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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51–100 Transition – or Not – to SBG

Working TogetherJanuary 1, 2016, is the date the Affordable Care Act provision redefining “small group” as 2–100 employees is slated to take effect. Whether or not that reclassification actually happens is a topic hotly debated. Either way, you and your clients can count on Health Net.

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Special Enrollment Period Extended to Off-Exchange Plans

SEPCalifornia Individual & Family Plans: Tax Season SEP Extended to Off-Exchange Plans

The tax season Special Enrollment Period we told you about in early March has been extended, in California, to off-exchange plans. This means your clients can apply directly through Health Net of California, Inc. or Health Net Life Insurance Company (Health Net). Clients can enroll through April 30, 2015.

The tax season Special Enrollment Period (SEP) is a limited enrollment opportunity for consumers who did not realize there was a tax penalty in 2014 or learned they may face a penalty in 2015. This SEP runs through April 30, 2015.

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Preventive Care That’s Easy on the Wallet

Many screenings are covered at no cost under the Affordable
Care Act

In charge of your healthHere’s a quick update about preventive services provided at no cost under ACA.

We’re talking about services that can help improve and, in some cases, save lives – services such as blood pressure screenings, mammograms, many types of vaccinations, and many children’s screenings.

Feel free to share this update with your clients!

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Health Law Has Helped Insure 16.4 Million

A total of 16.4 million non-elderly adults have gained health insurance coverage since the Affordable Care Act became law five years ago this month – a “historic” reduction in the number of uninsured, the Department of Health and Human Services said.

Those gaining insurance since 2010 include 2.3 million young adults aged 18 to 26 who were able to remain on their parents’ health insurance plus another 14.1 million adults who obtained coverage through expansions of the Medicaid program, new marketplace coverage and other sources, according to HHS’ report .

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Starting Line-Up and Enhanced Choice Portfolios

Updates and More Selling Opportunities: For California Large Groups

Starting line-upHealth Net of California, Inc. and Health Net Life Insurance Company (Health Net) are working to help renew your clients with coverage for 2015. The following updates to our Starting Line-Up (SLU) and Enhanced Choice portfolios will help us maintain compliance with the Affordable Care Act (ACA) and simplify administration.

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Marketplace Update: Tax Season SEP

Western Region Brokers

The state and federally facilitated marketplaces are offering a Special Enrollment Period (SEP) for people who did not know or understand that there is a tax penalty for not having health insurance. In California, the SEP began February 23, 2015, and continues through April 30, 2015. In states like Arizona where the marketplace is federally facilitated, the SEP is March 15, 2015, through April 30, 2015.

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ACA: Minimum Essential Coverage (MEC) Reporting Requirements

All Western Region Brokers:  ACA: Minimum Essential Coverage (MEC) Reporting Requirements for Insurers and Health Plans (ACA Section 6055)

Under Section 6055 of the ACA, entities that provide minimum essential coverage, including health plans, insurance carriers and self-insured groups, must

  • Report data to the IRS about the coverage for each enrolled individual, including spouses and children using Form 1095-B.
  • Issue annual statements to “responsible individuals” (this is usually the subscriber) about their coverage that can be used as documentation for tax purposes.

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