by Admin. | Oct 30, 2017 | family health insurance, Health Care Reform, Individual Exchanges, individual health insurance, Obamacare
6 Changes to 2018 Individual Health Insurance Open Enrollment Period
HealthCare.com Offers Insight on 6 Changes to 2018 Individual Health Insurance Open Enrollment Period. The health insurance Open Enrollment Period for 2018 opens Nov 1st and now lasts only 45 days. HealthCare.com provides insight on the abbreviated timeline and other notable changes to watch out for.
HHS released final 2018 Notice of Benefit. Contact us today at (855) 667-4621 or info@medicalsolutionscorp.com.
6 Changes to 2018 Individual Health Insurance Open Enrollment Period
MIAMI and NEW YORK, Oct. 27, 2017 /PRNewswire/ — Despite efforts from the federal government to reform the Affordable Care Act, the 2018 health insurance Open Enrollment Period – the time when Americans can change Obamacare health insurance plans or a join a new plan for the upcoming year – will still begin on November 1, 2017. But this has left most Americans confused about how this year’s open enrollment differs from the previous three.
Unlike previous Open Enrollment Periods, which each occurred over a 90-day window, this year’s open enrollment will last just 45 days – starting on November 1 and lasting until December 15. The shortened timeframe means Americans will have less time to make decisions about their healthcare. While some U.S. states have extended the enrollment periodfor their individual state exchanges (notably, California and New York), most states will follow the condensed 45-day enrollment window.
There are several major changes to the open enrollment process in addition to the condensed 45-day enrollment window. It’s likely that many consumers will be caught off-guard, as these changes to open enrollment have not been well publicized. HealthCare.com cofounder and CEO, Howard Yeh, explains how these open enrollment changes may affect consumers and the coverage options available to them.
1. Changes to Re-Enrollment:
“In previous enrollment periods, people were provided with several government notices to compare their current plan with other healthcare plans on the Marketplace. This year, it’s unclear whether consumers will be provided those notices. That’s why it’s important to shop around for a different health insurance plan during open enrollment. If consumers don’t compare their plan options, they run the risk of being re-enrolled in the same plan. This is the case even after the enrollment period has already passed. If their current plan’s monthly premium is set to increase, they may get stuck with a plan that doesn’t fit their needs, or is otherwise unaffordable.”
2. The End of Subsidies Towards Cost-Sharing Reductions:
“The Trump administration has decided to stop financing cost-sharing reduction (CSR) subsidies to insurance companies. Most insurers predicted this in fact. The prices for Silver plans (the only plans for which these cost-sharing reductions were made available). This means higher insurance premiums and out-of-pocket costs for some. This also means, though, that people in some areas of the country may encounter Gold and Platinum plans that cost just as much or even less than Silver plans.”
3. Fewer Insurers, Fewer Options:
“Several insurers have filled in the gaps left by the exit of major insurance companies like Aetna and Anthem from the Marketplace. While this ensures that consumers across the country have healthcare options available to them. In reality, the options are significantly slimmer than those in previous years. In many areas of the country, only one ACA health plan option will be available to consumers. Most plans are costlier that may be prohibitive for many.”
4. Higher Costs Overall:
“Costs for ACA plans overall will be higher compared to previous years – with insurers charging, on average, 20% more on premiums. These costs have outpaced income growth. Leading to a unique affordability gap – where people make too much to qualify for Obamacare tax credits, but make too little to actually afford a Bronze plan. Under the law, those unable to afford a Bronze plan are exempt from paying the penalty for not having health insurance, “Marketplace affordability exemption”). This year, we expect more than 1.5 million people to qualify for that exemption – a significant increase from the 600,000 two years ago.”
5. Less Government Assistance:
“The federal government has also slashed funding for different initiatives intended to encourage and support people enrolling in Marketplace coverage. Notably, there will be less help available from ‘navigators’ and government spending on Obamacare outreach and advertising is now virtually nonexistent. This means it’s up to consumers to actively seek out help when signing up – and it’s up to nonprofit organizations and private companies to step up and make sure consumers get the information they need.”
6. Decrease in Participation Due to Rise of Alternatives to Traditional Health Insurance:
“Motivated by increasing costs and limited options, more consumers are moving towards alternatives to ACA health insurance. Relatively unknown healthcare options, like association plans and faith-based healthcare, are becoming more popular. And people may start using short-term health insurance plans – which typically serve as temporary coverage solutions. They may reult in full-time replacements to traditional coverage, especially due to the President’s executive order. The short term plans may now last up to a year (compared to the previous limit of three months).”
