Yearly Archives: 2015

  • The exchanges are working, except for those for whom they are not working…the carriers

    December 30, 2015

    United Health Care is the largest carrier in the country for the moment…and the first one to decide to pull out of the health insurance marketplaces (exchanges). They can’t make money (and they are not the only ones) in a regulated environment and where they have to take even unhealthy individuals on a guaranteed basis or any number of people on group plans when there could easily be a case of adverse selection. Who can make money in this environment? One major carrier is saying they can’t.

  • Agencies Issue Final Rule on Grandfathered Health Plans and Other Initiatives | Petaluma Employee Benefits

    December 29, 2015

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    By Danielle Capilla
    Chief Compliance Officer at United Benefit Advisors

    Capitol Building, Washington DCFederal agencies recently issued a final rule that essentially combined a variety of interim final rules and non-regulatory guidance on a variety of Patient Protection and Affordable Care Act (ACA) initiatives such as grandfathered health plans, preexisting condition exclusions, internal and external appeals, rescission’s of coverage, lifetime and annual limits, emergency care access and dependent coverage. The final rule was very similar to the previous guidance it consolidated. The final rule goes into effect on January 1, 2017. At that time all of the prior interim rules will be superseded.

    The final rule also noted that various transitional rules are now void, such as the allowance of grandfathered health plans to exclude children under age 26 who were eligible for other group health plan coverage, and rules that provided a special enrollment period for children under age 26 who had been excluded from coverage.

    Information on grandfathered health plans is shared below. For more information on the final rules related to pre-existing conditions, lifetime and annual coverage limits, rescission’s, adult children, appeals, designation of a primary care provider and access to emergency care, download UBA’s free ACA Advisor, “Agencies Issue Final Rule on Grandfathered Health Plans and Other Initiatives.”

    The final rule reaffirmed that grandfathered status applies separately with respect to each benefit package. For example, a group health plan with a preferred provider organization (PPO) plan, a point of service (POS) arrangement, and a health maintenance organization (HMO) option would each carry grandfathered status (or not) separately. Requirements for grandfathered status notification remain the same — plans must include a statement that the plan or health insurance coverage believes it is a grandfathered health plan in any summary of benefits provided under the plan. The model disclosure notice remains the same.

    Grandfathered plans have been governed by anti-abuse rules, to prevent plans from maintaining grandfathered status when employees transferred into the plan are from a transferee plan that would have caused the transferor plan to lose grandfathered status if its terms were adopted. There is an exception for bona fide reasons for employee transfers, such as a plan being eliminated by the carrier.

    The final rule noted that a plan that eliminated substantially all benefits needed to diagnose a condition would cause a plan to lose its grandfathered status, but purposefully declined to provide a bright line rule to interpret the requirement. Excessive increases to a single or limited number of copayments would cause a plan to lose grandfathered status, even if the remaining copayments remained the same.

    Plans that add additional tiers (such as individual plus one, individual plus two) will not lose grandfathered status if the contribution rate for the new tiers is not below the previous non-self-only tier by more than five percent. Employers with grandfathered health plans that offer wellness programs should take great caution if the wellness program imposes penalties for failing to meet standards, this could put the plan’s grandfathered status at risk. Finally, grandfathered health plans may move brand-name versions of drugs that become generic to a higher cost-sharing tier.

    For more information on the final rules related to pre-existing conditions, lifetime and annual coverage limits, rescission’s, adult children, appeals, designation of a primary care provider and access to emergency care, download UBA’s free ACA Advisor, “Agencies Issue Final Rule on Grandfathered Health Plans and Other Initiatives

    Read More …

  • Proposed Benefit Payment and Parameters Rule Released | CA Employee Benefits

    December 24, 2015

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    By Danielle Capilla
    Chief Compliance Officer at United Benefit Advisors

    ProposedPaymentFederal agencies have released the proposed rule for the 2017 Benefit Payment and Parameters. Among other items, it provides updates and annual provisions relating to:

    • Risk adjustments, reinsurance, and risk corridors programs
    • Cost-sharing parameters and cost-sharing reductions
    • User fees for Federally-Facilitated Exchanges (FFEs)
    • The standards for open enrollment for the individual market for the 2017 benefit year
    • Updates to the Small Business Health Options Program (SHOP)
    • Definitions of large and small employer
    • Guaranteed availability
    • Medical loss ratio (MLR) program

    The Benefit Payment and Parameters rule is typically finalized in the first quarter of the year following the release of the proposed version. Comments on the proposed rule are due by December 21, 2015 (today).

    The proposed rule would set cost sharing for the 2017 calendar year for self-only coverage at $7,150 and $14,300 for other than self-only coverage. The 2017 open enrollment period would be from November 1, 2016, to January 31, 2017.

    The proposed rule suggests amending the regulatory definitions of “large” and “small” employers to match the definition set by the Protecting Affordable Coverage for Employees Act (PACE Act). The definitions would be revised to define a large employer as one that averages at least 51 employees in the previous year, but states may elect to define large employers as those with 101 or more employees. Similarly, the definition of small employer would change to an employer with an average of at least one but not more than 50 employees on business days during the preceding calendar year. States may elect to define a small employer as one with 100 or fewer employees. The rule would also provide that, for an employer not in existence the preceding calendar year, its size should be determined by its reasonable expectation of the average number of employees during the year.

    Download UBA’s ACA Advisor for additional detail on proposed rules related to:

    • The rating area for a small group plan
    • Availability of small group coverage based on employer contribution or group participation rules
    • Standards of conduct for agents and brokers
    • Special enrollment periods
    • Employer appeals of an employee’s eligibility
    • “Vertical choice” options

    Read More …

  • What’s the cost of a Cadillac? No, they can’t just repeal the tax

    December 23, 2015

    Once everyone finally saw what the Cadillac tax would do, there was predictable outrage. After all, it is outrageous, especially when they set numbers in 2010 that would not take effect until 2018. So there has been huffing and puffing in the past year and Democrats and Republicans alike trying to junk this heap. But they can’t do it easily, as a little recognized aspect of the ACA requires that the money the Cadillac tax was supposed to raise has to be raised somewhere else. No one has any suggestions at this point…

  • Use These Effective Time Management Strategies | Petaluma Benefits Broker

    December 21, 2015

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    by: Merrie C. Weeks

    BUSYIf you desire to have good time management then you need to have a strategy or an action plan. Following these strategies will help you get the most out of your days.

    First thing to do is Prioritize your work.

    Start each day by ranking the things that you much do. Starting with the most important and unpleasant tasks first, then go from there. Those things that can wait for later that day should be listed towards the bottom of your list. Don’t make your list too long because there are only so many hours in a day and you don’t want to feel like you will never get it all accomplished.

    Second thing is to Assign Work Time Frame for each task.

    At first this might not seem realistic but it is mostly so that you will have some sort of idea how long it will take to finish each task. You will find that once you start a task, it won’t really take very long unless it is a big project. If so, then break it down so that you can see some progress.

    Third Be Flexible.

    Unexpected things come up from time to time so if you have to stop to take care of some other matter, do not worry and stress out if you don’t accomplished a certain task in the time frame you set. Just like the saying goes, “Rome wasn’t built in a day” so make sure you allow for those time when things come up. Don’t let these things such as phone calls, important emails,kids and life in general frustrate you, the important thing to remember is that you are making progress on your list.

    Fourth thing is to Say No if it isn’t important.

    Whether you work from home or out of the home there are things that can distract us and waste time. Limit small talk with co-workers, family, friends, etc. while you are working. Respect your decision to make a plan and stick to it. Others will need to understand that if it isn’t something that needs to be taken care of right this minute then it can wait.

    Fifth is to Delegate.

    Remember that you probably can’t do everything yourself so if there is a task that you might not be very good at or like doing and there is someone that can do the task then by all means pass it on. In this way the task will get done and you won’t waste time putting it off because you can’t accomplish it yourself.

    Compromise when necessary.

    As your day progresses the urgency of a task may also change. There may be times when your tasks will need to be re-prioritized, rescheduled, postponed or dropped altogether, making adjustments if things come up that needs your attention is important.

    Everyone has limitations and if you realize what those are then you will know what you can work on later to improve those skills or know in advance what tasks you will need help with.

    Learning to manage your time is not to stress your day so remember to relax and learn as you go. The more you practice managing your time, the better you will get at it. Time management is so that you will take control of your days and see how much you really can accomplish each day and then enjoy some time with family and friends. This is your only viable option no matter where you are working, this is the only way to accomplish anything worthwhile.

    Read More …

  • Negotiating over COBRA Coverage – Use EXTREME CAUTION! | California Benefits Broker

    December 17, 2015

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    By Elizabeth Kay, Compliance & Retention Analyst
    AEIS Advisors
    A UBA Partner Firm

    CautionHave you ever overheard the new employee in the break room, bragging about how good their health insurance was with their previous employer, and how much less expensive it was than the coverage they are currently being offered?

    You may think ”If it was so good, then why give it up?” There are always a number of factors that can lead to someone making a job change, but what happens when COBRA becomes a part of the negotiating process when they are working out the terms of employment with the new company?

    We know that, as of November 2014, the Department of Labor (DOL) made it very clear that an employer cannot pay the premium for an individual plan of an employee or an employee’s dependents, period. If they do, the employer could pay an excise tax of $100 per day they are out of compliance per employee affected. That could be up to $36,500 for ONE employee, for ONE year!

    But what if a prospective employee were coming to work for you, and the plan with their current employer had similar coverage but lower premiums because the employer was a larger company, the employees were in very good health overall and the employer had negotiated very low rates with its carrier as a result, or the employer was based in a different state where health care costs were lower? What if that prospective employee tells you that you could pay their COBRA premiums and pay less premium for them than if they enroll in your plan? Many employers would love to save $500 a month for one employee. But the deal is not nearly as sweet as it sounds, and here’s why.

    While it is not illegal for an employer to pay for COBRA premiums, if it is for a group plan and not an individual plan, it can create other problems with regard to ERISA and COBRA compliance.

    As soon as an employer pays the premium on a pre-tax basis on behalf of an employee for its company policy or another policy, an employer-sponsored plan is created, and is therefore subject to both ERISA and COBRA regulations.

    ERISA requires that the plan sponsor distribute notifications to enrollees of the plan, including a Summary Plan Description, and other documents that contain specific plan details. If the employee’s plan benefits were under another employer’s plan, it may be difficult to get that information and distribute it to your employee.

    Federal COBRA regulation requires that the employee have access to the same coverage for up to 18 months after he or she loses eligibility for the plan due to termination of employment, for example. What happens if the COBRA plan terminates because that previous company goes out of business and its group plan dissolves? Now the current employer is obligated to continue the employee’s coverage, perhaps without a means to do so.

    Or, what if this employee terminates from your company after 12 months? It now becomes your responsibility to provide the employee with 18 months of COBRA coverage, except the employee has already used a portion of his or her COBRA eligibility while under your employment. Since COBRA is an employer obligation, you could be responsible for providing COBRA coverage to an employee who was never enrolled in your company’s group policy in the first place.

    It becomes a sticky mess, indeed!

    On the flip side, what about negotiating an employee’s severance package? If an employee is leaving your company and you are putting together a severance package, be careful when including paying for the employee’s COBRA continuation coverage. Many employers will offer to pay for three, six or 12 months of COBRA premiums on behalf of the terminated employee.

    While this can be done, be careful how you word it in the severance agreement. Most employer sponsored plans are on a 12 month contract. If you make a very general statement saying you will pay to continue the employee’s COBRA coverage at your expense for 12 months, and your premiums skyrocket at renewal, or if you change carriers, and the terminated employee chooses a more expensive plan with richer benefits, you could be on the hook for the increase in premiums.

    If you are clear in the severance agreement about the amount you will commit to pay on the employee’s behalf, or clear about the level of coverage to be provided (platinum, gold, silver, or bronze level plan, for example), then you will be better protected.

    If you are paying COBRA premiums on a tax-exempt basis for a current employee, or you are concerned about a severance agreement that you made with a terminated employee, please seek advice from your ERISA or employment law attorney.

