5 Myths About Health Care Reform and Dental Benefits

Myth 1: “Only medical benefits are impacted by health care reform.”

 Fact: Dental benefits are also impacted. Small groups ( <50 employees in most states) are required to
include pediatric oral services as one of the 10 Essential Health Benefits (EHBs) in 2014.

Myth 2: “As a small business, I won’t be impacted by the changes.”

Fact: Groups with under 50 lives will not face penalties for not offering coverage; however those that do need to be compliant with the EHB regulations — which includes providing pediatric dental care — beginning in 2014.

Myth 3 : “I don’t expect a significant premium increase since I’m a small company.”

Fact: Experts expect that most groups, small and large, will face significant premium increases. According to one report, medical increases for small groups could range from 25–130%, causing many employers to reexamine their benefit strategies — and possibly off er more voluntary options. I expect Defined Contribution Health  Plans (DCHP's, 105's) to take over a major piece of the business in 2015.  Companies will want to remain competitive for the best employees.  To do so, offering a strong benefits package gives a clear advantage. 

Myth 4 :“The pediatric care EHB will need to be provided by the medical carrier.”

Fact: In most states, the pediatric dental EHB can be purchased from a dental carrier — on or o ff exchange — as a stand-alone benefit or as a part of their dental plan.

Myth 5 :“Benefits purchased on the exchange are lower cost and low quality.”

Fact: Many medical carriers are expected to off er a smaller network to save on costs, but the benefit options off ered by dental carriers through the exchange will be largely comparable to what is available today, and
similar to what is available off -exchange.

Written By: Guardian®
The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10

Can't Shop When You Want To Shop - Special Enrollment Periods

Special Enrollment Period – how it’s changing the game . A special enrollment period is a window which allows an individual to enroll in an individual health insurance plan outside the annual open enrollment period. Each special enrollment period is “triggered” by certain qualifying events that are required by law. In most cases, special enrollment periods last 60 days from the date of the qualifying event. There are many qualifying events that can trigger the special enrollment period. Here are some key events to remember: ■Losing minimum essential health coverage ■Getting married ■Divorce ■Relocating ■New child ■Change in income ■Medicaid or CHIP ■Cobra expiration ■Health plan decertified

In the 1st Open Enrollment Period: WHY ARE YOU ALLOWED TO KEEP CHANGING THE LAW

The Government continues to play with the consumer mind creating havoc in unfair ways. We are at our knees to their decision about "OUR" Healthcare. What's next? Regulation and Government Control of additional insurance markets? I have taken initiative to help guide familys and businesses through this historical change in healthcare. I do not believe in the system that has been created with reform, but it is an opportunity to help. What I don't understand is the idea of the open enrollment period and why it wasnt delayed!? We are over 6 weeks in to enrollment, the law was supposedly set in stone, yet laws have changed on a weekly basis. Traditional policies have been canceled and resold again, FSA rules have changed for the better, SHOP delayed to 2015, Catastrophic coverage added to the metal plans to create an "affordable" option, the 3:1 community ratio was going to save higher age demographic premiums (not the case), the website healthcare.gov apparently takes 17,000 people per day but I have yet to see my options and have tried for 44 days straight. It is sickening to see these public officials lie to American's on live national television such as CNBC "Squwak," stating the coverage is an affordable, cheaper option compared to today's market. With all this turmoil in place they are now attacking another freedom we hold, most common to the business owner. I have advised many on the opportunity to avoid the rules of Obamacare by self funding their group. Still a great option to employers, but for how long?!!! The Government is now targeting the issue and has made strides in certain states. Check out this article below released last week by Avalon Benefits...... Today, more than 60% of workers in large corporations and 80% of unions, along with 15% of workers in small businesses, are covered by self-insured plans. In fact, most of the 100 million workers now covered by self-insured plans don't even know it. The differences to them are that minimal. The exemption from many ObamaCare rules will encourage more businesses to shift to self-insurance -- but there's a nationwide drive to stop them. White House Targets Self-Insurance The White House is leading the charge to close what it calls the "self-insurance loophole" with a laundry list of tactics that were spelled out in a paper published by the hyper-liberal Center for American Progress, titled "The Threat of Self-Insured Plans Among Small Businesses." They've already had some success: A new California law greatly increases the cost to self-insure. Here in New York, legislation effectively bans companies with fewer than 50 employees from self-insuring. Republicans (and independent-minded Democrats) in Congress and in the states need to stand firmly against these efforts. It's the best way for businesses -- small, medium and large -- to avoid many of the taxes and mandates that come with ObamaCare. According to industry research, a typical self-insured group can expect to save more than 10% (versus traditional health insurance) without having to sacrifice quality of care. Even uninsured individuals in many states can access self-insurance via trade associations and community groups, instead of having to buy high-cost individual policies through the ObamaCare exchanges. The administration and its allies fear that the more people gravitate toward the successful, free-market self-insurance approach, the worse their government-engineered health "reform" will look. We're already seeing the beginning of this trend. Despite the president's repeated promises to the contrary, too many Americans are now finding out to their dismay that they can't keep insurance plans they like -- because the ObamaCare law is forcing insurers to cancel them. Worse, they have to spend much more for replacement policies. Meanwhile, ObamaCare penalties and onerous rules have forced many companies to lay off workers or cut hours to turn full-time employees into part-timers. Small-business owners should not have to make their hiring decisions based upon tens of thousands of pages of regulations in the Affordable Care Act. That's why the escape hatch is so appealing. Self-insured companies can tailor their health benefits to meet the needs of their workers. They don't have to pay for services their employees neither need nor want. And self-insured plans pay their own medical costs, without having to subsidize the health-care costs of other groups. It should be every elected official's goal to help find ways to free employers from dictatorial rules that hinder their growth. ObamaCare does the opposite, and that's why the self-insurance option needs to be preserved. Millions of Americans are seeing firsthand what a disastrous law this is, and searching for ways to escape. Democrats are panicked: If enough businesses do not join ObamaCare and instead opt into self-insured plans, their prized program is sure to implode quickly as its costs skyrocket. Of course, it may well implode anyway -- but "progressives" are trying to save it by forcing as many people as possible into it. Self-insurance can save countless Americans from ObamaCare's overpriced, low-choice, poor-quality health care. Preventing the president and his political cronies from undermining this alternative is vital. It's a winning fight for small businesses, our economy and the American people. © Copyright Warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'UTC' for 'GMT/0.0/no DST' instead in /usr/home/avalon/www/htdocs/inc_footer.php on line 19 2013 Avalon Benefit Services, Inc. All rights reserved. No reproduction of any images or content without written consent.