Approximately 20 million people will shop for health insurance during this Open Enrollment Period. HealthCare.gov a top destination for consumers looking to shop around for the best-priced plan on Marketplace health insuranc. Additonaly, alternatives to ACA coverage (like short-term health insurance plans) are included.
RELATED LINKS: For important updates throughout open enrollment, follow us medicalsolutionscorp.com on Facebook, Twitter, or visit our call us 855-667-4621 for more customized information.
by Admin. | Aug 24, 2017 | group health insurance, Health Care Reform, latest health insurance news, NY News, Obamacare, Small Business Group Health, Tax
CareConnect Withdraws from NYS Market
CareConnect today has announced their intent to withdraw from the NYS 2018 market. The ACA Risk Adjustment Program was penalizing CareConnect again $100 Million for 2018 after a $112 million tax in 2017.
The problems CareConnect was facing were not new and was covered in last month blog. This problem has bipartisan recognition and Cuomo Administration Asks Feds for ‘Immediate Changes’ to Risk Adjustment Program. While this tax or “risk adjustment penalty” was intended to increase competition it is blamed as the single largest bankruptcy cause for the 12 of 16 Obamacare Co-Ops such as the Health Republic of NY and for start-ups like Oscar and CareConnect.
The formula used to calculate payments in the risk-adjustment program has been criticized for unfairly favoring larger plans with more claims experience. Smaller companies that sell on the ACA’s exchanges have said they don’t have as many claims data, and therefore their membership base looks healthier than it is. In a twisted way, the young companies in need of help were actually subsidizing mature Insurers with legacy data systems.
Who is CareConnect?
CareConnect is a physician/hospital-owned Insurer by Northwell Health also formerly known as North SHore LIJ. Careconnect manages the health of 400,000 individuals, including 125,000 customers. Outside of the risk adjustment penalty the Insurer was managing population health and would have posted a profit. Their past rate increases were single digits.
Sadly, this is a tremendous consumer market hit. Their growth was predicated on delivering excellence of care while still mindful of consumer affordability, see chart below. Not only were they on average 20-30% less expensive but their benefits were typically enhanced. Example: A Tradition Gold plan member would NOT have a deductible nor coinsurance for surgeries and hospital stays at a time when all competing Gold plans did.
Regrettably, no State appeal has been victorious as of yet. With logger-head federal conflicts in Government today on repairing Obamacare flaws the victims will once again be the middle-class consumer.
See Press release:
https://www.northwell.edu/about/news/press-releases/while-preserving-its-population-health-commitment-northwell-withdraw-careconnect-nys-insurance-market
Next Step:
Please sign up for the Sept 13th webinar below on CareConnect Exit & Next Steps for Your Group.
by Admin. | Aug 20, 2017 | family health insurance, group health insurance, Health Care Reform, healthcare, Individual Exchanges, individual health insurance, latest health insurance news, NY News, Obamacare, Small Business Group Health, State Exchanges
NYS 2018 Final Rates Approved 
NYS has approved 2018 Final Rates last week. Small group rates will increase 9.3% while the individual rate average increase will be 13.9%.
As per NY State Law carriers are required to send out early notices of rate request filings to groups and subscribers see original –NYS 2018 Rate Requests. With only 3 months of mature claims, experience for 2017 health insurers’ requests are historically above average. Ultimately the State reduces this request substantially. This year, however, NYS acknowledged that medical costs increased, citing a 7-percent average increase on the individual market and an 8.5-percent increase on the small group market. The administration also acknowledged drug prices have impacted insurers, pointing specifically to blockbuster drugs for Hepatitis C.
OTHER STATES
The national rate trend, however, has been much higher than in past years due to higher health care costs Like other states throughout the nation, the 2017 rate of increase for individuals in New York is higher than in past years partly due to the termination of the federal reinsurance program. The loss of the program’s a.k.a. federal risk reinsurance corridor funds account for 5.5 percent of the rate increase.
How are neighboring States doing? In NJ, not that bad. According to a review of filings made public last week the expected rate increase will likely be half. Example: Horizon Blue Cross Blue Shield requested a 4.8% increase on their OMINA Plans. For CT market, on the other hand, things are much worse at least for the individual marketplace with average 25% rate increases.
While the individual mandate is still the law, Washington has made it clear that they aren’t going to enforce the mandate. That means fewer people will buy health insurance raising the prices for those who do.
