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Do you know how Texas group Health Insurance is changing?


Elimination of Co-Payments for Screenings and Preventive Care
Starting in September of 2010, employer-sponsored (and other) group health plans and Texas health insurance issuers are prohibited from requiring co-pays for all preventive services recommended by an independent expert panel, the United States Preventive Services Task Force. Co-pays are also eliminated for certain recommended immunizations, breast cancer screenings and other preventive care/screenings for women and children. However, this requirement does not apply to “grandfathered” health plans, which are defined in PPACA as any plan in which at least one individual was enrolled as of March 23, 2010.

Note: Pay careful attention to the cost-sharing requirements for office visits under this rule.

Employee Wellness Discounts
Starting January 1, 2014, PPACA enhances such wellness discounts by permitting group health plans to give reductions of up to 30 percent of the cost of premiums to employees who participate in such wellness programs. This may be expanded to 50 percent subject to the discretion of the Secretary of Health and Human Services (HHS).

Break Time for Nursing Mothers
Effective immediately, the PPACA also provides that employers covered by the Fair Labor Standards Act must provide reasonable break time and a private space – other than a restroom – for nursing mothers for up to one year after the birth of a child. Employers are not required to compensate employees during such break times. Additionally, employers with less than 50 employees may qualify for exceptions if it can be proven that the requirement would impose an undue hardship on the employer.

Posting of Nutritional Requirements
By March of 2011, the Secretary of HHS must publish regulations requiring all chain restaurants (defined as any establishment that has 20 or more locations operating under the same name) to disclose the nutritional content of all menu items. Specifically, the number of calories for each item must be disclosed on menus, menu boards and drive through menu boards, and such menus must also feature “a succinct statement concerning suggested daily caloric intake.”  This requirement also extends to buffet items, and vending machines maintained by companies that operate 20 or more machines.

Government Funding for Wellness Programs
In addition to the specific provisions outlined above, PPACA also creates a “Prevention and Public Health Fund” which will be administered through HHS and will support prevention and public health programs.  Beginning with the fiscal year 2010, $500 million will be appropriated to various programs within HHS, with the amount of appropriations increasing each year to $2 billion in the fiscal year 2015 and each year thereafter. Under PPACA, the funds are to be used for activities such as prevention research and health screenings, the Community Transformation grant program (designed to fund state and municipal wellness programs by creating walking paths, nutrition awareness programs, etc.), Education and Outreach Campaign for Preventive Benefits (a planned public-private partnership to raise awareness on preventive care), and immunization programs.

Additionally, school-based health centers (facilities that provide primary health care to students on school campuses) will receive $50 million per year in grant funding through 2013. These grant monies are to be used only for expenditures on facilities and equipment, not for hiring personnel.

Justin Lawhorn
Justin Lawhorn
I have been in the insurance business since 2001 and had the fortunate opportunity to start my own agency in 2002 as an independent agent offering group health insurance, individual health, life, and dental insurance.
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