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PPACA: The webinar answers, part 1

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A few weeks ago, we joined with Aflac Inc. (NYSE:AFL) to run a webinar on the possible effects of the Patient Protection and Affordable Care Act (PPACA) on the commercial health insurance community.

Webinar attendees submitted 44 questions about topics more substantive than “How do I find a recording of the webinar?” (The answer to that question. Please click here. Fill out a registration form and you will get access to the webinar archive.)

The underlying, unspoken question seemed to be, “What will happen to me?”

The answer to that seems, really, to be, “Be kind and live to the fullest, for no one knows what the future holds.”

Here are attempts to answer the first batch of six questions.

1. Why does everyone seem to call the law something different?

“PPACA” is actually part of a two-law package — PPACA itself and the Health Care and Education Reconciliation Act (HCERA).

The Obama administration and some PPACA critics who are trying to show they are fair-minded about call the law “the ACA.”

Many people and organizations that hate the law call it “Obamacare.”

Some people and organizations that are trying to be neutral call the law “PPACA.”

Both supporters and critics call the law a “health reform law.” Some people and organizations that are trying to be neutral wonder there one person’s “health reform law” is another person’s “health system mangling law” and call the law a “health system change law.”

2. What does all of this mean for carriers of products such as dental insurance and vision insurance?

Insurers will probably sell some stand-alone dental visions through the exchange system in most if not all states.

It’s possible that major medical plans sold through the exchanges will include pediatric dental benefits, but HHS seems to be indicating that, because all exchanges will probably offer stand-alone dental plans, the major medical plans may not need to offer pediatric dental benefits, after all.

For brokers, the biggest question may simply be what PPACA will do to overall employment levels and enrollment in employer-sponsored benefit plans. If group health plan enrollment holds reasonably steady, the effect on group dental and vision plans might be modest.

3. How is the government going to know who has coverage and who doesn’t?

Insurers are supposed to send enrollees and the Internal Revenue Service (IRS) notices of health coverage. The 2014 notices will be due Jan. 30, 2015.

4. Can any employee stay on the group because their cost is below 9.5 percent and their family go on the exchange and get a subsidy.

The IRS says the family can’t do that. The Obama administration might sincerely believe this interpretation and want Congress to change it, or it might see this interpretation as a way to prod employers to offer subsidized dependent care benefits at no cost to the government.

5. What happens if an indivdual doesn’t have insurance and ends up at the hospital door? Will the hospital have navigators in the ER room signing these individuals up?

A smart hospital will. Some hospitals have made a point of helping high-cost, uninsured enrollees in the PPACA Pre-Existing Condition Insurance Plan (PCIP) risk-pool program.

6. Does the “50 employees” limit for small groups count full-time employees only, or do they cover all employees employed?

The rules for counting employees are brutally complicated. If you are a benefits professional and you need to ask us, don’t ask us; go to your benefits law advisor and get the best available “employee counting calculator” from that advisor.

If you are an employer, talk to your professional benefits advisor.

If you are the benefits law advisor: Be brave. Life will get easier. (We hope.)

Next week: Answers about employee counting, benefit combinations, and more.

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