What Does the Individual Mandate Mean to Me?

This Know Your Insurance Piece explains what the Affordable Care Act’s individual mandate is and how it affects you.  It describes the penalty exemption for individuals who purchased health insurance coverage (either an Exchange plan or individual coverage outside of the Exchange) that was effective on or before May 1,2014.

Individual Insurance – What Does the Individual Mandate Mean to Me

Why should you buy vision coverage?

This is some great input from one of our partners, Ameritas, on the impor­tance of vision coverage. Thought it was important enough to share…

Vision insurance typically receives mixed reviews – some see the value and realize the impor­tance of the coverage, but others think it’s not essential and it’s more of a “luxury” benefit.  This week’s update is going to pass on infor­mation to show the great value of vision insurance, specif­i­cally on the eye exam.

A key point of vision insurance is to get insured’s to an annual compre­hensive eye exam.  I don’t mean an exam where you read letters on a Snellen chart – I mean a true compre­hensive eye exam.  The reason these exams are so valuable is the ability to detect vision condi­tions and other health problems.  Here’s a quick list of condi­tions and diseases that can be detected through a compre­hensive eye exam:

Eye Conditions Medical Conditions
Glaucoma Cardiovascular disease
Cataracts Demyelinating diseases
Macular Degeneration Endocrine condi­tions
Diabetic Retinopathy Inflammatory and Rheumatologic conditions
Infections of the eye Neuromuscular diseases
Corneal Dystrophy Tumors
Retinal Detachments

There are huge benefits to detecting these condi­tions early.  People can get treatment and many times not experience any damage, as long as these condi­tions are recog­nized early.  Combine this with the fact that a person with a vision insurance plan is more likely to go in for an eye exam than if they didn’t have insurance – THAT is the reason vision insurance is so valuable!  The coverage encourages preventive care and regular exams that helps keep people happy and healthy – and that’s the type of company employees are looking for!  On top of the exam benefits, vision insurance helps members pay for vision corrective services (lenses, frames, etc) and helps save them a signif­icant amount of money.  So the next time you are prospecting or talking to a current client that does not have vision coverage, you’ll be able to explain and show them that vision insurance is a great value to add to the benefits package.

Updated Application Period for Individual Coverage

Covered California announced today that individuals who have started an online appli­cation by March 31 will have until April 15 to complete their appli­cation and to select a Covered California health plan.  Note this applies to online appli­ca­tions only.

Individuals who start an online appli­cation by 11:59 p.m. on March 31, 2014 will have until 11:59 p.m. on April 15, 2014 to complete their appli­cation and select a plan.  To start an application, individuals must take at least the following steps:

  • Create an online account.
  • Complete all required infor­mation on the “Apply for Benefits” page and click on “Continue.”  The page contains two required fields.
  • After clicking on “Continue,” the individual will be taken to the “Consent for Verification” page, where they need to click on “Save & Exit” or “Continue.”
  • Individuals must return to their online account no later than April 15 to complete the appli­cation and select a plan.

Individuals who complete their appli­ca­tions, and make their premium payment on time, will get coverage beginning May 1 and avoid the tax penalty for lack of insurance. Click here for infor­mation about how to pay and payment deadlines.

Again, the open enrollment completion period applies only to online appli­ca­tions.  Paper appli­ca­tions must be completed (including plan selection) and postmarked by March 31, 2014 in order to meet the open enrollment deadline for Covered California health plans.

Certified Insurance Agents are encouraged to use Covered California’s online enrollment portal for starting appli­ca­tions by the March 31 deadline, and then use the next two weeks to help their clients complete the process.

After the end of open enrollment on March 31, consumers may be eligible for Covered California’s special enrollment period, which can be triggered by one of several “quali­fying life events,” as defined under the Affordable Care Act. Some of those quali­fying events include:

  • Getting married.
  • Having a baby or adopting a child.
  • Permanently moving to a new area that has different health plan options.
  • Losing other health care coverage that is considered minimum essential coverage.
  • A change in income that would affect an enrollee’s eligi­bility for financial assistance.

Low-cost or no-cost coverage through Medi-Cal is also available to consumers year-round, and they can check their eligi­bility and sign up on the Covered California website, through its Service Center or with the help of assisters.

Covered California also operates its Small Business Health Options Program (SHOP) year-round for businesses with 50 employees or fewer.

Covered California’s next open enrollment period, for 2015 coverage, will begin in fall 2014.

Departments Release Final Regulations on the 90-day Waiting Period

On Feb. 20, 2014, the Departments of Labor, Health and Human Services and the Treasury released final regula­tions on the Affordable Care Act’s 90-day waiting period limit. These regula­tions generally finalize provi­sions in proposed regula­tions issued in March 2013, with minimal changes. At the same time, the Departments released a separate proposed rule regarding a new provision permitting orien­tation periods under the 90-day waiting period limit.

Under these regula­tions, employers may require employees to success­fully complete a reasonable and bona fide employment-based orien­tation period as a condition for eligi­bility for coverage under a plan. However, the orien­tation period may not exceed one month. In addition, the final regula­tions provide that a former employee who is rehired may be treated as newly eligible for coverage upon rehire, and may be required to satisfy the plan’s waiting period again.

The final regula­tions apply for plan years beginning on or after Jan. 1, 2015. However, the 2013 proposed regula­tions provided that the 90-day waiting period limit would apply for plan years beginning on or after Jan. 1, 2014. Thus, for plan years beginning in 2014, the Departments will consider compliance with either the 2013 proposed regula­tions or the final regula­tions to constitute compliance with the 90-day waiting period limit requirement.

Employer Mandate Delayed until 2015

The U.S. government has announced that the employer mandate, one of the most significant portions of the Affordable Care Act (ACA), will not be enforced until 2015.

Under the provision, companies with 50 or more full-time employees would have faced fines of up to $3,000 per employee if they didn’t offer their employees affordable health insurance.

The one year delay is designed to accomplish two goals:

  • Allow the government to consider ways to simplify the new reporting requirements consistent with the law
  • Provide time to adapt health coverage and reporting systems while employers are moving forward with offering affordable coverage to their employees

Click here for more information directly from the Treasury Department’s website.

Notice of Exchanges

Covered California

California was the first state to create a health benefit exchange following the passage of federal health care law. Covered California is charged with creating a new insurance market­place in which individuals and small businesses can get access to health insurance. With coverage starting in 2014, Covered California will help individuals compare and choose a health plan that works best for their health needs and budget.

To view the full booklet detailing Covered California, click here: CC Health Plans Booklet

A 3-page press release is available hereCOVERED CA-HealthPlans

The high-level presentation is available here: Covered California HP Announcement

Model Notice

Per the PPACA, employers covered by the Fair Labor Standards Act (FLSA) are required to provide a notice to employees about the state’s health insurance exchanges. Originally, the deadline for offering the exchange notice was March 1, 2013. However, on May 8, 2013, the Department of Labor issued a technical release extending the date to October 1, 2013.

The notice must be provided in writing in a manner calculated to be understood by the average employee. It may be provided by first-class mail. Alternatively, it may be provided electronfi­cally if the requirements of the Department of Labor’s electronic disclosure safe harbor at 29 CFR 2520.104b-1 are met.

There is no requirement to obtain an employee’s signature; however, an employer may want to track delivery and receipt of the notice.

The model notice is available here: Model Notice

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