    Read More …

  • They keep amending it, but they cannot kill it…another change in the Affordable Care Act

    December 16, 2015

    Republicans continue to beat their breasts, but there are certain aspects that remain pests, and these keep failing to meet the tests…of credulity and practicability. In the recent Bipartisan Budget Act of 2015, President Obama quietly erased the “auto enrollment” feature that was supposed to help employers, who didn’t want the help. Another one bites the dust…but there are plenty of provisions left

  • Cadillac Tax – Should employers be making changes now? | California Employee Benefits

    December 14, 2015

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    By Elizabeth Kay, Compliance & Retention Analyst
    AEIS Advisors
    A UBA Partner Firm

    ChangeAheadThe Affordable Care Act (ACA) has brought about many changes in employee benefits. Plans have been eliminated, benefits added, rules changed, and rules have been delayed.

    The ACA has always been a heavily debated topic between the Republicans and Democrats, and now that we are coming up to another presidential election we know that we can expect it to be talked about quite a lot.

    Some speculate that the Republicans will attempt to repeal the law, again, but the truth of the matter is that the ACA is bringing in too much revenue for a repeal to be successful. The Congressional Budget Office (CBO) projections there will be $353 billion dollars in revenue from the ACA over the next 10 years.

    This means that in order for the Republicans to be successful in repealing any part of the law that generates revenue, they will need to find a way to replace that lost revenue.

    Looking at the projected cost increases based on its annual Health Plan Survey of over 18,000 health, plans offered by nearly 11,000 employers nationwide, UBA estimates that nearly three out of four U.S. employers will be hit with the Cadillac tax by 2022. With alarm bells sounding, many employers are planning benefit cuts to avoid the tax and, as a result, the CBO actually expects the ACA’s Cadillac tax (and Medical Device Tax) won’t generate the most revenue. Instead they are counting heavily on the second largest source of expected revenue from the ACA: $209 billion dollars from ”other sources.”

    What are ”other sources?” The CBO believes that there will be an increase in income taxes due to employers that reduce employee health plans in order to avoid having to pay the Cadillac tax, and in turn raise their employees’ wages to compensate.

    If this scenario were realistic (although reducing benefits due to the rising cost of premiums without any increase in wages seems to be more realistic), we should see employers begin to modify their plans in anticipation of the Cadillac tax in 2018, and then a significant increase in salaries. But will employers act sooner? If the Cadillac tax were to be repealed by Congress, it would most likely happen in 2017 after the presidential election. The question then becomes when should employers make these changes? Do they make them now, live with the potential for the Cadillac tax to be eliminated, and their payroll will just remain higher? Or do they wait to make those changes until 2017, the year before the tax goes into effect?

    As if another tax were not bad enough, the 2015 UBA Benefits Survey shows that, if some employers were to reduce benefits to avoid the Cadillac tax, they would no longer be able to offer a plan that meets the ACA minimum value requirement. It seems hard to believe that a plan could have premiums that are more than $10,200 annually for one person yet have an actuarial value of only 60 percent. And with the ever-increasing cost of health care, premiums will only continue to rise over the next three years. More and more employers will have to make difficult decisions about their benefit plans.

    There is hope that legislators will add an actuarial value safe harbor into the Cadillac tax provision so that employers who are offering a plan that meets an actuarial value of less than 90 percent will be exempt from the Cadillac tax. Otherwise, an applicable large employer that is subject to the ACA’s “play or pay” rules may have to pay the Cadillac tax, and will also be fined for not offering a plan that meets the minimum value requirements.

    Read UBA’s latest press release for the percentages of employers likely to be subject to the Cadillac tax broken down by actuarial value.

    Download the free 2015 Health Plan Survey Executive Summary for additional information on health plan cost trends across the U.S., including employer contributions and costs for employees.

    To benchmark your plan against others in your region, industry or size bracket, contact a UBA Partner near you to run a custom benchmarking report.

    Read More …

  • More CO OPS fly the coop…continuing failure of an ACA experiment

    December 11, 2015

    Then Arizona and then Michigan, which became the 12th co op failure of the year, which now makes it half of all of these non profits who have failed to provide adequate coverage for a reasonable length of time…at considerable taxpayer cost. As of the end of the third quarter this year, the remaining surviving 11 co ops have lost $200 million, which is triple the losses they reported at the end of June.

  • Holiday Health Check-List: Use It or Lose It | Petaluma Employee Benefits

    December 10, 2015

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    www.newsusa.com

    fsa2016As the end of the year nears, many of us are preoccupied with holiday parties, searching for the perfect gift for loved ones or making lists of things to accomplish before the new year begins. During this busy time, one important task is often forgotten on the to-do list: Make sure to use flexible spending account (FSA) funds before it’s too late.

    Some employers will allow you to roll over $500 of your FSA funds into the next year. However, for those who are not permitted a carryover, these funds must be used by the end of the benefits year, which for most people is Dec.31. Otherwise the funds will be forfeited back to your employer. In fact, each year more than $400 million in tax-free income is wasted when FSA holders don’t spend these funds or fail to submit expenses to be reimbursed.

    That said, it’s not too late to create a health care checklist to keep you and your family on a healthy track during these last few weeks of the year. Here are five ways to ensure you get the most out of your benefits dollars:

    1. Schedule annual check-ups with ALL physicians. Visit important specialists, such as an optometrist, dentist, dermatologist or gynecologist, along with your primary care physician.

    2. Don’t forget about eye care/medical aids. Consider whether you need an additional pair of eyeglasses, contact lenses or even orthotic shoe inserts to help utilize FSA funds.

    3. Consider purchasing low-cost health care items. Stock up on items for year-round and emergency use, such as first-aid kits, contact solution, thermometers, neck/wrist/joint braces, aspirin and other pain relievers.

    4. Ask employers about unique FSA offerings. Find out whether Lasik eye surgery, massages, acupuncture treatments, and other unique procedures or treatments are included in your FSA plans.

    5. Submit receipts. If spending your entire FSA funds still seems unrealistic after any last-minute checkups and first-aid purchases, double-check to make sure you’ve submitted past receipts for eligible out-of-pocket health care purchases so you can be reimbursed.

    “It’s important to review your out-of-pocket expenses from the past year and consider any changes that may occur to gain a better idea of how much to contribute to an FSA in the coming year,” says Matthew Owenby, senior vice president and chief human resources officer at Aflac.

    By creating a list, and checking it twice, you can ensure that you don’t leave money on the table as you prepare for a new year.

    Read More …

  • Overpromising leads to overregulation…which was not “fine” with the carriers

    December 9, 2015

    Due to “unacceptable inaccuracies” in their directories, Blue Shield was hit with a fine of $350,000 and Anthem $250,000. In addition, Blue Shield had to reimburse $38 million to enrollees “who incurred out of network costs” due to inadequate information about the status of their providers. No wonder doctors were confused when patients asked about the lists…

  • 2016 Annual Limits Card Back by Popular Demand | Petaluma Benefits Broker

    December 7, 2015

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    By Bill Olson
    Chief Marketing Officer at United Benefit Advisors

    AnnualLimits

    Many employee benefit limits are automatically adjusted each year for inflation (this is often referred to as an “indexed” limit). UBA offers a quick reference chart showing the 2016 cost of living adjustments for health and Section 125 plans, qualified plans, Social Security/Medicare withholding, compensation amounts and more. This at-a-glance resource is a valuable desk tool for employers and HR practitioners.

    Here’s a snapshot of the 2016 health plan limits; be sure to request the complete chart from a UBA Partner.

    2016BenefitLimits

    Read More …

  • What if they made a recommendation and nobody cared? New mammogram standards

    December 4, 2015

    The American Cancer Society has made new recommendations on the required timing and frequency of mammograms. The new guidelines say that women with an average risk of breast cancer should begin getting annual mammograms at age 45 (was 40), and also that women age 55 and above should cut back to every other year (was every year). Marin doctors disagree…

  • Can Employers Access Current or Prospective Employee Social Media Accounts? | California Employee Benefits Specialist

    December 3, 2015

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    By Bill Olson
    Chief Marketing Officer at United Benefit Advisors

    SocialMediaWe’ve become a very connected society, but that doesn’t mean we want to share everything with everybody. Take, for example, your social media site (e.g., Facebook, Twitter, LinkedIn, etc.). Typically, you have a select network of individuals with whom you want to connect and share your life, thoughts, and opinions. But what happens when a current or prospective employer wants access to your social media account either as a “friend” or by demanding your login and password information?

    In an article on the website of Employee Benefit News titled, “Can employers access an employee’s social media account?,” it outlines how the law is changing in some states and when there’s an exception to request social media access. Some states do not allow an employer to ask an employee to either friend them or give them access to their social media accounts. In addition, there are states that prohibit a company from asking an employee to log in to their social media site while a company representative is present and watching. Furthermore, the laws in some states also have language in them forbidding retaliation against an employee who does not provide his or her social media access. Not all states have laws pertaining to employee rights with social media, but with those that do the law often varies. If a company has employees in multiple states, it needs to be especially careful, which is why it’s always best to consult with an attorney. This blog entry, as well as the website article, should not be taken as legal advice.

    Granted, sometimes an employer has legitimate reasons to want to see what an employee is posting. Examples of these would include when an employee is speaking negatively about the company, using social media to bully or harass another employee, or posting company information that’s proprietary and confidential. Regardless, the employer will need to be careful and consult an attorney before attempting to request or otherwise access an employee’s social media account. Because of these reasons, there are often exceptions built into a state law that allow for internal investigations, violations of company policy, or illegal activities.

    An important point to note is that many of these laws allow companies to review any information that’s publicly available. So if a company is doing a simple Internet search of your name during the hiring process and certain information or photos happen to turn up on a public website, then all that is fair game.

    Read More …

  • When the C-Suite Gets Seriously Sick | CA Benefits Broker

    December 1, 2015

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    By Bill Olson
    Chief Marketing Officer at United Benefit Advisors

    CSuiteSomeone in the C-Suite of a company gets sick. I’m not talking about a cold or flu; I’m talking about a major, possibly even terminal, illness. Depending on the level of severity, what can the human resources department do to help communicate this information properly to the company’s employees?

    There will always be privacy concerns, but there are also requirements with the Securities and Exchange Commission (SEC) that mandate publicly traded companies to disclose information that may impact an investor’s decision to buy or sell stock. A serious illness could be interpreted as something that needs to be reported to the SEC. Other than that, how much information should a C-Suite executive share with HR, when should he or she share it, and should they discuss any plans for a successor – either temporary or permanent? On the HR side, how much of this should they release to the rest of the company?

    Based on an article on Human Resource Executive Online titled, “Disclosing Illness in the C-Suite,” when handled correctly, the disclosure of an executive’s illness can do more than satisfy SEC compliance. It can reassure employees and investors that the company has a plan going forward, it can address important questions, and it can stop the almost certain spread of false rumors.

    Sharing information today is common and rapid, which makes hiding a major illness next to impossible. Rather than letting the company’s rumor mill disclose the information in a way that could be harmful to the executive and his or her family, detrimental to the company, and potentially completely false, it’s better to have it come directly from a company representative. Current examples include Goldman Sachs CEO and Chairman Lloyd Blankfein, who sent a memo to employees and the SEC just one day after his lymphoma diagnosis. Contrast this with Apple CEO Steve Jobs who withheld his cancer diagnosis for an entire year. The latter example is cited as a textbook case of how not to handle this. The “doom and gloom” speculation of what was happening to Jobs was rampant both internally at Apple and with investors.

    This type of speculation almost always leads to decreased employee morale and productivity, which is why HR should communicate information as quickly as possible. That being said, it’s up to the C-Suite executive to determine how much information he or she wants to divulge. The role of HR is to communicate how this is going to impact the company’s daily operations, whether someone will be temporarily assuming those responsibilities, and if the company has a succession plan in place if the executive is not able to return to work.

    Because this type of news can disrupt the operations of a company, HR should continually provide updates and put them in a positive light. As it states in the article, you can’t draft this type of plan, especially a plan of succession, after a critical illness diagnosis is announced. This is something that must be thought of ahead of time in order to avoid the turbulent aspect it can produce. Regardless of this, HR also needs to emphasize the seriousness of the issue and that it must be handled with respect, sensitivity, and professionalism.

