![]() Plans that meet these criteria are referred to as “qualified health plans.” Examples of such include the authority to:Įstablish criteria that health insurers must meet in order to sell insurance to consumers who receive the federal subsidies described above (for people with income up to 400% of federal poverty guidelines). Gives presidential appointees, such as the Secretary of Health and Human Services, at least 40 regulatory powers that have the force of law. “Many small businesses have also reported that they were unaware of the credit.” “The cost and complexity involved in claiming the tax credit was significant, deterring small employers from claiming it.” “The credit can only be claimed for two consecutive years after 2013.” “The amount of the credit is also limited if premiums paid by an employer are more than the average premiums for the small group market in the employer’s state.” ![]() “For those employers who do claim the credit, the credit amount ‘phases out’ to zero as employers employ up to 25 full time equivalent (FTE) employees at higher wages.” “Few small employers qualify for the maximum credit amount.” “The maximum amount of the credit does not appear to be a large enough incentive for employers to offer or maintain insurance.” Government Accountability Office, this tax credit “has not been widely claimed” because: These subsidies take the form of a tax credit, which cost $541 million in 2014. ![]() Subsidizes certain health insurance plans for businesses with 25 or fewer full-time-equivalent employees who earn an average of less than $50,000 per year in 2014 (indexed for inflation thereafter). “The new enrollees used more medical services across all sites of care-including inpatient hospital admissions, outpatient visits, medical professional services, prescriptions filled and emergency room visits.” The increased rates of these diseases were 24% for hypertension, 32% for coronary artery disease, 52% for depression, 94% for diabetes, 140% for Hepatitis C, and 242% for HIV. “Members who newly enrolled in BCBS individual health plans in 20 have higher rates of certain diseases … than individuals who already had BCBS individual coverage.” Per a 2016 report by Blue Cross Blue Shield (BCBS): The added costs of insuring people after they become ill raises the premiums of other customers. This mandate, which began in 2014, also requires health insurers to enroll all applicants with no more than a 90-day waiting period. Requires health insurers to issue coverage to all applicants regardless of their preexisting conditions and charge them the same rates as people who have been paying insurance premiums for years. Īccreditation, licensure, certification, review, and audit requirements for healthcare facilities and professionals. Mandates that restrict insurers from setting premiums based upon certain risk factors that drive healthcare spending. ![]() ![]() State regulations that prohibit residents from buying health insurance in other states. Mandates that require insurers to pay for health conditions that existed before customers purchased insurance. Ī Medicare/Medicaid requirement that requires hospitals to provide translators under certain circumstances for patients who do not speak English. įood and Drug Administration drug and medical device approval processes. Mandates that prohibit insurers from charging copayments for certain classes of services and drugs. Mandates that require insurers to cover the cost of specific treatments and practitioners. Government directives and reporting requirements. Paperwork and billing procedures required by private insurers and government programs. ![]()
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