Wellness Programs in PPACA Spotlight

Under the Patient Protection and Affordable Care Act (PPACA), wellness is one element of health care reform that is taking center stage. 

Generally, health plans may not discriminate based on a health factor against individual participants with regards to eligibility, benefits, or premiums (health factors include health status, medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability, and disability). However, an exception to this rule allows for premium discounts, rebates, or modifications to otherwise applicable cost sharing in return for adherence to certain programs of health promotion and disease prevention, otherwise known as wellness programs.

PCORI Update: Brokers Take Note as Patient-Centered Research Ramps Up

As Brokers prepare for their upcoming role as more active participants in state health insurance exchanges, they may also want to keep an eye on the Patient Centered Outcomes Research Institute (PCORI), now looking to fund patient-centered research.  BenefitMall previously discussed in a blog how the Patient Protection and Affordable Care Act (

2012 PPACA Implementation Highlights

The implementation train for the Patient Protection and Affordable Care Act (PPACA) continues to pick- up speed with a number of important implementation dates in 2012. 

Keeping up with the pace can be challenging. To assist, the U.S. Department of Health and Human Services (HHS) offers  a website that helps track the major reform efforts, titled “What’s Changing and When.” Also useful is an online article posted by the White House that gives a year-by-year overview of the PPACA timeline.    

Here’s a snapshot of some 2012 milestones:

Accountable Care Organizations

Contract Award Puts Wheels in Motion for Establishing Federal Insurance Exchange Program

In an effort to provide consumers with competitive insurance options as mandated by the Patient Protection and Affordable Care Act (PPACA), the federal government has awarded a $93.7 million, multi-year contract to CGI Federal, Inc. to establish a federal health insurance exchange. The Centers for Medicaid & Medicaid Services (CMS) Center for Consumer  Information & Insurance Oversight (CCIIO) has hired CGI Federal, Inc., a U.S.  subsidiary of CGI Group, Inc., to build the federally-sponsored health insurance marketplace that will “provide millions of Americans with ‘one-stop shopping’ for affordable coverage,” according to the CCIIO website. The CGI Group, Inc.

States Given Responsibility of Defining Essential Benefits

In a press release issued today (December 16, 2011), the U.S. Department of Health and Human Services has announced that state exchanges will now determine their benchmark for essential benefits based upon use of the most popular plans in their region and the ten benefit categories of care that were originally defined in the health care reform regulations. This change to move the responsibility of essential benefits to the state level will give states the flexibility to match their exchange plans to be equal to those offered by a typical employer in the state. Further, those states that have a broader based health care coverage mandate will not be penalized for incorporating their states mandates into their definition of essential benefits.

New Research Indicates Most Employers Will Continue to Sponsor Health Benefits for Employees Despite PPACA Mandates

Four recent surveys confirm the notion that the majority of employers will continue to offer employer-sponsored health benefits in 2012 and beyond. The national surveys, conducted by Mercer, Towers Watson Health Care, GfK and Kaiser Family Foundation/Health Research & Educational Trust, yielded fairly consistent results that indicate employers overall continue to view their health benefits plans as a key component of the employee benefit offerings. The survey feedback also confirms that few employers plan to terminate their health benefit plans when state health insurance exchanges, mandated by the Patient Protection and Affordable Care Act (PPACA), become operational in the fall of 2013.  

Mercer Study

Brokers are Key to Successful Implementation of Health Benefits Tax Credits

One of the more positive aspects of the Patient Protection and Affordable Care Act (PPACA) was the authorization of a federal tax credit for small business owners who offer health insurance benefits to their employees. This tax credit potentially is worth a great deal of money to small business employers. Despite the potential for significant cost savings, efforts to promote the Small Business Health Care Tax Credit to small businesses have missed the mark.

PPACA’s Public Relations Challenge & Opportunity: Keeping Consumers Informed

When Congress was considering the Patient Protection and Affordable Care Act (PPACA) in the spring of 2010, then House Speaker Nancy Pelosi (D-CA) made this now-famous statement: “But we have to pass the bill so that you can find out what is in it, away from the fog of the controversy."[1] Although many poked fun at Pelosi’s gaffe at the time, the reality is that she was right. We are still finding out what is in PPACA, even 18 months after its passage. Above all, the on-going regulatory process has perpetuated this journey.      

Changes for Health Savings Accounts for 2011 and Beyond

In recent years, Health Savings Accounts (HSAs) have proved a great way for individuals and families to cover the cost of medical expenses through a high deductible health plan arrangement.  Due to their popularity, HSA enrollment has been expanding quickly, with an estimated 10 million Americans selecting this approach to coverage. 

Similar to last year, pre-tax contributions to HSA plan are limited to $3,050 for a single individual and $6,150 for a family.  If an individual is age 55 or older, an additional “catch-up” contribution of $1,000 is also permitted. 

Department of Labor Delivers Selected Medical Benefits Report: HHS to Define Standardized Benefit Offerings

One of the more influential mandates put into place by 2010’s Patient Protection and Affordable Care Act (PPACA) is the requirement that every state have a public health insurance exchange.  The legislation gave states the option to either create their own insurance exchange (and receive various grants from the federal government) or to let the federal government create the exchange for them.

A major step involved in creating state-run health exchanges is making sure insurance plans offered by the state-run exchanges are on par with those offered by private providers.  PPACA mandates that health plans offer an “essential health benefits package,” a minimum of benefits provided by every plan through the state exchanges.  The essential health benefits package is, according to PPACA, to be defined by the Secretary of the Department of Health and Human Services (HHS).  To help determine what the package should be, PPACA also directs the Department of Labor (DOL) to conduct a survey of employer-sponsored health plans in order to determine the types and numbers of benefits usually covered by employers, and to report the results of the survey to HHS.