The Affordable Care Act (ACA) requires individual and group health plans to report publicly their medical loss ratios (MLR), which represent the percentage of each premium dollar that is spent on health care services and quality improvement. ACA also requires such plans beginning on January 1, 2011, to provide an annual rebate to enrollees if the MLR is below the minimum requirement for the applicable market. The minimum requirement is 80% for individual and small group markets and 85% for the large group market.

Though the ACA directs a national standard for all insurance carriers’ MLR, some states may require more stringent ratios. The ACA’s MLR requirements will serve as a floor, below which insurance carriers may not fall without being penalized as noted above. However, US Department of Health and Human Services (HHS) has the discretion to grant a state-specific waiver of the MLR requirement, and several states have requested and received waivers. North Carolina received an MLR waiver from HHS, effectively reducing the minimum MLR for individuals in 2011 to 75%. In 2012, that requirement will be raised to the statutory minimum of 80%. Otherwise, MLR requirements are 80% for small groups, and 85% for large groups.
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The term “actuarial value” has not been frequently used, even in the insurance business…yet! Even those in the business may have a hard time understanding it and even harder time explaining it. But the Affordable Care Act (ACA) uses actuarial value to describe many of the requirements and restrictions for compliant plans, so it becomes increasingly important to understand and explain what this term means and how it applies in a post-ACA world.
Actuarial value is often seen as the “true” value of a plan. It is the percentage of covered costs that the plan expects to pay for an enrollee in the plan. As an example, a person with a plan that had an actuarial value of 70% would be responsible for on average 30% of the cost of the covered benefits under the plan. Depending on the behavior of the enrollees in the plan, the actual value of the plan may vary slightly. Until the passage of ACA, “actuarial value” was not a household term. Long-time insurance employees likely have a loose grasp on the concept, but in the post-reform world, it will be a commonly used tool to estimate the true value of a plan.
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Executive Brief
Prepared by BCBSNC Health Policy Office
Overview
The Affordable Care Act (ACA) changes the very foundation of the way health insurance is purchased with the introduction of public health insurance Exchanges, a standardization of health insurance plans, and the creation of new financial assistance programs call subsidies. Each American may have a different experience with many of the reforms depending on factors such as their income, health status, and how they currently obtain their insurance. One group that received special attention under the ACA are American Indians and Alaska Natives (AN/AIs). Of particular note to health insurance issuers is the fact that these groups will have unique rules regarding subsidies and enrollment.
Subsidies
Two types of subsidies exist under the ACA: premium tax credits and cost-sharing reductions. Only available through the public Exchanges, the premium tax credits reduce the cost of the premium to individuals and families while the cost-sharing reductions reduce the out-of-pocket costs once a member has enrolled. For AI/ANs, the premium tax credits are applied just like anyone else who qualifies on the Exchange. However, the cost-sharing reductions have been modified for AI/ANs. For most individuals without access to other affordable coverage, the (more…)

Blue Cross Blue Shield wants to help you save. Consider one of our new low cost plan options. To help lessen the financial impacts of health care reform, BCBSNC has created several new plan options for 2014.

BCBSNC Catastrophic Plans in 2014:

+Substantial savings with preventive care covered at no charge3

+ Exemption from some of the rules of the Affordable Care Act (ACA)

Subsidies cannot be applied to this plan.

IFor more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). It would be our pleasure to help you navigate through the Health Care Reform changes in accordance with the new regulations of Obama care. Call us for details.

Information from a BCBSNC publication on 8/12/13.

Let’s get to the question on everyone’s minds: What does this mean for me?  The people most affected financially by Obama Care are those who purchase individual policies or get their insurance through a small-business employer.  Of those affected, some customers will pay less than they do now, but many will pay more. Federal subsidies will offset the rates for some people – but many will be eligible for only a partial subsidy.  Here’s how health insurance premiums will be impacted for different people choosing a mid level plan.

But how will Blue Cross and BlueShield of North Carolina’s individual and small business customers be affected specifically?

Because of the impacts of the Affordable Care Act, about half of our customers will see their premiums increase by 50 percent or more before federal subsidies. We expect about half of our customers will qualify for subsidies, which will help off set their costs – though the amount of those subsidies can vary greatly. Of course, subsidies don’t actually reduce the cost of coverage. They simply shift it to someone else. The federal government pays for the subsidies and the cost share shifted to taxpayers.

The above information is from “The Cost of Change” from Blue Cross Blue Shield of North Carolina.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). It would be our pleasure to help you navigate through the Health Care Reform changes in accordance with the new regulations of Obama care. Call us for details.

You will need a new BCBSNC plan for 2014.
+ BCBSNC automatically map you to a new 2014 plan and send you that rate in September. To maximize savings, it is important for you to explore your options.
+ Starting October 1 in accordance with Obama Care, you will be able to go to Member Services  to link to the Health Insurance Marketplace where you can confirm subsidy eligibility. Compare your rate from our September rate letter to the rate of a new 2014 plan with subsidies or a low cost plan. This side by side comparison will help you decide what is best for you.
+ Remember, changes to the plan you were mapped to must be made by December 15, 2013 for the plan to be effective January 1, 2014.
+ If you make no changes, your mapped plan will start January 1, 2014.

