February 14, 2014
Updated March 18, 2014
Associations have their own private health insurance and employee benefit marketplaces because these marketplaces bring all of those who have benefits to offer together with your members who need them. All in one safe, convenient, robust and competitive environment that provides choices to your members unlike anything small businesses have ever had.
Another reason to have your own association private health insurance and employee benefits marketplace is that having such a marketplace allows your members to keep up with compliance challenges posed by the Patient Protection and Affordable Care Act. Our clients are up-to-date on the following ObamaCare delays and changes. Check and see how your members are doing.
- March 5, 2014 – People in plans that don’t comply with Obamacare can keep renewing them as late as October 2016, avoiding a new round of cancellations during the 2014 campaign season. [For additional detail see our blog post https://gbacapg.wordpress.com/2014/03/06/another-week-another-aca-extension]
- Employer-mandate delayed again: The administration delayed for an additional year provisions of the employer mandate, postponing enforcement of the requirement for employers with between 50-99 employees until 2016 and relaxing some requirements for employers with 100 or more employees. Businesses with 100 or more employees must offer coverage to 70% of their full-time employees in 2015 and 95% in 2016 and beyond. (February 10, 2014) All gbac APG association private health insurance and employee benefit marketplaces assure compliance with ACA compliance requirements.
- Equal employer coverage delayed: Tax officials will not be enforcing in 2014 the mandate requiring employers to offer equal coverage to all their employees. This provision of the law was supposed to go into effect in 2010, but IRS officials have “yet to issue regulations for employers to follow.” (January 18, 2013) All gbac APG association private health insurance and employee benefit marketplaces assure compliance with ACA compliance requirements.
- Expanding catastrophic hardship waiver to those with canceled plans: The administration expanded the hardship waiver, which allows some people to purchase catastrophic health insurance, to people who have had their plans canceled because of ObamaCare regulations. This is only a temporary fix so these plans will again be illegal in 2015, conveniently after the November 2014 elections. (December 19, 2013)
- Extending Preexisting Condition Insurance Plan: The administration extended the federal high risk pool until January 31, 2014 and again until March 15, 2014 to prevent a coverage gap for the most vulnerable. The plans were scheduled to expire on December 31, but were extended because it has been impossible for some to sign up for new coverage on healthcare.gov. (December 12, 2013) (January 14, 2014)
- Exempting unions from reinsurance fee: The administration gave unions an exemption from the reinsurance fee (one of ObamaCare’s many new taxes). To make up for this exemption, non-exempt plans will have to pay a higher fee, which will likely be passed onto consumers in the form of higher premiums and deductibles. (December 2, 2013)
- Insurance companies may offer canceled plans: The administration announced that insurance companies may reoffer plans that previous regulations forced them to cancel. Not all insurance companies agreed that they had the legal authority to do this, nor did all state insurance commissioners. (November 14, 2013)
- Delaying the individual mandate: The administration changed the deadline for the individual mandate, by declaring that customers who have purchased insurance by March 31, 2014 will avoid the tax penalty. Previously, they would have had to purchase a plan by mid-February. (October 23, 2013) All gbac APG association private health insurance and employee benefit marketplaces assure compliance with ACA reporting requirements.
- Delaying the online SHOP exchange: The administration first delayed for a month and later for a year until November 2014 the launch of the online insurance marketplace for small businesses. The exchange was originally scheduled to launch on October 1, 2013. (September 26, 2013) (November 27, 2013) Given the difficulties with the government exchanges operating to serve individuals ranging from security concerns to lack of operations to poor plans to lack of available networks of doctors and hospitals, no small business member of an association needs to rely on the government SHOP exchange when their association has its own private marketplace. Our association private marketplaces offer all carriers and all plans available in each state and all operating successfully – unlike the government exchanges.
- Self-attestation: Because of the difficulty of verifying income after the employer-reporting requirement was delayed, the administration decided it would allow “self-attestation” of income by applicants for health insurance in the government exchanges. This was later partially retracted after congressional and public outcry over the likelihood of fraud. (July 15, 2013) All gbac APG association private health insurance and employee benefit marketplaces assure compliance with ACA requirements.
- Employer-mandate delay: By an administrative action that’s contrary to statutory language in the ACA, the reporting requirements for employers were delayed by one year. (July 2, 2013) All gbac APG association private health insurance and employee benefit marketplaces assure compliance with ACA requirements.
- Delaying a low-income plan: The administration delayed implementation of the Basic Health Program until 2015. It would have provided more-affordable health coverage for certain low-income individuals not eligible for Medicaid. (March 22, 2013)
- Small businesses on hold: The administration has said that the federal exchanges for small businesses will not be ready by the 2014 statutory deadline, and instead delayed until 2015 the provision of SHOP (Small-Employer Health Option Program) that requires the exchanges to offer a choice of qualified health plans. (March 11, 2013) Again, small businesses as members of trade associations with their own private health insurance and employee benefit marketplaces are not troubled by the problems in the government exchanges.
- Doubling allowed deductibles: Because some group health plans use more than one benefits administrator, plans are allowed to apply separate patient cost-sharing limits to different services, such as doctor/hospital and prescription drugs, allowing maximum out-of-pocket costs to be twice as high as the law intended. (February 20, 2013) All gbac APG association private health insurance and employee benefit marketplaces assure compliance with ACA requirements and receive guidance on managing their benefit plans.
- Closing the high-risk pool: The administration decided to halt enrollment in transitional federal high-risk pools created by the law, blocking coverage for an estimated 40,000 new applicants, citing a lack of funds. The administration had money from a fund under Secretary Sebelius’s control to extend the pools, but instead used the money to pay for advertising for Obamacare enrollment and other purposes. (February 15, 2013)
- Subsidies may flow through federal exchanges: The IRS issued a rule that allows premium assistance tax credits to be available in federal exchanges although the law only specified that they would be available “through an Exchange established by the State under Section 1311.” (May 23, 2012) This is a matter pending litigation in the federal courts.
- Employee reporting: The administration, contrary to the Obamacare legislation, instituted a one-year delay of the requirement that employers must report to their employees on their W-2 forms the full cost of their employer-provided health insurance. (January 1, 2012) All gbac APG association private health insurance and employee benefit marketplaces assure compliance with ACA reporting requirements.
- Medicare Advantage patch: The administration ordered an advance draw on funds from a Medicare bonus program in order to provide extra payments to Medicare Advantage plans, in an effort to temporarily forestall cuts in benefits and therefore delay early exodus of MA plans from the program. (April 19, 2011)
Your association can give your members every advantage they need to have access to the widest variety of benefit choices that they would not see elsewhere – professional guidance on constructing their employee benefit programs – and compliance with whatever Washington has done and will do next.