Chiropractic/acupuncture benefit changes for small groups
Effective January 1, 2016, chiropractic and acupuncture benefits will no longer be offered as optional riders for your small group clients’ Affordable Care Act (ACA)–compliant plans.
We’re making this change to comply with ACA rules, which mandate that all benefits offered in any ACA-compliant plan must be embedded as part of the benefit plan design and can’t be offered through a separate rider. All members currently enrolled in a plan with these benefits can continue to receive them if your clients offer one of the plans described below.
Grandfathered plans aren’t affected by this change. Groups with these plans can continue to offer chiropractic and acupuncture benefits through a separate rider.
What will change?
Your groups with ACA-compliant metal plans won’t be able to offer chiropractic and acupuncture benefits through an optional rider when they renew their coverage in 2016.
Only the following Kaiser Permanente ACA-compliant plans will include chiropractic and acupuncture benefits, with the cost of the benefits embedded in the medical plan rate:
- Platinum 90 HMO 0/15 (new plan for 2016)
- Gold 80 HMO 500/30
- Silver 70 HMO 1000/50 (replaces Silver 70 HMO 1000/40)
If your clients don’t currently offer these plans, they can’t purchase a separate chiropractic and acupuncture rider upon renewal. If they already offer one of these plans with a separate chiropractic and acupuncture rider, those benefits will automatically be part of their plan and included in their rate in 2016. If they’re already enrolled in one of these plans but didn’t add a chiropractic and acupuncture rider in 2015, they’ll now enjoy these benefits when they renew their coverage in 2016.
How rates will be affected
If your clients are enrolled or plan to enroll in the Platinum 90 HMO 0/15, Gold 80 HMO 500/30, or Silver 70 HMO 1000/50 plans, chiropractic and acupuncture benefits will be automatically included as part of their plan benefits. When they receive their monthly statement, they’ll notice that the amount due for chiropractic and acupuncture benefits is $0.00.
If their chiropractic and acupuncture benefits are discontinued as a result of this change, they’ll no longer be charged for the additional chiropractic and acupuncture plan. Their monthly statement will show that the amount due for this plan is $0.00.
If your clients offer a grandfathered plan together with a separate chiropractic and acupuncture plan, they’ll continue to be billed separately for these benefits.
No action needed at this time
There’s nothing you or your clients need to do right now. We’ve sent a letter to your clients letting them know about this change. At their renewal, they’ll receive specific information about their 2016 plans, benefits, and rates.
If they want to continue offering chiropractic and acupuncture benefits to their employees, and they don’t have one of the plans listed above, they’ll have the opportunity to change their plan to one that includes these benefits by using the Renewal Changes form. Their renewal packet will provide the information they need to review these other plan options.
Employees who will lose their chiropractic and acupuncture benefits as a result of this change should be notified that these benefits won’t be available to them effective on their renewal date. If your clients choose to continue offering these benefits through a plan with embedded chiropractic and acupuncture benefits, they should let their employees know about this new option.
If your clients have any additional questions, they can contact the Customer Connection Team at 800-790-4661, option 3.