Renewals are HIGH!!!

Trending this week with Health Reform, I thought the below situation may benefit some of you by bringing it to your attention. The following will hit home for most individual policy holders and small business employer sponsored group plans next year whether it’s Anthem, Med Mutual, Assurant, Aetna, Humana, Celtic, or United Health. This week I had to call a client age 57 and healthy, about a notice from Anthem stating her health insurance premium is set to increase from $387/month (current) to $703/month (renewal) with the new Exchange. An 81.7% increase in premium. Another client age 32 with his healthy wife and 2 boys, approached me about their renewal set to increase from $598.63/month (current) to $999.71/month (renewal) with the new Exchange. A 67% increase in premium. Prepare for rate shock, as stated in my previous emails. This is what many can expect with the upcoming “Affordable Care Act.” Planning ahead, your participation with an exchange policy can be delayed another year. Early renewal or carrier shopping for a new effective date is important to control health insurance costs over the next 12-14 months. We will “early renew” the policies from the examples above on 12/1/13 to further delay participation in an Exchange Policy until 12/1/14. Both premiums will remain close to their current by taking the early renewal strategy or switching carriers. This process is very similar for small business owners offering group health plans. Each individual, family, and business will have a unique situation. Those of you currently with high premiums and pre-existing conditions, the Exchange could mean good news. Some Individuals will need to take into account their Modified Adjusted Gross Income (MAGI) for possible subsidy/premium credit on the public exchange. For those of you currently with Anthem: Anthem sent out a letter to all individual and family policy holders regarding significant premium rate increases forthcoming on January 1, 2014. This was sent early by mistake with misprinted renewal dates. If you are an Individual Anthem policy holder, your current policy and premium will hold for the contract 12 months and “early renewal” will still be offered. A 6/1/13 effective date will not renew until 6/1/14. The renewal date is incorrect, however the premium rate increase is what one can expect when the 12 month contract expires. At the 2014 renewal date, the policy will automatically shift to a similar Exchange “Metal Plan” along with the new rate. Anthem will be sending out corrected letters next week.

