This presentation will help you understand the strategies for patient enrollment & navigation and there by reduce the risk of caring for the uninsured.
Understanding the ObamaCare North Carolina Health Insurance Plans
As a result of the Affordable Care Act (a.k.a. ObamaCare) the following provisions are now in place for health insurance policies with an effective date January 1, 2014 or after:Individuals cannot be declined for health insurance or charged more due to their health status or gender.
Insurance premiums are based on age, your zip code and tobacco usage.
Coverage limitations or exclusions based on pre-existing conditions are not allowed.
Elimination of annual and lifetime coverage limits.
Prohibition of declining an individual for coverage based on their participation in an approved clinical trial.
Maternity and mental health are included on all policies.
Preventative dental is covered with a $25 copay for members up to age 19. There is also some vision coverage for this age group.
Whether or not your children are students they can stay on your policy until age 26.
Introduction of the Medical Loss Ratio (MLR) which ensures that 80% of the premium dollars paid to the health insurance issuer are spend on providing health care. An insurance company that does not do this must provide rebates to their policyholders
http://www.hisonc.com/obamacare-north-carolina
This presentation will help you understand the strategies for patient enrollment & navigation and there by reduce the risk of caring for the uninsured.
Understanding the ObamaCare North Carolina Health Insurance Plans
As a result of the Affordable Care Act (a.k.a. ObamaCare) the following provisions are now in place for health insurance policies with an effective date January 1, 2014 or after:Individuals cannot be declined for health insurance or charged more due to their health status or gender.
Insurance premiums are based on age, your zip code and tobacco usage.
Coverage limitations or exclusions based on pre-existing conditions are not allowed.
Elimination of annual and lifetime coverage limits.
Prohibition of declining an individual for coverage based on their participation in an approved clinical trial.
Maternity and mental health are included on all policies.
Preventative dental is covered with a $25 copay for members up to age 19. There is also some vision coverage for this age group.
Whether or not your children are students they can stay on your policy until age 26.
Introduction of the Medical Loss Ratio (MLR) which ensures that 80% of the premium dollars paid to the health insurance issuer are spend on providing health care. An insurance company that does not do this must provide rebates to their policyholders
http://www.hisonc.com/obamacare-north-carolina
The Guide to Health Insurance Exchanges provides an overview of what the exchanges are and how they work, as well as reports on what happened right after they opened. The guide will help both employers and consumers to better understand exchanges by explaining the different types including public exchange for individuals, the SHOP exchange for small businesses, or a private marketplace for larger companies.
Although the Affordable Care Act has benefited the health insurance consumer in many respects, it has also added to the confusion. This presentation, Given by Wanda Stephens in Raleigh, North Carolina, details some of the many facets to Obamacare in NC.
for more information visit http://www.hisonc.com/obamacare-north-carolina/
National Health Council - Preparing for Exchange Enrollment (July 2013)National Health Council
What patient advocacy organizations need to know as they help people with chronic conditions understand the essential health benefits provided under the Affordable Care Act and assist people in enrolling in state exchanges
What every employer needs to know about healthcare reform september 2013Nicholas McGill
This is a slide deck covers the latest news and a detailed look at the ins and outs of healthcare reform and is by far the most useful and informative presentation I've seen. Originally presented by David L. Fear Sr. RHU in September 2013, and shared with permission by Heroik Media.
Join us as we learn about the benefits of the Affordable Care Act, the ways you can get help paying for insurance, and where you can get help enrolling. (Hint: We can help!)
The Guide to Health Insurance Exchanges provides an overview of what the exchanges are and how they work, as well as reports on what happened right after they opened. The guide will help both employers and consumers to better understand exchanges by explaining the different types including public exchange for individuals, the SHOP exchange for small businesses, or a private marketplace for larger companies.
Although the Affordable Care Act has benefited the health insurance consumer in many respects, it has also added to the confusion. This presentation, Given by Wanda Stephens in Raleigh, North Carolina, details some of the many facets to Obamacare in NC.
for more information visit http://www.hisonc.com/obamacare-north-carolina/
National Health Council - Preparing for Exchange Enrollment (July 2013)National Health Council
What patient advocacy organizations need to know as they help people with chronic conditions understand the essential health benefits provided under the Affordable Care Act and assist people in enrolling in state exchanges
What every employer needs to know about healthcare reform september 2013Nicholas McGill
This is a slide deck covers the latest news and a detailed look at the ins and outs of healthcare reform and is by far the most useful and informative presentation I've seen. Originally presented by David L. Fear Sr. RHU in September 2013, and shared with permission by Heroik Media.
Join us as we learn about the benefits of the Affordable Care Act, the ways you can get help paying for insurance, and where you can get help enrolling. (Hint: We can help!)
