Health care administration under the Affordable Care Act is tricky enough, but none more so than in California. Currently there are two options for the golden state – either consolidating into one regulatory agency or combining between two agencies, the California Department of Insurance (CDI) and Department of Managed Health Care (DMHC), to properly maintain a system that will ensure consumer protection. Those supporting consolidation believe that the fewer hands in the pot will avoid confusion and conflicting interpretations of federal laws. Oversight between two entities can also result in added government and administrative burdens, and difficulty in monitoring what is being purchased and sold in the marketplace.
Posts Tagged ‘Universal Health Care’
Health Insurance Regulation in California Under Health Care Reform
Tuesday, September 13th, 2011Health Insurance Exchanges
Friday, August 5th, 2011Whether you are for it or against it, health care reform marches on. As states scramble to either fight the constitutionality of the bill, or create models for health care administration, January 1, 2014 edges ever closer and brings with it the start of health insurance exchanges. These exchanges are proposed to be implemented by January 1, 2014. In theory, these exchanges purport to provide individuals and businesses the same buying power as larger companies by pooling risks and premiums. However, how these exchanges operate remains to be seen.
Preventive Services and Your Health Plan
Thursday, December 23rd, 2010With health care reform came certain guidelines that would be implemented right away. One provision states that health plans must cover preventive care at 100% – with no cost sharing (i.e. co pays, deductibles, or coinsurance). However, does this mean you can rush out to take care of all those things you have been postponing? Well, yes and no, as many items listed under the government’s guidelines are age and gender specific. Add to that the need to ensure your provider codes the preventive care correctly so it will be covered completely, this can get tricky. Here are some important things to note once your plan has added the preventive care benefit on your plan:
Calfornia First In Line To Set Up Health Care Exchanges
Thursday, December 2nd, 2010Governor Schwarzenegger recently signed two bills (SB 900 and AB 1602) which puts California at the forefront of establishing health insurance exchanges. Although these exchanges won’t be open for business until 2014, this bill will start California on the road to implementing this vital piece of health care reform. Federal guidelines do outline how the exchanges work, but each state is allowed leeway to create the exchange to work with their individual state’s needs. Proponents of this bill believe that as California becomes the first state to being the framework, it is expected that other states will be looking to California’s model for guidance in how to create their own structures. Opponents fear that this surely means an increase in taxes and fees.
Blue Shield Ends 12 Month Rate Guarantees
Thursday, October 28th, 2010
Should You Grandfather Your Group Plan?
Thursday, October 21st, 2010
Many small business owners are now facing the tough decision as to whether they should grandfather their plans, or make necessary changes to bring down their costs. There are pros and cons to both sides, and the decision should not be a rushed one. Therefore, we want to provide some guidance tools to help you make the right choice.
With the recent rate increases there may be a desire or need to choose a higher deductible plan with lower rates.
- If you increase the deductibles, coinsurance, or maximum out of pocket exposure, your new plan will be subjected all changes in the recently passed healthcare reform act.
Grandfathered Plans and Your Options Now
Friday, September 24th, 2010What does it mean to lose “grandfathered status”? This may or may not be a concern to you. In a nutshell, this means is your plan will now have to comply with all regulations mandated by health care reform. One of the most important things to know is that along with guarantee issue coverage for all applicants, premium ratios cannot exceed 3:1. Currently, most carriers implement rate variations every 4 years — i.e. 30-34, 35-39, and so on and so on. With the reduction of rate brackets (from 8 to 3), one can only imagine that premiums for younger clients will be much higher than they currently are in order to meet this requirement.
Rules Governing Grandfathered Health Plans
Monday, August 30th, 2010One outstanding declaration in President Obama’s health care reform plan is the promise people who like their current health plan will have the option to keep it. How will this work? The plan is to grandfather in policies in order to “protect the ability of individuals and businesses to keep their current plan while providing important consumer protections that give Americans – rather than insurance companies – control over their health care”, per the U.S. Department of Health and Human Services, Labor and Treasury. Also, “The new regulation also provides stability and flexibility to insurers and businesses that offer health insurance coverage as the nation transitions to a more competitive marketplace in 2014 when businesses and consumers will have more affordable choices through exchanges”*.
Many Important Health Care Reform Changes for Young Adults
Thursday, June 17th, 2010While many young adults faced losing coverage as they aged off their parent’s plan, had no coverage in the case of an unexpected pregnancy, or merely had the bare necessities covered by their school plans, all can breathe a sigh of relief as health care reform promises to end their fears.
As mentioned in earlier posts, the most immediate change is coverage will be extended to overage dependents, as long as they are not offered other employer sponsored coverage, up through their 26th birthday. This helps ease the burden of uninsured claims, as many of these adult children would wait over two years before attempting to obtain their own coverage.
Health Care Reform – where it is headed?
Monday, May 17th, 2010We are now well into the first year following the passing of the health care reform bill. However, we still are not completely sure of what the changes are going to be, and how it will affect all of us. While some portions of the bill are clear cut, such as extending coverage to overage dependents, many of the larger concepts remain to be fully explained. How are small and large businesses going to be able to afford coverage for their employees? How will the tax breaks help or hurt? How can coverage for all Americans remain affordable?
