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Membership Minute

The First 5 people in Florida to recruit 2 NEW MEMBERS from January 8 – April 8, 2014 will receive a $50 Visa Gift Card. Plus, that’s half way to the 4 new members needed for a $250 gift card from NAHU! –ONLY 2 REMAINING!

The membership campaign will run from July – April 30, 2014 (the end of the membership GAIN contest). Members have unlimited opportunities to be rewarded for recruiting new members!

For the first four new members you recruit from July 1 – April 30, 2014, you get to choose to:

• Have your membership dues waived for one year; OR
• Receive a $250 American Express Gift Card

For every additional four new members you recruit from July 1 – April 30, 2014, you will:

• Receive a $250 American Express Gift Card

Carolyn Grant with PROVinsure

PPACA “Fixit Bills” Bill #1 would exempt veterans who receive benefits through TRICARE from being counted as an employee that can trigger the employer mandate; #2 would exclude emergency services volunteers from the same employer mandate calculation.

Sustainable Growth Rate (SGR) the way Medicare payments to doctors are calculated has caused great concern on both sides of the aisle, however, they cannot agree to a fix.

With 17 days to go, it doesn’t look like the Administration will make their number of 6 million. As of the end of February there are only 4.2 million enrolled. HHS Secretary Kathleen Sebelius when grilled by the House Ways and Means Committee could not answer the questions, “how many of the policies have been paid for?” Her answer was that they do not collect that information; this is contrary to many large carriers that report this information has been turned into the White House. According to Politico, the four top insurance companies have reported that about 15%-20% of those signed up have not paid their first monthly premium.

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.

The CBO also confirmed and projected that the risk corridor would actually produce $8 billion in revenue for the government.

This week, The Wall Street Journal broke the news of another treasure hidden within a recent complicated regulatory document, but questions remain about how valuable it might be. A technical bulletin issued last week (the same one that says that retroactive tax credits may be eligible for people who had to buy non-marketplace coverage due to technical glitches) also extends a December 2013 policy that allows Americans whose coverage was cancelled to opt out of the mandate altogether to seek a hardship extension from the law’s individual mandate through 2016. Originally, these individuals were allowed to seek a one-year waiver.

As you may know, the Administration released a 700-plus-page proposed regulation that would transform the Medicare Advantage and Medicare Prescription Drug Program — and not for the better. In short, the proposed regulation eliminates choices for seniors, raises seniors’ premiums and drug costs, and does great harm to agent commissions. It also would severely limit seniors’ choice in providers, limit their plan selection choices and hinder their access to the services of licensed health insurance agents to help them with their coverage needs. NAHU sent official comments to CMS on the proposed rule last week. In particular, we highlighted our concerns about the proposed agent commission structure in the rule and the impact those changes will have on the ability of all beneficiaries to seek the services of a certified agent.

The Obama Administration announced this afternoon that they are extending the federal Preexisting Condition Health Plan (PCIP) for high-risk individuals by one more month (till April 30) before folding it into the exchanges. This is the third extension of PCIP so far, which was supposed to end on December 31, 2013. The additional month is intended for those “who have not yet found new health insurance coverage through the Marketplace,” according to the Administration’s announcement. It’s unclear where the additional funding for this coverage extension will come from, but NAHU supports this transition relief for high-risk individuals.

Capital Conference talking points and other materials used can be found here.

We’re currently accepting nominations for the 2014-2015 Board of Directors. Interested or want to nominate someone to serve, contact your Nominations Committee:

Ashley Wynkoop , Nominations Chair (321) 247-0057
ashley.wynkoop@cigna.com