Key issues to consider while preparing for private exchange opening

Thank you again for inquiring about the Member Benefits Exchange for State Bar of Georgia members. The Exchange will be open for shopping in mid-January, and we hope that you will create an account and review the products and services that will be available to you, your family, and your employees. The Affordable Care Act has required health insurance carriers to make changes to their product offerings to comply with health care reform. Many of these changes went into effect beginning on January 1, 2014, and as a result, most Americans will have some decisions to make about their health insurance.

Below are a few considerations to make as we approach the opening of the private exchange:

For members with a “grandfathered” health plan

If you are currently insured, the first thing you’ll want to determine is if you have a “grandfathered plan”. This will make a very big difference in how new PPACA provisions will affect you. A “grandfathered” health plan as used in connection with the Affordable Care Act is a group health plan that was created—or an individual health insurance policy that was purchased—on or before March 23, 2010. Grandfathered plans are exempt from many changes required under the Affordable Care Act. Plans or policies may lose their “grandfathered” status if they make certain significant changes that reduce benefits or increase costs to consumers. How do I know if my plan is grandfathered? A health plan must disclose in its plan materials whether it considers itself to be a grandfathered plan. While there are very few plans remaining that maintain “grandfathered” status, if your plan is one of them, you’ll want to be very careful about making any changes to your plan. You will likely want to keep your “grandfathered” plan as long as you can. If you have any questions about your existing plan, our Benefits Counselors can provide you with a free analysis.

For members currently insured by small group plans

Our initial comparisons show that 2014 individual plan rates compare very favorably with many small group plan rates. Many small groups (especially micro groups with 5 or fewer employees) will find it more advantageous to move towards purchasing individual policies rather than a small group plan. In most states, individual coverage rates have traditionally been significantly lower than small group rates. One problem has been, however, that prior to 2014, individual policies have been fully underwritten. The chances of one or more employees being denied coverage for a pre-existing condition are pretty good. As a result, small employer group insurance has been the only viable coverage option for many small law firms and solo practitioners since group coverage is guaranteed acceptance for all employees. Beginning on Jan. 1, 2014, individual policies are no longer fully-underwritten and cannot deny coverage due to pre-existing conditions. If you currently have a small group plan, that is not “grandfathered”, you may want to consider looking at a comparable individual plan on the private exchange. You can choose to do this right away, or as your next group renewal date approaches. Our benefits counselors can help you make that comparison and also explain some of the other features that are available to employer groups.

For members currently insured by an individual plan

A tactic that was utilized by many individual health policy issuers, was to allow current insureds to extend their current plan and rates into 2014. This was accomplished by allowing insureds to renew their plans in December 2013, thus delaying many of the mandated PPACA 2014 provisions as well as the adjusted premium increases that are being attributed to PPACA. This was very attractive to individuals that were satisfied with their policy and want to keep it in its current state for at least one more year. If your health insurance provider did not extend this offer to you, you may want to inquire with your provider. If your provider does not allow you to do so, you will need to select a new plan for 2014.

For members currently without coverage

Beginning in January, you’ll be able to create an account on the Member Benefits Private Health Exchange and begin exploring your options.

For members that qualify for a PPACA tax credit

Like many Americans, you may have attempted to register on the federal Health Insurance Marketplace. When the private exchange opens, we can help you with this process. First, through our registration process, we can help you determine if you qualify for a health care reform subsidy (a tax-credit). If you do, we can assist you through the process of applying for the tax credit and evaluating qualified health plans on the Public Exchange. Our Benefits Counselors provide unbiased guidance on which plans will best meet your needs and there is no additional cost for the services provided by our Benefits Counselors.