Zane Benefits' Employee Health Benefits Blog

Maine Health Insurance Exchange Guide

Zane Benefits — Thu, 23 May 2013 22:10:00 GMT

This guide provides an overview of the Maine Health Insurance Exchange including the history of the exchange, how the exchange will operate, and exchange information for Maine residents and small businesses.

Maine Health Insurance Exchange Introduction

Beginning in 2014, as part of the Affordable Care Act (ACA), health insurance coverage for individuals and small businesses will become available through new state health insurance exchanges (also called health insurance marketplaces).

Most importantly, the key tax credits (e.g. the small business healthcare tax credits) and tax subsidies (e.g. individual health insurance tax subsidies) will only be available for coverage purchased through a state health insurance exchanges.

All states have three options for setting up a state health insurance exchange for 2014:

Build a state-based exchange
Enter into a state-federal partnership exchange
Default to a federally-facilitated exchange

Maine will default to a federally-facilitated health insurance exchange, however Maine will be involved in the plan management functions and navigator program.

Maine Health Insurance Exchange - History

In November 2012, Maine Governro Paul LePage announced to federal officials that Maine would default to a federally-facilitated health insurance exchange. This came after legislation to establish a state-based health insurance exchange failed in 2011 and 2012. However, Maine will maintain control of all plan management functions including contracting with carriers, reviewing insurance plan rates and plan compliance with ACA.

Click here for more information on Maine's Health Insurance Exchange Planning.

Maine Health Insurance Exchange - What is It?

The Maine Health Insurance Exchange will be operated through a federally-run health insurance exchange, also referred to as the Health Insurance Marketplace. As mentioned previously, Maine will maintain control over plan management. Starting in October 2013, Maine residents will be able to access information about all the plans available through the Exchange. The SHOP Exchange will also be available to small businesses with 100 or fewer employers. Coverage from the Exchange starts in January 2014.

According to an estimate by healthcare.gov, 144,959 or 13% of Maine’s non-elderly residents are uninsured.

More information on the federally-run Maine Health Insurance Exchange can be found here.

Maine Health Insurance Exchange - What Plans will be Available?

All plans offered through the Maine Health Insurance Exchange will meet the ACA definition of a Qualified Health Plan (QHP). The plans will be offered by level of coverage for essential health benefits (EHB), to allow consumers to compare plans on an "apples to apples" basis. The four "metal" levels are: Bronze (plan pays 60%), Silver (plan pays 70%), Gold (plan pays 80%) and Platinum (plan pays 90%).

This week, The Bangor Daily News reported that only two insurance providers had filed to offer plans through the Exchange: Maine Community Health Options, and a collaboration between Anthem Blue Cross and Blue Shield and MaineHealth. (Read article here.) The plans will go through a formal review process and plans will be finalized by the October 2013 opening.

Maine Health Insurance Exchange Navigator Program

Although Maine is defaulting to the federally-run exchange, on April 13, 2012, the Governor signed legislation restricting the Navigator program in the state (LD 1497). The program would allow brokers to act as Navigators in the exchange, but would require others who want to serve as Navigators to register or obtain a limited license, with the criteria for certification to be determined by the superintendent of insurance.

FAQ: Does My Small Business Have to Provide Health Insurance?

Christina Merhar — Thu, 23 May 2013 16:01:00 GMT

As a small business owner, you may be asking "starting in 2014, do I have to provide health insurance to employees?" No business has to offer health insurance. However, the Affordable Care Act includes a mandate for certain large employers (with over 50 full time equivalent employees) to either offer qualified and affordable health benefits, or pay a tax penalty. This is commonly referred to as the employer mandate, “play or pay” requirement, or employer shared responsibility.

It is important for your business to understand whether you are defined as an applicable large employer by the IRS, as the mandate and employer tax penalties only apply to your business if you are an applicable large employer.

Less Than 50 Employees? No Mandate or Penalties

If your business has less than 50 employees, the mandate and tax penalty does not apply to you.

What is an Applicable Large Employer?

For the majority of businesses this is a simple calculation. However, for businesses on the border with many part-time or seasonal employees, the calculation will be more in-depth.In general, if your business employed an average of 50 or more full-time equivalent (FTE) employees during the previous calendar year, you are considered an applicable large employer for the current year.

First, a business is defined as an applicable large employer on a calendar-year basis. For example, you could be an applicable large employer in 2015, but not in 2014. Did your business employ 50 or more full-time employees on average during the preceding calendar year? If yes, then you are an applicable large employer for the current calendar year.

Second, your business is NOT an applicable large employer if:

You employed less than 50 full-time employees on average during the previous calendar year, or
You employed more than 50 full-time employees no more than 120 days during the previous calendar year due to a seasonal workforce.

Calculating Full-Time and Part-Time FTEs

For the purposes of determining whether your business is an applicable large employer, your business must include all full-time employees plus the full-time equivalent of your part-time employees.

A full-time employee is defined as working on average at least 30 hours of service per week in a given month. How many full-time employees do you have?

Next, factor in part-time employees. To calculate the full-time equivalent of part-time employees, add the number of hours worked by part-time employees in a given month and divide the total by 120. How many full-time equivalent part-time employees do you have?

Finally, the sum of the full-time employees and the full-time equivalent of the part-time employees is the number used to determine whether your business is an applicable large employer. If the sum is 50 or over, you are an applicable large employer.

Worksheet: How to Calculate FTEs

Here is a worksheet outlining the above FTE calculations.

Now that you've determined if you're an applicable large employer, and you know if you "have" to offer health insurance... what's next? Here are additional health care reform articles to help your business decide your health care reform strategy:

Pennsylvania Health Insurance Exchange Guide

Zane Benefits — Wed, 22 May 2013 21:59:00 GMT

This guide provides an overview of the Pennsylvania Health Insurance Exchange including the history of the exchange, how the exchange will operate, and exchange information for Pennsylvania residents and small businesses.

Pennsylvania Health Insurance Exchange Introduction

All states have three options for setting up a state health insurance exchange for 2014:

Build a state-based exchange
Enter into a state-federal partnership exchange
Default to a federally-facilitated exchange

Pennsylvania will default to a federally-facilitated health insurance exchange.

Pennsylvania Health Insurance Exchange - History

Originally, the Pennsylvania Insurance Department took the lead on planning for the health exchange. In November 2011, the Insurance Department released a report suggesting the state would support a state-based exchange. In January 2012 the Insurance Department released draft legislation to establish multiple private exchanges. However, there was concern that this type of model would not meet the ACA exchange requirements. In December 2012, Governor Tom Corbett announced that Pennsylvania would default to the federally-run exchange, citing uncertain federal guidance and cost.

Click here to read more on Pennsylvania's Health Insurance Exchange planning.

Pennsylvania Health Insurance Exchange - What is It?

The Pennsylvania Health Insurance Exchange will be operated through a federally-run health insurance exchange, also referred to as the Health Insurance Marketplace. Starting in October 2013, Pennsylvania residents will be able to access information about all the plans available through the Exchange. The SHOP Exchange will also be available to small businesses with 100 or fewer employers. Coverage from the Exchange starts in January 2014.

According to an estimate by healthcare.gov, 1,242,351 or 12% of Pennsylvania’s non-elderly residents are uninsured, of whom 1,141,718 (92%) may qualify for either tax credits to purchase coverage in the Marketplace or for Medicaid if Pennsylvania participates in the Medicaid expansion.

More information on the Pennsylvania Health Insurance Exchange can be found here.

Pennsylvania Health Insurance Exchange - What Plans will be Available?

All plans offered through the Pennsylvania Health Insurance Exchange will meet the ACA definition of a Qualified Health Plan (QHP). The plans will be offered by level of coverage for essential health benefits (EHB), to allow consumers to compare plans on an "apples to apples" basis. The four "metal" levels are: Bronze (plan pays 60%), Silver (plan pays 70%), Gold (plan pays 80%) and Platinum (plan pays 90%). More information on the types of plans that will be available, and the carriers offering plans in Pennsylvania, is expected by late summer 2013.

Pennsylvania Health Insurance Exchange - Role of Insurance Professionals & Navigators

The Pennsylvania Health Insurance Exchange will follow federal guidelines for insurance professionals selling policies through the Exchange and for navigators assisting consumers and small businesses.

Insurance professionals will be able to register with the Pennsylvania Health Insurance Exchange and receive any commissions directly from the carriers (using their Exchange ID number and NPN).

The Pennsylvania Health Insurance Exchange navigator program will assist consumers in making choices about their health care options and accessing their new health care coverage, including access to premium tax credits for some consumers. The federal government will run the navigator program in Pennsylvania.

ACA Employer Mandate and Rules for Controlled Groups

Christina Merhar — Wed, 22 May 2013 16:14:00 GMT

The Affordable Care Act (ACA) requires large employers (with 50+ full time equivalent employees) to either offer minimum value and affordable health insurance coverage to full time employees, or pay an employer health insurance tax penalty based on full-time employees. This requirement is also commonly referred to as the ACA employer mandate, "play or pay" or employer shared responsibility.

An employer might be thinking:

"If I divide my company into several smaller companies can I avoid the employer mandate?"

Or,
"I own several businesses under the same parent company; how do I determine if I'm an applicable large employer?"

The short answer is: When a business entity is considered a controlled group (as defined below), the business is considered a single employer under the ACA employer mandate.

So, employees of companies within the same controlled group must be aggregated to determine whether the commonly-owned companies are subject to the employer mandate.

3 Types of Controlled Groups

There are three types of controlled groups that are considered one employer for the purposes of the ACA employer mandate. The IRS defines, and provides example of, these three controlled groups in IRS Code § 414 (b) and 414 (c).

