Key Points for Health Reform

  • 10/23/2010. Separation point between Grandfathered and newer plans which are subject to new mandates
  • 10/23/2010. First wave of new mandates started. Preventative benefits to be covered at 100%. Children policies are guaranteed issue regardless of health. Life time maxes go away. Dependent children can remain on parent’s plan till age 26. MLR requirements dictate a percentage of gross premium goes to benefits. Establishment of PCIP plan for people unable to qualify for individual/family.
  • 7/1/2012 Maternity is covered on all plans for both grandfathered and non-grandfathered plans in California.
  • 8/2012. Rebates go out to Californians based on MLR requirements.
  • 10/1/2012 New requirements for benefits notification to employees with standardized benefit explanation.
  • Jan 1st, 2013, 3% tax on passive source of income for individuals making over $200K or couples making over $250K including real estate gains, dividends, etc.

 Points below have not occurred yet

  • Effective Jan 1st 2014, there will be four plans (platinum, gold, silver, and bronze) plus a lower priced option for young adults on both the individual and family market. Kaiser $30 Copay no-deductible plan is used as benchmark for metallics.
  • Fall of 2013, we should have benefit details and pricing since people can begin to enroll for coverage then for a Jan 1st, effective date.
  • Coverage will be guaranteed issue (regardless of health) for most Californians.
  • Between 130% (expanded Medi-Cal basis) of poverty and 400%, most Californians will receive an immediate subsidy when they purchase health insurance through the Exchange (online shopping market which we’ll have access to from Tiers (higher rates based on health) will go away on both individual and group markets.
  • We expect band compression since oldest age band can not be more expensive than 3 times the youngest age band. Age 40 and below will likely rise as a result.
  • Individuals that do not have adequate insurance will be levied a penalty (most likely through taxes)
  • Group will now be 1-100 employees but fines/mandates primarily affect groups over 50 employee.
  • Most current plans will end on Jan 1st 2014 except for grandfathered plans (which will be few and far between especially on the group market). .

Our take on Health Reform:
There are many aspects we like, but our major concern is that of cost since the bill primarily addresses universal coverage but not efforts to keep cost down.

As we get more information, we’ll continue to add it.


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