Collaborate with local non-profit organization, Habitat For Humanity
- Provide leadership to team of architect and construction management students
- Perform a scope of work analysis, re-design areas in each home as needed, select materials, draft measured drawings, determine quantities and perform other duties as required by the partner organization
These slides are used to present the Skillaware Electronic Process Performance Support System during the U.S. launch by U.S. System Integrator (Hylasoft Inc. Chicago)
September is an extremely important month for Content Marketers.
Not only is there a rich variety of important events- from regional festivals to travel to grammar days, there are a lot of opportunities for brands to engage customers.
Hence, we have compiled some conversation ideas for September, so you don’t have to!
Here's the ultimate guide to plan your brand's content and get the engagement going this October.
From Non-Violence Day and Dusshera to World Vodka Day, here are some wide ranging additions to your marketing communication mix.
An Obamacare Primer -- cutting through the complexityAdrian Ho
Much of what is reported on re the ACA (or "Obamacare") is politically motivated, or is more about the politics than the actual content of the law itself. This deck is my attempt to cut through all the complexity and distortions and simply explain what is in the ACA and why it is in there.
An Overview of the ACA (aka Obamacare), October 2013Adrian Ho
Theres a lot of noise out there about Obamacare, much of it politically driven. This presentation is my attempt to focus on the facts and boil down the over 2000 page law into a short succinct summary
Online Conference Takes “Deep Dive” into Affordable Care ActPYA, P.C.
PYA’s Martie Ross, Principal, joined three other panelists in a full-day, online conference sponsored by the American Institute of Certified Public Accountants to offer an in-depth look at healthcare reform under the Affordable Care Act (ACA).
McKonly & Asbury Webinar - The Patient Protection and Affordable Care ActMcKonly & Asbury, LLP
We continued our Celebrating 40 Years of Excellence! Fall Webinar Series with a webinar focusing on the impact of The Patient Protection and Affordable Care Act and next steps for employees, hosted by Suzanne Sentman (Human Resource Director with McKonly & Asbury) with featured guest Kent Evans (Vice President / Human Capital Consultant with Willis of Delaware, Inc).
Check out our Upcoming Events page for news and updates on our future seminars and webinars at http://www.macpas.com/events/.
View a full recap of this webinar at http://www.macpas.com/register-today-for-mckonly-asburys-free-the-patient-protection-and-affordable-care-act-webinar/.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
2. Affordable Care Act 101
Subsidies and Plans
Open Enrollment Rules and Deadlines
The Future of Healthcare
Why Marketplace Nebraska?
3. Clients Asking:
Does the Affordable Care Act affect me?
How do I get a tax subsidy?
How do I enroll in the Marketplace?
What are the Bronze, Silver, Gold, and
Platinum Plans?
What are cost sharing reduction plans and
who qualifies for them?
4.
5. The Patient Protection and Affordable
care Act (PPACA) was signed into law on
March 23, 2010.
Various portions of the law began being
implemented in 2010 and will continue
until 2018.
Federal and state governments are largely
implementing these provisions.
◦ *PPACA does not affect those on Medicare, or
covered under the VA, Tricare system
6. Covering the Uninsured & Underinsured
population
◦ Approximately 32 million more Americans
Improving the Transparency and Ease of
Purchasing Health Insurance.
◦ The Exchange System
Creating National Standards
◦ Essential Health Benefits (EHBs)
Standardizing Benefit Packages
◦ Summary of Benefits
Reducing medical and Insurance Costs
7. Guarantee Issued. Cannot be denied coverage
No Pre Existing Condition Limitations
Comprehensive coverage
Essential health benefits
Tax Subsidies to offset premium
9. Sec. 1302(b)(1)
Services covered
include:
• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including
behavioral health treatment
• Prescription drugs
• Rehabilitation and Rehabilitative services & devices
• Laboratory services
• Preventative and Wellness services and Chronic Disease
Management
• Pediatric services, including oral & vision care
10. 10
Employer Impacts Description Small Group
Fully Insured
Large Group
Fully Insured
Self-
Funded
Individual
1
Essential Health
Benefits (EHB) *
• Health Plans must provide Essential
Health Benefits for individual and
small group
Yes No No Yes
2
OOP Max * • OOP limits must comply with OOP
limits for HSA plans
• All cost sharing (including copays)
for EHB services must count toward
OOPM
Yes Yes Yes Yes
3
Deductible
Limits *
• Beginning 2014 plan design
deductibles may not exceed a $2,000
(self-only) or $4,000 (other than self-
only) annual limitation
Yes No No No
4
Metallic Levels • Four tiers of coverage for EHB
packages: Bronze, Silver, Gold, and
Platinum and catastrophic coverage
(under 30-year-olds only)
• Requirement to meet actuarial value
of one of four plans
• Requirement in and out of Exchange
Yes No No Yes
Pre-existing
Condition
Exclusion
(All Ages)
• Beginning in 2014, pre-existing
condition exclusions must be
removed for all members, not just
those under age 19
Yes Yes Yes Yes
For many 2014 provisions, we are awaiting further
guidance. Information will be updated.
