Glenwood Springs’ business seminar offers insight on health insurance changes
Essential Health Benefits
10 required coverage categories under the Patient Protection and Affordable Care Act
Ambulatory patient services
Maternity and newborn care
Mental health and substance abuse services, including behavioral health treatment
Preventative and wellness services, and chronic disease management
Pediatric services, including oral and vision care
GLENWOOD SPRINGS, Colorado — Big management changes loom for many businesses, especially those with 50 or more employees, as key provisions of the 2,700-page federal Patient Protection and Affordable Care Act begin to take effect later this year.
“This is a transitional year,” said Scott Bolitho of Glenwood Insurance Agency, who presented a seminar at the Hotel Denver on Tuesday morning about the coming regulatory changes that businesses and individual consumers will need to adhere to.
“But 2014 is when the rubber really meets the road with these new regulations,” Bolitho advised about 90 people gathered for the informational “Straight Talk About the Affordable Care Act” seminar, sponsored by the Glenwood Springs Chamber Resort Association.
By late summer or early fall this year, all employers must provide notice to their workers about the availability of new health insurance exchange options starting with the 2014 enrollment period. Those options will vary from state to state.
Employers with 50 or more full-time or full-time equivalent workers are required to sponsor health insurance plans, or face penalties. Businesses that already provide health insurance will come under the new rules of the Affordable Care Act, also known as “Obamacare.”
The law was intended to rein in the high cost of healthcare, which in 2011 came to $2.5 trillion, equalling one-sixth of the U.S. Gross Domestic Product and costing each person in the U.S. about $8,000, Bolitho explained.
After the new healthcare reform law was passed by Congress and signed by President Obama in late 2009, several provisions went into effect immediately.
Included among them were the mandatory extension of family health insurance benefits to dependents up to age 26, elimination of lifetime insurance maximums, elimination of pre-existing condition clauses for children, full coverage for preventative care, a small-business tax credit, and in-network coverage for emergency services.
Additional provisions continued to kick in each year since. But the biggest changes — including new employer mandates related to health benefit exchanges, reporting requirements, tax credits, small business subsidies, and fines for noncompliance — take effect in 2014.
Among the new provisions for individuals will be:
• Expanded benefits in 10 required coverage categories, including maternity care, preventative and wellness care, mental health and substance abuse services.
• Affordability provisions for employees of large groups (50+), limiting an employee’s contribution to no more than 9.5 percent of their gross income.
• Caps on deductibles.
• Out-of-pocket maximums.
• Guaranteed renewability.
• No pre-existing conditions for all ages.
• Coverage for adult children up to age 26, even if they have employer coverage.
Individuals and families with incomes at least 50 percent above the national poverty level (currently $16,700 annually) must be enrolled in a health benefit plan of some sort, whether through an employer or the state health insurance exchange.
Exemptions are given based on income, religion, citizenship or other qualifiers. Government workers who receive healthcare benefits are also exempt.
Penalties for not having health insurance are also spelled out in the Affordable Care Act. However, the IRS may not use enforcement mechanisms to make people pay a penalty, according to the new law.
“It’s really a non-enforceable penalty, at this point,” Bolitho said.
The biggest impact will be on the insurance industry, he said.
The main premise of the Affordable Care Act was that “health insurance had to be reformed, and it was reformed,” he said. “Health insurance companies will have to cover a lot more than they did before.”
To prepare for the coming changes, Bolitho recommended business owners begin planning to inform their employees about their insurance options, review the employer mandates in the law, and develop a business strategy that considers the new requirements.
The seminar also included a presentation by Chris McDowell of the Aspen Clinic, which is working with healthcare providers in the Roaring Fork Valley to ensure the quality care provisions of the new law are met.
“We are moving from a volume-driven system to a quality-driven system,” McDowell said. “Our focus is, are we getting the outcomes we desire and are we making people healthy.”
The Aspen Clinic is also assisting businesses in developing workforce wellness programs.
The chamber seminar was recorded for rebroadcast on Cable Channel 10 in Glenwood Springs, Carbondale and Rifle. The show is scheduled to air at noon, 7 p.m. and midnight on Sunday, May 26.
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