Friday, November 21, 2014

Maryland Parental Leave Law for Employers with 15-49 Employees

Beginning October 1, 2014, all Maryland businesses with 15-49 employees will be required to provide six weeks of unpaid leave to an employee upon the birth of their child or the placement of an adopted or foster care child. This new law requires that the employer hold the employee’s job and benefits for up to six weeks or return the employee to an “equivalent position” when the employee returns within the six week leave period. Premiums for benefits may be recovered by the employer if the employee fails to return to work after the leave ends 

This new Maryland law is geared to providing employees who work for smaller employers with a watered-down version of federal Family and Medical Leave Act (FMLA).  Under FMLA employers with 50 or more employees must offer 12 weeks of unpaid leave for a medical condition or to provide care for a family member with a medical condition.   .

Employers may want to draft policy and take necessary steps to comply with the new law.

Thursday, November 6, 2014

Group Health Plans That Fail to Cover In-Patient Hospitalization Services

Health plans that are trying to offer a stripped down Minimal Value plan to save costs and avoid penalties need to be careful.  The Fed is cracking down on these types of plans by requiring in-patient hospitalization services as part of the coverage.  Please see below release via IRS Guidewire. 

Group Health Plans That Fail to Cover In-Patient Hospitalization Services

Notice 2014-69 advises employers and other taxpayers that employer-sponsored health plans that fail to provide substantial coverage for in-patient hospitalization services or for physician services do not provide minimum value within the meaning of § 36B and that the IRS, the Treasury Department, and the Department of Health and Human Services (HHS) expect shortly to propose regulations to this effect.  The notice also advises that IRS, Treasury, and HHS are considering whether the continuance tables underlying the Minimum Value Calculator produce valid actuarial results for plans with these designs. Employers offering plans that fail to cover in-patient hospitalization or physician services should exercise caution in relying on the Minimum Value Calculator to demonstrate that these plans provide minimum value for any portion of a taxable year after publication of final regulations.

Notice 2014-69 will appear in IRB 2014-48 dated Nov. 24, 2014.

Monday, October 6, 2014

Parental Leave Law Now In Effect October 1, 2014-FMLA Light

Beginning October 1, 2014, all Maryland businesses with 15-49 employees will be required to provide up to six weeks of unpaid parental leave to an employee upon the birth of their child or the placement of an adopted or foster care child. The Parental Leave Law requires the employer to hold the employee’s job for up to six weeks or return the employee to an “equivalent position” when the employee returns within the six week leave period.  In order to qualify under this law, the employee must have worked for the employer 12 months and a minimum of 1250 hours in the previous 12 months. 
For employers with more than fifty employees, Family and Medical Leave Act (FMLA) already requires those employers grant 12 weeks of unpaid leave for various qualifying family and medical events, the new Maryland law is geared to providing employees who work for smaller employers with a lighter version of FMLA.  One major difference is that the new Maryland law does not cover medical leave (as it is limited to parental leave) and it only provides for six weeks of leave.  As is under FMLA, employee benefits must be maintained by the employer while on leave.  Premiums may be recovered by the employer if the employee fails to return to work after the leave ends
Employers should update employee handbooks and draft Parental Leave Policy that adheres to the new law.

Friday, September 12, 2014

HIPAA-Responsibilities-Frequently Asked Questions

HIPAA is at the forefront of many employers minds. As many are struggling to comply, hopefully some of the following questions and answers from HHS Website will help.  

What Is Health Information Privacy


The HIPAA Privacy Rule provides federal protections for individually identifiable health information held by covered entities and their business associates and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of health information needed for patient care and other important purposes. 
The Security Rule specifies a series of administrative, physical, and technical safeguards for covered entities and their business associates to use to assure the confidentiality, integrity, and availability of electronic protected health information.

Who must comply with HIPAA privacy standards?


As required by Congress in HIPAA, the Privacy Rule covers:
  • Health plans
  • Health care clearinghouses
  • Health care providers who conduct certain financial and administrative transactions electronically. These electronic transactions are those for which standards have been adopted by the Secretary under HIPAA, such as electronic billing and fund transfers.
These entities (collectively called “covered entities”) are bound by the privacy standards even if they contract with others (called “business associates”) to perform some of their essential functions. The law does not give the Department of Health and Human Services (HHS) the authority to regulate other types of private businesses or public agencies through this regulation. For example, HHS does not have the authority to regulate employers, life insurance companies, or public agencies that deliver social security or welfare benefits. See our business associate section and the frequently asked questions about business associates for a more detailed discussion of the covered entities’ responsibilities when they engage others to perform essential functions or services for them.

