1)The Affordable Care Act requires large employers (usually those employing more than 200 workers) to automatically enroll new full-time employees in their health benefit plans (subject to any legally permissible waiting period), and to continue the enrollment of current employees in a health benefit plan.  It further requires notice and an opt-out opportunity for employees who have been automatically enrolled. 

The Department of Labor had previously indicated that it intended to issue regulations on the automatic enrollment rules before 2014.  In what will likely come as welcome relief to many large employers, Notice 2012-17 indicates that, in order to ensure coordinated guidance and a smooth implementation process, the DOL has concluded that regulations implementing the ACA’s automatic enrollment provisions will not be ready to take effect by 2014.  Until such regulations are finalized, employers are not required to comply with these automatic enrollment provisions.

2)Employer Shared Responsibility-a key component of the Affordable Care Act which hinges on employers’ determination of which employees are considered full-time workers.   This provision, currently scheduled to take effect in 2014, would assess a penalty against certain “applicable large employers” (those with 50 or more full-time employees) that either fail to offer “minimum essential coverage” to their full-time employees, or that offer coverage that is “unaffordable” relative to an employee’s income.  “Full-time” is defined to mean an employee who is employed an average of at least 30 hours per week.  

The FAQs indicate that the Departments intend to issue guidance that would allow employers to use a “look-back/stability period safe harbor” for purposes of determining whether a current employee has averaged at least 30 hours of service per week during the measurement period.  As described in an earlier IRS Notice, under this approach, an employer would be permitted to determine each employee’s full-time status for a defined prospective period (the stability period) by measuring that employees’ hours over a defined retrospective period (the look-back period).  The Departments anticipate that future guidance will allow look-back periods and stability periods of up to 12 months.

The Departments also intend to issue guidance on how to handle newly-hired employees.  The FAQs specifically propose a methodology for determining full-time status in situations where, based on the facts and circumstances, it cannot reasonably be determined whether a newly-hired employee is expected to work full-time.

3)Waiting Period-under ACA rules, an employer must not have waiting periods that are longer than 90 days.  This rule is set to take effect on January 1, 2014. Under those existing regulations, a waiting period is defined as the period that must pass before coverage for an employee or dependent who is otherwise eligible to enroll under the terms of a group health plan can become effective.  This suggests that other eligibility conditions that are not based solely on the lapse of a time period (such as full-time vs. part-time status, or bona fide job categories) will still be permitted.  In fact, the FAQs specifically state that nothing in the waiting period rules will require employers to offer coverage to part-time employees or to any other specific category of employees.

The FAQs also confirm that the Departments intend to issue guidance addressing the coordination of the employer shared responsibility provision with the 90-day waiting period limitation.  That guidance is expected to provide that, at least for the first three months following an employee’s date of hire, an employer will not be subject to a shared responsibility tax penalty merely because it fails to offer coverage to the employee during the waiting period.

It will be held Tuesday, March 20 from 8 a.m. to 10 p.m. at Feather Sound Country Club. For more information contact Karoline Moran (kmoran@ccfninsurance.com) or call her at (727) 797-0441. You can register online at http://events.r20.constantcontact.com/register/event?oeidk=a07e5mc3wwh1f93f316&llr=t8pfe4dab

Despite these warnings, it doesn’t appear the Legislature will act before the end of its annual session March 9 because any fix will cause higher insurance rates — not a popular decision, particularly in an election year. But any increase would be minuscule compared to those that will be required if a disaster strikes before a fix is made.

Officials have already abandoned a special $12 billion expansion of the fund when it became apparent they wouldn’t be able to fund it and are worried about their ability to meet the present $11.7 billion obligation.

“I’m dumfounded that our approach to risk management is to pray that we don’t have a storm,” said first-term state Rep. Bill Hager, a Boca Raton Republican and former insurance commissioner in Iowa. “Only luck has saved us from a financial disaster.”

One of the important subjects broached in the article concerns long-term care insurance.  While it’s often overlooked and undervalued, it’s an important part of retiree healthcare planning.  If you or a loved one has questions about health benefits, long-term care insurance, or disability insurance, give us a call, we’ll be happy to discuss with you a plan that makes sense for you and your family.