A bipartisan group of congressional representatives has discussed an agreement to extend and guarantee the payments, but it’s unclear whether they could do so by the new filing deadline of Sept. 5. A lawsuit filed by Congress against the Obama administration to challenge the payments is still pending. In addition, Trump has repeatedly threatened to withhold payments to insurers that reduce cost-sharing – deductibles, copays and coinsurance – paid by low-income customers. More than half of New Jersey’s marketplace customers receive that assistance, and without it, most would be unable to afford coverage.
Finally, a tax on health insurance premiums is due to be reinstated in 2018 after a one-year “tax holiday” approved by Congress for 2017. That contributed 2.3 percent to the rate hikes that insurers requested last year.
SMALL GROUP MARKET VS. INDIVIDUAL MARKET
The new premium hikes ranged from as little as .8% percent for Hudson Valley’s Crystal Run Health Insurance Company to a whopping 20.4% percent increase for Albany region’s CDHP. Importantly, small group market is still more advantageous than individual markets unless one gets a sizable low-income tax credit.
Overall, about 350,000 individual plan consumers will be affected by the price hike, while more than a million users will be hit by higher small group fees. Last year, Blue Cross Blue Shield released a study showing Obamacare user costs were 22 percent higher than people with employer-sponsored health plans, while UnitedHealth plans to exit most Exchanges see – Breaking: Oxford Exits Metro Indiv & Oxford Liberty HMO 2017.
The correct approach for a small business in keeping with simplicity is a Private Exchange and with our large buying group PEO partnerships. This is a true defined contribution empowering employees with a choice of leading insurers offering paperless technologies integrating HRIS/Benefits/Payroll. Both employee and employers still gain tax advantage benefits under the business. Also, the benefits, rates and network size are superior under a group plan as the risk are lower for small group plans than individual markets.
* All amounts are rounded to the nearest 1/10.
**Indicates that the company makes products available on the “New York State of Health” marketplace.
Learn how a Private Exchange and our PEO Partnership can help your group please contact us at info@medicalsolutionscorp.com or (855)667-4621.
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by Admin. | Jul 6, 2017 | Health Care Reform, NY News
Cuomo Administration Asks Feds for ‘Immediate 
Changes’ to Risk Adjustment Program
Yesterday marked 1 the year anniversary since the above Politico article “Cuomo Administration Asks Feds for ‘Immediate Changes’ to Risk Adjustment Program” was published. Little has changed and the controversial ACA Risk Adjustment is proving to be a company killer rather than the intended savior.
What is Risk Adjustment?
The permanent risk-adjustment program is meant to keep ACA insurers from cherry-picking healthier plan 
members over sicker, costlier ones. It collects payments from plans with healthier than average members and distributes that money to plans saddled with sick, high-cost members. The zero-sum program is based on a patient’s risk score, which factors in demographic information and health conditions. The CMS said 709 insurers participated in the risk-adjustment program.
The formula used to calculate payments in the risk-adjustment program has been criticized for unfairly favoring larger plans with more claims experience. Smaller companies that sell on the ACA’s exchanges have said they don’t have as much claims data, and therefore their membership base looks healthier than it is.
Several small plans and co-ops formed under the ACA have sued over the risk-adjustment formula. Evergreen Health co-op in Maryland, for instance, sued in June 2016 to block the federal government from requiring it to pay millions in risk-adjustment charges. Co-ops New Mexico Health Connections and Minuteman Health of Massachusetts filed similar suits last year.
This punishes start-up growth companies. A local example would be small group/individual market CareConnect’s $129M and Oscar’s $44M negative adjustment while United has had a windfall of nearly $330M positive adjustment. Put another way, this is an unintended welfare program for the rich legacy Insurers paid for by the very companies needing help in the market.
Risk-adjustment transfers for individual-market plans
Risk-adjustment transfers for small-group market plans
Cuomo Adjusting to Risk Adjustment?
Since last months NYS 2018 rate filing announcement the justifiable calls from members have been “Why are my #CareConnect rates going up 19%”. A whopping $119 Million in RISK ADJUSTMENT is owed to Center for Medicare Services. Alarmingly, this is not a political partisan issue and all agree on the flaws and unintended consequences. CMS has acknowledged the flaws but are working with a 5 year time frame. Sadly young companies cannot afford to stay in business by then.
