FL Small Business Health Insurance Florida’s Small-Business Health Insurance Exchange a 2-Year Bust
FlaglerLive | May 11, 2010
'The invisibles go head to head,' a French engraving of the early 19th century.
By Jim Saunders
Health News Florida
When Republican lawmakers created the Florida Health Choices program in 2008, they billed it as a way to deregulate the health-care market for small businesses.
Two years later, Florida Health Choices has still not started offering coverage, and its leaders and lawmakers face a philosophical choice that could determine whether the program survives.
Florida Health Choices would not qualify as a state insurance exchange under the federal health-reform law, the Patient Protection and Affordable Care Act, signed into law in March. As a result, backers of the Florida Health Choices program will have to decide whether to push forward with their free-market vision or go along with requirements in a federal law that is loathed by many Republicans.
All states must have such an exchange by 2014 to help small businesses and individuals buy insurance coverage. But while the general thrust of the exchanges and Florida Health Choices is similar, the federal law doesn’t allow for the Florida program’s hands-off approach to the coverage that would be sold.
“We said we’re going to create a marketplace where nobody dictates what has to be sold or bought,” said Florida Health Choices Chairman Aaron Bean, a former lawmaker who led efforts to create the program. “The federal government is completely 180 degrees opposite of what we have done.”
Exchanges are a critical part of carrying out what has become known as the federal law’s “individual mandate,” which will require almost all Americans to have health insurance by 2014. In approving the mandate and exchanges, Congress also approved minimum standards for benefits, which Florida Health Choices does not meet.
Without changes to Florida Health Choices — or to federal law — the state would have to create at least one new exchange to meet the federal requirements. If Florida doesn’t set up such an exchange, the federal government would reach agreement with a non-profit organization to operate it.
Bean said Florida Health Choices will continue moving forward, and he hopes to start offering coverage this fall. As a sign of that, the program’s board of directors agreed Friday to hire Rose Naff, former head of the Florida Healthy Kids Corp., to serve as its first chief executive officer, at an annual salary of $120,000.
At least they're healthy.
A former Republican House member from Fernandina Beach, Bean said he hopes Florida Health Choices will become “entrenched” and spur public support. He also said he hopes the November elections will bring changes in Washington.
But the prospect of a clash with federal law comes on top of repeated delays in getting the program started. Allen Douglas, a National Federation of Independent Business official in Florida, called the program a “good idea,” but he said it might be well into 2011 before many small businesses could participate — even if Florida Health Choices starts operating this fall.
“They drug their feet for two years. This was passed in 2008,” Douglas said. “Now they are where they are.”
Florida Health Choices was created in what amounted to a legislative shotgun wedding between the state House and Gov. Charlie Crist. While House leaders pushed for Florida Health Choices, Crist wanted a program known as Cover Florida that allowed insurance companies to sell stripped-down policies.
In the end, lawmakers and Crist approved a bill that included both programs. But two years later, neither has put a dent in reducing the nearly 4 million uninsured Floridians.
Cover Florida had signed up only 5,462 people as of Dec. 31, the end of its first year of operation.
Under Florida Health Choices, small businesses would be able to enroll in the program, and their employees could choose from a variety of health coverages provided by private companies. While that could involve buying insurance coverage, it also could involve such things as buying pre-paid contracts for limited health-care services.
The idea, at least in part, is to give a centralized system where small businesses can help employees get health coverage. Small businesses often do not have the buying power of large corporations and are not able to spread insurance risks as easily, which makes health coverage difficult to afford.
The insurance exchanges in the federal health-reform law also are designed to serve as markets where small businesses and individual customers can go for coverage. But unlike Florida Health Choices, the exchanges are required to sell insurance policies that include a list of “essential” benefits such as hospitalization, maternity care and prescription drugs.
Mary Beth Senkewicz, deputy commissioner for life and health at the Florida Office of Insurance Regulation, said lawmakers would need to make substantial changes in the 2008 law if the state wants to use Florida Health Choices as its exchange. She said it also would require changing the focus and philosophy of the program.
“I think you are well-positioned, if you are willing to adapt,” Senkewicz told the Florida Health Choices board.
Board member Tom Arnold, secretary of the state Agency for Health Care Administration, said the board needs to keep in mind the “big picture” as it moves forward with Florida Health Choices. He said the federal law could determine whether the program survives.
But in the meantime, the program is trying to overcome the continuing delays in getting started. Those delays began, at least in part, because it took Crist until early 2009 to name members of the board.
