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Summary of Health Plan

Discussion in 'US Health Care Reform' started by Darryl, Mar 23, 2010.

  1. Darryl

    Darryl Approved members

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    Not sure if this is accurate, but my company's insurance representative emailed it to me tonight. Feel free to reply with any corrections or additions...

    HEALTH CARE REFORM SIGNED INTO LAW

    On March 23, 2010, President Obama signed historic health care reform legislation into law. Although a second reconciliation bill still needs to go to the Senate for approval, the health care reform legislation that was enacted will affect health insurance for all Americans and will have a particularly strong effect on employers who sponsor group health plans. The requirements of the law will take effect over the next few years, with the earliest changes effective the first day of the plan year after 6 months from the passing of the bill as follows:

    Within 6 months (September 23, 2010):
    • Lifetime caps on coverage are prohibited;
    • Plans may not cancel the policies of people who fall ill;
    • Children with pre-existing conditions can not be denied coverage;
    • Dependent children must be offered coverage under their parents? plans up to age 26; and
    • Small employer tax credits (see ?SHOP Exchanges? and Subsidies below).
    Within 9 months (December 23, 2010):
    • Individuals unable to obtain insurance due to pre-existing conditions will be eligible for subsidized coverage under a new high-risk insurance program. This coverage will continue until 2014, when coverage through Medicaid and new state-run insurance exchanges are expanded to cover more of the population.
    In 2013:
    • There will be an annual limit on the maximum election amount for Flexible Spending Accounts under Cafeteria Plans of $2,500.00 per year; and
    • Families with annual gross income higher than $250,000 will have to pay an additional 3.8% tax on all investment income and contribute higher amounts to Medicare through payroll taxes.
    In 2014:

    Uninsured Penalties
    • Individuals will be required to purchase health insurance by 2014 or be subject to a penalty. The first year, the penalty is $95 or 1% of gross annual income, whichever is greater. Subsequently, the penalty will increase to $695 or 2% of income.
    • Waivers will be available for those who cannot find a policy that costs less than 8% of their income, for families who fall below the income-tax filing thresholds and for individuals with religious objections.
    • Individuals who cannot find a plan that costs less than 8% of their income, regardless of age, will also be eligible to purchase catastrophic policy that otherwise would be limited to individuals under age 30.
    Medicaid
    • Medicaid will be expanded to cover more low-income individuals with incomes up to 133% of the federal poverty level (about $29,327 for a family of four) who have not reached age 65.
    "SHOP Exchanges? and Subsidies (Small Business Health Options Programs)
    • States will be required to have Health Care Exchanges where small businesses will be able to pool together to buy insurance. Individuals with income higher than 133% but less than 400% of the federal poverty level (about $29,327 to $88,200 for a family of four).
    • Small employers (those with 100 employees or less) will have the ability to purchase insurance at lower rates through these exchanges.
    • Large employers (those with more than 100 employees) will be able to participate in SHOP.
    • Premiums will be capped at a percentage of income from 3% to 9.5%.
    • Over the next four years until these state-run exchanges are in place, small employers with 10 or fewer Full Time Equivalent (FTE) employees earning less than $25,000 will be eligible for a tax credit of 35% of health insurance costs. Companies with 11 to 25 FTE workers earning up to $50,000 will be eligible for partial tax credits.
    • After the exchanges are in place, the credit will be increased to 50% for the first two years the company buys insurance through the exchange.
    Employer-Sponsored Coverage
    • Group health plans will be prohibited from setting rates or denying coverage based on pre-existing conditions, from placing excessive waiting periods on eligibility for benefits for new hires (90-day maximum, and from placing annual and lifetime dollar limits on benefits. Insurers will only be able to vary premiums based on geographic location, age and tobacco use.
    • Group health plans will be required to cover specific services and at least 60% of employee health costs overall. Plans that do not meet these requirements will be subject to additional penalties.
    • Employees who pay more than 9.5% of their income on premiums or whose group health plan covers less than 60% of the cost of their benefits will be eligible to purchase coverage through the state-run exchange.
    • The reform package does not require employers to provide health insurance to their employees. However, beginning in 2014, tax penalties will be assessed for companies with 50 or more FTE employees that do not provide health insurance of up to $2,000.00 per employee, with the first 30 employees being exempt.
    • Employers with more than 200 FTE employees must automatically enroll employees in their group health plan and allow employees the opportunity to opt out.
    • A grant program will be established to encourage small and mid-sized employers to develop workplace wellness programs.
    In 2018
    • Employers will be taxed on high-end ?Cadillac? health plans (those with total premiums of $10,200 or more for singles and $27,500 for families) each year. The excess premium will be subject to a 40% tax.
    In 2020
    • The gap in Medicare prescription drug coverage will be phased out by 2020.
    The Next Step:

    The reconciliation bill is expected to be debated by the Senate in the next few weeks that contains amendments to the law. SHOP exchanges may start to receive federal funding as early as next year, although states may wait until 2014 to implement them. Rules and guidance on how to implement these requirements are expected as well.

    What Employers Should Do Now:
    No immediate action is required of employers at this time. We will continue to provide updates and guidance on this health care reform legislation as it becomes available.
     
