Thanks Anne for the "facts". Maybe it will get some crabs back in their shells. Do you mind finding "fact" showing that who can be navigators (chambers of commerce), and how they will be "granted" lump sum amounts of money, and it won't go to individuals producers.
So What's Really Going to Happen to the Group Market
- Thread starter Crabcake Johnny
- Start date
- Thread starter
- #102
- 14,808
Actually:
Certification of Exemption from Individual Mandate Provided by the Exchange
An exchange must grant a certification attesting that an individual is exempt from the individual
mandate or from the penalty because (1) there is no affordable qualified health plan available through the exchange or the individual's employer, or (2) the individual meets the equirements
for any other such exemption from the mandate or penalty. The exchange must provide the Secretary of the Treasury with the names and the taxpayer identification number of each of these
individuals.
http://www.nahu.org/legislative/resources/Individual Mandate and Related.pdf
It clearly states that the exchange is only capable of granting an exemption from the individual mandate which is where I'm getting that you can purchase plans outside of the exchange but it does not satisfy the mandate.
Certification of Exemption from Individual Mandate Provided by the Exchange
An exchange must grant a certification attesting that an individual is exempt from the individual
mandate or from the penalty because (1) there is no affordable qualified health plan available through the exchange or the individual's employer, or (2) the individual meets the equirements
for any other such exemption from the mandate or penalty. The exchange must provide the Secretary of the Treasury with the names and the taxpayer identification number of each of these
individuals.
http://www.nahu.org/legislative/resources/Individual Mandate and Related.pdf
It clearly states that the exchange is only capable of granting an exemption from the individual mandate which is where I'm getting that you can purchase plans outside of the exchange but it does not satisfy the mandate.
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- Staff
- #103
I think you're mixing up "exempted" and "requirement satisfied". You have satisfied the requirement to purchase insurance (the individual mandate), and are therefore not subject to the penalty if you purchase inside the exchange or purchase a qualified plan outside the exchange. Exemptions are for those who are NOT purchasing insurance but are exempt from the mandate and the penalty.
Also, free vouchers are another issue altogether. That's for employer groups that essentially give coupons to their employees to go to the exchange.
And as for crabs, I'm cooking some for dinner! Just kidding, John.
- Thread starter
- #105
- 14,808
I'm in the actual bill - plans sold outside the exchange can be qualified only if certified by the exchange. The carrier must also offer one silver and one gold plan inside of the exchange, meet minimum benefit requirements and be the same price as exchange plans.
Each state gets to determine if a plan sold outside of the exchange can be certified based on many criteria, one of which is whether or not a state thinks a carrier has imposed excessive or abusive rate increases. So none of this is up to the carrier regarding certified plans outside of the exchange, but each state.
It's page 328 Subtitle D.
Each state gets to determine if a plan sold outside of the exchange can be certified based on many criteria, one of which is whether or not a state thinks a carrier has imposed excessive or abusive rate increases. So none of this is up to the carrier regarding certified plans outside of the exchange, but each state.
It's page 328 Subtitle D.
- 15,041
Any way you slice it, more people will qualify for some level of subsidy than those who don't.
- Thread starter
- #107
- 14,808
Here's the navigator language from the bill:
(i) NAVIGATORS.—
(1) IN GENERAL.—An Exchange shall establish a program
under which it awards grants to entities described in paragraph
(2) to carry out the duties described in paragraph (3).
(2) ELIGIBILITY.—
(A) IN GENERAL.—To be eligible to receive a grant under paragraph (1), an entity shall demonstrate to the Exchange involved that the entity has existing relationships, or could readily establish relationships, with employers and employees, consumers (including uninsured and underinsured consumers), or self-employed individuals likely to be qualified to enroll in a qualified health plan.
(B) TYPES.—øAs amended by section 10104(h)¿ Entities described in subparagraph (A) may include trade, industry, and professional associations, commercial fishing industry
organizations, ranching and farming organizations, community and consumer-focused nonprofit groups, chambers of commerce, unions, resource partners of the Small Business Administration, other licensed insurance agents and brokers, and other entities that—
(i) are capable of carrying out the duties described
in paragraph (3);
(ii) meet the standards described in paragraph
(4); and
(iii) provide information consistent with the standards developed under paragraph (5).
(3) DUTIES.—An entity that serves as a navigator under
a grant under this subsection shall— (A) conduct public education activities to raise awareness of the availability of qualified health plans; (B) distribute fair and impartial information concerning enrollment in qualified health plans, and the availability of premium tax credits under section 36B of the
Internal Revenue Code of 1986 and cost-sharing reductions
under section 1402; (C) facilitate enrollment in qualified health plans;
(D) provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under section 2793 of the Public Health Service Act, or any other appropriate State agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage; and
(E) provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange or Exchanges.
(4) STANDARDS.—
(A) IN GENERAL.—The Secretary shall establish standards for navigators under this subsection, including provisions to ensure that any private or public entity that is selected as a navigator is qualified, and licensed if appropriate, to engage in the navigator activities described in this subsection and to avoid conflicts of interest. Under such standards, a navigator shall not—
(i) be a health insurance issuer; or
(ii) receive any consideration directly or indirectly
from any health insurance issuer in connection with
the enrollment of any qualified individuals or
employees of a qualified employer in a qualified health
plan.
(5) FAIR AND IMPARTIAL INFORMATION AND SERVICES.—The
Secretary, in collaboration with States, shall develop standards
to ensure that information made available by navigators is
fair, accurate, and impartial. (6) FUNDING.—Grants under this subsection shall be made from the operational funds of the Exchange and not Federal funds received by the State to establish the Exchange.
(j) APPLICABILITY OF MENTAL HEALTH PARITY.—Section 2726
of the Public Health Service Act shall apply to qualified health
plans in the same manner and to the same extent as such section applies to health insurance issuers and group health plans.
(k) CONFLICT.—An Exchange may not establish rules that conflict with or prevent the application of regulations promulgated by the Secretary under this subtitle.
This is confusing, I know. But what this is referring to by "certified" is what plans can be sold by an insurer outside the exchange. That's different than certifying a person's exemption from the mandate/penalty, which is also different from satisfying the mandate.
In my post above I used the word "qualified", and this uses "certified", but it's essentially meaning the same thing. If a person purchases a qualified/certified plan outside the exchange he has satisfied the requirement to purchase insurance and is not subject to the penalty. Other people might also get a certification for a complete exemption from the mandate & penalty.
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My head hurts from all this serious thinking. I've decided to join CHUMPS in "GET OUT NOW!!". I'm gonna quit work and relax. Or maybe I'll quit posting, go back to work, and relax! LOL.
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- Thread starter
- #109
- 14,808
I've already submitted my application to be a navigator. Looking forward to fun times.
- Staff
- #110
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