NEWS & UPDATES

The Patient Protection and Affordable Care Act

Since the Senate passed the Reconciliation Bill, Daines Insurance has strived to inform our clients on how this will impact their health care plans and the impact on their business.  Until the state and federal entities work to issue the regulations that will better define how the provisions of the bill work in practice, it is our recommendation that you make no changes to your current policies at this time.  We will keep you informed of the changes necessary to comply with new regulations as they become available.
We are in a six-month waiting period to allow health plans and employers to prepare for the legislative changes.  And many provisions will not take effect for several years.

As we understand it currently, the following items are likely to be implemented during the next 18 months:

• Access to temporary high-risk pools for adults who have had no health insurance for at least six months and have pre-existing conditions.
• Insurance companies cannot rescind or cancel an individual’s coverage due to a health condition except in cases involving fraud and intentional misrepresentation.
• Insurers cannot apply pre-existing condition waiting periods for children under the age of 19.
• Insurance companies cannot impose lifetime dollar limits on coverage.
• Insurance companies must allow dependents to stay on their parent’s policies until age 26 if the dependent is not eligible to enroll in an employer-sponsored group health plan.
• Medicare prescription drug beneficiaries who hit the “donut hole” in coverage will have a small added benefit.
• Tax credits for the 2010 calendar year will be available to some employers who currently offer health insurance coverage to their employees.

To be eligible for the credit, employers must:

• Have no more than 25 employees
• Employees’ average annual wage must be less than $50,000
• Employers must contribute at least 50 percent to total premium cost

The maximum small employer tax credit is 35 percent and is available to those with 10 or less full-time employees whose average annual wages are less than $25,000. The credit phases out as firm size and average wages increase. The IRS will have to develop the process for claiming this credit.

The provisions of this law that will bring the most significant change will not take effect until 2014. They include:

• The establishment of insurance exchanges,
• Guaranteed coverage for adults regardless of health conditions,
• Expansion of Medicaid,
• Subsidies for families with incomes up to 400 percent of the federal poverty level,
• Health industry fees,
• Employer penalties, and
• The individual mandate, which requires the purchase of health insurance or payment of a penalty.

If you have questions, please don’t hesitate to contact our office at 903-793-3034 and will be happy to track down an answer for you. We will continue to update you about developments in health insurance reform.  We are committed to keeping our valued clients fully informed of the impact of health insurance reform.

Thank you for your patience as we work to understand and implement the Patient Protection and Affordable Care Act.