CFAHU April 2014 Newsletter
Calendar of Events
4/4/14 FAHU Leadership Training
4/5/14 FAHU Board Meeting
4/9/14 CFAHU Board Meeting
4/9/14 CFAHU Luncheon
4/25/14 CFAHU NAIFA CF Charity Golf tournament
5/14/14 CFAHU Board Meeting
5/20/14 CFAHU Luncheon
We will be hosting NAHU President, Tom Harte, and he will be sharing the latest snipets from Washington DC on health care reform BUT, more
BLT Iceberg WedgeJerk Chicken with Mango Pineapple SalsaMashed Cinnamon Sweet PotatoesBroccoliniWarm Rolls with ButterIced Tea, Water and CoffeeStrawberry Shortcake
Lunch cost is $10 for Members, $35 for Guests. CE is free for members, $20 for non-members.
RSVP by 8:00 AM on Monday 4/7 if you will be attending to firstname.lastname@example.org.
CFAHU & NAIFA Central Florida 2014 Charity Golf Tournament
Friday, April 25, 2014
12:00 Noon Registration, 1:00 PM Shotgun StartMetroWest Country Club2100 S Hiawassee Road, Orlando, FL 32835Entry Fee is $100 per Golfer to include box lunch and post-tournament buffet.Proceeds to benefit the Russell HomeSponsorship opportunities available here.Thank you to the following Sponsors:
Title Sponsor Signage Sponsor Trophy Sponsor
And Hole Sponsor: The Vaughn Group, Inc.
- Have your membership dues waived for one year; OR
- Receive a $250 American Express Gift Card
- Receive a $250 American Express Gift Card
Finally, we may have some MLR relief, although not on broker commissions. HHS has acknowledged that all the carriers have had to invest cleaning up messes related to the reform rollout cost a lot of money, and that it probably isn’t exactly fair to penalize them for it on their MLR calculations.
- HHS has also promised a new rule on navigators, specifically noting that they will be looking at identifying state laws applying to navigators or other assisters or application counselors that are preempted by federal law, prohibiting certified application counselors from receiving compensation from insurers, requiring application counselors to be recertified annually, and authorizing civil money penalties against navigators, non-navigator assisters and certified application counselors who violate federal requirements.
- Next year’s open enrollment will be a month longer than originally planned—November 15, 2014, through February 15, 2015.
- If a state wants to switch to a state-based exchange this year, or is thinking about reverting back to a federal exchange because its state-based is so troubled (cough, cough, Oregon and Maryland), they need to let HHS know by June 15
- In the SHOP exchanges, insurers may not offer composite premiums to employers where employee choice is permitted. However, employers buying SHOP coverage will be allowed to make up their own composite premium under specified parameters if the employer contributes a fixed dollar amount.
- Next year in the non-SHOP group marketplace, if a carrier wants to, it can issue composite rates to small groups provided that it charges the tobacco rate increase separately by person and locks in on one composite rate for the whole year. Right now, a carrier can’t composite rate unless a state law specifically allows it and the provision for next year is not mandatory, so you will likely see variation in the marketplace.
- Next year, if a carrier does elect to issue composite rates, two tiers of composite premiums must be offered—one for family members age 21 and older and another for family members below age 21. HHS can approve state variations on tiered rating, so your state can request to go back to the old-school four-tier composite rate methodologies, but it will require some legwork on their part.
- Web brokers will be able to work with agents to sell SHOP plans too, and they will have to follow all of the existing individual market rules.
- The out-of-packet maximums have been set for 2015: $6,600 for self-only coverage and $13,200 for family coverage. The small-group deductible cap has also been set at a maximum of $2,050 for self-only coverage and $4,100 for family coverage.
- Stand-alone dental plans also got new cost-sharing rules. They cannot have cost-sharing exceeding $350 for one covered child and $700 for two or more covered children. Dental plans must achieve an actuarial value of either 70% or 85%. Stand-alone dental plans may not offer composite premiums to small groups where the employer offers employee a choice of dental plans.
- None of the extended 2013 plans qualify for any of the law’s three risk-adjustment mechanisms (aka, the Three Rs requirements).
- The risk-adjustment piece of the Three Rs requirement, which is the one that facilitates the transfer of money from insurers that have lower risk beneficiaries to insurers that absorbed more than their fair share of higher-risk enrollees will have a user fee of 96 cents per member per year to be charged to individual and small-group insurers covered by the program.
- For 2015, the reinsurance program fee will be $44 per covered life and the program coverage can apply to individual and small-group claims that exceed $70,000 and will cover 50% of the cost of those claims up to $250,000. Also, the rule lowers the 2014 attachment point to $45,000.
- Self-insured plans that are fully self-administered (no kind of TPA assistance whatsoever) are exempt from the reinsurance fee for 2015 and 2016 are similar to those found in the federal flood and terrorism insurance programs.
Day on the Hill talking points can be found here.