Pertinent Federal Law Review Pertinent to Florida Licensed Insurance Professionals

 

Each state’s insurance director manages most insurance issues and products at the state level. There are, however, instances in which the state and federal governments work together, for example, Medicaid is a state

 

Pertinent Federal Law Review Pertinent to Florida Licensed Insurance Professionals

 

Each state’s insurance director manages most insurance issues and products at the state level. There are, however, instances in which the state and federal governments work together, for example, Medicaid is a state and federally funded program.



State and Federal Relationship


There is a relatively new (3-years) Federal Insurance Office (FIO) that was created by the Dodd-Frank Wall Street Reform and Consumer Protection Act (DFA), which, so far, has allowed states the same freedoms as before creation of the FIO.

The fall of the economy, during which we endured the exposure of an insurance industry debacle, played a significant role in Title V of the DFA. It created the FIO and appointed a director who had previously been the acting Insurance Director in Illinois, and an officer for the NAIC. This appointment allowed a voice for the state-run industry and, as the director said during his first press conference, the FIO has refrained from stepping into state lines. He can, however, intervene if a reasonable request is made. The FIO authorities extend to all lines of insurance except health and LTC insurances (except those lines of insurance included with life or annuity components).

 

Although the FIO states, “authority extends to all lines except health … “ we can hardly call the Affordable Care Act “health insurance without federal input!” We have been virtually hit over the head with volumes of Affordable Care Act documentation, rules, policies, and dates. The Act is set to run on a rolling calendar, which results in yearly changes to the rules you become accustomed, each time January 1st rolls around. On a Federal level, these are AFA laws for 2014 and 2015.

 

 

Affordable Care Act Updates

 

Prohibiting Discrimination Due to Preexisting Conditions or Gender.  The law implements reforms that prohibit insurance companies from refusing to sell coverage or renew policies based on an insured having a preexisting condition. In the individual and small group market, the law eliminates the ability of insurance companies to charge higher rates due to gender or health status. Effective Date: January 1, 2014.

 

Eliminating Annual Limits on Insurance Coverage. The law prohibits new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual receives. The law will phase out annual limits by 2014. Effective Date: January 1, 2014.

 

Ensuring Coverage for Individuals Participating in Clinical Trials. Insurers are prohibited from dropping or limiting coverage because an insured chooses to participate in clinical trials. This applies to all clinical trials that treat cancer or other life-threatening diseases. Effective Date: January 1, 2014.

 

 

IMPROVING QUALITY AND LOWERING COSTS

 

Making Care More Affordable. To make it easier for the middle-class to afford insurance, tax credits are available for people with income between 100 and 400 percent of the poverty level and are not eligible for other affordable coverage. In 2014, 400 percent of the poverty level is $46,680 for an individual or $95,400 for a family of four. The tax credit can be taken in advance, so it can lower premium payments each month, rather than making families wait for tax time. It’s also refundable, so even moderate-income families can receive the full benefit of the credit. These individuals may also qualify for reduced cost sharing (copayments, co-insurance, and deductibles). Effective Date: January 1, 2014.

Establishing the Health Insurance Marketplace. If employers don’t offer insurance, individuals can buy it directly in the Health Insurance Marketplace. Individuals and small businesses can buy affordable and qualified health benefit plans in this new transparent and competitive insurance marketplace. The Marketplace offers a choice of health plans that meet certain benefits and cost standards. Members of Congress are getting their healthcare insurance through the Marketplace, and everyone else is able buy insurance through the Marketplace too. Effective Date: January 1, 2014.

 

Increasing the Small Business Tax Credit. The law implements the second phase of the small business tax credit for qualified small businesses and nonprofit organizations. In this phase, the credit is up to 50 percent of the employer’s contribution to provide health insurance for employees.  There is also up to a 35 percent credit for small nonprofit organizations.  Effective Date: January 1, 2014.

 

 

INCREASING ACCESS TO AFFORDABLE CARE

 

Increasing Access to Medicaid. Americans who earn less than 133 percent of the poverty level (approximately $15,521 for an individual and $31,721 for a family of four) are eligible to enroll in Medicaid. States will receive 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years. Effective Date: January 1, 2014.

 

Promoting Individual Responsibility. Under the law, most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans. If affordable coverage is not available to an individual, he or she will be eligible for an exemption. Effective Date: January 1, 2014.

 

Paying Physicians Based on Value Not Volume.  Effective January 1, 2015.

.[Source: http://www.hhs.gov/healthcare/facts/timeline/timeline-text.html#2013]

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Text Box:  © 2015 Wall Street Instructors Online, LLC. 
No part of this material may be reproduced without the written permission of the publisher.

 

 

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