1. Parent-Subsidy Group: When one or more businesses are connected through stock ownership with a common parent corporation (such as a chain); and

80% of the stock of each corporation (except the common parent) is owned by one or more corporations in the group, and
Parent Corporation must own 80% of at least one other corporation.

2. Brother-Sister Group: A group of two or more corporations, where five or fewer common owners own directly or indirectly a "controlling interest" of each group and have “effective control”. A common owner must be an individual, a trust, or an estate.

Controlling interest: Generally means 80% or more of the stock of each corporation (but only if such common owner own stock in each corporation); and
Effective control: Generally more than 50% of the stock of each corporation, but only to the extent such stock ownership is identical with respect to such corporation.

3. Combined Group: A group consisting of three or more organizations that are organized as follows:

Each organization is a member of either a parent-subsidiary or brother-sister group, and
At least one corporation is the common parent of a parent-subsidiary, and is also a member of a brother-sister group

Click here to view the IRS source and examples of these types of controlled groups.

To summarize, if the business entity falls under one of these three types of controlled groups, then for the purposes of the employer mandate the entity is considered one employer.

How Controlled Groups Calculate the Health Insurance Tax Penalty

Once the business determines if they are a controlled group under the IRS definition, they then need to determine:

Is the business an "applicable large employer” (50+ FTE employees)? Again, the controlled group is considered one employer.
What is the penalty if I do not offer “minimum essential coverage”?
What is the penalty if I offer “minimum essential coverage,” but it is not “affordable” for some of my employees?

For details on each of these steps see: Quick Guide to Calculating the Business Health Insurance Tax Penalty.

Washington DC Health Insurance Exchange Update

Zane Benefits — Wed, 22 May 2013 13:00:00 GMT

The Washington DC Health Insurance Exchange announced last Friday which insurance carriers intend to offer policies through their health insurance marketplace. The DC Health Insurance Exchange has been closely watched because, by 2016, all individual and small group policies will be purchased only through the public exchange.*

DC Health Insurance Exchange Carriers Announced

According to the DC Health Benefit Exchange Authority:

Seven (7) health insurance carriers plan to offer 259 plans on the small group "SHOP" exchange.
Four (4) health insurance carriers plan to offer 34 plans on the individual exchange.

Insurers have until May 31, 2013 to submit their proposed rates with the Insurance Department. The DC Exchange will provide details on costs once health insurance policies and rates are approved. Many DC residents will be eligible for significant financial help in the form of federal tax credits to reduce the cost of insurance.

According to the DC Health Benefit Exchange Executive Director Mila Kofman in a recent press release: “This shows that insurance companies serving the District’s insurance consumers are committed to offering good options for businesses and people here. I thank the insurance companies for their commitment to helping the District’s Marketplace Exchange be successful. As a result, we will have a strong, competitive market where individuals and small businesses will have a wide variety of options when buying high-quality health insurance.”

Here are the carriers that have filed intent with the DC Health Insurance Exchange:

Click here for press release and chart source.

*Future of DC Individual and Small Group Private Insurance Markets?

As mentioned previously, DC has closed their private individual insurance market and private small group market (in a transitional effort by 2016). However, this decision has been strongly opposed by several business interests. The DC Council is expected to decide this week whether to require small businesses to purchase group health insurance plans through the public exchange as planned.

Louisiana Health Insurance Exchange Guide

Zane Benefits — Tue, 21 May 2013 22:46:00 GMT

This guide provides an overview of the Louisiana Health Insurance Exchange including the history of the exchange, how the exchange will operate, and exchange information for Louisiana residents and small businesses.

Louisiana Health Insurance Exchange Introduction

All states have three options for setting up a state health insurance exchange for 2014:

Build a state-based exchange
Enter into a state-federal partnership exchange
Default to a federally-facilitated exchange

Louisiana will default to a federally-facilitated health insurance exchange.

Louisiana Health Insurance Exchange - History

Governor Bobby Jindal has been a vocal opponent of health care reform and Medicaid expansion. During the 2012 legislative session, Senate Bill 744 was introduced to establish the Louisiana Health Insurance Exchange, however the bill did not have support from Governor Jindal and the legislation failed when the 2012 session ended. In July 2012, Governor Jindal announced that Louisiana would default to a federally-facilitated health insurance exchange, and that Louisiana would not participate in Medicaid expansion.

Click here to read Louisiana's Health Insurance Exchange announcement.

Louisiana Health Insurance Exchange - What is It?

The Louisiana Health Insurance Exchange will be operated through a federally-run health insurance exchange, also referred to as the Health Insurance Marketplace. Starting in October 2013, Louisiana residents will be able to access information about all the plans available through the Exchange. The SHOP Exchange will also be available to small businesses with 100 or fewer employers. Coverage from the Exchange starts in January 2014.

According to an estimate by healthcare.gov, 794,805 or 20% of Louisiana’s non-elderly residents are uninsured.

More information on the Loiusiana Health Insurance Exchange can be found here.

Louisiana Health Insurance Exchange - What Plans will be Available?

All plans offered through the Louisiana Health Insurance Exchange will meet the ACA definition of a Qualified Health Plan (QHP). The plans will be offered by level of coverage for essential health benefits (EHB), to allow consumers to compare plans on an "apples to apples" basis. The four "metal" levels are: Bronze (plan pays 60%), Silver (plan pays 70%), Gold (plan pays 80%) and Platinum (plan pays 90%). More information on the types of plans that will be available, and the carriers offering plans in Louisiana, is expected by late summer 2013.

Louisiana Health Insurance Exchange - Role of Insurance Professionals & Navigators

The Louisiana Health Insurance Exchange will follow federal guidelines for insurance professionals selling policies through the Exchange and for navigators assisting consumers and small businesses.

Insurance professionals will be able to register with the Louisiana Health Insurance Exchange and receive any commissions directly from the carriers (using their Exchange ID number and NPN).

The Louisiana Health Insurance Exchange navigator program will assist consumers in making choices about their health care options and accessing their new health care coverage, including access to premium tax credits for some consumers. The federal government will run the navigator program in Louisiana.

What Health Insurance Premiums Can an HRA Reimburse?

Rick Lindquist — Tue, 21 May 2013 15:19:00 GMT

Health Reimbursement Arrangements (HRAs) are federally regulated, employer-sponsored health benefit plans that allow participants to receive reimbursement for eligible out-of-pocket healthcare expenses (including certain health insurance premiums). Reimbursements for eligible medical expenses made via an HRA are 100% employer funded, and are generally excluded from federal, state and Social Security taxes.

What Health Insurance Premiums Can an HRA Reimburse?

HRAs can reimburse the following types of insurance premiums provided they were not already paid with pre-tax dollars:

Major medical individual health insurance premiums
Limited benefit individual health insurance premiums
Dental care and Vision care premiums
Qualified Ancillary premiums (e.g. accident policies)
Medicare Part A or B, Medicare HMO, and employer-sponsored health insurance premiums
Medicare Advantage and Supplement premiums
COBRA Premiums

What Other Medical Expenses Can an HRA Reimburse?

An eligible expense is any healthcare expense incurred by a participant, their spouse, or dependent, that is approved by the IRS and eligible for reimbursement under your specific company plan.

Please note that expenses reimbursed through the plan cannot be itemized and resubmitted through an income tax return or any other benefit plan per IRS regulations.

It's important to note that each businesses' HRA is different. Employers can choose to customize their HRA with different monthly allowances, varying allowances by class of employee, and specific reimbursable and non-reimbursable expenses.

The following is a sampling of HRA-eligible expenses:

Acupuncture	Hearing Aids	Medications
Ambulance	Home Care	Nursing Services
Birth Control	Hospital Services	Operations
Chiropractor	Insurance Premiums	Psychologist
Eye Exams	Lab Fees	Transplants

8 Ways HRAs Help a Small Business Grow

Christina Merhar — Tue, 21 May 2013 13:00:00 GMT

Stand-alone Health Reimbursement Arrangements (HRAs) provide small businesses a way to offer employees excellent health benefits without the cost or complication of group health insurance.

An HRA is a Section 105, employer-funded, tax advantaged employer health benefit plan that reimburses employees for out of pocket medical expenses and personal health insurance premiums. A stand-alone HRA is not linked with a group health plan, rather the stand-alone HRA is the employee health benefit. A stand-alone HRA is also referred to as a "pure" defined contribution health plan or a stand-alone Health Reimbursement Account.

Here are eight (8) ways stand-alone HRAs help small businesses get out of the health insurance business and focus their valuable resources on growing their business, while still providing a valuable health benefit that helps recruit and retain key employees.

#1: HRAs Provide Employees Plan Choice

With a stand-alone HRA, the small business provides employees with a fixed HRA allowance. Employees then purchase any personal health insurance policy, and are reimbursed for their policy (up to the amount of their HRA allowance). Employees can choose any health insurance policy that fits their specific health needs including the type of plan (high-deductible, low-deductible, HSA-compatible, etc), what the plan covers (maternity, dental, etc) and carrier.

Compared to an employer-sponsored plan: With an employer-sponsored plan, the employer chooses and administers the insurance plan. Small businesses, however, have little bargaining power in the small-group market. Of businesses with less than 200 workers, 86% that offer an employer-sponsored plan only offer one (1) plan.

#2: HRAs Reduce Red Tape

Offering a stand-alone HRA reduces the time the business spends on health benefits administration and paperwork. Once the HRA plan is set up online, the health benefit becomes a payroll function where the small business uses HRA software to add reimbursements to payroll. For the average small business, HRA administration takes 5 minutes a month. Less administrative time means more time available to run and grow the business.

Compared to an employer-sponsored plan: Small businesses select their employees’ insurance plans and play a larger role in plan management.

