects of all types of waste are also well documented.Technology seems incapable of solving all the problems it has created. This is seen in many quarters as a failure of the concept. Many fail to realize that it is the societal use of technology that gives rise to these dangers. This makes it harsh for the society to blame technology for its shortcomings. In the face of all the prevailing arguments, one might just ask if both concepts are actually separable.Do you want to know more? Read our articles and findings on