Health Care Reform

With all the changing laws and company rules, Midwest Certified is here to help guide you through the always changing health insurance environment. Please see the links and downloads below to help you. If you have any questions, please feel free to contact your sales representative or call us at (847) 640-8000.

 

 

What is a Grandfathered Plan?


A plan is considered grandfathered if it hasn't made significant changes to benefit including but not limited to the points below. To see the full press release from HHS pleae visit this link.

Cannot Raise Co-Insurance Charges: Grandfathered plans cannot increase this percentage.

Cannot Significantly Raise Co-Payment Charges: Frequently, plans require patients to pay a fixed-dollar amount for doctor’s office visits and other services. Compared with the copayments in effect on March 23, 2010, grandfathered plans will be able to increase those co-pays by no more than the greater of $5 (adjusted annually for medical inflation) or a percentage equal to medical inflation plus 15 percentage points. For example, if a plan raises its copayment from $30 to $50 over the next 2 years, it will lose its grandfathered status.

Cannot Significantly Raise Deductibles: Many plans require patients to pay the first bills they receive each year (for example, the first $500, $1,000, or $1,500 a year). Compared with the deductible required as of March 23, 2010, grandfathered plans can only increase these deductibles by a percentage equal to medical inflation plus 15 percentage points. In recent years, medical costs have risen an average of 4-to-5% so this formula would allow deductibles to go up, for example, by 19-20% between 2010 and 2011, or by 23-25% between 2010 and 2012. For a family with a $1,000 annual deductible, this would mean if they had a hike of $190 or $200 from 2010 to 2011, their plan could then increase the deductible again by another $50 the following year.

Cannot Significantly Lower Employer Contrbutions: Many employers pay a portion of their employees’ premium for insurance and this is usually deducted from their paychecks. Grandfathered plans cannot decrease the percent of premiums the employer pays by more than 5 percentage points (for example, decrease their own share and increase the workers’ share of premium from 15% to 25%).

For the full press release from HHS please visit this site.

 

Humana Health Care Reform: Key Provisions for Employers

Humana has released a detailed overview of the changed under the health care reform law that went into effect September 23rd, 2010. You can download the form here.

If you have any questions please feel free to contact us. 847-640-8000

 

Child Only Policies

Starting 6-months after enactment of the ACA, children under 19 cannot be denied coverage, also known as guaranteed issue, and no pre-existing condition waiting periods. Below is the information on both BCBS and Humana's guidelines for these changes.

BCBS

BCBS is going to offer a guaranteed issue no pre-ex policies starting October 1st, 2010. The product is called Blue Pathways and will be offered online for direct sales only, no agent involvement. If the policy is grand fathered, written before March 23rd, 2010, a dependent added to a policy still will be subject to underwriting and a possible declination. For more information please contact your sales representative.

Humana

Humana will no longer offer coverage to children under 19 effective September 23rd, 2010. This includes a primary applicant under 19, a spouse under 19, and child only policies. Dependents under 19 will be able to apply with a parent of legal guardian, however, if the parent or legal guardian is uninsurable, the dependent is also ineligible.

If you have any questions please let us know. 847-640-8000.

 

Do you qualify for the Small Business Tax Credit?

As part of the PPACA law, or Health Care reform, Small Businesses may be eligible for a tax credit of up to 35% from 2010-2013, and increasing to 50% in 2014 if certain criteria are met. The basic guidelines for the credit require a business to have less than 25 FTE (Full Time Equivalent) employees that each make less than an average of $50,000 a year.

There are currently phase outs for those employees making between $25,000 and $50,000 at a business with 10-25 employees. Those companies will not qualify for the entire 35%, and may not be eligible at all.

 

Humana Health Care Reform Law

Humana One has released a Health Care Reform Brochure that Humana members should have received at renewal but that can be used now to help with any questions.