#3: HRAs Offer Financial Predictability

Offering a stand-alone HRA aids financial predictability for small businesses. With a stand-alone HRA, the small business decides how much they will contribute to employees' health care expenses. There are no minimum or maximum amounts a business can contribute, so if a business wants to contribute any amount to employees' health care costs, they can afford a stand-alone HRA. This level of cost controls and flexibility leads to financial predictability, allowing the business to grow faster.

Compared to an employer-sponsored plan: While monthly premium rates are predictable, most businesses face an annual premium increase year after year. According to a recent study by Aon Hewitt, the average employer-sponsored health premium was projected to increase 6.3% in 2013. Steady 5-10% annual premium increases add up fast for any business.

#4: HRAs Free Up Cash Flow

A stand-alone HRA is a notional account and funds do not accumulate in a separate account. Rather, the business reimburses employees only after their employees incur expenses. Because the business does not need to pre-fund the HRA allowances, and only reimburses once employees show proof of eligible expenses, the HRA frees up cash flow for the business. This is valuable for any growing business and makes offering the benefit feasible for many start-ups and small businesses.

Compared to an employer-sponsored plan: Premiums are usually paid monthly or quarterly. The key difference is that with a stand-alone HRA, the business reimburses employees directly on payroll, and only for expenses they've incurred (up to the amount they have available).

#5: HRAs Help Increase Employee Morale

Provided in the right way (and using the right HRA Software provider), offering a stand-alone HRA increases employee morale because the small business is offering employees more choices and better choices than they currently have. Employees are no longer limited to the "one-size-fits-all" insurance choice. The portability of personal insurance policies is a great benefit to employees; when employees leave the business they keep their insurance policy. And, in 2014 all policies will be guaranteed-issue and affordable through the health insurance Marketplaces. There are two key factors when offering the HRA, however. (1) Choose the right HRA Software provider who will help educate employees and offers an easy-to-use online system, and (2) Coordinate with an insurance agent who can help employees select and purchase a personal insurance policy.

Compared to an employer-sponsored plan: Most employees are only familiar with a traditional employer-sponsored plan and because of this, many perceive a group health plan as a better benefit ("this is what we've always received"). And until recently there weren't state risk pools in every state, so for some sick employees coverage under an employer-sponsored plan was their best (if not only) option for coverage. This "moral obligation" to provide a guaranteed-issue group health plan goes away in 2014 when all individual policies become guaranteed-issue as part of health care reform.

#6: HRAs Get Small Businesses Out of the Health Insurance Business

Small businesses are are typically not health insurance experts, nor do small businesses want to spend valuable time gaining expertise. With limited resources and staff, the time spent comparing policies, dealing with questions/complaints, and managing the plan falls on the business owner. This is valuable time that could be spent growing the business. By offering a stand-alone HRA the small business can get out of the health insurance business and allow employees to make smart health insurance decisions for themselves.

Compared to an employer-sponsored plan: Time is required working with a broker to select the plan/s, manage questions or issues, and going through the renewal process each year.

#7: HRAs Lower Health Benefits Costs

A central idea behind stand-alone HRAs is that small businesses can offer a benefit that employees value while lowering overall health benefit costs. Cost savings are seen because:

The small business sets and controls the amount of HRA funds provided to employees.
The individual policies employees purchase cost, on average, 25-35% less than group health insurance policies for the same coverage. In other words, the business's money goes farther.
The small business controls what happens to employees' unused HRA funds at the end of the plan year, meaning the business can allow the unused funds to roll over, partially roll over or make the allowance use it or lose it (no funds roll over). These HRA features contribute to cost-savings and control of financial risk.

Compared to an employer-sponsored plan: The cost of group health insurance is defined by a few variables such as the type of plan/s selected, the carrier, and either the health and age of employees (in the 38 states where medical underwriting is currently allowed) or by community-rating.

#8: HRAs Allow Flexible Plan Design

With a stand-alone HRA there are no minimum participation requirements, and small businesses can offer different levels of benefits to different employees based on bona-fide job criteria such as job description, location, hours worked, etc. This flexibility in HRA plan design can help a business recruit and retain key employees and contain costs. For example, a business could offer $250/month for managers and $100/month for entry-level staff. Or, a business could start offering health benefits to only key directors and add an HRA benefit for other employees as the business grows.

Compared to an employer-sponsored plan: 50%-75% of employees must participate in the plan and there is less flexibility to offer different benefit levels to different employees.

Georgia Health Insurance Exchange Guide

Zane Benefits — Mon, 20 May 2013 22:02:00 GMT

This guide provides an overview of the Georgia Health Insurance Exchange including the history of the exchange, how the exchange will operate, and exchange information for Georgia residents and small businesses.

Georgia Health Insurance Exchange Introduction

All states have three options for setting up a state health insurance exchange for 2014:

Build a state-based exchange
Enter into a state-federal partnership exchange
Default to a federally-facilitated exchange

Georgia will default to a federally-facilitated health insurance exchange.

Georgia Health Insurance Exchange - History

Originally, Georgia Governor Nathan Deal signed Executive Order in June 2011 to create the Georgia Health Exchange Advisory Committee. The purpose of the committee was to recommend how Georgia should offer a health insurance exchange. The committee released a set of reports recommending a structure for a state-based exchange, however on November 16, 2012 the Governor's office released an announcement that Georgia would default to the federally-facilitated exchange citing cost and lack of federal guidance.

Click here to read the Governor's press release.

Georgia Health Insurance Exchange - What is It?

The Georgia Health Insurance Exchange will be operated through a federally-run health insurance exchange, also referred to as the Health Insurance Marketplace. Starting in October 2013 Georgia residents will be able to access information about all the plans available through the Exchange. The SHOP Exchange will also be available to small businesses with 100 or fewer employers. Coverage from the Exchange starts in January 2014.

According to an estimate by healthcare.gov, 1,698,880 or 20% of Georgia’s non-elderly residents are uninsured, of whom 1,592,480 (94%) may qualify for either tax credits to purchase coverage in the Marketplace or for Medicaid if Georgia participates in the Medicaid expansion.

Click here for information on the federally-run Georgia Health Insurance Exchange.

Georgia Health Insurance Exchange - What Plans will be Available?

All plans offered through the Georgia Health Insurance Exchange will meet the ACA definition of a Qualified Health Plan (QHP). The plans will be offered by level of coverage for essential health benefits (EHB), to allow consumers to compare plans on an "apples to apples" basis. The four "metal" levels are: Bronze (plan pays 60%), Silver (plan pays 70%), Gold (plan pays 80%) and Platinum (plan pays 90%). More information on the types of plans that will be available, and the carriers offering plans in Georgia, is expected by late summer 2013.

Georgia Health Insurance Exchange - Role of Insurance Professionals & Navigators

The Georgia Health Insurance Exchange will follow federal guidelines for insurance professionals selling policies through the Exchange and for navigators assisting consumers and small businesses.

Insurance professionals will be able to register with the Georgia Health Insurance Exchange and receive any commissions directly from the carriers (using their Exchange ID number and NPN).

The Georgia Health Insurance Exchange navigator program will assist consumers in making choices about their health care options and accessing their new health care coverage, including access to premium tax credits for some consumers. The federal government will run the navigator program in Georgia.

What is a "Pure" Defined Contribution Health Plan?

Christina Merhar — Mon, 20 May 2013 13:00:00 GMT

Defined contribution health plans are fast becoming popular with small businesses as an alternative to group health insurance. With a "pure" defined contribution plan a business contributes a fixed dollar amount (a "defined contribution") toward employees' health care costs, including purchasing their own personal insurance policies.

The shift from employer sponsored plans (a "defined benefit") to defined contribution health plans is similar to the shift in retirement savings from pensions (a defined benefit) to 401Ks (a defined contribution). After realizing the savings associated with moving away from defined benefit retirement plans, many businesses are also applying this model to their healthcare benefit programs.

However, the term "defined contribution health plan" has become a buzzword in the industry, and doesn't always mean the same type of heatlthcare benefit. This article provides a definition of a "pure" defined contribution health plan.

Pure Defined Contribution Health Plan

With a pure defined contribution health plan, the business offers health benefits in the form of a stand-alone Health Reimbursement Arrangement (HRA) instead of a group health insurance plan. The business simply uses the HRA to reimburse employees tax-free for their personal insurance policies (and other eligible medical expenses, as the business defines in their HRA plan).

Pure defined contribution health plans allow the business to get out of the insurance business. A pure defined contribution plan is not linked to a group health insurance plan. Rather, the defined contribution health plan is the business's health benefit.

To summarize, with a pure defined contribution health plan:

The business provides employees a fixed monthly allowance for health insurance premiums and other eligible medical expenses. No group health plan is offered.
Employees purchase their own individual health insurance premiums (often with the help of a broker or agent). Employees have unlimited choices in policies, and can purchase any type of plan from any carrier. Starting in 2014, employees can purchase policies through the new state health insurance marketplaces. Also, in 2014 all personal policies will be guaranteed-issue and massive individual premium tax credits will be available for plans purchased through the marketplaces.
Using HRA Software, employees submit their expenses and the business reimburses them tax-free on payroll, up to the amount available.

Defined contribution health plans provide the same tax benefits as a group health plan. However, one hurdle preventing some businesses to switch to a defined contribution health plan was key employees with a pre-existing condition. In 2014 this hurdle goes away. With guaranteed-issue policies starting in 2014 and massive tax subsides through the health insurance marketplaces, defined contribution health plans now have all the same benefits of a defined benefit (group health insurance plan), often at a much lower cost for the business and employees.

Other Variations of Defined Contribution Health Plans

So, how else is the term "defined contribution health plan" being used? One popular variation is a type of defined contribution within group health insurance offerings.

