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Virtus Featured in NBJ - Beware of 'Affordable' Health Access Plans That Promise Too Much

Beware of 'Affordable' Health Access Plans That Promise Too Much

Round 2 of is now front and center before all of us, our employees and their families. The new CEO of Healthcare.govKevin Counihan, recently commented that we are ready to maximize enrollment and make the process simpler. Let's believe him and hope he's right for everyone's sake. However, there is one thing of which all employers need to be mindful.

You have likely been approached by a variety of sources claiming to own the silver bullet to your high-cost claimants. Finally, you think. There's reason to smile, and relief is in sight. Good news like this, and in the same year that the Titans win the Super Bowl. Sadly, I have to write that those are the odds that these solutions are in compliance. Know that I would love to write nothing other but feel obligated to at least inform you.

The 'plans' promise employers a no-risk way to transfer high claimants from the ranks of their self-insured plans over to the public exchange.


  1. High-cost medical and/or prescription drug claimants are identified.
  2. Someone has a conversation with the employee about their high-cost claims and offers alternatives.
  3. The participant can stay on the current plan or go to the public exchange where the employer will reimburse their premium with a tax gross-up.
  4. The participant could then choose a Gold plan on the exchange which may have better benefits that the employer's plan.

Problem: Unfortunately, there are many. To name a few, they violate one or more provisions within the following federal laws: ACA, ERISA, Medicare, HIPAA, IRS Code and/or the ADA. I'm happy to share details if you'd like to call me.

The sad reality is that these plans promise a magical potion to fix every employer's high-cost claims problems and they're simply too good to be true and should be avoided.

Hopefully, one day soon, I'll be writing about a true silver bullet solution.


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