    Hopefully, an HR department will never have to deal with this unfortunate experience. Striking a balance between the C-Suite executive’s privacy and everyone else’s need to know may be one of the most difficult things an HR department can face. This is why planning ahead can often provide that level of confidence during this time of corporate instability.

    Read More …

  • How to Reduce Fullness | Petaluma Employee Benefits

    November 27, 2015

    By Serena Styles
    www.livestrong.com

    apple and tapeWhen you eat a large meal, there is about a 20 minute span between when your stomach is full and when your brain recognizes that fact. For 20 minutes, you can continue eating and not realize the feeling of fullness in your stomach. This can result in severe overeating with uncomfortable after effects. Although you cannot take back your indulgence, a few simple remedies help reduce fullness so you can fell better as soon as possible.

    Step 1

    Lie down and place something warm on your stomach for about 10 minutes directly following the meal. A warm water bottle or a heating pad that does not place too much pressure is best. This aids your stomach in digesting the food and often calms the initial discomfort of fullness.

    Step 2

    Take a walk. Although a feeling of fullness creates the desire to continue lying down for hours, gentle exercise helps relax your stomach and ease discomfort. Walking also gives your metabolism a boost, encouraging your body to start using some of the food you ate. Walk slowly and do not push yourself; allow your stroll to be leisurely. Walks as short as five minutes often do the trick, but lengths upward of 20 minutes do no harm to your body.

    Step 3

    Drink a glass of water to aid in digestion. One 8-ounce glass is plenty; drink it slowly so you do not increase the intensity of your fullness feeling. Some individuals find greater relief from drinking carbonated water, or water with 1 teaspoon of baking soda mixed in. However, no scientific research definitively supports this claim. In addition, many individuals enjoy a drop of peppermint extract in their water or opt for peppermint tea instead. The peppermint is reputed to settle a full stomach.

    Step 4

    Engage in light stretching to relax your abdominal muscles and relieve discomfort. Reaching your hands over your head and bending back slightly from a standing position elongates your stomach. In addition, trunk twists stretch your obliques, the muscles alongside your stomach, aiding in further relief. Stretch for two to five minutes and never push your muscles to the point of pain.

    Step 5

    Take an over-the-counter antacid medication to lessen the chance of discomfort later. One dose reduces bloating that commonly follows uncomfortable fullness. Follow the package instructions and take only as much as necessary to relieve your symptoms.

    Step 6

    Consume fiber-rich foods such as legumes, oat bran, berries, whole grains, green vegetables, nuts and potatoes. The fiber helps regulate your digestive system, keeping things moving after overeating. Continue eating fibrous foods for about two days after the fullness feeling; if your system gets backed up, you will experience a second bout of discomfort.

    Tips

    Avoid overeating in the future by drinking at least two 8-ounce glasses of water 10 to 15 minutes before your meal. This triggers your mind to know when you are full earlier in your meal. In addition, chew your food slowly and try to be the last one to finish eating at the table. This ensures you give your body enough time to let you know when your stomach is full.

    Read More …

  • Ways to increase Employee Participation in a Wellness Program | Petaluma Benefits Broker

    November 24, 2015

    Finding different ways to increase employee participation in a wellness program is challenging. Without a majority participation rate, your wellness goals are probably not going to accomplish your ideal employee health target. Please review this short video highlighting some of the strategies that you could implement in your wellness program.

  • UBA Health Plan Survey: Plans Popular with Employers Aren’t Always Tops with Employees | California Employee Benefits

    November 19, 2015

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    blueface

    The UBA Health Plan Survey tracks plans offered by region as well as enrollment by region. From a prevalence perspective, preferred provider organization (PPO) plans are most prevalent in the Central U.S., though they generally dominate nationwide, except in the Northeast where consumer-directed health plans (CDHPs) are most prevalent.

    SurveyImage1

    From an enrollment perspective, PPO plans have the greatest enrollment in the Central U.S. The Southeast and Northeast saw the biggest increase in PPO enrollment (7% and 8% respectively) this year. Enrollment in health maintenance organizations (HMOs) is down across most of the country, but is on the rise in the Central and Western U.S. Point of service (POS) plan enrollment has stayed virtually flat from last year. CDHP enrollment is highest in the Northeast U.S. at 29.2%, an increase of 11.5% over 2014. But the Southeast saw nearly a 23% increase in CDHP enrollment from 2014. Conversely, the North Central U.S. saw a 23.5% decrease in CDHP enrollment.

    SurveyImage2

    Sometimes, plans offered by employers are also equally desired by employees; in other words, what is offered most is also what employees opt to enroll in the most. For example, CDHPs and PPO plans are the most prevalent plans in the Northeast and also the top two plans employees enroll in. But it is interesting to note that those employees flip the order of their preference, favoring PPO plans more than CDHPs, while CDHPs are most popular among employers. Employers and employees in the Southeast, North Central and Central states mostly see eye-to-eye when prioritizing PPO plans, followed by CDHP plans as a distant second. In the West, employees enroll in PPO plans at a far greater rate than the prevalence rate of these plans among employers.

    This information can be very helpful when choosing your plan offerings. Download the free 2016 Health Plan Survey Executive Summary for additional information on health plan cost trends across the U.S., including employer contributions and costs for employees.

    To benchmark your plan against others in your region, industry or size bracket, contact a UBA Partner near you to run a custom benchmarking report.

    Read More …

  • New codes cause headaches – what was wrong with ICD9? Is the new ICD10 better?

    November 18, 2015

    Logistical nightmares. Carrier non cooperation. Electronic Medical Records. What else can we throw at doctors to make them wish they never wend to med school? A new code book.   As one article put it, “the codes cover everything from parrot bites to getting sucked into a jet engine.” The cost to change systems and adapt to the new ICD10 code book is estimated to be over $3 billion. For example, there are 25 codes just for diabetes. So if your doctor is asking more questions, and there are delays in your insurance payment…you can thank the newest and best method for reporting.

  • CMS Provides Clarity on PACE Act Implications for States | California Benefits Broker

    November 17, 2015

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    By Danielle Capilla
    Chief Compliance Officer at United Benefit Advisors

    CMSClarityThe Providing Affordable Coverage for Employees (PACE) Act amended the Patient Protection and Affordable Care Act (ACA) and redefined small employers as those with 50 or fewer employees; it also gives states the option to expand the definition to include employers with up to 100 employees (or, practically speaking, those with 51 to 100 employees, also called “mid-size employers”). Prior to the ACA, all states defined small employers as those with 1 to 50 or 2 to 50 employees; however, many have passed legislation redefining the group size up to 100 employees beginning in 2016. States are now in the process of determining what they define as “small employer.”

    The Centers for Medicare & Medicaid Services (CMS), in response to the PACE Act, issued an FAQ on the impact of the PACE Act on small group expansion. CMS clarified that states that choose to expand the definition up to 100 employees beginning January 1, 2016, were required to notify CMS of the decision by October 1, 2015. States with other effective dates should notify CMS of the decisions as soon as is practical. A state’s definition is legally binding on health insurance issuers.

    Regarding rate filings by the carriers, the FAQ stated that states with a state-based Small Business Health Options Program (SHOP) that do not rely on the federal platform have the discretion, consistent with state law and regulations, to allow resubmission of small group coverage rate filings, including changes to rates for the first quarter of 2016. Technical constraints will prohibit carriers to change rate filings for the first quarter in states that utilize a federally-facilitated (FF) SHOP or a state-based SHOP using the federal platform. Rates may be adjusted effective April 1, 2016.

    On November 1, 2015, the beginning of open enrollment for 2016 coverage, all FF-SHOP eligibility screens on HealthCare.gov will ask employers if they have 1 to 50 employees for purposes of SHOP eligibility. CMS is working to update these screens as quickly as possible in applicable states.

    The PACE Act will not affect counting methodologies used by SHOPs in relation to employer shared responsibility, medical loss ratio (MLR) calculations, risk adjustment or risk corridors. The definition of a small employer for purposes of MLR, risk corridors, and risk adjustment will follow the state definition. Reporting for those programs during a transition in the state definition of small employer in the applicable reporting year should align with the policy issued to the employer, regardless of actual employer size.

    For more information on the PACE Act, download UBA’s ACA Advisor, “PACE Act Passes House, Senate.

    For comprehensive benchmarking information on health care costs among employers with 51 to 100 employees—including the rate outlook now that PACE has passed and community rating may be avoided for these groups—download UBA’s 2015 Health Plan Survey Executive Summary.

    Read More …

  • DOL Issues FAQ on Mental Health Parity and ACA Market Reform Provisions | CA Employee Benefits

    November 12, 2015

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    By Danielle Capilla
    Chief Compliance Officer at United Benefit Advisors

    QuestionMarkThe Department of Labor (DOL) recently provided an informational FAQ relating to the Mental Health Parity and Addiction Equity Act (MHPAEA) and Patient Protection and Affordable Care Act (ACA) market reform provisions. Non-grandfathered group health plans and individual or group market health insurance must cover a variety of preventive services without any cost-sharing requirements. Required preventive services include “breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies,” obesity screening and weight management services for certain individuals, colonoscopies for certain age groups, and contraception coverage for women.

    Lactation Counseling

    The FAQ clarified that plans and issuers are required to provide a list of lactation counseling providers within the network. The plan’s Summary of Benefits and Coverage (SBC) should include an Internet address or other contact information so a beneficiary may be able to obtain a list of network providers. Further, plans subject to ERISA must ensure that provider network information accompany the Summary Plan Description (SPD). Similar obligations exist for issuers of qualified health plans and the ACA’s Marketplace plans and SHOP plans.

    If a plan does not have in-network lactation counseling providers, the plan may not impose cost sharing for lactation counseling services obtained out of network. If a state does not license lactation counselors and plans require providers to be licensed by the state, and the service could not be provided in the scope of another type of provider license (such as a registered nurse), the plan will have to provide coverage for the services without cost sharing. Plans may not limit lactation counseling services without cost sharing to an inpatient basis. Coverage for lactation support services must extend for the duration of breastfeeding. Plans may not require individuals to obtain equipment within a specified time period, such as within six months of delivery, in order for it to be covered without cost sharing.

    Obesity Screening and Interventions

    The FAQ clarified that non-grandfathered group health plans and issuers must cover, without cost sharing, screening for obesity in adults. In addition, federal guidelines recommend that, for an adult patient with a body mass index of 30 or higher, intensive multicomponent behavior interventions should be provided. Plans and issuers may use reasonable medical management techniques to determine the scope of such services, but may not impose general exclusions on those services which can encompass group and individual high intensity sessions, behavior management activities, and others.

    Colonoscopies

    Plans may not impose cost sharing for the required specialist consultation prior to colonoscopy screenings, if a provider determines the pre-procedure consultation is medically appropriate. Furthermore, pathology exams on a polyp biopsy from a colonoscopy performed as a preventive service must be covered without cost sharing.

    Contraception Coverage Accommodations for Self-Funded Plans

    Qualifying non-profit or closely held for-profit employers with an ERISA-covered self-insured plan have two methods for obtaining their religious accommodation in relation to the objection to provide coverage of contraceptive services. They may either complete EBSA Form 700 or provide a letter to the Department of Health and Human Services. The DOL will use either method to notify the plan’s third party administrator (TPA) so the TPA may provide coverage for contraception separately.

    BRCA Testing

    The DOL has previously provided FAQs regarding BRCA testing (relating to breast cancer susceptibility) requirements. The DOL now clarifies that women found to be at increased risk for breast cancer, using a screening tool designed to identify family history that may be associated with an increased risk of having a potentially harmful gene mutation, must receive coverage, without cost sharing, to test for BRCA mutations.

    Wellness Programs

    The FAQ clarified that wellness programs with non-financial or in-kind incentives, such as gift cards, thermoses and sports gear, for wellness program participants that satisfy a standard relating to a health factor are subject to federal wellness program regulations.