In this arrangement, the business sets an amount to contribute to employees' health insurance premiums, but provides a limited menu of health insurance options (for example, employees choose from 2-5 insurance policies). This type of "employee choice" group health insurance offering is common with larger businesses. It is also one of the features that some state small business SHOP Marketplaces will offer to small businesses as part of health care reform in 2014 (and that all state SHOP Marketplaces will be required to offer by 2015).

Alaska Health Insurance Exchange Guide

Zane Benefits — Sat, 18 May 2013 03:58:00 GMT

This guide provides an overview of the Alaska Health Insurance Exchange including the history of the exchange, how the exchange will operate, and exchange information for Alaska residents and small businesses.

Alaska Health Insurance Exchange Introduction

All states have three options for setting up a state health insurance exchange for 2014:

Build a state-based exchange
Enter into a state-federal partnership exchange
Default to a federally-facilitated exchange

Alaska will default to a federally-facilitated health insurance exchange.

Alaska Health Insurance Exchange - History

On July 17, 2012, Governor Sean Parnell announced that Alaska would allow the federal government to operate the Alaska Health Insurance Exchange. The Governor's announcement came after the State of Alaska completed a study on health insurance exchange planning. In the announcement, the Governor stated the cost and uncertainty of federal guidance the reasons for not implementing a state-based health insurance exchange. Click here to read the Governor's press release.

Alaska Health Insurance Exchange - What is It?

The Alaska Health Insurance Exchange will be operated through a federally-run health insurance exchange, called the Health Insurance Marketplace. Starting in October 2013 Alaska residents will be able to access information about all the plans available through the Exchange. The SHOP Exchange will also be available to small businesses with 100 or fewer employers. Coverage from the Exchange starts in January 2014.

According to an estimate by healthcare.gov, 39,421 or 21% of Alaska’s non-elderly residents are uninsured, of whom 126,344 (91%) may qualify for either tax credits to purchase coverage in the Marketplace or for Medicaid if Alaska participates in the Medicaid expansion.

Click here for information on the federally-run Alaska Health Insurance Exchange.

Alaska Health Insurance Exchange - What Plans will be Available?

All plans offered through the Alaska Health Insurance Exchange will meet the ACA definition of a Qualified Health Plan (QHP). The plans will be offered by level of coverage for essential health benefits (EHB), to allow consumers to compare plans on an "apples to apples" basis. The four "metal" levels are: Bronze (plan pays 60%), Silver (plan pays 70%), Gold (plan pays 80%) and Platinum (plan pays 90%). More information on the types of plans that will be available, and the carriers offering plans in Alaska, is expected by late summer 2013.

Alaska Health Insurance Exchange - Role of Insurance Professionals & Navigators

The Alaska Health Insurance Exchange will follow federal guidelines for insurance professionals selling policies through the Exchange and for navigators assisting consumers and small businesses.

Insurance professionals will be able to register with the Alaska Health Insurance Exchange and receive any commissions directly from the carriers (using their Exchange ID number and NPN).

The Alaska Health Insurance Exchange navigator program will assist consumers in making choices about their health care options and accessing their new health care coverage, including access to premium tax credits for some consumers. The federal government will run the navigator program in Alaska.

Does Offering an HRA Disqualify Employees from Individual Premium Tax Credits?

Christina Merhar — Fri, 17 May 2013 14:58:00 GMT

A common question is "will offering a standalone HRA in 2014 prevent employees from obtaining individual premium tax credits?" The answer is no. Employees who receive a standalone Health Reimbursement Arrangement (HRA) benefit can still access premium tax credits, as long as they meet other eligibility criteria based on household size and income. This is because an HRA does not consitute an "eligible employer-sponsored plan". In other words, offering a standalone HRA to employees does not disqualify them from the individual preminum tax credits.

What is the definition of an eligible employer-sponsored plan?

According to 26 USC Section 5000A(f)(2):

The term “eligible employer-sponsored plan” means, with respect to any employee, a group health plan or group health insurance coverage offered by an employer to the employee which is—

(A) a governmental plan (within the meaning of section 2791(d)(8) of the Public Health Service Act), or

(B) any other plan or coverage offered in the small or large group market within a State.

Such term shall include a grandfathered health plan described in paragraph (1)(D) offered in a group market.

As an HRA is not 1) a governmental plan, or 2) offered in the small or large group market within a State, so the HRA is not an "eligible employer-sponsored plan".

Note: If an employer offers an integrated HRA, an HRA combined with a qualified and affordable group health insurance plan, employees would not be eligible for the individual premium tax credits as the group health insurance plan (which IS an "eligible employer-sponsored plan") would disqualify them.

What are the Individual Premium Tax Credits?

Starting in 2014, significant tax credits will be available to help individuals buy individual health insurance coverage through the new state health insurance marketplaces.

The tax credits will only be available to individuals who enroll through the state's INDIVIDUAL health insurance marketplace and are not already enrolled in an "eligible employer-sponsored plan".
If an employee is eligible for these tax credits, his or her cost of insurance will be capped at 2% - 9.5% of his or her household's income.
The tax credits are available for individuals and families who meet certain income requirements and do not have access to affordable health insurance through an "eligible employer-sponsored plan" or another government program.

For more details on eligibility and the credit amount see: What is my Individual Premium Tax Credit?

How Employers Can Tax Advantage of the Individual Premium Tax Credits

An employer can take advantage of these individual premium tax credit savings, and continue to offer employees a valuable health benefit, by offering a standalone HRA (also called a pure defined contribution plan). Then, employees purchase policies on the marketplace and access these individual premium tax credits. With this model, both the business and employees save a combined 50% on health insurance costs.

Also, since an HRA is not an "eligible employer-sponsored plan", a standalone HRA cannot satisfy the "play or pay" requirement (also called employer mandate or employer shared responsibility). However, this play or pay requirement is only applicable to businesses with 50+ full time equivalent employees. For businesses with less than 50 employees, a standalone HRA combined with the individual health insurance marketplace may be a no-brainer. Businesses with 50+ full time equivalent employees may find that choosing not to offer group health insurance, accepting applicable tax penalties and offering a standalone HRA provides cost-savings and value to the business and employees. Businesses with over 50 employees should simply conduct a cost analysis.

North Carolina Health Insurance Exchange Guide

Zane Benefits — Thu, 16 May 2013 20:00:00 GMT

This guide provides an overview of the North Carolina Health Insurance Exchange including the history of the Exchange, how the Exchange will operate, and Exchange information for North Carolina residents and small businesses.

North Carolina Health Insurance Exchange Introduction

All states have three options for setting up a state health insurance exchange for 2014:

Build a state-based exchange
Enter into a state-federal partnership exchange
Default to a federally-facilitated exchange

North Carolina will default to a federally-facilitated health insurance exchange.

North Carolina Health Insurance Exchange - History

In 2011, Governor Beverly Perdue indicated intent to establish and operate a state based health insurance exchange. However all three bills that were introduced in the 2011-2012 session to establish a state-based health insurance exchange failed. After this, North Carolina Department of Insurance (NCDOI), the North Carolina Department of Health and Human Services (NCDHHS), and the North Carolina Institute of Medicine (NCIOM) led exchange planning in the state. In November 2012, Governor Perdue announced the state’s intent to establish a state-federal partnership health insurance exchange.

However, in February 2013 newly-elected Governor Pat McCrory issued a statement announcing that North Carolina would abandon efforts to establish a partnership exchange and default to the federally-facilitated exchange.

Click here for more information on North Carolina's exchange planning.

North Carolina Health Insurance Exchange - What is It?

The North Carolina health insurance exchange will be operated through a federally-run health insurance exchange, called the Health Insurance Marketplace. According to healthcare.gov, starting in October 2013 North Carolina residents will be able to access information about all the plans available through the Exchange. The SHOP Exchange will also be available to small businesses with 100 or fewer employers. Coverage from the Exchange starts in January 2014.

According to an estimate by healthcare.gov, 1,346,601 or 17% of North Carolina’s non-elderly residents are uninsured, of whom 1,252,882 (93%) may qualify for either tax credits to purchase coverage in the Marketplace or for Medicaid if North Carolina participates in the Medicaid expansion.

Click here for information on the federally-run Exchange.

North Carolina Insurance Exchange - What Plans will be Available?

All plans offered through the North Carolina Health Insurance Exchange will meet the ACA definition of a Qualified Health Plan (QHP). The plans will be offered by level of coverage for essential health benefits (EHB), to allow consumers to compare plans on an "apples to apples" basis. The four "metal" levels are: Bronze (plan pays 60%), Silver (plan pays 70%), Gold (plan pays 80%) and Platinum (plan pays 90%). More information on the types of plans that will be available, and the carriers offering plans in North Carolina, is expected by late summer 2013.

North Carolina Health Insurance Exchange - Role of Insurance Professionals & Navigators

The North Carolina Health Insurance Exchange will follow federal guidelines for insurance professionals selling policies through the Exchange and for navigators assisting consumers and small businesses.

Insurance professionals will be able to register with the North Carolina Health Insurance Exchange and receive any commissions directly from the carriers (using their Exchange ID number and NPN). For more information see: Role of Agents in Health Insurance Marketplaces.

The North Carolina Health Insurance Exchange Navigator program will assist consumers in making choices about their health care options and accessing their new health care coverage, including access to premium tax credits for some consumers. The federal government will run the navigator program in North Carolina.

Affordable Care Act: Play or Pay?

Christina Merhar — Thu, 16 May 2013 13:00:00 GMT

Should we play or pay? Employers with over 50 employees are trying to figure out how to deal with the Affordable Care Act's "employer mandate" which requires applicable large employers to either offer health insurance, or else pay a tax penalty.

But what employers should be asking is: how can I take advantage of the Affordable Care Act (ACA) individual insurance premium tax subsidies and actually save money on health care costs?

