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Showing posts from January, 2013

The California Individual Health Market Under PPACA (2014)

There seems to be quite a bit of confusion out there as regards the upcoming healthcare reform market for individuals and families in California.

There will be one pool of people in the overall market comprising one single risk pool.  In that overall single pool there will be two markets available for individuals and families in California to purchase qualifying health plans (QHP) which have not yet been developed by the carriers for the markets (deadline for the exchange is May 31, 2013).  QHPs must fall into a 'precious metals' tier of Platinum, Gold, Silver, Bronze and one Catastrophic Tier.  They must meet actuarial values  as determined by the PPACA.

The Exchange

California will operate a state health benefits exchange which will offer plans inside of the exchange to those who wish to purchase those plans and especially for those seeking premium subsidy assistance or credit (or both).  Subsidy for exchange plans will be based on financial qualification and will be set to the…

CA SB 1431 Small Group Stop-Loss Bill Is Back On!

According to an e-blast from health underwriters today, the CA Legislature intends to re-open SB 1431 (De Leon) which was shelved last year.  

SB 1431 essentially raises the stop-loss amounts for self-funded small group plans in California to a level commensurate with large employer plans.  SB 1431, if passed and implemented, would likely force most small employers in California (under 50 employees) to revert to fully-insured health plans for their employees.


VA And TRICARE Meet 'Obama Care' Requirements

According to a document released by the White House, both VA (Veteran's Administration) and TRICARE health coverage meet the 'individual responsibility requirement' to maintain qualified health insurance under the PPACA (Obama Care).

Those who are eligible for VA services and those who have TRICARE(myself included) coverage will not be required to change coverage nor purchase a new coverage plan from the California Health Benefits Exchange in 2014.  

Those eligible for VA services may also purchase a qualifying health plan (QHP) if they so desire, but are not required to purchase a plan.  

White House Memo on VA/TRICARE