I’m an employer that offers a fully insured group health plan for my employees. Is the fully insured group health plan subject to all of the Privacy Rule provisions?


The Privacy Rule recognizes that certain fully insured group health plans may not need to satisfy all of the requirements of the Privacy Rule since these responsibilities will be carried out by the health insurance issuer or HMO with which the group health plan has contracted for coverage of its members. In particular, a fully insured group health plan that does not create or receive protected health information other than summary health information (see definition at 45 CFR 164.504(a) (GPO)) and enrollment or disenrollment information is not required to have or provide a notice of privacy practices. See 45 CFR 164.520(a)(2) (GPO).

Moreover, these group health plans are exempt from most of the administrative responsibilities under the Privacy Rule. See 45 CFR 164.530(k). These health plans are still required, however, to refrain from intimidating or retaliatory acts (45 CFR 164.530(g) (GPO)), and from requiring an individual to waive their privacy rights (45 CFR 164.530(h) (GPO)). The documentation requirements at 45 CFR 164.530(j) apply to these group health plans only to the extent of amendments, if any, made to the plan documents for the sharing of information with the plan sponsor under 45 CFR 164.504(f) (GPO). Additional information about the Privacy Rule, including guidance and technical assistance materials is available through the Department of Health and Human Services Office for Civil Rights Web site.

Must all small health plans comply with the Privacy Rule?


No. Certain plans are specifically excluded from having to comply with the HIPAA Administrative Simplification requirements, including the Privacy Rule. See 45 CFR 160.103 (GPO). An employee welfare benefit plan that has less than 50 participants and is administered by the employer that establishes and maintains the plan is not a HIPAA covered entity. These plans, therefore, are not subject to the Privacy Rule. For additional information regarding compliance with the Privacy Rule, see the Office for Civil Rights Web site.

Are the following types of insurance covered under HIPAA: long/short term disability; workers' compensation; automobile liability that includes coverage for medical payments?


No, the listed types of policies are not health plans. The HIPAA Administrative Simplification regulations specifically exclude from the definition of a “health plan” any policy, plan, or program to the extent that it provides, or pays for the cost of, excepted benefits, which are listed in section 2791(c)(1) of the Public Health Service Act, 42 U.S.C. 300gg-91(c)(1). See 45 CFR 160.103. As described in the statute, excepted benefits are one or more (or any combination thereof) of the following policies, plans or programs:
  • Coverage only for accident, or disability income insurance, or any combination thereof.
  • Coverage issued as a supplement to liability insurance.
  • Liability insurance, including general liability insurance and automobile liability insurance.
  • Workers’ compensation or similar insurance.
  • Automobile medical payment insurance.
  • Credit-only insurance.
  • Coverage for on-site medical clinics
  • Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.

What Is Protected Health Information (PHI)?


The Privacy Rule defines PHI as individually identifiable health information, held or maintained by a covered entity or its business associates acting for the covered entity, that is transmitted or maintained in any form or medium (including the individually identifiable health information of non-U.S. citizens). This includes identifiable demographic and other information relating to the past, present, or future physical or mental health or condition of an individual, or the provision or payment of health care to an individual that is created or received by a health care provider, health plan, employer, or health care clearinghouse. For purposes of the Privacy Rule, genetic information is considered to be health information.

For Covered Entities and Business Associates

The HIPAA Rules apply to covered entities and business associates.  
Individuals, organizations, and agencies that meet the definition of a covered entity under HIPAA must comply with the Rules' requirements to protect the privacy and security of health information and must provide individuals with certain rights with respect to their health information. If a covered entity engages a business associate to help it carry out its health care activities and functions, the covered entity must have a written business associate contract or other arrangement with the business associate that establishes specifically what the business associate has been engaged to do and requires the business associate to comply with the Rules’ requirements to protect the privacy and security of protected health information. In addition to these contractual obligations, business associates are directly liable for compliance with certain provisions of the HIPAA Rules.
If an entity  does not meet the definition of a covered entity or business associate, it does not have to comply with the HIPAA Rules.  See definitions of “business associate” and “covered entity” at 45 CFR 160.103.

