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Greetings!
The U.S. Supreme Court has upheld the constitutionality of the Affordable Care Act. As an employer and as a citizen, each of us will be affected by this ruling. In the coming months, TACT will be delivering information to all members in an effort to create a full understanding of the law. While there are many undefined and undetermined pieces of the Act, there is much that is known that we are happy to share and discuss. As always, if you or your employees have any questions, feel free to contact our office. This is a work in progress. There are many half-truths and myths regarding this issue. We want to make sure you are getting the correct message.
TACT - Dedicated Insurance Professionals
you know and trust...like Family.
Sincerely,
Stoney Jackson
Executive Director
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Exchange and Operation
Effective January 1, 2014, each state must have established an "Exchange" to provide health insurance to individuals and companies with 100 or less employees.
The Exchange must be open to large employers effective January 1, 2017.
Plans offered under the Exchange may not pass more than 40% of the total benefit costs to employees. Additionally, out-of-pocket costs must be limited to certain amounts.
Generally, for companies with 100 or fewer employees, deductibles may not exceed $2,000 (individuals) or $4,000 (families).
Those individuals at or under 400% of the federal poverty level are eligible for a subsidy up to 2/3rd of the premiums charged for Essential Health Benefits - currently, FPL is $10,050 (individual) and $22,050 (family of four).
All plans offered through an Exchange must provide "Essential health Benefits", generally defined to include:
- Ambulatory patient services and emergency services,
- Hospitalization,
- Maternity and newborn care,
- Mental health and substance abuse disorder services,
- Prescription drugs,
- Rehabilitative services,
- Laboratory services,
- Preventative and wellness services, and chronic disease management, and
- Pediatric services
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Exchange Compliance
July 9, 2012 Press Release of Rick Perry, Governor
"Texas has no intention of implementing a state insurance exchange or expanding Medicaid as part of Obamacare."
"I will not be party to socializing healthcare and bankrupting my state in direct contradiction to our Constitution and our founding principles of limited government."
Federal Exchange
Texas may pursue a state-partnership exchange, where Texas may administer and operate exchange activities associated with plan management and/or consumer assistance.
Qualified Health Plans offered through an Exchange will have to meet Texas licensure and solvency requirements.
Texas will maintain responsibility for health plans licensed and offered in Texas.
HHS will rely on Texas for advice and recommendations regarding provider network adequacy standards under the Exchange. HHS plans to make efforts to harmonize Exchange policy with the existing Texas programs and laws wherever possible.
If Texas does not choose to retain Medicaid and CHIP eligibility determinations, the Exchange will make these determinations using Texas eligibility rules and standards.
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Coverage Reform
Reforms to Commercial Coverage:
(January 2014)
- Guaranteed issuance of all group and individual plans
- No medical underwriting, no discrimination based on health status
- Elimination of preexisting condition exclusions
- Waiting periods for group plans limited to 90 days
- Limitation on deductibles in small group market ($2,000 individual, $4,000 for family coverage)
- Rating restrictions for group and individual market: may only rate based on age (variations limited to 3 to 1), family composition, geography, and tobacco use (variations limited to 1.5 to 1)
- Minimum benefit standards for group and individual plans
- Cannot exclude individuals who participate in clinical trials; must cover routine care that would otherwise be covered
- Waiting period cannot exceed 90 days (employer plans)
- All plans sold (inside and outside of Exchange) are considered a single individual or small group risk pool for rating purposes
Market Reforms: Other Provisions
Consumer Operated and Oriented Plan (CO-OP) program to foster creation of non-profit member-run health insurance companies to offer qualified health plans within Exchange.
Funds of $6 billion allocated to finance grants and loans to entities to establish CO-OPs by July 1, 2013.
Allows states to merge individual and small group markets (January 2014).
Permits employers to offer rewards of up to 30% of the cost of premiums for participating in wellness programs that meet certain standards; provisions included for non-discrimination.
Creates a 10 state pilot program to allow similar programs in individual health plans.
Permits states to form health care choice compacts that would allow multi-state insurance sales in participating states with joint agreement. Consumer protection provisions prevail in state where enrollee resides. If state wants to participate, must enact law (January 2016)
Health insurers can apply with federal HHS to offer nationwide plans; certain conditions apply. |
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Where Do We go From Here?
What if Texas refuses to implement the Exchange?
The PPACA requires HHS to establish and operate an Exchange in Texas.
What if the Texas Legislature passes legislation regarding the Exchange that Governor Perry vetoes?
The PPACA provides broad authority to HHS to establish standards and regulations to implement the statutory requirements related to the Exchange.
What if President Obama is not reelected?
Republicans' best (and perhaps last) hope for overturning the PPACA is to win the White House and majorities in both houses of Congress, and then use budget reconciliation to repeal the law.
How will control of the House of Representatives affect PPACA?
Over the past 18 months with a Republican controlled House, the House has taken 30 floor votes to try to repeal, defund or dismantle PPACA without success.
How will control of the Senate affect PPACA?