    Mental Health Parity

    The MHPAEA amended various laws and regulations to provide increased parity between mental health and substance use disorder benefits and medical/surgical benefits. Generally financial requirements such as coinsurance and copays and treatment limitations for mental health and substance use disorder benefits cannot be more restrictive than requirements for medical and surgical benefits. Regulations also provide that a plan or issuer may not impose a nonquantitative treatment limitation (NQTL) unless it is comparable and no more stringent than limitations on medical and surgical benefits in the same classification.

    The FAQ provided that any criteria for making medical necessity determinations, as well as processes, strategies, evidentiary standards, or other factors used in developing NQTLs and applying them must be disclosed for both mental health and substance use disorder benefits and medical and surgical benefits, regardless of assertions that the information is proprietary or has commercial value. Furthermore, although group health plans are not required to provide a summary description of medical necessity criteria that is written to be understandable for a layperson, they may do so. It is not, however, a substitute for providing the underlying criteria if the documents are requested.

    Read More …

  • Market not cooperating with COOPs – Obamacare premise is short on promise

    November 11, 2015

    First there were the rumblings of trouble, and then the floodgates opened and tax dollars are no longer working the way in which they were intended. The Affordable Care Act offered the promise of increased competition with insurance carriers, by creating CO OPs on a non profit basis. Unfortunately, the “non” was the operative word, and now almost all of them are shutting down. The list is long, the end was sudden for 9 of the 23 created, for a total loss to the federal government of $900 million: Oregon, Colorado, Nevada, Louisiana, Tennessee, Kentucky, South Carolina, Utah and New York in a period of two months.

  • Reporting and Plan Documents Under ERISA and Cafeteria Plan Rules | Petaluma Employee Benefits

    November 5, 2015

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    By Danielle Capilla

    Chief Compliance Officer at United Benefit Advisors

    CafeteriaLineThe Employee Retirement Income Security Act (ERISA) was signed in 1974. The U.S. Department of Labor (DOL) is the agency responsible for administering and enforcing this law. For many years, most of ERISA’s requirements applied to pension plans. However, in recent years that has changed, and group plans (called “welfare benefit plans” by ERISA and the DOL) now must meet a number of requirements.

    Generally, ERISA applies to:

    • Health insurance – medical, dental, vision, prescription drug, health reimbursement arrangements (HRAs) and health flexible spending accounts (FSAs) (Health savings accounts are not governed by ERISA but the related high deductible health plan is.)
    • Group life insurance
    • Disability income or salary continuance unless paid entirely by the employer from its general assets
    • Severance pay
    • Funded vacation benefits, apprenticeship or other training programs, day care centers, scholarship funds, and prepaid legal services
    • Any benefit described in section 302(c) of the Labor Management Relations Act (other than pensions on retirement or death)

    Cafeteria plans, or plans governed by IRS Code Section 125, allow employers to help employees pay for expenses such as health insurance with pre-tax dollars. Employees are given a choice between a taxable benefit (cash) and two or more specified pre-tax qualified benefits, for example, health insurance. Employees are given the opportunity to select the benefits they want, just like an individual standing in the cafeteria line at lunch.

    Cafeteria plans are not ERISA plans, but many of the components benefit plans offered through a cafeteria plan are subject to ERISA. This is because a cafeteria plan serves as a vehicle for employees to elect benefits and pay for them. This can create confusion for plan sponsors when they determine what ERISA obligations they have in relation to their cafeteria plan, as well as to their individual offerings.

    Only certain benefits can be offered through a cafeteria plan and not all benefits offered under a cafeteria plan can or will be subject to ERISA. Employers should take care to understand the distinctions and interplay between ERISA requirements and cafeteria plan requirements. Request UBA’s ACA Advisor, “Reporting and Plan Documents Under ERISA and Cafeteria Plan Rules” for comprehensive information on reporting, Form 5500, and requirements for plan documents.

    Read More …

  • Happy Halloween …! | Petaluma Benefits Broker

    November 2, 2015

    …or is it????

    candyDid you get to go out and trick or treat with your family over the weekend or were you one of the smart ones that stayed home and gave it out instead??? It doesn’t take a brain surgeon (or any doctor for that matter) to tell you that kids just LOVE candy. But did you know that as Americans, we eat almost 7 tablespoons on average of the stuff everyday! Sugar is hidden in a variety of different formats, such as sucrose, dextrose, or glucose, but almost all of it provides the empty calories that can be the fast track gateway to diabetes, heart disease, and arthritis. But there is an easy solution – simply try to eat less of it. Even the smallest change can and will make a difference to your overall health.

    So think about your dentist’s offer to buy back your Halloween candy, (some offer up to a dollar for every pound of candy you bring in!) and try fooling your sweet tooth with one of these healthy snack alternatives instead:

    • Fresh fruit
    • Yogurt
    • Homemade frozen Popsicle’s
    • Baked apples
    • Homemade Fruit smoothies
    • Nuts and seeds
    • Celery with peanut butter
    • Raw carrot sticks, cucumber slices, green pepper wedges (or any fresh vegetables, for that matter) served with a small amount of yoghurt based dip or hummus

    and of course, please always remember to brush your teeth or swish with water after you indulge – your dentist will love you for it.

  • It works in California – except where it doesn’t – the fix is in

    October 28, 2015

    According to the Associated Press, California’s health insurance exchange (Covered California) is “still sluggish when it comes to resolving customer service problems, leaving many people unable to access health care or finalize their tax returns” according to the Health Consumer Alliance. The problem, of course, is that problems there also redound to the carriers on the other side. So if you didn’t like carriers, now you have to deal with two levels you don’t like.

  • Cafeteria Plans: How to Handle Participant Contributions | CA Employee Benefits

    October 22, 2015

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    By Danielle Capilla
    Chief Compliance Officer at United Benefit Advisors

    CafeteriaCafeteria plans, or plans governed by IRS Code Section 125, allow employees to pay for expenses such as health insurance with pre-tax dollars. Employees are given a choice between a taxable benefit (cash) and specified pre-tax qualified benefits, for example, health insurance. Employees are given the opportunity to select the benefits they want, just like an individual standing in the cafeteria line at lunch.

    Only certain benefits can be offered through a cafeteria plan:

    1. Coverage under an accident or health plan (which can include traditional health insurance, health maintenance organizations (HMOs), self-insured medical reimbursement plans, dental, vision, and more)
    2. Dependent care assistance benefits or DCAPs
    3. Group term life insurance
    4. Paid time off, which allows employees the opportunity to buy or sell paid time off days
    5. 401(k) contributions
    6. Adoption assistance benefits
    7. Health savings accounts or HSAs under IRS Code Section 223

    Some employers want to offer other benefits through a cafeteria plan, but this is prohibited. Benefits that you cannot offer through a cafeteria plan include scholarships, group term life insurance for non-employees, transportation and other fringe benefits, long-term care, and health reimbursement arrangements (unless very specific rules are met by providing one in conjunction with a high deductible health plan). Benefits that defer compensation are also prohibited under cafeteria plan rules.

    Cafeteria plans as a whole are not subject to ERISA, but all or some of the underlying benefits or components under the plan can be. The Patient Protection and Affordable Care Act (ACA) has also affected aspects of cafeteria plan administration.

    Employees are allowed to choose the benefits they want by making elections. Only the employee can make elections, but they can make choices that cover other individuals such as spouses or dependents. Employees must be considered eligible by the plan to make elections. Elections, with an exception for new hires, must be prospective. Cafeteria plan selections are considered irrevocable and cannot be changed during the plan year, unless a permitted change in status occurs. There is an exception for mandatory two-year elections relating to dental or vision plans that meet certain requirements. Participants may only make election changes based on IRS provided changes in status, or certain triggering events as contained in the Health Insurance Portability and Accountability Act (HIPAA).

    For all the best practices regarding participant contributions, including when participants are unable to pay their required contribution, request UBA’s new ACA Advisor, “Cafeteria Plans: Participant Contributions.

    To benchmark your health plan against others in your industry, region, and group size, be sure to pre-order the 2015 Health Plan Survey Executive Summary to get the most up to date information on premiums, employee/employer contributions, plan design trends and more.

    Read More …

  • Exchange Success – More people are needed

    October 21, 2015

    There are reports that they are enrolling enough to ensure their success – a recent report shows that the Obama Administration will now need “more than double the number…to reach 21 million next year, the target set in budget projections” per the Washington Times. This while Republicans are still threatening to overthrow the law, but also while the Supreme Court has officially sanctioned it. So who will win…and lose…going forward?

  • Americans Prefer Cleaning Toilets Over Researching Health Benefits | CA Benefits Broker

    October 20, 2015

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    www.newsusa.com

    springcleanWhen it comes to choosing the right health insurance plan, American workers are not spending much time researching the best options for themselves or their families. Even though the terms of health insurance policies can change year over year, 56 percent say they devoted less than 30 minutes to researching their benefits options during their last open enrollment, according to the 2015 Aflac Open Enrollment Survey.

    In fact, many workers would rather be doing almost anything other than researching their health benefits. The survey found that more than a third (38 percent) would rather clean out their email inboxes, 23 percent would rather clean their toilets and 18 percent would rather do their taxes.

    Despite the shift to more consumer-directed health care, U.S. workers are in denial about the financial consequences resulting from their health insurance choices. This is concerning, given that an Aflac study found more than half (52 percent) of workers have less than $1,000 on hand to pay out-of-pocket medical costs associated with unexpected serious illness or injury. And 42 percent waste up to $750 annually with mistakes made during open enrollment with insurance benefits.

    Employees need to weigh not only the monthly cost of insurance plans, but also the amount of the total cost of their health care that they will be responsible for.

    Here are four tips to help employees choose the right benefits and protect their wallets:

    1. Review and compare benefits information. Be aware of annual insurance policy changes to avoid costly mistakes.

    2. Understand the financial implications your choices have on your budget. Calculate yearly medical expenses, like deductible costs and monthly premiums.

    3. Consider adding voluntary insurance for more financial protection. Accident, critical illness and hospital policies help cover what major medical insurance doesn’t, such as out-of-pocket costs and other expenses that continue to roll in even if you’re too ill or injured to work.

    4. Seek advice from HR or insurance consultants to help understand your benefits coverage.

    Read More …

  • Medicare becomes Mediscare – some seniors will pay a lot more next year

    October 14, 2015

    This is where the pendulum shifts unpredictably – Social Security cost of living increases will not occur in 2016 which should affect roughly 70% of those on Medicare. They will be “held harmless” and will not face an increase in their Medicare Part B premiums. The rest? They will have to make up the difference between what inflation is forecast and what the 70% don’t pay. This will result, according to the government, in increases as much as 52%:

     

    Income
    Single <$85,000 $85-$107,000 $107-$160,000 $160-$214,000 >$214,000
    Married  <$170,000  $170-$214,000  $214-$320,000  $320-$428,000  >$428,000
    2015  $104.90  $146.90  $209.80  $272.70  $335.70
    2016  $159.30  $223.00  $318.60  $414.20  $509.80

  • Zen Battles – whose ego is involved in this

    October 7, 2015

    Zen Payroll was one of three main payroll purveyors to Zenefits – now that is over Zen Payroll is now Gusto and have a healthy appetite for competition They are now in the benefits game – and Zenefits has said they are in the payroll game (while not saying it at the same time), even as they are sued and countersuing ADP

  • Don’t Let Spooky Pests Haunt Your Home This Fall | Arrow Benefits Group

    October 5, 2015

    www.newsusa.com

    SpookyPestsWith Halloween and cooler weather right around the corner, sightings of creepy creatures indoors are sure to be on the rise as they search for cozy places to hole up for the winter. Rats, bats and spiders are the stuff nightmares are made of, and for good reason; these creepy critters are capable of spreading disease, and incurring serious harm to people, and even causing property damage.

    The National Pest Management Association (NPMA) offers the following guide on three common, creepy fall invaders, along with a few tips for preventing your home from turning into a true haunted house!

    Rats

    These primarily nocturnal pests are known to gnaw through almost anything to obtain food or water, including plastic or lead pipes. Rats are able to fit through an opening the size of a quarter, and once inside they are capable of spreading diseases such as plague, jaundice, rat-bite fever, trichinosis and salmonellosis.

    Tip: Before bringing decorations out of storage and into the home, inspect all boxes for signs of infestation such as gnaw marks and rodent droppings. When it’s time to put away decorations, store them in a plastic, sealed box to keep rodents out.

