Tag Archives: Access Health CT

Public Exchanges – Am I Eligible?

The Affordable Care Act is impacting how employers are offering coverage to their employees, if they’re continuing to offer at all. An option for employees who wish to opt out of their employer sponsored plan has been, and at least for now, continues to be the accessibility of the Public Exchanges. The common question from those who may wish to opt out, since the enrollment period is over for 2014, is “When can I enroll in the Public Exchange, and am I even eligible?”

Most residents in the state of Connecticut must wait until the next open enrollment period (November 15, 2014 – February 15, 2015) to get health care coverage through our state run program, Access Health CT. However, individuals may be able to get coverage earlier, depending on their situation. Continue reading Public Exchanges – Am I Eligible?

Ovation Shines a Light on the Newest Players in the Connecticut Health Plan Market

Executives representing more than 60 Hartford-area companies joined the Ovation team for a thought leadership event last week. The event was the third in the organization’s Chief Executive Series which takes place in May and November each year. The focus was on “Emerging Market Forces in the New World of Connecticut Health Plans” and featured a panel of leaders from Harvard Pilgrim Healthcare, HealthyCT, ProHealth Physicians and Rogers Benefit Group. Ovation Managing Principals Bill Carew and Brian Driscoll acted as panel moderators.

Continue reading Ovation Shines a Light on the Newest Players in the Connecticut Health Plan Market

4 Emerging Health Plan Innovations in the Connecticut Insurance Market

One of the new trends that have emerged as a result of the Affordable Care Act (ACA) is the strategic option for employers to define their contribution and provide employees with significantly more choices in the insurance products they may want to buy for themselves and their families.  The platform to do this is known as a Private Exchange, and there are many options available, as I outlined in my last post: Choices on Top of Choices: Deciphering the Private Marketplace Landscape with 7 Essential Components.

As many are aware, Ovation has been hosting bi-weekly seminars on our own Private Exchange, the Digital Benefits Marketplace (DBM).  These seminars explore the concept of how the rise of the consumer will transform the future of employer-sponsored benefit plans. Each of the seminars has included an opportunity to see a test drive of the marketplace from the employer’s perspective. Additionally, we are pleased to announce the completion of our Digital Benefits Marketplace Experience Room, in which employers can receive a one-on-one test drive of the solution (see photos below).


















In addition to this exciting new macro trend in healthcare, employers sponsoring a health plan in Connecticut should be aware of the three recent emerging options: Healthy CT, Harvard Pilgrim HealthCare and ProHealth Physicians Accountable Care Organization (ACO).

A brief overview of each follows:

Healthy CT

HealthyCT is a non-profit, Consumer Operated and Oriented Plan (COOP), whose development was encouraged by healthcare reform law and funded by the federal government.  Their model is based upon the concept of a Patient Centered Medical Home (PCMH) relying heavily on the Primary Care systems to help improve quality of care while lowering costs. Their provider network development is ongoing.

HealthyCT has been writing individual and small business coverage since January 1, 2014 and has recently begun targeting larger groups (50 employees or more) with very aggressive pricing. To learn more, visit www.healthyct.org.

Harvard Pilgrim HealthCare (HPHC)

Harvard Pilgrim HealthCare, also a non-profit, has been around for 35 years primarily serving members in Massachusetts, but they have their sights set on Connecticut with a tentative roll out of July 2014. For 10 years, HPHC has been recognized as America’s number one health plan.  HPHC has been using the services of Mickey Hebert, whose background in the Connecticut marketplace should accelerate HPHC’s acclimation to the state.  To learn more visit www.harvardpilgrimhealth.org.

ProHealth Physicians Accountable Care Organization (ACO)

ProHealth Physicians was formed in 1997 with a mission to empower Primary Care physicians through improved care processes and patient outcomes. One of the health system models encouraged by health care reform is the concept of an Accountable Care Organization (ACO). ProHealth has formed an ACO and are in the process of developing a direct-to-employer solution to improve quality of care and reduce cost. ProHealth believes their approach to population health management and provider reimbursements will improve the system for all constituents. To learn more visit https://www.prohealthmd.com/.

These innovative insurance options are a direct result of the emerging healthcare marketplace. Each represents a potential option for employers who offer a health plan in the state of Connecticut. The genesis and practical application of these options, plus the Digital Benefits Marketplace, will be discussed in Ovation’s spring Chief Executive Series event, “Emerging Market Forces in the New World of Connecticut Health Plans” on May 21st, 2014 at The Society Room in Hartford, Connecticut.

For more information or to register, contact Lisa Hathaway at lhathaway@digitalbenefitadvisors.com.

2014 Is Right Around The Corner – Arm Your Employees With Information (And Keep Them From Flooding Your HR Office)

With October 1st just past and January 1, 2014 right around the corner, a new wave of attention is being focused on health care reform, the Marketplaces, and the future of ACA. New options, new coverages, new eligibility rules, and sometimes misleading or half-truths in the media create uncertainty and confusion. Whatever your political leanings, the need to level set some basic information is key to setting a clear path and clearing through the clutter for your employees.