Play or Pay Defined

First, what does play or pay mean? Play or pay is a concept that requires employers with over 50 FTE employees to provide health insurance to their employees ("play") or pay a tax or premium toward a publicly provided system that covers people without private insurance ("pay"). The ACA play or pay requirement is also referred to as the "employer mandate" or "employer shared responsibility."

The Play or Pay Decision ... and how to Play Differently

Many employers are asking should we play, pay, or play differently with a defined contribution plan? The decision is not always easy or straightforward. Ultimately, employers want to provide a health benefit that is valuable to employees (i.e. recruitment and retention), and has value to the employer (i.e. the best benefit for the cost). The three choices an employer for employers with over 50 employers are to play, pay or play differently with defined contribution.

To play means your company would offer employees health insurance that meets essential health benefits and is affordable to employees, by ACA standards.
To pay means your company would choose to not offer health insurance and instead pay a tax penalty. (Tip: many companies who plan on paying, simply think of the tax penalty as a contribution to their employee's health benefits)
To play differently is the middle ground between play and pay. It means your company chooses not to offer a group health insurance plan, pays any applicable penalties, and instead offers employees a health benefits allowance (called “Pure Defined Contribution”). Employees purchase policies from an insurance agent, online, or through the new health insurance marketplaces. Then, the company reimburses employees for their policies tax-free up to the amount of their allowance.

Why Would an Employer Play Differently?

An employer would consider playing differently because it will likely:

Save employees and employers a combined 50% on health insurance costs.
Allow employees a full choice of health insurance plans.
Provide employees with better, more flexible health insurance options.

With the new Individual Health Insurance Marketplaces (guaranteed-issue and affordable because of the insurance premium tax subsidies), defined contribution plans now have all the same benefits of a group health insurance plan at a lower cost for the employer and employees.

Defined Contribution & Employee Health Insurance Cost Analysis

To decide whether to play, pay or play differently with a defined contribution plan, an employer with over 50 employees should conduct a simple cost analysis. Compare the cost of the three options:

Qualified, affordable group health insurance
Defined Contribution Plan + applicable penalties
Penalties

Less Than 50 Employees? No Play or Pay Decision

If your company has less than 50 employees, the mandate and tax penalty (and thus the play or pat decision) does not apply to you. With the new health insurance marketplaces and insurance tax subsidies, many small employers will:

Drop their group health insurance plan (if they have one).
Allow employees to purchase policies through their state health insurance exchange and be able to take advantage of individual tax subsidies.
Reimburse employees for their premiums (or a portion of their premiums) through the defined contribution plan (a stand-alone Health Reimbursement Arrangement).

Utah Health Insurance Exchange Guide

Zane Benefits — Wed, 15 May 2013 21:15:00 GMT

This guide provides an overview of the Utah Health Insurance Exchange including the history of the Exchange, how the Exchange will operate, and Exchange information for Utah residents and small businesses.

Utah Health Insurance Exchange - Introduction

All states have three options for setting up a state health insurance exchange for 2014:

Build a State-Based Exchange
Enter into a State-Federal Partnership Exchange
Default to a Federally-Facilitated Exchange

Utah will enter into a unique state-federal partnership: Utah will run the small business "SHOP" exchange, and the federal government will run the individual health insurance exchange. The Utah Health Insurance Exchange will open October 1, 2013, with coverage beginning January 1, 2014.

Utah Health Insurance Exchange - History

Utah has one of the more unique histories in developing their Health Insurance Exchange. Prior to federal health care reform, former Govenor Jon Huntsman signed HB 133 in 2008 and HB 188 in 2009 which created the Utah Health Exchange. Additional legislation (HB 294 and HB 128) was signed into law in 2010 and 2011, respectively, by current Governor Gary Herbert amending provisions related to health care reform in 2010. These later pieces of legislation reauthorized the Health System Reform Task Force to evaluate options for bringing the state’s already existing exchange into compliance with the Affordable Care Act.

These laws, along with HB 144 introduced in February 2012, allowed small businesses to participate in a type defined contribution or "employee choice" model where small businesses and employees could compare, select, and enroll in commercial health insurance online. In 2012 the Utah Exchange was rebranded Avenue H.

The biggest question over the last few months has been, would the federal government certify Avenue H as Utah's small business "SHOP" exchange while also allowing Utah to default to the federally-run individual health insurnace exchange?

On May 10, 2013, Utah announced they reached an agreement with the US Department of Health and Human Services (HHS) for Utah to run Avenue H, the small business "SHOP" health exchange, without a competing federal solution or interjection from the federal government, and that the federal government would run the individual health insurance exchange.

In a press release by Avenue H, Governor Herbert said "The only way this was going to work was if we were granted flexibility. Fortunately for all, HHS proved to be flexible, concurring with everything we proposed to be able to operate an exchange that meets the needs of Utah residents," said the Governor. "The new model clearly outlines what Utah will do and what HHS will do. We are sticking with our exchange and moving forward."

With Utah's Health Insurance Exchange, Utah will maintain oversight over qualified health plans, including certification, recertification, decertification and compliance. Utah will also continue to administer the Medicaid program through existing Medicaid structure.

The federal government will be responsible for operating the individual health insurance exchange, conducting pre-certification for Medicaid and CHIP eligibility, and managing tax credits through the individual exchange.

Click here for more information on Utah's Health Insurance Exchange history.

Utah Health Insurance Exchange for Individuals

The Utah Health Insurance Exchange will be operated through a federally-run Health Insurance Exchange (also called the "Health Insurance Marketplace"). According to healthcare.gov, starting in October 2013 Utah residents will be able to access information about insurance plans available through the Exchange.

According to an estimate by healthcare.gov, 359,579 or 15% of Utah’s non-elderly residents are uninsured, of whom 332,969 (93%) may qualify for either tax credits to purchase coverage in the Marketplace or for Medicaid if Utah participates in the Medicaid expansion. Through the Exchange, Utah residents can shop for and compare insurance plans, access insurance premium tax credits, and be screened for eligibility in public assistance programs such as Medicaid and CHIP.

Click here for information on the federally-run Utah Health Insurance Exchange.

Utah Health Insurance Exchange for Small Businesses

Avenue H is Utah's existing small group health insurance exchange for small businesses with 2-50 employees. Avenue H will serve as Utah's official "SHOP" Exchange. Avenue H will include an "employee choice" model, where a business owner can contribute a set dollar amount and employees can shop for a health insurance plan from one of three carriers: Regence BlueCross BlueShield, SelectHealth, or UnitedHealthcare. According to their website, Avenue H currently offers 140 plans among the three carriers and aims to add more carriers by the end of 2013.

Click here for more information on Avenue H.

Utah Health Insurance Exchange - Role of Insurance Professionals & Navigators

The Utah Health Insurance Exchange for individuals will follow federal guidelines for insurance professionals selling policies through the Exchange, and for Navigators assisting consumers.

For individual plans, insurance professionals will be able to register with the federally-run Utah Health Insurance Exchange and receive any commissions directly from the carriers (using their Exchange ID number and NPN). For more information see: Role of Agents in Health Insurance Marketplaces.

For small group plans, insurance professionals will register with Avenue H. Training and registration information is available on their website.

The Utah Health Insurance Exchange Navigator program will assist consumers in making choices about their health care options and accessing their new health care coverage, including access to premium tax credits for some consumers. The federal government will run the Utah Navigator program.

Oregon Health Insurance Exchange Rates - Proposed 2013

Zane Benefits — Wed, 15 May 2013 14:03:00 GMT

Oregon Health Insurance Exchange released proposed rates for coverage starting 2014. The Oregon Health Insurance Exchange, Cover Oregon, will be Oregon's marketplace where individuals and small businesses can shop for health insurance plans and receive access to ACA tax credits and subsidies. How much will health plans cost for individuals, families, and small businesses through the Oregon Health Insurance Exchange?

The Oregon Insurance Division and Department of Consumer and Business Services (DCBS) recently released proposed health plan rates for Oregon individuals, families, and small businesses. The Oregon Health Insurance Exchange will open October 1, 2013, for coverage starting January 1, 2014.

According to the DCBS, thousands of Oregon residents are expected to purchase personal insurance policies using federal financial help (tax subsidies) through the Oregon Health Insurance Exchange. The Oregon Health Insurance Exchange intends to provide consumers with more choices, especially for individuals with pre-existing conditions, as federal law makes all policies guaranteed-issue.

Oregon Health Insurance Exchange - Proposed Carriers

Oregon currently has a highly-competitive health insurance market, which will be reflected in the Oregon Health Insurance Exchange's offerings. Along with 16 insurers, two (2) Consumer Operated and Oriented Plans (CO-OPS) filed plans and proposed rates with the Oregon Insurance Division. All plans still require approval by the Oregon Insurance Division. Carriers and rates will be finalized by July 2013. Proposed carriers in the Portland area for individual plans include FamilyCare Health Plans, Freelancers Co-Op of Oregon, Health Net Health Plan of Oregon, John Alden Life Insurance Company, Kaiser Foundation Health Plan of the NW, LifeWise Health Plan of Oregon, Moda Health Plan, Oregon's Health Co-Op, PacificSource Health Plans, Providence Health Plan, Regence BlueCross BlueShield of Oregon, Time Insurance Company, and Trillium Community Health Plan.

Click here to read DCBS news release.

Oregon Health Insurance Exchange - Proposed Individual Plan Rates

The proposed Oregon Health Insurance Exchange rates for individual plans are divided by county, age, and carrier. For the Portland area, a bronze plan for a 40-year-old, non-tobacco-user averages $265/month (before individual tax subsidies). In 2012, the average individual policy in Oregon (across all ages, adults and children) was $207/month. Here's a look at all proposed rates for individual coverage in the Portland area:

Click here to view source.

