Adjusted Community Rating under PPACA is explained here, what Employers and Individuals need to know.
For more information for Individuals CLICK HERE OR For Employers CLICK HERE
Posts Tagged catastrophic health insurance
This is an overview of the Penalties, Taxes, Fees, and other items that need to be considered and calculated by individuals and businesses as it relates to the Provisions and mandates under the Patient Protection and Affordable Care Act PPACA.
For more information for Individuals CLICK HERE OR For Employers CLICK HERE
Below in the BOX is a list of resources that you can use to understand what “EHB” or Essential Health Benefits are and how they work, who is respondible for providing them and who is exempt.
For more information for Individuals CLICK HERE OR For Employers CLICK HERE
Check out this folder below for resources that explain what the MLR (Minimum Loss Ratios) are and how they can affect you, your company.
For more information for Individuals CLICK HERE OR For Employers CLICK HERE
Grandfathering Under the Affordable Care Act
For more information for Individuals CLICK HERE OR For Employers CLICK HERE
Appeals under the Affordable Care Act
For more information for Individuals CLICK HERE OR For Employers CLICK HERE
Preventive Care Available under the Affordable Care Act
For more information for Individuals CLICK HERE OR For Employers CLICK HERE check out the resources in the BOX folder below as well.
Today, the Supreme Court issued an opinion related to health care reform. A divided Supreme Court upheld the constitutionality of the Obama administration’s health-care law. The court said Congress was acting within its powers under the Constitution when it required most Americans to carry health insurance or pay a tax. Chief Justice Roberts’ vote saved the ACA.
The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.
The bottom line is that the entire ACA is upheld, with the exception that the federal government’s power to terminate states’ Medicaid funds is limited.
Please see below for a detailed overview of each opinion.
- The individual mandate survives as a tax. The only effect of not complying with the mandate is that you pay the tax. The Court holds that the mandate violates the Commerce Clause, but that doesn’t matter b/c there are five votes for the mandate to be constitutional under the taxing power. The Court holds that the Anti-Injunction Act doesn’t apply because the label “tax” is not controlling.
- The Medicaid provision is limited, but not invalidated. A majority of the Court holds that the Medicaid expansion is constitutional but that it will be unconstitutional for the federal government to withhold Medicaid funds for non-compliance with the expansion provisions. Another way to think about Medicaid is that the Constitution requires that states have a choice about whether to participate in the expansion of eligibility; if they decide not to, they can continue to receive funds for the rest of the program.
Click here to read the official opinion.
Original Posted by Rick Lindquist on Thu, Jun 28, 2012 @ 09:15 AM
From the beginning of the Chief’s opinion: “We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation’s elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenged provisions.”
Posted @ Thursday, June 28, 2012 10:03 AM by Rick Lindquist
English: The United States Supreme Court, the highest court in the United States, in 2010. Top row (left to right): Associate Justice Sonia Sotomayor, Associate Justice Stephen G. Breyer, Associate Justice Samuel A. Alito, and Associate Justice Elena Kagan. Bottom row (left to right): Associate Justice Clarence Thomas, Associate Justice Antonin Scalia, Chief Justice John G. Roberts, Associate Justice Anthony Kennedy, and Associate Justice Ruth Bader Ginsburg. (Photo credit: Wikipedia)
Interim final rules contain details about the preventive care provision
As you may know, the health care reform law includes a provision requiring health insurers to cover preventive services with no member cost sharing. Recently-published interim final regulations clarify this provision. Non-grandfathered plans issued or renewed on or after September 23, 2010, will not include member cost sharing or copays for the following preventive care provided in-network:
- Evidence-based items or services that have a rating of A or B in the current recommendations of the United States Preventive Services Task Force.
- Immunizations for routine use in children, adolescents, and adults that are recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.
- For infants, children and adolescents, evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration.
- For women, to the extent not otherwise addressed by the United States Preventive Services Task Force recommendations, evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration.
Other key points:
- This impacts non-grandfathered plans issued or renewed on or after September 23, 2010.
- This applies to in-network services. Out-of-network services will have the same cost-sharing requirements as they do today.
- Most of the recommended screenings, immunizations and exam services are already on our preventive services list. We are adding the new, required preventive services to this existing list.
- An example of a new preventive service is counseling related to aspirin use, tobacco cessation, obesity and alcohol use.
- Some services currently covered as medical/maternity will now be considered preventive services. This includes several recommended screenings for pregnant women.
As with the other provisions in the health care reform law, we’re committed to implementing this provision in a manner that helps members have access to quality health care services. If you have any questions, talk with your sales representative.