    Bats

    Bats are frequently associated with vampires and haunted houses, causing an unfounded fear in many people. However, it is important to note that bats are common carriers of rabies, a disease that can be fatal in humans, and their droppings can lead to histoplasmosis, a lung disease.

    Tip: Screen attic vents and openings to chimneys, and install door sweeps this fall to keep bats out of the home. If an active bat infestation is suspected, it is important to contact a licensed pest control professional because bats are protected by law in most states.

    Spiders

    While most spiders that invade homes are simply an annoyance, albeit a creepy one, the brown recluse and black widow spiders will bite when threatened and can cause painful — possibly fatal — reactions. Prompt medical attention is required if you’ve come into contact with one of these venomous spiders.

    Tip: Avoid coming in to contact with spiders by keeping garages, attics and basements clean and clutter-free. Be sure to wear heavy gloves when moving items that have been in storage, such as Halloween decorations.

    For more information on preventing pests this fall, please visit www.pestworld.org.

    Read More …

  • How to Get Employees’ Attention during Open Enrollment | Arrow Benefits Group

    October 2, 2015

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    By Matthew Augustine, GPHR, REBC
    CEO of Hanna Global Solutions, a UBA Partner Firm

    EmployeeAttentionIt’s that time of the year – open enrollment season is here! Insurance carriers are presenting renewals and brokers are presenting ways to alleviate the cost pressure with innovative cost management strategies. HR and benefits professionals are under pressure to think out of the box and come up with new and improved benefit programs to engage employees. Benefits administration companies are busy getting staffed, trained and ready for long hours and last-minute client decisions. And employees are getting ready for the barrage of benefits-related communications that are coming their way.

    Are employees really looking forward to this?

    My daughter was recently hired by a global pharmaceutical company and had to complete her benefits enrollment online. She was definitely was not looking forward to this part of her onboarding process. For her, it was one of those necessary ”to do” items that had to be checked off, and the less time it took, with the least bit of engagement or attention required from her, the better. That is, until I intervened and pointed out the possibility of higher costs and money being left on the table if she ignored some of the attractive benefit programs.

    Employees comparison shop for other purchases, so why aren’t they curious about the price differences between plans and ways they could save money with the right choices? HR and benefits professionals have been looking for better ways to engage employees in the enrollment process for many years, especially as costs have escalated, and employers have had to scale back their share of costs.

    Online enrollment systems with attractive presentations of benefit programs and ”engaging” user experiences in enrollment are one method. Forcing employees to select from a portfolio of plans using a combination of their own and employer money is another way. Add to all this a big dose of communications, both in print and online, that attempt to educate employees on their benefit options.

    Within a couple of months of her starting her job, my daughter received an award for her contribution to work on a project. The reward was in the form of points that she could redeem for items offered on a rewards website. She was much more interested in browsing the ”stuff” that she could get with her rewards, or with rewards she could earn in future, than in browsing for something as important as insurance coverage.

    Maybe a creative blend of shopping for rewards and shopping for insurance and other traditional employee benefits is what we need to get employees engaged in benefits enrollment. Many employers already offer enrollment rewards – gift cards for attending an open enrollment meeting, credits for completing a health risk assessment, and other such ideas. The next step is to integrate the benefits enrollment process with the employee reward program in a seamless experience, using one portal for comparing and enrolling in benefit plans, and offering payroll deduction options for purchases made with reward points.

    With added reward products and programs on the shelves, employee benefits enrollment systems will become online marketplaces that attract employees to shop there.

    Learn more about UBA’s online private insurance exchange platforms.

    For information on how your health plan stacks up against other employers, pre-order the 2015 Health Plan Executive Summary, which highlights the latest findings of the UBA survey, the largest health plan cost survey in the industry.

    Read More …

  • Attention Shoppers – California joins the crowd of web sites to help you figure medical costs

    September 30, 2015

    The Department of Insurance, fulfilling their promise of providing consumers meaningful information, have launched a new web site in conjunction with UCSF to provide quality ratings and other information about area physicians and hospitals – www.cahealthcarecompare.org
    This is not the only site to provide valuable information. Others include Hospital Compare from the Centers for Medicare and Medicaid Services and, in California, www.calqualitycare.org and new entrants include the Health Care Blue Book and Price Check

  • IRS Proposes Minimum Value Rule Change to Mesh IRS and HHS Rules | CA Benefits Broker

    September 29, 2015

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    Posted by Danielle Capilla

    ChangesAheadBeginning in 2015, under the Patient Protection and Affordable Care Act (ACA), large employers must offer affordable, minimum value coverage to their full-time employees or potentially pay a penalty. Some companies have or had been marketing a plan that they state satisfies the minimum value requirement (an actuarial value of 60 percent), based upon a calculator provided by the Department of Health and Human Services (HHS), even though the plan does not cover inpatient hospital charges. New information provided by the IRS and HHS in 2014 and recently in 2015 should be considered as employers review their benefit offerings.

    What’s the practical impact? Employers that are subject to play or pay requirements of providing minimum essential and affordable, minimum value coverage should ensure that the plans they are offering provide substantial coverage of inpatient hospitalization and physician services. If they do not, their employees will be eligible for a premium tax credit to subsidize the cost of health insurance.

    An employee who was offered an employer plan that was minimum essential, affordable coverage, and offered (in addition to meeting actuarial value standards) substantial inpatient and physician services, would not be eligible for the premium tax credit if the acceptable employer coverage began on or after November 3, 2014.

    Employers who offer affordable, minimum essential coverage that meets actuarial value but does not offer substantial inpatient and physician services will be subject to the play or pay penalty for plan years beginning on or after March 1, 2015, unless they meet the exception requirements relating to the inpatient and physician services.

    For a complete review of the changes, including when the exception can be used and the most recent 2015 changes, download UBA’s ACA Advisor, “IRS Proposes Minimum Value Rule Change to Mesh IRS and HHS Rules”.

    Read More …

  • 2015 UBA Health Plan Survey: Preliminary Findings Are Out! | CA Benefits Broker

    September 24, 2015

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    newsflash

    By Bill Olson
    Chief Marketing Officer at United Benefit Advisors

    UBA’s annual Health Plan Survey, the largest of its kind, provides data on 10,804 employers sponsoring 18,186 health plans. While the full findings will be released soon, preliminary data on average health plan costs, premiums, and contributions is now available.

    The average annual health plan cost per employee for all plans in 2015 is $9,736, a 2.4 percent increase from the previous year; employees picked up $3,333 of that cost, while employers covering the balance of $6,403.

    2015SurveyResults

    The average premium for all employer-sponsored plans was $509 for single coverage and $1,211 for family coverage.

    20.6 percent of all plans required no employee contribution for single coverage (a 5.1 percent decrease since 2014), and 7.3 percent required no contribution for family coverage (a 3.9 percent decrease since 2014).

    For plans requiring contributions, employees contributed an average of $140 for single coverage and $540 for family coverage, which is only a slight increase from 2014 results – 3.7 percent and 5.5 percent respectively.

    Employer Coverage

    Among all employers surveyed, more than half (53.7 percent) offer only one health plan choice to employees, with 28.7 percent offering two choices. As far as plan choices, preferred provider organizations (PPOs) continue to dominate the market (46.8 percent of plans offered and 54.8 percent of employees enrolled), and health maintenance organization (HMO) plans continue to decrease, as they’ve done since 2012 when they accounted for 19.1 percent of the market but now account for only 17.3 percent. Consumer-directed health plans (CDHPs) continue to show the greatest increase in growth, up 10 percent from 2012 through 2015.

    Most employers (72.5 percent) define full time work as 30 hours per week, and 7.6 percent define it as 40 hours per week. Only 9.9 percent of employers require fewer than 30 hours per week.

    Read UBA’s full press release announcing the initial findings.

    Pre-order a copy of the 2015 UBA Health Plan Survey Executive Summary which will be published soon with comprehensive data.

    Read More …

  • Cadillac Tax | California Benefits Broker

    September 21, 2015

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    Investigate how your employer is going to address the Cadillac Tax issue!

    A quick and easy to follow video which highlights the financial implications of the new excise tax and what you should be aware of now. This video (from a blog post on www.accountingaccidentally.com) has been written from the accounting view and not the insurance view, and as such gives you a few more things to think about. This “Cadillac” excise tax is eventually going to affect us all and the more aware and informed we are – the more prepared we will be.

    YouTube

    AccAccIf you would like to view the blog post directly, please click here.

  • Affordable Care Act Information Returns | California Employee Benefits

    September 17, 2015

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    By Danielle Capilla
    Chief Compliance Officer at United Benefit Advisors

    FinancialPaperworkUnder the Patient Protection and Affordable Care Act (ACA), individuals are required to have health insurance while applicable large employers (ALEs) are required to offer health benefits to their full-time employees. In order for the Internal Revenue Service (IRS) to verify that (1) individuals have the required minimum essential coverage, (2) individuals who request premium tax credits are entitled to them, and (3) ALEs are meeting their shared responsibility (play or pay) obligations, employers with 50 or more full-time or full-time equivalent employees and insurers will be required to report on the health coverage they offer. (If ALEs are not offering coverage, they will have to report on that, too).

    Reporting will first be due early in 2016, based on coverage in 2015. All reporting will be for the calendar year, even for non-calendar year plans. Mid-size employers (those with 50 to 99 employees) will report in 2016, despite being in a period of transition relief in regard to having to offer coverage. The reporting requirements are in Sections 6055 and 6056 of the ACA. Sections 6055 and 6056 reporting is done on IRS Forms 1094-C, 1095-C, 1094-B, and 1095-B.

    For calendar year 2015, the required forms must be filed by February 29, 2016, or March 31, 2016, if filing electronically. Employers with 250 or more 1095 Forms must file electronically with the “Affordable Care Act Information Returns” or AIR. The IRS is encouraging all entities to file electronically. Employers utilizing a vendor service should confirm that the service they are using can handle the act of reporting, electronic or otherwise. Employers using a vendor should confirm that their chosen vendor is set up to file the returns for them, and have or will have successfully completed the testing phase. Employers who wish to use a vendor instead of filing themselves should be aware that many of the reporting vendors have a capped amount of clients they can assist.

    Employers who are doing their own electronic filing should ensure they are ready to use the AIR system. Being ready to use the system is a time-consuming process; ample time should be given to ensure an employer is up and running.

    For detailed information on the steps employers should follow to use AIR, download UBA’s ACA Advisor, “Affordable Care Act Information Returns”

    Read More …

  • Arrow Wins Best Places to Work 2015!

    September 17, 2015

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    We are proud to announce that we have won North Bay’s Best Place to Work award from our community and team nominations. This is especially important to us because the criteria for the award is also based on individual independent rankings from our own team members. We look forward to continuing our commitment to our community by serving those in it to our very best. Thank you team Arrow!

  • Arrow Benefits Group just featured in North Bay Biz Magazine article – Health Care Check-up

    September 15, 2015

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    Arrow team members just interviewed and featured in an article about healthcare and the affordable healthcare act. “The business of making health care available and affordable to all Americans is a laudable—but complicated—task. The main issue, these days, is how to make the Affordable Care Act (ACA) work in tandem with employer plans; it’s a puzzle that’s leaving everyone overwhelmed by the administrative burden and worried about the cost of premiums.”

    Read entire article here…

  • IRS Releases Draft 2015 Instructions for 6055/6056 Reporting | Petaluma Employee Benefits

    September 14, 2015

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    By Danielle Capilla
    Chief Compliance Officer at United Benefit Advisors

    IRSUnder the Patient Protection and Affordable Care Act (ACA), individuals are required to have health insurance while applicable large employers (ALEs) are required to offer health benefits to their full-time employees. In order for the Internal Revenue Service (IRS) to verify that (1) individuals have the required minimum essential coverage, (2) individuals who request premium tax credits are entitled to them, and (3) ALEs are meeting their shared responsibility (play or pay) obligations, employers with 50 or more full-time or full-time equivalent employees and insurers will be required to report on the health coverage they offer. Reporting will first be due early in 2016, based on coverage in 2015. All reporting will be for the calendar year, even for non-calendar year plans. Mid-size employers (those with 50 to 99 employees) will report in 2016, despite being in a period of transition relief in regard to having to offer coverage. The reporting requirements are in Sections 6055 and 6056 of the ACA. Draft instructions for both the 1094-B and 1095-B and the 1094-C and 1095-C were released in August 2015.

