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Millions Trapped in Health-Law Coverage Gap

Nearly five million lower-income Americans are caught in a mismatch of state and federal rules that leave them with no help to buy insurance, while better-off workers can buy coverage with taxpayer-funded subsidies.

Ernest Maiden was dumbfounded to learn that he falls through the cracks of the health-care law because in a typical week he earns about $200 from the Happiness and Hair Beauty and Barber Salon.

Like millions of other Americans caught in a mismatch of state and federal rules, the 57-year-old hair stylist doesn’t make enough money to qualify for federal subsidies to buy health insurance. If he earned another $1,300 a year, the government would pay the full cost. Instead, coverage would cost about what he earns.

Read the full report here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Don’t Look Now, But Obamacare Might Just Hit A Sign-Up Projection

Three million people have signed up for private insurance coverage through the health law marketplaces, according to Health and Human Services. That still leaves the Obama administration lagging behind its initial projections for overall health law enrollment–but also closer to hitting monthly sign-up expectations it set back in September.

Health and Human Services says that at least 800,000 people signed up for coverage through this week. So this new figure shouldn’t be seen as representing overall January enrollment–that number will likely inch up a bit, when the Obama administration releases a monthly enrollment report in February. Back in September, the Obama administration had projected 1.1 million people would sign-up in the first month of 2014–and these new figures suggest that enrollment could easily hit that number.

Read the full report here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Breaking Health Insurance News: Mandate Delayed for MSBs

White House delays health insurance mandate for medium-sized employers until 2016

For the second time in a year, the Obama administration is giving certain employers extra time before they must offer health insurance to almost all their full-time workers.

Under new rules announced Monday by Treasury Department officials, employers with 50 to 99 workers will be given until 2016 — two years longer than originally envisioned under the Affordable Care Act — before they risk a federal penalty for not complying.

Companies with 100 workers or more are getting a different kind of one-year grace period. Instead of being required in 2015 to offer coverage to 95 percent of full-time workers, these bigger employers can avoid a fine by offering insurance to 70 percent of them next year.

Read the full report here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Are Wellness Programs Allowed Under HIPAA’s Nondiscrimination Rules?

The HIPAA nondiscrimination provisions generally prohibit group health plans from charging similarly situated individuals different premiums or contributions or imposing different deductible, copayment or other cost sharing requirements based on a health factor. However, there is an exception that allows plans to offer wellness programs.

If none of the conditions for obtaining a reward under a wellness program are based on an individual satisfying a standard related to health factor, or if no reward is offered, the program complies with the nondiscrimination requirements (assuming participation in the program is made available to all similarly situated individuals).

For example:
* A program that reimburses all or part of the cost for memberships in a fitness center.
* A diagnostic testing program that provides a reward for participation rather than outcomes.
* A program that encourages preventive care by waiving the copayment or deductible requirement for the costs of, for example, prenatal care or well-baby visits.
* A program that reimburses employees for the costs of smoking cessation programs without regard to whether the employee quits smoking.
* A program that provides a reward to employees for attending a monthly health education seminar.

Wellness programs that condition a reward on an individual satisfying a standard related to a health factor must meet five requirements described in the final rules in order to comply with the nondiscrimination rules.

The wellness program rules are generally effective for the plan year starting on or after July 1, 2007.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Are Wellness Programs Allowed Under HIPAA’s Nondiscrimination Rules?

The HIPAA nondiscrimination provisions generally prohibit group health plans from charging similarly situated individuals different premiums or contributions or imposing different deductible, copayment or other cost sharing requirements based on a health factor. However, there is an exception that allows plans to offer wellness programs.

If none of the conditions for obtaining a reward under a wellness program are based on an individual satisfying a standard related to health factor, or if no reward is offered, the program complies with the nondiscrimination requirements (assuming participation in the program is made available to all similarly situated individuals).

For example:
* A program that reimburses all or part of the cost for memberships in a fitness center.
* A diagnostic testing program that provides a reward for participation rather than outcomes.
* A program that encourages preventive care by waiving the copayment or deductible requirement for the costs of, for example, prenatal care or well-baby visits.
* A program that reimburses employees for the costs of smoking cessation programs without regard to whether the employee quits smoking.
* A program that provides a reward to employees for attending a monthly health education seminar.

Wellness programs that condition a reward on an individual satisfying a standard related to a health factor must meet five requirements described in the final rules in order to comply with the nondiscrimination rules.

The wellness program rules are generally effective for the plan year starting on or after July 1, 2007.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.