Blue Cross Blue Shield of IL Small Groups: Important Dates

While some people I talk to know that they can start making choices as of October 1, no one seems to know the specifics on what will happen with their specific policy going into next year.  Are you responsible for making decisions about your small group policy?  Do you have a BCBS of IL small group policy?  Here are some important dates to take note of?

– September 23, 2013, you must decide whether or not to change your anniversary date to December 2013 only if you are making a plan change.

– October 15, 2013, you must decide whether or not to change your anniversary date to December 2013 if you do not need to change your plan.

I am sure some of your saying “What? Why would I want to change my anniversary date?”  Policies that are renewed in the new year will have different rules that will generally lead to higher rates for your group.  Not always.  This is why you need to review your options with your agent.  If you haven’t heard from your agent and this is the first you have heard about this, I would suggest finding a different agent.  But I digress…

BCBSIL is allowing small groups to keep their current plan or change to a different 2013 plan and keep it for all of 2014 by changing their anniversary date to December of 2013.  Or, they can choose to renew January 1 and choose one of the new 2014 policies.  If no choice is made, it will default to the January 1 anniversary date.  This will usually lead to a more expensive plan for your employees.  You should have received from BCBSIL a Market Impact Analysis to help you make this choice.

So, get educated and make a choice.  If you don’t, a choice will be made for you.  Also, don’t be afraid to explore other options.  More to come…

UPS to exclude spouses/domestic partners from coverage

First, I apologize.  I am getting behind on the many things to report.  There is more to come this week as I get time between clients.  Secondly, don’t you just love how a headline can skew the perception of an article and thus skew an opinion?

So, there was an article yesterday with the headline “UPS to drop 15,000 spouse from insurance, cites Obamacare”.  I don’t know if you have noticed, but the term Obamacare tends to be a polarizing term.  The company referred to the Affordable Care Act, but the author chose to put Obamacare in the title for affect.  She might have done it for search results.  That is a possibility I won’t dismiss, but it slants the opinion and audience of the article.  My point is I think this is ineffective.  But I digress…  Let’s get into the details.

What UPS did was poll their employees to find out which employees had spouses that were eligible for coverage through their own employer.  The ACA law states that employers must cover employees and their dependent children but not spouses or domestic partners.  So, they chose to not cover spouses that have coverage available with their own employer and this only applies to the non-union workforce.  In the statement from UPS, they refer to the rising costs due to ACA but at the same time saving $60 million as a result of the move.  Yes, it is true that ACA adds additional costs to healthcare benefits for an employer.  This is not due to just the rising cost of health insurance due to the increases in coverage requirements.  It is also due to ACA fees that insurers must pass along to their customers such as the Health Insurer Fee, the Reinsurance Fee and the PCORI Trust Fund Fee.  So, UPS was looking for a consistent way to exclude coverage without overly harming their workforce.  Unless you can think of another way, UPS decided the smallest, legal pool of people to exclude was the spouses who were eligible for insurance with their own employers regardless of the cost of those plans.  Why did they do that?  Because the law allowed it.  Was this an unintended consequence?  I would bet on it.

So, my point to this post is that businesses have to make decisions that may not be popular with their workforce or the public.  Healthcare costs are continuing to escalate and this law does nothing to slow those increases for big business.  In fact, with the additional fees, they must find other ways to curb the increase in healthcare costs.  In fact, since there is no mandate for 2014 for businesses, there is actually a dis-incentive to provide health insurance to employees for 2014 as those fees I stated above are placed on the insurance companies and passed along to corporations or the policy holders.  In the end, UPS found a solution that had the smallest affect on their workforce.

I wouldn’t be surprised if we hear of more businesses following UPS’s lead if they haven’t done so already.  Here is the link to the original article:

http://www.bizjournals.com/atlanta/morning_call/2013/08/ups-to-drop-15000-spouses-from.html?ana=RSS&s=article_search&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+bizj_atlanta+%28Atlanta+Business+Chronicle%29&page=all

Thank you to Diane for bringing this article to my attention.  More to come…

Did you get a post card from Blue Cross Blue Shield of IL?

As I explained in my last article, BCBSIL policy holders are in for a big change come the beginning of next year.  This is what the post card said.  It said “Changes are coming”.  I received mine over the weekend.  If you have an individual/family policy (not group) with BCBSIL, did you receive your postcare.  If you did, please put in a comment.  The message on the postcard means that your current coverage is going away and you will be forced into an exchange/marketplace plan with a higher cost if you stay with BCBSIL individual/family policy (again, this doesn’t apply to group policies).  Whether that cost is more or less depends on a lot of things but most importantly, will you qualify for a subsidy and how big will it be?

Be educated.  Explore your options between now and the end of the year.  I will have the ability to sell current plans, private exchange plans and the government exchange plans.  You want to work with an agent that has the ability to sell all three types of plans.  And I highly recommend your work with an agent and not a Navigator.  That is a subject for another day, but in summary, you want to work with an agent that has all 3 options available to them.  Of course, you want to work for an agent that you feel comfortable with and you feel is going to recommend the best plan for your regardless of how it affects their paycheck.  Depending on your income, age, health and your health insurance preferences will depend on which of those 3 options will be best for you and your family.

