Health Care Bill Update

On October 13, 2009, the Senate Finance Committee approved Senator Max Baucus’s (D-Montana) health care bill, the America’s Healthy Future Act, by a vote of 14 to 9. Senator Olympia Snowe (R-Maine) was the only Republican to vote with the committee’s 13 Democrats in favor of the bill. The Congressional Budget Office (CBO) estimated the cost of the bill at $829 billion over 10 years.

The bill will now be fully merged with Sen. Kennedy’s HELP bill with hands-on participation from Senate Majority Leader Harry Reid and key Administration officials. Some of the most contentious issues to be resolved in the merger include the fate of the HELP bill’s government option, the Finance Committee’s weak individual mandate penalties and new taxes and fees on the insurance industry.  

The stated aims of the legislation are to lower costs, provide quality, affordable health care coverage, make purchasing health insurance easier, prohibit discrimination due to health factors and improve the way the health care system delivers care. However, many in Congress are divided on whether the bill can meet these objectives. Opponents of the bill have argued that it will increase costs for many Americans, rather than making health care more affordable.  

Stayed tuned for MANY updates as this bill is vollyed about  the Senate and House.

NYS Health Coverage Expansion Through Age 29

Effective September 1, 2009  the “Age 29” law, permits eligible young adults through the age of 29 to continue or obtain coverage through a parent’s group policy. Insurers will notify employees of this benefit. Employees or their eligible dependents may then elect the benefit and pay the premium, which cannot be more than 100% of the single premium rate. This benefit, referred to here as the “young adult option,” is separate and distinct from the “make-available” requirement. It is called the young adult option benefit because it permits eligible young adults to continue their coverage through a parent’s health insurance coverage once they reach the maximum age of dependency under the policy. Young adults may also elect this coverage when they newly meet the eligibility criteria, such as if they lose eligibility for group health insurance coverage.

“Age 29″  Frequently asked questions

Three New Federal Healthcare Mandates Will Impact Healthcare Costs

American’s with Disabilities Act (ADA) Amendments

• • Effective October 3, 2009 for all large and small groups.
  • Hearing Aids:
    • Coverage of hearing aids will be standard.
    • Dollar limits mirror Durable Medical Equipment (DME) and Prosthetics and vary by state and plan
    • Limited to one device as follows:
      • Connecticut every 12 months
      • New Jersey every 24 months
      • New York every 3 years 

 Mental Health/Substance Use Parity

• • Effective October 3, 2009 for large (51+ lives) groups.
  • The new law does not allow more restrictive financial requirements for mental health and substance use disorder coverage than for any other medical expense.
  • It specifically states that deductibles, copayments, coinsurance, and out-of-pocket expenses must be in parity.
  • A plan may still have an aggregate lifetime limit and an aggregate annual limit that is applied to both medical and mental health/substance use disorder benefits.
  • The law also prohibits treatment limits on mental health and substance use disorder benefits that are more restrictive than those of medical/surgical benefits. The law specifically requires the following limitations to be in parity:
    • Limits on frequency of treatment
    • Limits on number of visits
    • Limits on number of days of coverage
    • Other similar limits on the scope or duration of coverage.

 Michelle’s Law

• • Effective October 9, 2009 for individual plans, large, and small groups.
  • Prevents dependent children covered under a group health plan from losing coverage if they are forced to take a medically necessary leave of absence from school

Governor Patterson Slams Healthcare Premium Costs

 

Health care premiums will be increasing as a result of the State Legislature approving the Governor’s proposed increases in taxes, fees and assessments on your health benefits as part of his Deficit Reduction Plan. This increase may very well come prior to your next annual renewal.

 

In short, as part of the Deficit Reduction Plan, the Governor has added to the State Premium tax and has imposed a new tax on certain physician services.

 

The insurance carriers are required to collect these taxes, fees and assessments and there will be no exceptions or extensions. The estimated overall percentage is thought to be between 1% and 5% which will be passed along to the carriers’ clients. At this point, the carriers are determining how and when they will roll this out.  For more details on these taxes see my Feb 4th post. 

 

We will monitor this situation and advise you as we get additional information

 

DOL Releases ARRA COBRA Model Notices

 

The DOL has released the new model notices today. We will be reviewing all new notices and sharing with you via email under which circumstances to use these new notices.  COBRA NOTICES 

 

DOL creates website on COBRA coverage under the American Recovery and Reinvestment Act of 2009

All employers and employees now have a site that answers questions about the COBRA coverage under ARRA. Individuals who request treatment as an assistance eligible individual and are denied such treatment by their group health plan may have the right to appeal to the DOL. The DOL is currently developing a process and an official application form that will be required to be completed for appeals. According to the website, The DOL is actively working to issue additional guidance regarding the COBRA premium reductions.  I expect to see the DOL’s final notices regarding changes under ARRA next week.  Important IRS forms are also available in spanish and english at this site.  Stay tuned for more information.

Go to DOL COBRA ARRA site

Patterson Proposes to Increase Taxes on Self Insured Health Plans and HCRA Assessments

Governor Patterson’s proposed State Budget will impose substantial additional costs to your employee and retiree health plans. These additional taxes and assessments will impact all plans including private business, schools, colleges & universities, hospitals and union funds.

This proposed tax would impose a $1 assessment per claim over $20 that is processed under a self insured program including prescriptions drugs and a 240 million increase in the HCRA “covered life” assessment paid by all entities providing health insurance.

The Governor has chosen a bad time to tax businesses that provide healthcare to employees and families to help bridge the states financial crisis. We need to get this message to him that these proposals would be devastating if they are not eliminated from the final budget.

Call your legislators in Albany now as they are working hard on this budget and need to hear from all businesses now on eliminating these taxs

New Jersey Healthcare Reform Update

Beginning in July 2009, all children in NJ up to age 19 will be required to have health insurance under ”Kids First” mandate.  This is currently a soft mandate and does not access penalties for non compliance, but does provide many opportunities to obtain affordable coverage. One key feature of the reform is an expansion of the NJ FamilyCare to parents with incomes from 133% to 200% of the FPL.  For more information go to NJ FamilyCare  

Effective January 1.2009 NJ group contract language for dependent coverge to age 30 has been expanded please see attached United Healthcare/Oxford Notice

David Patterson explains Obesity Tax

Patterson addresses obesity epidemic head on when he presented the state budget last Tuesday and proposed a tax on sugared beverages like soda. Research has demonstrated that soft-drink consumption is one of the main drivers of childhood obesity. Read more 

Here is NYS Gov. David Patterson:

Final rule will expand FMLA for military families and clarify rules for workers and employers

The U.S. Department of Labor has published a final rule on Nov. 17 to update its regulations under the 15-year-old Family and Medical Leave Act (FMLA) — a measure that will help workers and their employers better understand their rights and responsibilities, and speed the implementation of a new law that expands FMLA coverage for military family members.

 

This final rule, for the first time, gives America’s military families special job-protected leave rights. Click here for new rules