Tuesday, June 10, 2014

Health Insurance Outlook

Guest Blog Post by: Benjamin Faesel, Capital BlueCross
Senior Manager, Healthcare Reform
Benjamin.Faesel@CapBlueCross.com

If you like your plan, you can keep it

On March 5, 2014, President Barack Obama’s administration announced more changes to the health care reform law, including allowing people with health insurance plans that don’t comply with Affordable Care Act (ACA) standards to keep them through October 2016 if their states allow it.

This extension allows states to decide whether these non-compliant plans can continue to be offered. Many states have allowed insurers to continue offering these plans to consumers for the short term.  This extension only applies to current policyholders -- new customers must enroll in plans that meet the ACA standards, which are designed to ensure consumers receive a minimum level of coverage.

In the letter issued by the Centers for Medicare & Medicaid Services (CMS), it states that health insurance coverage in the individual or small group market that is renewed for a policy year between Jan. 1, 2014, and Dec. 31, 2014, will not be considered to be out of compliance with the following market reforms:

• Community rating
• Guaranteed issue and renewability of coverage
• Prohibition of coverage exclusions based on pre-existing conditions
• Non-discrimination based on health status
• Non-discrimination regarding health care providers
• Comprehensive coverage (i.e., coverage of essential health benefits and the application of maximum out-of-pocket limits)
• Coverage for participation in clinical trials

Policies that were in effect on Dec. 31, 2013, are eligible for the transitional safe harbor.  In order to take advantage of this extension, insurers must send a notice to individuals or small businesses who otherwise would have received cancellation notices, informing them of any changes in the options that are available to them, which of the above market reforms would not be included in coverage, the potential option to enroll in exchange coverage (including information on exchange access and the availability of a premium tax credit), and their right to enroll in coverage outside the exchange that complies with the above reforms.

The March 5, 2014, memo states that the transitional policy will be extended through Oct. 1, 2016.  This means that the extension will apply to policy years beginning on or before Oct. 1, 2016. CMS is also contemplating an additional one-year extension (i.e., through Oct. 1, 2017).


If you have questions whether or not your plan meets the requirements for the extension, please contact your broker, the Greater Lehigh Valley Chamber of Commerce, or your Capital BlueCross representative. 

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