Making Sense of Health Care Reform

couple with insurance agent12/10 Update

Individual Exchange Enrollment Assistance Sites

11/21 Update 

After President Obama last week provided states the flexibility to continue non-PPACA-compliant health plans into next year, State Insurance Commissioner Ted Nickel announced this morning that Wisconsin will allow this “keep your plan” change. Insurance companies are not required to continue coverage, and some may not, but in the spirit of doing all we can to best serve our members and clients, Physicians Plus will make as many options as possible available, including the ability to continue their current policies. We will offer PPACA-compliant plans for new and renewal business starting on January 1, 2014, and we’ll also allow current customers to renew on any currently offered plan design until October 1, 2014. We will inform customers of the differences between compliant and non-compliant plans. Like any change of significance, there are many important details:

• Small group and individual policy holders covered by Physicians Plus on or before 10/1/13 can renew their policies in 2014, postponing adoption of a PPACA-compliant plan until 2015.

• Small groups and individuals who decided to renew early, effective 12/1/13, may continue these policies and renew early a second time before 10/1/14, effectively continuing their non-PPACA-compliant policies into 2015.

• Those that switched to a 12/1/13 renewal date will remain on that cycle unless they ask us to revert to their original renewal date.

• Small groups and individuals can change plan designs. Changing plans will not impact the ability to renew through 10/1/14.

• Carriers are allowed to update rates for non-complaint plans with effective dates up to 10/1/14. OCI anticipates trend and PPACA fees will be included in these updates, and Physicians Plus is in the process of performing those calculations.

• Some small groups and individuals already received 1/1/14 or later renewals for PPACA-compliant plans, meeting the required 30- or 60-day rate change notification. These groups and individuals have the opportunity to continue their current plan at these 1/1/14 or later renewal dates. OCI views this as a “plan change” which does not have the same notification requirement. We will provide updated rates to those wishing to continue on a non-PPACA-compliant plan.

• There can be no change to PPACA-compliant plans already filed.

• Any small group or individual that renews on a non-PPACA-compliant plan on or after 1/1/14 must be informed by the carrier the ways in which their plan does not meet PPACA mandates and that other options are available.

This is what we know today; certainly there are more details to come. The state’s bulletin outlining this change can be found here: OCI Health Plans Bulletin about non-ACA Compliant Plans Dated 11/21/13.

11/15 Update

On November 14, President Obama announced that he will allow insurers to continue current plan designs through 2014, even if they do not meet all coverage standards outlined by the Patient Protection & Accountable Care Act (PPACA). This is a significant shift in the law (and may still require congressional action). However, this change does not force any extension of coverage, it merely allows it. The final decision on whether to allow or deny current plan continuation (for those otherwise required to switch to a PPACA-compliant plan upon renewal) will be left to each individual state.

Physicians Plus is in regular contact with the state insurance commissioner’s office in an attempt to learn more details about if, how and when this new wrinkle will be implemented in Wisconsin. Accordingly, we are certainly keeping our options open and await further clarification and direction from the state. If the state authorizes Wisconsin insurers to continue current plan designs in 2014, we will act in the best interests of our members and customers.

Visit our web site frequently as we’ll post additional updates as information is available.


As we continue our work understanding the new laws and how to implement applicable changes, we are committed to helping our members, customers and business partners learn what health care reform means to them.


Purchasing Health Insurance in the "Gap Year" 2013:

Tips for Health Insurance Consumers in the 2013 "Gap Year"

Physicians Plus has both a business relationship with eHealthInsurance and their permission to share this article.

Affordable Care Act Fees: What are the fees and what do they mean for you  


Stay informed: links to external agencies providing more detailed information

Federal Resources
Early Retiree Reinsurance Program
Health Insurance Marketplace
Internal Revenue Service
Small Business Health Care Tax Credit: Questions and Answers

State Resources
Wisconsin Office of the Commissioner of Insurance

Trade Associations
American Health Insurance Plans (AHIP)
Wisconsin Association of Health Plans
National Association of Health Underwriters (NAHU)