http://newsroom.cigna.com/images/56/839403_ChoiceFundExecSummary_v8HR.pdf
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On September 3, 2010, the Department of Health & Human Services issued guidance on the process for obtaining a waiver of the requirement to eliminate annual dollar limits on medical plans.
Organizations that offer limited benefit plans will need the waiver to continue offering plans with their current annual dollar limits between now and 2014.
Plans may apply for a waiver if compliance would result in a significant decrease in access to benefits or a significant increase in premiums. For insured plans, either the plan or the insurer can apply for the waiver.
To be eligible to apply for a waiver:
The plan or policy must have been in effect before September 23, 2010
The application must be submitted at least 30 days before the first day of the plan year for which a waiver is being requested. Applications will be processed within 30 days after they are received.
For plan years beginning before November 2, 2010, the waiver request must be submitted at least 10 days before the first day of the plan year and HHS will process the application at least 5 days before the first day of the plan year.
The application must include all of the following:
The terms of the plan or policy
The number of individuals covered
The annual dollar limits and the rates
Documentation supporting anticipated premium increases and/or decreased access
Attestation statement signed by the plan administrator or the CEO of the insurer that elimination of annual limits would result in significant premium increase and/or decrease in access to coverage.
A waiver is valid for one plan year only. A separate application must be submitted for each plan year until 2014. For plan years beginning on or after January 1, 2014, waivers will no longer be allowed.
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We would like to share with you a summary of wellness and prevention initiatives as a result of the Patient Protection and Affordable Care Act (PPACA), as amended by the Health Care and Education Reform Act.
Elimination of Co-Payments for Screenings and Preventive Care
Starting in September of 2010, employer-sponsored (and other) group health plans and health insurance issuers are prohibited from requiring co-pays for all preventive services recommended by an independent expert panel, the United States Preventive Services Task Force. Co-pays are also eliminated for certain recommended immunizations, breast cancer screenings and other preventive care/screenings for women and children. However, this requirement does not apply to “grandfathered” health plans, which are defined in PPACA as any plan in which at least one individual was enrolled as of March 23, 2010.
Note: Pay careful attention to the cost-sharing requirements for office visits under this rule.
Employee Wellness Discounts
Starting January 1, 2014, PPACA enhances such wellness discounts by permitting group health plans to give reductions of up to 30 percent of the cost of premiums to employees who participate in such wellness programs. This may be expanded to 50 percent subject to the discretion of the Secretary of Health and Human Services (HHS).
Break Time for Nursing Mothers
Effective immediately, the PPACA also provides that employers covered by the Fair Labor Standards Act must provide reasonable break time and a private space – other than a restroom – for nursing mothers for up to one year after the birth of a child. Employers are not required to compensate employees during such break times. Additionally, employers with less than 50 employees may qualify for exceptions if it can be proven that the requirement would impose an undue hardship on the employer.
Posting of Nutritional Requirements
By March of 2011, the Secretary of HHS must publish regulations requiring all chain restaurants (defined as any establishment that has 20 or more locations operating under the same name) to disclose the nutritional content of all menu items. Specifically, the number of calories for each item must be disclosed on menus, menu boards and drive through menu boards, and such menus must also feature “a succinct statement concerning suggested daily caloric intake.” This requirement also extends to buffet items, and vending machines maintained by companies that operate 20 or more machines.
Government Funding for Wellness Programs
In addition to the specific provisions outlined above, PPACA also creates a “Prevention and Public Health Fund” which will be administered through HHS and will support prevention and public health programs. Beginning with the fiscal year 2010, $500 million will be appropriated to various programs within HHS, with the amount of appropriations increasing each year to $2 billion in the fiscal year 2015 and each year thereafter. Under PPACA, the funds are to be used for activities such as prevention research and health screenings, the Community Transformation grant program (designed to fund state and municipal wellness programs by creating walking paths, nutrition awareness programs, etc.), Education and Outreach Campaign for Preventive Benefits (a planned public-private partnership to raise awareness on preventive care), and immunization programs.
Additionally, school-based health centers (facilities that provide primary health care to students on school campuses) will receive $50 million per year in grant funding through 2013. These grant monies are to be used only for expenditures on facilities and equipment, not for hiring personnel.
Small Business Grants for Wellness Programs
The PPACA includes a grant program to assist small businesses in providing comprehensive workplace wellness programs. Grants will be awarded to eligible employers to provide their employees with access to new workplace wellness initiatives. The grants will be awarded beginning in 2011 with $200 million appropriated for a five year period.
An eligible employer is an employer that:
Employs fewer than 100 employees who work 25 hours or more per week; and
Did NOT have a workplace wellness program in place as of March 23, 2010 (date of PPACA enactment)
The PPACA requires the Secretary of HHS to develop program criteria that are based on research and best practices. A comprehensive workplace wellness program must be made available to all employees and include:
Health awareness initiatives (including health education, preventive screenings and health risk assessments)
Efforts to maximize employee engagement (including mechanisms to encourage employee participation)
Initiatives to change unhealthy behaviors and lifestyle choices (including counseling, seminars, online programs and self-help materials)
Supportive environment efforts (including workplace policies to encourage healthy lifestyles, healthy eating, increased physical activity and improved mental health)
Note: The money will likely go quickly. Small businesses need to be prepared with a wellness program which meets the criteria and requirements as described in the PPACA and developed by the Secretary of HHS.