Tuesday, July 22, 2014


By Andrew Zajac
July 22 (Bloomberg)

President Barack Obama’s health care overhaul suffered a potentially crippling blow as a U.S. appeals court ruled the government can’t give financial assistance to anyone buying
coverage on the insurance marketplace run by federal authorities.  

The decision, if it withstands appeals, may deprive more than half the people who signed up for the Patient Protection and Affordable Care Act the tax credits they need to buy a health plan.

The way PPACA is written makes clear that the subsidy is available only to people who
bought plans on state-run exchanges, a three-judge panel in Washington ruled today.

Only 14 states have opted to set up their own marketplaces, making delivery of tax credits via
the federal exchange crucial to meeting Obamacare’s goal of broadening health-care coverage
in the U.S.

“A very large share of people need the subsidies,” said Robert Blendon, a professor of health
policy at the Harvard School of Public Health in Boston.

If the ruling isn’t overturned, “it basically would significantly cripple the law,” Blendon said in an
interview before the ruling.

Friday, July 11, 2014


If you have medical, dental, vision, Employee Assistance Program, Flexible Spending Account (FSA), Health Reimbursement Arrangement (HRA), Life Insurance, Short or Long Term Disability plans, the Department of Labor may be knocking on your door asking for a Summary Plan Description (SPD) and Plan Document. They will want to know when you distributed the SPD to your employees and how.  If you can't provide this information in a timely fashion you may be fined up to $110 per day.

A SPD is an outline of an employee benefit plan(s) provided under ERISA and listed above.  It contains information such as the plan administrator, requirements for eligibility and participation in the plan(s), circumstances that result in disqualification or denial of benefits and identity of insurers administering the plan.

Oftentimes employers believe this is the responsibility of the insurance company but it is actually the employer who must make sure they are compliant.  Medical, Dental, Vision Insurance companies will issue Certificates of Coverage which may have a great deal of the information that a SPD will have but will usually fall short of the needed language.  

Typically with employers of less than 500 employees they will use a "Wrap-Around Plan" which creates a single document for all insured benefits.  

If you do not have this in place, you need to get this done as the Department of Labor is starting to audit companies with more tenacity and looking for those dollars to fund the ACA .  Costs can range from $200 to $1000 or more.

Thursday, June 5, 2014

IRS Regulations Clarify Employer ACA Reporting Requirements-Long but important!