Defunding and repeal efforts large and small have been tucked into everything from defense appropriations to student loans, but most have failed or stalled in the Democratic-controlled Senate.
If law is revised or revoked, what key elements of the PPACA might be preserved?
- Annual and lifetime limits -It is not clear exactly what heath benefits are "essential."
- Restrictions on rates and medical loss ratios
- Guarantee issue - In most states, insurance companies can now deny non-group coverage to people based on their health status.
- Play or pay - Some believe that many employers will stop offering coverage and pay the penalties. Others contend that the trade-offs involved are complicated, especially for firms with a mix of low- and high-income workers.
- Age - Coverage for enrollees' adult children until age 26, even if the young adult no longer lives with his or her parents, is not a dependent on a parent's tax return, or is no longer a student.
- Pre-existing exclusion prohibition - If guaranteed issue is preserved, that plus immediate coverage will likely impact premium rates very adversely.
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Requirement to Buy Coverage
Courtesy The Kaiser Family Foundation
Do any of the following apply?
- You are part of a religion opposed to acceptance of benefits from a health insurance policy.
- You are an undocumented immigrant.
- You are incarcerated.
- You are a member of an Indian tribe.
- Your family income is below the threshold requiring you to file a tax return ($9,350 for an individual, $18,700 for a family in 2010).
- You have to pay more than 8% of your income for health insurance, after taking into account any employer contributions or tax credits.
If YES - There is no penalty for being without insurance
If NO - Were you insured for the whole year through a combination of any of the following?
- Medicare.
- Medicaid or CHIP
- TRICARE
- The vetaran's health program.
- A plan offered by an employer.
- Insurance bought on your own that is at least at the Bronze level.
- A grandfathered health plan in existence before the health reform law was enacted.
If YES - The requirement to have insurance is satisfied - no penalty.
If NO - There is a penalty for being without insurance
Penalties -
2014 - Penalty is $95 per adult and $47.50 per child up to $285 for a family or 1% of family income, whichever is greater.
2015 - Penalty is $325 per adult adn $162.50 per child up to $975 for a family or 2% of family income, whichever is greater.
2016 and beyond - Penalty is $695 per adult and $347.50 per child up to $2085 for a family or 2.5% of family income, whichever is greater.
The penalty is pro-rated by the number of months without coverage, though there is no penalty for a single gap in coverage of less than 3 months in a year. The penalty cannot be greater than the national average premium for Bronze level coverage in an Exchange. After 2016, penalty amounts are increased annually by the cost of living.
An Explanation Flow Chart of Penalties for Employers Not Offering Affordable Coverage Under the Affordable Care Act Beginning in 2014 can be found by clicking
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Texas Cotton Ginners Association announces statewide safety seminars.
TCGA Regional Gin Safety Seminars
Informational Flyer
Registration Form
Natinal Grain and Feed Association
and Grain Journal Magazine
invite all facility managers and key employees in the grain handling, processing, milling, and feed industries to a day and a half conference Aug. 1-2
Click here for information and registration details.
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Stoney - Walking the Walk
Stoney's weekly update: July 17th he weighed in at 228.8 pounds just a little over his ideal weight of 225 pounds. This is very close to where he has been weighing in at for the last three weeks and that is with him being on the road traveling and eating out for the last three weeks. He hasn't gained any inches during this time and he continues to feel good and continues to be very Happy!
Note From Stoney:
Follow Stoney's progress on Facebook!
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Did you know...
White corn is considered as a low glycemic index (GI) food? Glycemic index is the ranking of food from 0 to 100 that tells whether a food will raise blood sugar levels dramatically, moderately or just a little.
Low GI food, like white corn, is good on the proper control and management of diabetes mellitus. It delays hunger pangs and promotes weight loss in overweight people as well as extend the endurance of an athlete because of a slow-releasing fuel for the muscles!
Courtesy Texas Corn Producers
To read more health news affecting you,
Like us on Facebook!
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All of the information presented above is available to you via e-mail or mail. If you would like a detailed copy, please contact the TACT office
by calling 806-747-7894.
Refer Us!
Click above to learn more or
to contact the TACT office. |
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Contact Us
Texas Ag Coop Trust
1802 East 50th St., Ste. 107
Lubbock, TX 79404
806-747-7894
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Texas Ag Coop Trust
Officers, Board of Trustees
George Reed, Chairman
United Farm Industries
Plainview, TX
Gregg Allen, Secretary
Olton Grain Coop
Olton, TX
Jim Turner
Dalhart Consumers Fuel Association
Dalhart, TX
Paul Wilson
United Cotton Growers
Levelland, TX
Cary Eubanks
Slaton Coop Gin
Slaton, TX
Dean Sasser
Farmers Coop Elevator
Levelland, TX
Bret Brown
Sunray Coop
Sunray, TX
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Texas Ag Coop Trust
is endorsed by:
Texas Grain & Feed
Association
Texas Cotton Ginners Association
 Texas Coop Marketing Exchange
Texas Corn Producers |
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