Changes to health plan benefits
how coverage must be offered and administered
as well as offering a new way for coverage to be purchased
Some of these provisions, whether you receive health coverage through your employer or purchase it on your own, may not affect you directly, or immediately. For example, some Wellmark members have received notification that they may elect to remain on their current plan through 2014 or they may choose a new ACA compliant plan when open enrollment begins in October.
Investing a little time now to review key ACA provisions will make it easier for you to understand changes in the coverage you may be offered by your employer. Or, if you are purchasing coverage on your own, familiarizing yourself with ACA basics can go a long way in helping select the best plan for you and your family. As always, you can count on Wellmark to help inform and guide you through changes.
You may have already experienced the following benefit changes that were implemented over the past couple of years; however, come Jan. 1, 2014, they will be expanded. Here’s how:
The Supreme Court upheld the Individual Mandate requirement as part of the ACA. This means that beginning Jan. 1, 2014, virtually every legal U.S. resident will be required to have health insurance coverage (referred to as minimum essential coverage), or pay a tax penalty, known as Individual Shared Responsibility.
What qualifies as minimum essential coverage?
Here are some key points for you to know:
Most Wellmark plans already meet the minimum essential coverage requirement. Your health plan may change in order to meet other requirements, but you will not face a tax penalty as a result of the individual shared responsibility as long as you keep your coverage.
As part of health care reform, a set of 10 categories of benefits will be put into place called essential health benefits. While a majority of Wellmark plans already cover most of these benefits, beginning in 2014, many of the plans will be required to cover the following categories:
NOTE: Only non-grandfathered plans that are purchased on your own or obtained through a small group employer with 1 to 50 employees will be required to meet metallic tier levels.
*The U.S. Department of the Treasury issued transition relief for 2014, more information coming.
Starting in 2014, new individual and small group ACA plans will have four basic coverage levels:
These are known as Metallic Tiers. Each tier is defined by the portion of the claims paid by the insurer. This is known as the “actuarial value” of the plan.
For instance, for the Bronze tier, the plan typically pays 60 percent of the cost and you are responsible for the remaining 40 percent through out-of-pocket costs such as copayments, coinsurance and deductibles.
The graph below shows the actuarial value of the metallic tiers:
All the traditional places you purchase Wellmark coverage today will not change — even if you choose to purchase a new ACA compliant plan during the open enrollment period, which begins Oct. 1, 2013, for plan effective dates of Jan. 1, 2014. For instance, you can still purchase health insurance directly from Wellmark or through a broker or independent agent.
NOTE: Only non-grandfathered plans that are purchased on your own or obtained through a small group employer with 1 to 50 employees will be required to cover essential health benefits.