IRS Regulations Clarify Employer ACA Reporting Requirements

by: Mary Bauman
June 4, 2014

The IRS issued final regulations in March designed to simplify the employer reporting requirements imposed by the Affordable Care Act. Most importantly, the regulations permit combined reporting for the multiple requirements and simplify reporting where a large employer provides affordable group health coverage, which is of minimum value to almost all of its employees. This Q&A explains the new regulations and how they impact both small and large employers.
What are the reporting requirements?
The ACA added two sections to the Internal Revenue Code related to reporting. First, Section 6055 requires health insurers and employers sponsoring self-funded group health plans to annually report to the IRS and to responsible individuals (the enrolled employees), whether the coverage constitutes minimum essential coverage under the ACA. This reporting requirement will help the IRS to enforce the individual mandate penalty. We refer to this as “individual mandate reporting.”
Second, Section 6056 requires large employers with 50 or more full-time and full-time equivalent employees to report to the IRS and to full-time employees for two purposes:
  • To assist the IRS with enforcing the employer pay-or-play penalty; and
  • To assist full-time employees with determining their eligibility for a premium credit. It should be noted that even though mid-size employers with 50 to 99 full-time employees are not subject to pay or play for 2015, these employers are still subject to Section 6056 reporting for 2015 (and later years).  We refer to this as “pay or play reporting.”
Both reporting requirements were initially required under the ACA with respect to the 2014 calendar year. However, the effective date was delayed last year. Now, the first year for which reporting is required is 2015, with the reporting for 2015 due during the first quarter of 2016.
Are small employers subject to the reporting requirements?
Generally, no. Small employers with less than 50 full-time employees are not subject to pay-or-play reporting. And only small employers that sponsor self-funded group health plans are subject to individual mandate reporting. For small employers that sponsor fully insured plans, it is the insurer that is responsible for the individual mandate reporting.
What are the basic rules for large employers?
As with small employers, if a large employer’s group health plan is fully insured, the insurer will be responsible for the individual mandate reporting. The large employer will only be responsible for pay-or-play reporting. On the other hand, if the large employer sponsors a self-funded group health plan, the employer will be responsible for both the individual mandate and pay-or-play reporting. Under the new regulations, a large employer can satisfy both reporting requirements on a combined basis by using IRS Form 1095–C (the employee statements), along with IRS Form 1094-C (the transmittal form). The IRS is planning to release a draft version of the reporting forms in the near future.
For individual mandate reporting, the reports must include the Social Security number, or a shortened version of it, for the responsible individuals (the enrolled employees) and their enrolled dependents. However, if, after reasonable efforts, the Social Security number of an individual cannot be obtained (for example, in the case of a dependent), the individual’s date of birth may be used. The individual mandate reports must also include the months for which the individual is enrolled for at least one day during the month.
Pay-or-play reporting focuses on the employer’s full-time employees. All of the following information must be reported:
  • A certification as to whether the large employer offered its full-time employees and their dependents the opportunity to enroll in coverage (by calendar month).
  • The number of full-time employees for each calendar month.
  • For each full-time employee, the months for which coverage was available and the employee-only premium for the lowest cost medical option providing minimum value.
  • The name, address and Social Security number of each full-time employee.
  • The months during which the employee was covered under the employer’s group health plan.
Are any simplified reporting options available?
Yes.  The final regulations provide the following simplified pay-or-play reporting options:
1. Qualifying offers. Instead of reporting all of the information described above on a month-by-month basis, employers are permitted to report an employee’s name, address, Social Security number and indicator code for each full-time employee who receives a “qualifying offer” of coverage for all 12 months. (The indicator code is used to convey certain information about the employee, similar to the code used on the W-2). This simplified reporting option is not available for full-time employees who don’t receive a qualifying offer for all 12 months of the year.
A “qualifying offer” means:
  • The employee-only option is affordable (using the federal poverty line safe harbor) and of minimum value.
    • Coverage is also offered to the employee’s spouse and dependents.  
2. Transition Relief for 2015. For 2015 only, if a large employer certifies to the IRS that it has made a “qualifying offer” (as described above) to at least 95% of its full-time employees, the employer may use the simplified reporting option for all full-time employees, including those full-time employees who didn’t receive a qualifying offer for 12 months.
3. 98% offer. If a large employer certifies to the IRS that it offers coverage that is of minimum value and affordable (using any affordability safe harbor) to at least 98% of its full-time employees, it is not required to report any further information to the IRS. However, the employer must still satisfy the reporting requirement – sending a statement to each full-time employee.
What are the reporting deadlines?
Like income taxes, reporting to the IRS is due annually (even though the reports must include information on a monthly basis) – after the end of the calendar year to which the report relates. If the employer is required to file statements for 250 or more employees, the filing must be made electronically with the IRS and the deadline for filing reports is no later than March 31 following the calendar year to which the reporting relates. If the employee population is less than this threshold of 250 employees, employers have the option to file electronically or by mail.  The deadline for the electronic filing of statements with the IRS is March 31 and the deadline for filing by mail is by February 28 following the calendar year to which the reporting relates.
Statements to employees consist of an IRS form (1095–C) similar to the W-2 and are generally required to be sent by mail by January 31 following the calendar year to which the reporting relates. These employee statements can be mailed along with their W-2s. Employers may want to provide a cover memo of explanation, particularly for the first year when this form is new to employees.
Bauman is an attorney at law with Miller Johnson in Grand Rapids, Mich.

