Portability of Health Insurance Overview and State Actions

Transcription

1 Portability of Health Insurance Overview and State Actions Colorado Health Care Task Force August 10, 2009 By Richard Cauchi Director, Health Program - Denver National Conference of State Legislatures rev. 8/9/09 1 The problem of the uninsured can never be adequately and effectively addressed without first tackling the issues of coverage continuity and portability. - Ted Kennedy of Mass.? NO, it was - Ed Haislmaier- Heritage Foundation 2

2 What is health portability? A health insurance plan or coverage that remains in force, or eligibility to obtain or buy coverage, despite a change in employment or geographic location. Often ties to protections for pre-existing existing conditions & waiting periods. There is no standard or common legal definition! 3 Health Insurance Portability and Accountability Act HIPAA: some coverage is portable The 1996 federal HIPAA law provides: legal protections that require replacement health policies to cover pre-existing existing conditions in some cases. only a guarantee of access to a new set of private market health insurance benefits not the same policy or benefits. 4

3 HIPAA: not exactly portable HIPAA generally guarantees that people who want to switch to individual insurance can buy it, but it does not set a limit on the cost. A preexisting condition exclusion can last for up to 12 months after the enrollment date. A group health plan may impose a preexisting condition exclusion, but the length of the exclusion must be reduced by the amount of your prior creditable coverage. The new policy must be signed within 63 days of previous policy coverage. For a late enrollee a preexisting exclusion period can last up to 18 months. 5 "Elimination Riders" permitted for those not eligible for HIPAA 37 states allow health problems disclosed at the time of application to be excluded from coverage by an amendment to the individual health insurance contract called an elimination rider. 22 states have 18 mo. or permanent exclusions. Colorado & 23 other states have a shorter, 12 month pre-existing existing exclusion & "look back." 4 states have 6 or 9 month exclusions. Once coverage begins, a consumer who makes claims under the policy may be investigated to see whether the health problem was pre-existing. existing. In many states, it is not necessary for a health condition to have been diagnosed prior to the purchase of coverage for it to be considered pre-existing existing and be subject to exclusion or elimination.. 6

4 Some health coverage is portable Federal Medicare, Medicaid and Veterans (VA) benefits are portable. COBRA federal program provides temporary continuation or portability up to 18 months after leaving job, Employers with 20+ employees Premiums are 102% of full cost of policy price, without employer contribution. (This is expensive when not employed) Mini-COBRA 40+ states extend eligibility for continuation for small employers, usually employees. (CO: 100% of employed premium; 18 mo.) High Risk Pools 35 state plans for uninsurable individuals; self-employed; employed; after COBRA ends. CoverColorado has 7,100+ enrolled. (2007) 7 State-mandated Cafeteria Plans Tax-free individual plans save 25 to 40%. In five states (CT, MA, MN, MO, RI), use of "health reform" cafeteria plans are mandatory for some employers; This creates a kind of portability for enrollees, since changing employers may allow the worker to keep the same insurance policy. 8

5 State innovations: Massachusetts Connector (A Health Exchange) Created the insurance Connector in Merges individual and small-group markets. The Connector creates a safe world for small employers in particular. Employers are relieved of having to run an insurance plan while still contributing to it and assured that employees have quality coverage to pick from. Portability is guaranteed by law. Full & part-time time workers are eligible. 9 Mass. portability: multiple employers can contribute; choice of 6 plans 6 major health plans: -Blue Cross Blue Shield of Mass. -Fallon Community Health Plan -Harvard Pilgrim Health Care -Health New England -Neighborhood Health Plan -Tufts Health Plan 10

6 Source: Jon Kingsdale, Mass. presentation to CO Health Symposium 7/31/09 11 Launched Jan. 2009, Cover Florida Health Care is intended to provide coverage to residents ages without insurance for 6 months. No tax revenues used; consumers will use their own dollars to buy the relatively low-cost plans. Plans are portable from one employer to another because they are individual policies. Employers may voluntarily share in the cost of the plan with their employees or may assist employees with a payroll deduction. 12

7 A market based public/private partnership plan for small employers and uninsured workers with incomes up to $43,000/yr. and in companies with up to 50 employees. 3-share: state + employer + employee each 1/3. Enrollee s premium shares range between $37 and $109/mo. and coverage is portable. Owned by the individual Members keep coverage even if they leave an employer Continued coverage during brief periods of unemployment First dollar coverage (no deductible) for preventive and primary care. If job changes, member may have to assume the 1/3 of the premium being paid by the employer. 13 Will health reform solve portability?. Denver Post, 8/3/2009 There is wide agreement on the two elements that the public cares about most: insurance market reforms and the expansion of coverage, with subsidies, Drew Altman, Kaiser Family Foundation (7/31/2009) The glory days are coming to an end for the health insurance industry. Speaker Nancy Pelosi (7/31/2009) 14

8 PORTABILITY: often a bi-partisan policy issue! Republican, Tennessee 15 Source: Jon Kingsdale, Mass. presentation to CO Health Symposium 7/31/09 16

9 NCSL Health Insurance Resources Richard Cauchi, Program Director, Health-Denver ONLINE: Health Insurance - Health Finance Small Business Health 17