Monthly Archives: April 2014

Highmark Announces Small Employer Clients Can Keep Existing Health Insurance Coverage

Almost 200,000 people stand to benefit as Highmark Inc. announced April 24 that small employer business clients will be able to keep their current health insurance plans. This means customers with renewal dates between July and December 2014 will be able to delay for at least another year having to enroll in potentially costlier health plans that reflect new 2014 requirements of the Affordable Care Act. 

“Highmark appreciates the crucial role that small businesses play, serving as the backbone of the communities we serve,” said Deborah Rice-Johnson, president of Highmark Health Plan. “Enabling these small employer customers to stick with their current plans reflects our commitment to work with these important clients so that we can continue to provide affordable health coverage for their employees.”

The federal government announced last month that health insurers — with approval from their state insurance commissioners — could offer small employer customers the option to renew existing plans beyond 2014. The Pennsylvania Insurance Department subsequently said it was up to individual insurers to decide if they want to offer existing clients the option to renew their pre-Affordable Care Act plans.

“We expect the majority of our small employer clients to stay with their current plans, but Highmark offers a wide variety of plans that are compliant with the Affordable Care Act and meet the needs of our members,” said Rice-Johnson. “Some of these plans are built on a broad network and some are built on our Community Blue network, where members have a greater opportunity for cost savings when they use a select network of high-quality, lower-cost providers. But at this time, we understand that it may make sense for some of our small employer customers to stay with their current plans. We are offering them greater choice by giving them the option to stay in those plans.”

Whether small employer businesses choose to renew their current plans or opt to purchase new plans that reflect new 2014 requirements of the Affordable Care Act, renewal rates will vary based on the insured group.

Aetna Eligibility Guidelines for Small Groups

Aetna has updated their eligibility guidelines as it relates to sole proprietors, owners, partners, W-2 employees and husband / wife groups for 2014. These updates have been made to maintain compliance with state and federal requirements. Please review the updates  outlined below.

The following applies to Small Group Pennsylvania new business and renewals:

The definition of an employer is now one W-2 common law employee. This accommodates an owner with at least one “enrolling” W-2 common law employee who is not a spouse and not an owner.

Sole proprietors, owners of “S” corporations, partners in a partnership, and corporations qualify for coverage if there is at least one “enrolling” W-2 employee other than the owner(s) or spouse(s).

Husband and wife groups are not eligible based on the federal definition of a group. To be considered a group health plan; there must be at least one enrolling W-2 employee other than the owner and the spouse. The spouse of the owner is not considered an employee, even if paid as a W-2 employee. The owner and spouse are both considered to be owners and are eligible for individual coverage.

The group must meet the Pennsylvania participation guidelines.

– 2 to 4 eligible employees – 100%  of eligibles must participate, excluding valid waivers.

– 5 to 50 eligible employees – 75% of the eligibles must participate, excluding valid waivers.

This table provides examples of Small Group businesses and the eligibility rules for Aetna products.

LLCFather and son

No W-2 EEs

Not eligible
Sole Proprietor, Corporation or   LLC1 owner

1 enrolling W-2 EE

LLC1 owner

3 eligible W-2 EEs

1 W-2 EE is the spouse

Owner and spouse are the only 2   enrolling

2 others waiving

Not Eligible since no W-2 EEs   is enrolling who are not the owner and not the spouse
Corporation1 owner enrolling

1 W-2 (non-spouse) ENROLLING

2 W-2 EE waiving with   valid waivers





UPMC Offers WorkPartners CE Course

UPMC Health Plan is pleased to offer a new Continuing Education (CE) course. The topic is workers’ compensation, including details on the following:

  • Determination of compensability
  • Costs and premiums
  • Policy features
  • Accident investigation
  • Return-to-work (RTW)
  • Wages and benefits

You can earn four CE credits for this course.

The presentation will be led by:

Patrick Haughey, Senior Director, Commercial Workers’ Compensation UPMC WorkPartners

Steven Wagner, Senior Claims Manager, Commercial Workers’ Compensation UPMC WorkPartners

UPMC is holding four sessions in May:

Philadelphia: Tuesday, May 6 – DoubleTree Suites by Hilton Philadelphia West – 640 Fountain Road, Plymouth Meeting, PA 19462

Johnstown: Tuesday, May 13 – The Conference Center at University of Pittsburgh at Johnstown – 450 Schoolhouse Road, Johnstown, PA 15904

Erie: Wednesday, May 14 – Sheraton Bayfront Hotel -55 West Bay Drive, Erie, PA 16507

Pittsburgh: Thursday, May 22 – Marriott City Center – 112 Washington Place, Pittsburgh, PA 15219

All sessions run from 8:30 a.m. to 12:30 p.m., with registration and continental breakfast beginning at 8 a.m. Please register for your preferred location by clicking the button below. RSVP by Thursday, May 1. We hope to see you there!