Health Insurance Exchanges

Health Insurance Exchanges are government-regulated private health insurance markets where individuals can purchase standardized health insurance plans.
News & Analysis as of

High Rates of Unhealthy Enrollees in ACA Exchanges

Perhaps putting added pressure on insurers as they prepare to set rates for 2015, new evidence suggests that people enrolled in health plans under the Affordable Care Act have higher rates of serious health conditions than...more

Executive Briefing

In its decision on Templemire v. W&M Welding, Inc., the Missouri Supreme Court imposed a minimalist “contributing factor” causation standard on workers’ compensation retaliation claims. The decision overrules two precedents,...more

The IRS Says (Again) That Certain Employer Payment Plans Won’t Fly

The IRS recently issued two new Q&As to underscore that arrangements allowing employers to reimburse employees on a pre-tax basis for premiums used to purchase individual health coverage, either inside or outside of a public...more

Manatt on Medicaid: The Emerging Conversation About the Future of CHIP

During passage of the Affordable Care Act (ACA), a debate erupted over the future of the Children’s Health Insurance Program (CHIP), a well-established program that now offers coverage to 8 million children in low- and...more

Health Care Reform Implementation Update - June 2014

Secretary Burwell continues to settle in to her new position as the Department of Health and Human Services (HHS), this week making a number of management changes at the department; CMS released the long awaited proposed rule...more

Employer Reimbursements For Health Insurance Policy Premiums–Care Needed

Employers who reimburse employees on a pre-tax basis for premiums the employees pay on their own individual health insurance policies (whether under an Obamacare Exchange or otherwise) are at risk for a $100 per day per...more

Risk Taking in the Provider World: Is a Knox-Keene Plan a Good Strategic Move For You?

Reimbursement for health care services in California continues its shift toward capitation, resulting in health care providers increasingly forming their own health plans under the Knox Keene Health Care Service Plan Act (the...more

Changing Financial Landscape for Medical Debts of the Uninsured

The implementation of the ACA has afforded many with the opportunity to obtain insurance coverage. Despite the opportunity, a large number of individuals have either chosen not to enroll in a health plan or have been unable...more

CMS's Final Exchange and Insurance Market Standards Impact Qualified Health Plan Filings for 2015 and Beyond

On May 16, 2014, the Centers for Medicare & Medicaid Services ("CMS") released a final rule titled "Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond" ("Final Rule")...more

Changes to COBRA Notices and New Limited Special Enrollment Period

As employers think about the upcoming employer shared responsibility mandate, they should also be thinking about how the individual mandate and the Federally-facilitated Marketplace (the “Marketplace”) will affect their...more

Health Care Reform Implementation Update

Affordable Care Act (ACA) action on Capitol Hill this past week centered on investigations into improper ACA subsidy payments, a potential constitutional amendment proposal, and support for an appeal of the ACA in favor of a...more

Labor Pains: The $2 Million Part-Time Employee

One of your employees (we’ll call him “Don”) cannot enroll in your health insurance plan because you classify him as “part-time” (one who works less than 30 hours a week). This forces Don to get health insurance through a...more

COBRA Meets ACA – Time to Update COBRA Notices

The Affordable Care Act created a new option to obtain health insurance for employees who are losing job-based coverage—the Health Insurance Marketplace (commonly referred to as the “Exchange”). Because this new coverage...more

Is It a Violation to Help?

In a May 21, 2014, letter to the President of the American Hospital Association (AHA), U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius confirmed HHS’s position that private, not-for-profit...more

Health Care Reform Implementation Update - May 2014

Congress held several hearings last week ranging from Sylvia Burwell’s nomination for Secretary of the Department of Health and Human Services (HHS), to Medicare payment oversight, to post-acute care in Medicare. The Centers...more

Future of Nevada’s Insurance Exchange Uncertain after Exchange Board Votes to Cut Ties with Xerox

In response to the Affordable Care Act’s establishing Affordable Insurance Exchanges to provide individuals and small business employees with access to health insurance coverage, Nevada chose to create its exchange, the...more

DOL Issues Updated Model COBRA Notices

On May 2, 2014, the Department of Labor (the “DOL”) issued proposed regulations amending the notice requirements under the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (“COBRA”). The proposed regulations...more

Changes & Opportunities in 2014 for Small Employers under ACA

The Affordable Care Act (ACA) brings about significant healthcare reform changes, as well as opportunities for small employers in 2014. Many of the reforms affect all employers who sponsor group health plans; however, the...more

New COBRA and CHIP Notices Highlight Affordable Care Act Marketplaces

The Department of Labor recently issued updated model COBRA continuation coverage and Childrens’ Health Insurance Program (“CHIP”) notices. Plan administrators should begin using the new notices immediately. ...more

HEAL Advisory: New COBRA Model Notices and Coordination with Marketplace Enrollment

On May 2, 2014, the U.S. Departments of Labor and Health and Human Services published a series of guidance and model notices clarifying the provision of health insurance to recently terminated employees. The Department of...more

A Snake in the Grass No More? DOL Proposes New COBRA Forms

As part of its continuing efforts to update the sleepier corners of the employee benefits world to conform to the Patient Protection and Affordable Care Act (ACA), the U.S. Department of Labor (DOL) recently proposed new...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 33: The Impact of Value-Based–Plan Designs and Reference...

Whether a group health plan provides minimum value is central to the application of the Affordable Care Act’s employer shared responsibility rules. The particulars of the role of minimum value in determining assessable...more

HHS Creates A New And Limited Special Enrollment Opportunity In States With Federally-Facilitated Health Insurance Exchanges

On May 2, 2014, the Department of Health and Human Services (HHS) released guidance which creates a special enrollment opportunity in states with a federally-facilitated health insurance Marketplace (Marketplace) for...more

News from the Health Law Gurus™ - May 2014

Massachusetts to Start from Scratch with Health Insurance Website — Massachusetts plans to abandon its health insurance exchange website in favor of starting over from scratch, according to a New York Times report....more

New Model COBRA Notices

To coordinate information about the new marketplace/exchange coverage that may be available under the Affordable Care Act, today the U.S. Department of Labor, in conjunction with the IRS and U.S. Department of Health and...more

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