Health Care Reform is Here!  What it means for you and your business

Health Care Reform is here.  Nearly every individual and business will be affected somehow by the reform's provisions.  The Patient Protection and Affordable Care Act overhauls the environment of health care in the US.  The goal is to provide a minimum level of health care coverage for individuals.  For example, the new law requires most US citizens and legal residents to have health insurance.  Income eligible individuals and families will receive premium tax credits to help pay for coverage.  Those choosing not to carry coverage will pay penalties.

The Act places new responsibilities on employers that, over time, may well change the nature of employer-provided health care.  Employers choosing not to offer their employees qualifying coverage will pay an additional tax to help finance their employees' health care.  An exception applies for smaller businesses. 

Interim Final Rules for Group Health Plans Relating to Status as a Grandfathered Health Plan

The interim final rules for group health plans and health insurance coverage relating to status as a grandfathered health plan under the Patient Protection and Affordable Care Act were issued by multiple agencies on June 14, 2010.

The Interim final rules provide that a group health plan or health insurance coverage no longer will be considered a grandfathered health plan if a plan sponsor or an issuer makes any of the changes outlined:

* Eliminates all or substantially all benefits to diagnose or treat a particular condition

* The plan increases a percentage cost-sharing requirement (such as coinsurance) above the level at which it was on March 23, 2010.

* The plan increases fixed-amount cost-sharing requirements other than copayment (e.g., a $500 deductible or $2,500 out-of-pocket limit) more than the maximum percentage increase identified by the rule.

A plan makes certain changes with respect to annual or lifetime limits.

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Business Community loses fight against Price Controls

All proposed community-rated health coverage product price changes will need to undergo prior approval by the state insurance department.  The governor included the measure in emergency extender legislation that kept state government running without a budget.

Business organizations, insurance brokers, health insurers and hopsitals have opposed reinstatement of government rate setting for years.  Gov. Paterson used the measure to capture votes requried to re-impose prior approval, which had been repealed in 1995.

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