Archive for the ‘Legislation’ Category

Healthcare Reform Update

Posted on: February 13th, 2012 by Jon No Comments

We wish we had more black and white guidance, but the reality is that many provisions are still in play with the Patient Protection and Affordable Care Act (PPACA), such as:

  • U.S. Supreme Court to hear arguments in March regarding the constitutionality of the Individual Mandate and Medicaid Expansion provisions
  • House votes to repeal CLASS act, the long-term care (LTC) provision
  • Arizona moving forward but several other states delaying implementation of Health Insurance Exchanges
  • Current Medical Loss Ratio (MLR) calculation reducing the number of licensed health insurance agents that service small businesses and individuals

U.S. Supreme Court

Florida and 25 other states, including Arizona, have challenged the constitutionality of the Individual Mandate and Medicare Expansion provisions of the PPACA.  The U.S. Supreme Court is scheduled to hear arguments March 26-28th and a ruling is expected this summer.

The Individual Mandate is the requirement for all individuals to buy health insurance or pay a penalty, and is the underpinning for the guarantee issue provision.  The argument against is it exceeds the federal government’s power.

The Medicaid Expansion is the additional population covered when increasing the Medicaid qualifying income of individuals and families to 133% of the federal poverty level.  The argument against is it is a federal infringement on state legislative authority.

Regardless of the outcome of the Supreme Course case, we do not anticipate the whole PPACA will be repealed, especially given the popularity of provisions already in place (e.g., dependents now covered to age 26).  Instead, it will continue to be tweaked and refined via legislative and legal avenues.


Last October Health and Human Services (HHS) determined the Community Living Assistance Services and Support program (CLASS Act) was not financially solvent and earlier this month the House voted to repeal it.  We expect more legislative activity in this space given it is projected that by 2020, 15 million Americans will need LTC assistance, but currently less than 10 percent of people purchase private LTC insurance, putting further strain on Medicaid.

Health Insurance Exchanges

28 states, including Arizona, have taken steps to establish insurance exchanges; however, that is less than 60% overall.  Many states are holding off given the uncertainty of the outcome of the Supreme Court case (see above) and/or choosing to use the to-be-built federally run exchange instead.

Kristine Kassel continues to participate on the Arizona exchange work group for brokers and agents focusing on broker licensing and compensation, including the TBD “Navigator” role.  Other work groups include a health plans work group led by the Department of Insurance and concentrating on plan management requirements; a tribal work group developing outreach and education plans; an information technology infrastructure work group led by the Arizona Health Care Cost Containment System (AHCCCS); and a legislative work group.

Medical Loss Ratio (MLR)

The current MLR calculation received much attention during the National Association of Health Underwriters (NAHU) Capitol Conference in Washington DC last month.  Kristine Kassel and Jon Dolgaard were on the Arizona team who met with Representatives Jeff Flake (R-AZ) and Ed Pastor (D-AZ) to discuss the following.

  • Most small businesses work with a licensed independent health insurance agent given they do not have the expertise in-house to do this on their own.  This is the same approach they use for their legal, tax, 401(k) administration, etc. needs.
  • Independent health insurance agents do not work for insurance carriers; however, their commissions are paid by insurance carriers as a pass-through percentage of their client’s premium or client’s employee headcount.
  • Many independent insurance agents are already cutting back on health insurance services or no longer selling health insurance which is impacting small businesses’ and individuals’ ability to make educated choices about their health insurance.  The reason is that the PPACA’s MLR calculation currently includes insurance agent commissions; therefore, carriers are reducing the commissions to meet these requirements.

Two Congressional bipartisan bills are in progress to address this.  H.R. 1206 (Access to Professional Health Insurance Advisors Act) was introduced in the House last March and has more than 170 cosponsors thus far, including David Schweikert and more recently Ed Pastor from Arizona.  S. 2068 (Access to Independent Health Insurance Advisors Act) is the corresponding bill introduced earlier this month in the Senate.

Healthcare Reform Updates

Posted on: November 7th, 2011 by Kristine No Comments

Arizona is still working on the groundwork to set up a state exchange. Kristine is part of the broker committee to help provide feedback and insight to the Governors’ working group which is led by Don Hughes.

There has also been a halt placed on the implementation of the CLASS Act (Federal Long Term Care Program) at this time. 

Stay tuned for more information as it unfolds.

