Special Enrollment Periods (SEPs): What You Need to Know

Special Enrollment Period content has been added to the Broker and Employer ACA Reform Guide portals for IFP/SBG/Large. There you will find effective date determination and documentation on the following topics:

  • Life Changing Qualifying Events (QEs) – Mini Open Enrollment
  • Loss of Minimum Essential Coverage (MEC)
  • Additional Qualifying Events

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For more details on this and any other ACA-related topic, please log onto the Health Care Reform Guide at www.healthnet.com/employer/reformguide .

Same Sex Marriage Supreme Court Ruling – Update

Gavel_Flag-288x300The U.S. Supreme Court ruling on June 26, 2015 deems that all couples have the right to marriage regardless of their gender. Additionally, all states must recognize a marriage that was entered into in a different jurisdiction.

Effective June 26, 2015 health plans must cover married couples, regardless of gender, if spousal/dependent coverage is offered. Health Net of Arizona, Inc. will offer an additional Special Enrollment Period (SEP) to allow spouses to be added through September 30, 2015.

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Supreme Court ACA Ruling: Key Takeaways

Healthcare-reform-flag-stethscope-iStock_12474320l-300x199The 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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Preventive Care That’s Easy on the Wallet

SAF 0329_CMYKWe all want to do what we can to maintain good health. Of course, we have budgets to balance too. So it’s good to know that many important stay-well services—like recommended immunizations, tests and checkups—are covered under the Affordable Care Act (ACA) at no extra cost to you.

That means you typically don’t have to meet any co-pays, co-insurance or deductibles when you get these services from an in-network provider. Continue reading

ACA 90-Day Waiting Period Rule on Use of Orientation Periods

ACA 90-Day Orientation PeriodOn June 25, 2014, the government issued final rules regarding the use of “bona fide employment-based orientation periods” in connection with the Affordable Care Act’s 90 day waiting period limits.

These final rules largely track the proposed rules issued in February 2014.


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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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Reform Guide: Limits on Waiting Periods

waiting-period-iStock_000003717430Small-300x211The waiting – or probationary – period is the period of time set by an employer before coverage becomes effective for a new employee enrolling into the group’s health benefit coverage. Group health plans and health insurance carriers that offer group coverage may not apply a waiting period that exceeds 90 days. California law sets the limit at 60 calendar days (AB1083).

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The 2015 Employer Mandate is Coming! What Will You Do?

As of January 1, 2015, the Affordable Care Act (ACA) will impose an employer mandate that could dramatically affect large businesses. According to the ACA employer mandate, any employer group with 100 or more full-time employees may be subject to a tax penalty if it does not offer affordable medical coverage to its employees. Continue reading

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. Continue reading