Group items tagged

Proposed and final rules issued this spring surprised many by failing to bar large employers from offering insurance policies that could exclude benefits such as hospitalization. Offering bare-bones policies may result in some fines, but that expense could be less than the cost of offering traditional medical coverage. For large employers, "the feds imposed no minimum standard on how skimpy that coverage can be other than to say, in essence, it's got to be more robust than a dental plan or a vision plan," said Ed Fensholt, a senior vice president at insurance broker Lockton Companies. "We had customers looking at offering some relatively inexpensive and skimpy plan designs to satisfy the individual mandate at modest cost.”

The bare-bones plans cannot be offered to small businesses with fewer than 50 workers, or to individuals buying coverage through new online marketplaces that open for enrollment Oct. 1. But benefit experts expect some larger firms that buy outside the marketplaces or that self-insure to consider them. 

Skimpy insurance under the Affordable Care Act won’t be quite the same as it is now. Under the new rules, capping the dollar value of annual benefits isn't allowed, but excluding entire categories from coverage - such as hospital stays - is permitted, say benefit consultants. That's another way of keeping costs down.

Unless trends change significantly in 2013, the key determinants of whether a particular physician will be able to avoid a Medicare pay-for-reporting penalty are his or her specialty and the state in which the doctor practices

Once we understand the rules, we are pretty good at playing by them,” said Lee Hilborne, MD, a professor of pathology and laboratory medicine at the David Geffen School of Medicine at the University of California, Los Angeles.

An employee who worked 1,800 hours over the course of the measurement period would average 34.6 hours per week, and would thus be eligible for coverage.  The “administrative period,” which can be up to 90 days, is the period where you enroll these eligible employees. The “stability period,” which has to be at least as long as the measurement period, defines how long they will have coverage.

Just remember that, starting in 2015, employees always have to be in a stability period for full compliance. So employers should not wait until October of next year to start planning.  Even though the mandate is delayed, employers still have to prepare.