Health Care Reform is a big step toward increasing access to health care coverage for all Americans. With it comes a lot of changes to the benefits you offer your employees. You can count on us to help you understand the changes and what they mean for your company and your employees. We’ll let you know about changes before your health benefit plan renews so you can make the best decisions for your employees.
We encourage you to take part in a conversation with your agent, call us directly or stop by a Florida Blue Center to learn more.
Choose a category to learn more. Be sure to check back often for updates.
Small businesses (with less than 25 full-time employees) that provide health care benefits may be eligible for a federal tax credit if they meet certain requirements. Find more information at www.irs.gov.
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We’re continuously working to provide your employees with valuable health benefits that fit your budget. Together, our plans and the new tax credit provide you even greater savings.
The Summary of Benefits and Coverage (SBC) is a new document required to be provided for all health plans by the Affordable Care Act (ACA) legislation. The SBC requirement applies to all individual policies and group health plans regardless of plan size, funding arrangement, or grandfather status.
The SBC uses plain language to summarize information about available health plans. It is designed to give people easily understandable information about a health insurance plan's benefits using a standard format to help them compare plans and make enrollment and coverage decisions.
Employers need to understand their responsibilities in the distribution of the SBC to employees and the potential penalties for non-compliance. For more information please reference the following documents:
A temporary program established by reform to reimburse employers for certain early retiree expenses. Early retirees are those age 55-64 who aren’t eligible for Medicare. The program is no longer accepting applications. To learn more visit www.hhs.gov.
Employers can no longer offer insurance coverage that favors highly compensated individuals. Only grandfathered fully insured plans are exempt from the non-discrimination testing requirement. Note: Enforcement of this provision has been delayed.
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As an employer, you need to know that these changes may impact the selection of health plan options to help you comply with the new health care reform laws.
All U.S. citizens and legal residents will be required to have “minimal essential health coverage,” which will be fully defined prior to 2014. In 2014, if your company has an average of at least 50 full-time employees (or the part-time equivalent), you must offer “minimum essential health coverage” to avoid employer penalties.
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Talk to your agent or call us directly about your company’s existing coverage and options for providing coverage before the mandate. You can count on us to have a number of qualified health benefit plans and solutions available to meet your business needs.
Starting in 2014, large businesses (those with 50 or more employees) that do not provide adequate health insurance will be required to pay a penalty if their employees receive premium tax credits to buy their own insurance in the Exchange. The penalty for a large employer that does not offer coverage will be $2,000 per full-time employee beyond the company's first 30 workers.
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Talk to your agent or call us directly about your company’s existing coverage and options for providing coverage before the mandate. You can count on us to have a number of qualified health plans available to meet your business needs.
The amount of time you require employees to wait for coverage, once eligible, must not exceed 90 days for all group health benefit plans starting in 2014.
A grandfathered plan is any health insurance plan that was in effect prior to March 23, 2010. Any major benefit changes to a grandfathered plan will cause it to lose its grandfathered status.
Individuals and small businesses will have the option of shopping and comparing health insurance through this Exchange beginning no later than January 1, 2014. Health benefit plans offered through the Exchange will meet certain cost and benefit requirements.
Preventive Services, like mammograms and colonoscopies, help prevent and detect diseases early. This benefit ensures that your employees receive preventive services and immunizations without a cost-share when they go to an in-network provider. All plans that are not grandfathered are required to provide this benefit.
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Your employees’ health and wellness is always our top concern. That’s why we removed many of the limits on most of our health benefit plans last year for preventive care, before the health care reform changes. We’re now offering health care plans with no cost-share on routine preventive services and immunizations received in-network.
Beginning August 1, 2012, some health insurance plans (but not all) will be required to provide the expanded Women's Preventive services at $0 member cost share for in-network providers.
These services include, but are not limited to the following:
1) Annual Well Woman Visits
2) Screening for Gestational Diabetes
3) HPV Testing
4) Counseling for Sexually Transmitted Infections
5) Counseling & Screening for HIV
6) Contraceptive Methods & Counseling
7) Breastfeeding support, supplies and counseling
8) Screening & Counseling for Interpersonal & Domestic Violence
Your employees' health care coverage includes the removal of annual dollar limits for essential benefits. This means that insurance plans cannot limit the annual dollar amount paid for these benefits.
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It’s reassuring to know that you have health plan choices without annual dollar limits on essential health benefits for your employees.
This provision removes lifetime dollar limits for essential benefits. This means that insurance plans cannot limit the maximum dollar amount paid for these benefits.
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We’ve removed the lifetime limit on the amount we pay for all covered benefits, not just essential benefits. Now, your employees have greater protection.