Oregon Health Insurance Exchange - Proposed Small Business Group Rates

The Oregon Health Insurance Exchange also provided proposed small business group rates (for businesses with 50 or fewer employees). For the Portland area, a bronze plan for a 40-year-old, non-tobacco-user single employee averages $273/month (before employer contribution). In 2012, the average single premium for employer-based health insurance was $421/month (averaged across all ages and Oregon businesses). Here's a look at all proposed rates for small business coverage in the Portland area:

Click here to view source.

Virginia Health Insurance Exchange Guide

Zane Benefits — Tue, 14 May 2013 23:00:00 GMT

This guide provides an overview of the Virginia Health Insurance Exchange including the history of the Exchange, how the Exchange will operate, and Exchange information for Virginia residents and small businesses.

All states have three options for setting up a state health insurance exchange for 2014:

Build a State-Based Exchange
Enter into a State-Federal Partnership Exchange
Default to a Federally-Facilitated Exchange

Virgina will default to a federally-facilitated health insurance exchange, while maintaining involvement with plan management functions. The Virginia Health Insurance Exchange will open October 1, 2013, with coverage beginning January 1, 2014.

Virginia Health Insurance Exchange - History

Originally, Virginia officials explored operating a state-based health insurance exchange. In April 2011, Virginia Governor McDonnell signed HB 2434 into law declaring the state’s intent to establish a state-based health insurance exchange. The legislation was based on recommendations by the Virginia Health Reform Initiative Advisory Council. However in November 2011, Governor McDonnell opposed passing additional legislation needed for the establishment of a state-based exchange until after the Supreme Court ruled on the ACA in June 2012. After ACA was upheld, numerous bills to establish a state-based health insurance exchange were introduced in the 2012 Virginia Legislature however none were brought to voting.

In March 2013, Virginia received approval from the Center for Consumer Information and Insurance Oversight (CCIIO) to perform plan management activities of the Virginia Health Insurance Exchange. The federal government will oversee and manage all other Exchange functions.

Click here for more information about Virginia's Health Insurance Exchange planning.

Virginia Health Insurance Exchange - What is it?

The Virginia Health Insurance Exchange will be operated through a federally-run Health Insurance Exchange (also called the "Health Insurance Marketplace"). According to healthcare.gov, starting in October 2013 Virginia residents will be able to access information about insurance plans available through the Exchange. The SHOP Exchange will be available to small businesses in Virginia for businesses with 100 or fewer employees. Coverage starts January 1, 2014.

According to an estimate by healthcare.gov, 844,752 or 12% of Virginia's non-elderly residents are uninsured, of whom 775,334 (92%) may qualify for either tax credits to purchase coverage in the Exchange or for Medicaid if Virginia participates in Medicaid expansion. Through the Exchange, Virginia residents can shop for and compare insurance plans, access insurance premium tax credits, and be screened for eligibility in public assistance programs such as Medicaid and CHIP.

Click here for information on the federally-run Health Insurance Exchange.

Virginia Health Insurance Exchange - What Plans will be Available?

All plans offered through the Virginia Health Insurance Exchange will meet the ACA definition of a Qualified Health Plan (QHP). The plans will be offered by level of coverage for essential health benefits (EHB), to allow consumers to compare plans on an "apples to apples" basis. The four "metal" levels are: Bronze (plan pays 60%), Silver (plan pays 70%), Gold (plan pays 80%) and Platinum (plan pays 90%). More information on the types of plans that will be available, and the carriers offering plans in Virginia, is expected by late summer 2013.

Virginia Health Insurance Exchange - Role of Insurance Professionals & Navigators

The Virginia Health Insurance Exchange will follow federal guidelines for insurance professionals selling policies through the Exchange, and for Navigators assisting consumers and small businesses.

Insurance professionals will be able to register with the Virginia Health Insurance Exchange and receive any commissions directly from the carriers (using their Exchange ID number and NPN). For more information see: Role of Agents in Health Insurance Marketplaces.

The Virginia Health Insurance Exchange Navigator program will assist consumers in making choices about their health care options and accessing their new health care coverage, including access to premium tax credits for some consumers. The federal government will run the Navigator program in Virginia.

How to Start Offering Employee Health Benefits

Christina Merhar — Tue, 14 May 2013 13:00:00 GMT

A big milestone for any small businesses is offering small business health insurance for the first time. Your small business is off the ground, you're looking to hire your first employee, or perhaps you need a health benefits package to retain a key employee.

So, where do you start when you're ready to offer employee health benefits? Here are 5 quick tips to offering health benefits for the first time.

Tip #1: Understand the advantages (and value) of offering employee health benefits

Most small business owners are familiar with the reasoning: Offer the right health benefits, and jump-start your business's growth. When you give employees health benefits they value, they'll be more satisfied, miss fewer workdays, be less likely to quit, and have higher commitment to helping your business grow. Here are three key advantages of offering health benefits to your employees.

Recruitment & Retention of Key Employees: Employee health benefits are a valuable tool in recruiting key employees and retaining your top talent. While the importance of this for your small business may depend on industry competition in your area and the age and demographics of your workforce, it will be an important factor in your overall compensation package.
Tax advantages: By offering a traditional group health plan or an alternative solution such as a defined contribution health plan, you can offer employees a tax-advantaged health benefit. These tax advantages increases your overall compensation package and allows you an income tax deduction for the contribution. In other words, your business expense is less than the value of the health care benefit to the employee.
Employee wellness: Insurance coverage keeps employees healthy and working. Preventative care and more affordable access to health care prevents your employees from taking extended periods of sick leave, allowing your small business to be more productive and profitable.

Tip #2: Analyze the risks (and costs) of offering employee health benefits

As a small business, you must assess costs and risk of any new expenditure. Likewise, it is important to understand the risks and costs of offering employee health benefits.

Cost: The cost will vary depending on the type of employee health benefits you choose (more on your options in tip #3). For example, health insurance premiums rise every year. The uncertainty of rate renewals with a group health insurance plan makes financial planning difficult. Small businesses can have more control over costs with a defined contribution health plan.
Administrative Commitment: Budget for the administrative time of offering employee health benefits. With a traditional group health insurance plan, your small business will spend time choosing the coverage and then spend regular time filling out forms, remitting premiums, and acting as intermediary between employee and insurer. With a defined contribution health plan, administrative time is reduced. For example, you will spend time at the front-end of setting up the defined contribution health plan and then spend 5-10 minutes each month adding reimbursements to payroll.

Tip #3: Research your employee health benefits options

Today there are new options for small business health benefits. The two main types are a traditional group health insurance plan and a defined contribution health plan.

Group Health Insurance Plan: Also called "employer-sponsored" health insurance, a group health insurance plan covers all employees and their family members. These plans are generally uniform in nature, offering the same benefits to all employees or members of the group. Unlike individual health insurance, group health insurance is purchased by an individual (or family member) indirectly through the individual's (or family member's) employer. Group health insurance is dependent on an individual's (or family member's) employment.
Defined Contribution Health Plan: Rather than paying the costs to provide a specific group health insurance plan (a "defined benefit"), employers can fix their costs on a monthly basis by establishing a defined contribution health plan. Defined contribution health plans are an affordable alternative to employer-sponsored group health insurance plans. Defined contribution health plans by themselves are not health insurance plans, rather you offer employees a tax-free allowance to spend on their own personal policies and other medical expenses. A defined contribution health plan is like a business expense account for health care.

Within these two types, there are several more options to consider. See: Small Business Health Insurance Options.

Tip #4: Work with a trusted insurance broker

To help navigate your best options, work with a trusted insurance broker who is knowledgeable about small business health insurance options, defined contribution health plans, and health care reform.

Tip #5: Understand how health care reform impacts your small business employee health benefits

There are three key health care reform regulations every small business should know about health care reform:

Individual Mandate: Starting in 2014, health care reform requires everyone to obtain minimum essential coverage for themselves (and their dependents) or pay a penalty.
Employer Mandate ("Play or Pay"): Beginning in 2014, all applicable large employers (50+ FTE employees) must offer "minimum essential coverage" that is "affordable" to their employees. Applicable large employers who fail to offer minimum essential coverage that is affordable will be required to pay a "penalty" on their tax return. Less than 50 FTE employees? This does not apply to your small business.
Health Insurance Exchanges: Starting in 2014, health insurance coverage for individuals and small businesses will become available through new state Health Insurance Exchanges (aka "Marketplaces"). The new tax credits (e.g. the small business healthcare tax credits) and tax subsidies (e.g. individual health insurance tax subsidies) will only be available for coverage purchased via a state health insurance Exchange. Additionally, all plans become guaranteed-issue.

How do the exchanges fit into your employee health benefits decision? As a small business, you will be able to shop for a group health insurnce plan through the exchange. Or, if you decide on a defined contribution health plan, employees can shop for personal policies through the exchange, likely recieve a subsidy discount for their policy, and be reimbursed for the non-subsidiezed portion through their defined contribution allowance.

CMS Releases SHOP-Only Marketplaces FAQs

Zane Benefits — Mon, 13 May 2013 18:10:00 GMT

Last week the Centers for Medicare and Medicaid Services (CMS) released a set of frequently asked questions on the Small Business Health Options Program (SHOP)-only marketplaces. The SHOP Marketplaces are the small business group health insurance exchanges required in each state per the Affordable Care Act (ACA).

The FAQ comes shortly after the federal government delayed the "employee choice" SHOP option in the federally-run SHOP Marketplace until 2015. Under the employee choice option, a small business could offer insurance through the SHOP Marketplace and allow employees to pick from a variety of insurance plans (like many larger employers do today). The ability for employees to choose from a variety of insurance options will not be available through the federally-run SHOP Marketplace until 2015.

