David M. Gilston Insurance Agency, Inc.

The Kaiser Family Foundation released a report estimating the impact the Patient Protection and Affordable Care Act’s (PPACA) medical loss ratio (MLR) provisions will have on health insurance consumers this year in the form of premium rebate checks that are supposed to be mailed to health insurance consumers this August. Although $1.3 billion, the total amount of the projected rebates seems large, when you read the fine print, it becomes apparent that these rebates aren’t quite the bonus some have been predicting. Furthermore, the coverage disruptions, loss of agent services, and higher overall premiums caused by both the MLR requirements specifically and PPACA generally, negate any consumer benefit the rebates may provide.

As discussed in our previous blog article, earlier this year, Mary Landrieu (D-LA) had submitted legislation (S. 2068) to try to help protect health insurance agent and broker jobs by attempting to exclude independent health insurance producer compensation from the medical loss ratio (MLR) requirements in the Patient Protection and Affordable Care Act (PPACA). On April 17th, Landrieu, along with cosponsors Johnny Isakson (R-GA), Lisa Murkowski (R-AK) and Ben Nelson (D-NE) re-filed the bill, now titled S. 2288.

The Department of Human Health Services released its rules for states regarding the implementation of health insurance exchanges. According to the HHS, the rules provide “a framework to assist states in building Affordable Insurance Exchanges.” They also “set minimum standards for Exchanges, give states the flexibility they need to design Exchanges that best fit their unique insurance markets, and are consistent with steps states have already taken to move forwards with Exchanges.”

The final rule from the Department of Health and Human Services (HHS) on the Summary of Benefits and Coverage (SBC) and the Uniform Glossary requirements of the Patient Protection and Affordable Care Act (PPACA) was announced on February 9, 2012. According to the HHS, this document will explain “in plain language, simple and consistent information about health plan benefits and coverage. Starting on September 23, 2012, health insurers and group health plans will be required to provide the SBC and uniform glossary to consumers.

Mary Landrieu (D-LA) has submitted legislation (S 2068) to try to help protect health insurance agent and broker jobs by attempting to exclude independent health insurance producer compensation from the medical loss ratio (MLR) requirements in the Patient Protection and Affordable Care Act (PPACA). The bill’s co-sponsors are Ben Nelson (D-Neb.), Johnny Isakson (R-GA) and [...]

On January 3, 2012 the Internal Revenue Service issued interim guidance, Notice 2012-9, an amendment of Notice 2011-28, discussing the PPACA requirement of employers to include the cost of employer-sponsored health insurance coverage on each employee’s annual W-2 Form. Notice 2011-28, issued last March, had postponed this requirement until tax year 2012 and made it optional for all employers for the 2011 W-2 Forms.

Because the Patient Protection and Affordable Care Act’s Summary of Benefits and Coverage (SBC) and Uniform Glossary requirements are yet to be clearly defined, the Department of Labor (DOL) submitted guidance that has delayed the effective date of these changes, therefore causing concern of a new compliance date. As described in a previous reform blog article, the SBC is intended to provide insured members with information about the plan they have or can be used when shopping for coverage and comparing plans. The Uniform Glossary is designed to help consumers have a better understanding of terminology when making a buying decision. The DOL, Internal Revenue Services (IRS) and the Department of Health and Human Services (HHS) had originally proposed March 23, 2012 as the compliance date. Due to the delay, a new compliance date is yet to be chosen. The guidance stated that, “until final rules are issued on this topic, group health plans and health insurance issuers are not required to comply.”

Employer-sponsored health insurance coverage has consistently decreased between 1995 and 2010 and this trend is expected to continue, according to a report created by the Employee Benefits Research Institute (EBRI). The implementation of the exchange program created by the Affordable Care Act (ACA), taking effect in 2014, could cause an increase of employers dropping coverage.

Nearly seven out of ten people turning 65 this year will experience some form of disability and will need paid or unpaid help with basic living activities. This creates the need for long-term care, which is quite expensive. The costs for nursing home care vary widely, averaging $6,500 per month. People who receive long-term care services at home spend an average of $1,800 per month. Medicare does not cover long-term care services. Medicaid pays for such services only for people with limited financial means; qualifying for Medicaid often means exhausting all other resources. To help provide another option, the government established the Community Living Assistance Services and Supports (CLASS) Act to be an optional, government-backed, long-term care insurance program for American workers to help pay for long-term services and supports they may need in the future. A five-year vesting period is required before benefits can be collected.

The essential benefits report, created by the Institute of Medicine (IOM), has been released. The Affordable Care Act requires the package to reflect benefits covered by a typical employer plan and include 10 categories. According to the report, HHS officials will compare potential services and products against a set of critera, created by the IOM, including medial effectiveness, safety and relative value compared with alternative options, and evaluate whether the package as a whole protects the most vulnerable individuals, promotes services that have proved effective and addresses the medical concerns of greatest important to the public. In keeping with their assigned task, the IOM did not address and specific types of benefits in their recommendations. It instead tells the Secretary of HHS how to define the minimum benefits. Click here to view additional recourses by the IOM including the IOM’s press release, criteria, report brief and report release presentation.