Category Archives: Health Care Reform

What if I have alot of Part-Time, Seasonal or Variable Hour workers?

Employers are going to have to track a lot more information under these circumstances, under the 400-page “90 day waiting rule” section of Health Care Reform.

Here how it will work-

The Employer will select a “Measurement Period” of 3, 6 or 12 months.  Consider this a “look-back period” during which time you will determine the average number of hours worked by each employee.  You must use the same time period for all employees.   This “Measurement Period” would take the place of the normal “waiting period” you apply to full time employees.

Any employee working more than the 30 hour requirement, on average, in the measurement period would be eligible for insurance at the end of the period.  They would be guaranteed insurance for the same length of time as the measurement period, and this time frame is called the “Stability Period.” You then have 90 days to actually get the individual covered (“Administrative Period“).

So lets look at a real life example:

You have three variable hour employees, and you choose a 6 month measurement period.

Joe comes in pretty regularly and averages 27 hours, although the last two months he has averaged more than 30.

Ann works wildly varying hours and the last two months has only worked an average of 15.  However, her 6 month average is 33 hours per week.

Karen works a regularly assigned 24 hours each week consistently.

You would be required to offer insurance only to Ann.  She would be eligible to stay on the insurance for 6 months at which time her eligibility would be revisited.  Joe and Karen are not eligible for the next 6 months, but you have to continue to track their hours so you can relook at it in 6 months.

As you can see, there will be a lot of tracking needed…

 

Who is exempt from Health Care Reform?

The law provides exemptions for some very specific circumstances.  I get asked this question at almost every seminar I do – ” Is it true that so-and-so is exempt?”

You should be aware that Medicaid, Medicare and TriCare (Military coverage) are all considered to meet the requirements of the law, and therefore no exemption is needed in those cases.  So here are the exemptions:

1)  Religious Conscience- If your organized religion does not believe in accepting private or public insurance, you may be exempt.  Originally put in for the Amish and Old Order Mennonites, but may have wider inclusion.  It is available to any group covered under Treasury Rule 26 CFR 1.5000A-3(a).  There has been a consistent rumor that the Muslim sect would be exempt;  that is untrue.

2)  If no affordable health insurance option is available.  Note that this means affordable under the rules, not what you think is affordable.  You would be exempt if the only available plan exceeds more than 8% of your income.

3)   Membership in a health care sharing ministry.  These programs are recognized in 22 states and have about 160,000 members.  They share expenses between the members of the ministry.

4)  Incarceration, but only after the disposition of charges.

5)  Membership in an Indian Tribe that is federally recognized.

6)  Hardship- for a month or months in which a person has unexpected, significant increases in essential expenses, with natural or human-caused.  This one comes with several pages of rules and documents needed.

7)  Undocumented immigrants are exempt.  But in order to get the exemption, wouldn’t they have to document themselves?

8)  Short Term Coverage Gaps of no more than 3 months are acceptable.

9)  Individuals with income below $9750 – essentially those that are not required to file a tax return.

 

The law recognizes that you may be eligible for more than one exemption at a time.   There may be some significant changes to these exemptions prior to October 1.

Consumers’ Choice CO-OP licensed in South Carolina

Consumers’ Choice Health Plan received its Certificate of Authority to offer
health insurance benefits to South Carolinians. This “authority” is an
important step in the ability to market benefit plans on the new federal
Health Insurance Marketplace (the “Exchange”) and through local agents
and brokers.

Consumers’ Choice recently submitted all of their benefit plans to the federal
government for review and believes their consumer-focused approach will
appeal to South Carolinians who want to have a say in how their health
care coverage is delivered. Benefit plans are also being filed with the
SC’s Department of insurance.

Just One Insurer To Sell On New Hampshire Exchange

NAHU- Beyond California, several states were in the news over the holiday
weekend for making progress, or a lack thereof, toward implementing
their insurance exchanges. For example, the AP
(5/28, Ramer) reports that one week out from the deadline to apply to
sell insurance on New Hampshire’s new exchange, only Anthem Blue
Cross/Blue Shield has expressed interest in doing so. According to Scott
Baetz, co-chairman of a panel advising the state on implementing the
overhaul law, this news “was the latest in what he called a series
of potential disappointments.” He said, ‘‘This is really disheartening.
At this point, I don’t how much value it’s going to bring to small
businesses. I feel like small businesses have been pushed to the side or
into a holding pattern. And for a state like New Hampshire, that has so
many small businesses, it’s really preventing us from realizing the
full scope of benefits that were the intention of the Affordable Care
Act.’’

California Exchange To Offer Lower Rates, Less Choice Among Providers

With last week’s big reveal of plans and rates to be offered on
California’s insurance exchange, coverage of that state was heaviest.
First, the Los Angeles Times (5/25, Terhune) reported that though health insurance rates for the
Covered California exchange “came in lower than expected” this week,
“one downside for many consumers will be far fewer doctors and hospitals
to choose from.” Those who “want UCLA Medical Center and its doctors in
their health plan network next year, for
instance,” may have to choose Anthem Blue Cross, while Cedars-Sinai
Medical Center, “one of Southern California’s most prestigious and
expensive hospitals, said it’s not included in any exchange plans at the
moment.” The Times said “exclusive arrangements, increasingly tight
networks and outright exclusions are becoming more common.”

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
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