The Affordable Care Act (ACA) is ushering in an era of comprehensive health care reform. 

Whether you’re an individual, family, employer or producer, our goal is to help you understand what the ACA means for you and how it may impact you financially.

What Our Clients Need to Know.

• Most small group and individual health plans in Washington State for 2014 are new. This is because of certain requirements of the Affordable Care Act, including that all plans for small group and individuals and families include the 10 essential benefits. We can help guide our clients to plans that are similar to what they already have.
  
  
• Some of our individual and family clients may qualify for government assistance in paying for their premiums or other out-of-pocket costs. They can see if they qualify by going to our state's online exchange marketplace, the Washington Healthplanfinder.
  
  
• Clients who do qualify for assistance, must purchase a plan through Healthplanfinder to get that assistance.  We are authorized to sell plans on Healthplanfinder, and our clients can easily locate us on the Healthplanfinder website by entering Shirley Boyle Souder or 98006.  In order to continue serving our existing clients or build new relationship’s, it is  important that our clients take this step.
  
  
• If you are interested in individual catastrophic health plans, these plans will only be available through Healthplanfinder, and that only individuals under age 30 or those with financial hardship (as determined by the state exchange) will be able to purchase these plans. Catastrophic health plans must include the 10 essential health benefits.
• If a small business doesn't choose to offer an employer-sponsored health plan, their employees can purchase a plan through Healthplanfinder or directly from a health carrier.
  
  
• The Small Business Health Options Program (SHOP) exchange will be very limited in 2014 in the plans it has for small employers. There is only one carrier offering small group products, and they are only available in a couple of counties. Group Health will offer a portfolio of small group plans outside the exchange to fully meet the needs of current and prospective small group employers.
  
  
• Renewals for your small group clients occur at the same time as in previous years. For instance, if a small employer group renews their current plan on Aug. 1, 2013, their open enrollment period will precede their Aug. 1, 2014 renewal. There is a proposed rule before the Office of the Insurance Commissioner that details the open enrollment period for small groups beginning in 2014. When the final rule is issued, we'll share this information.

 

What Are the 10 Essential Benefits

One part of the Affordable Care Act specifies that all individual and family and small group health plans include the 10 essential benefits. Here's a list of these benefits.

• Ambulatory patient services. The care you receive without being admitted to a hospital. For example, at a clinic, a physician's office, or a same-day surgery center.
  
  
• Emergency care. Care for conditions which, if not immediately treated, could lead to serious disability or death.
  
  
• Hospitalization. The care and services you receive as a patient in a hospital, such as care from doctors and nurses, tests and drugs administered during your stay, and room and board.
  
  
• Maternity and newborn care. The care provided to women during pregnancy, and during and after labor and delivery, and care for newborn children.
  
  
• Mental health and substance abuse disorder services, including behavioral health treatment. This is care to evaluate, diagnose, and treat mental health and substance abuse issues.
  
  
• Prescription drugs. These are drugs prescribed by a doctor to treat an acute illness like an infection, or to treat an ongoing condition like high blood pressure.
  
  
• Rehabilitative and habilitative services and devices. The former refers to relearning skills lost due to disease or injury, and the latter to keeping and learning age-appropriate skills and functioning.
  
  
• Laboratory services. The testing of a patient's blood, tissues, etc., to help a doctor diagnose a medical condition or monitor the effectiveness of a treatment.
  
  
• Preventive and wellness services including chronic disease management. This includes routine physicals, screening, and immunization. Chronic disease management is an integrated approach to manage an ongoing condition like asthma or diabetes.
  
  
• Pediatric services for children under age 19 including the nine benefits already listed, and dental services such as preventive and restorative care, and vision care such as eye exams and prescription glasses.

 

Group Health
https://ghc.inshealth.com/?allid=Gro21010&agentid=146581

Lifewise Health Plan of WA
https://lwwa.inshealth.com/?allid=Lif25311&agentid=187111

Regence Blue Shield
http://www.regence.com/individual/medical/index.jsp?agentid=0105933-0000

Regence Blue Shield
Group Health
Lifewise Health Plan of WA
Premera Blue Cross
Aetna
United Healthcare / AARP
Humana
Mutual of Omaha
Dental Health Services