Tuesday, April 15, 2014

PPACA costs fall as premiums beat forecast

April 14 (Bloomberg) -- The health law will cost $104 billion less over the next decade, the Congressional Budget Office said after premiums for private Obamacare plans came in lower than the agency expected.
The premium for a benchmark “silver” level plan, the second-most generous available, will average $4,400 in 2016, the CBO said today in a report – 15 percent less than it forecast in 2009. The budget office reports regularly on the economic effects of the law.
About 6 million people on average are expected to be enrolled in 2014 in private health plans through insurance exchanges created by the Patient Protection and Affordable Care Act, the budget agency said. The U.S. health secretary, Kathleen Sebelius, said last week that 7.5 million people signed up for private plans with enrollment set to end tomorrow.
White House press secretary Jay Carney called the CBO report “welcome news.”
“It shows that marketplace health-care costs have gone down, because premium estimates have gone down,” he told reporters in a briefing.
Sebelius’s enrollment figure exceeded an initial CBO estimate of 7 million made before the exchanges opened Oct. 1 and technology failures prevented millions from immediately signing up. In February, the agency revised its estimate to 6 million.
Imprecise statistics
The estimate “cannot be compared directly with the number of people who have enrolled through the exchanges as of any given date,” according to the CBO report. “The number of people who will have coverage through the exchanges in 2014 will not be known precisely until after the year has ended.”
President Barack Obama on April 11 credited Sebelius with the turn-around when he announced his nominee to replace her, White House budget director Sylvia Mathews Burwell.
The CBO’s latest estimate is for all of 2014 and includes people who are able to sign up or leave coverage after April 15 because of life-changing events such as marriage or losing a job. The agency said that 7 million would also join Medicaid, the government program for low-income people that is being expanded in 26 states, a decrease of 1 million since February.
The total number of people enrolled in exchange plans at any point during the year may be higher than the CBO’s estimate of 6 million on average “because some people will be covered for only part of the year,” the budget agency said in a report.
Declining subsidies
The agency said it reduced its estimate of the cost of the program because it anticipates the government will provide less in subsidies that help people pay premiums for the Affordable Care Act plans. The government will pay $17 billion this year, a $3 billion decrease from its February estimate, the agency said. The aid, available to people earning less than four times the poverty level, or about $95,000 for a family of four, will cost about $1 trillion through 2024, the CBO said in its report, a reduction of about $200 billion since February.
The budget office said premiums are expected to rise more rapidly after 2016, at about a 6 percent annual rate, to $6,900 on average for the benchmark silver-level plan in 2024.
While the Medicaid expansion is expected to cost $20 billion in the first year, an increase of $1 billion from the February estimate, the projected cost of $792 billion through 2024 is unchanged.
The CBO said it expects fewer Americans and employers to pay fines to the government for not carrying insurance or offering it to their workers, a loss of revenue that somewhat offsets the reduction in the cost of subsidies.
Penalty revenue
Penalty payments for violating the law’s requirement that people carry insurance, known as the individual mandate, will total $46 billion in the next decade from an estimate of $52 billion in February. Revenue expected to be collected from employers that refuse to offer insurance totals $139 billion over a decade compared with $151 billion forecast in February.
Many people who refuse to buy insurance this year will be able to avoid paying fines because of a series of exceptions the Obama administration has created. The same is true for businesses, which aren’t required to cover any of their workers next year unless they employ 100 people or more.
April 14, 2014

Monday, March 31, 2014

Last-Day Rush Causes Another Malfunction of

WASHINGTON — For a second time on Monday, the federal website where consumers can sign up for medical coverage under President Obama’s health care law unexpectedly stopped taking applications. It is the last day of open enrollment for the year.

Aaron Albright, a spokesman for the Department of Health and Human Services, indicated that the second failure occurred shortly after noon, and that it seemed to be caused by a flood of traffic on the site, Earlier, he had said that the first failure, for about three hours in the morning, was caused by a software error unrelated to traffic volume. By 1:40 p.m., Mr. Albright said the site was functioning normally again.

Before the second failure was fixed, he released a statement that said: “There are a record number of people trying to access right now — more than 100,000 people concurrently in the system as of noon. The tech team monitoring in real time has identified an issue with users creating new accounts. The application and enrollment tools are unavailable to new users at the moment. The tech team is working to resolve the issue as quickly as possible.”Although the sign-up functions were disabled, other parts of the site were functioning normally, Mr. Albright said. That included the Data Services Hub, which verifies data entered by consumers against federal databases at agencies including the Internal Revenue Service and the Social Security Administration.

Mr. Albright said that consumers who had started applications would be able to complete their enrollment after the latest problem was fixed. On Monday morning, the enrollment system on was taken offline for scheduled maintenance between 1 a.m. and 5 a.m., but then remained down for several more hours because of a software bug discovered by technology personnel during maintenance.A surge of traffic has hit in the final days of open enrollment, the administration has said.

Last week, the administration said it would extend the deadline for people who tried to apply but were blocked by technical problems with the site. It also said that it had exceeded its revised goal of signing up six million people over the federal exchange and similar sites run by the states.

