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Top Canadian Chooses US Health Care (8/31/2010)

Notice Regarding the New California Life Settlement Law (6/29/10) 

Health Care Reform Mandates 2010 to 2014 & Beyond (6/18/10)

- UnitedHealthcare Update on Large Group

- Healthcare: What is a Grandfathered Plan?

Sales Expo 2010 - Speaker Adam Brackemyer Slide Presentation (6/17/10)

Governor Signs One Health Care Bill and Vetoes Three Others; Two Bills Still Pending - October 12, 2009

Among the Bills signed into law:

  • Assembly Bill 119, also by Jones, prohibits insurers from charging differing premiums to men than to women. (as expected by CAHU, and frankly unstoppable, and a change we can live with).

Among the Bills vetoed:

  • Assembly Bill 2, by Assemblyman Hector De La Torre, D-South Gate, would have restricted the ability of health insurance firms to rescind policies after a costly claim is made.  Opponents have argued that the bill would place an onerous burden of proof on insurance firms: Schwarzenegger opportunity agreed, saying AB 2 "benefits trial lawyers rather than consumers."
  • Assembly Bill 98, by De La Torre, would have required health plans to cover maternity services.  It was the third time Schwarzenegger had vetoed such a bill.  "I continue to have serious concerns about the rising costs of health care and believe the potential benefits of a mandate of this magnitude will translate to fewer individuals being able to afford coverage."
  • Assembly Bill 513, by Assemblyman Kevin De Leon, D-Los Angeles, would have required health plans that cover maternity services to provide a lactation consultant and breast pump rental.  "This, like other mandates, only increases cost in an environment in which health coverage is increasingly expensive," the governor wrote.
  • As for AB 244 (Mental health Parity) and AB 730 (the "other" bill on IFP Policy Rescissions)...no official word yet on them so far, though the deadline to sign or veto was Sunday 10/11.  I fully expected him to veto AB 244, while approving (or allowing to become law) AB 730 after it got amended into a bill that causes us little concern anymore.

Comparison of the Coverage Provisions in the American Health Choices Act and the House Democratic Tri-Committee Health Reform Legislation - August 3, 2009

US Capitol.jpg

The recent federal stimulus plan provides for a 65% reduction in COBRA premiums for eligible individuals for up to nine months. Assembly Bill 23 (AB 23) requires insurers to mail a notice of the right to elect Cal-COBRA health insurance coverage to everyone who was laid off between September 1, 2008 and December 31, 2009. This includes current Cal-COBRA recipients and allows them to choose the 65% reduction as well. (5/15/09)

How is AB 23 different than the American Recovery and Reinvestment Act of 2009 (ARRA) signed into federal law on February 17, 2009?
AB 23 requires insurers to extend federal premium assistance of 65% reduction to Cal-COBRA premiums to employees who were involuntarily terminated between September 1, 2008 and December 31, 2009 and worked for an employer with fewer than 20 employees that offers health care coverage.

Which segments of the business community does this affect?
This bill impacts small businesses (2-19 employees) that offer health care benefits and would notify their health insurers of involuntarily terminated employees.

What are clients that are members of this segment of the business community responsible for?
These employers are still required to promptly notify their health insurer of all employees who are involuntarily terminated. In addition, they must respond promptly to their insurer’s requests for employee verification of the involuntary termination. If they involuntarily terminate(d) employees between September 1, 2008 and December 31, 2009 they must sign a “Verification of Involuntary Termination Form.” These forms will be supplied by the insurers to verify the involuntary layoff.

If my clients have former employees that enrolled in Cal-COBRA after September 1, 2008, what are they eligible for?
These employees must complete a “Request for Treatment as an Assistance Eligible Individual Form.” If eligible, they can obtain premium assistance back to March 1, 2009 or later. If an employee is currently enrolled under Cal-COBRA, they are eligible as of March 1, 2009.

