Health Care Reform Update — Grandfathered Plans

The Department of Health and Human Services, along with other government Agencies, continues to provide guidanceregarding how and when both insured and self-insured health plans can keep their “grandfathered” status. Employers may keep their existing plans, provided those plans were in place on March 23, 2010, while providing new benefits required under the reform measures. However, plans will lose this “grandfather” status if they choose to significantly cut benefits or increase out-of-pocket spending for their employees. Further, employees participating in plans that make such changes will gain new consumer protections.

We’re continuing to learn about the detailed layers of health care reform, including:

• Plans will not lose grandfathered status for voluntary changes made to increase or adopt consumer protections in the health reform law, or to conform to legal rules. However, plans that decrease covered benefits, increase enrollees’ contributions or cost-sharing methods, or change annual or lifetime limits will generally lose grandfathered status. Perhaps of more significant importance, insured plans generally cannot change carriers without losing grandfather status.
• Coverage subject to a Collective Bargaining Agreement (CBA) in effect on March 23, 2010, must comply with the same coverage and cost-sharing standards — such as eliminating certain lifetime limits — at the same time non-CBA grandfathered plans must comply. However, insured CBA coverage will be considered grandfathered until the last agreement in effect on March 23, 2010, expires — even if the insurance carrier changes in that period.
• These grandfather regulations apply separately to each benefit package available under a group health plan. For example, it appears that if a group health plan includes several benefit options, such as a PPO or HMO, the loss of grandfathered status for one benefit package will not affect the status of other packages.
• Retiree-only plans, as well as limited-scope dental and vision plans and other “excepted benefits,” remain exempt from the health reform coverage and cost-sharing standards, including the bans on lifetime and annual dollar limits.

It should be noted that plans claiming grandfathered status must include a statement (model language to be provided) and contact information in plan materials given to participants. Plans must keep records of plan terms in effect on March 23, 2010, and any other documents that verify or explain grandfathered status.

For further information, log on to Healthreform.gov.

Lee Butler, SPHR, Managing Director

Health Care Reform: Important Things that You Need to Know

Along with the year long contentious debate over the recently signed Health Care Reform bill, there have also been many misconceptions and falsehoods spread that the Health Care bill is bad for small business. Truth be told, as with most legislation, there is both some good and some not so good. The good is that this bill will do much to counter the skyrocketing costs of health Insurance while cutting a projected 138 billion dollars from the federal deficit between 2010 and 2019 and an additional 1.2 trillion over the second decade which could, in turn, reduce taxes and interest rates. Additionally, Starting with 2010 taxes, small businesses with fewer than 25 employees that pay at least 50% of the health care premiums for their employees qualify for a tax credit up to 35% of your premiums (50% after 2014 if you purchase insurance through an exchange). How much of a credit you’ll get depends on the number of employees you have and their average wage. NOTE, This tax deduction is not available to sole proprietors, so you may want a different corporate legal form. The not so good is that there are no caps on health insurance premiums. This may cause insurance companies to hike rates significantly before they have competition in 2014. If a company has more than 50 employees, They will have to provide coverage, or pay a fine beginning in 2014.

These are a few of the highlights. Check out the details in the Small Business Majority’s, “What’s in Health Care Reform for Small Businesses” , detailed fact sheet.  The Small Business Majority was founded by small business owners to present an impartial view of the issues that have the greatest impact on small businesses.

~Kevin Lawton

An Argument for Privatizing Health Care!

Today my 17-year-old daughter returned from Senegal, Africa with her French class. I admire the tenacity of the 11 students and 2 teachers who visited the third world country to experience a culture unlike their own. Having participated in a teacher exchange program, the students at Oakton High School visited their former exchange teacher, Mr. Jobe,  who returned to his native country in June of 2009.  The group was in Senegal for a period of 10 days.

What does this have to do with health care you say? I regress only temporarily to tell you that in order to prepare for a trip of this magnitude it became necessary to ensure that my daughter was up on those shots necessary to ensure her protection. Hepatitis A, Typhoid, Yellow Fever, Meningitis, even HINI and the ‘regular’ strain of flu.

Imagine my dismay when her life long doctor’s office (she has been treated there since she was an infant) could not advise me on the appropriate preventive measures we would need to take to mitigate her risk of infection and disease. They referred me to a private health care provider, HealthSmart Vaccines. www.healthsmartvaccines.com Not surprisingly, that was the same group that came onsite to the Helios offices last fall and administered the Flu vaccine for all interested parties.

My experience with the staff at HealthSmart exceeded my expectations! They were not only knowledgeable regarding the specific vaccines we would need, but educated us both on the climate, culture and helped us understand what to expect in general.  I can’t express the comfort I received from Kathy Miller, the RN that vaccinated Amanda.  Kathy agreed to see us on my schedule and there was never a wait!  I tell you, it was a phenomenal experience in customer service. Kathy provided us an incredible amount of comfort and genuine caring.  Although a number of the vaccines were not covered by insurance (nor was the malerone–antimalaria pills), the experience to me was absolutely worth the out of pocket expenditure.  Dick Miles, President of HealthSmart,  also took the time to welcome us and meet Amanda on one of our visits.  (We had to go back when Amanda’s doctor’s office was out of seasonal flu shots.) How do you put a price on comfort and reassurance? Especially when your child visits a third world country with the threat of new disease and limited health care options should she need them abroad.

HealthSmart also makes house calls… hmmmm…. sounds like a fabulous new way to consider health care to me!

~Kathy Albarado