Health Insurance Market Reforms Sample Clauses

Health Insurance Market Reforms. Providing Assistance to Individuals and Small Businesses, Coverage Appeals, and Complaints
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Health Insurance Market Reforms. In Sections 1311(a)(4)(A)(ii) and 1321(c)(1)(B)(ii)(II), the Affordable Care Act requires each State to show progress implementing the health insurance market reforms that are set forth in Subtitles A and C of the Affordable Care Act as a condition of receiving establishment grants and for certification of the State’s Exchange. Making progress on implementation would include passing State legislation or issuing appropriate regulations implementing these reforms as well as other activities, including stakeholder consultation on these issues and development of a plan to implement these reforms. These activities will be carried out by the State. HHS will release guidance on how States demonstrate progress in implementing these reforms. States must also demonstrate they are enforcing Affordable Care Act consumer protections to be certified as eligible to operate an Exchange.
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Health Insurance Market Reforms. In 2010, California moved aggressively to enact state legislation implementing key provisions of the ACA affecting health insurance markets, including: ▪ California Health Benefit Exchange -- AB 1602 (Chapter 655 Statutes of 2010) SB 900 (C. 659) Creates the California Exchange; establishes the five‐member governing board and describes the basic responsibilities and authorities of the Exchange; ▪ Premium rate review -- SB 1163 (C. 661)) Requires all health insurance premium filings with CDI and DMHC to be reviewed and certified by an independent actuary to ensure premium costs are accurately calculated and all proposed rate increases to be posted on the carrier and regulatory websites making costs transparent. These consumer protections exceed what federal law requires under the ACA; ▪ Dependent coverage -- SB 1088 (C. 660) Prohibits carriers from setting the limiting age for dependent children covered by their parents’ health insurance policy at less than 26 years of age; ▪ Coverage for children -- AB 2244 (C. 656) Implements the federal ACA prohibition on pre-existing condition limitations for children under age 19 and provides additional protections beyond federal law. Establishes a mandatory open enrollment period in the individual market, during which carriers can adjust rates for children based on health status, up to a maximum of two times the standards rate for a healthy child. Prohibits carriers from offering new individual policies to anyone in the state for five years if they fail to write new contracts for children on or after January 1, 2011; ▪ Coverage for preventive services -- AB 2345 (C. 657) Requires health coverage contracts and policies to cover preventive services as specified in the ACA with no cost‐sharing; and ▪ Cancellation and rescission of coverage -- AB 2470 (C. 658) Prohibits California carriers from canceling insurance unless there is a demonstration of fraud or intentional misrepresentation of material fact. Exceeds federal law and requires carriers to continue coverage during the period of a consumer’s appeal to CDI or DMHC for review of the decision to cancel or rescind coverage. Both CDI and DMHC have responded with additional regulatory or policy guidance as necessary to further refine the requirements and clarify how specific provisions will be enforced. Early insurance reforms are in effect, including premium rate review, coverage for children, preventive services without cost sharing and limits on rescission. Both depa...
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Health Insurance Market Reforms. As reported in the section on Exchange progress, California acted quickly to pass legislation to implement the earliest ACA health insurance market reforms and is in the process of implementation and enforcement. There is much still to do. Both CDI and DMHC are actively engaged in identifying the additional legislative and regulatory authority and enforcement that will be necessary for California to fully comply with ACA market reforms. There are currently nearly two dozen bills moving through the California Legislature on ACA implementation, many of which are focused on health insurance market reforms, including legislation to conform California’s small employer access law to federal requirements, medical loss ratio standards, and legislation to establish a basic health plan option in California. The Exchange does not currently have staff to analyze and comment on pending state legislation but will need to build that capacity during the Level I grant period. With sufficient legal and policy staff and/or consulting expertise the Exchange will be able to identify and work with policymakers and stakeholders regarding state legislation and regulatory implementation of federal market reforms. The Exchange will work collaboratively with CDI and DMHC to evaluate the impact of federal reforms on California markets and on the ability of the state to establish a viable and sustainable Exchange given the potential risk mix inside and outside of the Exchange. CA-ACA included state authority and requirements related to health insurance carriers both inside and outside of the Exchange. Specifically, CA-ACA: ■ Requires carriers participating in the Exchange to offer and sell on a guaranteed issue basis at least one product in each of the five coverage levels outlined in the ACA; ■ Authorizes the Board to require carriers in the Exchange to offer additional products within each of the five coverage levels; ■ Requires carriers in the Exchange to guarantee issue to individuals and small employers outside the Exchange all products available to individuals and small employers inside the Exchange; ■ Requires carriers offering individual coverage but not participating in the Exchange to offer at least one standardized product designated by the Exchange in each of the four levels of coverage in the ACA and prohibits carriers outside the Exchange from offering the catastrophic level of coverage; and ■ Authorizes the Board to determine the minimum requirements a carrier must meet...
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Related to Health Insurance Market Reforms

  • Health Insurance The Couple agrees that: (check one)

