The proposed rule, which applies only to employer-sponsored health insurance, would allow employers to join together as a single group to purchase insurance in the large group market. These improvements stand to open health insurance coverage for millions of Americans and their families by making it more affordable for thousands of small businesses and sole proprietors. By joining together, employers may reduce administrative costs through economies of scale, strengthen their bargaining position to obtain more favorable deals, enhance their ability to self-insure, and offer a wider array of insurance options.
Since 2014 under Affordable Care Act rules, new ACA qualified health plans had just one rate for dependents from ages 0 to 20. In 2018 there will now be 7 different age based rates with the first for ages 0 – 14. Beginning at age 15 there will be a separate age rates per year up to age 20. The new member level age rating does not apply to grandfathered plans.
Western Health Advantage (WHA) has announced that the Department of Managed Health Care has approved their expansion for small group plans into the Bay Area. They also noted that they will not seek re-certification of their Covered California small group plans because of this expansion. WHA’s exit from the Covered California for Small Business plans does not affect their individual and family plan offerings through Covered California.
As part of our ongoing efforts to manage these drug costs, we are expanding our precertification program to include medical specialty edits. The expansion of our precertification program will allow clients who currently have our precertification program to benefit from these enhancements. There are two components to this expansion:
Covered California announced today the rates and expansion plans for its small group health insurance exchange, Covered California for Small Business. The statewide weighted average rate increase is 5.9 percent, for employers and their employees beginning Jan. 1, 2017, which is down from the 7.2 percent increase in 2016.
If you are a small employer, there is a tax credit that can put money in your pocket. The small business health care tax credit benefits employers. The credit is available to eligible employers for two consecutive taxable years beginning in 2014 or later.
The definition of a small business in California has expanded to include groups with 1-100 full-time equivalent (FTE) employees. Second, the Affordable Care Act (ACA) employer mandate now requires businesses with at least 50 full-time equivalent employees to provide health coverage for their employees and dependents or face a tax penalty.
Members will be allowed only 15 days per fill during the first 30 days, when starting on a select group of new specialty drugs. Copays are prorated during this time. The Split Fill program only applies to the first month of the drug fill at Accredo Specialty Pharmacy. After that, the prescription is filled as it is written by their doctor.
Small employer group plans acquired through Covered California Small Business program will see benefit and coverage changes consistent with changes implemented for individual and family plans in 2016. Covered California has released a spread sheet comparing the 2015 benefit level to the new 2016 benefits by coverage type. The most significant changes will occur on Bronze level plans where coinsurance is rising from 30% to 100% after the deductible for many covered benefits. In addition, Kaiser and Health Net will be discontinuing their Silver 70 H.S.A. plans.
Insurance Commissioner Dave Jones announced today that Department of Insurance actuaries found Aetna Life Insurance Company’s most recent small group health insurance rate increase excessive and unreasonable. Aetna is increasing rates for small businesses and their employees by an annual average of 27.4 percent.