Viewing posts from: September 2013

Exchange Premiums Released by HHS – Average 62% Increase for Women and 99% for Men

Posted September 25, 2013 by PHaynes

Have you been waiting months to hear how “affordable” plans are going to be under the Affordable Care Act?  Or, do you call it Obamacare, and you’ve been waiting to see how much the costs will be driven up?  Well, last night HHS (the US Department of Health and Human Services) finally let some data out.  Their press release is full of rosy predictions and positive spin and reflects the best topping they could put on this order of humble pie:  premiums “will be lower than originally expected.”  Unfortunately, the truth, however, is vastly different from the spin.

The Manhattan Institute for Policy Research has analyzed HHS’ numbers and has concluded the following:

  • Younger men, average increase 97 to 99 percent
  • Younger women, average increase 55 to 62 percent

Worst examples?

North Carolina -Women’s rates will triple. Men’s rates will quadruple.


  • Today, a 27 year old man in Memphis can buy a plan for as low as $41/month.  On the exchange, the lowest state average is $119/month.  That’s a 290% increase.
  • Today, a 27-year-old woman in Nashville can also buy a plan for as low as $58/month. On the exchange, the lowest-priced plan in Nashville is $114/month.  That’s a 197% increase.  Even with a tax subsidy, that plan is $104 a month, almost twice what she could pay today.
  • Today, women in Nashville can choose from 30 insurance plans that cost less than the administration says insurance plans on the exchange will cost, even with the new tax subsidy.
  • In Nashville, 105 insurance plans offered today will not be available in the exchange.

In stark contrast, the White House blog, chose to focus on other details and looked to other states when summarizing the data for their report.  “Nearly all eligible uninsured Americans (about 95 percent) live in states with average premiums below earlier projections. And nearly all consumers (about 95%) will have a choice of health insurance companies, each of which offers a number of different plans,” wrote Jeanne Lambrew, deputy assistant to the president for health policy.

Earlier this month, Forbes magazine and some colleagues from the Manhattan Institute published an interactive map that detailed PPACA/Obamacare’s impact on individually-purchases health insurance premiums in 13 states and the District of Columbia.  They concluded that premiums increased in those states by an average of 24 percent.  [Those states were mostly “blue” states that have their own, state-based exchanges].

With less than five days to go before Open Enrollment is slated to begin, HHS releases a press release that summarizes a selection of the premium data.  They “bolster” this press release with the release of a light, 15-page report.

HHS’ Spin?

What do you really want to know?  You want to know how much rates will go up NEXT year, under PPACA/Obamacare, relative to THIS year, right?  Well, when the HHS announces “Premiums nationwide will also be around 16 percent lower than originally expected”, they aren’t answering your question.  In fact, they are muddying the issue.  They are taking what the CBO (Congressional Budget Office) projected the rates to be in 2016 and comparing those rates to HHS’ own findings.  It may be overly charitable to call HHS’ summary “spin”.

As Avik Roy reports in Forbes, former CBO director Douglas Holtz-Eakin agrees that HHS is hiding the true analysis from consumers. “There are literally no comparisons to current rates. That is, HHS has chosen to dodge the question of whose rates are going up, and how much. Instead they try to distract with a comparison to a hypothetical number that has nothing to do with the actual experience of real people.”

And, today House Ways & Means Chairman David Camp (R-MI), said, “Today, the Administration confirmed that the President will not keep his promise that Americans will see a $2,500 decrease in their premiums.  Their (HHS’) announcement made clear that American across the country will pay more for health care.  Hardworking people in the state of Michigan could pay almost 100 percent more than they do today.  American need relief from this unworkable law, it is only fair.”


HHS Issues New Sample HIPAA Privacy Notices

Posted September 20, 2013 by PHaynes

HHS’ Office for Civil Rights (OCR) and Office of the National Coordinator (ONC) for Health Information Technology have collaborated to develop model Notices of Privacy Practices (NPPs) for health care providers and health plans to use to communicate with their patients and plan members.