More to come…

Blue Cross Blue Shield of IL changes

If you have health insurance coverage through Blue Cross Blue Shield of Illinois (BCBSIL), you need to read this.  Disclaimer:  I have coverage through Blue Cross Blue Shield, but I will be switching soon as a result of this information.

BCBSIL delivered information to agents/brokers that disclosed how they will be transitioning into the full implementation of the Affordable Care Act.  They had separate information for individual and small group policies (less than 150 persons).  The biggest effect is on individual policies.

Individual policies:  Existing major medical policy holders will be required to make a choice to one of the new Public or Private Exchange plans between October 1 and December 15 in order to have new coverage effective Jan 1 2014.  Your existing coverage/plan is going away.  Also, from September through the end of the year, BCBSIL will not be taking new applications for major medical coverage except for the new ACA plans.  If you need coverage and absolutely want BCBSIL, you will only be able to obtain a short term policy to bridge you to the beginning of next year.  Existing policy holders will receive a postcard stating that they need to make a decision for their new coverage/plan sometime in the next few weeks.

Small groups:  Small groups will have a much better option.  They will be able to choose a new anniversary date of December 2013 and carry their current coverage through next year or choose a new ACA plan.

Starting Jan 1 of next year, all new major medical policies, regardless of the company issuing the policy, must comply with all the new coverage requirements.  From now until the end of the year, different health insurance companies are handling it differently in Illinois.

Why is this important news?  It is well documented (look up the KFF calculator to see for yourself) that the new ACA plans will cost much more than the current plans.  BCBSIL is not giving their customers a choice in whether to keep their current policy in place for 2014 while other insurance companies like Assurant and United Healthcare (UHC) are allowing policies issued through the end of the year to be kept in place through 2014.  BCBSIL says that they are being forced into this decision by the Illinois Department of Insurance.  Why aren’t Assurant and UHC being forced to do the same thing?  I suspect it is because BCBSIL will be part of the public exchange while Assurant and UHC are not for 2014.

So what does this mean for you?  Get educated!  Some people will be better off selecting new health insurance on the public exchange because their government subsidy will be enough to make the new insurance less expensive.  While people with MAGI less than 400% of the FPL will receive a subsidy, I have found that people with 300% or less will have insurance less expensive than their current coverage.  This is about 70k per year for a family of 4 and around 34k for individuals.  Also, if you have BCBSIL, don’t wait to look at your options.  Things change.  Currently, some insurance companies will continue to sell the current, less expensive policies through the end of the year which will stay in place through the end of 2014, but things could change.  BCBSIL implies that they believe that other insurance companies will be unable to continue to sell their current policies after October 1 referring to an Illinois Department of Insurance decision.

Let me help you determine your options.  Please call me so I can help you evaluate your options.  I will be happy to provide you the information so you can make an informed decision.

A few more disclaimers:  This is only for BCBS of IL.  Yes, Illinois only.  Also, I am an agent for BCBSIL and a current policy holder.  I have nothing against BCBSIL and feel they have been forced into this position especially since they are handling small groups much differently, but that is only a guess based on the information I have been provided.

I am here to help.  Again, more to come…

ACA: Out of Pocket Max clarification

If you are reading up on ACA and all the changes that are happening as the government tries to roll out this complicated legislation, you may have heard that out of pocket maximums are no longer in effect.  Well… not exactly.  A few articles did clarify it correctly, but a number of articles did not state specifically what was affected and why.  So, here is what one of the insurance carriers said when clarifying the issue.

“You may have read media stories the past few days reporting that the Affordable Care Act (ACA) out-of-pocket maximum (OOPM) requirements have been delayed. We want to clear up any confusion.

The stories are actually referring to the OOPM safe harbor for group health plans and group health insurance issuers for the 2014 plan year, which the federal government announced back in February. Although the issue is now getting media coverage, nothing has changed since February. The safe harbor applies to non-grandfathered group health plans when benefits under the plan are administered by more than one service provider.”

So, in short, only group plans are affected and only group plans where benefits are administered with separate service providers (i.e. mental health, precription and medical could be separate).  This will effect very few people and, to me, is pretty much a non-story.

As I have stated, there are many good things in the ACA and plenty of bad things.  There is no need to inflate the seriousness of this issue.  Focus on the more serious issues that need to be fixed.

More to come…  Do you have Blue Cross Blue Shield (BCBS) individual policy or a group policy?  Stay tuned as BCBS has recently stated their transition plans and also suggests what other health insurance issuers will be doing before October 1.  This is big news and will be in my next blog entry.

