Yesterday there was an announcement that the Affordable Care Act
was going to hold off the implementation of the out of pocket limits. This hit
the news wires and the sparks really flew. I have spent a lot of time today to
find out exactly what was happening and find it is not the big deal it appeared
to be. First it did not apply to individual policies and second I have found it
will not apply to the Small Business Health Option Plan in California[SHOP].
Please see email from Micah at the Bay Area Council along
with a link to New Republic.
The second email is from Leesa Tori at Covered California
confirming it will have no impact on SHOP. My guess is that will also have
little to no effect outside Covered California. What is interesting is this
announcement was originally made in February and very few people knew about it
until yesterday.
Scott Hauge
President
Small Business California
2311 Taraval Street
San Francisco, CA 94116
shauge@cal-insure.com
415-680-2188
President
Small Business California
2311 Taraval Street
San Francisco, CA 94116
shauge@cal-insure.com
415-680-2188
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Scott,Looking into this further, I’m not sure that it’s even
applicable. Here’s a good summary. This is much more limited than
it’s being made out to be in the press and I’m not sure it would even
potentially apply to the SHOP.
“Employers told the administration that coordinating records
from the different plans was difficult, so the administration gave them some
leeway. Employers who already have such arrangements—and only employers who already have such
arrangements—can have one extra year to put new accounting systems in place.
During that time, the $6,350 limit will apply to “major medical”—doctor visits,
hospitalizations, and so on—but not prescriptions, dental, or vision.”
Best,
Micah
Micah Weinberg, PhD | Senior Policy Advisor | BAYAREA COUNCIL
1215 K Street, Suite 2220 | Sacramento, CA 95814
916-949-6240 (c) 916-706-1277 (o) |
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From: Leesa Tori [mailto:leesa.tori@thetorigroup.com]
Sent: Wednesday, August 14, 2013 11:32 AM
To: Scott Hauge
Subject: Re: SHOP
Sent: Wednesday, August 14, 2013 11:32 AM
To: Scott Hauge
Subject: Re: SHOP
Hi Scott, we do not intend to change our benefit designs and
I think it’s business as usual for us with no change. Hope you are
well! Thank you. L.
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