    Draft 2015 Instructions

    Following the June release of the draft forms, the IRS has issued draft 2015 instructions, which include a variety of changes from the 2014 instructions. For the 1094-C and 1095-C forms, the following important clarifications were provided: (1) who must file, (2) information on extensions and waivers, (3) how to correct returns, (4) an example and further information on the 98% offer method, (5) information on the new plan start month box, (6) multiemployer plan reporting, (7) offers of COBRA coverage, (8) reporting on employee premiums, and (9) break in service information. For the 1094-B and 1095-B forms there were fewer updates, with information regarding penalties for not reporting and how to file for an extension.

    There is no target date for the final versions of either the forms or instructions, however it is generally anticipated they will be released in the fall of 2015.

    Who Must File

    The draft instructions clarify that all ALEs (employers with 50 or more employees) must file one more 1094-C forms (including the designated authoritative transmittal) and a 1095-C for each employee who was a full-time employee for any month of the year.

    Extensions and Waivers

    The draft instructions provide information on requesting extensions and waivers. Automatic 30-day extensions will be given to entities filing Form 8809, and no signature or explanation is needed. Form 8809 must be filed by the due date of returns in order to be granted the 30-day extension. Waivers may be requested with Form 8508, and are due at least 45 days before the due date of the information returns.

    Corrections to Forms 1094-C and 1095-C

    The draft instructions provided detailed instructions on correcting returns. Separate instructions are given for correcting authoritative 1094-C and 1095-C forms. Steps are given for a variety of mistakes, including incorrect full time employee counts, premium amounts, and covered individual information.

    Extensions to Furnish Statements to Employees

    Employers may request an extension of time to furnish statements to recipients by mailing a letter to the IRS with information including the reason for the delay. If the request is granted, the maximum extension that will be given is 30 days.

    Penalties

    The draft instructions incorporate the new penalties for failing to file information returns, which are now $250 for each return that an employer fails to file. The IRS again noted that, for 2015 reporting, penalties will not be imposed for filing incorrect or incomplete information so long as the employer can show it made a good faith effort to comply with the requirements. The “grace period” does not apply to employers who fail to file or who file late.

    98 Percent Offer Method

    The draft instructions provided clarification of the 98 percent offer method. This method requires employers to certify that they offered affordable health coverage providing minimum value to at least 98 percent of their employees. The instructions clarify how to report on an employee in a limited non-assessment period. The instructions make clear that an individual in a limited non-assessment period does not count against the employer’s 98 percent calculation.

    Plan Start Month Box

    The draft instructions provide information on the new “plan start month” box, which is optional for 2015. This box is intended to provide the IRS with information used to calculate an individual’s eligibility for premium tax credits, which is based on the employer plan’s affordability, calculated by plan year.

    Multiemployer (Union) Plan Relief

    The 2014 instructions had told ALEs not to enter a code in Part II, Line 14 of Form 1095-C for coverage that is not actually offered, as the information must reflect the coverage offered to the employee. In 2015 ALEs with multiemployer plans are instructed to enter code 1H on line 14 for any month in which an employer enters code 2E on line 16. Code 2E indicates an employer is required to contribute to a multiemployer plan on behalf of the employee for that month, and is eligible for multiemployer interim relief. This is intended to assist with reporting challenges for multiemployer plans.

    COBRA Coverage

    The draft instructions provide information on how to handle offers of COBRA coverage. If COBRA is offered to a former employee upon termination, it is only reported as an offer of coverage if the employee enrolls in coverage. If the former employee does not enroll (even if his or her spouse or dependents enroll), employers should use code 1H (no offer of coverage) for any month in which the COBRA offer applies. If an employee is offered COBRA (due to loss of eligibility), that coverage is reported in the same way and with the same code as an offer of coverage to any other active employee.

    Line 15 Calculations

    The draft instructions clarify how to calculate employee contributions: by dividing the total employee share of the premium for the plan year by the number of months in the plan year to determine the monthly premium.

    Break in Service

    The draft instructions note that in certain circumstances an employee may have a break in service (which may be due to termination) during which he or she does not earn hours of service, but upon beginning service, is treated as a continuing employee rather than a new hire. The instructions clarify that the individual should only be treated as an employee during the break in service for reporting purposes if the individual remained an employee (was not terminated). An employee on unpaid leave would be treated as an employee for reporting purposes.

    Read More …

  • UBA Survey Finds Self-Funded Pharmacy Plans Have Increased Nearly 30 Percent in Five Years | Petaluma Benefits Broker

    September 10, 2015

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    By Bill Olson
    Chief Marketing Officer at United Benefit Advisors

    PharmacyAs a result of the Patient Protection and Affordable Care Act (ACA) triggering cost increases for fully insured employer-sponsored health insurance plans, more employers are moving to a self-funded model for pharmacy plans, particularly among large employers (1,000+ employees), according to the 2014 United Benefit Advisors (UBA) Health Plan Survey.

    UBA’s survey, the nation’s largest benchmarking survey with nearly 10,000 employers responding, shows that self-funded pharmacy plans have increased 29.8 percent (from 8.4 percent) in the last five years and fully insured pharmacy plans have decreased 2.7 percent (from 91.6 percent). Although fully funded pharmacy plans still dominate with 89.1 percent of the market, self-funded pharmacy plans now make up 10.9 percent of all plans, as of 2014.

    “Despite the large amount of capital necessary to pay for fluctuating claim costs, self-funding can be more affordable for pharmacy benefits,” says a representative from TrueNorth Companies/MedOne, a UBA Partner Firm.

    The survey finds that 66.1 percent of employers with 1,000+ employees have self-funded prescription plans, while nearly all small employer plans (1 to 99 employees) are fully insured. Regional differences do have a major impact, however. For example, 99 percent of California plans are fully insured, with only the state’s largest employers offering self-funded plans. North-central employers, on the other hand, have more self-funded plans, at 17.7 percent.

    “North-central employers are more likely to self-fund due to the favorable climate for doing so – less competitive workforce, higher-than-average concern for costs, and a greater amount of manufacturing and agricultural businesses,” says TrueNorth Companies/MedOne.

    Read UBA’s full press release for more on these findings as well as the latest trends in stop loss coverage.

    Read More …

  • DOL Issues Guidance on Classification of Independent Contractors | CA Employee Benefits

    September 8, 2015

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    By Danielle Capilla
    Chief Compliance Officer at United Benefit Advisors

    workersThe Department of Labor (DOL) has issued an “Administrator’s Interpretation” to assist employers in determining if a worker is an employee or an independent contractor. The DOL has determined that many employers are incorrectly classifying employees as independent contractors, which can harm the worker and open the employer up to various liabilities. Unfortunately, there is no clear-cut checklist or rule in determining a worker’s status. Employers who are unsure about the categorization of workers should consult their legal counsel to review the factors provided by the DOL and its application to a specific situation or worker.

    The distinction between employee and independent contractor is important, as employees are entitled to workplace protections such as minimum wage, overtime, and workers’ compensation. Furthermore, under the Patient Protection and Affordable Care Act (ACA) employees are entitled to health benefits if they work for an applicable large employer and work more than 30 hours a week. The ACA regulations specifically state that independent contractors are not considered a common-law employee for purposes of providing health benefits. Because of the difference in protections offered to employees versus independent contractors, employers must be careful to ensure they do not misclassify an individual. The DOL has found that many employers are also incorrectly labeling someone as an “owner,” “partner,” or “member of a limited liability company” rather than properly determining if they are an “independent contractor” in order to avoid having to determine the worker’s status. The DOL was clear that this is inappropriate, and all workers should have their title and classification properly determined.

    The DOL’s guidance rests on the fact that when determining employee versus independent contractor, courts use a “multi-factorial ‘economic realities’ test,” which focuses on an individual’s economic dependence on an employer or business.

    The DOL advised that the economic realities test should be applied in view of the Fair Labor Standards Act’s (FSLA) broad scope of employment and the “suffer or permit” standard; and that the economic realities factor guides the determination on whether the worker is truly an independent business or is an economically-dependent employee. The DOL provides a variety of factors that should be weighed to answer these questions. The factors should be considered indicators of the broader concept of economic dependence and should not be used as a checklist.

    The DOL’s “suffer or permit” standard broadens the scope of employment relationships that are covered by the FLSA and, at its core, finds that an individual is an employee if the individual is economically dependent on the employing entity. The courts look to the economic realities of the relationship, rather than the label the employer gives it. An economically-dependent worker is considered an employee. Someone who is in the business for him or herself is an independent contractor.
    For comprehensive information on the factors an employer should consider when determining if an individual is an independent contractor or an employee, download UBA’s ACA Advisor, “DOL Issues Guidance on Classification of Independent Contractors”.

    Read More …

  • Will the Republicans ever give up? Apparently not…McConnell speaks out again

    September 4, 2015

    Senate Majority Leader Mitch McConnell has now championed a renewed push to bypass a filibuster and repeal Obamacare “Republicans are united in working to repeal the broken promises of Obamacare” he said, and will “continue our effort to use reconciliation to fulfill the promise we made to our constituents”

  • Start Today: First Steps to Getting Healthy | Arrow Benefits Group

    September 3, 2015

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    Active Running GirlWelcome to September – which if you were not aware is the appointed “Self Improvement Month”, so we must ask ourselves “Why wait until January to tackle and defeat any bad habits that the long hot summer allowed us to indulge in?”. Sure the summer was filled with plenty of long lazy days and ice cream but with the cooler and more manageable weather approaching, getting ourselves outside to exercise is easier than ever. The added bonus of being outside during this season is being able to watch and experience the changing colors of the fauna – it will make for a super pretty backdrop for any stroll or walk.

    www.newsusa.com

    It’s never too early or too late to be healthy, but not everyone knows where to start. A combination of diet, exercise and healthy supplements can go a long way toward improving the quality of your life. And the prevalence of social media means that you’re never alone in your efforts.

    Follow these steps to help get you started on a road to better health:

    Eat Wisely and Well

    A healthy diet is the foundation of a healthy lifestyle. In particular, starting the day with a healthy breakfast has many benefits. Data from multiple studies have shown that people who eat breakfast are less likely to overeat and snack later in the day. Breakfast doesn’t have to be boring or tasteless either. Granola cereals, such as System LS Rise granola, are high in fiber and protein. In particular, System LS Rise features organic ancient chia seeds and barley malt. Also, think outside the box (cereal box, that is). Breakfast can be a breakfast bar, a protein shake or even leftover pizza from last night.

    Be Smart About Supplements

    Sometimes diet isn’t quite enough, especially for those who eat more meals on the go. In those situations, a multivitamin designed to help support the immune system and provide missing nutrients can help fill the void. Supplements make sure your body is getting what it needs to be healthy.

    Build Your Support System

    Improving your health can be a struggle, and a little encouragement goes a long way. Today’s social media outlets provide multiple options for seeking advice, as well as sharing health tips and information. For example, the System LS Facebook page provides a place to comment on health and nutrition, share ideas and get motivated by reading success stories.

    Get Moving

    Moderate exercise can yield a multitude of health benefits, from improving mood, to lowering cholesterol, to building bone density. Other benefits of exercise include maintaining a healthy weight and boosting your energy (because your heart and lungs are working more efficiently). In addition, exercise can enhance your sex life by improving your energy and appearance, which will also boost your self-confidence. Have trouble sleeping? Exercise may be the cure.

    Read More …

  • Penalties upon Penalties…the ACA keeps piling them on, but sneaks them in the back door

    September 2, 2015

    The Trade Preferences Extension Act of 2015 was about extending a trade agreement for certain partners of the United States, but one of the law’s revenue offsets includes a provision that increases penalties for incorrect information returns, including those required by the ACA, to $250 per day (was $100 per day) with an annual cap of $3,000,000 (was $1,500,000)

    This comes on top of the original penalties for employers who did not file a timely statement or fail to include all the required information or includes incorrect information, which was $100 per return for which the failure occurs – and it is charged twice, since both sections would be violated.

