The Centers for Medicare and Medicaid Services (CMS) has announced its intention to propose major changes to how small employers in Small Business Health Options Program (SHOP) Marketplaces using HealthCare.gov would enroll in SHOP plans taking effect on or after January 1, 2018. Among other things, CMS intends to promote broker participation in SHOP plan enrollment.
Established as part of the Affordable Care Act (ACA), SHOP Marketplaces offer eligible small employers an online process for offering health insurance coverage to their employees. The federal government operates federally facilitated SHOP Marketplaces in states that did not elect to establish their own state-based Marketplace, while some state-based SHOP Marketplaces also use the federal HealthCare.gov platform. Currently, employers wishing to purchase health insurance coverage through a federally facilitated SHOP Marketplace or a state-based SHOP Marketplace on the federal platform must verify eligibility for coverage, enroll in coverage, and make premium payments via HealthCare.gov.
Intended Changes to SHOP Marketplaces
Under the approach CMS intends to propose, SHOP enrollment in states that currently use the federal platform would be removed from HealthCare.gov. Instead, small employers would enroll in SHOP coverage with the assistance of a broker registered with a federally facilitated SHOP, or directly with an insurance company offering SHOP plans, for plan years beginning on or after January 1, 2018. Employers would still obtain a determination of eligibility by going to HealthCare.gov.
In addition, CMS anticipates that its intended proposal will give state-based SHOP Marketplaces the option to direct small employers to SHOP-registered brokers and insurance companies for SHOP plan enrollment.
Click here for more information from CMS.
UnitedHealthcare has reached a new agreement with St. John's Episcopal Hospital.
St. John's Episcopal Hospital, located in Far Rockaway, New York, will stay participating with both the UnitedHealthcare and Oxford networks for all commercial fully insured and self-funded products.
Members may continue to use St. John's Episcopal Hospital on an in-network basis, with no disruption in care
Disability Contracts have a lot of moving parts.
Look for these Enhancements When Comparing Plans:
“Or” definition of disability – “Or” definition provides comprehensive income protection, with a focus on returning to work. Using the “or” definition, employees qualify for benefits by meeting either of the following criteria:
“Own job” definition – When it comes to returning to work, many disability insurance carriers have “own occupation” language in their contracts for both STD and LTD, while some contracts provide an “own job” definition for STD. Own Job means the carrier looks at the job the employee was performing on the date of the disability – not the occupation. Why is this key? STD coverage is typically purchased as a replacement for or supplement to sick leave – or as a salary continuance benefit – with the expectation that the employee will return to his or her original job. So, the “own job” definition is a significant distinction.
“Unable to earn 80%” language – Some disability contracts require a “20% income loss” to start paying disability benefits while other contracts require an employee be “unable to earn 80%” of their pre-disability income.
What’s the difference? It can be considerable.
Disabled employees whose income is based partially or totally on commissions, services or billable hours may not experience an immediate income loss. The “20% income loss” language doesn’t recognize the immediate impact of a disability because payments from these sources can continue to be received after the disability begins. The “unable to earn 80%” feature in the Principal contract acknowledges the impact of the disability immediately, and allows the employee to qualify for benefits sooner.
Isaac, a real estate agent, sells his usual share of new business in May and June. In July, he’s diagnosed with a disabling illness. As part of his treatment schedule, he’s restricted to a 20-hour work week. He continues to receive commission checks during this time from sales made in May and June. As a result, “20% income loss” is not realized for the first two months of his disability. The Principal contract recognizes that Isaac is “unable to earn 80%” of his pre-disability income because his treatments have restricted him to work at 50% capacity, even though he continues to receive income from sales prior to the disability. This provision allows Isaac to begin qualifying for disability benefits sooner than he would under a contract with the “20% income loss” language.
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Source: HR 360, Inc.
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