Probationary Period Update – CA SB1034

California’s Limit on Waiting Periods (Probationary Periods)

As we communicated to you a few weeks ago, Governor Brown signed CA SB1034 into law on Friday, August 15, 2014. CA SB1034 repeals California’s stricter 60-day limit on waiting periods (in accordance with AB1083) and allows employers to follow the federal ACA’s 90-day waiting period limitation. CA SB1034 also prohibits insurers and health plans from imposing waiting periods, although the insurer or health plan may administer waiting period on behalf of the employer (as long as the employer’s waiting period does not exceed the ACA’s 90-day limit).

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Probationary Period Update – CA SB1034

California’s Limit on Waiting Periods (Probationary Periods) – CA SB1034 Signed into Law

As you may know, Governor Brown signed CA SB1034 into law on Friday, August 15, 2014. CA SB1034 repeals California’s stricter 60-day limit on waiting periods (in accordance with AB1083) and allows employers to follow the federal ACA’s 90-day waiting period limitation. CA SB1034 also prohibits insurers and health plans from imposing waiting periods, although the insurer or health plan may administer waiting period on behalf of the employer (as long as the employer’s waiting period does not exceed the ACA’s 90-day limit).

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Mental Health Parity Act – Final Rules

For all Western Region Brokers

The Mental Health Parity and Addiction Equity Act (MHPAEA) Final Rules were released on November 13, 2013 and apply to health plans effective on or after July 1, 2014.

The Final Rules provide clarification on how the benefits for alternate care services under the mental health and chemical dependency rehabilitation benefits should be covered for the purposes of achieving parity. Alternate care benefits include partial hospitalization, day treatment and intensive outpatient programs.

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CommunityCare HMO Open Access Basic (Catastrophic) Plan and Hardship Exemption

For Arizona Brokers – Arizona Individual & Family Plans

The Health Net of Arizona, Inc. CommunityCare HMO Open Access Basic (Catastrophic) plan is available to individuals who are under age 30. The plan is also available to individuals age 30 and older who are exempt from the federal requirement to maintain essential coverage.

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Health Law’s ‘Uninsurance’ Fine Capped

IRS officials have capped the amount of money that individuals could face for failing to obtain health insurance this year to $2,448 per person and $12,240 for a family of five. The maximum penalty would only hit individuals without insurance whose income is above $244,800. For families of five or more, the maximum penalty would affect people making a combined yearly income of $1.2 million.

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Reform Update: More on Employer Shared Responsibility

Q & A:  Employer Shared Responsibility

Starting in 2015, employers of at least 50 full-time employees will be subject to the Employer Shared Responsibility provisions under section 4980H of the Internal Revenue Code (added to the Code by the Affordable Care Act).

Q. I understand that the Employer Shared Responsibility provisions apply only to employers employing at least a certain number of employees. How many employees must an employer have to be subject to the Employer Shared Responsibility provisions?

A. To be subject to the Employer Shared Responsibility provisions for a calendar year, an employer must have employed during the previous calendar year at least 50 full-time employees or a combination of full-time and part-time employees that equals at least 50.

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Reform Update: Employer Shared Responsibility

Starting in 2015 (due to transition relief announced in IRS Notice 2013-45), employers of at least 50 full-time employees (including multiple part-time employees equivalent to full-time employees) will be subject to the Employer Shared Responsibility provisions under section 4980H of the Internal Revenue Code (added to the Code by the Affordable Care Act). If such employers fail to sufficiently offer affordable coverage meeting minimum value, they will be at risk for owing shared responsibility payment.

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Notice on CA AB 369 – Continuity of Care

California Brokers

In order to comply with California Bill AB 369, pertaining to Continuity of Care, Health Net mailed letters to all active PPO/HMO Individual members on an ACA plan (both on and off exchange) with effective dates from January 1, 2014 through April 1, 2014.

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Reform Reminder: What are Benefit Metal Levels?

Starting in 2014, all non-grandfathered health plans in the individual and small group markets (both inside and outside of the exchanges) must provide coverage that meets certain distinct levels of coverage. The levels of coverage are called benefit “metal levels” and are based on the actuarial value (AV) of the plan.

To determine the AV of a health plan, the U.S. Department of Health and Human Services (HHS) developed an AV calculator using a set of claims data reflecting the population expected to enroll in the individual and small-group markets in 2014.

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Reform Update: Exchange Insurance Credits

Obama Administration Allows Insurance Credits For People Unable To Enroll Through Flawed Exchanges.

The AP reported that the Obama Administration recently issued a health law fix designed to assist floundering state-run health insurance exchanges, including Oregon’s.

The US Department of Health and Human Services announced that state residents unable to sign up through their respective state exchanges will still be allowed to receive Federal tax credits even if they purchased their policies outside of an exchange. Funds are available retroactively.

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