Healthcare Reform: Initial Enrollment Period

It's almost here!! Prepare for a mess.... Health Care Reform’s initial enrollment period is rapidly approaching October 1, 2013. For the everyday consumer this brings confusion, along with opportunity for some and concern for others. I have taken over Mosaic Employee Benefits, LLC to educate clients and their networks on the Patient Protection and Affordable Care Act (PPACA) relative to the unique planning strategies that have come about. Individuals and Small Businesses must note that PPACA does not make coverage "affordable" for everyone. Specifically, Milliman's report projects that individual premiums in Ohio will increase by as much as 55 to 85 percent in 2014 not including current medical trend, which has been an average increase of 7 to 8 percent nationwide each year. Moreover, some individuals may see their premiums increase by 90 to 130 percent depending on their current health status, while others may see decreases. Those in the small group market (employers with 2 to 50 employees) are projected to experience average increases of 5 to 15 percent in 2014, not including yearly medical trend increases. However, some small groups may see increases of up to 150 percent, while others may see decreases of 40 percent depending on the group's current age demographic and health status. Why the fluctuation in premiums? The guaranteed insurance law has solved the issue of an individual being declined for pre-existing conditions. Pre-existing conditions and gender no longer come into play. The cost will now rely on Age, Family Demographic, and Smoker Status. With new laws, an insurance carrier may not charge a 64 year old more than 3 times the premium of a 21 year old (new law community ratings 3:1 spread, current law 8:1 spread). The young and healthy will inherit the burden of the cost while individuals nearing or at age 64 with pre-existing conditions will most likely save premium dollars. How to plan? Failing to have an plan may prove to be costly. 1. Compliance – Two forms attached, offering insurance or not offering insurance. Employers must distribute the appropriate form to their employee’s by the October 1st, 2013 deadline. It is important to be able to track distribution. 2. Early Renewal Strategies – Most major medical insurance carriers are offering groups and individuals early renewal rates this December. Early renewal contracts extend the current plan participation, rates, and benefits thru December of 2014, delaying participation in a new exchange plan to 2015. **key for those with expected increases under new 2014 laws 3. Tax Credits – Businesses that have low income employees must be careful with affordable coverage laws. By providing group insurance and making it affordable (9.5% of income or less), you may hinder an employee’s chance of qualifying for assistance with individual plan premiums. 4. Individuals can now see their estimated premium cost for new “Metal Plans” on the health reform calculator for the state of Ohio: http://www.healthedeals.com/health-care-reform-calculator a. The below annual premiums reflect an individual making **$45,000 annually, nonsmoker (male or female - no longer matters come 2014 as all premium rates are unisex) i. 21 years old (no tax credit available at $45k income)–Bronze: $1,814 / Silver: $2,117 / Gold: $2,419 / Platinum: $2,721 ii. 31 years old (no tax credit available at $45k income)–Bronze: $2,505 / Silver: $2,922 / Gold: $3,340 / Platinum: $3,757 iii. 41 years old (no tax credit available at $45k income)–Bronze: $3,195 / Silver: $3,727 / Gold: $4,260 / Platinum: $4,792 iv. 51 years old ($171 projected annual tax credit at $45k income)-Bronze: $3,773 / Silver: $4,431 / Gold: $5,088 / Platinum: $5,745 v. 61 years old ($1,061 projected annual tax credit at $45k income)-Bronze: $3,673 / Silver $4,462 / Gold: $5,251 / Platinum $6,040 **Important: Only MAGI (modified adjusted gross income) is considered for subsidy qualification. Assets, as they stand now, will not be on the application for consideration.

Saving in your 30's

As I meet with more and more individuals and families in their mid 20's and 30's I find myself running into a common theme, Debt and lots of it, in all different ways.  Is it because the married couple had children too early, we are a spending society, or people just fail to plan these days on the hipster live now mode? 
The dramatic increase of health insurance premiums coming in 2014 certainly won't help the situation, with increases expected to range 50% - 300%.  These increases will bring a slew of mid 20's and 30's individuals to take the penalty in 2014 and forego health insurance.  If they don't take the penalty, they will take the increase, then what?  More debt!

Here are a few pointers to help fix your young adult years.  The ability to sleep at night knowing you are living a "comfortable" lifestyle, debt free!

1. Pay off your nonmortgage debt. Your thirties bring financial responsibilities you may not have had in your twenties, such as a mortgage or a family. Nothing frees up cash to meet those obligations like getting rid of your debt. Hopefully you paid off your credit cards in your twenties (if you didn't, make it a top priority). Next, focus on getting rid of student loans and other nonmortgage debt, such as auto loans.

 

2. Kick the debt cycle altogether. What good is it to pay off your loans only to take out another one and rack up more debt? An easy way to save for big-ticket items, and avoid going back into debt, is to put money you would have used for monthly debt payments, car payments, and interest charges into a savings account. For instance, after you make that final $300-per-month auto loan payment, keep making an equal payment to yourself. After one year, you'll have $3,600 saved. 

 

3. Get serious about retirement. Your twenties were the time to start investing. No matter how little money you had to spare, it gave you a great head start. Now it's time to look at your goals and set a plan in motion to reach them.

PPACA News Updates

1. Beware -Surprise: A new tax bill for you???
           - If you are one of millions who qualify to take advantage of a government subsidy when purchasing health insurance, be careful!  You could get hit by a surprise tax bill if your income was not accurately projected.  The subsidies for medical insurance are based on your current income.  If you or your spouse receives a raise fiscal year you may end up with a bigger subsidy than you are entitled to.  Law states you will have to pay back some if not all of this subsidy during tax season 2015!  Open enrollment is set for 10/1/2013 on the individual marketplace/exchange.  SHOP for small businesses has been delayed to 2015, announced 4/2/2013.  Could the individual exchange follow?