The unofficial 3 tests presumptions of good regulations have been missed:
- Regulations must be non-political
- Designed with excellence
- Executed perfectly
The good news is that CMS can change this regulation without an act of Congress. Regrettably, no State appeal has been victorious as of yet. For Governor Cuomo’s part the majority of the policies outlined in a press release from the governor’s office do not directly address the Risk Adjustment appeal and are already state law and would do nothing to protect New Yorkers’ from the skyrocketing costs they’d likely bear if the subsidies that underpin the Affordable Care Act are reduced or repealed.
In conclusion, to the clients suffering a 19% increase for 2018 the biggest fear is not having to change companies. The real fear, in fact, ought still to be will that company be around next year? This regulation, ironically,only affects individuals and small busnesses.
by Admin. | Jun 7, 2017 | family health insurance, group health insurance, Health Care Reform, Health Exchanges, individual health insurance, latest health insurance news, NY News
Yesterday, NYS 2018 Rate Requests filings were released. The total weighted average increases were 11.5% small groups and 16.6% individual market. This early filing request deadline request requirement is not an Obamacare requirement. As per NY State Law carriers are required to send out notices of rate increase filings to groups and subscribers.
These are simply requests and the state’s Department of Financial Services has authority to modify the final rates. But they are the first indication of what New Yorkers can expect when shopping for health insurance on the individual marketplace at the end of this year. The news comes as insurance companies across the country brace consumers for another year of large rate hikes, owing in part to the composition of the individual market, and in part to the uncertainty over the future of the law under the Trump administration.
Background:
By comparison last year NYS 2017 Rate Request early filings were higher at 12.3% small group and 19.3% for individuals. The final filing rates were lower NYS 2017 Final Rates were 8.3% small group and 16.6% for individuals. The NYS 2016 Rates final rates were 9.8% small group and 17.1% for individuals. Using these past figures one projects a 2018 Final Rates of 7% small groups and 14% individuals.
With only 3 months of mature claims in 2017 to work of off Insurance Actuaries have little experience to predict accurate projections. Simply put the less credible information presented to actuarial the higher the uncertainty and higher than the expected rate increase. The national rate trend, however, has been much higher than in past years due to higher health care costs and the loss of Federal reinsurance fund known as risk reinsurance corridor.
Individuals:
Individual rates are expected to be higher than the small group market. The national rate trend, however, has been much higher than in past years due to higher health care costs Like other states throughout the nation, the 2018 rate of increase for individuals in New York is higher than in past years partly due to the termination of the federal reinsurance program. The loss of the program’s aka federal risk reinsurance corridor funds accounts for 5.5 percent of the rate increase.
This is one of the reasons why the individual market is significantly more costly to operate than the small group as per recent Aetna and United Healthcare pull out of most State Individual Exchanges. Another local example was last year’s Oscar Health Insurance which had lost $105 million and is asking for up to 30% rate increase. The 3-year-old company said the increase was necessary because medical costs have risen, government programs that helped cover costs are ending, and its members needed more care than expected. For 2018, with successful pivotal changes, Oscar is asking below average 11% individual increase and a decrease of 3.2% small group next year.
Small Groups:
While small group rates are better risk and naturally lower rates. There is some rate shock with notably Careconnect. CareConnect, the financially struggling health insurance arm of Northwell Health, has asked the Cuomo administration to allow an average 30 percent premium hike on the individual market in 2018. The company, which lost $157 million in 2016, is asking for small group increases that range between 9 and 24 percent.
THE THREE R – RISK CORRIDOR, RISK ADJUSTMENT & REINSURANCE designed to mitigate the adverse selection and risk selection. The problem, according to many insurance companies, is that the formula is flawed, and CareConnect executives have consistently complained that they are at an unfair disadvantage. The Cuomo administration has taken steps to ameliorate some of those problems, giving the DFS the authority to essentially overrule the federal numbers. In its first-quarter financial report, executives made clear that the risk adjustment penalty was a threat to its business.
Defined Contribution Choice:
Instead, the correct approach for a small business in keeping with simplicity is a defined contribution model using a Private Exchange. This is a true defined contribution empowering employees with the choice of leading insurers offering paperless technologies integrating HRIS/Benefits/Payroll. Both employee and employers still gain tax advantage benefits under the business. Also, the benefits, rates and network size are superior under a group plan as THE RISK OUTLINED ABOVE ARE HIGHER FOR INDIVIDUAL MARKETS THAN SMALL GROUP PLANS.
You may view the NYS 2018 Rate Requests DFS press release, which includes a recap of the increases requested and approved by clicking here.
