5 Key Reform Questions for Brokers, Health Plans, and Businesses

Posted by Rick Lindquist on Wed, Jul 25, 2012 @ 12:33 PM

U.S. businesses have traditionally paid premiums to insurance companies to cover workers with a single "defined benefit" group health insurance plan. However, due to changes in the individual market, most of these businesses will consider switching to a "defined contribution" health benefits program, where employers give workers a monthly allowance to purchase their own "individualized" coverage through a private or public health insurance exchange.

Health Reform Provides Massive Federal Subsidies for Individual Policies

Under the health law, individuals or families making as much as four times the U.S. poverty level -- that's approximately $90,000 for a family of four -- are eligible for health insurance premium subsidies. In states that don’t set up exchanges, a federally run national site will take over.

health insurance subsidies

Public Health Insurance Exchanges are Being Developed Now for 2014

The development of the public health insurance exchanges for 2014 is under way. These public exchanges will provide new opportunities for health insurance companies and brokers to provide new, value-added services. Similarly, private health exchanges, which have been around for years, are adapting their services for employers and defined contribution.

Below are 5 key questions brokers, health plans and businesses should be prepared to discuss during the upcoming renewal periods.

1. Broker Role: How can insurers and brokers integrate and/or coordinate with federally run health insurance exchanges?

2. Public exchanges: What insurance options will be available in public health exchanges?

3. Defined contribution: How can employers, insurers and broker adopt defined-contribution platforms?

4. Employer Penalty: First, Does it apply? Then, based on the comparitive costs of "paying or playing", should the employer provide qualified, affordable coverage or provide a defined contribution plan and pay the penalty?

5. Private exchanges: What role will private health exchanges play in 2013, 2014 and beyond?

Note: This should not be taken as legal or tax advice.

Tags: Private Health Exchange, Defined Contribution, Health Reform, ACA, PPACA, Health Plans, Brokers, Health Insurance Exchanges, Public Health Exchange

Comments

Employer Penalty - I know employer penalies may apply when certain employyes of certain sized firms buy a policy from an exchange.

Question: Is that a PUBLIC exchange or Private exchnage or both?

And if the policy is bought outside any exchange, but then partially reimbursed under Zane Def Benefit, does the purchase fall into a possible employer penlaty category?

Posted @ Sunday, August 05, 2012 1:03 PM by Jeff

Employer Penalty - I know employer penalties may apply when certain employees of certain sized firms buy a policy from an exchange.

Question: Is that a PUBLIC exchange or Private exchange or both?

And if the policy is bought outside any exchange, but then partially reimbursed under Zane Def Benefit, does the purchase fall into a possible employer penalty category?

Posted @ Sunday, August 05, 2012 1:04 PM by Jeff

Generally:

<50 ees = no penalty
>=50 ees = penalty if employee(s) receives subsidy

<<Is that a PUBLIC exchange or Private exchange or both? >>

Individual public exchange only, and they must be receiving a subsidy.

<<And if the policy is bought outside any exchange, but then partially reimbursed under Zane Def Benefit, does the purchase fall into a possible employer penalty category?>>

If the policy is purchased outside the public exchange, the employee cannot receive a subsidy, and the employer does not pay a penalty for that employee.

Posted @ Monday, August 06, 2012 8:18 AM by Rick Lindquist

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