Benefits Consulting Group of Florida, Inc. – Orlando, FL

Effective April 1, 2016 you must ensure that a prior authorization has been approved before you have one of the services listed below:

• Advanced Imaging:  Radiological services such as CTs, CTAs, MRIs/MRAs, PET scans, nuclear medicine and cariovascular system procedures such as myocardial imaging, myocardianl infusion studies and cardiac blood pool imaging.
• Select Medical Pharmacy Drugs: The list of drugs affected by this change is available online at floridablue.com/authorization or by calling customer service for assistance.
• Sleep Studies:  Services to diagnose certain sleep disorders such as snoring, apneas or hypopneas in a home or facility setting.
• Spine Care:  Services to manage pain related to the spine, such as injections and surgeries.
• Radiation Oncology:  Radiation therapy services provided in an outpatient setting.

President Obama has signed an agreement on two major legislative packages regarding the budget and tax agreements that were previously approved by Congress.

These bills included changes that affect several health care related provisions under the Affordable Care Act (ACA).

ACA provisions included in the agreement would:

• Delay implementation of the ACA Excise Tax (“Cadillac” tax) for two years,  making it effective in 2020 instead of 2018.
• Implement a moratorium on the ACA 2.3 percent Medical Device Tax which has already taken effect.  This tax would not apply to sales for calendar year 2016 and 2017.
• Suspend the ACA Health Insurance Tax for one year (2017).
• Extend a measure that prevents the federal government from shifting funds to pay for the ACA’s risk corridors program.

Washingon-Congress is getting closer to delaying a tax on expensive employer-sponsored health plans, imperiling a levy that was a key revenue source and cost-control measure in the 2010 health law.

Bipartisan support for killing or suspending the start of the so-called Cadillac tax, which is scheduled to take effect in 2018, is growing.

With President Barack Obama saying he would veto an outright repeal, lawmakers are pushing to postpone the tax for two years.  They are seeking to wrap it into a package they are negotiating with the administration that would extend several expired and expiring business tax breaks and middle-class tax credits.

A delay would punt the fate of the tax, which is a part of the Affordable Care Act, to the next president, who is likely to be more open to striking it down.  Republican presidential candidates have supported a repeal, as has Democratic front-runner Hillary Clinton.

The tax applies to company plans valued at more than $10,200 for individual coverage and $27,500 for a family.

Supporters of the tax say it would curb health-care spending.  They also say employers will offset pared-down plans with higher wages.  Critics say the tax will hurt middle-class workers and affect a large swath of businesses.

2016 offers individuals and families additional opportunities to save for current and future health care with a Health Savings Account (HSA):

• HSA holders can choose to save up to $3,350 for an individual and $6,750 for a family (HSA holders 55 and older get to save an extra $1,000 which means $4,350 for an individual and $7,750 for a family) – and these contributions are 100% tax deductible from gross income.
• Minimum annual deductibles are $1,300 for self-only coverage or $2,600 for family coverage.
• Annual out-of-pocket expenses (deductibles, copayments, and other amounts, but not premiums) cannot exceed $6,550 for self-only coverage and $13,100 for family coverage.

For more detailed information on HSA plans and taxes, visit the U.S. Department of Treasury website atwww.ustreas.gov or talk with your tax advisor.

President Obama recently signed a new law into effect requiring  hospitals to inform patients if they are categorized as outpatients receiving observation services rather than inpatient admission. The bill H.R. 876 is entitled the Notice of Observation Treatment and Implication for Care Eligibility or NOTICE. This required notification must occur within 36 hours of the beginning of observation services.

Humana recently announced that they have signed a new agreement with Florida Hospital that allows Humana commercial group and individual members, including those enrolled in exchange plans, to receive in-network care at Florida Hospital locations in the Orlando area. This new contract went into effect July 1 and includes all Florida Hospital locations in the Central Florida area. Florida Radiology Imaging center and Centra Care locations will also resume participation under all commercial healthcare plans.

It was recently announced that Aetna has agreed to acquire Humana, one of the country’s leading managed health companies. This transaction is expected to give Aetna over 14 million new members. This combination is not expected to close until the second half of 2016.  We will be sure to keep you updated on any new developments.

The Supreme Court ruled Thursday, June 25, 2015, that subsidies used to purchase health insurance on the federally facilitated marketplace are legal.  The 6-3 decision in King v. Burwell means that tax credits continue to be valid in the 34 FFM states.

The rules enhance the consumer shopping experience in a number of ways.  For example, health insurance issuers must provide online access to a copy of the individual coverage policy for each plan or group certificate of coverage.  And these documents must be made publicly available to all potential consumers prior to when a consumer applies, so they are clearly informed about what a plan will and will not offer.  The final rules make few changes to the rules proposed in December 2014.

In continuing the goal of providing clear and straightforward information to consumers about health plans available in their area, health insurance issuers and group health plans must still provide a brief SBC that includes coverage examples and a uniform glossary to consumers.  Revisions to SBC, coverage examples and uniform glossary are anticipated to be finalized by January 2016 after the Departments utilize consumer testing and receive additional input from the public, including the National Association of Insurance Commissioners (NAIC).  The revisions will apply to SBCs for coverage beginning on or after January 1, 2017.

Humana has not reached agreement with the HCA System hospitals and the contract is terminating July 1, 2015.  It has been reiterated that both parties have every intention of coming to mutual terms and we will keep you posted or their progress.