Healthcare Reform Timeline

2010

• No Lifetime or Annual Limits – No lifetime or annual maximum limits on essential benefits.
• No Preexisting restriction for children – No children under 19 can be denied coverage for preexisting conditions.
• Tax Credits for Small Employers – Employers with fewer than 25 employees and average annual wages of less than $50,000 may be able to claim a tax credit on 2011 tax return.
• Preventive Service Coverage – Plans must cover preventive services without members sharing costs.
• Nondiscrimination Testing – Employer plans are barred from favoring highly compensated employees.
• Reinsurance for employers with retirees – Program for employers providing insurance to retirees over 55 not eligible for Medicare.

2011

• New Restriction in HSA, FSA and MSA Fund Use – Over the counter drugs can no longer be reimbursed and tax for non-medical is 20%.
• Wellness Grants for Small Businesses – Employers with fewer than 100 employees can tap into over $200 million in federal grants.
• W-2 Reporting – Employee’s W-2 must report health coverage that is excluded from employees’ gross income.
• Community Living Assistance – Assistance for those with limitation encouraging employers to auto enroll employees in program.

2013

• Administration Simplification – Rules established making payments, enrollment claims and authorization process simpler.
• Medicare Tax Increase - Part A tax rate on wages goes up from 1.45% to 2.3% for certain individuals.
• Employers Must Inform Employees of Health Options – Employers must provide info on employer plans, health exchanges, and subsides.

2014

• Individual Mandate – Everyone must have insurance or pay a penalty.
• Employer Mandate – Employers with more than 50 employees must provide coverage pay penalty if any employee receives a subsidy.
• Large Employers Auto Enrollment – employers with more than 200 full-time employees that offer coverage must auto enroll employees. Employees can not opt out.
• Health Insurance Exchanges – State must have exchanges up and running by 2014 or the federal government set it up.
• Wellness Incentives - Employers can offer rewards of up to 30-50% of premiums to employees who take part in wellness and meet health standards.
• No Preexisting Condition Exclusions – Coverage can not be denied for those with preexisting conditions.
• Comprehensive Coverage Requirement – Individual and small group plans must include essential benefits.
• Limits on Deductibles and Copayments – Group health plans deductibles are limited to amounts allowed for HSA plans.
• Ban on All Annual Limits – Plans may no longer impose any annual benefits limits.

2018

• Cadillac Plan Excise Tax – Tax on employer plans valued at over $10,200 for individuals and $27,500 for families.

Information provided by the Word & Brown Companies

Healthcare Tax Credits

Here is some of the basics of the healthcare credits available for small businesses (see linked article for more information http://www.lifeandhealthinsurancenews.com/News/2010/5/Pages/IRS-Releases-Small-Group-Tax-Credit-Examples.aspx?nul ):

For tax years 2010 to 2013, the maximum credit is 35% of premiums paid by eligible small business employers and 25% of premiums paid by eligible employers that are tax-exempt organizations,” officials write in a summary of the notice.

Employers with 10 or fewer FTE employees that pay annual average wages of $25,000 or less can qualify for the maximum credit.

Employers with 10 to 25 FTE employees that pay annual wages of $50,000 or less can qualify for a smaller tax credit.

ANTHEM BLUE CROSS RESPONDS TO QUESTIONS ON RATE ADJUSTMENTS

Here is Anthem Blue Cross response to their recently announced rate increases.

Anthem Blue Cross - Feb. 9: We understand and strongly share our members’ concerns over the rising cost of health care services and the corresponding adverse impact on insurance premiums. Unfortunately, the individual market premiums are merely the symptoms of a larger underlying problem in California’s individual market rising health care costs.

The increasing demand for medical services, the use of new prescription drugs, and demand for advanced technologies are driving up the cost of health care at an unprecedented rate. Anthem is investing in many initiatives to reduce the cost of care, promoting wellness and preventive care for our members and communities, as well as, working with providers to encourage high-quality, evidence-based care, which costs less over time.

In addition, our health plans offer members significant discounts through access to a large network of health care providers across the country. These efforts, however, cannot completely offset all the increases linked to the cost of care. The pricing structure of our individual products is a reflection of the medical risks and costs associated with this market. As the cost of care increases, premiums rise accordingly.

Anthem regularly evaluates its rate structure to make sure that the cost of claims incurred is offset by the premiums collected, and that we anticipate the cost of future, expected claims. At times, based on the cost of covering benefits, rates may be either raised or lowered. To assist members who are looking to explore alternative plan options, Anthem offers a team of licensed Health Plan Advisors. These advisors are dedicated to assisting members in finding solutions to meet the balance between their coverage needs and their budget, especially in these challenging economic times.

Regarding how often an adjustment is made to a member’s rates:

Anthem complies with all state regulations regarding rate increases and depending on the plan, we are required to provide members with a 30 day notice of any rate adjustment.

It is important to note that premiums are expensive because the underlying health care costs are expensive. Anthem offers a variety of health benefit plans, and we are dedicated to working with our members to find health coverage plans that are the most appropriate, and affordable for their needs.

We are more than happy to take a look at a member’s health benefit plan and review possible options to more closely meet the member’s current needs. This may include moving to a lower priced plan.

We are determined to support quality care for our members, we share their concerns about the upward rise in premiums and must adjust our rates as needed to cover the costs and risks associated with providing quality health care for all of our individual members.