It also, however, has taken the board months to name a chief executive. Board members widely praised Naff, who led Florida Healthy Kids Corp. from 1990 to 2008 and most recently has held a high-ranking position at the Florida Department of Business and Professional Regulation.
“I’m in a hurry,” Bean said. “People in the state of Florida are ready to buy and sell product.”
Florida Health News Capital Bureau Chief Jim Saunders can be reached at 850/228-0963 or by e-mail here.
Changes To Health Law - Cigna Individual & Family Plans Health Care Reform Benefit Insert - New Customers
INSURED BY CONNECTICUT GENERAL LIFE INSURANCE COMPANY
The Patient Protection and Affordable Care Act (“PPACA”), or “Health Care Reform” as we have all come to know it, is changing the face of health insurance. Our policies already include many of the provisions of the new law which puts CIGNA ahead of health reform in many ways.
In accordance with new laws, effective October 1, 2010 CIGNA policies have been updated to include the following benefits:
• Dependent children can now stay on your policy up to the age of 26
• Exclusions for pre-existing conditions no longer apply to individuals under the age of 19
• Preventive care, including routine physicals will be covered 100%, no deductible
• All lifetime maximums have been removed
We understand that these expanded benefits combined with the rising cost of health care services impact the cost of health care and ultimately the cost of insurance. That’s why we offer programs and services that help you get the most from every dollar you spend on your health and wellness. From our health assessment tool that allows you to identify and address health problems early, to the ability to choose doctors, hospitals and local clinics based on quality and cost information. You can also speak with a nurse 24 hours a day, seven days a week or use the cost calculators, wellness programs and information on www.myCIGNA.com. As a new CIGNA customer, we hope you take full advantage of these benefits.
CIGNA fully supports the goal to provide every American with quality health coverage they can afford. We will continue to work with lawmakers to make sure this goal is met and will focus on our mission to help you and all of our customers improve your health, well-being and sense of security. As additional details become available, we will share this information with you.
For more information about your policy or the programs and services that come with your coverage, please contact your broker or Billing and Enrollment at 1-877-484-5967. You can also learn more about Health Care Reform by visiting CIGNA's new website, www.informedonreform.com.
Thank you again for choosing CIGNA to help you protect your health and wellness.
"CIGNA" and the "Tree of Life" logo are registered service marks, and “www.informedonreform.com” is a service mark of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries, including CIGNA HealthCare of Arizona and Connecticut General Life Insurance Company, and not by CIGNA Corporation. In Arizona, HMO plans are offered by CIGNA HealthCare of Arizona, Inc. In Texas, Open Access Plus Plans are considered preferred provider plans with certain managed care features. Major medical insurance policies are insured by Connecticut General Life Insurance Company.
844021 07/10 © 2010 CIGNA
Individual & Family Plans Health Care Reform Benefit Insert – Continuing Customers
INSURED BY CONNECTICUT GENERAL LIFE INSURANCE COMPANY
The Patient Protection and Affordable Care Act (“PPACA”), or “Health Care Reform” as we have all come to know it, is changing the face of health insurance. Our policies already include many of the provisions of the new law which puts CIGNA ahead of health reform in many ways.
However, beginning October 1, 2010, you will see the following changes in your coverage:
• Dependent children can now stay on your policy up to the age of 26
• Exclusions for pre-existing conditions no longer apply to individuals under the age of 19
• Preventive care, including routine physicals will be covered 100%, no deductible
• All lifetime maximums have been removed
These expanded benefits combined with the rising cost of health care services and other factors such as age, significantly impact the cost of health care and ultimately the cost of insurance.
That’s why we offer programs and services that help you get the most from every dollar you spend on your health and wellness. From our health assessment tool that allows you to identify and address health problems early, to the ability to choose doctors, hospitals and local clinics based on quality and cost information. You can also speak with a nurse 24 hours a day, seven days a week or use the cost calculators, wellness programs and information on www.myCIGNA.com. These are just a few of the ways we are working to control the cost of health care for you.
CIGNA fully supports the goal to provide every American with quality health coverage they can afford. We will continue to work with lawmakers to make sure this goal is met and will focus on our mission to help you and all of our customers improve your health, well-being and sense of security.
For more information about the changes to your policy or the programs and services that come with your coverage, please contact your broker or call a CIGNA Renewal Specialist at 1-877-484-5966. You can also learn more about Health Care Reform by visiting CIGNA's new website, www.InformedOnReform.com.
Thank you again for choosing CIGNA to help you protect your health and wellness.