The HIPAA Privacy Rule gives individuals a fundamental right to be informed of the privacy practices of health plans and health care providers, as well as to be informed of their privacy rights with respect to their personal health information. Health plans and covered health care providers are required to develop and distribute a notice that provides a clear, user friendly explanation of these rights and practices.

Many entities have asked for additional guidance on how to create a clear, accessible notice that their patients or plan members can understand. In response, OCR and ONC have provided separate models for health plans and health care providers. These options include:

  • Notice in the form of a booklet;
  • A layered notice that presents a summary of the information on the first page, followed by the full content on the following pages;
  • A notice with the design elements found in the booklet, but formatted for full page presentation.
  • A text only version of the notice.

The models reflect the regulatory changes of the Omnibus Rule and can serve as the baseline for covered entities working to come into compliance with the new requirements. In particular, the models highlight the new patient right to access their electronic information held in an electronic health record, if their provider has an EHR in their practice. Covered entities may use these models by entering their specific information into the model and then printing for distribution and posting on their websites.

  • Booklet
  • Layered Notice
  • Full Page
  • Text Only
  • Questions and Instructions

For more information about the HIPAA Privacy Rule and the Notice requirements, see the HHS’ guidance here.

  • A covered entity must make its notice available to any person who asks for it.
  • A covered entity must prominently post and make available its notice on any web site it maintains that provides information about its customer services or benefits.

NPP Employers & Health Plan Sponsors – NPP (“Notice of Privacy Practices”)

HHS’ Instructions

Questions and Instructions for using the Model Notices

Providers – NPP (“Notice of Privacy Practices”)

2013 Revised Healthcare Reform Timelines, Version 11

Posted September 12, 2013 by PHaynes

If you want to see 10 pages of health reform in a 1 page timeline (well, 1 page for Employers and 1 page for Employees) then please visit our website (

But, if you are looking for details specific to just a certain year or plan, then you can’t do better than this implementation timeline from The Kaiser Family Foundation.

AP Benefit Advisors’ Timelines

IRS Completes Health Penalty Rules

Posted September 11, 2013 by Megan DiMartino

By Allison Bell,

Who will really have to pay the penalties to be imposed on the uninsured next year?

The Internal Revenue Service has tried to answer that question in a new batch of final regulations on the Patient Protection and Affordable Care Act individual coverage ownership mandate provisions, also known as the rules on “shared responsibility” for maintaining “minimum essential ”

The “MEC” rules, in the PPACA-created Section 5000A of the Internal Revenue Code, are similar to but somewhat different from the rules for figuring out which taxpayers qualify for the tax credit subsidy.

The final regs, based on a February draft, are set to appear in the Federal Register Friday. Officials are estimating that 36 million taxpayers will have to fill out MEC-related paperwork, and that figuring out whether the shared responsibility rules apply will take an average of about 12 minutes per taxpayer.

As expected, the IRS has ruled that unions and other organizations, including professional employer organizations — PEOs — can provide coverage that meets the MEC standards.

An employer’s self-insured plan will also meet the MEC standards, whether or not the self-insured plan could be sold in a state’s large-group or small-group insured market.

The IRS has not yet decided what to say about an employer that simply gives workers cash and sends them out to buy their own individual health coverage, through the new public exchange system, a private exchange, or wherever they can find coverage.

The IRS will define ordinary Medicaid coverage as MEC.

Pregnant women with Medicaid will not have MEC, because some states offer pregnant women skimpy forms of Medicaid, officials said.

The IRS has not yet decided what to do about “medically needy” people with Medicaid — nursing home residents and others who, technically, are not poor, but qualify for Medicaid because of high medical expenses. The U.S. Health and Human Services secretary may decide that some of them have MEC, IRS officials said.

IRS officials also:

– Decided taxpayers should have to take responsibility for health penalties for any dependents they have, whether they are “qualifying children” or not, and whether the taxpayers claim the children or not.

– Held that neither adoptive parents nor parents placing a child up for adoption need to worry about a shared responsibility penalty during the month that the child is adopted.