HC-Reform1-460x172Whether your philosophy is to “inform and over-inform” or to “keep it to the bare facts,” I recommend implementing a robust communication plan. Not only will you be viewed as well-versed in these challenging topics, you will also be serving to reduce employee stress about the multitude of changes and choices that lie ahead. Consider communicating these topics the way you would ramp up communications for open enrollment. Create posters, emails and payroll stuffers by utilizing the language I’ve suggested below in part or in whole:

Health Care Reform Overview

The Health Care Reform law, officially known as the Patient Protection and Affordable Care Act, was signed by President Obama in March 2010. The law is intended to expand access to affordable quality health care for Americans.

The law will be implemented over a 10-year period. Several rules of the law take effect in 2014. Some things may affect you and your family while others may not.

What’s Taken Effect So Far?

Here is a quick review of what has taken effect so far as a result of the health care reform law.  For more information, review the interactive timeline on www.healthcare.gov or visit this link.

• Children Covered to Age 26 – Your dependent children up to age 26 can be covered under your medical plan, even if they are married, not living with you or not financially dependent on you.
• Summary of Benefits and Coverage (SBC) and Uniform Glossary – During each year’s enrollment, you will receive a Summary of Benefits and Coverage in paper or electronic form with information about our plan in a standard format so you can compare our plan to other coverage such as your spouse’s plan.
• W-2 Reporting – Each January, we will report the total value of your medical plan for the previous year on your W-2 tax form. This is for your information only and does not affect your income or taxes.
• No Lifetime Maximum – There is no lifetime dollar limit on the amount your medical plan will pay for “essential health benefits.” This refers to a set of benefits including the 10 general categories listed below. All plans may not include or cover all of these categories. However, for those items that are included, that plan cannot place lifetime dollar limits on those benefits.

Essential Health Benefits 10 General Categories:
1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance abuse disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

• Additional Medicare Taxes – Individuals earning more than $200,000 and couples earning more than $250,000 began paying additional Medicare taxes in 2013.
• Preventive Care – Preventive care services like annual physicals and immunizations are covered at no additional cost to you. Effective August 1, 2012, non-grandfathered plans were required to cover additional women’s preventive services with no coinsurance, copays or deductibles, including certain health screenings, breast-feeding equipment and supplies, and contraceptives.
• Doctor Choice – If your plan requires you to choose a primary care doctor, you can select a general practitioner, family practitioner, internal medicine specialist or pediatrician. Women can also visit an obstetrician/gynecologist without a referral.
• Emergency Care – Emergency room services from any hospital are paid at the in-network level – even if the hospital isn’t in our plan’s network.
• Prescriptions for OTC Drugs – You must have a prescription to pay for most over-the-counter drugs from a Health Savings Account, Health Reimbursement Account or Flexible Spending Account.
• Flexible Spending Account Annual Contributions – The maximum amount you can contribute to a Health Care Flexible Spending Account is $2,500 per year.
• Health Savings Account Penalty – If you use your Health Savings Account for purchases not listed as eligible health care expenses under the federal tax code, you will pay a 20% penalty on those purchases.

Health Care Reform in 2014 and Beyond
You may have read or heard about some of the health care reform rules coming in the future. From the new Health Insurance Marketplaces to new requirements for having medical coverage, some significant parts of the law are taking effect in the coming months. To understand how health care reform may or may not impact you and your family, consider visiting www.healthcare.gov for more information.

The Individual Mandate
A new requirement called the individual mandate is taking effect on January 1, 2014. All U.S. citizens and legal residents, with a few exceptions, are required to have “minimum essential coverage.” Coverage under one of our medical plans will satisfy this requirement. Other types of coverage that meet the individual mandate include plans provided by another employer, Medicare, Medicaid or individual health insurance.

The Exchange Marketplace
You may have heard about Health Insurance Marketplaces, or Exchanges, that all states are scheduled to open this fall. Marketplaces are being developed as new options where people can compare and purchase standard health insurance plans.

Federal subsidies may be available to assist low to moderate income individuals in paying the premium for health insurance purchased through the new Health Insurance Marketplaces. Eligibility for a subsidy is based on income. However, individuals who are eligible for employer-sponsored coverage that is “affordable” and provides “minimum value” are not eligible for the subsidy.

Coverage under policies purchased through the Marketplace can begin as early as January 1, 2014, and individuals can start enrolling on October 1, 2013. Connecticut’s Marketplace is AccessHealthCT www.accesshealthct.com

The Exchange Marketplace Notice
As required by the health care reform law, we will be providing/have provided you with a notice that contains information about the new Health Insurance Marketplace.

There are several reform-related benefit changes taking effect in 2014, including:

• No Pre-existing Condition Limits – No one will be denied coverage based on a pre-existing condition.
• No Annual Dollar Limits – There are no annual dollar limits on the amount our plan will pay for each year.
• Coverage Waiting Period – The waiting period before coverage begins will not be more than 90 days.
• Coverage for Clinical Trials – If you participate in a clinical trial, our plan will cover routine patient costs for care you receive as part of the clinical trial.

My hope in providing you the information above is to arm you with the most important information that you should be communicating with your employees, in language that is easily understandable.  Your goal as an advisor for your employees is to clear through the clutter for them, and give them the best information possible so that they can be educated consumers of their health care. If you utilize the above content in a well thought-out communication plan, you deliver it in bite sized, easily understandable pieces, and you do it consistently, then the visits to your office should dwindle.

This post is for general informational purposes only and is not intended for and should not be used as legal or tax advice. While we have attempted to provide current and accurate information, users should seek professional advice from their legal, tax and benefit plan advisors.