* Not required for grandfathered plans
15. Starts November 15th 2014
Ends February 15th 2015
If enrolled after the 15th, the effective date is
not for the immediate month but for the nest
month out
16. Overall, 30 percent of employers will definitely or
probably stop offering ESI in the years after 2014.
Businesses with fewer than 50 full-time employees
most impacted by potential to seek alternative
insurance and compensation models
At least 30 percent of employers would gain
economically from dropping coverage even if they
completely compensated employees for the change
through other benefit offerings or higher salaries.
Move toward a more informed and engaged approach
to selecting and managing your health
17. CMS NEWS
FOR IMMEDIATE RELEASE Contact: CMS Media Relations Group
May 2, 2014 (202) 690-6145 or
press@cms.hhs.gov
Administration announces proposal to clarify availability
of Health Insurance Marketplace coverage to workers eligible for
COBRA
WASHINGTON – The Obama administration today announced updates to model notices informing
workers of their eligibility to continue health-care coverage through the Consolidated Omnibus
Budget Reconciliation Act. The updates make it clear to workers that if they are eligible for COBRA
continuation coverage when leaving a job, they may choose to instead purchase coverage through
the Health Insurance Marketplace.
“In many cases, workers eligible for COBRA continuation coverage can save significant sums of
money by instead purchasing health insurance through the Marketplace,” said Assistant Secretary of
Labor for Employee Benefits Security Phyllis C. Borzi. “COBRA continues to play an important role in
helping workers and families maintain coverage after a job loss, and it is important that workers
know that in some cases there is a Marketplace option as well.”
Workers and their families who are eligible for employer-sponsored coverage generally must be
informed of their right to COBRA continuation coverage at the start of employment. They must also
be informed of their right to purchase COBRA coverage when separating from a job. The proposed
changes to the model notices would offer information on more affordable options available through
the Marketplace, where workers and families may be eligible for financial assistance that would not
otherwise be available for COBRA continuation coverage. In most cases, workers and their families
eligible for, but not enrolled in, COBRA continuation coverage would be able to enroll in Marketplace
coverage outside of the normal open enrollment period.
“We are pleased that the Marketplace is providing affordable health insurance options to consumers,”
said Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner. “With over eight
million enrollees, we know that the Marketplace is working and is providing consumers with
additional choices and control over their health care.”
The Departments of Labor, Health and Human Services, and Treasury are also publishing frequently
asked questions related to the proposed changes to model notices. The FAQs are posted on the
Department of Labor website at http://ww.dol.gov/ebsa/faqs/faq-aca19.html and the HHS website
at http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs19.html.
In addition, HHS is publishing a clarifying bulletin regarding a special enrollment period in the
Marketplace for individuals already enrolled in COBRA continuation coverage. The bulletin is posted
on the HHS website at http://www.cms.gov/CCIIO/Resources/Regulations-and-
Guidance/Downloads/SEP-and-hardship-FAQ-5-1-2014.pdf.
The updated model notices are posted on the Department of Labor website at
http://www.dol.gov/ebsa/modelgeneralnotice.doc and
http://www.dol.gov/ebsa/modelelectionnotice.doc. A related notice of proposed rulemaking on the
COBRA notice requirements will be published in the May 7 edition of the Federal Register. The notice
of proposed rulemaking can also be viewed here at http://www.dol.gov/ebsa/pdf/cobranprm.pdf.
#
CMS NEWS
FOR IMMEDIATE RELEASE Contact: CMS Media Relations Group
May 2, 2014 (202) 690-6145 or
press@cms.hhs.gov
Administration announces proposal to clarify availability
of Health Insurance Marketplace coverage to workers eligible for
COBRA
WASHINGTON – The Obama administration today announced updates to model notices informing
workers of their eligibility to continue health-care coverage through the Consolidated Omnibus
Budget Reconciliation Act. The updates make it clear to workers that if they are eligible for COBRA
continuation coverage when leaving a job, they may choose to instead purchase coverage through
the Health Insurance Marketplace.
“In many cases, workers eligible for COBRA continuation coverage can save significant sums of
money by instead purchasing health insurance through the Marketplace,” said Assistant Secretary of
Labor for Employee Benefits Security Phyllis C. Borzi. “COBRA continues to play an important role in
helping workers and families maintain coverage after a job loss, and it is important that workers
know that in some cases there is a Marketplace option as well.”
