Individuals

Posted July 30th, 2013 in Producers, Employers, Individuals

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).

Posted July 29th, 2013 in Producers, Employers, Individuals

The Exchanges are supposed to have verification systems in place to help determine if an enrollee has access to affordable health insurance coverage from their employer. Since the Employer Mandate reporting requirements are being delayed until 2015, the Exchanges won't have this verification system in place next year.

Instead the Exchanges will have to rely on self-reporting for this information in 2014.

Posted July 8th, 2013 in Individuals, Employers, Producers

Section 3210 of the Affordable Care Act (ACA) required nominal cost sharing to be added to Medicare Supplement Plans C & F. Under the current structure these Medicare Supplement plans eliminate nearly all of the cost sharing that is associated with Original Medicare.

It has been a common belief by many people that Plans C & F cause excessive and unnecessary utilization as a result of the limited cost sharing. The expectation was that Section 3210 would modify Plans C & F to include some form of a front-end deductible to encourage more appropriate uses of physician services.

Posted July 5th, 2013 in Individuals, Employers, Producers

Millions of Americans Countdown to October 1st

Less than 3 months from today marks the start of the 6 month open enrollment period under the Affordable Care Act (ACA). As officials scramble to promote the new healthcare reform enrollment season, we at Flexible Benefit Service Corporation (Flex) have been keeping up-to-date with the fluid changes of rules and regulations contained within the growing law.

Posted July 3rd, 2013 in Individuals, Employers, Producers

The U.S. Department of Treasury announced on Tuesday that the Employer Mandate will be delayed until 2015. This rule is also commonly referred to as the Employer Shared Responsibility requirement or the Pay or Play provision.

The Employer Mandate was set to impose financial penalties starting in 2014 on employers with 50 or more full-time equivalent employees that failed to offer health insurance to employees, as well as those employers that offered health insurance that was considered unaffordable.

Posted June 5th, 2013 in Individuals, Employers, Producers

Most health insurance professionals have some familiarity about the government subsidies that will be available next year to eligible individuals. These subsidies will reduce insurance premiums and out-of-pocket medical expenses for those that qualify, and will only be available to individuals that enroll in coverage through health insurance marketplaces, also known as the public exchanges.

Posted May 8th, 2013 in Individuals, Employers, Producers

The Center for Medicare and Medicaid Services (CMS) issued a statement on April 30, 2013 that the public exchange applications, officially referred to as the Marketplace Consumer Applications, have been revised.

The Invidual Short Form is now just three pages in length. The Family Form is also said to have been reduced by about two-thirds its original length.

Posted April 30th, 2013 in Individuals, Employers, Producers

What will the exchanges look like? What are the exchange deadlines? How will subsidies and payments be processed? There constantly seems to be questions about the health insurance marketplaces, also known as the exchanges.

The Center for Medicare & Medicaid Services (CMS) released a progress fact sheet about the exchanges on April 22, 2013. This new information provides additional details about eligibility and enrollment, plan management, financial management, consumer support and more.

Posted April 22nd, 2013 in Individuals, Employers

Like the popular television commercials with children explaining their theories on what’s better (when asked if more is better than less), they want more. The concept is that simple. People, in general, do not want to settle for less.

Small businesses want more from a program that is named the Small Business Health Options Program or SHOP exchange. The government, however, has stripped away the “options” (at least for a year). If you’re a worker for a small business employer who is offered the SHOP exchange, you really don’t have anything to “shop” around for.

Posted April 15th, 2013 in Individuals, Employers, Producers

The Obama administration announced last week that parts of the Small Business Health Options Program (SHOP) would be delayed until 2015. This announcement has created a lot of confusion in the market.

The SHOP will be a new health insurance marketplace to provide exchange-based coverage to small businesses with up to 50 employees in most states. The SHOP is still expected to be launched as planned in 2014, but one of its key components will be delayed until 2015.

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