Illinois Health Exchange

The Illinois Department of Insurance has been awarded a $5.1 million federal grant to develop and maintain a health insurance exchange where consumers can shop for coverage.

The nation's new health care law requires the exchanges to be running in states by 2014

Insurance exchanges will allow people and small businesses to comparison shop online for insurance.

The grant will help Illinois design the data infrastructure. It will go toward hiring staff to plan and coordinate with consultants to create the design features.

Gov. Pat Quinn said in a statement released Tuesday that the grant will help create a good exchange and develop tools to make it easy to use.

Illinois State Legislation Update – Recently Enacted Laws During its recently concluded legislative session, the Illinois General Assembly passed a va

Public Act 97-0091 (House Bill 1191) – Routine Care in Clinical Cancer Trials
Signed into law on July 11, this new law prevents a group accident and health insurance policy from excluding routine patient care administered to an insured participating in a qualified cancer trial if the policy covers that same routine patient care for an insured not participating in a qualified cancer trial. It further requires no difference in out-of-pocket liability between an insured in a trial versus one not in a trial. This law is effective Jan. 1, 2012.

Public Act 97-0142 (Senate Bill 1555) – Illinois Health Benefits Exchange Law / State Employees HSA Law
Also effective as of July 14, this law requires Illinois to establish a Health Insurance Exchange program that consists of a marketplace where individuals and businesses can purchase subsidized health care plans. The law includes the creation of a Legislative Study Committee to study and report on the implementation needs to establish the exchange. To ensure balance, six of the 12 appointed members will come from the Illinois House of Representatives and six members from the Illinois Senate. The committee is required to report on the governance of the program by Sept. 30.

This law does not create the actual health insurance exchange; it simply provides guidelines as to how the exchange will be set-up at the legislative level.

In addition, PA 97-0142 includes the creation of a health savings account (HSA) for employees of Illinois state agencies and departments. Beginning in taxable year 2011, each employer shall make available to each eligible individual a HSA program and deposit $2,750 annually into each individual’s account. The law provides that funds can only be used for:

1. the purpose of paying qualified medical expenses of the eligible individual or his or her dependents,
   
2. to purchase a health coverage policy, certificate, or contract, or
   
3. to pay for health insurance other than a Medicare supplemental policy for those who are Medicare eligible.

This law also repeals the Health Care Justice Act.

Public Act 97-0198 (House Bill 1825) – Oral Cancer Drug Parity
Signed by Governor Quinn on July 27, this law requires that health insurance plans that provide coverage for cancer medications cannot have more restrictive treatment limitations or more restrictive financial requirements for oral cancer medications than intravenous and injected cancer medications. However, the law does not mandate coverage for cancer medications.

Public Act 97-0281 (House Bill 2249) – A1C Diabetes Self-Management Training and Education
Signed on Aug. 9, this law requires a group policy of accident and health insurance that is amended, delivered, issued or renewed after the law’s Jan. 1, 2012, effective date to provide coverage for outpatient self-management training and education, equipment and supplies. Further, the law defines “diabetes self-management training” as instruction in an outpatient setting which enables a diabetic patient to understand the diabetic management process and daily management of diabetic therapy as a means of avoiding frequent hospitalization and complications. This is specifically designed to help diabetics maintain their A1C levels within the normal range.

Public Act 97-0282 (House Bill 3039) – Heart Disease Prevention Notification
This law requires insurers to provide annual information regarding the importance and value of early detection and proactive management for cardiovascular disease. It was effective immediately upon the governor’s signature on Aug. 9. However, doctors have up to 60 days to update their information.

Top Ten Reasons for using Dental Insurance

1. To Prevent Oral Cancer--According to The Oral Cancer Foundation, someone dies from oral cancer, every hour of every day in the United States alone. When you have your dental cleaning, your dentist is also screening you for oral cancer, which is highly curable if diagnosed early.

2. To Prevent Gum Disease—Gum disease is an infection in the gum tissues and bone that keep your teeth in place and is one of the leading causes of adult tooth loss. If diagnosed early, it can be treated and reversed. If treatment is not received, a more serious and advanced stage of gum disease may follow. Regular dental cleanings and check ups, flossing daily and brushing twice a day are key factors in preventing gum disease.

3. To Maintain Overall Good Physical Health—Recent studies have linked heart attacks and strokes to gum disease, resulting from poor oral hygiene. A dental cleaning every six months helps to keep your teeth and gums healthy and could possibly reduce your risk of heart disease and strokes.

4. To Keep your Teeth—Since gum disease is one of the leading causes of tooth loss in adults, regular dental check-ups and cleanings, brushing and flossing are vital to keeping as many teeth as you can. Keeping your teeth means better chewing function and ultimately, better health.

5. To Detect Dental Problems Early—Your dentist and hygienist will be able to detect any early signs of problems with your teeth or gums. Early detection of cavities, broken fillings and gum disease are easily treatable. If these problems go untreated, root canals, gum surgery and removal of teeth could become the only treatment options available.

6. To Maintain Good Oral Health—Your dental hygienist will help to ensure that you are maintaining your good oral health by visual examination and comparing your previous dental check-ups. If you are falling off track with your oral hygiene, your hygienist will help put you back on the right path.

7. To Use Your Dental Plan—Dental insurance plans usually pay for all or most of the cost of dental cleanings and check-ups every six months. Take advantage of this and save a lot of money in the long run by avoiding costly dental procedures that can result from poor oral hygiene. If you can’t afford insurance, get a discount dental plan for a few dollars a month, and you will pay a vastly reduced cost for the procedures. Even if the cleaning isn’t free, it’s cheap with a discount plan. It is more expensive later on if you don’t take care of these preventive items up front.

