Tuesday, November 23, 2010

HHS releases guidance on health reform MLR requirement

On Monday, November 22nd, the Department of Health and Human Services (HHS) released regulations detailing the medical loss ratio (MLR) requirement of the Patient Protection and Affordable Care Act (PPACA). The MLR rule requires that insurance companies spend at least 80 cents per premium dollar on medical care and quality, 85 cents per premium dollar for large group plans.

The regulations follow the National Association of Insurance Commissioners recommendations on deducting federal and state taxes from the MLR. They also allow “mini-med” plans to follow a different calculation formula than other plans in 2011.

Insurance companies that do not meet the medical loss ratio standard will be required to provide rebates to customers, with the first round of rebates beginning in 2012.

For more information on the MLR rule, view the Medical Loss Ratio Fact Sheet or the HHS Regulations.

Friday, November 19, 2010

Grandfathered status amended to allow for change in carriers

On November 15th, the Departments of Treasury, Labor, and Health and Human Services announced they are amending the Interim Final Regulations (IFR) on grandfathered health plan status. The amendment allows employers to switch insurance carriers and/or change their funding from Administrative Services Only (ASO) to fully insured without losing grandfathered status.

Under the amended rules, employers that offer the same level of coverage through a new carrier can remain grandfathered as long as the changes do not result in significant cost increases, a reduction in benefits or the other prohibited changes specified in the IFR.

This amendment is effective November 17, 2010 and is not retroactive, nor does it apply to individual policies. As such, insured plans that changed insurance carriers or self-funded plans that became fully insured prior to November 17, 2010 will still lose grandfathered status.

The original IFR stated that changing insurance carriers would cause an insured group health plan that was in effect on March 23, 2010 to lose its grandfathered status.

Friday, November 12, 2010

BCBSNC releases letter to assist groups in communicating Part D creditable coverage

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) created an ongoing notification requirement for groups with subscribers or dependents eligible for Medicare, even if the group doesn't offer retiree drug coverage.

It is the employer group's responsibility to provide member notification of their plan's status as creditable or non-creditable under Medicare Part D. It is recommended that groups consult the CMS website for updates.

BCBSNC has created the following Creditable Coverage Communication to assist groups in communicating information to Medicare eligible retirees about the group’s drug coverage and whether it is creditable.

The letter includes:
• General information about the MMA requirements
• A list of BCBSNC standard prescription drug plans and estimates of whether they are creditable, non-creditable or inconclusive
• A list of BCBSNC standard high deductible health plans with integrated prescription drug benefits and estimates of whether they are creditable, non-creditable or inconclusive

Friday, November 5, 2010

Webinar on Section 105(h) non-discrimination rules for fully-insured health plans

Senn Dunn Insurance invites you to participate in a webinar on November 30th, from 1:00 - 2:00 PM Eastern.
Reserve your seat now at: https://www1.gotomeeting.com/register/988142104

The Patient Protection and Affordable Care Act (PPACA) requires that fully-insured plans which lose grandfathered status comply with the requirements of section 105(h)(2) of the Internal Revenue Code. The 105(h) rules prohibit health plans from discriminating in favor of highly compensated individuals. These rules already apply to self-funded plans, but will now also apply to fully-insured plans, which have lost grandfathered status, effective on the first plan year beginning after September 23, 2010.

The penalty applicable to an employer who sponsors a fully-insured plan which violates the 105(h) rules is severe. The employer would be liable for an excise tax of up to $100 per day per employee “discriminated against.” This session will help employers understand the rules and what they need to do to make sure their benefits, eligibility, and contribution structure are in compliance.

Presenter: Bob Radecki, President, Benefit Comply, LLC
Bob Radecki has more than 25 years experience in the HR and employee benefits industry helping employers deal with difficult benefit and compliance matters. Previously, Bob founded and served as President of A.E. Roberts Company, a nationally recognized compliance consulting and training firm. He has served as the principal HIPAA consultant to a number of health insurance companies, and is recognized as a leading expert on a variety of benefit compliance issues including COBRA, FMLA, Health Reform and more. Bob has been the featured speaker at numerous industry events and conferences, and has published a number of articles concerning various compliance issues.

Thursday, November 4, 2010

Assistance Fund helps insured cover prescription co-pays

The Washington Post /Orlando Sentinel (11/3, Santich) reports that earlier this year, Edward Hensley and Jeff Spafford "launched the Assistance Fund, a national charity that covers pricey prescription-drug costs for those who have insurance but can't afford their co-pay," which may run up to thousands of dollars for certain medicines.

The charity serves an unmet need, as many pharmaceutical "companies typically have their own patient-assistance programs for the uninsured, options for the insured are more limited." The Assistance Fund will help "patients who earn up to seven times the federal poverty standard—income of $22,050 for a family of four." The charity has raised $20 million in donations, mostly from large corporations, including drug manufacturers. Currently, the fund is helping some 3,000 Americans, a number that Hensley and Spafford would like to greatly increase in 2011.

For more information, visit http://theassistancefund.org/.