Insurance is a major budget item and a financial necessity for nearly all Phillips County individuals and families. It is also a large expense for small businesses required to provide some health care provisions for its employees.
With this in mind the Phillips County Chamber of Commerce hosted a Health Care Reform Workshop at the Chamber office Wednesday. Two sessions were held –one in the morning and a second in the afternoon.
Cal Kellogg, executive vice president and chief strategy officer for Arkansas Blue Cross Blue Shield, was on hand to explain the sweeping changes that are coming October 1 as a result of the Health Care Reform Act. Kellogg provided some insight, with a power point presentation, into what small businesses owners need to know as the changes in the insurance industry slowly take place.
“October 1 is the key date,” stated Kellogg. “That's when the health insurance markets (exchanges) open.”
A second important date is December 15. That's the enrollment deadline to be included in Jan. 1, 2014 coverage, continued Kellogg.
“On January 1, regulations impacting employers go into effect,” stressed Kellogg. “And March 31 is the last day for individuals to enroll for coverage during 2014, unless you have a qualifying event.”
Kellogg defined “qualifying event” as a loss of a family member, loss of employment, etc.
According to Kellogg, regulations will be changing in small group and individual markets. The changes will occur in the area of new rating rules, new benefits and coverage requirements and Medicaid expansion. A new method of insurance ratings also will be introduced.
Kellogg said gender, age and industry ratings will be removed. Health status and pre-existing conditions also will no longer be considered.
Under the Health Care Reform Act, a new means of calculating premium rates will be implemented. Kellogg reports there will be a unique rate calculation for every member. Rates will be developed for families with up to three minor children.
“A fourth minor child and any additional children will be free,” commented Kellogg. “Children age 21 and over must be rated as adults.”
The new provisions require that all insurance must include what is considered “essential” health care benefits, added Kellogg. Essential health care benefits include: ambulatory patient services, emergency services, newborn and maternity care, hospitalization, mental health and substance use disorder services including behavioral health treatment, prescription drugs, rehabilitative, laboratory, preventive and wellness and pediatric services.
Kellogg reported that under the new plan deductibles cannot exceed $2,000/$4,000 adjusted annually. Also, there are no annual limits on essential health care benefits.
“There are going to be some winners and some losers as far as employers are concerned when the changes are fully instituted,” commented Kellogg. “Some rates are going up and some are going to go down.”
Kellogg praised the Arkansas Legislature for passing the Medicaid Private Option Plan. Through the Arkansas plan, adults with an income between 17 and 138 percent of the Federal Poverty Level will be eligible to participate in the Medicaid program.
Page 2 of 2 - “New eligible participants will shop for coverage in health insurance markets and buy Medicaid-approved benefit plans offered by private carriers,” stated Kellogg. “There will be some very desirable benefits at no premium cost. Employees may be eligible for Medicaid without any cost to the employer.”
Health insurance marketplaces, or exchanges, are grouped in levels of coverage as bronze, silver gold and platinum categories. A bronze plan will pay 40 percent of health care costs, a silver plan 30 percent, a gold plan 20 percent and a platinum 10 percent.