Blue Cross and Blue Shield of Illinois

 

November 22, 2013

2014 Changes for BCBSIL Non-Regulated Small Groups

Blue Cross and Blue Shield of Illinois (BCBSIL) wants to remind you of some important changes impacting non-regulated small groups with 51-150 employees that will take affect at your next renewal date, beginning with Jan. 1, 2014 renewals.

Out-of-Pocket Maximum Guidelines for PPO Plans
For plan years beginning on or after Jan. 1, 2014, the Affordable Care Act requires non-grandfathered plans to set limits on out-of-pocket expenses for in-network essential health benefits (EHBs). The out-of-pocket maximum (OOPM) cannot exceed $6,350 for individual coverage and $12,700 for family coverage for the 2014 plan year.

Based on these requirements, we are making the following changes to BluePrintSM PPO, PPO Value Choice, and Blue Choice SelectSM non-grandfathered plans for the 2014 plan year. These changes apply to standard (pre-packaged) groups (51+) and will not affect grandfathered plans:

  • Family deductible and OOPM will be converted from individual to aggregate to ensure that the family out-of-pocket expenses never exceed $12,700.
  • Deductibles for in-network EHBs will be applied to the OOPM (excluding pharmacy, dental and vision benefits provided by a separate service provider).
  • Copays for in-network EHBs will be applied to the OOPM (excluding pharmacy, dental and vision benefits provided by a separate service provider).
  • The OOPM will increase to include the amount of the deductible. Example: If the current PPO plan has a deductible of $1,000 and an OOPM of $2,500 today, the OOPM will be converted to $3,500 and include the deductible.

Additional Out-of-Pocket Maximum (OOPM) Changes
Beginning with Jan. 1, 2014, effective dates and after, the plan deductible and office visit copayments are now included in the out-of-pocket expense maximum.

Please note that the following items do not apply to the OOPM: prescription drug copayments, copayments and coinsurance applied to services received from an out-of-network provider, charges that exceed the eligible charge or the Schedule of Maximum Allowances, and reduction in benefits due to noncompliance with utilization management program requirements.  

Pre-existing Condition Exclusions Eliminated
Pre-existing condition exclusions on enrollees of any age must be eliminated, regardless of the plan’s grandfathered or non-grandfathered status.

Waiting Periods
Waiting periods for employees eligible for group coverage cannot be longer than 90 calendar days, regardless of the plan’s grandfathered or non-grandfathered status. The effective date of coverage cannot exceed 90 calendar days from the date of hire (unless an employee or dependent is late in electing coverage).

For employees who are already in a waiting period when the provision goes into effect, the days served prior to the renewal date will count toward the 90-day waiting period. The rules for this provision are still proposed and subject to change, pending final rules.

Muscle Manipulation and Naprapathic Services
The coverage level for muscle manipulation is changing to a 30-visit maximum per calendar year and naprapathic services is changing to a 15-visit maximum per calendar year, replacing a $1,000 maximum per year. This change is applicable to both non-grandfathered and grandfathered plans.

2014 HSA-compatible HDHP Requirements
Each year, the U.S. Treasury Department and Internal Revenue Service determine deductible minimums and out-of-pocket maximums for HSA-compatible (health savings account) high deductible health plans (HDHPs), as well as contribution maximums to HSAs. The rules apply to our BlueEdge HSASM plans.

2014 HSA and HDHP Annual Requirements

Individual Coverage

Family Coverage

Minimum Deductible
                                                                                2014                                                                                 2013


$1,250
$1,250


$2,500
$2,500

Maximum Out-of-Pocket (in network)
                                                                                2014                                                                                 2013


$6,350
$6,250


$12,700
$12,500

HSA Contribution Maximum
                                                                                2014                                                                                 2013


$3,300

$3,250


$6,550
$6,450

Minimum Embedded Deductible
                                                                                2014                                                                                 2013


$2,500
$2,500


$2,500
$2,500

2014 HSA Catch-up Contributions (age 55 and older): $1,000

Please contact your BCBSIL representative or producer with any questions.
 


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A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.