  • Taking Credit where No Credit is due…or paying too much…ACA penalties and subsidies

    August 31, 2015

    First we have over 700,000 ACA customers claiming tax credits for buying coverage but, according to the Finance Committee Chairman, “didn’t bother to file their taxes” and thus potentially burned the US government for $2 billion in bogus payments. Then again, there were over 300,000 that overpaid an average of $110 on their 2014 tax return. Giveth, taketh…but what was the number supposed to be and who is doing the counting?

    Family Rights…what is right and what did they write and what is left?

     A quick summary of what you need to know if you have 50 or more employees:

    1.  Must display a new poster regarding The Family Care and Medical Leave (CFRA)
    2.  Must also display a new poster regarding the Pregnancy Disability Leave
    3.  Time spent on pregnancy disability leave does NOT count toward the 12 weeks of insurance coverage an employee is separately entitled to under the CFRA for taking leave to bond with a new baby – thus an employer may be required to provide as much as 29 1/3 weeks of continued group health coverage
    4.  Employers now have only five business days to respond to CFRA leave requests (was 10)
    5.  Employers may require employees to use accrued vacation or PTO during otherwise unpaid portions of CFRA leaves
    6.  An employer must limit leave increments to the shortest period of time that the employer’s payroll system uses to account for absences or use of leave provided it is not greater than one hour
    7.  When the nature of the employee’s job makes it physically impossible to take intermittent leave during the middle of the employee’s shift, the employee shall be permitted to return to work if he or she is able to perform other aspects of the work that are not physically impossible, such as administrative duties
    8.  Employee expansion – under FMLA and CFRA an eligible employee had to work for an employer with at least 50 part or full time employees within 75 miles of the worksite. Under new regulations, California based employees without a fixed worksite location to commute to work may now be protected by the CFRA. Thus telecommuters and salespeople who are attached to the Home Office but are remote should now be covered by the CFRA

     

    Reinstatement Rights: employers are now expressly required to reinstate an employee returning from CFRA leave regardless of whether or not his/her position was replaced or restructured to accommodate the employee’s absence.

  • Record 103 winners for Journal’s Best Places to Work | Arrow Benefits Group

    August 28, 2015

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    BUSINESS JOURNAL STAFF REPORT

    http://www.northbaybusinessjournal.com

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    A record 103 companies and organizations have earned a spot in the Business Journal’s 10th annual Best Places to Work in the North Bay.

    The recipients, who will be recognized at an awards reception Sept. 30 and featured in a special section of the publication, include eight 10-time winners and nearly two dozen first-time winners including such prominent North Bay companies as Jackson Family Wines, Raptor Pharmaceuticals, Mike’s Bikes, GC Micro and American AgCredit.

    “We are over-the-top thrilled with this year’s recipients,” said Business Journal Publisher Brad Bollinger. “The recipients cover a broad range of industries and range from small companies to the region’s largest technology company, Keysight Technologies.

    “This program started out humbly in 2006 with 24 winners and here we are today with more than 100. And once again, it’s not because we made it easier. These winners rose to the challenge with an average employee satisfaction score that was higher than last year.”

    The awards are co-presented by founding underwriter Nelson along with underwriters Exchange Bank and Kaiser Permanente.

    The 10-time winners are Burr Pilger Mayer, Exchange Bank, First Community Bank, Ghirardo CPA, Kaiser Permanente’s Santa Rosa Medical Center and San Rafael Medical Center, Redwood Credit Union and Valley Tire & Brake.

    “These are eight very special organizations,” Bollinger said. “To be selected any year is an achievement. To do so for 10 consecutive years through a brutal recession and years of rapid change is testimony to the enduring strength of these organizations.”

    The recipients are selected based on the results of anonymous employee surveys and a review by the Journal editorial staff of worker comments and company applications. More than 8,000 surveys were submitted, and the winning companies represent nearly 16,800 employees.

    The winners are, listed alphabetically:

    • Adobe Associates
    • All American Containers
    • American AgCredit
    • Arrow Benefits Group
    • AUL Corp.
    • Bank of Marin
    • Bank of Napa
    • Becoming Independent
    • Best Collateral
    • BKF Engineers
    • Boisset Family Estates
    • Bradley Real Estate
    • Burr Pilger Mayer
    • Carlile Macy
    • The Center for Social and Environmental Stewardship
    • Century 21 North Bay Alliance
    • Chop’s Teen Club
    • ClaimRemedi
    • Coast Landscape Management
    • Codding
    • Coldwell Banker Brokers of the Valley
    • Committee on the Shelterless
    • Community Child Care Council of Sonoma County
    • Costeaux French Bakery
    • Council on Aging
    • Dal Poggetto & Company
    • DH Wine Compliance
    • Don Sebastiani & Sons
    • DriveSavers Data Recovery, eDiscovery and Digital Forensics
    • EO Products
    • EPIC Insurance Brokers & Consultants
    • Exchange Bank
    • First American Home Buyers Protection
    • First Community Bank
    • Friedemann Goldberg
    • GC Micro
    • George Petersen Insurance Agency
    • Ghilotti Bros.
    • Ghirardo CPA
    • Glassdoor
    • Health Services Integration
    • Hennessy Advisors
    • The Hitmen Termite & Pest Control
    • Hogan Land Services
    • Inn Marin and Rickey’s Restaurant
    • Jackson Family Wines
    • Kaiser Permanente San Rafael Medical Center
    • Kaiser Permanente Santa Rosa Medical Center
    • KCC
    • Keysight Technologies
    • Kiosk
    • La Tortilla Factory
    • LEMO
    • Linkenheimer
    • M.A. Silva USA
    • Marizco Landscape Management
    • Mengali Accountancy
    • Midstate Construction
    • Mike’s Bikes
    • Moss Adams
    • Mr. Rooter Plumbing
    • Nova Group
    • O’Brien Watters & Davis
    • O’Reilly Media
    • Parkpoint Health Clubs
    • Pepperwood
    • Perry, Johnson, Anderson, Miller & Moskowitz
    • Petaluma Health Center
    • Petaluma People Services Center
    • Pisenti & Brinker CPAs & Advisors
    • Private Ocean
    • ProTransport-1
    • Quattrocchi Kwok Architects
    • Raptor Pharmaceuticals
    • Redwood Credit Union
    • Redwood Empire Schools Insurance Group
    • The Republic of Tea
    • Santa Rosa Chamber of Commerce
    • Santa Rosa Community Health Centers
    • Schurter
    • Scott Technology Group
    • Sequoia Senior Solutions
    • Smith Dollar
    • Social Advocates for Youth
    • Sonic
    • Sonoma County Children’s Village
    • Sonoma Marin Area Rail Transit
    • Sonoma Technology
    • St. Francis Winery & Vineyards
    • Star Staffing
    • Summit Engineering
    • Summit State Bank
    • Terra Firma Global Partners
    • Valley Tire & Brake of Santa Rosa
    • Vantreo Insurance Brokerage
    • VinoPro
    • Vionic Group
    • Volt Workforce Solutions
    • W. Bradley Electric
    • Whistlestop
    • Woodruff-Sawyer & Co.
    • World Centric
    • WRA Environmental Consultants

  • Taking Credit and Spreading Blame…the return of Clintonscare…

    August 28, 2015

    Hillary Clinton has already said that if the Republicans take the White House, the Affordable Care Act would be repealed. In other speeches, she has stated that her work with the Clinton Health Security Act laid the groundwork for the ACA. True, but so did Truman, Johnson, and even Nixon in the various pieces of legislation they passed…but they are not around to claim it.

    Why are they Surprised the Rates went up? Actually not much

    Pundits and payers are up in arms because it has just been announced that the rates under the Covered California Exchange “negotiated” a 4% rate increase for the 2016 ACA plans. If it was truly negotiated, then some day it won’t – claims are claims, and finally rates are rates. What we have not yet seen are what the carriers will do on a direct basis. If they go up the same, then so much for negotiation. If they go up more…then negotiate away. It will all devolve to the mean anyway, because it’s a mean world…

  • Medicare Costs Explained | California Benefits Broker

    August 27, 2015

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    By Kathy Binkley, RHU, ChHC
    Benefit Advisor at The Wilson Agency
    A UBA Partner Firm

    healthcareI’m sure you’ve heard the phrase “Nothing in life is free,” and nothing is – not even Medicare. In most cases, you won’t have to pay a premium to get Medicare, at least for Part A (here’s a refresher on the different parts of Medicare), but that doesn’t mean it’s free. You’ve just pre-paid in the form of taxes. So you don’t have to worry about a premium for Part A, which covers in-patient hospital expenses, assuming you or your spouse paid Social Security for at least 10 years. However, there are other costs associated with Medicare, which vary depending on the specific insurance. Here are the costs for 2015.

    Part A (Hospital Insurance):
    $1,260 deductible (each benefit period)
    $315 copay (per day) days 61 through 90 at the hospital
    $630 copay (per day) days 91 through 150 at the hospital

    Part B (Medical Insurance):
    Monthly premium: $104.90
    Deductible: $147
    Cost Sharing: $20, varies

    Part D (Prescription Drug Coverage):
    Part D is also subject to a premium, which varies by plan and income. Additionally, prescriptions are subject to copayment or coinsurance and a deductible (if the plan has one).

    Penalties:
    There is a seven-month initial enrollment period for signing up for Part A and B. If you do not enroll during this time period and do not have creditable health coverage (such as an employer group health plan), you could be responsible for a paying a penalty.

    Medigap:
    Take another look at the prices for Part A. Can you imagine what you could end up paying for a long-term hospital stay? Medigap plans are additional insurance to help cover costs that Medicare doesn’t cover, such as copayments, coinsurance and deductibles. However, Medigap insurance requires an additional premium be paid.

    Needless to say, even with Medicare the costs can be catastrophic. This is why we can’t emphasize enough how important it is that you save enough money for retirement. However, we understand that in many situations people are unable or unaware of the exorbitant health care costs they will face in retirement, so here is an article that discusses additional ways that retirees can tame those health care costs.

    UBA resource

    Under federal regulations, Medicare is a secondary payer for many individuals who have an employer group health plan available to them, either as an employee or the dependent spouse or child of the employee. Read the answers to thirteen key questions about Medicare Secondary Payer rules including who is affected, what coverage must be offered to Medicare-eligible employees, whether Medicare premiums can be reimbursed, and more.

    Read More …

  • King v. Burwell – what does the Supreme Court decision actually mean?

    August 25, 2015

    In California, not much. The continued allowance of the subsidies for those members in the Federal Exchange certainly solidifies the position of the Exchanges and thus, indirectly, the California Exchange. The problem in California is whatever the problems are in California, which at this time is the fact that they may not be able to meet their financial commitments. So California could go the way of federal Exchanges, which have just been validated. Good news?

    What the decision does mean, of course, is that the Supreme Court has rebuffed the second challenge to the legality of the Affordable Care Act – which is now here to stay…at least until the next election. The media fallout included comments such as:

    Judge Scalia said “Roberts performed somersaults of statutory interpretation to save the act” and the decision was “interpretive jiggery-pokery” and “pure applesauce” and added that words

    “no longer have meaning if an Exchange that is not established by a State is established by a State” and, finally, that those justices who voted to retain the ACA did it for political reasons.

    On NBC, Chuck Todd said “you saw Republican presidential candidates from Jeb Bush to Marco Rubio and in particular Ted Cruz all pledging to say that if elected, that this presidential election is now about the last chance you have to stop Obamacare or to repeal Obamacare”

    Senator Lindsey Graham said the ruling “only reinforces why we need a President who will bring about real reform that repeals Obamacare and replaces it with a plan that expands consumer choice, increases coverage, delivers better value for the dollar and gives states more control without stifling job creation”

    House Speaker John Boehner said “we will continue our efforts to repeal the law and replace it with patient centered solutions that meet the needs of seniors, small business owners and middle class families”

    However, according to ABC’s Jon Karl “Publicly, Republicans are expressing outrage over this ruling, but privately, many Republican leaders are breathing a sigh of relief, because if this ruling had gone the other way, more than 6 million Americans, most of them from states with Republican governors, would have lost their healthcare subsidies, and Republicans were deeply divided about what to do about it” – a sentiment echoed by a reporter from the Washington Post

  • How to Motivate Employee Participation in Your Wellness Program | CA Employee Benefits

    August 24, 2015

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    By Sara Saidi
    Marketing Coordinator at The Wilson Agency
    A UBA Partner Firm

    WellnessHave you ever heard the quote, “If you take care of your people, they’ll take care of your business?” It’s great advice and goes beyond ensuring that they get a paycheck each month. Does your company show that they care about an employee’s total well-being? You should, especially considering that an employee’s physical and mental well-being can affect productivity and consequently cost the company money. One great way to show employees that you are invested in them, and to help them stay healthy, is through a wellness program.