For a custom analysis detailing YOUR upcoming 2017-2018 renewal please contact our team at Millennium Medical Solutions Corp (855)667-4621. We work in coordination with Navigators to assist with Medicaid, CHIP Child Health Plus, Family Health Plus and Medicare Dual Eligibles. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
Summary of 2018 Requested Rate Actions
INDIVIDUAL MARKET
| Company Name |
2018 Requested Rate Action |
| Affinity |
23.5% |
| Care Connect |
29.7% |
| CDPHP |
15.2% |
| Crystal Run Health Plan, LLC |
8.7% |
| Emblem (HIP) |
24.9% |
| Empire ** |
N/A |
| Excellus |
4.4% |
| Fidelis |
8.5% |
| Healthfirst Insurance Company, Inc. |
13.0% |
| Healthfirst PHSP, Inc. |
22.1% |
| HealthNow New York |
47.3% |
| IHBC |
25.9% |
| MetroPlus |
7.9% |
| MVP Health Plan |
13.5% |
| Oscar |
11.1% |
| UnitedHealthcare of New York Inc |
38.5% |
| Total Weighted Average |
16.6% |
SMALL GROUP MARKET
| Company Name |
2018 Requested Rate Action |
| Aetna Life |
14.2% |
| Care Connect |
19.3% |
| CDPHP |
21.1% |
| CDPHP UBI |
8.6% |
| Crystal Run Health Insurance Company |
0.0% |
| Crystal Run Health Plan, LLC |
3.9% |
| Emblem (HIP) |
8.5% |
| Empire Healthchoice Assurance |
12.9% |
| Empire Healthchoice HMO |
13.8% |
| Excellus |
8.0% |
| Healthfirst Health Plan, Inc. |
10.0% |
| Healthfirst Insurance Company, Inc. |
10.0% |
| HealthNow New York |
8.9% |
| IHBC |
14.5% |
| MetroPlus |
5.1% |
| MVP Health Plan |
8.5% |
| MVP Health Services Corp |
11.7% |
| Oscar |
-3.2% |
| Oxford Health Insurance Inc |
11.4% |
| UnitedHealthcare Ins Company of New York |
15.2% |
| Total Weighted Average |
11.5% |
*These averages may change based on DFS’s review of the rate applications.
** Empire submitted a filing that DFS is evaluating.
by Admin. | May 4, 2017 | AHCA, Health Care Reform, HSA, Obamacare, Tax
Breaking: House Passes Obamacare Repeal & Replace
In a first step toward repealing and replacing Obamacare ie. Affordable Care Act (ACA), the House of Representatives narrowly passed the American Health Care Act (AHCA) today by a vote 217-213. Every House Democrat and 20 House Republicans opposed the measure. The bill will now be sent to the U.S. Senate. Until this legislation is passed by the U.S. Senate and signed into law by President Trump, all existing ACA requirements remain in effect, including penalties for noncompliance.
Notable Provisions of the American Health Care Act
If signed into law, the American Health Care Act would, among other changes, make the following revisions to key features of the ACA over the next three years:
SIMILARITIES
- Pre-Exissting Conditions Covered: Under the Affordable Care Act, insurance companies are required to cover pre-existing conditions. This is still the case under the AHCA, but the creation of High Risk Pools, funded with $8 billion dollars was an added amendment to the AHCA. Pools provide coverage if you have been locked out of the individual insurance market because of a pre-existing condition, and are subsidized by a state government. The premium is up to twice as much as individual coverage. Individuals who have a lapse in coverage of more than 63 days will be required to pay a 30 percent premium surcharge for 12 months when coverage is purchased.
- Adult Coverage to Age 26 Covered: People who are under 26 years old can stay on their parents’ health insurance plan under both the ACA and the AHCA.
- No Lifetime Cap: People who are under 26 years old can stay on their parents’ health insurance plan under both the ACA and the AHCA.
CHANGES
- “Pay or Play”: Penalties for noncompliance with the “pay or play” coverage requirement (which mandates, in general, that employers with 50+ FT
Click Image
employees [including full-time equivalent employees] must offer affordable, minimum value coverage to their full-time employees, or pay a penalty tax) are zeroed out. However, the Form 1094 & 1095 reporting requirements are unchanged by the bill.
- Individual Mandate: Penalties for noncompliance with the individual mandate are zeroed out, effectively repealing the mandate. In its place, the bill requires issuers in the individual or small group markets to impose a 30% penalty on the health insurance premiums of individuals who do not maintain continuous health insurance coverage.
- Essential Health Benefits: AHCA eliminates the requirement for Essential Health Benefits. The AHCA allows limited policies that are only in case of major illness or injury.
