With Health Reform Now Law, Industry Turns To Implementation

A critical problem is that health insurance plans expire at the end of every month, and the market reforms that will be implemented in the near future affect the individual and small groups that are predominately served by agents. Also affected are self-insured plans, she said.

She noted that the April 1 date is important because under the new law, grandfathering provisions pick up immediately.

Specifically, under these provisions, insurers won’t be able to drop coverage for a person who develops a health problem, and no longer will be able to set yearly or lifetime limits on coverage.

Health insurers cannot make any changes to a policy besides adding or subtracting employees, or to reflect changes made through collective bargaining agreements, she said.

Additionally, “No regulations have been written, and it is unclear when they will be written,” Waltman said.

She also cited new legislation that includes a small employer tax credit. “While we are being told that only 12% of employers will be affected, it is still unclear how that credit will work.”

Other provisions that will go into effect promptly that must be dealt with in new contracts are preventive care at first dollar level, and how to deal with children who graduate in June who are on their parents’ plans. Since a provision allowing them to stay on their parents’ plans until age 26 will go into effect in October, it is unclear whether they should be advised to get individual plans or to wait until they can get back on their parents’ plans in October.

“There are a lot of questions,” Waltman said. “But, there are no answers yet.”

Kopperud of the CIAB said the CIAB members are the brokers and consultants to plans that cover tens of millions of Americans.

“We’ve been drinking from the firehose of questions about how employers will need to adjust to the legislation now and in the coming years,” he said. “There are a million moving pieces of health reform, and there’s not a single employee or employer who won’t be impacted by it,” Kopperud said.

“It’s gratifying to be reminded again about the essential, core value equation that sophisticated brokers bring to their customers at a time of confusion and anxiety.”

Other provisions that go into effect this year include creation of interim, high risk pools to help people who can’t get insurance because of costly, pre-existing medical problems. This provision will go into effect in July.

Under the provision, the Department of Health and Human Services must create a temporary high-risk pool program by the end of June. The caps this year on out-of-pocket costs for enrollees are $5,950 for individuals and $11,900 for families.

Another provision that goes into effect this year is that seniors who purchase prescription drug coverage under Part D of Medicare will get a $250 rebate this year if they reach a coverage gap, known as the doughnut hole, in which they pay as much as 100% of a brand-name drug’s costs. By 2011, seniors are to get a 50% discount on brand-name drugs they need during the coverage gap; by 2014, the gap is to be closed.

As for insurers, AHIP’s Zirkelbach noted AHIP’s support for “Enroll America,” a collaboration with Families USA. Enroll America is a 50-state enrollment and informational effort designed to get all uninsured Americans in one type of health plan or another.

“Our focus is on streamlining the enrollment process so people who are newly eligible can get coverage,” Zirkelbach said.

“We are also seeking to minimize disruptions in current insurance plans for the more than 200 million Americans that we serve,” he said.

AHIP is going to be doing a lot of work with its member companies to be a resource for them and provide information for them throughout this process, Zirkelbach said.

Regarding the exchanges, the Department of Health and Human Services has selected Jay Angoff, former Missouri insurance commissioner and former health regulator in New Jersey, as its liaison with the National Association of Insurance Commissioners.

A HHS spokesman confirmed Angoff’s appointment. “Jay Angoff, a former Missouri insurance commissioner, has been brought on as a senior advisor at HHS, and he’ll play a key role in a new office to be created that oversees the private insurance market,” said Nicholas Papas, an HHS spokesman.

According to several people who attended the quarterly NAIC meeting, Angoff spoke at both a public session and in a private meeting with the state regulators.