The White House press secretary, Jay Carney, said during his daily briefing on Monday that he was not sure when final enrollment figures would be available. But, he said, “here on the last day of enrollment, we’re looking at a number substantially larger than six million people enrolled.”

Thursday, March 27, 2014

White House Says ACA Enrollment Has Hit Their Revised Lower Goal of Six Million

White House Says Health Care Rolls Top Goal: 6 Million


WASHINGTON — The White House said on Thursday that more than six
million people had signed up for medical insurance plans under President
Obama’s health care law, exceeding the administration’s revised goal for
enrollment by the Monday deadline.

Demand for new policies has surged in recent days as the open
enrollment period draws to a close, the White House said, with 1.5 million
visits to and 430,000 calls to the program’s call centers on
Wednesday alone. The enrollment figure is up from five million a week

Mr. Obama, who was traveling in Italy, held a conference call to thank
volunteers who are helping to enroll uninsured Americans, officials said.
“The president encouraged the navigators and volunteers to redouble
their efforts over the next four days and leave no stone unturned in trying
to bring affordable health coverage to as many Americans as possible,”
White House officials said in describing the call.

Enrollment began in October. The administration recently scaled back
its original estimate of signing up seven million people.

Republican lawmakers have played down the enrollment numbers and
continued to press for an overhaul or a repeal of the law. Even some
Democratic senators in competitive re-election races have prescribed changes to the law.
Some conservative commentators took to Twitter on Thursday to ask
how many of the six million enrollees had paid their insurance premiums.
The White House has not been willing to say.

© 2014 The New York Times Company

Tuesday, March 25, 2014

Report from the Maryland Health Benefits Exchange

Report from the Maryland Health Benefit Exchange about Maryland Health Connection, the state-based health insurance marketplace 
BALTIMORE (March 21, 2014) -- As we enter the final days of open enrollment, we have seen a spike in interest and activity on Maryland Health Connection.
Counting both individuals who have gained Medicaid coverage and those who have selected a private health plan through Maryland Health Connection, 248,230 Marylanders have enrolled in coverage since January 1. This includes 203,394 Marylanders in Medicaid and 44,836 through private health plans. This puts Maryland more than 95 percent of the way towards our goal of 260,000 gaining coverage during the first open enrollment period.
We continue to do everything we can to get as many Marylanders as possible enrolled by March 31. Marylanders who have not yet enrolled are encouraged to visit to complete an application and enroll in coverage.

------If you are not eligible for a subsidy through the exchanges and need coverage directly and quickly you can click this link for a medical and/or dental plan through Carefirst Blue Cross Blue Shield.  
Thanks, Ben

Wednesday, March 5, 2014

Obama administration allows health plan renewals for two more years

WASHINGTON Wed Mar 5, 2014 6:10pm EST
(Reuters) - The Obama administration said on Wednesday it would allow health insurers to extend plans that fail to comply with its signature healthcare law for an additional two years, giving some consumers the option of keeping their policies into 2017.
In a release of comprehensive insurance guidelines for next year, officials also said the government was extending the 2015 open enrollment by one month to create a three-month period running from November 15, 2014, to February 15, 2015.
The guidelines also presented an early glimpse of the cost of Obamacare-compliant plans, saying the annual cap on out-of-pocket expenses for consumers would rise to $6,600 for individuals and $13,200 for families. Expenses are currently capped at $6,350 for an individual and $12,700 for a family.
The change in the renewal policy could help Democrats in November's congressional elections by eliminating the possibility of a new wave of insurance plan cancellations just before the vote. It also allows some policies to be continued past the November 2016 presidential election.
But administration officials described the guidelines as a response to conversations with a range of stakeholders including consumers, insurers and state regulators. They said the number of people affected, estimated at between 500,000 and 1.5 million, was expected to shrink rapidly as consumers shift into Obamacare-compliant policies.
The initial decision to allow one-year renewals last November followed a public outcry as millions of consumers received notice from insurers that their plans would be canceled because they did not comply with Obamacare's consumer protection standards.
Officials said on Wednesday the change would require them to adjust a risk mitigation program to protect insurers from unexpected losses, and indicated that they could relax a consumer-protection rule that currently prohibits insurers from spending more than 20 percent of plan revenues on administrative costs including marketing.

