Benefits Buzz
The Affordable Care Act (ACA) requires non-grandfathered plans to impose limitations on out-of-pocket expenses for essential health benefits starting in 2014. The out-of-pocket limitations will be capped next year at $6,350 for single coverage and $12,700 for family coverage.
However, some self-funded plans will be exempt from this requirement until 2015. The guidance indicates that self-funded plans contracting with multiple service providers can delay this requirement for one year.
The Center for Medicare and Medicaid Services (CMS) has launched the first part of the certification process required for producers to sell insurance products in federally facilitated and state partnership exchanges.
There are different requirements that must be completed depending on the products that the producer wishes to sell. Please note that some courses are highly recommended but not required.
On Monday, July 22nd, 2013, Governor Pat Quinn signed legislation that will expand the Medicaid program for residents of Illinois starting in 2014. Illinois is now the 23rd state that has decided to move forward with the expansion of its Medicaid program.
The Affordable Care Act (ACA) provides federal funds for states opting to expand its Medicaid program. Federal funds will pay for all of the costs to cover newly eligible people from 2014 to 2016. The federal funds will then start to gradually drop from 2017 until 2020 where it will level off at a 90% payment rate from that year and moving forward.
The public insurance exchanges are expected to introduce a new way for individuals to obtain health insurance coverage next year. However, with the introduction of these exchanges comes a number of complexities and nuances. That includes the topic of premium payment processing and late payments.
Individuals that qualify for Advanced Premium Tax Credits (APTC) through the exchanges will have a portion of their premium subsidized by the federal government, but the balance of the premium will be their responsibility.
The Health Insurance Marketplaces, also known as the Exchanges, are supposed to be operational in two months. October 1, 2013 is the expected date when individual consumers and small businesses can start to enroll in coverage through the Exchanges for the 2014 calendar year.
Guidance issued on May 1, 2013 confirms that producers will play a significant role in helping individuals and employers enroll in coverage through the Federally-facilitated and State Partnership Exchanges.
The House of Representatives, controlled by the Republican Party, voted earlier this month to delay the Individual Mandate by one year. It voted 251-174 in favor of delaying the requirement for most individuals to obtain health insurance until January 1, 2015.
This marks the 38th time that the House has tried to repeal or scale back the Affordable Care Act (ACA).
