OLYMPIA, Wash. – The individual health insurance market will have two special open-enrollment periods for children this year. Parents who want to add their children to their individual health plans or buy child-only plans can do so from March 15-April 30, 2011 and from Sept. 15-Oct. 31, 2011.

Insurance Commissioner Mike Kreidler filed a regulation today, creating this year’s open-enrollment periods in the individual market.  The individual health insurance market is for people who do not have access to employer-sponsored health insurance.

New consumer protections under the federal Affordable Care Act prevent health insurers from denying coverage to children with pre-existing health conditions.  However, special open-enrollment periods are allowed.During open-enrollment times, children under age 19 cannot be denied health insurance because of a pre-existing condition. People looking for coverage for their children outside of the enrollment dates can apply either to the Washington State Health Insurance Pool (WSHIP), or if they qualify, to the new Pre-existing Condition Insurance Plan (PCIP-WA). To enroll in PCIP-WA, you must have been uninsured for at least six months and have a pre-existing medical condition.

 Exceptions where parents can apply for individual coverage for their kids anytime include the birth or adoption of a child or if a child or the parent:

•  Is no longer eligible for a state program.
• Loses coverage due to a divorce.
• Loses employer-sponsored coverage.
• Moves and their plan is not available where they live.

 In 2014, when the full health reforms take effect, no one of any age can be denied insurance because of a pre-existing condition.

Anyone with questions about the individual health insurance market can call our Insurance Consumer Hotline at 1-800-562-6900.

In addition, the annual open enrollment period runs from November 15 – December 15 for a January 1st effective date.  Children enrolling during this period are NOT required to complete the Standard Health Questionnaire.

All children under the age of 19 are not subject to ANY pre-existing condition waiting periods regardless of their effective date.

Mercer, the benefits consulting firm, last week put the cost of a single health reform law provision — dependent eligibility expansion — at up to an extra 2 percent increase in medical premiums beyond what would otherwise be expected for 2011.  It is becoming exceedingly clear that it costs more to get more.

Read more here about the recently released interim rules released by the U.S. Departments of Health and Human Services (HHS), Labor & Treasury relating to status as a grandfathered plan.  This recap is provided courtesy of National Association of Health Underwriters.

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA) which revised by the House Reconciliation Bill that was signed into effect on March 30, 2010.

With this new law, the employer based system of providing healthcare to employees is maintained. There is NOT a public plan and individuals will be required to have coverage by 2014.

While this law makes several positive changes, the focus is more on health insurance reform than health care reform as it fails to address many of the underlying factors which continue to contribute to the skyrocketing cost of healthcare.

At the present time, we do not have a lot of detail with regards to the definitions of certain provisions as well as the method for implementation.

So what does this mean for you? Here is a summary of the timeline of the items (not all inclusive) that will affect you— (for more detailed information, please visit our website and select healthcare reform)

Effective immediately:

• New federal rate review process is established
• State grants to establish ombudsman programs are awarded
• National risk-pool is created 90 days from enactment
• Temporary retiree reinsurance program is established
• Small business tax credit is established

Effective on or after 10/1/2010:

• Lifetime benefit maximums are prohibited
• Cost sharing or caps on preventive benefits are eliminated.
• Coverage for dependents up to age 26 is mandated (married child can be a dependent)
• Eliminates pre-existing condition exclusions for dependent children under age 19
• Allows for restricted annual limits on essential benefits (as determined by Department of Health & Human Services HHS)
• New health plan disclosure and transparency requirements are created
• $250 rebate for Medicare participants falling into Rx donut-hole

Effective on or after 1/1/2014:

• Health Insurance Exchange is created
• Guarantee issue is required
• Rating restrictions are imposed for factors such as age, area, family composition and smoking status
• Individual and Employer requirements are established
• Pre-existing condition exclusions are eliminated
• Waiting periods for coverage are limited to 90 days
• An essential health benefits package is established that provides a comprehensive set of services.
• States are allowed the option to merge the individual and small group markets.

Source—“Healthcare Reform Implementation Timeline” – Kaiser Family Foundation, 3/31/2010

Lunch & Learn Seminars Coming Soon!

Beginning in May, we will be hosting lunch & learn seminars to help you better understand the impact of this new legislation. Watch your email for a list of dates and times.

These will be free seminars and a brown bag lunch will be provided.

Check our website frequently for updates and availability as space will be limited.

Key Changes to Medicare Part D Drug Benefit Coverage Gap

One of the most beneficial components of the new PPACA law is that over time, it will reduce the amount that Medicare Part D enrollees will have to pay for prescription drugs when they fall into the “coverage gap.” The coverage gap in 2010 is $3,610 and approximately 14% of all enrollees reach this coverage gap.

Beginning in 2011, the new reform law will reduce the amount that Part D enrollees are required to pay for their prescriptions when they reach the gap.

2011— a 50% discount of the total cost of brand name drugs in the gap, as agreed to by pharmaceutical manufacturers.

Over time, Medicare will gradually phase in additional subsidies in the coverage gap for brand-name drugs (beginning in 2013) and generic drugs (beginning in 2011).

We Have Moved!

We have a new home! As of April 1st, we have re-located to the Burnham Drive Professional Plaza.

Our new address is:

11505 Burnham Drive NW, Suite 101
Gig Harbor, WA 98332.

Our phone, fax, email and mailing address remain unchanged.

Click here to read this thought-provoking article.