While there are still many unanswered questions regarding the implementation of the above mentioned programs, especially the small business wellness grant funding, adding provisions for wellness and prevention under PPACA is one small step for a healthier workforce.
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Background
The new IRS Small Business Health Care Tax Credit opportunity may enable eligible employers to expand their benefit plans to include specialty benefits and potentially offer a richer plan to their employees.
The tax credit program helps small businesses and small tax-exempt organizations afford the cost of covering their employees’ health care benefits. Visit the IRS site for additional support materials, including a video and frequently asked questions about the program. For more information please contact your UnitedHealthcare account executive.
http://www.brainshark.com/brainshark/vu/view.asp?pi=599859779
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From Humana
September 23 marks the six-month anniversary of the enactment of health reform. As a result, some key changes take effect.
The following changes take place for all health plans:
Lifetime limits. Plans may not impose lifetime dollar-limits on essential benefits.
Rescissions. No rescissions are permitted, except in cases of fraud or intentional misrepresentation.
Coverage for adult children. Children may stay on their parents’ policies until age 26 if coverage isn’t available through their work, regardless of their marital status.
Pre-existing conditions. Group plans and new individual plans may not impose pre-existing condition exclusions for children under 19 (does not apply to grandfathered individual plans).
http://apps.humana.com/marketing/documents.asp?file=1428206
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http://www.publix.com/pharmacy/Free-Antibiotics.do
Amoxicillin
Ampicillin
Cephalexin (capsules and suspension only)
Sulfamethoxazole/Trimethoprim (SMZ-TMP)
Ciprofloxacin (excluding Ciprofloxacin XR)
Penicillin VK
Doxycycline Hyclate (capsules only)
Erythromycin Stearate and Ethylsuccinate
Grouphealthflorida.com offers Florida Group Health
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visit http://www.grouphealthflorida.com.
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1-800-873-5713 X 101
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When the Health Care Act passed, the President promised that everyone that liked their health care plan could keep it. As we’ve already discussed in our previous posts regarding grandfathering, those promises were not exactly true.
But, if you like what you have and it clearly is not allowed under the new law – what can you do? The answer has been that the administration have begun offering waivers to some groups postponing implementation of this year’s items, allowing a number of insurers, small businesses and unions to keep their current plans.
Over the last several weeks 30 insurers, unions and businesses received these one-year waivers, allowing them to maintain minimal coverage for their mini-med plans far below what is required by the new law.
Insurers and companies who have applied for waivers argue that mini-med premiums would have to increase significantly, making it unaffordable and forcing them to pass these costs along to employees. They are threatening to drop employee coverage altogether, thereby throwing more people into the uninsured pool.
On the insurer side, some health insurance companies are contemplating dropping certain plans, in particular mini-med plans. Eliminating the annual caps on these plans make them a financial pitfall.
Grouphealthflorida.com offers Florida Group Health
Insurance. To learn more about group health insurance,
visit http://www.grouphealthflorida.com.
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http://forms.unum.com/StreamPDF.aspx?strURL=/FMS_108023-2.pdf&strAudience=StreamByNumber
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Insurance. To learn more about group health insurance,
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To help people take control of their health care costs, we’re offering Aetna’s exclusive Member Payment Estimator. It’s a convenient way for our members to avoid surprises when it comes to their health care bills. With this innovative resource, members can get personalized, real-time estimates for their health care costs. Based on their plan details and doctor’s fee schedule, members can see and compare costs for hundreds of commonly used services and procedures from participating Aetna providers.
By logging in to their Aetna Navigator® secure member website before going to the doctor, members can find out:
• The total cost of a procedure, plus Aetna’s contribution
• Deductible and coinsurance payments
• What other local health care providers charge for the same services
We created this tool to help members better prepare their budgets and not be surprised by unexpected costs. Because Aetna’s Member Payment Estimator delivers personalized, real-time health cost information, it’s easy for members to know their costs before they go to the doctor.
http://www.aetnatools.com/?p=mpe
Grouphealthflorida.com offers Florida Group Health
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As part of our ongoing commitment to helping you understand the changing landscape of health care coverage, we are sending a series of communications on the Patient Protection and Affordable Care Act (PPACA). The communication series will focus on the key milestones, components, facts and provisions of health care reform. The first in the series focuses on the timeline of the PPACA and the anticipated impact of the 2010 changes.
The PPACA will expand the availability of health care coverage to millions of Americans. While some of the measures of the PPACA will be implemented this year, many do not take effect until 2014 and some extend out to 2020. We have created a high-level overview of the timeline to showcase key milestones of the measures. It is important to note that many of these reforms and their effective dates are subject to the rules and regulations process both at the state and federal levels — which could alter the intended timing of implementation.
http://www.aetna.com/news/2010/hcr_timeline_7_10.pdf
Grouphealthflorida.com offers Florida Group Health
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