This benefit ensures that emergency services will be covered at the same cost share amount whether received in or out of network or without prior authorization. Emergency services include any medically necessary services received in a hospital. All plans that are not grandfathered are required to provide this benefit.
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The last thing your employees need to worry about during an emergency is where to go for care. Now they can rest assured knowing that no matter where they go for emergency services, they’re covered.
Health plans cannot set coverage limitations for insured children under age 19 due to a pre-existing condition. Beginning 2014, adults will not be denied access to coverage or have coverage limitations due to a pre-existing condition. Prior to 2014, adults in Florida that cannot obtain Individual insurance can apply for the national Pre-existing Condition Insurance Plan (PCIP), a new health coverage option created by health care reform for people with pre-existing conditions. For more information about PCIP, go to www.PCIP.gov or call 1-866-717-5826
The Mental Health Parity and Addiction Equity Act (MHPAEA) ensures that medical and mental health benefits cost-share amounts are in parity. This change applies to group employer plans that cover 50 or more employees.
Beginning September 23, 2012, insurance companies must provide a standard summary of the benefits and coverage offered through a plan to increase the member’s understanding of their coverage. This summary should be provided to your employees at the time of application or enrollment in a specific plan.
As of December 31, 2010, non-prescription over-the-counter drugs (other than insulin) that are purchased using funds from a Health Savings Account (HSA), Flexible Spending Account (FSA) or Health Reimbursement Account (HRA) will be assessed a tax penalty of 20%.
Several criteria on the quality of care will be used as measures on the effectiveness of plans offered by health insurance companies Insurance companies must submit annual reports to the government and members. These reports will detail how benefits improve health outcomes, prevent hospital readmissions, improve patient safety, and help promote health and wellness activities.
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Quality improvements and reporting have helped us provide affordable health care, value and choice for our members for many years. We strongly support quality improvements required by health care reform to improve quality health care for everyone.
Reform established a new process for reviewing rate increases at the state level.
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Our plan rates are regularly reviewed by the State of Florida’s Office of Insurance Regulation (OIR). The OIR approves our rates before we can make our plans available. We have always complied with governmental regulations and will continue to do our part to provide affordable care for your employees.
Insurance companies must meet minimum Medical Loss Ratios (MLRs). An MLR is the percentage of premiums that an insurance company uses for medical costs versus the amount that goes to paying administrative costs. Insurance companies must report MLR annually. If an insurance company does not meet the minimum MLR requirements, it must issue annual rebates to customers.
This change ensures that health insurance coverage can only be cancelled due to fraud, an intentional misrepresentation of facts, or failure to pay the premium.
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We have a long-standing practice of not cancelling health insurance coverage. You can count on us for your health needs.
Individuals with pre-existing conditions, who cannot get coverage, will now be able to get insurance. They can enroll in the federal high-risk insurance pool if they haven’t had insurance for six months or longer. For information, go to www.PCIP.gov or call 1-866-717-5826.
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We’re here to answer your employee’s questions and help them get coverage. Please encourage them to call us or talk to us in person at a Florida Blue Center.
Insurance companies that offer child-only policies cannot deny coverage for children under age 19. Not all insurance companies offer child-only health insurance policies. By 2014, guaranteed insurance coverage will be expanded to everyone.
This change requires health plans that cover dependents to provide coverage for young adults up to age 26. Your employee’s dependents can receive coverage even if they’re married, living outside of Florida, no longer students or financially independent.
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We understand the importance of providing quality health care to your employees and their families. That’s why we offer you the option to continue dependent coverage up to age 30.
Medicaid, a health insurance program for people and families with low incomes, is expanding to include non-elderly, non-pregnant individuals who are at or below 133% of the federal poverty level based on household income. This expansion takes effect January 1, 2014, for participating states.
An additional $11 billion in funding for Community Health Centers (CHCs) will be provided over the next five years. CHCs deliver quality preventive care to low-income residents. Services can include primary care, dental care, women's health, podiatry, counseling services, health promotion and education, physiotherapy, advocacy and intervention.
Health care reform provides $50 million in state grants for developing alternatives to resolving medical malpractice disputes through lawsuits. Alternative resolutions will emphasize patient safety, disclosure of health care errors and timely resolution.
This information is being provided in an effort to share with you some of the changes required under the Patient Protection and Affordable Care Act, otherwise known as Health Care Reform. Please know that plan benefits are subject to change and may be revised based on guidance and regulations issued by the Secretary of Health and Human Services. This information does not cover all of the law’s provisions and should not be used as legal advice for your decisions. We encourage you to seek professional advice regarding how Health Care Reform on how your decisions impact your health insurance.
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