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Division of Insurance to Allow Continuation of Non-ACA Compliant Health Plans through 2015

May 21st, 2014 9:43am - Posted By: Colordao Department of Labor

 May 2nd, 2014-Press Release

The Colorado Division of Insurance (DOI) announced today that it will allow insurance carriers to continue through 2015 health insurance plans for individuals and small groups that do not comply with new insurance rules that started in January 2014. Read the press release as well as the full bulletin.

This decision is based upon President Barack Obama's announcement in March to allow such plans to continue.

“Allowing insurance companies to continue these plans for another year gives people more options and more time to navigate the transition to the Affordable Care Act (ACA),” said Marguerite Salazar, Commissioner of Insurance. “This added time will help them determine the best course of action for themselves and their families.”

Insurance carriers will not be required to continue their non-ACA-compliant plans and will need to make their own business decisions in this regard. When making a coverage decision, the DOI encourages consumers to take the time to consider their health insurance options carefully. Consumers should compare premiums, out of pocket costs, consumer protections, and eligibility for tax credits only available through Connect for Health Colorado.

This decision means that consumers who renewed individual or small group plans in 2013 may be able to renew these plans in 2014 for continuation into 2015, should their insurance company decide to continue plans.

Renewals can be completed through Dec. 31, 2014, with an expiration date for plans of no later than Dec. 31, 2015. However, carriers will not be allowed to reinstate plans previously discontinued in 2013, nor does this decision allow for the sale of new plans not compliant with state and federal law.

New legislation is not needed to allow this extension. House Bill 13-1266, concerning the alignment of state health insurance laws with the requirements of the federal “Patient Protection and Affordable Care Act,” became known as the Alignment Bill.

The purpose of the Alignment Bill was to align Colorado's health insurance laws with the Affordable Care Act and to give the DOI the authority to regulate insurers in alignment with federal requirements and guidance. The Centers for Medicare and Medicaid Services issued guidance stating that certain plans could be continued that would otherwise be discontinued because they did not meet the requirements of the ACA. In aligning the DOI's policy with this guidance from CMS, this decision by the DOI provides more time for consumers to transition into the new health care marketplace.

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March 31st Deadline for Purchasing Individual Health Insurance

March 21st, 2014 10:31am - Posted By: Connect for Health Colorado Update

The deadline for uninsured Coloradans to enroll in commercial health insurance for 2014 is March 31. After that, uninsured Coloradans cannot get commercial coverage until 2015 unless they have a special circumstance, such as losing a job that provided coverage or moving to the state. The next open enrollment period will be November 15, 2014 to February 15, 2015. Coloradans can apply for Medicaid and Child Health Plan Plus at any point during the year. More information is available here.

What happens if an individual submits an application for financial assistance by March 31, 2014, but does not receive an eligibility determination by March 31?

Connect for Health Colorado will accept enrollments for customers who submitted an application for financial assistance by March 31, 2014, even if they didn’t receive an eligibility determination by March 31.                                                                                                                                                                                

Must individuals have a Connect for Health Colorado account to be able to have their applications processed?               

No. As long as a customer has submitted an application for financial assistance by March 31, 2014, Connect for Health Colorado will honor that date and support the customer in enrolling in a health plan.                                                                                                                                              

What happens if I experienced a technical problem while trying to enroll and, as a result, was not able to enroll by March 31?

Connect for Health Colorado will evaluate each case where a technical problem was experienced and, as appropriate, work with the customer to facilitate enrollment.

Does an individual need to apply online?

No. We will accept applications for financial assistance submitted online, on paper and through PEAK (the State Medicaid/CHP+ website) by March 31, 2014.

What date do you consider for a paper application?

The date of application for a paper application is generally the date we receive the application.          

Once an individual receives an eligibility determination, is there a time limit to enroll?

Customers who applied during the open enrollment period but received an eligibility determination after the open enrollment period closed will have until May 31, 2014 to select an insurance plan and enroll through Connect for Health Colorado.                                                           

When will the individual’s health insurance take effect?

The effective date of coverage will depend on when the customer selects a plan and enrolls. If enrollment occurs before the 15th of the month, then coverage will be effective the first of the immediate following month. If enrollment occurs after the 15th of the month, then coverage will be effective the first of the second following month. For example, if a customer applies on March 25, 2014, receives a Medicaid denial on April 2, 2014, selects and enrolls in coverage on April 5, 2014, then the effective date of coverage will be May 1, 2014.  If the same customer selects a plan and enrolls in coverage on April 16, 2014, then the effective date of coverage will be June 1, 2014.