– Suggested that, to keep things simple, people can get out of paying the penalties if they can show that they and their dependents have had coverage for at least one day per month for at least nine months out of the year and haven’t abused the system by intentionally buying insurance that protects them for just one day per month. “The IRS will reconsider this rule if future developments indicate that the rule is being abused,” officials said.

IRS Proposes New Rules on Employer Mandate

Posted September 6, 2013 by PHaynes

On Sept. 5, 2013, the IRS released two long-awaited proposed rules governing health care coverage information reporting requirements. These requirements were originally supposed to apply to coverage in 2014 but the IRS has decided to delay these reporting requirements until 2015, in conjunction with the employer mandate delay. [Read prior news about the delay here].

The proposed rules implement reporting requirements for large employers and health insurance issuers, sponsors of self-insured plans and others. The first proposed rule generally requires large employers (i.e. those with 50 or more full-time employees) to report their compliance with the employer mandate to the IRS and the level of coverage they provide to their employees. Employers must provide similar information to their employees to enable the employee to determine his or her eligibility for a tax credit. The second proposed rule imposes similar reporting requirements on health insurance issuers, sponsors of self-insured plans, government agencies, and other individuals that provide minimum essential coverage under PPACA (aka The Affordable Care Act, aka “Obamacare”).

The first coverage reports to the IRS under both rules, which will cover the 2015 calendar year, are due by Feb. 28, 2016, with subsequent reports due annually thereafter by February 28 for the previous calendar year. The first coverage reports to employees under both rules, covering the 2015 calendar year, are due by Jan. 31, 2016, with subsequent reports due annually thereafter by January 31 for the previous calendar year.

Additional analysis will be shared once we’ve compiled and worked through these two notices (the 72 page notice for Reporting by Applicable Large Employers on Health Insurance Coverage Offered Under Employer-Sponsored Plans and the 42 page notice Information Reporting of Minimum Essential Coverage).


We are also looking for your input to add to our comments to the IRS.  All comments to the IRS are due by early November 2013 and a public hearing has been scheduled for November 19, 2013, at 10 a.m., in the auditorium, Internal Revenue Building, 1111Constitution Avenue NW., Washington, DC.  Reports to each covered-employee are due by January 31, 2016 and data/reports to the IRS are due by February 28, 2016.

The Treasury Department is highlighting this as an attempt to “streamline” the reporting process.  They outline a number of possible ways under which reporting could be lessened for some groups.

Links to the Proposed Rules:

Top Benefits Legislation and Update Blogs

Posted September 5, 2013 by Megan DiMartino

Benefits legislation throughout the United States has rarely been as substantive and sweeping as it has in the last few years. Many of these legislative changes are just beginning to take effect, and some are already being rewritten. On AP Benefit Advisors Benefits News we keep you informed of all the benefits legislation updates as they take place, and evaluate the impact they might have on your organization. Here are a few of the most recent benefits updates:

Links to Federal and State Exchanges/Marketplaces

Posted September 4, 2013 by PHaynes

Listed below you will see the website addresses for the Federal Exchange (now called the Marketplace) as well as each State’s Marketplace.   If your state is not listed please use the Federal Marketplace (link) and you’ll receive information about the Federal Exchange/Marketplace.

*Utah-based individuals must use However, Small Business Health Exchange/SHOP users may use this link.

Things you’ll need when applying:

  • Social Security Numbers for all applicants that want/need coverage
  • Employer and income information for everyone in your household (for example, from pay stubs or W-2 forms-Wage and Tax Statements)
  • Policy numbers for your current health insurance plans
  • A completed Employer-Coverage-Tool (page 2 of the Federal Checklist) for every job-based plan you are eligible for.

You can apply for 2014 coverage as soon as October 1, 2013.  Please note:   enrolling in a State or Federal Marketplace/Exchange is not a status change that would permit you to drop your Employer-Sponsored-health-plan midyear.  In many cases, you will need to make a Marketplace/Exchange election during their designated Open Enrollment periods and later drop your Employer-Sponsored-health plan at your employer’s next open enrollment.

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