Anthem Blue Cross will not be participating in the California SHOP Exchange

Legacy Benefits & Insurance Benefits learned today that Anthem Blue Cross will not be participating in the California SHOP Exchange, Covered California.

In June, Covered California eliminated the requirement that Qualified Health Plans wanting to participate in the individual exchange must also apply to participate in the SHOP exchange. Because Anthem is no longer required to participate in SHOP, as a condition of being on the individual exchange and because Anthem already participates in a private small group exchange, Anthem has withdrawn its SHOP application. Anthem will, however, continue to participate in the individual exchange.

We have been informed that there are a variety of reasons that led Anthem to this decision and we will provide you with additional information as it becomes available in the coming weeks/months. Anthem remains fully committed to the off-exchange small group market and believes this decision will allow them to put the necessary attention on their off-exchange small group efforts and individual work.

Breaking News - Coverage and Income Verification Delayed

The U.S. Department of Health & Human Services, the Treasury Department, and the Obama Administration have announced another important changes to the implementation of the Affordable Care Act (ACA). 

The government announced it will move to an "honor system" in 2014 for coverage and income verification. States operating marketplaces (i.e., exchanges) will not be required to confirm a consumer's statement that he or she does not have employer-sponsored coverage, nor will states have to verify reported income, which determines a person's eligibility for a premium subsidy. Income verification has been postponed until 2015. However, consumers who misrepresent their income on the application for exchange coverage are subject to a penalty of up to $25,000.

PPACA Employer Mandate Delayed till 2015

The Obama administration unexpectedly announced Tuesday it is delaying the employer mandate under the Patient Protection and Affordable Care Act until 2015.

The mandate — which requires mid-sized and large employers to offer health insurance coverage to their workers — was one of the main requirements of the health care overhaul that was set to go into effect Jan. 1, 2014. 

This ruling does NOT change the individual mandate set to begin 1/1/2014.

You will see many articles about the reasons for this announcement, I am advising my clients that between now that the opening of the exchanges on 10/1/2014, best course of action is not to panic or make sweeping changes to their benefits. 

In September, Covered California (the CA exchange) will be providing broker training and our industry should then have better information to provide our clients. 

Till then, please stay informed but realize what you hear today could change tomorrow.

Individual Penalty Transition Relief for Those Eligible to Enroll in Employer-Sponsored Coverage with a Plan Year That Begins in 2013 and ends in 2014

Because many employer-sponsored plans have non-calendar plan years, employers have questions regarding how employees and/or dependents who waived employer-sponsored coverage but would need to have minimum essential coverage beginning January 1, 2014 might avoid the Individual Shared Responsibility Payment (i.e. individual penalty).  

IRS Notice 2013-42, issued Wednesday 6/26/2013, addresses these questions and provides an employee, or an individual with a relationship to the employee, who is eligible to enroll in a non-calendar year employer-sponsored plan with a plan year beginning in 2013 and ending in 2014 will not be liable for the individual penalty until the end of the 2013-2014 plan year. Thus, employees and dependents that choose to wait until the 2014-2015 plan year to enroll in coverage will not be subject to the individual penalty for the months in 2014 that are part of the 2013-2014 plan year.