If my clients have former employees that chose not to enroll in Cal-COBRA after September 1, 2008, can they enroll now and what are they eligible for?
If an employee was involuntarily terminated between September 1, 2008 and December 31, 2009, they should be eligible for the premium assistance assuming they meet the other federal requirements. The insurer has 14 days from the date AB 23 was signed by the Governor (May 12, 2009) to notify the former employees of their ability to enroll, similar to the notifications the employee received when employment was originally terminated but now it will include information about the federal premium assistance. The employee then has 60 days to enroll in Cal-COBRA and elect to receive the premium assistance.

What can be done if the former employer’s group health plan denies an application for the premium reduction for Cal-COBRA participants?
The applicant can appeal. The Secretary of the Department of Health and Human Services (HHS) is required to make a determination regarding an appeal within 15 business days after receiving a request for review. The Center for Medicare and Medicaid Services (CMS), which is part of HHS, will oversee appeals for federal, state, and local governmental employees, as well as appeals related to Cal-COBRA. CMS expects to begin processing appeals no later than May 1, 2009, and will provide further information regarding where to submit appeals in the near future.

Inquiries regarding Cal-COBRA subsidy appeals should be directed to :
NewCobraRights@cms.hhs.gov or the following address: CMS c/o COBRA APPEALS 7500 Security Blvd. Baltimore, MD 21244 Mail Stop C2-12-16
California Department of Insurance 1-800-927-HELP

Our local Assembly member Nathan Fletcher was a co author of  AB23 that Gov. Arnold Schwarzenegger signed legislation Tuesday, May 12, 2009.  The bill allows workers laid off from small businesses to receive federal aid for health insurance. (5/15/09)

Assembly Bill 23 by Democratic Assemblyman Dave Jones from Sacramento makes Californians who work for employers with two to 19 employees — and lost their jobs through layoff or other involuntary termination — eligible for a 65 percent federal subsidy of their health insurance costs.

Employees laid off by larger businesses already qualify under the federal stimulus bill.

AB 23 also gives those who lost their jobs from Sept. 1, 2008 through Feb. 16, 2009 and did not elect to continue their health insurance under the Consolidated Budget Reconciliation Act — better known as COBRA — the ability to seek that coverage now with the federal subsidy.

Few people eligible for continued health coverage when they lose their jobs have taken it in the past due to the expense. Hoping to boost participation and stem the rising number of Americans without insurance, the federal stimulus act signed by President Obama in February includes money to pick up 65 percent of the cost for most laid-off workers and their families for up to nine months.

IRS Issued 20 Q&As Regarding Form 941 and COBRA Premium Subsidy

The American Recovery and Reinvestment Act (the "Act"), which was enacted on Tuesday, February 17, 2009, provides federal assistance for payment of COBRA premiums to employees and covered family members with adjusted gross incomes below a maximum threshold who lost or will lose coverage due to involuntary termination of employment from September 1, 2008 through 2009. These federal assistance provisions impose new obligations upon sponsors of single-employer group health plans, multiemployer plans and group health insurers, and the Internal Revenue Service, Department of Labor, and Department of Health and Human Services are all working on guidance necessary to implement the new law.

Today, the first of that guidance was released in the form of 20 Questions and Answers that the IRS posted to its website to address issues relating to claiming the COBRA subsidy as a credit on Form 941, and certain other issues, including:

  1. The documentation that entities who claim the credit are expected to maintain,
  2. Information about a 2 month transition rule available to employers,
  3. Clarification about the criteria for COBRA subsidy eligibility,
  4. Clarification about the entity responsible for claiming the credit, and
  5. The mandatory aspect of the new law.

The guidance and IRS news release are available at: http://www.irs.gov/newsroom/article/0..id=204709.00.html

SB1440 Article

CAHU Healthy Solutions

As a California life insurance agent, you are exempt.  Thanks to great lobbying work by our friends at NAIFA.  California's Constitution exempts all life agents from city buisness license taxes and fees.

HECG Analysis of Health Insurance Exchanges

Legal & Economic Analysis of Health Insurance Exchange Mechanisms - CE Course 294198


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