Affiliated Marketing Group Newsletter Archive

On Monday, Health and Human Services released broad new operating rules for state-run health insurance exchanges, which form a key part of the 2010 federal healthcare reform law that will face landmark Supreme Court hearings in just two weeks.

The regulations are intended to provide state lawmakers flexibility on federal deadlines as they meet the complex task of building state and regional insurance markets before a January 1, 2014, deadline.

Covering 642 pages, the final document provides guidance on how states should establish exchanges, qualify health plans for participation and determine the eligibility of both individuals and small business that want to use exchanges to provide health coverage to their employees.

State exchanges are part of a two-pronged system intended to provide health coverage for about 30 million uninsured Americans under the Patient Protection and Affordable Care Act; the second part being a dramatic expansion of the joint federal-state Medicaid program for the poor.

The exchanges amount to federally subsidized state-run insurance markets designed to provide consumers Web-based access to affordable health plans that meet minimum quality standards.

The Supreme Court will hear arguments March 26^th-28^th stemming from a case in which 26 states and a business group claim healthcare reform should be overturned as unconstitutional because it requires most adults to buy private health insurance or pay a penalty. A ruling by the Court is expected by July 1^st, 2012.

Known as the individual mandate, this provision of ACT is intended to limit insurance risk in the exchanges by ensuring that younger, healthier adults participate. Otherwise, analysts say, the exchanges could become dominated by older, sicker adults, which would mean higher costs and fewer participating plans.

A number of States have delayed participation until the ruling is out. About 33 states have received federal grant money to help set up exchanges.

The new rule retains a January 1, 2013, deadline for state exchanges to meet federal standards but also would allow states to qualify after January 1 if they can prove their exchanges will be ready to offer open enrollment by October 1, 2013.

The federal government will establish its own exchanges in states that fail to meet standards in time.

Are Your Group Renewals Too High?

OptiMed GAP may be the solution to help you control cost! Employers may be able to keep renewals to 6% or below using OptiMed GAP.

OptiMed Gap is specifically designed to help save direct health insurance premium costs by allowing employers greater freedom in selecting lower cost high deductible plans or plans with higher out of pocket coinsurance maximums. OptiMed GAP is designed to fill that hole. Optimed GAP can cover deductible and coinsurance.

Simply put, by plugging in OptiMed GAP, employers may be able to raise deductibles and out of pocket maximums to obtain lower cost coverage.

Features:

Guaranteed issue

No pre-existing condition limitations

No health questions asked

First dollar benefit

May be written down to 5 lives

Compatible with HMO, PPO, POS, or HDHP

Electronic enrollment options available

OptiMed Gap may be written down to 5 lives.

OptiMed GAP may be offered on a Voluntary Basis.
Please note that OptiMed GAP is not compatible with an HSA.

OptiMed Limited Medical plans fall outside the scope of the new Health Care Reform as “excepted benefits” as defined under HIPAA and the Public Health Service Act (PHS Act). Speak to our Group Representatives to learn more about our plans and services.

Contact Heather Matias for Quotes.

Mini-medical plans are limited indemnity benefit plans, meaning they pay only a limited benefit for a covered service at an affordable premium for both employers and employees alike. Mini-medical plans are not to be confused with major medical insurance and they are not meant to replace major medical plans.

Mini-medical plans fill a rapidly growing niche in the group health insurance marketplace by assisting employers to provide their non-covered employees real benefits that can help with employee retention without causing serious financial pain.

1. Employer groups who currently have a major medical plan in place but have part time and hourly employees who do not qualify to participate or who cannot afford the plan.

2. Employer groups who can no longer afford the escalating costs of a traditional plan or who have never considered offering benefits.

3. Franchisor groups who are looking to offer a program to their franchisees to assist retention rates and employee morale.