Health Care Reform
Strategic Benefits ConsultingEmployers must not only understand the specifics of reform but also anticipate the unintended consequences and potential changes in the marketplace as insurance carriers and providers of service adjust their delivery of healthcare in this new highly regulated environment. Our knowledge will help you navigate through the complex intricacies of reform and new benefit options to create a solution that matches your needs. Regardless of the solution, self-insured or fully-insured, we have the knowledge to implement and service your benefit programs. We stay focused on your needs and the needs of your employees with a professional team prepared to answer questions and find innovative solutions. We will keep you informed by continually providing updates through e-mails and newsletters, as well as regular interaction with our team.
Notify Employees of the Health Care
Employer Obligation to Notify Employees of the Health Care Exchange
Effective January 1, 2014, a federally operated Health Insurance Marketplace (previously called Exchange) will be available in Texas.
This option to purchase health insurance is required by the Affordable Care Act (ACA) in addition to the private insurance marketplace traditionally available to Texas employers and insureds.
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To Renew Early or Not to Renew Early
TO RENEW EARLY OR NOT TO RENEW EARLY….THAT IS THE QUESTION.
We know that there have been plenty of reports in the media about the delay in the Employer Mandate and possible delays in other components of the law, but there is no reason to believe that there will be a delay in the provisions that affect the small group employers. The carriers and state regulators are well on their way to completing the new rating of small employer plans and we fully expect implementation to proceed.
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Actuarial Value and Metallic Plans
Metallic Levels and Actuarial Value
All Small Business and Individual plans must meet certain product requirements starting in 2014. In addition to the required Essential Health Benefits (EHB) described in our Newsletter of May 16, minimum value is also required. The value of coverage is not defined using specific deductibles, copays and coinsurance. Rather, it is specified using the concept of an “actuarial value” (AV). The higher the actuarial value, the less the employee will have to pay in the form of cost sharing. A plan provides “minimum value” if it pays at least 60% of the covered benefits and the employee pays 40%. The higher the actuarial value, the less the employee will have to pay. No employee should have to pay more than ,350 for their share of the expenses (excluding premiums).
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