Since similar legislation failed last year, it’s uncertain at this point if the 2012 Florida Legislature will pass a serious auto insurance reform bill.

Many people who have been unable to get health insurance can now get
coverage through the Pre-Existing Condition Insurance Plan (PCIP), created
under the Affordable Care Act. PCIP is provided through the U.S. Department of
Health and Human Services and administered by GEHA in more than 20 states.

Choose the plan that fits your needs
PCIP enrollees can choose from three plan options, with different levels of premiums,
calendar year deductibles, prescription deductibles and prescription copays. The
HSA Option provides an opportunity to open a Health Savings Account, a tax-exempt
account where you can deposit funds for eligible medical expenses.

Each of the three PCIP plan options provides preventive care (paid at 100%, with no
deductible) when you see an in-network doctor and the doctor indicates a preventive
diagnosis. Included are annual physicals, flu shots, routine mammograms and
cancer screenings. For other care, you will pay a deductible before PCIP pays for
your health care and prescriptions. After you pay the deductible, you will pay 20%
of medical costs in-network. The maximum you will pay out-of-pocket for covered
services in a calendar year is $6,050 in-network/$7,000 out-of-network. There is
no lifetime maximum or cap on the amount the plan pays for your care. Benefits
are effective on or after January 1, 2012.

Are you eligible?

To be eligible for the Pre-Existing Condition Insurance Plan, you must be a citizen
or national of the United States or residing in the U.S. legally, have been uninsured
for at least the last six months, and have a pre-existing conditionor have been
denied coverage because of your health condition.

“We are concerned about the precedent this proposed rule would set,” said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, the industry’s trade group. “As we learn more about how this rule would be operationalized, we will provide comments through the regulatory process.”

Zirkelbach said insurers “have long offered contraceptive coverage to employers as part of comprehensive, preventive benefits that aim to improve patient health and reduce health care cost growth.”

Employers who have signed on for such health plans in the past paid part of the cost of birth control prescriptions, while their employees also bore some expense through co-payments.

In a free market economy, these “free lunches” don’t work.  Time will tell how this ends but right now it’s not good news for consumers.

According to the WSJ article, “

A sister entity, the Florida Hurricane Catastrophe Fund, is on the hook to reimburse insurers operating in the state up to $18.4 billion for losses they would incur from major storms. It has about $7 billion on its books from accumulated premiums from the past six years, in which Florida has been hurricane-free.A diverse group that includes Gov. Rick Scott, senior state officials, business groups, a taxpayer-watchdog group and environmentalists is concerned that the state traded protection against natural disaster for possible future financial disaster in allowing the entities to grow as big as they have.The concern is a major hurricane could cause serious problems: If the two entities were unable to sell post-disaster bonds as planned, some insurers could become insolvent, homeowner claims for repairs could go unpaid, and assessments and surcharges on policyholders statewide could damage the economy.”

Some believe that the only way to stop this disturbing trend is to allow Citizens to raise its rates.  A “measure, proposed in a shortened legislative session scheduled to conclude at the end of March, would seek to move the funding of hurricane losses to the global reinsurance market.At present, the Cat Fund counts on selling municipal bonds, if needed, after a major hurricane or series of midsize ones to raise cash to forward to insurers so they can cut checks to their policyholders. Such posthurricane bonds would be paid off through assessments on property-casualty policyholders of all insurers in the state and many types of insurance, with businesses bearing a significant burden.”

According to the Florida Insurance Council, the states oldest and largest insurer trade association, the Council is working hard to protect Florida’s consumers and businesses from skyrocketing premiums and unfair practices that hurt all of us.  Here are some of the initiatives in which the Council is engaged this session:

Automobile Insurance Fraud

The Florida Personal Injury Protection (PIP) law is designed to help reduce the need for people to sue to cover the cost of injuries resulting from automobile accidents. However, the $10,000 minimum requirement for PIP coverage in Florida has become a “dollar target” for fraud artists taking advantage of the system. According to a Jan. 2011 study by the Insurance Information Institute, insurance costs associated with rampant no-fault fraud are rising by 70 percent each year, and these costs are passed along to Florida drivers.

