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Healthcare Law
continuing the discussion |
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Greetings!
As TACT continues its efforts to deliver timely and accurate information regarding the decision of The U.S. Supreme Court to uphold the constitutionality of the Affordable Care Act, our goal remains for our members to have a full understanding of the law.
This issue of InTACT continues with our discussion from July 31. We invite you to share this news with your coworkers and employees and find us on Facebook to see and share opinions.
As always, if you or your employees have any questions, feel free to contact our office. This is a work in progress. 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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Coverage Reform
Reforms to Commercial Coverage:
(Sept. 2010)
(Grandfathered plans not subject to some of the requirements)
- No pre-existing condition exclusion for children up to age 19
- Guaranteed issue of coverage to children up to age 19 on parent's policy (no federal requirement for individual child-only policy)
- Coverage for "dependent" children, regardless of marital status, financial dependency, or residence, up to age 26 on parent's policy or group coverage
- No lifetime maximum limitation on "essential benefits"
- No annual maximum limitation on "essential benefits" - step implementation permitted - current annual cap allowed is $1,250,000
- 100% coverage for certain preventative care services
Revised claims and appeal provisions
- Rescissions are included as adverse determination
- Required external review procedure
- Small employer defined for federal mandates as 1-100 employees
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
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Grandfathered Plans
Union plans are not subject to the Act until the termination of the last agreement that relates to health coverage.
- Voluntary amendments to comply with the Act are permitted without voiding the above exclusion
- Above exclusion is not technically a grandfather exclusion
- Once subject to the Act, such plan could qualify for grandfather status
A plan may avoid application of some of the Act's new rules if such plan qualifies as a "grandfathered health plan".
- Defined to include any group health plan or individual coverage that was in effect on March 23, 2010
- After March 23, 2010, re-enrollment and addition of dependents is permitted without destroying grandfather status
The following would apply to grandfathered plans:
- Prohibition on pre-existing condition exclusions
- Prohibition on excessive waiting periods
- Lifetime and/or annual limits, though limits may apply on certain medical procedures
- Extension of dependent coverage to age 26
- Prohibition on rescission of coverage
Employer Plans: FLSA (Fair Labor Standards Act) Modifications
An employer is prohibited from discharging or discriminating against any employee who has received a premium tax credit or cost-sharing subsidy.
An employer who sponsors a plan and has 200 or more full-time employees must offer automatic enrollment and provide adequate notice of such feature.
Effective March 1, 2013, an employer must provide each employee at the time of hiring a notice containing:
- The existence of the Exchange, its services and a contact number to the Exchange,
- That the employee may be eligible for a premium tax credit and cost-sharing reduction, and
- That if employee purchases benefits through the Exchange, he or she would lose tax-advantaged employer contributions to the employer-sponsored plan
Employers must provide reasonable breaks to mothers for the purpose of breastfeeding and expressing milk for an infant up to 1 year of age.
- Employer must also furnish a private space (other than a restroom)
- Requirement does not apply to employers who have less than 50 employees if compliance with such requirement would cause an undue hardship (though state laws may apply)
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Where Do We Go
From Here?
As attention shifts from passage of healthcare legislation to its implementation, there are still many questions being asked.
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.
Reader questions (as of August 7) on the new healthcare law listed by topic are available by clicking here.
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Stoney - Walking the Walk
Stoney weighed in August 7 at 230 pounds. He is maintaining his weight now and hasn't added any inches! Even though he is weighing about 5 pounds more than his original goal of 225 he is still way below his weight back in January when he weighed in at 252 pounds. Stay tuned as he continues his transformation and join Stoney and begin your own weight loss transformation.
Note From Stoney:
Follow Stoney's progress on Facebook!
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August is National Immunization Awareness Month.
Give It Your Best Shot!
Shots aren't just for babies. As children grow, protection given by some immunizations can begin to wear off. Preteens, teens and young adults all need to get certain shots. In fact, everyone should follow recommended shot schedules, including getting seasonal flu vaccines. The US has eliminated, or come close to eliminating, life-threatening diseases such as smallpox and polio that were once common.
Vaccines help protect against illness rather than trying to get  well after the fact. Children can develop risks for more diseases as they enter their preteen years. Help your children
stay healthy during their teen years by keeping up-to-date on vaccines. Don't assume that your children received all recommended shots in the past. Talk to their doctor now about any needed vaccines.
Better health starts with a smart plan. Follow a set timetable for shots to keep you and your family safe from illnesses that can be avoided.
Sources: Centers for Disease Control and Prevention; National Institute of Health
To read this article and more information affecting your health, visit us on Facebook!
Boost Your Immune System -
Sending your children to school, stepping inside the local gym, or even putting your hands on a grocery store cart can compromise your health.
Risks of bacteria, toxins, flu viruses and colds, with  fevers, throat infections, and coughs abound. There are preventative measures we can take to strengthen our body's natural defenses against attack. Putting these wellness tips into practice will help boost your body's immune system and decrease your vulnerability to sickness.
1. Take vitamin C and a quality multivitamin (without iron) daily. Other antioxidant-rich natural supplements with antiviral effects include: elderberry, black currant, CoQ10 (ubiquinone), garlic, olive leaf extract, zinc, resveratrol, Pycnogenol, green or white tea extracts, acai berry, echinacea, quercetin, curcumin and alpha lipoic acid. (Ask your naturopath professional which of these supplements best suits your health needs before taking.)
2. Eat 5 to 10 servings of antioxidant-rich fruits and vegetables daily, such as fruits, blueberries, broccoli, melons, sweet and hot peppers, carrots, and dark green leafy vegetables like spinach and kale. Consume high fiber foods, like fruits, potatoes, dark green leafy vegetables, flaxseed, and brown rice to rid the body of toxins. Don't get enough vegetables in your diet? Drink a natural green beverage. It's easy to make your own healthy green drink. (We call ours ABC.) Purchase powdered alfalfa, barley, and carrot. Mix equal amounts together in a container. Add one heaping tablespoon powder mixture to 1/2 cup water or apple juice, shake or stir and drink, first thing each morning.
3. Have some local, raw honey, in moderation, daily. (Raw honey has not been processed: heated or filtered.) Raw honey has powerful antioxidant properties and contains bee pollen and propolis, which not only boost the immune system but have anticancer properties, builds immunities to allergies, aid in detoxification, increase energy levels, and contain beneficial enzymes and antimicrobial properties. Buy directly from a local beekeeper. Ask if chemicals were used in the colonies. Do not purchase if they were. Take note! Children under one year old should not consume honey.
4. Exercise 5 to 6 days a week for at least 30 minutes a day, or for 60 minutes a day for the best results.
Regular exercise helps with lowering inflammation in your body. According to the latest medical findings, inflammation is more detrimental to your health than bad cholesterol. Exercise is also a great stress reducer. Combine cardiovascular exercises with weight training exercises. Do resistance exercises or other muscle building exercises, daily.
5. Avoid obesity. Don't overeat. If you have a tendency to overeat, begin each meal with a piece of fresh fruit or a green salad. Take modest portions. Don't rush through meals; relax and eat slowly. Wait 10 minutes after eating before taking seconds. It takes at least that long for your stomach to tell your brain that it's full. Better yet, eliminate second servings.
For more tips on boosting your immune system, read the rest of this article in the Farmers' Almanac.
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The above healthcare-related information 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.
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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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