Small Business’s – EmployER Medical Plans are now guaranteed coverage with just one common law employee (AB 1083), who isn’t a spouse. No medical questions are asked! The law allows up to 30% discounts for participation in wellness programs along with full tax deduction for the employer premiums (IRC Section 106) and no taxable income to your employees. If you are making your employees pay a portion of the premium, that too can be deductible for you and employees Learn More⇒ IRC Section 125.
Before Health Care Reform we had AB 1672 (1992) where two employees were required, but husband & wife counted. Medical History and claims could make a difference in premiums of up to 20% under the Rating Adjustment Factor (RAF) system. Sole Proprietors, C Corps and husband & wife partnerships with no common law employees can still get guaranteed coverage in the Individual market, but must wait for Open Enrollment or Special Enrollment, like when their Pre ACA plan renews and they get bumped out. Their premiums (free quotes) can still be tax deductible, line 27 – 1040 or a business tax return.
Small Business can enroll year around, you do not have to wait for Open Enrollment. See the brochures and other pages in this section of our website. Feel free to call 310.519.1335 or email us [email protected] for more information. Our services and consultation are free as long as you appoint us as your agent for no additional charge as we are compensated by the Insurance Companies to help you.
CHFC Brochure on Before & After Health Care Reform
Blue Shield Flyer Small businesses and the ACA Rev 3.2013
California’s small business market in 2014 dropped by 11% to 2.1 million enrollees. Meanwhile, enrollment in the individual market increased by 47% to 2.18 million during the same period. The sharp uptick in the individual market largely was driven by Covered California and the availability of subsidies to help pay for premiums for plans purchased through the exchange. Learn More⇒ CA Healthline 5.26.2015
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The Health Plan Identifier Rule (Administrative Simplification) requires group health plans to get a health plan identifier (HPID) by November 5, 2014 and begin using it in HIPAA transactions by November 7, 2016. Blue Shield of California has obtained an HPID and is ready for the November 5, 2014 deadline. However, we understand that some of our Administrative Services Only (ASO) plans and fully insured accounts are asking how to comply with the rule. ASOs are also required to do so.
The Affordable Care Act included a provision called Administrative Simplification, which broadens existing requirements under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
The Administrative Simplification Rules set standards and operating rules for how issuers like Blue Shield of California and other covered entities interact with providers, particularly regarding electronic transactions of information. The ultimate goal of these requirements is to reduce costs by streamlining transactions and making existing standards work more efficiently.
Fully Insured Groups
Fully insured groups that purchase health insurance through Blue Shield of California are not likely to be considered a health plan by HIPAA and are not required to obtain their own Health Plan Identifier. Guidance available on the CMS website may be referenced for groups unsure if they qualify as a health plan as defined by HIPAA.
Self-funded and Shared Advantage Plans
A self-funded plan is a health plan as defined by HIPAA. As a controlling health plan (CHP), self-funded plans will be required to obtain an HPID even if the plan does not conduct any of the electronic transactions and the HPID will not be used for this purpose. Based on our understanding, most self-funded plans will meet the definition of a CHP and need to obtain their own HPID.
The deadline for obtaining an HPID is November 5, 2014. To help health plans, the Center for Medicare and Medicaid Services (CMS) created an HPID website that has information about the HPID, including videos and presentations. The site also includes details about the Health Plan and Other Entity Enumeration System (HPOES). This is the system a self-funded health plan will use to obtain an HPID. Self-funded plans that have specific questions are urged to contact their own legal counsel.
Blue Shield of California’s Response
As a Controlling Health Plan, Blue Shield of California must comply with these mandated requirements. We have obtained an HPID and are compliant with the November 5, 2014 date. Fully insured Blue Shield groups use our HPID. We will not be applying for any HPIDs on behalf of any of our self-funded plans.
The second part of the rule requires the use of the HPID in the HIPAA standard transactions by November 2016. Blue Shield of California will be assessing the implementation of the HPID in the standard transactions in 2015.
Under ACA premiums will rise for some Small Biz and lower for others california health line.org