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Free Webinar Series Begins March 6th-RSVP today!

February 26th, 2014 5:00pm

 

Spring Into Healthcare Reform-2014

 

Series Kickoff!                   REGISTER FOR WEBINAR HERE: Thu, Mar 6, 2014 9:00 AM - 10:00 AM MST

 

Healthcare Reform          REGISTER FOR WEBINAR HERE: Thu, Mar 13, 2014 9:00 AM - 10:00 AM MDT

 

Off-Exchange Small Group Market            REGISTER FOR WEBINAR HERE: Thu, Mar 20, 2014 9:00 AM - 10:00 AM MDT

 

SHOP Exchange               REGISTER FOR WEBINAR HERE: Thu, Mar 27, 2014 9:00 AM - 10:00 AM MDT

 

ERISA Compliance        REGISTER FOR WEBINAR HERE: Thu, Apr 3, 2014 9:00 AM - 10:00 AM MDT

 

Partially Self-Funded Products           REGISTER FOR WEBINAR HERE: Thu, Apr 10, 2014 9:00 AM - 10:00 AM MDT

 

Considering a PEO?          REGISTER FOR WEBINAR HERE: Thu, Apr 17, 2014 9:00 AM - 10:00 AM MDT

 

Direct Patient Care-Nextera Healthcare       REGISTER FOR WEBINAR HERE: Thu, Apr 24, 2014 9:00 AM - 10:00 AM MDT

GRAND FINALE SHOWCASE!

Friday April 25th, 4-7 p.m.

Meet the Presenters and Health Insurance Representatives

Hampton Inn & Suites

6333 Lookout Road, Boulder, CO 80301 

RSVP HERE for the Showcase

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Employer Mandate (Large Groups Only)-Final Ruling February 2014

February 14th, 2014 4:16pm

 Employer Mandate Final Regulations Issued

The Employer Mandate

The employer mandate applies to employers with 50 or more full-time employees or full-time equivalents. These employers must:

·        Offer “affordable” (costs no more than 9.5% of an employee’s wages) and “minimum value” (covers 60%+ of total covered costs) coverage to full-time employees working at least 30 hours a week and their dependent children up to age 26.

·        Pay a penalty if they do not offer the required coverage and one or more employees receive a premium tax credit for coverage purchased through the Marketplace.

The employer mandate was originally effective for 2014, but was delayed until 2015.

The Treasury Department issued final regulations on the employer shared responsibility provisions, commonly known as the “employer mandate,” on February 10, 2014. The regulations covered several topics:

Phasing in of the Employer Mandate by Employer Size

Employers with 50 to 99 full-time employees will not face penalties for not offering coverage to full-time employees and their dependents up to age 26 until the first plan year beginning on or after January 1, 2016. These employers will need to certify that they are not reducing the size of their workforce to stay below 100 employees.

Employers with 100 or more full-time employees and their dependents up to age 26 will not face penalties if they offer coverage to 70% of their full-time employees in 2015. They will need to offer coverage to 95% of full-time employees beginning in 2016.

The full-time employee definition remains at 30 hours or more per week. The definition of dependent has been revised to exclude stepchildren and foster children. It continues to exclude spouses.

Extension of Transition Relief for 2015

The final regulations extend transitional relief in several ways, including:

·        Employers with non-calendar-year plans must comply with the employer mandate as of the beginning of the first plan year commencing after January 1, 2015.

·        The requirement to offer dependent coverage will not apply in 2015 to employers that are taking steps to offer dependent coverage by 2016.

·        Employers can use a six-month “look back” period to determine whether they had at least 100 full-time or full-time equivalent employees in the previous year, which aligns with the phasing in of the penalties.

·        In 2014, employers may use a six-month measurement period to determine the stability period during which employees with variable hours must be offered coverage.

However, there was also relief for 2014 allowing employer plans to recognize the individual mandate and the availability of coverage through the Marketplaces as an allowable Section 125 life status event. This particular relief has not been extended into 2015.

Determining Full-Time and Part-Time Employees

The regulations clarify the methods employers can use to determine whether employees are full-time. They also address these specific situations:

·        Bona fide volunteer workers for government and tax-exempt entities, such as firefighters and emergency responders, are not considered full-time employees.

·        Teachers and other education employees are considered full-time employees even if they don’t work full-time year-round.

