Protecting the Consumer
According to ACA, legislators agreed to do all they could to address the interest of consumers, answer questions, assist with any concerns associated with health care plans, reduce fraud, waste, abuse, and protect consumers from entering situations that will cause them to lose their health care coverage. While this is a goal, it cannot be clearly understood how it will be fully effectuated.
Evergreen Health Partners has determined that it will embrace change and attempt to offer employers and their employees with the most appropriate research and choices that will comply with ACA. At present, much of the effort comes in strategic planning and timeline deliverables.
For instance, traditional fully insured health plan choices for employers with 50 employees or less will require the insurer to spend a minimum of 80% of total premium on claims. The incentive for insurers is to ensure a healthy small group pool so that premiums are competitive. Careful vigilance on trends with insurers as to their evolving price and claims policy will be important as Evergreen Health Partners’ clients face the need to prepare for things like a 100% insured workforce, versus the present opt-out system. The opt-out system allows employees who have little to no pre-existing medical conditions to seek coverage alternatives elsewhere if premium costs are prohibitively high. This may even be the case with a contribution forthcoming from their employers. Employers should brace for the fact that employees presently opting out or declining coverage will look to jump back into the group insurance arrangement because employers will still be required to pay at least 50% of the bottom line premium cost.