Here’s what you should know about your plan:
+ The rate you pay for health insurance has always changed due to rising medical costs, but your rate may increase even more because of changes under health care reform. Some of the changes include increased benefits and new taxes and fees.
+ You may qualify for new federal subsidies that can help offset your monthly premium.
+ On October 1, log into Member Services and we will link you to the Health Insurance Marketplace so you can confirm subsidy
eligibility and ensure maximized savings.
+ Another way to save on premium costs is to consider one of the many new, low cost plan options such as Blue Value or Blue Select.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). It would be our pleasure to help you navigate through the Health Care Reform changes in accordance with the new regulations of Obama care. Call us for details.

Information from a BCBSNC publication on 8/12/13.

BlueCross BlueShield wants to help you save. Consider one of our new low cost plan options. To help lessen the financial impacts of health care reform, BCBSNC has created several new plan options for 2014.

Blue Value is one of these options.  The coverage you need, the savings you want. Blue Value features the lowest costs of all our plans. This plan offers:

+ Quality, cost-effective coverage
+ A limited network of providers and pharmacies
+ Prescription drug requirement

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.

Information from a BCBSNC publication on 8/12/13.

If you like your Grandfathered Plan, keep it. Automatic renewal will continue coverage. If you switch to a new 2014 BCBSNC plan, subsidies may save you money. Not switching may mean you are “leaving money on the table”.

BCBSNC will be sending you your new 2014 rate in September. Starting October 1, you can go to Member Services to link to the Health Insurance Marketplace to confirm subsidies. You can compare your rate from our September rate letter to the rate of a new 2014 plan with subsidies. This side by side comparison will help you decide what is best for you.  Remember, changes to your plan must be made by December 15, 2013 for the plan to be effective January 1, 2014.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.

Information from a BCBSNC publication on 8/12/13.

Cost-Sharing Reductions are only available to those who qualify. Again, they do not apply to Grandfathered Plans. If you qualify, you will want to take advantage of both Cost-Sharing Reductions and Advanced Premium Tax Credits. You can use them both to maximize your savings.Cost-Sharing Reductions are only available to individuals who are ineligible for public coverage and are unable to get qualified health insurance through an employer.

COST-SHARING REDUCTIONS:

2014 plans will be grouped into four metallic levels: Bronze, Silver, Gold and Platinum. In order to take advantage of Cost-Sharing Reductions, you must choose a Silver plan. They help lower out-of-pocket expenses, such as deductibles, co-pays and coinsurance.

Cost-Sharing Reductions are only available for households with incomes thatare between 100% and 250% of the Federal Poverty Level (FPL).

For example, let’s say you go to the doctor and are charged $100. Normally with a Silver plan you might have a co-pay of $25, but because
you qualify for Cost-Sharing Reductions and you chose a Silver plan, you may have a co-pay as low as $5.

Cost-Sharing Reductions can also lower deductibles. For example, a $3,500 deductible may be lowered to $500.

With Cost-Sharing Reductions, you essentially pay for a Silver plan but receive the richer coverage of higher metallic level plans, thereby reducing your out-of-pocket expenses. If you qualify for Cost-Sharing Reductions, you should take advantage of this cost savings benefit.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.

Information from a BCBSNC publication on 8/12/13.

There are two types of federal subsidies to help reduce health care costs in 2014.They are Advanced Premium Tax Credits and Cost-Sharing Reductions.

+ Advanced Premium Tax Credits lower your monthly premium.

+ Cost-Sharing Reductions help lower out-of-pocket expenses including deductibles, co-pays and coinsurance at the place of service, like doctor and hospital visits. Subsidies are only available on new 2014 plans for those who qualify. Subsidies cannot be applied to Grandfathered Plans, but it may be worth it to switch.

+ Advanced Premium Tax Credits are only available to individuals who are ineligible for public coverage and are unable to get qualified health insurance through an employer.

+ Advanced Premium Tax Credits are determined by income and family size in relation to established Federal Poverty Levels (FPL). Many Americans will qualify for Advanced Premium Tax Credits, including the middle class. Those that qualify must have a household income between 100% and 400% of FPL for their family size.

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You are going to hear a lot about health care reform over the next few months, including information on federal subsidies.

+ Those individuals without a Grandfathered Plan will have to move to a new 2014 plan. Subsidies will make health care more accessible to more
people and ease the impact of higher premium costs.

+ Subsidies are determined by income and family size in relation to established Federal Poverty Levels.

+ You may qualify for subsidies, however, they do not apply to your Grandfathered Plan. You do have the option of switching to a new 2014 plan (leveraging potential subsidies), but these benefits may come at an increase to your monthly premium.

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Federal and NC Definitions Now Aligned

Date: 08/23/2013

Recently, the North Carolina (NC) legislature passed House Bill 649, which made changes to NC’s Small Employer Group Health Coverage Reform Act in order to align federal and NC definitions related to small employer group health plans – specifically, those definitions included as part of the Affordable Care Act.

Important changes affecting BCBSNC employer groups beginning January 1, 2014 include:

Sole Proprietorship Change

Self-employed individuals (or sole proprietors) with no common-law employees are no longer eligible for non-grandfathered small employer health plan coverage; conversely, a sole proprietor is eligible for group coverage if there is at least one common law employee (e.g., non-family member, etc.) employed.

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