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. Continue reading

For Your Employees: Tips on Choosing Health Coverage

February is Wise Health Consumer Month – an observance designed to help business owners, employees, individuals, and families better understand their health-insurance options. This year’s Wise Health Consumer Month is particularly timely, because open enrollment in the Affordable Care Act’s Health Insurance Marketplace – as well as in state health insurance exchanges – ends on March 31 of this year. Continue reading

Health Care Reform Reminders: What is SHOP?

ACA Quick Facts: What is the Small Business Health Options Program (SHOP)?


Several provisions of the Affordable Care Act (ACA) affect small businesses, their employees, and families. Currently, smaller businesses are less likely to offer health insurance coverage to their employees than larger companies: 57% of small businesses with 50 or fewer workers offered health benefits to employees in 2011, compared to 92% of businesses with 51 to 100 workers, and 97% of businesses with 101 or more workers. Continue reading

2013 Health Coverage Snapshot

While the word “change” was frequently used throughout 2013 to characterize health care in America, recently released studies of the year almost gone by paint a relatively static picture. Following is a snapshot of U.S. health-coverage trends over the last 12 months. Continue reading

Health Care Reform Update: Reporting Minimum Value

Options for employers, and what Health Net is doing


The Affordable Care Act requires that employers notify current employees about the health insurance marketplaces (Marketplaces) by October 1, and notify employees hired after that date at the time of hire. The notice includes stating whether a group health plan meets the minimum value standard. Continue reading

Health Care Reform Q&A: Essential Health Benefits (Final Rule)

Essential Health Benefits, Actuarial Value & Accreditation Standards (Final Rule)

Here is an update on one aspect of the Affordable Care Act that you may find helpful as an employer.


Background information


On February 20, 2013, the U.S. Department of Health and Human Services (HHS) released a final rule that details standards for health insurers related to coverage of essential health benefits (EHBs) and actuarial value. In addition, the final rule includes a timeline for qualified health plans to be accredited in the federally-facilitated exchange and provides an application process for the recognition of additional accrediting entities for purposes of certifying qualified health plans. Continue reading

When it Comes to Health Care Costs, America is No. 1

As a nation, America has plenty about which to be proud. In fact, the United States can claim No. 1 status on numerous fronts – from having the world’s largest Gross Domestic Product – to earning the most Olympic medals.


The USA also ranks No. 1 in money spent for health care. This particular top-notch status, however, isn’t necessarily a good thing. As an employer, you know that health care costs can take up a large part of your budget. Here are some interesting facts: Continue reading

Health Care Reform Q&A: Wellness Program Incentives

Incentives for nondiscriminatory wellness programs in group health plans


Here is an update on one aspect of the Affordable Care Act that you may find helpful as an employer.


On May 29, 2013, The Departments of Health and Human Services (HHS), Labor and the Treasury jointly issued final rules on wellness program incentives effective for plan and policy years starting on or after January 1, 2014.


The Affordable Care Act (ACA) prohibits group health plans and group health insurers from discriminating against individuals in eligibility, benefits or premiums based on enumerated health factors such as medical condition, claims experience, medical history, and genetic information.

Continue reading

Good News for Health Net Small Business Groups!

Health Net Selected for Covered California Small Business Health Insurance Exchange (SHOP)


A message from Scott St. Clair

We are excited to announce that Health Net Life Insurance Company has been selected as a carrier to participate in the Covered California small business exchange in all 58 counties.


Throughout California, small business groups will be able to select affordable, easy-to-use health coverage from Health Net. Health Net will offer PPO insurance plans that deliver a good balance between premiums and cost-sharing. SHOP premiums are expected to be announced in early August and we expect our SHOP premiums to be competitively priced vs. other carriers. Continue reading

Reform Q & A: Grandfathered Plans

As federal health care reform was being debated, many Americans expressed the desire to keep the health plans they currently have. In order to address this concern, the ACA has provided for “grandfathered” plans.


While the law requires all health plans to provide certain new benefits to consumers, it allows plans that existed on March 23, 2010 (the ACA effective date), to make routine changes without losing grandfather status. Plans lose their grandfather status only if they choose to significantly cut benefits or increase out-of-pocket spending for consumers.


The Departments of Health & Human Services (HHS), Labor and Treasury have issued Interim Final Rules that specify how grandfathered status will be defined and maintained. When final rulings are issued, answers to these questions may change. Continue reading