New pricing at renewal. "Community Rating" has taken the place of risk assessment when determining the rates for a group. Under the Affordable Care Act (ACA), all small group (1-50 employees) plans will have the same rates for the same demographics. Some of you may experience a drop in rates if you were rated higher on the risk factor scale, and others of you could see a significant increase, if you were a low risk group.
Under ACA, pediatric dental is mandatory for children ages 18 and under. Insurers like HealthPartners, Medica, and Preferred One have built this in to all of their medical plans whether you have children or not. Blue Cross adds it to their family plans, but it can be extrapolated if the member can prove they have other qualified dental coverage. The premium rate is then adjusted. The dental covers preventive care twice a year at 100%, and services like fillings, extractions, crowns, etc., are subject to the medical plan's deductible and coinsurance. Cancelling an individual dental policy in exchange may then not be a wise decision.
Pediatric Vision. Under ACA, an eye exam, glasses, and/or contacts must be covered for children ages 18 and under.
EHB or Essential Health Benefits (covered in our last newsletter), are the 10 required essential benefits required under ACA, including pediatric services for oral and vision care.
Another restriction is that waiting periods can no longer be more than 90 days for new employees.
Also, employers with more than 200 employees that offer health coverage will be required to automatically enroll new full-time employees in coverage. Employees may then opt out.
Written summaries of Coverage must state whether the plan provides minimum essential coverage and must be provided to all participating and new employees. Your plans will comply if they are not already, at your 2014 renewal.
Small Employer Tax Credit maybe be available for you. This credit has been in effect since 2010, however, beginning in 2014, eligible small employers will only be able to access this tax credit through the State Exchange MNsure's SHOP. Small employers may qualify if they employee up to 25 full-time equivalent (30 hrs) employees, the average annual wages are less than $50,000, and the employer contributes at least 50% of the premium.
Employees not eligible for your group plan may be eligible for a premium discount or subsidy through the MNsure Exchange for a qualified health plan (QHP). However, if your employee is eligible for your group plan, they would not be eligible for a subsidy; they still could enroll in an individual plan without the premium discount. Enrollment for an individual plan can be outside of the MNsure Exchange if you do not qualify for a subsidy, which I would highly recommend since there are still many problems with the functionality of MNsure. I am also MNsure certified and can assist anyone in selecting an appropriate plan inside and outside of the Exchange, so don't hesitate to contact me with questions or if you need assistance.
This will be a year of watch and see. There are so many challenges yet ahead with implementing all of the ACA changes, and I hope it was not all for nothing. Good intentions but a huge undertaking mixed with mis-guided politics. We will keep you informed as best as we can, and know that we are here to help you.
