The National Association of Health Underwriters (NAHU) is a non-profit professional association organized to promote the common business interests of health insurance brokers and agents. According to the NAHU Website, it aims to advance public knowledge of the need and benefit of health insurance products and services.

In a recent article in TIME, Kate Pickert suggests that the first victims of health reform will be insurance agents and brokers. 

The National Association of Insurance Commissioners (NAIC) is a professional association for state insurance commissioners.  

A state insurance commissioner is the chief insurance regulator in most U.S. states.  Generally, the insurance commissioner heads the state's insurance division, often referred to as the Department of Insurance.  

The department of insurance (DOI) is the state government department or division responsible for the regulation of insurance regulations.

The "unknowns" associated with medical loss ratios (MLRs) calculations have been the cause of increased anxiety in the broker community.  Beginning January 1st, 2011, the new medical loss ratio requirements will be in full force.

The health reform law requires that health insurers spend at least 80% (the "medical loss ratio" or MLR) of individual and small group premiums. If an insurer does not meet the "medical loss ratio", it must pay rebates to its customers.

On August 18, the National Association of Insurance Commissioners (NAIC) approved the new form (called the "blank") that health care plans must submit in the future to report the percentage of premiums they spend on health care. The next step is to write a regulation for calculating the medical loss ratio.

In this regulation, the NAIC will define which health care and quality improvement efforts count as "medical loss." The health reform law gave the NAIC the task of guiding Health and Human Services on how to classify expenditures, but HHS will have the final say.

Click here to access the blank form.

A medical loss ratio (MLR) is the percentage of insurance premium dollars spent on health care claims.

A common question we receive at Zane Benefits is: "Can I Offer a Defined Contribution Health Plan to 1099 Contractors?"

Health Reimbursement Arrangements (HRAs) can reimburse the following types of insurance premiums provided they were not already paid with pre-tax dollars:

Section 125 Premium Only Plans (POPs) can reimburse the following types of insurance premiums provided they were not already paid with pre-tax dollars:

The employer can use an ERISA and HIPAA-compliant defined contribution health plan to contribute to employees' individual health insurance costs without violating federal law.

Some companies might want to pay directly for an employee's individual health insurance plans without utilizing an ERISA and HIPAA-compliant defined contribution health plan, but doing so will put the employer out of compliance with federal regulations and increase the employer's
(and employee's) tax liability.

There are two major reasons an employer should never pay for its employees' individual health insurance plan:

A defined contribution health plan can reimburse any expense considered to be a qualified medical expense by the IRS, including premiums for individual health insurance policies. Note that employers may restrict the list of reimbursable expenses in any way they choose. 

Yes! With a defined contribution health plan, an employer can give employees different contributions based on classes of employees.  Federal regulations state that “a plan or issuer may treat participants as two or more distinct groups of similarly situated individuals if the distinction between or among the groups of participants is based on a bona fide employment-based classification consistent with the employer's usual business practices.”

No. Defined contribution health plans do not need to be funded until an actual reimbursement is made.  A company is not required to fund any portion of employees' defined contributions in separate bank accounts.   

No. There is no limit on the amount of money an employer can contribute to an employee’s defined contribution health plan.  Also, there is no minimum contribution requirement.

No. There are no minimum participation requirements that a company must meet in order to offer a defined contribution health plan.  Also, there are no maximum participation requirements.  

No. There is no minimum contribution requirement that employer must contribute to an employee’s defined contribution health plan. Also, there is no maximum contribution limit.

Due to the rising costs of group health insurance, many companies can no longer afford to offer traditional health insurance to their employees. Fortunately, defined contribution health plans can provide an affordable alternative to traditional group health insurance.

In 45 states, insurance carriers are allowed to reject applications for individual health insurance if the applicant has a preexisting medical condition. If a child of the applicant has a preexisting condition, the child cannot be denied individual health insurance if they are under the age of 19.  

The following states offer their citizens with pre-existing medical conditions the ability to purchase individual health insurance through a state insurance risk pool.

A pre-existing medical condition is a health problem that existed before an individual applied to enroll in a health insurance plan.

Most group health insurance plans are "unilateral contracts". This means that employers can cancel a group health insurance plan at any point during the year. While most carriers “request” 30 days notice, this is not always required.

A group (also known as "employer-sponsored") health insurance plan covers an individual and their family members.  Unlike individual health insurance, group health insurance is purchased by an individual (or family member) indirectly through the individual's (or family member's) employer.  Group health insurance is dependent on an individual's (or family member's) employment.

Group health insurance plans are declining in the United States.  The number of people covered by group health insurance plans has substantially declined—less than 50% of small businesses offer group health insurance today.

An individual (also known as "personal" or "family") health insurance plan covers an individual and their family members.  Unlike group health insurance, individual health insurance is purchased by an individual directly from the insurance company.  Individual health insurance is independent of an individual's (or family member's) employment.

Companies that sponsor a welfare benefit plan and have over 100 participants at the beginning or end of the plan year are required to file a Form 5500 Annual Report for health flexible spending accounts and health reimbursement arrangements if the plan had 100 or more participants during the plan year.

Effective September 23, 2010, the health reform bill prohibits group health insurance plans from imposing lifetime limits on essential health benefits.  However, plans may impose certain annual limits on essential health benefits until January 1st, 2014.  This new requirement applies to plans with effective dates of coverage on September 23, 2010 or later. 

Effective January 1, 2013, a maximum election limit will be placed on the amount an employee can contribute to a health Flexible Spending Account (FSA). 

HRAs, POPs and Tax-free Individual Health Insurance are 100% allowed in Texas if administered the correct way.

The term "essential health benefits" refers to the minimum coverage requirements that health insurance plans (offered in the individual market, small group market, exchanges, etc.) must provide.