(Reporting by David Morgan; Editing by Peter Cooney)
-------Sadly all of those people who liked their medical plans but were pushed into ACA compliant plans won't be able to get them back....BBS

Monday, March 3, 2014

Only nine Marylanders have signed up for the states retroactive health insurance

Only nine Marylanders have signed up for temporary, retroactive health insurance made possible by emergency legislation aimed at helping people who tried to get coverage through the state’s faulty online health insurance marketplace, encountered problems and were stuck with medical bills to pay.
Two months ago, state officials predicted that as many as 5,000 people might need the help, which would have cost the state millions of dollars. Since then, the four health insurance companies participating in the state exchange offered their own retroactive insurance, helping about 300 households — and turning the state’s option into a last-resort for special cases.
The small number of enrollees “is a sign that there are not so many people who are having so many challenges that they are going that route,” said Joshua Sharfstein, Maryland’s secretary of health and mental hygiene, at a budget hearing Wednesday. “We’ve been doing an enormous amount of work — a lot of elbow grease — to try to patch different parts of the system so that we can get through open enrollment.”
But at budget hearings and an oversight meeting this week, a few lawmakers questioned whether the low number of is really a sign of success. Some asked what the state is doing to promote the option. Senate Minority Leader David R. Brinkley(R-Frederick) said Monday that he has diminishing confidence in the exchange’s ability to make any accurate predictions.
On Friday, federal health officials announced they will bend some of their rules in the coming month to help those living in states where the exchanges that have not been working well, which could include Maryland. The government plans to help pay for certain health plans that consumers buy on their own — not through the exchange — and help make that insurance retroactive.
Maryland was one of 14 states that decided to build its own online health insurance marketplace, a key feature of President Obama’s Affordable Care Act, rather than rely on the federal version. But Maryland’ssite crashed on its first day and has yet to work as planned, greatly hindering enrollment in private health insurance plans.
As of Feb. 22, 35,636 Marylanders had enrolled in a private health plan through the exchange, far behind the original goal of having at least 150,000 people signed up by the end of March. Earlier this week, state officials announced that their goal was based on faulty research and that a better estimation is 75,000 to 100,000 people. Enrollment for those plans opened Oct. 1 and will close March 31. The next enrollment period, for insurance starting in 2015, will open Nov. 15.
The exchange has been working better than when it first launched,with technology officials saying that they have fixed hundreds of glitches and continue to work on hundreds more. But when the New Year rolled around, thousands of Marylanders who needed health insurance were still without it.
In early January, Maryland Gov. Martin O’Malley (D) and Lt. Gov. Anthony G. Brown (D) asked lawmakers to help those people. The administration proposed legislation to expand enrollment in a state-run insurance program — called the Maryland Health Insurance Plan — that was established a decade ago to help high-risk individuals who couldn’t get coverage elsewhere. People in dire need of health insurance could enroll in this program and receive coverage that is retroactive to Jan. 1 or the first day of following months. The premiums of these plans are often higher than in private plans, which was expected to motivate people to not stay for long.
As lawmakers weighed that option, the four insurance companies participating in the exchange provided their own retroactive health insurance. For one week in mid-January, Marylanders could register to receive insurance that would be retroactive to Jan. 1. More than 1,300 households expressed interest. Of those, 562 were found to be eligible for Medicaid and nearly 300 households enrolled. All of those applications had to be manually processed and did not go through the exchange.
Once that happened, state officials said there was less of a need for the state to also offer retroactive insurance, but they said there could still be a few hundred people who require the help.
When O’Malley signed the legislation into law in late January, he said: “If it affects just one family, it is worth the effort, especially depending on the condition or the size of a hospital bill or other treatment bill incurred.”
Carolyn A. Quattrocki, the exchange’s acting executive director, told lawmakers Mondaythat about 7,000 applications are still stuck in Maryland’s system. As for the exact number of people who are not getting the health insurance they seek, a spokeswoman for the exchange said Friday that they do not have “any reliable estimate.”
------The primary reason people are going to the exchanges is because they are eligible for subsidies or credits.  Even with the financial help for lower income people in the Maryland Health Insurance Plan the costs are considerably higher than those through the exchanges.  It seems most are willing to wait for exchange plans instead.  If you are not eligible for a subsidy, and in need of coverage, there is NO reason to subject yourself to the hassles of going through the exchanges.....BBS

Wednesday, February 26, 2014

Why Most Small-Business Owners Will See Premiums Rise Under A.C.A.

