The document summarizes updates related to the Affordable Care Act (ACA) for the week of October 6-12, 2014. It notes that 77 new carriers will offer plans on the state and federal exchanges in 2015, a 25% increase over 2014. It also discusses that certificates of creditable coverage will no longer be needed under the ACA, qualifying events for mid-year plan enrollment, an increase to the PCOR fee, and that a new CEO has started at Healthcare.gov focused on improving the site.

1. What You Need to Know About the ACA
Week of October 6-12, 2014
Presented by: George Gonser, CEO Spring Insurance Group
LinkedIn: spring-consulting-group-llc
Twitter: @SpringsInsight
Proprietary and Confidential
©Copyright 2014 Spring Consulting Group, LLC. All rights reserved

2. 2
More Health Insurance Options
in State/Federal Exchanges in 2015
 Department of Health Human Services announced
last week that 77 new carriers will participate in and
offer plans on the Exchanges next year.
 25% increase from 2014
 Open enrollment begins November 15th

3. 3
More Health Insurance Options
in State/Federal Exchanges in 2015 (cont)
 In Massachusetts, United Health Plan will be offering
plans for 2015
 United has to be a more involved player in the space for
2015 & beyond.

4. 4
HIPAA Certificates No Longer Needed
 Medical plans will no longer be required to provide
Certificates of Creditable Coverage
 Certificates of Creditable Coverage showed that a
person had previous creditable coverage in order to
reduce pre-existing condition restrictions
 The ACA prohibits the use of pre-existing
condition criteria for most types of health coverage
 Thus, negating the need for the certificates

5. 5
Qualifying Event Requirement for Plan
Enrollment Outside of Open Enrollment
 Plan sponsors are responsible to apply their
qualifying event eligibility rules
 Documentation from employee required to prove
qualifying event
 Sample qualifying events:
 Employment status change
 Marital status change
 Birth of a child
 Death of a family member
 Relocation
 Expiration of COBRA benefits

6. 6
PCOR Fee Adjusted
 Patient Centered Outcomes Research (PCOR) fee has
risen from $2 to $2.08 per covered life for plan years
ending on/after 10/1/14 -9/30/15
 PCOR is set up to fund research into how to deliver
health care that is more efficient, effective and
affordable
 Insurers pay PCOR fee except in cases of self-funded
plans where employers would pay fee;
 Fee only applies to non-excepted benefits and is due
by 7/31 of the following calendar year after plan end

7. 7
New CEO for Healthcare.gov
 Kevin Counihan started as new CEO of
Healthcare.gov on September 8, 2014;
 Counihan joins the federal exchange after overseeing
Access Health CT, Connecticut’s state exchange and a
stint at the Massachusetts Health Connector
 Focused on improving site performance and making it
more user-friendly along with implementing a broker-partnership
arrangement similar to his successful
implementation in Connecticut.

8. 8
Contact Us
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Email: insight@springgroup.com
Twitter: @springsinsight