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Issue: # 114
| <June 19, 2014 |
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Dear :
Average renewals are still all over the place. In the small group marketplace we have noticed that if you have a traditional co-pay, and not a deductible plan, increases have been substantial - meaning 15% to 25%. We do not know if this is a co-incidence, or if the carriers are trying to transition all small groups into deductible plans! There are very few companies remaining that have old co-payment plans left. The norm now is that employees are subject to deductibles per member of $500, $1,000 or $2,000 with a cap of two times the individual for a family.
We are often asked what the deductible applies to, but it is easier to answer what it does not apply to:
- 1) prescriptions (co-payment)
- 2) emergency room (co-payment--some companies do apply deductible)
- 3) annual well care exam (free not even a co-payment)
- 4) routine office visits to PCP and specialist (co-payment)
- 5) annual mammogram and OBGYN
Everything else applies to deductible:
- 1) Hospitalizations
- 2) Day Surgeries
- 3) MRI-PET-CAT scans
- 4) X-rays
- 5) Services outside a normal office visit like blood work and other diagnostic testings
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More companies are taking a look at tiered networks, which have different co-payments for different hospitals, the more expensive the hospital the more you pay; for example, MedCity (St Vincent's) may cost $250 while UMass $2,500. These plans are examples of Consumer Driven Health Plans. In other words, the Consumer makes their own decisions to determine how much they will pay out of pocket.
If you have a health insurance plan and we are not your broker, maybe you should ask yourself if we deserve to be your broker since you are reading this?? All you need to do is assign your group to us and we will be able advocate for you every day like we do for our current clients. E-mail us ,
Sincerely,
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Open Enrollment For State Exchange
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This year's Open Enrollment has ended and the next Open Enrollment created by ACA (Obamacare)will be between November 15th, 2014 and January 15, 2015 for plans effective January 1st. In Massachusetts, we did not elect to be part of the Federal Exchange, but instead have set up our own exchange called the Connector Authority which crashed.
Do you think they will be ready for the next open enrollment period?
Things are not looking very good for the subsidized health plan which is suppose to be operational July 1st, click here. The end of the year will be here before you know it. If this is not fixed, we may have to scrap the Connector Authority and join the Federal Exchange.
Estimates are that the Connector Authority has already cost approxoimately $60,000,000 dollars. Who knows where that number will be by the end of the year.
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Waiting Period & Cobra Notices
Health insurance premiums are very expensive and the last thing you want is to hire a new employee, put them on your plan, pay a portion of the premium and then have to chase them for Cobra premiums for the next 18 months if they do not work out. As a result employers, should have a waiting period as long as possible.
Effective January 1, 2014 under ACA the longest an employer can now have a waiting period is 90 days. Employers should also note the Cobra notification letter should be amended to include a new paragraph that states employees can also seek insurance through the State Exchange.
WE will prepare the model language for this paragraph and get it out to you.
Email us with any questions!
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My Healthy Health Plan (Fallon)
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In past newsletters we have talked about Blue Cross and their Healthy Actions Plan, which enables employees earn up to $300 and employers get a refund based on participation of the employees. Fallon has had a similar plan called Healthy Health Plan that is included in the premium and employees are able to earn up to $200, but the employer does not have the ability to get any refund.
April 1st, Fallon has increased eligibility for the $200 to all adult dependents 18 and over, not just the employee. We know of no other company that has extended this type of benefit beyond the employees insured under the group plan. If you have Fallon, you do not have to wait till renewal. The benefit was expanded April 1st.
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Employers Requirements To Provide Health Insurance
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Last year Massachusetts Lawmakers repealed what was referred to as the Employer Fair Share Program. Remember this story from the Boston Globe. Last week the Connector Authority formally voted to repeal the Massachusetts law requiring employers with 11 full-time or part-time equivalents to offer health insurnace or pay a fine. They had no choice since they no longer had a means to enforce the law without the Employer Fair Share Program.
- This year (2014), no employers of any size are required to provide health insurance.
- Next year (2015), employers with at least 100 full-time employees will have to offer coverage to at least 70% of their full-time employees or pay an annual $2,000-per-employee penalty. In calculating the penalty, an employer can exclude 80 of its full-time employees in 2015.
- Then in 2016, the mandate will apply to employers with at least 50 full-time employees, with the 80-employee exclusion in calculating the penalty for not offering coverage permanently dropping to 30 employees.
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