healthcare reform
Posted July 7th, 2016 in Producers, Employers, Individuals
It should be pretty clear by now that two of the biggest provisions of the Affordable Care Act (ACA) are the Individual and Employer Mandates. The Individual Mandate requires all Americans to have a health insurance plan or pay a penalty, unless an exemption applies. Factors that may influence the amount of the Individual Mandate penalty include household size and income. The Employer Mandate requires employers with 50 or more employees to offer health insurance coverage to at least 95% of its full-time employees or risk penalties.
The Department of Health and Human Services (HHS) recently issued a final rule which effectively implements Section 1557 of the Affordable Care Act (ACA). The new rule prohibits certain discriminatory acts from occurring for health programs or activities that are administered by HHS, including plans that are sold on federal and state Marketplaces.
The fourth installment of the Patient-Centered Outcomes Research Institute (PCORI) fees will be due on July 31, 2016.
As its name suggests, PCORI is a research institute, and it was created by the Affordable Care Act (ACA) as a way to improve clinical effectiveness. It is partially funded by fees charged to health plans.
The following list contains information and some reminders about the upcoming PCORI fee that is due:
In the first part of this series, we discussed how everyone from insurance companies to employers has been affected by the Affordable Care Act (ACA), but no group more so than employees - the true healthcare consumer.
As required under the ACA, the federal government must conduct audits of Marketplace coverage to ensure that only people who are truly eligible are receiving a subsidized plan.
Effective Spring 2016, CMS launched an "Employer Initiatives" Program to aid in the auditing process. As part of this program, CMS may contact an employer to request whether or not one or more employees were enrolled in minimum essential coverage, or whether or not they were offered a health plan which was affordable and had minimum value.
Since the Affordable Care Act (ACA) took effect, Flex has been following closely as the market transitions further away from traditional healthcare concepts. The following is the first piece in a three-part series that addresses key industry issues, trends and solutions related to Consumer-Driven Accounts (CDAs).
The Centers for Medicare and Medicaid Services (CMS) unveiled a new interim final rule on May 6, 2016 which amends certain special enrollment periods (SEPs) in the individual marketplace and revises certain rules pertaining to consumer operated and oriented plans (CO-OPs). The rule aims to curb abuse of the SEP, which insurers have said is occurring when consumers claim to have a qualifying event but actually do not. The rule also aims to strengthen the CO-OP program.
Posted April 25th, 2016 in Producers, Employers, Individuals
The President of the United States can have a significant impact on the shape and direction of health care, as has been seen with President Obama and the passage of the Affordable Care Act (ACA). The American people will cast their vote for the next President of the United States on November 8, 2016. The future of the health care industry will largely be influenced by the outcome of the election. Here is a very high level summary on how the presidential candidates have suggested they would change the health care industry:
Donald Trump
Originally posted on January 2, 2015 and updated on April 10, 2015, June 19, 2015 and April 11, 2016.