Since the announcement of the delay in this key feature of the SHOP Marketplace, some states have been asking if they can develop their own Marketplace for small businesses while using the federally-run individual Marketplace. A state can do this if they submitted it in their blueprint (their official ACA health insurance exchange planning document).

Here are the FAQs, directly from CMS's release:

May a state operate only a Small Business Health Options Program (SHOP) while the individual market Marketplace is operated as a Federally-facilitated Marketplace (FFM)?

"We will propose through rulemaking that, for 2014, a State that submitted a Blueprint pursuant to §155.105(e) to operate a State-based Marketplace and received conditional approval may request to operate a State-based SHOP while the individual market Marketplace is operated as an FFM. All states would have the same option starting in 2015."

Click here to read the CMS FAQ released May 10, 2013.

Can any state elect to operate a state-based SHOP in 2014?

"We intend to propose through rulemaking that only states that have submitted blueprints and received conditional approval to operate as a State-based Marketplace in 2014 are eligible to submit a request to HHS to operate only a state-based SHOP in 2014."

Click here to read the CMS FAQ released May 10, 2013.

Will the requirements for a state to operate a state-based SHOP while the individual market Marketplace is operated as a FFM be different for 2015?

"We intend to propose through rulemaking that states wishing to operate only a state-based SHOP in 2015 or beyond be required to submit a Blueprint that is being specifically developed for the State-based SHOP/individual market FFM arrangement."

Click here to read the CMS FAQ released May 10, 2013.

If a state elects to operate a state-based SHOP only, will the state be required to operate a navigator program for the SHOP? If so, are the requirements for the state-based SHOP-only navigator programs the same?

We intend to propose through rulemaking that, if a state operates only a state-based SHOP, the SHOP must have a navigator program, consistent with the statute. We also intend to propose that the state may choose to limit navigators in a SHOP-only navigator program to consumer outreach and education activities. The proposed rulemaking would also provide that the FFM would operate a navigator program in the individual market FFM in states that operate only a state-based SHOP.

Click here to read the CMS FAQ released May 10, 2013.

Iowa Health Insurance Exchange Guide

Zane Benefits — Mon, 13 May 2013 15:45:00 GMT

This guide provides an overview of the Iowa Health Insurance Exchange including the history of the Exchange, how the Exchange will operate, and Exchange information for Iowa residents and small businesses.

Beginning in 2014, as part of the Affordable Care Act (ACA), health insurance coverage for individuals and small businesses will become available through new state Health Insurance Exchanges. Most importantly, the key tax credits (e.g. the small business healthcare tax credits) and tax subsidies (e.g. individual health insurance tax subsidies) will only be available for coverage purchased through a state Health Insurance Exchange.

All states have three options for setting up a state Health Insurance Exchange for 2014:

Build a State-Based Exchange
Enter into a State-Federal Partnership Exchange
Default to a Federally-Facilitated Exchange

Iowa is planning to enter a state-federal partnership Exchange, and transition to a state-based Exchange by 2015.

Iowa Health Insurance Exchange - History

Originally, Iowa formed the Health Benefit Exchange, a collaboration of the Iowa Department of Public Health, the Iowa Insurance Division, the Iowa Department of Human Services, and the Iowa Department of Revenue. The committee was tasked with making recommendations for Iowa's Health Insurance Exchange.

On December 14, 2012, Governor Terry Branstad announced to the federal government that Iowa would pursue a state-federal partnership Exchange. Iowa plans to oversee plan management functions of the Exchange and will continue to perform Medicaid and CHIP eligibility determinations. Iowa plans to work toward a state-based exchange by 2015.

On March 5, 2013, Iowa received conditional approval from the US Department of Health and Human Services to establish a state-federal partnership Exchange. Final approval is contingent upon the Iowa meeting all Exchange activities on time. If Iowa does not meet milestones on time, Iowa will default to a federally-facilitated Exchange.

Click here to read more on Iowa's Health Insurance Exchange Planning.

Iowa Health Insurance Exchange - What is it?

The Iowa Health Insurance Exchange will be an online marketplace where Iowa residents will be able to shop for and compare insurance plans, access any applicable insurance premium tax credits, and be screened for eligibility in public assistance programs such as Medicaid and CHIP. The SHOP Exchange will be available to small businesses in Iowa for businesses with 100 or fewer employees.

According to healthcare.gov, 255,072 or 10% of Iowa’s non-elderly residents are uninsured, of whom 234,100 (92%) may qualify for either tax credits to purchase coverage in the Marketplace or for Medicaid if Iowa participates in the Medicaid expansion (Iowa is still undecided as of May 9, 2013 if they are participating in Medicaid expansion).

Iowa residents and small employers can receive assistance from Navigators, in-person assistors, and insurance agents and brokers. The Iowa Health Insurance Exchange will open October 1, 2013 for enrollment, with coverage starting January 1, 2014.

Click here for more information on the Iowa Health Insurance Exchange.

Iowa Health Insurance Exchange - What Insurance Plans Will be Available?

Under the Affordable Care Act, all insurance plans sold on the Iowa Health Insurance Exchange will be qualified health plans (QHPs) that meet federal requirements and provide essential health benefits (EHB). The Exchange will offer uniform plans categorized in four "metal" levels of value. These metal levels are intended to allow consumers to compare plans with different levels of coverage for EHB. The levels include:

Bronze (60% actuarial value)
Silver (70% actuarial value)
Gold (80% actuarial value)
Platinum (90% actuarial value)

At the time of writing specific information on the types of plans, carriers and cost have not been released for Iowa.

Health Care Reimbursement Account - What is it?

Christina Merhar — Fri, 10 May 2013 20:00:00 GMT

A health reimbursement account is another term used for a Section 105 Health Reimbursement Arrangement (aka Health Reimbursement Account or HRA). With a health care reimbursement account, any employer can reimburse employees tax-free for eligible health care expenses including health insurance premiums. Think of it as a business expense account for health care.

Introduction to Health Care Reimbursement Accounts

A health care reimbursement account is an IRS approved, employer-funded, tax advantaged employer health benefit plan that reimburses employees for out of pocket medical expenses and individual health insurance premiums. A health care reimbursement account is not considered health insurance. A health care reimbursement account allows the employer to make contributions to an employee's account and provide reimbursement for eligible expenses. A health care reimbursement account is an excellent way to supplement health insurance benefits and allow employees to pay for a wide range of medical expenses not covered by insurance.

Health Care Reimbursement Accounts are Notional

A health care reimbursement account is simply an agreement between the employer and employees. In other words, they are notional arrangements where no funds are expensed until reimbursements are paid. Through a health care reimbursement account, employers reimburse employees directly only after the employees incur approved medical expenses.

Health Care Reimbursement Accounts have no Annual Limits

Unlike a Health Savings Account (HSA) or a Flexible Spending Accounts (FSA), there is no limit to the amount of money an employer can contribute to an employee’s health care reimbursement account.

Health Care Reimbursement Account Eligible Expenses

A health care reimbursement account may reimburse any expense considered to be a qualified medical expense under IRS Section 213 of the Code, including premiums for personal health insurance policies. Within IRS guidelines, employers may restrict the list of reimbursable expenses in any way they choose. The following is a sampling of health care reimbursement account eligible expenses:

Doctor's Visits
Prescription medications
Ambulance
Hospital Services
Operations
Chiropractor
Insurance Premiums
Psychologist
Eye Exams
Lab Fees

Curious about other eligible health care expenses? See this list of health care reimbursement account eligible expenses.

Health Care Reimbursement Accounts Allow Annual Rollover

Health care reimbursement account balances may roll forward from year to year. Employers can design the program not to allow balances to rollover from one year to the next. However, limiting the rollover feature defeats a key health care reimbursement account advantage. Employers may allow employees to have access to their health care reimbursement account after retirement. However, employers may not pay or distribute cash or other benefit balances to any employee.

Health Care Reimbursement Account Administration Reporting Features

HRA Administration reporting features make real-time monitoring of health care reimbursement account liabilities, reimbursements and utilization easy. Employers can change plan benefits at any time or cancel the entire plan at any time. Further, health care reimbursement accounts allow employers to establish plan-year maximum reimbursements for any given category of expense (e.g., dental) and to establish a maximum balance that any participant class may hold at a time.

Health Care Reimbursement Account by Another Name

The term "health care reimbursement account" is synonymous with many other terms, and can be used interchangeably with the following:

Health Reimbursement Arrangement (HRA)*
Health Reimbursement Account (HRA)
Health Reimbursement Plan (HRP)
Medical Expense Reimbursement Plan (MERP)
Medical Reimbursement Plan (MRP)
Medical Reimbursement Accounts
Section 105 Plan

*Health Reimbursement Arrangement is the most common term, and is the term the IRS uses to describe these types of programs (See IRC Section 105(b) and IRS Publication 969).

Employer ACA Marketplace Notice Requirements

Zane Benefits — Fri, 10 May 2013 17:05:00 GMT

As part of the Affordable Care Act (ACA), employers are required to notify their employees of the coverage options available through the new Health Insurance Exchanges ("Marketplaces"). Originally, employers were required to notify employees by March 1, 2013. However, the employer ACA Marketplace requirement was delayed in January. Employers are now required to notify employees by October 1, 2013.

On May 8, 2013 the Department of Labor (DOL) issued new guidance on the notice to employees on coverage through the Marketplaces.

What Does the Employer ACA Marketplace Notice Need to Include?

