PACE Act Signed: Definition of Small Business Group Varies by State

Last week brought another change to the Affordable Care Act.


Health care reform updateThe definition of small business group, which was slated to change to 1-100 employees in 2016, will remain at 1-50 employees nationally. What happens on the state level depends on the state legislatures.  On October 1, 2015, Congress approved legislation to repeal the Affordable Care Act provision, which previously expanded the definition of small business group to 1-100 employees.

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Minimum Essential Coverage Reporting Activity

Health Net will begin requesting Subscriber and Dependent Social Security Numbers on September 21, 2015

The Affordable Care Act (ACA) Section 6055 requires Health Net to report Minimum Essential Coverage (MEC) data to the IRS about the coverage for each individual, including covered dependents starting in 2016.

Health Net will report MEC data to the IRS for all commercial fully insured business with the exception of Individual Marketplace (“on-exchange”) plans. Health Plans are not required to report for government programs including state health plans, Medicare, and Medicaid/Medi-Cal.

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Opinion on the Affordable Care Act Remains Largely Unchanged

Most Say They Can Afford Their Prescription Drugs, But One in Four Say Paying is Difficult

Looking for ways to save money?About half of Americans (54%) report currently taking a prescription drug, and a large majority of them (72%) say their prescriptions are very or somewhat easy to afford. However, about a quarter (24%) say paying for their drugs is difficult, and difficulties rise among those with low incomes (33%) or those currently taking four or more prescription drugs (38%) – and is highest for those in fair or poor health (43%).   Continue reading

More Than an ID Card

Health Net focuses on early access and prevention


Looking through their vacation picturesHere at Health Net, we don’t wait until people get sick to help out. Our job, always, is to connect members with the care they need. Under the Affordable Care Act and with the risk adjustment program, reaching out to members is even more important.

We want our members to use their benefits, so they can be their healthiest! That’s why we’re doing outreach to encourage our members to get their annual wellness exam.

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August 31 Deadline: Covered California News

California Individual & Family Plans
August 31 Deadline for Proof of Citizenship/Immigration Status to Covered California

Clients who enrolled in health coverage through Covered California have until August 31, 2015, to submit any requested documentation required to verify their citizenship or immigration status. Help us help them keep their coverage.

Having health insurance through Covered California is dependent on being “lawfully present” in the United States as a U.S. citizen, U.S. national, or an individual with eligible immigration status.

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December 2015 Renewals and Plan Closures for Small Business Groups

California Small Business Group Plans


broker_hubIt’s time. The mass migration to ACA-compliant plans is set for December 1, 2015, as small business groups renew following the extra year of transitional relief. Along with this change comes Small Group 2.0! Clients renewing December 1 are the first to have access to our new simplified Small Group 2.0 portfolio!

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Supreme Court Ruling: Key Takeaways

Court Finds for the Government


Health care reform updateThe United States Supreme Court ruling upholding Affordable Care Act subsidies in federal-exchange states was made public on June 25, as only one of two cases released on this almost-final day of the court’s term. With its 6-3 decision, the court preserved the structure of the Affordable Care Act. Here are key takeaways of the decision.

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ACA – Medical Loss Ratio (MLR) Reporting and Rebate Payments

Western Region Brokers

Starting in 2015 for 2014 reporting year, the dates insurers must report MLR results and pay rebates (if any) to policyholders have changed as follows:

  • Insurers must report their MLR results by July 31 of each year (in previous years, insurers filed results on June 1)
  • If an MLR rebate is due to the policyholder, the rebate must be paid by September 30 (previously, rebates were paid by August 1)

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Update on Covered California

Amid slower growth, California’s Obamacare exchange cuts proposed spending

Los Angeles Times / May 13, 2015
By Chad Terhune

After using most of $1 billion in federal start-up money, California’s Obamacare exchange is preparing to go on a diet.  That financial reality is reflected in Covered California’s proposed budget as well as a reduced forecast calling for 2016 enrollment of fewer than 1.5 million people.

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