Workers and their families who are eligible for employer-sponsored coverage generally must be
informed of their right to COBRA continuation coverage at the start of employment. They must also
be informed of their right to purchase COBRA coverage when separating from a job. The proposed
changes to the model notices would offer information on more affordable options available through
the Marketplace, where workers and families may be eligible for financial assistance that would not
otherwise be available for COBRA continuation coverage. In most cases, workers and their families
eligible for, but not enrolled in, COBRA continuation coverage would be able to enroll in Marketplace
coverage outside of the normal open enrollment period.
“We are pleased that the Marketplace is providing affordable health insurance options to consumers,”
said Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner. “With over eight
million enrollees, we know that the Marketplace is working and is providing consumers with
additional choices and control over their health care.”
The Departments of Labor, Health and Human Services, and Treasury are also publishing frequently
asked questions related to the proposed changes to model notices. The FAQs are posted on the
Department of Labor website at http://ww.dol.gov/ebsa/faqs/faq-aca19.html and the HHS website
at http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs19.html.
In addition, HHS is publishing a clarifying bulletin regarding a special enrollment period in the
Marketplace for individuals already enrolled in COBRA continuation coverage. The bulletin is posted
on the HHS website at http://www.cms.gov/CCIIO/Resources/Regulations-and-
Guidance/Downloads/SEP-and-hardship-FAQ-5-1-2014.pdf.
The updated model notices are posted on the Department of Labor website at
http://www.dol.gov/ebsa/modelgeneralnotice.doc and
http://www.dol.gov/ebsa/modelelectionnotice.doc. A related notice of proposed rulemaking on the
COBRA notice requirements will be published in the May 7 edition of the Federal Register. The notice
of proposed rulemaking can also be viewed here at http://www.dol.gov/ebsa/pdf/cobranprm.pdf.
#
CMS NEWS
FOR IMMEDIATE RELEASE Contact: CMS Media Relations
Group
May 2, 2014 (202) 690-6145 or press@cms.hhs.gov
Administration announces proposal to clarify availability
of Health Insurance Marketplace coverage to workers eligible for COBRA
WASHINGTON – The Obama administration today announced updates to model notices informing
workers of their eligibility to continue health-care coverage through the Consolidated Omnibus Budget
Reconciliation Act. The updates make it clear to workers that if they are eligible for COBRA continuation
coverage when leaving a job, they may choose to instead purchase coverage through the Health
Insurance Marketplace.
“In many cases, workers eligible for COBRA continuation coverage can save significant sums of money by
instead purchasing health insurance through the Marketplace,” said Assistant Secretary of Labor for
Employee Benefits Security Phyllis C. Borzi. “COBRA continues to play an important role in helping
workers and families maintain coverage after a job loss, and it is important that workers know that in
some cases there is a Marketplace option as well.”
Workers and their families who are eligible for employer-sponsored coverage generally must be informed
of their right to COBRA continuation coverage at the start of employment. They must also be informed of
their right to purchase COBRA coverage when separating from a job. The proposed changes to the model
notices would offer information on more affordable options available through the Marketplace, where
workers and families may be eligible for financial assistance that would not otherwise be available for
COBRA continuation coverage. In most cases, workers and their families eligible for, but not enrolled in,
COBRA continuation coverage would be able to enroll in Marketplace coverage outside of the normal
open enrollment period.
“We are pleased that the Marketplace is providing affordable health insurance options to consumers,”
said Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner. “With over eight million
enrollees, we know that the Marketplace is working and is providing consumers with additional choices
and control over their health care.”
The Departments of Labor, Health and Human Services, and Treasury are also publishing frequently asked
questions related to the proposed changes to model notices. The FAQs are posted on the Department of
Labor website at http://ww.dol.gov/ebsa/faqs/faq-aca19.html and the HHS website at
http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs19.html. In
18. GAP Plans can help cover cost of rising
deductibles
Stand alone hospitalization, accident, and
critical illness plans can address specific
concerns
Disability insurance helps minimize loss of
income if unable to work due to injury or
illness
19. Experienced
Trusted
Licensed and insured
Team of Licensed Professionals
Creative solutions for a ever changing world
Local assistance and support
Visit us at:
www.marketplacenebraska.com
Editor's Notes
Talk to slide
Health plans participating in an Exchange must meet standardized affordability, Essential Health Benefits, and consumer protection requirements. The Exchanges will determine how much flexibility health plans have for offering different benefit plans within the Exchange. The Act requires that plans offered through the Exchange meet the cost-sharing requirements with one of four levels of coverage:
The platinum plan with a 90% actuarial value
The gold plan with an 80% actuarial value
The silver plan with a 70% actuarial value or,
The bronze plan with a 60% actuarial value
Plans must be + or – 2% of the target
Beginning in 2017, if a state chooses to include large groups in its exchange, these rating restrictions will than apply to large groups (other than self-funded group health plans offered in the same market) in the state.