All employers subject to the FLSA must provide notice to all current employees (regardless of part-time or full-time status) by October 1, 2013. For employees hired after October 1, 2013, the information is to be provided at time of hire. Employers are not required to provide a separate notice to dependents. The notice needs to:

Inform employees about the existence of the Marketplace including a description of the services provided by the Marketplace, and how employees may contact the Marketplace for assistance.
Notify employees that if their company's health insurance plan does not offer minimum essential coverage (covers less than 60 percent of costs), that the employee may be eligible for a premium tax credit through the Marketplace.
If the employee purchases a qualified health plan through the Marketplace, the employee may lose the employer contribution (if any) to any health benefits plan offered by the employer and that all or a portion of such contribution may be excludable from income for Federal income tax purposes.

The DOL has released two model notices on their website, one for employers not offering a group health plan and one for employers offering a group health plan. Employers may use these sample notices, or provide their own notice granted it meets the requirements listed above.

Employer ACA Marketplace Notice: Employers Not Offering a Group Health Plan

Here is a copy of the DOL notice for employers not offering a group health plan.

Employer ACA Marketplace Notice: Employers Offering a Group Health Plan

Here is a copy of the DOL notice for employers offering a group health plan.

Health Care Reform Resources for Employers

Survey: 56% of Small Businesses Don't Understand Health Care Reform

Christina Merhar — Fri, 10 May 2013 13:05:00 GMT

Most small businesses don't understand health care reform laws or the Health Insurance Exchanges, and most are concerned that health insurance prices will go up the next few years. These are a few key findings from eHealth's recent "Small Employer Health Insurance Survey (March 2013)." The survey was conducted in February 2013 and surveyed 260 small employers (all with less than 50 employees).

The survey provides insight on small business health insurance and small employers' understanding and perception of health care reform.

56% of Small Businesses Confused About Employer Mandate

According to the survey, 32% of the small businesses (all with under 50 employees) responded incorrectly that they would be required to offer health insurance in 2014. Additionally, 24% thought incorrectly that if they would pay a tax penalty for not offering health insurance. That's 56% of small businesses who don't fully understand how health care reform impacts them.

Small businesses with less than 50 FTE employees are not subject to the employer mandate (and tax penalties) to offer qualified, affordable health insurance to employees.

Click here to read full article and view source.

62% of Small Business Can't Explain Health Insurance Exchanges

The public Health Insurance Exchanges will be available in every state. Starting in October 2013, individuals can purchase individual/family policies through the Exchange and receive tax subsidies (if eligible) lowering the cost of their policy. There will also be a small business (SHOP) Exchange option, where small businesses can purchase group health insurance.

Businesses will be required to educate employees about the Health Insurance Exchanges. So, are small businesses knowledgeable about the Exchange? The survey found that in general, no. Sixty-two percent said they could not confidently define or explain the Health Insurance Exchanges, and 20% said they vaguely understood. Only 18% of small businesses said they understood the Health Insurance Exchanges well enough to explain them.

Click here to read full article and view source.

Small Businesses Think Health Care Reform Will Increase the Cost of Health Insurance

The survey showed that small businesses are concerned with the cost of health insurance after health care reform is fully implemented. A majority (59%) thought that insurance costs will go up in the next few years, 21% didn't know, 11% thought prices would go down and 8% thought prices would stay the same.

Click here to read full article and view source.

Small Businesses Offer Health Insurance for Moral Obligation, Recruitment

The survey also polled small businesses on the primary reason they offer health insurance. As in past, the top reasons remain moral obligation (44%) and recruitment of key employees (31%).

Click here to read full article and view source.

Small Businesses Rely on Health Insurance Agents for Health Care Reform Info

With the confusion of the ACA, where are small businesses turning to for information? The survey indicated that small businesses turn most to their insurance agent/broker, insurance company, small business association and government.

Click here to read full article and view source.

Do these trends accurately portray what you're seeing with small business health insurance and health care reform? Let us know in the comments below.

South Carolina Health Insurance Exchange Guide

Zane Benefits — Thu, 09 May 2013 20:00:00 GMT

This guide provides an overview of the South Carolina Health Insurance Exchange including the history of the Exchange, how the Exchange will operate, and Exchange information for South Carolina residents and small businesses.

All states have three options for setting up a state Health Insurance Exchange for 2014:

Build a State-Based Exchange
Enter into a State-Federal Partnership Exchange
Default to a Federally-Facilitated Exchange

In November 2012, South Carolina announced they would default to a federally-facilitated Health Insurance Exchange. The South Carolina Health Insurance Exchange will open October 1, 2013, for coverage beginning January 1, 2014.

South Carolina Health Insurance Exchange - History

Originally, South Carolina explored creating a state-based Health Insurance Exchange. In March 2011, Governor Nikki Haley created the South Carolina Health Planning Committee via Executive Order 2011-09. The purpose of the Committee was to recommend if and how South Carolina should establish a state-based Exchange. The committee recommended that South Carolina not establish a state-based Exchange siting ambiguous operational guidance and rules. In November 2012, Governor Haley informed the Department of Health and Human Services (HHS) that South Carolina would default to the federally-facilitated Health Insurance Exchange.

Click here for more information on South Carolina's Exchange planning process.

South Carolina Health Insurance Exchange - What is It?

The South Carolina Health Insurance Exchange will be operated through a federally-run Health Insurance Exchange (branded as the "Marketplace"). According to healthcare.gov, 726,847 or 18% of South Carolina's non-elderly residents are uninsured, of whom 684,987 (94%) may qualify for either tax credits to purchase coverage in the Marketplace or for Medicaid if South Carolina participates in the Medicaid expansion.

Through the Exchange, South Carolina residents will be able to shop for and compare insurance plans, access insurance premium tax credits, and be screened for eligibility in public assistance programs such as Medicaid and CHIP. The SHOP Exchange will be available to small businesses in South Carolina for businesses with 100 or fewer employees. Coverage starts January 1, 2014. More information on the federally-run Health Insurance Marketplace can be found here.

South Carolina Health Insurance Exchange - What Plans Will be Available?

All plans offered through the South Carolina Health Insurance Exchange will meet the federal ACA definition of a Qualified Health Plan (QHP). The plans will be offered by level of coverage for essential health benefits (EHB), to allow consumers to compare plans on an "apples to apples" basis. The four "metal" levels are: Bronze (plan pays 60%), Silver (plan pays 70%), Gold (plan pays 80%) and Platinum (plan pays 90%). More information on the types of plans that will be available, and the carriers offering plans in South Carolina, is expected by late summer 2013.

South Carolina Health Insurance Exchange - Role of Insurance Professionals & Navigators

The South Carolina Health Insurance Exchange will follow federal guidelines for insurance professionals selling policies through the Exchange, and for Navigators assisting consumers and small businesses.

Insurance professionals will be able to register with the South Carolina Health Insurance Exchange and receive commissions directly from the carriers (using their Exchange ID number and NPN to track sales). For more information see: Role of Agents in Health Insurance Marketplaces.

The South Carolina Health Insurance Exchange Navigator program will assist consumers in making choices about their health care options and accessing their new health care coverage, including access to premium tax credits for some consumers. The federal government will run the navigator program in South Carolina.

Lack of Competition on the Health Insurance Marketplaces?

Christina Merhar — Thu, 09 May 2013 12:55:00 GMT

The October 1, 2013 open enrollment of the Health Insurance Marketplaces is right around the corner. The mantra of the Marketplaces is "Choice, Competition and Clout for States." But which insurance carriers will offer health insurance plans in the Marketplaces? Will there be enough choice for individuals and small businesses? Will there be enough competition to keep prices low for individuals and small businesses?

Only 140 (vs. 900) Insurance Carriers Intend to Sell on Federal Marketplace

In late April, the deadline for insurance carriers to express intent of selling on the federal Marketplace was extended to early May. Gary Cohen, deputy administrator of CMS and director of the Center for Consumer Information and Insurance Oversight (CCIIO), admitted to the House Energy & Commerce subcommittee that only 140 insurers had expressed interest in selling qualified health plans (QHPs) on the federal Marketplace... as compared to the estimated 900 insures the administration originally predicted.

This trend is carrying over into states operating their own state-based Health Insurance Marketplaces. For example in Illinois, only six (6) insurance carriers had expressed intent to sell on the Illinois Health Insurance Marketplace as of May 1. The six (6) carriers would sell a combined 165 health policies. These numbers, too, are far lower than expected (Source: Washington Post).

Marketplace Carrier Competition to Mimic State Competition Now

The level of competition in the Marketplaces will vary by state and will likely mimic the current level of insurance carrier competition. For example, experts predict states that already have strong health insurance carrier competition, such as in Colorado, Minnesota and Oregon, will have more diverse plans offered through the Marketplaces and will attract more insurance carriers. Similarly, states that have near-monopolies now such as Alabama, Hawaii, Michigan, Delaware, Alaska, North Dakota, South Carolina, Rhode Island, Wyoming and Nebraska will have limited competition in the Marketplaces (Source: Kaiser Health News).

Why aren't more health insurance carriers expressing intent to participate? Is it because unhealthy consumers will flood to the Marketplaces in the first year? Is it because they still feel uncertain about federal and state rules? This is only speculation. The insurance companies have been mostly silent about their participation, or lack of participation in the Marketplaces.

Delayed SHOP "Employee Choice" Leading to Higher Costs for Small Businesses?

Another piece is that the the "employee choice" feature of the small business marketplace (SHOP) was delayed until 2015. The SHOP's "employee choice" feature would let small businesses offer employees a menu of insurance policies. This feature/requirement has been delayed until 2015, and in 2014 small businesses with fewer than 100 employees will be able to offer a single policy to their employees, as they have in the past. Without the "employee choice" feature, critics say the small business exchange will do little to pressure health insurance carriers to offer lower-priced plan options.

Will less competition and choice really impact the overarching goals of health care reform? Will more insurance carriers step forward?

What do you think? Let us know in the comments below.