"CIGNA" and the "Tree of Life" logo are registered service marks of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries, including CIGNA HealthCare of Arizona and Connecticut General Life Insurance Company, and not by CIGNA Corporation. In Arizona, HMO plans are offered by CIGNA HealthCare of Arizona, Inc. In Texas, Open Access Plus Plans are considered preferred provider plans with certain managed care features. Major medical insurance policies are insured by Connecticut General Life Insurance Company.
843627 07/10 © 2010 CIGNA
Individual & Family Plans Health Care Reform Benefit Letter – Continuing Customers
INSURED BY CONNECTICUT GENERAL LIFE INSURANCE COMPANY
Dear Valued Customer,
The Patient Protection and Affordable Care Act (“PPACA”), or “Health Care Reform” as we have all come to know it, is changing the face of health insurance. Our policies already include many of the provisions of the new law which puts CIGNA ahead of health reform in many ways. However, beginning October 1, 2010, you will see the following changes in your coverage:
• Dependent children can now stay on your policy up to the age of 26
• Exclusions for pre-existing conditions no longer apply to individuals under the age of 19
• Preventive care, including routine physicals will be covered 100%, no deductible
• All Lifetime dollar limits have been removed
Please see the enclosed Notice for additional details about Lifetime dollar limits and instructions to enroll a dependent that may have previously met the dependent age maximum.
We understand that these expanded benefits combined with the rising cost of health care services impact the cost of health care and ultimately the cost of insurance. That’s why we offer programs and services that help you get the most from every dollar you spend on your health and wellness. From our health assessment tool that allows you to identify and address health problems early, to the ability to choose doctors, hospitals and local clinics based on quality and cost information. You can also speak with a nurse 24 hours a day, seven days a week or use the cost calculators, wellness programs and information on www.myCIGNA.com. These are just a few of the ways we are working to control the cost of health care for you.
CIGNA fully supports the goal to provide every American with quality health coverage they can afford. We will continue to work with lawmakers to make sure this goal is met and will focus on our mission to help you and all of our customers improve your health, well-being and sense of security. As additional details become available, we will share that information with you.
For more information about the changes to your policy or the programs and services that come with your coverage, please contact your broker or call a CIGNA Renewal Specialist at 1-877-484-5966. You can also learn more about Health Care Reform by visiting CIGNA's new website, www.InformedOnReform.com.
Thank you again for choosing CIGNA to help you protect your health and wellness.
Sincerely,
Chris Hocevar
President, CIGNA Individual & Family Plans
"CIGNA HealthCare" and the "Tree of Life" logo are registered service marks of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries, including Connecticut General Life Insurance Company, and not by CIGNA Corporation. In Arizona, HMO plans are offered by CIGNA HealthCare of Arizona, Inc. In Texas, Open Access Plus Plans are considered preferred provider plans with certain managed care features. Major medical insurance policies in these states are insured or administered by Connecticut General Life Insurance Company.
844024 07/10 © 2010 CIGNA
Individual & Family Plans Legal Notice
INSURED BY CONNECTICUT GENERAL LIFE INSURANCE COMPANY
Patient Protection and Affordable Care Act (PPACA) Notices
Individual Plans
The Patient Protection and Affordable Care Act of 2010 (PPACA) provides several requirements for individual health plans. CIGNA is providing the special notices below as a result of two of those requirements: Elimination of lifetime dollar limits and Coverage of dependent children to age 26. More details on the effect to your plan will be provided soon.
Lifetime Dollar Limits
The lifetime limit on the dollar value of benefits under your CIGNA HealthCare plan no longer applies. Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan. Individuals have 30 days from the date of this notice to request enrollment. For more information you can call CIGNA at 1-877-484-5967.
Dependent Coverage
Individuals whose coverage ended, or who were denied coverage (or were not eligible for coverage), because the availability of dependent coverage of children ended before attainment of age 26 are eligible to enroll in your CIGNA HealthCare plan. Individuals may request enrollment for such children for 30 days from the date of notice. Enrollment will be effective retroactively to October 1, 2010.* For more information you can call 1-877-484-5967.
*Please note enrollment is guaranteed only for those children who were previously covered under your policy but lost coverage due to exceeding the dependent age limit. Individuals who were not previously covered under your policy or whose coverage terminated for reasons other than exceeding the dependent age limit are subject to medical underwriting and may be declined.