·        Seasonal employees who typically work six months or less are not considered full-time employees; this includes retail workers employed exclusively during holiday seasons.

·        Schools with adjunct faculty may credit 2¼ hours of service per week for each hour of teaching or classroom time.

·        Work done by students in federal or state-sponsored work-study programs will not be counted in determining if they are full-time employees.

Safe Harbors for Determining if Coverage is Affordable

The regulations confirm that employers can use W-2 wages, hourly rates or the federal poverty level to determine whether the coverage they offer is “affordable.” If using the W-2 safe harbor, full W-2 wages must be used and cannot be reduced for salary reduction elections under a 401(k) plan or a cafeteria plan.

New Businesses and New Employees

If an employer didn’t exist in the prior calendar year, the employer should determine whether it is a large employer based on the average number of employees it reasonably expects to employ on business days in the current year.

For new employees, the employer is not subject to a penalty for the first three months of employment if coverage is offered no later than the first day of the fourth month of employment.

Next Steps

Read the fact sheet

Review the regulations

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Listen to the ER Notification/Early Renewal Webinar

September 29th, 2013 7:43pm

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Need More Info on ER Notifications and Early Renewals?

September 22nd, 2013 10:17pm

Join us for a free webinar, Tuesday, September 24th, from 10:00-11:00 am to learn more!

RSVP Here!

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Announcement for Anthem Blue Cross Individual Policy Holders

September 22nd, 2013 9:56pm

Individual Anthem Blue Cross Clients,

You will either be receiving or have recently received a letter from Anthem Blue Cross regarding the options that will be available in 2014.

There will also be another letter following in the next 2 weeks that will allow you the opportunity to continue with your current individual plan until November 30, 2014 along with the rate to continue that plan. 

As we believe rates will be substantially higher and the plans will be very different for 2014 ACA (Affordable Care Act) compliant plans, we encourage you to let us assist you in this decision by providing you individual options that will be available. 

We are also certified brokers with Connect for Health Colorado if you qualify for a government subsidy plan. When you receive the letter with your renewal rate, please contact us as we are here to help through this confusing time.  

If you know of others needing assistance, please feel free to give them my name and number to reach out to us. Please contact Judy Nehring, Individual Specialist, at RiteHealth Solutions with any questions or concerns.

Judy Nehring,

jnehring@ritehealthsolutions.com

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Discontinuation Letters from Carrier Start Now!

September 22nd, 2013 9:29pm

IMPORTANT ANNOUNCEMENT: Discontinuation Letters

You will be receiving a letter very soon (if not already) about the discontinuation of your policy in 2014! Here are sample letters from Anthem Blue Cross for small groups, and for individual policies.

Unless you have a Grandfathered policy, will receive this letter. Regardless of whether you have an employer sponsored health plan or an individual/family policy, you will receive this letter!

What does it mean?

In September 2013, in accordance with state requirements, your health insurance company will begin notifying you that your current non-grandfathered health plan(s) will no longer be available on your next renewal date in 2014. This notice will be sent 90 days in advance of the policies renewal date.

This is because NONE of the current policies inforce are ACA compliant so they will have to be discontinued on or after January 1, 2014 at the policy renewal date. All policies sold on or after January 1st are ACA compliant and approved by the CO Division of Insurance.

Join us, October 16th, for a free luncheon as we introduce and explain all the details about these new health insurance plans!

RSVP here!

Please note that those individuals or small businesses who are choosing the "Early Renewal Option", this notice will apply to the discontinuation of your policy NEXT November or December (in 2014).  If you choose not to renew early in 4th Qtr 2013, then the discontinuation of your policy will occur at your original renewal date in 2014.

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Early Renewal Reminder-Due Date for Decision Approaching!

September 22nd, 2013 8:56pm

Have you decided on your 4th Quarter Early Renewal option?  See our blog on July 26th about the Early Renewal options depending on your insurance company.

Experts are predicting over 80% of all groups are going to take advantage of Early Renewals.

Why consider a 2013 effective date versus waiting until 2014? There are many reasons to renew early including:

Lock in a Q4 pre-community rated rate (for those with favorable RAFs)

Maintain a preferred RAF (Industry rating discount)

Access to current known plan options

Consolidate renewal dates among multiple lines of coverage

Buy yourself more time to evaluate the impact of PPACA

If your health insurance policy renewal automatically in October, November or December you will not be receiving this Early Renewal option. For those of you who renew outside 4th Quarter, please review the information we have sent you and make your decision prior to 10/1/2013! If you can't decide if this is a good option for you, please contact us right away!