Small Business Health Care Tax Credit

Are you a small business owner?  If so, you want to be aware of the information in this post.  As part of the Affordable Care Act, small businesses that meet certain criteria can qualify for a tax credit of up to 35% from 2010 and 2013, and up to 50% tax credit for the tax years of 2014 and 2015.  In order to qualify for the tax credit, small businesses need to meet the following criteria:

– the small business must cover at least 50% of the cost of a single person’s coverage (not family or any other type)
– the small business must have less than 25 full-time equivalent employees (FTE)
– the small business employee’s must have an average wage (not mean) of less than $50,000 per year.  This is calculate by taking total income divided by the total FTE employees.
– and most importantly, for 2014 and beyond, in order to qualify for the tax credit, the small business must purchase small group coverage via the public/government marketplace (aka SHOP – Small Business Health Options Program)

Full Time Equivalent (FTE) is defined as 40 hours a week or 2080 hours a year.

Also, there is a phaseout for FTE and average wage.  If your small company has 10 or less FTE employees and the average wage is less than $25,000 per year, you can maximize your tax credit.  Otherwise, there is a proportional phaseout for both FTE (11 to 25 FTE) and average wage ($25,001 to $50,000 per year).

Here are the sources for my information:

http://www.taxpayeradvocate.irs.gov/calculator/SBHCTC.htm#StartCalculator – this is a calculator you can use to estimate your small business tax credit for 2012.
http://www.irs.gov/pub/irs-pdf/i8941.pdf – instructions on how to fill out form 8941 (Credit for Small Employer Health Insurance Premiums)
http://www.irs.gov/uac/Small-Business-Health-Care-Tax-Credit-for-Small-Employers – summary of the tax credit

I am not an accountant so there is no warranty, implied or otherwise, associated with this information.  Sorry, but I felt the need for a disclaimer.

Come October, there will be more options than ever before.  I am licensed to sell health insurance on the open market.  I have also recently been certified to sell insurance on the public/government marketplace for both individuals and small business (SHOP).  Another disclaimer: I am not eligible to sell Medicaid or Medicare. I will be able to help you weed through your options and find the program that meets your requirements and balance that against the private vs public programs available.

More to come…

Did you know? – Preventative Services

I have asked people if they knew about the preventative services that are available for free as part of your health insurance premiums.  I have gotten a variety of answers.  Some people say, big deal… I am on a copay plan.  Others have no idea what constitutes a preventative service.  As part of the ACA, these services are legislated on all major medical health insurance policies.  Also, they are not subject to deductible, co-insurance or copays.  This is effective now.  Here is a list of what is covered at no cost currently:

Breast Cancer screening
– Mammography (women 40+)
– Genetic screening and counseling (women at high risk)
– Preventative medication counseling (women at high risk)

Cervical Cancer
– Pap testing
– High-risk HPV DNA testing (women 30+ with normal pap results)

Colorectal cancer
– One of the following: fecal occult blood testing, colonoscopy, or sigmoidoscopy (adults 50-75)

Cardiovascular health
– Hypertension screening (blood pressure)
– Lipid disorders screenings (cholesterol)
– Aspirin (men 45-79; women 55-79)

Obesity
– Screening
– Counseling and behavioral interventions
– BMI screening

Type 2 Diabetes screening (adults w/ elevated blood pressure)

Depression screening

Osteoporosis screening (women 65+, women 60+ at high risk)

Immunizations (I won’t list them all here, but all the ones you would want are covered)

Physicals

Newborn and adolescent screenings (again, I won’t list them but they are part of a child’s recommended Dr. visits from Newborn through 6 years)

Alcohol misuse screening and counseling

Tobacco counseling and cessation interventions

Intensive healthy diet counseling (adulst w/ high cholesterol, CVD risk factors, diet related chronic disease)

Interpersonal and domestic violence screening, counseling (women)

Well-woman visits

Pregnancy- Related screenings, but this does not include all doctor visits or the actual birth.  It also includes breastfeeding support/counseling.

STI and HIV counseling/screenings

Sexual disease screenings

Contraception (women)
– All FDA-approved contraceptive methods as prescribed
– Sterilization procedures
– Patient education and counseling

WOW, that is a lot.  This applies to all non-grandfathered policies.  Non-grandfathered mean policies that were originated after March 23, 2010.  Most people’s policies are not grandfathered.

For me, there were some surprises.  But the takeaway is that there is no reason to put off a doctor visit to have yourself checked out.  This is effective now; not next year.  For people with major medical, this won’t cost you anything.  No copay, not subject to deductible or coinsurance.

As always, please let me know if you have any questions about the information I put in this blog or even about your current coverage.  More to come…

 

Public Exchange eligibility (for the employed)

I will make this post short.  Did you know if your employer offers health coverage that you may still be able to get insurance on the public exchange?  If your insurance coverage through your employer for a plan that is at least 60% actuarial value is greater than 9.5% of your gross income, then you are eligible for obtaining insurance on the public exchange and thus, eligible for the subsidy if your income is less than 400% of the poverty level.

I like examples so let me show you an example.  I recently reviewed an employer’s health plan.  Their high deductible plan for a family was $905 a month.  This means if a person earned under around $114k, they would be eligible to obtain insurance on the public exchange.  Of course a family of 4 would need to earn under around $94k in order to be eligible for a subsidy.

So, if you feel your employer’s health insurance costs too much, there are other options.  More to come…