New York Times
A new report from the federal government that says more small employers will see premiums increase than fall under the Affordable Care Act appears to have put the Obama administration on the defensive once again. But the report is remarkable as much for what it reveals about the current state of the small-group market as for how it might look under Obamacare, as the law is commonly known.
The report was produced by the Centers for Medicare and Medicaid Services at the request of Congress, and it is largely an exercise in the theoretical. The Affordable Care Act outlaws premium discrimination based on a company’s industry, the size of its group, or the health status and gender of its employees. The law also limits premium variation based on age, and the study assumes that when all these rules eventually take effect, all small companies and their workers will pay essentially the same rates.
Meanwhile, the agency estimates that today, under the current rules, two-thirds of small employers pay premiums that are below the average rate and one-third pay above-average premiums. Therefore, under an Affordable Care Act that is fully in place, two-thirds will see their premiums rise, and one-third will see premiums fall.
Of course, we have long known that some people would pay more for health insurance under Obamacare and some people would pay less. What is interesting is the skew: Why is it that two-thirds of employers, and employees, according to the study, have paid below-average premiums? Why isn’t it closer to 50/50? The answer, according to the study, is that under the old system, companies that paid lower premiums because their employees posed smaller health risks were more likely to offer health insurance in the first place.
But according to Jonathan Gruber, a health economist at M.I.T. whose work was cited in the C.M.S. report, those companies’ premiums were not as far below the average as the premiums of those businesses that insured older, less healthy employees were above the average. “The most expensive firms are very expensive, while the cheaper ones aren’t that much cheaper,” Mr. Gruber said. “So what that means is that while the cheaper firms will lose, they will lose by less than the most expensive firms gain. The 65/35 is still consistent with the overall roughly net zero result that the Congressional Budget Office, myself, and others have estimated.”
It is also possible that companies that have not provided health insurance because it was too expensive may now be offered rates lower than what they were quoted in the past. The report estimates 18 million people get insurance through the small-group market, though not all will be affected by the new premium rules one way or the other. But according to the most recent figures from the Census Bureau, about 31 million people work for businesses with fewer than 50 employees. That means the current market leaves about 42 percent of small-business employees uninsured, and some of those would most likely find small-group insurance more affordable under the new rules.
The report did not quantify how much premiums would rise or fall. And it acknowledged that Congress asked the agency to study only three of the law’s provisions and that other aspects of the law could affect how premiums change. “The impact could vary significantly depending on the mix of firms that decide to offer health insurance coverage,” the study said. “In reality, the employers’ decisions to offer coverage will be based on far more factors than the three that are focused on in this report.”
Republicans in Congress took the opportunity presented by the report to attack the law. Representative Sam Graves, the Republican from Missouri who heads the House Small Business Committee, called it “one more in a long line of broken promises from President Obama and Washington Democrats.”
Curiously, the Obama administration seemed restrained in its response, choosing not to address the new study directly. When asked for a comment, a spokeswoman for the Department of Health and Human Services, Joanne Peters, said only, “Since the Affordable Care Act became law, health care costs have been growing at the slowest rates on record and premiums are growing at less than one-half the pace seen a decade ago. The law is making it easier for businesses to offer coverage, just like it did in Massachusetts when employer coverage increased after reform passed.”
Tom Daschle, the former Democratic majority leader in the Senate and President Obama’s first nominee to lead the Department of Health and Human Services, bemoaned what he said was an increasingly one-sided debate. “There are so many ways to look at this,” said Mr. Daschle, who is now a senior policy adviser to the law firm DLA Piper, of the C.M.S. report. For one thing, he said, the tax credits available to very small businesses that offer insurance will “change tremendously the way premiums are paid.”
He went on to question why the administration had not responded more forcefully. “I think it’s been a big mistake that we’re not pushing back as hard as we can,” he said. “There’s an old saying attributed to Winston Churchill: a rumor gets halfway around the world before the truth gets its shoes on. That has happened over and over again with the Affordable Care Act.”
-------Seems time will tell.  However costs for small group plans that were non-grandfathered migrating from the small group market to ACA plans have seen significant increases in older family coverage plans but decreases to younger insureds. BBS 
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