By Kate Ranta on Feb 3, 2014 5:30:53 PM
As a valued advisor for your clients, it’s beyond important that you remain informed about all things ACA. We’ve got a few key updates for you.
In mid-November, President Obama announced a transitional policy that allows for the renewal of non-ACA compliant plans into 2014. Following the announcement, the Centers for Medicare & Medicaid Services (CMS) sent state insurance commissioners a letter that explained,
“Health insurance coverage in the individual or small group market that is renewed for a policy year starting between January 1, 2014, and October 1, 2014, and associated group health plans of small businesses, will not be considered to be out of compliance with the market reforms specified below under the conditions specified below.”
The specified market reforms include:
- Community rating (rule that prevents health insurers from varying premiums within a geographic area based on age, gender, health status or other factors)
- Prohibition on excluding preexisting conditions
- Requirements to cover essential health benefits, provide minimum actuarial value (percentage of total average costs for covered benefits that a plan will cover), and limit cost sharing
The conditions include:
- The issuer must explain to enrollees the provisions of the ACA with which the policy is not complying and that enrollees have the option to purchase a policy through an exchange
Several states have agreed to implement the transitional policy, including Florida. Others are undecided, or are choosing not to implement the transitional policy, such as New York.
The Small Business Health Options Program or SHOP is a separate portion of the federal and state exchanges where employer groups can purchase plans for their employees. With SHOP products, employees can choose from any carrier offering a Qualified Health Plan (QHP) or Qualified Dental Plan (QDP) in the federal or state exchanges.
An important development is that the federal SHOP market was delayed in 2014. Groups can go on healthcare.gov to browse and compare SHOP plans. They’ll have to work with an agent, broker or insurance carrier to enroll. This is good news for brokers, who can take a proactive approach and contact their small groups to offer assistance.
Remember, you can encourage your groups to check out www.SolsticeCare.com for comprehensive benefits to meet their health care needs.
Are you Exchange Certified?
In order to sell on the federal marketplace, you need to be certified. The Center for Consumer Information and Insurance Oversight has great resources and instructions on how to get certified (there are a few steps): http://www.cms.gov/cciio/programs-and-initiatives/health-insurance-marketplaces/a-b-resources.html. And, here is the login link for the marketplace certification: https://marketplace.medicarelearningnetworklms.com/Default.aspx.
Keep in mind, some states (such as New York, for example) have their own certification requirements. Be sure to check out the proper steps you need to take so you can get to selling ASAP!