  • Group Health Insurance The Employer shall provide a comprehensive health care insurance program for all permanent full-time and part-time employees. Health Plan characteristics and benefits shall be as provided in the Employer’s Agreement with the Ohio Civil Service Employees Association (hereinafter OCSEA). Regardless of the plan, employees will pay fifteen percent (15%) of the premium and the Employer will pay eighty-five percent (85%) of the premium; however for any alternative plans offered pursuant to the Agreement with OCSEA, the employees’ premium share will be determined by the Director of DAS, but will not exceed fifteen percent (15%) of the premium. The Employer’s premium share shall be paid on behalf of eligible employees as provided in the Employer’s Agreement with OCSEA. Employees who include a spouse as a dependent for healthcare coverage shall pay a surcharge as provided in the Employer’s Agreement with OCSEA. Eligibility provisions for employees enrolling in State provided health care plans shall remain the same as those in effect in the Employer’s Agreement with OCSEA. The Employer reserves the right to perform dependent eligibility audits upon recommendation of the Joint Health Care Committee. Health care costs paid on behalf of ineligible dependents will be subject to recovery. Deductibles, co-payments, and other plan design provisions for all benefit programs shall be the same as those prescribed in the Employer’s Agreement with OCSEA. Every year the Employer shall conduct an open enrollment period, at which time employees shall be able to enroll in a health plan, continue enrollment in their current plan, switch to another plan, subject to plan availability in their area, or waive coverage. The timing of the open enrollment period shall be established by the Director of the Department of Administrative Services (DAS), in consultation with the Joint Health Care Committee. Changes outside of open enrollment may only occur as prescribed in the Employer’s Agreement with OCSEA. Open Enrollment Fairs shall be held in accordance with Employer’s Agreement with OCSEA. There shall be established a Joint Health Care Committee composed of representatives of management, and of the various labor Unions representing State employees. The Committee shall meet regularly to monitor the operation of the State’s health care plans, and to make recommendations for the improvement of the plans and cost containment procedures. The Employer shall provide funding for dental, vision and the life benefits as described in Article 21 of the Employer’s Agreement with OCSEA and the Union’s Benefits Trust. Employee health insurance payments will be deducted from every paycheck. In the event an employee is receiving disability leave or Workers’ Compensation benefits, the Employer- policyholder shall continue, at no cost to the employee, the coverage of group health insurance for such employee for the period of such leave, but not beyond twelve (12) months. If the employee’s leave extends beyond twelve

  • Health Insurance Benefits To the extent provided by the federal COBRA law or, if applicable, state insurance laws, and by the Company’s current group health insurance policies, Executive will be eligible to continue Executive’s group health insurance benefits at Executive’s own expense. If Executive timely elects continued coverage under COBRA, the Company shall pay Executive’s COBRA premiums, and any applicable Company COBRA premiums, necessary to continue Executive’s then-current coverage for a period of 12 months after the date of Executive’s termination of employment; provided, however, that any such payments will cease if Executive voluntarily enrolls in a health insurance plan offered by another employer or entity during the period in which the Company is paying such premiums. Executive agrees to immediately notify the Company in writing of any such enrollment. Notwithstanding the foregoing, if the Company determines, in its sole discretion, that it cannot provide the foregoing benefit without potentially incurring financial costs or penalties under applicable law (including, without limitation, Section 2716 of the Public Health Service Act), the Company shall in lieu thereof provide to Executive a taxable monthly amount to continue his group health insurance coverage in effect on the date of separation from service (which amount shall be based on the premium for the first month of COBRA coverage), which payments shall be made regardless of whether Executive elects COBRA continuation coverage and shall commence in the month following the month in which Executive incurs a separation from service and shall end on the earlier of (x) the date on which Executive voluntarily enrolls in a health insurance plan offered by another employer or entity during the period in which the Company is paying such amounts and (y) 12 months after the date of Executive’s separation from service.

  • Health Insurance Portability and Accountability Act of 1996 This paragraph was intentionally left blank.

  • Health Insurance Portability and Accountability Act Grantee certifies that it is in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law Xx. 000-000, 00 XXX Parts 160, 162 and 164, and the Social Security Act, 42 USC 1320d-2 through 1320d-7, in that it may not use or disclose protected health information other than as permitted or required by law and agrees to use appropriate safeguards to prevent use or disclosure of the protected health information. Grantee shall maintain, for a minimum of six (6) years, all protected health information.

  • Health Insurance Coverage (a) An employee who is laid off or separated from employment on or after July 1, 1994, under circumstances which entitle such employee to reemployment rights under this Article, other than pursuant to Section 23, may elect to continue membership in their health benefit plan, upon advance payment of the regular percentage contribution to the cost of the plan, during the first six

  • Retiree Health Insurance Retired members of the Department receiving, or to receive City of Lincoln monthly pension checks, may participate in the group comprehensive health care plan for active City employees, provided that each retiree so desiring will execute the required forms in a timely fashion, and further provided that each retiree will be required to pay the full monthly cost at the current rates subject to any rate increases which may occur from time to time. Such payment will be made by payroll deduction from pension checks, or by direct payment in the case of an early retiree.

  • Health insurance premiums If you are unemployed and have received unemployment compensation for 12 consecutive weeks under a federal or state program, you may take payments from your IRA to pay for health insurance premiums without incurring the 10 percent early distribution penalty tax.

  • Drug Free Workplace Act The Contractor will assure a drug-free workplace in accordance with 45 CFR Part 76.

  • Alcohol and Drug-Free Workplace City reserves the right to deny access to, or require Contractor to remove from, City facilities personnel of any Contractor or subcontractor who City has reasonable grounds to believe has engaged in alcohol abuse or illegal drug activity which in any way impairs City's ability to maintain safe work facilities or to protect the health and well-being of City employees and the general public. City shall have the right of final approval for the entry or re-entry of any such person previously denied access to, or removed from, City facilities. Illegal drug activity means possessing, furnishing, selling, offering, purchasing, using or being under the influence of illegal drugs or other controlled substances for which the individual lacks a valid prescription. Alcohol abuse means possessing, furnishing, selling, offering, or using alcoholic beverages, or being under the influence of alcohol.

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