Gov. Rick Scott notes Florida motorists are paying a fraud tax of almost $1 billion and likens it to a state income tax. Staged accidents, excessive or unnecessary medical treatment, inflated or questionable claims and excessive litigation are driving up the cost of insurance. FIC has worked with statewide officials and Florida legislators, including Rep. Jim Boyd and Sen. Joe Negron, to develop strong public policy to reduce fraud and abuse, lower auto insurance rates and protect honest consumers who need affordable coverage.

Property Insurance Risks

Citizen’s Property Insurance Corporation (CPIC) was created by the State of Florida post Hurricane Andrew to be an insurer of last resort providing coverage unavailable from private insurers. Citizens is now the insurer of first resort with premiums substantially lower than private insurers. It has grown from about 400,000 policies in 2006 to more than 1.5 million. Why is that a problem for Florida? Citizens is undercutting the private market and accumulating exposure it will be unable to handle following the inevitable monster hurricane. Citizens’ rates do not cover its losses after a major hurricane, and the shortfall is financed through assessments on all Floridians. As a result of the 2004/2005 hurricanes, Floridians are paying assessments on all residential insurance policies statewide, all private passenger auto policies, commercial property and casualty policies on charitable organizations and all other commercial property except for workers’ comp and medical malpractice. Had there been more landfall events in recent years, more assessments would be compounded on Floridians. Citizens must be dramatically downsized and must return to its appropriate role, the insurer of last resort.

Health and Life Insurance Cost Controls and Mandates

FIC’s 2012 legislative priorities also include life and health issues. The Council will oppose mandated benefits that increase insurance premiums. It will promote a grievance procedure for insureds. It will promote a Florida health insurance exchange to avoid implementation of a federal health exchange. Life issues include appropriate standards for the sale of annuity products to senior consumers, restrictions on Stranger-Owned Life Insurance and passage of the Interstate Insurance Product Regulation Compact getting new life insurance products to maker faster and as a lower cost.

Business Coalition’s Legal Reform Agenda

FIC and the major business groups will continue to fight inequities in the legal system, including unfounded bad faith lawsuits against insurers and their business policyholders. FIC is pursuing insurer civil remedy reform and other legal reforms with the Florida Justice Reform Institute, the Florida and National Chamber of Commerce, Associated Industries of Florida and other groups.

These are just some of the important legislative initiatives that have a tremendous impact on our quality of life in Florida.  Businesses as well as consumers should be actively engaged in this fight if they want Florida to be a state of economic opportunity and a quality standard of living for all citizens. 

“The White House announced this afternoon that there would be no change in the regulations issued previously by the Department of Health and Human Services which would require the Diocese of St. Petersburg to change its existing health care plan that presently covers all employees (including priests and religious) to include provision for contraceptives and contraceptive and aborti-facient procedures. These prescriptions violate our institutional and personal consciences and I have warned before that this bishop and this diocese will not accept nor provide them. The callous disregard for long held personal and ecclesial beliefs augurs a chilling moment for believing and practicing Catholics in these United States. It is my hope that the United States Conference of Catholic Bishops will immediately challenge these regulations in court and right up to the highest court and that a stay of their implementation will await final judicial disposition. Our forbearers left Europe because of religious intolerance such as this and founded this nation promising religious tolerance and freedom.”

For the 70,000 or so employees of Catholic institutions throughout the United States, this issue goes beyond the realms of politics and theology.  It will undoubtedly affect their health insurance coverage.  Some Catholic bishops, like Bishop Lynch, have vowed to stop offering health insurance coverage for all employees in protest of the mandate.  If other bishops and leaders of other religious institutions follow suit, healthcare coverage will be in jeopardy for thousands of American who may then be forced to seek individual health insurance policies at a much higher rate.

For all those whose healthcare coverage lies precariously in the balance, let’s hope both sides can work out their differences so that employees don’t lose their healthcare benefits.