8. To Create a Plan for Treatment—If your dentist diagnoses any problems in your mouth, he will most likely give you a treatment plan. This treatment plan should have the cost of each procedure that you will need, so that you can discuss financial arrangements with the front office.

9. To Have a White, Bright Smile—Your dental hygienist can remove most tobacco, coffee and tea stains. During your cleaning, your hygienist will also polish your teeth to a beautiful shine.

COBRA subsidies finally at an end?

Remember those pesky COBRA subsidies? The federal COBRA subsidy, originally introduced in March of 2009, provided that 65% of the cost of COBRA health insurance premiums would be covered by the employer for up to 15 months. To be subsidy eligible, recipients must have originally become eligible for COBRA as the result of an involuntary termination of employment occurring between September 2008 and May 2010.

Well, it is possible that they are coming to an end. The last group eligible recipients (those who began receiving assistance in May 2010) would cease to be subsidy eligible as of August 31, 2011. That means that if you still have former employees receiving subsidies for COBRA coverage, that should end as of next month. Also, there is presently no action from Congress pending to extend the subsidy further.

Although there is no specific notice requirement, we recommend that if you have COBRA participants that are still receiving the subsidy, you provide them with some notice that their subsidy eligibility is coming to an end. Consider a simple notice that the subsidy period has expired and that they are now responsible for 100% of the COBRA premiums if they want to continue coverage.

fromm Employee Benefit News

IRS to Issue New Health Care Reform Law Affordability Test

August 15, 2011

IRS to Issue New Health Care Reform Law Affordability Test

The Internal Revenue Service said it will develop new rules that will make it easier for employers to determine if their health care plans are “affordable” and exempt from a stiff financial penalty mandated by the health care reform law.

Under the law, starting in 2014, employers are liable for an annual $3,000 penalty for those employees whose required health insurance premium contribution for single coverage exceeds 9.5 percent of family income and the employees are eligible for federal premium subsidies to buy coverage through state insurance exchanges.

In rules proposed Aug. 12 that were welcomed by employers, the IRS said it will develop a safe harbor in which coverage would be considered affordable so long as the premium contribution for single coverage did not exceed 9.5 percent of employees’ W-2 wages.

The IRS said it is developing the new safe harbor to give employers more certainty on whether their plans will pass the affordability test.

“Giving employers the ability to base their affordability calculations on their employees’ wages [which employers know] instead of employees’ household income [which employers generally do not know] is intended to provide a more workable and predictable method of facilitating affordable employer-sponsored coverage for the benefit of both employers and employees,” the IRS said in its notice of proposed rule-making. That notice is expected to be published in the Aug. 17 Federal Register.

Employers had complained that it would be difficult—if not impossible—for them to know employees’ household income, creating a big obstacle to determine whether their plans would be considered affordable, said Anne Waidmann, a director with PricewaterhouseCoopers in Washington, D.C.

The IRS safe harbor “would provide more certainty and effective planning,” said Frank McArdle, a principal with Aon Hewitt Inc. in Washington, D.C.

“This will make it easier for employers to do the necessary calculations,” said Chantel Sheaks, a principal with Buck Consultants, also in the District.

The IRS also affirmed that the 9.5 percent affordability test is to be applied only on single coverage, allowing employers to charge higher amounts for family coverage.

“While we think that was clear in the law, employers will welcome the additional clarity,” said James Klein, president of the American Benefits Council in Washington, D.C.

from Workforce Management

New Guidelines Provide Additional Women’s Preventive Care with No Cost Sharing

On August 1, 2011, the Department of Health and Human Services (HHS) released an amendment to the Interim Final Regulations for preventive care under the Patient Protection and Affordable Care Act (PPACA). The amendment applies to non-grandfathered individual insurance policies as well as non-grandfathered insured and self-insured group health plans.

The amendment provides additional guidelines for women’s preventive services. Health plans will need to cover women’s preventive services, including birth control, without copayments or deductibles. The guidelines reflect the recommendations made last month by the independent Institute of Medicine.

For plan years beginning on or after August 1, 2012, non-grandfathered plans will be required to cover the following additional preventive care services for women with no cost sharing:

• Annual well-woman visits
• Screening for gestational diabetes
• HPV DNA testing for women 30 years and older
• Sexually-transmitted infection counseling
• HIV screening and counseling
• FDA-approved contraception methods and contraceptive counseling
• Breastfeeding support, supplies, and counseling
• Domestic violence screening and counseling

For more detail on the amendment and the additional preventive care services for women, visit: www.hrsa.gov/womensguidelines/.

For more information on the existing PPACA preventive care guidelines, visit: http://www.healthcare.gov/center/regulations/prevention/taskforce.html.

Plans may impose cost sharing on brand name preventive drugs if a generic version is available and is just as effective and safe for the patient to use. Cost sharing would not be permitted on the generic drug.

Religious Exemption
The regulations do not provide for a religious exemption. However, the regulations permit the Health Resources and Services Administration (HRSA) to establish exemptions from these guidelines for coverage of contraceptive services for group health plans of religious employers. A religious employer is defined as an organization that meets all of the following criteria:

• The promotion of religious values is the purpose of the organization
• The organization primarily employs individuals who share the religious beliefs of the organization
• The organization primarily serves people who share the religious beliefs of the organization
• The organization is a nonprofit organization as described in the Internal Revenue Code Sections 6033(a)(1) and 6033(a)(2)(A)(i) and (iii).

No religious exemption is available for individual policies; they must cover contraceptives with no cost sharing.