Healthcare Reform Update

Posted on: August 22nd, 2011 by Kristine No Comments

Last week it was decided that the ruling as to whether an Individual Health Insurance Mandate will be required for all citizens by 2014, has most likely been moved to the Supreme Court to make a decision next session.

The past few months Arizona has been meeting as a committee run by Don Hughes who was appointed by our Governor, Jan Brewer, to move forward with offering a Statewide Exchange instead of joining as part of the Federal Exchange. They are still waiting for the HHS requirements to see how to best set up the exchange, but currently they are researching several options. There are about 20 committee members ranging from Brokers, Insurance Companies and Department of Insurance Representatives. The Exchange will need to be set up by October 2013 and prepared operationally for January 2014 sales. This will affect both group and individual sales.

The Medical Loss Ratio will be required for Insurance Companies to report to the clients that they insure to see if any Rebates are owed to the client if their claims are below the loss ratio. This reporting will be required starting in 2011 and if any Rebating is owed to the client the checks must be distributed by August 1 of the following year. At that point the client will be required to reimburse their employees based on the amount of contributions the employer and employee contribute. You will be receiving more information on this from your particular carrier.

H.S.A. Guidelines

Posted on: March 29th, 2011 by Kristine No Comments

The contribution amounts for 2010 and 2011 are $3,050.00 for individuals and $6,150.00 for family. If you are over 55 years of age you are eligible to do a catch up contribution of $1,000.00.

You can contribute to your H.S.A. account for the prior year until April 15th or the day taxes are filed for the previous year.

Health Care Reform Wellness Grant Update for Small Employers

Posted on: March 29th, 2011 by Kristine No Comments

Beginning this year, grants are available for small employers to provide their employees access to new workplace wellness programs.

Eligible employers include:

  • less than 100 employees working 25 or more hours per week, AND
  • did not have a workplace wellness program as of March 23, 2010

The program must include:

  • Health awareness initiatives
  • Efforts to maximize employee engagement
  • Initiatives to change unhealthy behaviors and lifestyle choices
  • Supportive environment efforts

Eligible employers must submit an application to HHS (Health and Human Services) that includes a proposal for the program. Their website is listed below. Grants will be available until the budgeted amount ($200 million) runs out.

Wellness Grant Application for Small Employers 

3rd Quarter Updates & News

Posted on: September 30th, 2010 by Kristine No Comments

This quarter has kept our team very busy with all the Healthcare Reform changes. A few of these regulations that are effective today include coverage for pre-existing conditions for children under 19, dependent coverage for children up to age 26 who currently do not have other group coverage, unlimited lifetime limits for all policy holders and emergency services treated as in network. I have been doing several presentations on the subject so if you want more information please call our office.

I am hoping that many of these changes will help create more consumer awareness. And also realize that we are here to support you and your employees with any questions or challenges that you have. There is a lot to keep up with and it will be important to see how we can bring the costs down with all the new benefit additions.

We also added a new staff member, Colleen McCombs, who will be assisting Ryan Hansen with Account Management. Please feel free to call her and have her help you with any service issues. Also, we are happy to announce we added another baby to the Benefits by Design family. Ryan Hansen delivered Carson James on September 11, 2010. Both Mother and baby are doing great and Ryan will be back at work in November.

Personally I wanted to share with you that I was nominated for the Athena Award this year. I was not selected as a finalist, but it really is a great honor to be part of such a great group of successful women. Here are some other activities I am keeping active with: Tempe Leadership, Tempe Chamber of Commerce Board, Athena Powerlink Board, Gabriel’s Angel’s Board, ASBA Board and recently the Phoenix NAWBO Board as President-Elect. I truly feel that volunteering is what helps us grow as a person through leadership and learning.


Posted on: May 27th, 2010 by admin No Comments

Benefits by Design is keeping you up to date with Legislation that pertains to you.

March 31, 2010 – Newsletter

Posted on: March 31st, 2010 by admin No Comments

HealthCare Legislation

As your benefits advisor, we would like to take this opportunity to provide you a summary of the key components of the health care reform legislation and how it may impact you and your business. We expect that given the number of years that it will take to fully rollout these reforms, there will continue to be changes to many elements of the legislation. However, for the first time in over a year, we have a much clearer view of the changes that will potentially take place. This bill will: (more…)