  2. Toni

    Toni Banned

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    Thanks for getting to the heart of the matter, as always. This should have been the first post.
     
  3. Illinifan

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    I am hoping to get a version of this from the company I work for so we can compare them and see how similiar they are.
     
  4. mamort

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    Darryl, thanks for the post.
     
  5. deeann

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  6. tiffanie1717

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    Thanks for posting. It makes things much clearer.
     
  7. Darryl

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    Sounds like there might be a loophole in the law at the moment, but the article does say:

    "To ensure that there is no ambiguity on this point, the secretary of HHS is preparing to issue regulations next month making it clear that the term 'pre-existing exclusion' applies to both a child's access to a plan and his or her benefits once he or she is in the plan for all plans newly sold in this country six months from today," HHS spokesman Nick Papas said."
     
  8. Lance

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    As I noted elsewhere, I wonder how many other loopholes and surprises will come to light over the coming months...:rolleyes:
     
  9. Brensdad

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    Imagine that. I bet there aren't any loopholes in Stupak's three airport grants he got the day before he caved in on his deeply held beliefs...uh...I mean came to an agreement with the adminstration.:rolleyes:
     
  10. Flutterby

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    I believe the 'pre-existing conditions' for children, went into effect as soon as President Obama signed the bill and the Vice Pres. dropped the F-bomb. :D
     
  11. Lance

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    You may believe it, but according to the press reports earlier (see link above), the elimination of the pre-existing condition exclusion did not get included in the bill. Of all the garbage that I expected to see in the bill, this was one piece I actually was pleased with, and it turns out not to be there.:(
     
  12. Flutterby

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    I have not heard this? Everything I've listened to and read says others wise.:confused:
     
  13. Toni

    Toni Banned

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    Had not heard that. What a comedy of errors!
     
  14. Lance

    Lance Approved members

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    Posted elsewhere, but here is the link for the AP article. They are going to "fix" this, but as I have also noted elsewhere, I wonder how many other things they screwed up in their rush to pass a bill without reading it.
     
  15. Darryl

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    So I'm trying to understand, do we think the law requiring insurance to cover children with pre-existing conditions is good, or bad?

    If we think it's good, then we should be upset at people who opposed this assurance for children and who fought and won to delay the protection until 2014, and we should happy with the Obama administration and the democrats for announcing that they are going to close the loophole. Sometimes you have to make deals with the devil to get a law passed. But apparantly Obama intends to make good on his committment, and to give children the protection they deserve.
     
  16. frizzyrazzy

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    you'd think its good, right? I think its good. The fact that it's possible that this was goof but is now being fixed is also good. But now it's just arguing for arguing sake. people would rather point and laugh than agree that it's a good thing. Verified by the fact that the threads with real info on health care reform, such as this, are being overlooked in favor of that other one.
     
  17. Darryl

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    I don't think it was a goof - it sounds like just a last minute deal between those who want all children to have access to health care vs. those who don't. Last minute deals always have to be made to get a deal done so a congressman can go back to their district and say proudly, such as in this case, "I succeeded in denying health care to children". It is agreed by both parties that the denial of health care will be reversed in the days after the bill is signed, but the congressman can then blame the access to health care for children on the democrats, rather than taking heat from their own constituents. This is all part of politics, not a surprise or a mistake or a good, it's all part of getting a deal done.
     
  18. Lance

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    Michelle - Hell may freeze over, but I'm with you and Darryl on this. I think it's a good thing that they are fixing this. My concern is that with the way this bill was put together, and with the little scrutiny the actual bill received (most of the rhetoric was based on what people thought was in the bill because virtually nobody actually had the time to read the whole thing). I'm afraid that other little (or not so little) surprises may continue to pop up, and the fixes may not be so simple.

    On a side note, it's so nice and peaceful over here in this thread :D. All the troublemakers are hanging out in the other room arguing about everything but healthcare. :rolleyes:
     
  19. Thoover

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    I work for an Brokerage Insurance company in Maryland, this is the information we received yesterday, and will be discussing more of it this afternoon.

    If any of you would like to see , there are limitations on Pre-ex. I can email this PDF file to whomever would like to view it. Its about 5 pages and Not sure how I can post it here:

    Pre-Ex Condition states: For Plan years beginning six months after the date of enactment there can be no pre-existing limitations for coverage of children under the age of 19, however insurers could still reject those children outright for coverage in the individual market until 2014.

    In 2014 this act would prohibit Pre-Ex condition exclusion )for children, the exclusion are prohibited starting six months after enactment) and annual limits on coverage (which were restricted beginning six months after enactment).

    On the good side children can remain on their parents group plans till the age of 26. This has changed from age 23 to 25 last year now they are only adding one more year which to me is better then dropping them if they are not a full time student in college, this would be regardless of student status. .:cwds:

    If any of you would like me to email this to you I can do so or if I could post it without typing the entire 5 pages let me know...
     
  20. Toni

    Toni Banned

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    If you email it to me (I will PM you), I will scan it in as text at work and post it in parts. Very busy at work this week but I can get it in, not pretty, but as text.
     

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