What will happen January 1, 2014

 

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For individuals without health insurance

  1. The Good - “Guaranteed Issue” - Insurers can’t deny coverage for pre-existing conditions.
  2. More “good news” - 5 different insurance companies participating with multiple offerings.
  3. And the “good news” continues - enhanced benefits including prescription coverage.
  4. The “not so good news” - Complex landscape. There are over 40 different programs being offered by 5 different insurance companies.  Unless you are in the know, the support of an insurance broker seems key to navigate and select successfully. 
  5. Also, it appears cost have risen by as much as 30% in some instances.
  6. The “Switzerland” (neutral) - the individual mandate was not enforced in US Territories (ie. Puerto Rico, among others).  Therefore, enrollment in a health plan is not compulsory or taxed. 
  7. However, your open enrollment period is from 10/1/13 - 3/31/14.  After the special enrollment period is over, insurance companies WILL impose special subscription conditions including but not limited to higher premium rates.

For Non-Grandfathered small employers  (defined as 2-50 employees)

  1. All Essential Health Benefits have to be covered with no annual or lifetime $$$ maximums.
  2. Maximum annual deductibles cannot exceed $2,000 for individuals or $4,000 for couple and family coverages.
  3. Maximum annual out-of-pocket for individual - $6,400 and $12,800 for couple and family.  Once they reach that maximum, covered services will be provided at 100%.
  4. Your renewal will be determined by an Adjusted Community Rating formula. In other words, your demographics, not your utilization, will determine your rates. 
  5. Fees, fees and more fees!
  6. PCORTFF - exactly! The Patient-Centered Outcomes Research Trust Fund Fee is equal to the average number of lives covered during the policy year or plan year multiplied by the applicable dollar amount for the year.  For policy and plan years that end after Sept. 30, 2013 and before Oct. 1, 2014, the applicable amount is $2.
  7. Health Insurance Providers Fee - Insurance companies will bill this fee separately from your premiums.  Currently is estimated at 2% - 2.5% of monthly premium. 
  8. 90 day waiting period is the longest allowed period for any employee to be eligible for health insurance.  Coverage will start on day 91.
  9. Antidumping - no employer may induce its employees to opt-out of employer-sponsored coverage in favor of insurance available in the individual market.

 

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In summary

The health insurance landscape will be substantially different come January 1, 2014.  Give us a call (787.510.8010  •  787.604.7749), drop us an e-mail, post a comment, tweet us @ContinuaService, we will support through the complex marketplace and provide you with the necessary tools so that you can CONTINUA with your path.

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