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Tag Archives: Self-funded ERISA plans.
Healthcare Reform Bill Overview: Specifics to Self Insurance
The Patient Protection and Affordable Care Act (PPACA) of 2010
An Overview of the Health Care Reform Bill as it relates to the Self Insurance Industry.
The Patient Protection and Affordable Care Act of 2010 will bring about direct impacts on the self-insurance industry. The below bullet points summarize some of the implementations specific to self-funded health care plans.
The following changes are effective for all plans as they renew on September 23, 2010 and thereafter:
A.) Coverage of Emergency Services: All non-grandfathered self insured health plans (SIHP) must cover emergency services without the need for prior authorization; if services are out-of-network, cost sharing is the same as in-network.
B.) Restricted annual limits for essential benefits.
C.) Prohibition of Lifetime Limits: SIHP are prohibited from establishing lifetime limits on the dollar value of benefits. Exclusion: SIHP may place restrictions on non-essential health benefits.
D.) Prohibition of Pre-existing conditions: SIHP may not impose any pre-existing condition exclusions on enrollees under age 19. Effective January 1, 2014, all SIHP are prohibited from imposing pre-existing exclusions on any enrollee.
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Texas Health Insurance Plans – Small, Large And Self-Funded Group Plans
The most affordable health coverage for families and individuals is usually group coverage offered by employers. Larger companies have traditionally been able to offer better plans because of their larger purchasing power. Although employers and groups are not required to do so, most Texas health insurance plans are employer-based or offered as benefits through organizations and associations, including unions, churches and professional membership groups. Employers and groups that make health insurance available to employees and members are not required by law to contribute anything toward plan member premiums, although some insurance carriers mandate that employers pay at least 50% of employee premiums. Continue reading