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Health Insurance Marketplace (Exchange) User Fee

September 22nd, 2013 8:41pm

The Affordable Care Act (ACA or health care reform law) has a rule that establishes a marketplace user fee that ALL insurance companies that have plans in a federally-facilitated marketplace, including partnership models, must pay. Federally-facilitated and state-based marketplaces are charging an on-exchange fee for individual and small group participation.  

The Department of Health and Human Services (HHS) requires insurance companies to pool all user fee costs across their applicable market in a state to help avoid adverse selection on the marketplace. This means that, while the fee will be calculated based only on marketplace enrollment, the cost is applied to non-grandfathered individual and small group plans on and off the marketplace. 

Read more about Anthem Blue Cross's determined fees per state.

Remember that ALL insurance companies selling inside or outside the CO Exchange (Connect for Health Colorado) will be assessing these fees to their members to help pay for the Exchange. Anthem Blue Cross has just released their information first. We will be added each carriers fees once they release them to us.

Also please note that the Exchange fee will show as a separate line item on your bill for policies that renew on or after January 1, 2014.

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Frequently Asked Questions On the Employer Notifications

September 22nd, 2013 8:17pm

After announcing the requirement for the Employer Notifications,  the Department of Labor released a Frequently Asked Questions document to help answer questions from employers.

Department of Labor FAQ clarifies that the law does not specifically include a fine or penalty for employers who fail to comply with the notice requirement.

Initially, many individuals and policy experts believed that failure to comply with the notice requirement could trigger either penalties under the Fair Labor Standards Act or other PPACA market reform penalty requirements, including a $100/day per violation fine under the Public Health Services Act. However, legal research made it clear that the health reform law does not specifically tie compliance with the exchange notice requirements to any penalty provision.

However, just because there is no automatic fine for noncompliance, it does not mean that noncompliance is a good option or that agents and brokers should ever advise their clients to ignore the law. In fact, many employers may very well have liability in this area, as employees in plans subject to ERISA likely have the right to recover damages sustained as a result of the employer’s failure to provide information as directed under the law’s notice requirement. ERISA also provides for recovery of legal fees and other related damages. Furthermore, compliance with notice requirements could be a focus of routine Department of Labor audits of group health plans subject to ERISA. Employers with questions about potential liability should consult a labor attorney.

The law is very clear that businesses subject to the Fair Labor Standards Act must notify their employees about the exchange and that the notice should inform employees:

About the Health Insurance Marketplace; That, depending on their income and what coverage may be offered by the employer, they may be able to get lower cost private insurance in the Marketplace; and That if they buy insurance through the Marketplace, they may lose the employer contribution (if any) to their health benefits.

Employers do not need to use the model notices provided by the Department of Labor, but need to ensure that their notices include the key elements of information listed above.

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Employer Notifications Update

September 22nd, 2013 7:30pm

On July 26th on this site, we announced that the Department of Labor was requiring all employers (with annual revenue over $500,000 per year) to provide a letter to their employees introducing them to the new "Marketplace" to purchase health insurance starting 10/1/2013 for an effective date of 1/1/2014. The requirement asks eligible employers to send the letter to all employees, full time and part time, and regardless of whether or not they provide health insurance to their employees.

The deadline to provide employees with these letters is October 1, 2013!

We have provided all of our clients with the model letter and included our contact information, the clients contact information and the details of their health insurance eligibility.  Here is a sample of each letter: Letter for Employers with Health Insurance and Letter for Employers without Health Insurance.

Just last week, we also received a revised version of the letter from Connect for Health Colorado that explains more clearly that they are the Colorado "Marketplace" and provides more information specific to Colorado residents. I would recommend this form to employers who only have employees living in Colorado. Otherwise, the Department of Labor original model letters should be used.

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The Colorado SHOP Exchange

August 17th, 2013 5:51pm - Posted By: Rachel Zeman

Which insurance companies are participating in the SHOP Exchange for Small Groups? That is an interesting question. There seems to be a bit of a discrepancy in the reports released by the Division of Insurance. If you look at the list of Approved Carriers, it states that HMO Colorado (Anthem Blue Cross’ HMO plans) as well as Rocky Mt Hospital (Anthem Blue Cross’ PPO plans) will have 5 combined plans to sell in the Small Group Shop Exchange. But none of these plans are showing on the rate sheet under the On Exchange for Small Group table.          