"CIGNA" and the "Tree of Life" logo are registered service marks of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries, including CIGNA HealthCare of Arizona and Connecticut General Life Insurance Company, and not by CIGNA Corporation. In Arizona, HMO plans are offered by CIGNA HealthCare of Arizona, Inc. In Texas, Open Access Plus Plans are considered preferred provider plans with certain managed care features. Major medical insurance policies in these states are insured or administered by Connecticut General Life Insurance Company.
844022 07/10 © 2010 CIGNA
Small Group Plans Health Care Reform Benefit Insert
IMPORTANT NOTICE REGARDING PATIENT PROTECTION AND AFFORDABLE CARE ACT
As you are probably aware, the federal Patient Protection and Affordable Care Act (“PPACA”), will require numerous changes to health care coverage over the next several years. Changes effective for policies first issued or renewing on or after September 23, 2010 include the following:
• Dependent children covered to age 26
• No pre-existing condition provisions for anyone under age 19
• Elimination of lifetime dollar limits on essential benefits
• Restricted annual dollar limits on essential benefits
• No rescissions (retroactive termination) of coverage except for fraud or intentional misrepresentation of a material fact
• Preventive care, including routine physicals will be covered at 100%, no deductible (not applicable to grandfathered group plans)
• Various patient protections such as choice of primary care physician (PCP), direct access to OB/GYN services and emergency room coverage (not applicable to grandfathered group plans)
The federal regulatory agencies are in the process of providing insurers with specific requirements to implement these provisions of the law. We will provide detailed information about the specific changes to your policy as soon as possible..
Additional changes to your policy will be communicated as various PPACA provisions become effective through 2014.
You can find more information by contacting your broker or by visiting CIGNA's new website, www.InformedOnReform.com.
"CIGNA" and the "Tree of Life" logo are registered service marks, “Informed on Reform” and “www.InformedOnReform.com are service marks of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries and not by CIGNA Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (CGLIC) and HMO or service company subsidiaries of CIGNA Health Corporation. In Arizona, HMO plans are offered by CIGNA HealthCare of Arizona, Inc. In California, HMO plans are offered by CIGNA HealthCare of California, Inc. In Connecticut, HMO plans are offered by CIGNA HealthCare of Connecticut, Inc. In North Carolina, HMO plans are offered by CIGNA HealthCare of North Carolina, Inc. In Texas, Open Access Plus Plans are considered preferred provider plans with certain managed care features. All other medical plans in these states are insured or administered by CGLIC.
8
IMPORTANT NOTICE REGARDING PATIENT PROTECTION AND AFFORDABLE
CARE ACT (PPACA)
Please distribute a copy of this notice to all enrolled employees.
The Patient Protection and Affordable Care Act of 2010 (PPACA) provides several requirements for
group health plans. CIGNA is providing the special notices below as a result of two of those
requirements: Elimination of overall plan lifetime dollar limits and Coverage of dependent children to
age 26.
Lifetime Dollar Limits
The lifetime limit on the dollar value of benefits under your CIGNA HealthCare plan no longer applies.
Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to
enroll in the plan. Individuals have 30 days from the date of this notice to request enrollment. For
more information contact your employer.
Dependent Coverage
Individuals whose coverage ended, or who were denied coverage (or were not eligible for coverage),
because the availability of dependent coverage of children ended before attainment of age 26 are
eligible to enroll in your CIGNA HealthCare plan. Individuals may request enrollment for such
children for 30 days from the date of notice. Enrollment will be effective retroactively to [insert date
that is the first day of the first plan year beginning on or after September 23, 2010.] For more
information contact your employer.
"CIGNA" and the "Tree of Life" logo are registered service marks of CIGNA Intellectual Property, Inc., licensed
for use by CIGNA Corporation and its operating subsidiaries. All products and services are provided exclusively
by such operating subsidiaries and not by CIGNA Corporation. Such operating subsidiaries include Connecticut
General Life Insurance Company (CGLIC) and HMO or service company subsidiaries of CIGNA Health
Corporation. In Arizona, HMO plans are offered by CIGNA HealthCare of Arizona, Inc. In California, HMO plans
are offered by CIGNA HealthCare of California, Inc. In Connecticut, HMO plans are offered by CIGNA
HealthCare of Connecticut, Inc. In North Carolina, HMO plans are offered by CIGNA HealthCare of North
Carolina, Inc. In Texas, Open Access Plus Plans are considered preferred provider plans with certain managed
care features. All other medical plans in these states are insured or administered by CGLIC.
844023 07/10 © 2010 CIGNA
Small Group Plans Legal Notice
