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Tag Archives: Self insured emmployers
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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Employers rethink health benefit management amid cost hikes
Employers have long-term concerns about health care reform, as the law’s excise tax provision, not set to take effect until 2018, topped employers’ list of preoccupations in one recent survey.
Still, immediate worries were also top of mind, as one in four employer respondents to the Mercer study expect health reform’s 2011 requirements to add an additional 3% or more to next year’s cost increase.
One in ten of the 791 employers polled predict cost increases of an additional 5% or more, 41% expect an increase of 2% or less, 3% said they were already in compliance and expect no cost increase and the remaining 30% could not estimate the impact.
The additional projected cost increases are directly linked to the elimination of benefit maximums and the increase in the age of covered dependents to 26, both of which are of significant concern for about a fifth of employers.
For those looking ahead to 2018, the excise tax poses a significant or very significant concern for 29% of the survey respondents. An additional 29% say it is “a concern” while 42% say it is either not an issue or only a very slight concern.
Auto-enrollment for new hires into a health plan is a significant concern for 16% of plan sponsors as 88% currently do not automatically enroll new hires in a plan and many think that this change could result in more employees joining the plan. Continue reading