So it may be a while longer before we will know for sure if Anthem Blue Cross will be participating/selling their plans in the SHOP Exchange in 2014. Here is the list of carriers that will/will not be selling in the SHOP Exchange next year.

CO Choice, COOP, Kaiser Permanente, Rocky Mountain Health, SeeChange Health (Participating in 2014)

Anthem Blue Cross (TBD)

United Healthcare (Not participating in 2014)

Also remember that joining in the SHOP Exchange does not provide your employees a government subsidy, but rather the opportunity for more plan selection across a variety of different insurance carriers. That is why it is going to be important to find out if Anthem Blue Cross will be on the list of participating carriers. The SHOP Exchange does offer a small employer tax credit of up to 35% for those who qualify.

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What About Rates?

August 17th, 2013 5:46pm - Posted By: Rachel Zeman

From the somewhat limited information released by the Division of Insurance, I can tell you that the new rates for 2014 look like less of an increase than some experts in our industry and some news media were communicating to us earlier this year. But let me reiterate, less of an INCREASE, as there will be an increase in rates across the board due to the health care reform mandates.

And also keep in mind, that based on your location, carrier options, plan design selection and individual/employee demographics, there will be a range of rate impact across the Colorado Market in 2014.

Here are a few quick examples of the estimated rate impact for Small Group Plans.

In Boulder County for a 40 year old, non tobacco user, employee only rate:

Example #1:

9/1/2013-Monthly Rate: $207.96/month -Industry code discount of .90, Anthem Blue Cross- $5,000/100% HSA Boulder Chamber Plan (the least expensive plan in the Boulder market right now)

Estimated 2014 Monthly Rate: $276.92/month- Assumed the same demographics, no industry code rating in 2014 (goes to 1.0), on the least expensive Bronze Level plan with Anthem Blue Cross in Boulder

% Increase in Premium: 33.16%

Example #2:The same estimated 2014 plan/rates as compared with the Anthem Blue Cross $75G Chamber plan at $237.11/month

% increase is 16.69% (assuming all other variables are the same)

Here is an example of the rate impact for Individual/Family Plans.  

In Boulder County for a “healthy” 40 year old, non tobacco user, individual rate:

Example #1: 9/1/2013-Monthly Rate Range: $113.62-$205.13/month on a variety of the least expensive plans available

Estimated 2014 Monthly Rate Range: $198.23-$352.25/month-Bronze level OFF Exchange plans

% Increase in Premium: 71.72%-74.46% increase average

BUT the 2014 rates are going to be guaranteed with no more medical questions or declining of coverage due to health. If you want an individual health plan next year, you will be guaranteed the coverage at the specified rate.

AND if you financially qualify for the CO Exchange (Connect for Health CO) you will receive a partial or full subsidy in premium. But the plans and/or network of doctors available may be different then outside (OFF) the CO Exchange. More to come on these options when we have the details from the carriers and Connect for Health CO.

OR it may be a good time to look at offering a Small Group Health Plan for yourself and employees? Let us help!

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2014 Colorado Market Changes

August 17th, 2013 5:40pm - Posted By: Rachel Zeman

There are several new insurance companies that will be selling in the Colorado market next year. And thankfully, all of the existing insurance companies currently selling in both the individual/family and small group markets will continue to sell health plans in 2014 in Colorado. However, some may or may not be selling health plans on the CO Exchange.

The Colorado Health Insurance Cooperative (COOP) and Colorado Choice Health Plans (CO Choice) will be new carriers selling on and off the CO Exchange in the individual/family and small group markets.

Denver Health Medical Plans and New Health Ventures will be the only new carriers selling plans exclusively in the Individual/Family CO Exchange.

Specific to the small group health insurance market, we are seeing a few changes in the ranking of competitiveness ($$) with carriers in the Colorado Market for 2014 (Outside the CO Exchange). Here is a general rank order of carriers from the least to most expensive premiums on the Bronze Level (based on the information released by the DOI):

In the Boulder Region: (1) Kaiser Permanente, (2) Anthem Blue Cross, (3) SeeChange Health, (4) COOP-new!, (5) Humana, (6) Rocky Mountain Health, (7) United Healthcare.

In the Denver Region: (1) Humana’s HMO-new!, (2) Kaiser Permanente, (3) CO Choice-new!, (4) Humana’s PPO, (5) Anthem Blue Cross HMO/PPO, (6) COOP-new!, (7) SeeChange Health, (8) Rocky Mountain Health, (9) United Healthcare.

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