Age Band Rating

[pahealthquotes]

Looks like the younger healthier population is going to get slammed. In PA we're expecting 40 to 50 % rate hikes for the 35 and under crowd. Wonder if many will just abondon ship and pay the penalty. What % increase are you expect to see in your home state?

Has there been any carrier/nahu push to get the enrollment period changed?

 

[stuy119]

Just saw this NYT article:

http://www.nytimes.com/2013/02/18/u...cern-over-costs.html?pagewanted=1&_r=2&ref=us

It seems that ER's with younger, healthier populations are doing what they can to keep costs down. And it's really getting the goat of the administration.

(Here's the spot to insert witty commentary about how the administration can't keep costs down within their own budgetary guidelines - if they were to submit a budget to begin with!)

 

[somarco]

But wait, there's more!

But, to avoid paying the new PPACA uninsured penalty tax, an individual worker simply needs some kind of minimum essential coverage from the employer, not necessarily coverage through the plan that meets the PPACA minimum actuarial value standards, Holloway said.

"Precisely how good must this minimum essential coverage be?" Holloway asked. "It appears any employer-based health care plan more robust than a dental or vision plan, or health flexible spending account, amounts to 'minimum essential coverage.'"

How minimal can PPACA-required coverage be? | LifeHealthPro

 

[Ann H]

What? You're kidding. I don't understand how that would work. I have been reading quite a bit about self-insured or PSF plans that circumvent many of PPACA rules, but is that what they are talking about in the link that Somarco just provided, as it is in the NY Times link below?

http://www.nytimes.com/2013/02/18/us/allure-of-self-insurance-draws-concern-over-costs.html

 

[AllenChicago]

From the article that Somarco linked to:

"An employer could offer one plan that would meet the PPACA minimum actuarial value requirements for one rate, and then offer a skinny, possibly cheaper minimum essential coverage plan alongside the minimum actuarial value plan, Holloway said."

Is this saying that an employer could offer a self-insured (expensive) plan for the higher income earners and the sickest employees, and a bare-bones MinEssCov plan (from an insurer) for everyone else?

If an employer has an expensive plan for certain employees, and gives $$$ to the rest of the employees so that they can shop on the exchange and get subsidies, will this keep the Employer and the Employees clear of IRS penalties? I guess it depends on the size of the group eh?

I admire those of you who understand the group rules associated with this ACA elephant!

 

[leevena]

From the article that Somarco linked to:

"An employer could offer one plan that would meet the PPACA minimum actuarial value requirements for one rate, and then offer a skinny, possibly cheaper minimum essential coverage plan alongside the minimum actuarial value plan, Holloway said."

Is this saying that an employer could offer a self-insured (expensive) plan for the higher income earners and the sickest employees, and a bare-bones MinEssCov plan (from an insurer) for everyone else?

If an employer has an expensive plan for certain employees, and gives $$$ to the rest of the employees so that they can shop on the exchange and get subsidies, will this keep the Employer and the Employees clear of IRS penalties? I guess it depends on the size of the group eh?

I admire those of you who understand the group rules associated with this ACA elephant!

As of today, there is nothing in the regulations that would prohibit an employer from utilizing this strategy of offering two plan options as outlined above. However, the implementation of such is a bit more difficult due to participation requirements from the carrier. If you utilized a dual-carrier approach, each will want some % of enrollment, such as 75% or so. If you want to offer a single carrier, with these types of benefit designs, that carrier may have minimum enrollment numbers needed to offer another option or they may not even have such a plan design available. And don't forget, you need to pay attention to the cost-sharing requirement of 9.5%.

Penalties are assessed on the employer once an employee enrolls via the exchange and receives the subsidy. So even if that employee got $ from the employer, the employer would be penalized if that employee received the subsidy.