- HSA Contribution Limits: Limits on contributions to health savings accounts (HSAs) are increased to equal the inflation-adjusted annual out-of-pocket expenses limitation imposed on high deductible health plans (currently $6,550 (self-only coverage)/$13,100 (family coverage)).
- Health FSA Contribution Limits: Limits on contributions to health flexible spending arrangements (health FSAs) are eliminated.
- Tax Credits for Individual Coverage: Replaces the ACA’s premium tax credits for individual market coverage with advanceable, refundable tax credits adjusted for both age and income.
- Market Reforms: Permits states to seek waivers from the ACA’s essential health benefits and age and health status community rating requirements.
- Medicaid: Allows states to elect to receive federal Medicaid funding via a block grant or per capita allotment, and alters the ACA’s Medicaid expansion.
The chart below summarizes some of the significant changes made by the AHCA.
|
Affordable Care Act (ACA)
|
American Health Care Act (AHCA)
|
Mandates
|
- Individual mandate
- Employer mandate on applicable large employers (ALEs)
|
- No individual or employer mandate effective retroactive to Jan. 1, 2016
- Insurers can impose a one year 30% surcharge on consumers with a lapse in continuous coverage (individual and small group market)
|
Assistance
|
- Income-based subsidies for premiums that limit after-subsidy cost to a percent of income
- Cost sharing reductions for out-of-pocket expenses
|
- Age-based refundable tax credits for premiums, phased out for higher incomes
- No cost sharing reductions for out-of-pocket expenses
- ACA subsidies phased out after 2019; AHCA credits effective in 2020
|
Medicaid
|
- Matching federal funds to states for anyone who qualifies
- Expanded eligibility to 138% of poverty level income
|
- Federal funds granted to states based on a capped, per-capita basis starting in 2020
- States can choose to expand Medicaid eligibility, but would receive less federal support for those additional persons
|
Premium Age Differences
|
|
- 5:1 (and the MacArthur amendment would allow a higher ratio)
|
Health Savings Account Limits
|
|
- Contribution limits increased to maximum out-of-pocket limit for HDHP coverage
- $6,550/$13,100 (effective retroactively to Jan. 1, 2017)
|
“Cadillac” Tax
|
- Cadillac tax on high-cost employer plans implemented in 2020
|
- Cadillac tax on high-cost employer plans delayed until 2026
|
Other Taxes
|
- 3.8% tax on net investment income
- Limit placed on contributions to flexible spending accounts
- Annual health insurance provider tax
- Over-the-counter medication excluded as qualified medical expense
- 0.9% Medicare tax on individuals with an income higher than $200,000 or families with an income higher than $250,000
|
- Repeal of these taxes retroactive to the beginning of 2017 (except for the repeal of the Medicare tax, which would begin in 2023)
|
Essential Health Benefits
|
- Individual and small group plans are required to offer ten essential health benefits
|
- Under the MacArthur amendment, individual and small group plans are required to offer the ten essential health benefits, but a waiver option is available
- Some Medicaid plans are not required to offer mental health and substance abuse benefits
|
MacArthur Amendment
The following chart summarizes the changes made to the AHCA by the MacArthur amendment.
| Insurance Market Provisions |
The MacArthur amendment:
- Reinstates Essential Health Benefits (EHB) as the federal standard (removes ability of states to define EHBs, but see waiver option)
- Maintains the following provisions of the AHCA:
- Prohibition on preexisting condition exclusions
- Prohibition on discrimination based on gender
- Guaranteed availability and renewability of coverage
- Coverage of adult children to age 26
- Community Rating rules (but see waiver option)
|
| Limited Waiver Option |
States may obtain waivers from certain federal standards, in the interest of lowering premiums and expanding the number of enrollees. States could seek waivers from:
- Essential Health Benefits (states could set their own definition of EHBs for the individual and small group markets starting in 2020, and increase the age rating ratio above 5:1 starting in 2018)
- Community rating rules, except for the following categories, which are not waivable:
- Gender
- Health Status (unless the state has established a high-risk pool or is participating in a federal high risk pool)
|
| Limited Waiver Requirements |
States must explain how the waiver will benefit the insurance market in their state, such as reducing average premiums, increasing enrollment, stabilizing premiums for individuals with pre-existing conditions, or increasing the choice of health plans.,Applications are automatically approved within 60 days unless denied by HHS. |
As always, please contact us info@medicalsolutiosncorp.com for a compliance review of your benefits offering. Click here to read the American Health Care Act in its entirety.