    Once you decide to start a wellness program, there are many things that must be considered, but one of the most important is figuring out how you are going to motivate employees to participate and invest in living a healthy lifestyle.

    Let’s take a look at the psychology behind motivation. Behavior can be regulated externally (e.g., gift rewards and punishment) or intrinsically (e.g., internal goals). To motivate your staff, the goal should be to leverage both of these methods to help employees develop healthy behaviors that will last a lifetime so that it essentially becomes second nature to them. That lasting change will be felt throughout your organization for a long time to come. Those that haven’t already incorporated healthy behaviors into their lifestyle will need the extra push, and that’s where an organized wellness program comes in.

    Here are different types of incentives that wellness programs typically use to give employees that extra push:

    • Financial (gift card or decreased premium)
    • Social recognition (awards)
    • Surprise incentives (every once in a while, surprise employees with an additional award – the element of fun will help keep employees motivated)

    To really create a well-designed wellness program, we suggest incorporating these other tips.

    Personalization

    If you want employees to be engaged and motivated, make the wellness program personalized so that it’s fair for all participants. Understand that not all employees are at the same level. It can often be easy to marginalize those who are already doing everything right. Try to find a way to recognize these employees as well. If employees can participate at their own fitness or readiness level, they will be more likely to participate.

    Communication

    At times, lack of participation cannot solely be attributed to an unwilling employee. It’s possible that employees are unaware of, or do not fully understand, the wellness program and the benefits of participation. To ensure a greater level of participation, make sure that you are properly communicating with your employees. According to a recent article in Plan Sponsor, Robert Kennedy, Health and Welfare practice leader with Fidelity’s Benefits Consulting business in Boston, says “incentives will get some employees engaged in the programs, but beyond that, communications play a strong role. Communications should set the context for employees—explaining why the employer is offering the programs and what it hopes to accomplish.” The article goes on to suggest, “frequent, short reminders about how to take advantage of incentives, using a variety of channels—emails, the employer’s intranet site or employee meetings. Short messages should contain a click-through for more detail for those employees who want it.”

    Peer pressure

    No one wants to be known as the only employee who doesn’t participate. Be careful not to call out any employee, but do get employees talking about the wellness program. In March, one of the ways in which our employees could obtain points toward a wellness credit (which decreased premium costs for those on the health plan) was to motivate other employees to participate. This works out great because most people want to demonstrate that they are a positive influence in the company and participating in activities with coworkers is a great way to do that.

    Spread incentives out over time

    To assist employees in developing a pattern of healthy behaviors, spread incentives out over time. This way they will be less likely to just take the money and run. Some employees will participate for the incentive, but over time the healthy behaviors will become habit. Some may even realize that they enjoy living a healthy lifestyle more than an unhealthy one as they experience the benefits of living well.

    Keep in mind that a wellness program is not one size fits all and, while turnkey programs should be easy to implement, companies should carefully think about their culture and what they want to achieve. People are motivated by different things, so what works for one person in your company may not work for another and what works for your company may not work for other companies.

    For information on wellness plan trends from the UBA’s Health Plan Survey, download our Executive Summary.

    Read More …

  • An Ounce of Prevention…Administration pounds out final rules for preventive coverage

    August 21, 2015

    The Departments of Labor, Treasury and Health/Human Services finalized interim final rules that establish an alternate way for eligible organizations that have a religious objection to covering contraceptive services to seek an accommodation from contracting, pricing, paying or referring for such services. In response to the Supreme Court Hobby Lobby case, the Departments also issued final rules for closely held for profit entities, determining standards on documentation and disclosure of the organization’s decision not to provide coverage for contraceptive services.

  • Summaries of Benefits and Coverage – a good idea – now made better?

    August 18, 2015

    The Departments of Labor, Treasury and Health/Human Services have jointly issued final regulations on the SBCs that all employers are required to provide their employees to outline the features of the medical insurance plans they offer. New rules are:

     

    1. An SBC may be issued prior to enrollment – no subsequent notice is required
    2. If an entity contracts with a third party to provide SBCs, they must monitor the third party
    3. Where multiple products are offered, the group health administrator must issue the SBC
    4. Until the new template is issued, plans and issuers may use SBC under 2013 guidelines
    5. SBC may be provided electronically in connection with their online enrollment or renewal
    6. Willful failure to provide required information is subject to a fine
    7. Final regulations effective September 1, 2015

  • Trade Bill Increases ACA Reporting Penalties; Reinstates Tax Credit | CA Benefits Broker

    August 17, 2015

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    By Danielle Capilla
    Chief Compliance Officer at United Benefit Advisors

    tradebillMost employers are familiar with the penalties assessed to applicable large employers that fail to offer minimum essential coverage that is minimum value and affordable. In addition to being required to offer coverage, employers (all applicable large employers, and all employers with self-funded plans regardless of size) are required to complete IRS reporting forms under sections 6055 and 6056 of the Patient Protection and Affordable Care Act (ACA). These forms are used to inform the IRS and employees about the coverage that was offered and enrolled in, allowing employees to satisfy the individual mandate and allowing employers to confirm they met the requirement to offer coverage.

    On June 29, 2015, President Obama signed the Trade Preferences Extension Act of 2015. The bill included significant increases for failure to file a number of required tax reporting forms, including the forms required under sections 6055 and 6056.

    For specifics on the penalty increases as well as information on the Health Coverage Tax Credit (HCTC) which was restored by the Trade Preferences Extension Act of 2015, view UBA’s ACA Advisor: Trade Bill Increases ACA Reporting penalties; Reinstates Tax Credit.

    For more information on forms for 6055/6056 reporting, see our recent blog.

    A more detailed overview of employer reporting requirements can be found in the UBA document “IRS Issues Final Forms and Instructions for Employer and Insurer Reporting Forms.”

    Read More …

  • No, Obamacare is not going to cure medical inflation…recent HHS report shows increase

    August 17, 2015

    “US health spending is expected to grow faster over the next decade than in recent years, reflecting a stronger economy, an aging population and higher levels of insurance coverage through the Affordable Care Act” according to a report from Health and Human Services.

  • They Paid the Penalty…so who lost?

    August 14, 2015

    In the end, 6.6 million taxpayers paid a penalty imposed for not having health insurance, which is roughly 10% more than what the Obama administration had predicted. The average penalty was $190. What was interesting was that about 300,000 taxpayers overpaid the penalty, as most should have received an exemption for their low income. Bloomberg reports that the
    “IRS has not decided yet whether to issue a refund for the overpayments” Say what?

  • The rich get richer…or different. Is growth always a good thing? Stay tuned

    August 12, 2015

    In the brokerage world, Willis climbs toward Towers, which should produce a collective yawn. Then ACE scores by making Chubb chubbier, but that’s all about property…and casualty.
    Then we get to the heart of the matter…will the combination of medical carriers cure any ills?
    Aetna is buying Humana, but this seems hardly human given their position in California.
    Now it’s Anthem blaring its merger with CIGNA (which stands for what?) but wait, I thought Aetna was at the summit in that mix, but wait, there’s more…and merger mania begins again in an era of easy money and lots of opportunities. Finally, Centene finds a safety net as it buys Health Net in California. Are we in 2007 again? What is odd is that the Aetna play is about Medicare Advantage business and not group coverage, and Centene is itself a Medicaid player and looking to round out its business, but what do they know about group coverage?

  • Taking Care of Your Child’s Eyes in Today’s Digitally Dependent World | Petaluma Benefits Broker

    August 3, 2015

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    www.newsusa.com

    glassesAccording to the American Optometric Association’s (AOA) 2015 American Eye-Q survey, 41 percent of parents say their kids spend three or more hours per day using digital devices, and 66 percent of kids have their own smartphone or tablet.

    It’s clear children’s use of digital technology continues to be an integral part of their lives in both the classroom and at home, and it’s predicted that by 2028 — the year in which kids entering kindergarten this fall will graduate high school — many schools will rely heavily on computer simulations for instruction and will even incorporate virtual worlds into curriculum.

    While these advances in the classroom may enhance learning, many digital devices are still relatively new, and the long-term effects on young eyes are not yet fully known. Most of today’s commonly-used devices give off high-energy, short-wavelength, blue and violet light, which may affect children’s vision and even prematurely age their eyes. Early research even shows that overexposure to this blue light could contribute to eye strain and discomfort and may lead to serious conditions later in life, such as age-related macular degeneration (AMD), which can cause blindness.

    The first step in taking care of children’s eyes is for parents to schedule a comprehensive eye exam for children prior to the beginning of each school year to check eye health and vision. Children now have the benefit of annual comprehensive eye exams, thanks to the Pediatric Essential Health Benefit in the Affordable Care Act, through age 18. The AOA recommends children have an eye exam by an optometrist soon after six months of age, again at age three and annually thereafter.

    With so much time spent on digital devices, it is also more important than ever for parents to watch for signs of digital eye strain in children. Symptoms can include burning, itchy or tired eyes, headaches, fatigue, loss of focus, blurred vision, double vision or head and neck pain. To protect their eyes and vision while using digital devices, parents should encourage children to take frequent visual breaks by practicing the 20-20-20 rule: when using technology or doing near work, take a 20-second break, every 20 minutes and view something 20 feet away.

    To find an optometrist in your area, or for additional information on children’s vision and the importance of back-to-school eye exams, please visit aoa.org.

    Read More …

  • No COOP eration with the ACA – the failure of a good idea

    July 29, 2015

    One of the vaunted advances of the ACA, in response to public request, was the creation of a public plan option to compete with private insurers offering coverage in the exchanges.   These new Consumer Operated and Oriented Plans (COOP) are slipping into insolvency. All but one lost money in 2014 and one failed spectacularly with the loss of 20% of all COOP enrollees nationwide. Finally, many of the remaining COOPs appear to be setting artificially low premiums to gain market share, losing money taxpayers are expected to cover. There are, of course, many reasons, and a lot of finger pointing, but the fact remains that they are competing for the same people as the private insurance carriers with a lot less capitalization and recognition and, in the end, insufficient enrollment to adequately spread risk that rose almost as soon as it began, as claims ran higher than expected. In the end, all the COOPs have borrowed more than $75 million in startup funds that must be repaid within five years along with $2 billion in low interest loans that are due within 15 years…and then the federal government, through HHS, provided emergency funding of $355 million in the last four months of 2014.

  • Health Spending is Growing Faster Again…Just Like Before

    July 27, 2015

    Analysis shows that health care spending was 7.3% higher in the first quarter of 2015 than in the first quarter of last year, with hospital spending increasing 9.2% alone. According to the US Census Bureau, greater use of health services as well as more people covered by the ACA appear to be responsible for most of the increase. As the economy improves, people are beginning to use more physician and outpatient services, while the number of days spent in hospitals also rose.

  • It had to happen…and now the rates are rising for individual plans

    July 24, 2015

    According to early filings , insurance companies are seeking wildly differing rate increases in premiums for 2016, with some as high as 85%. “They are unsure about how many more people will sign up for coverage and what their medical costs will be” as well as uncertainty about how the government will protect them against wild claim swings and potential losses, not to mention the pending Supreme Court decision, which may wipe out the many subsidies now available.

    They are now seeing the rising expense of prescription drugs and actual claims data they are getting from the early wave of enrollees. This last year is the first full year they have credible data, and now the truth is known. Blue Cross Blue Shield of North Carolina, for example, cited costs of emergency room use, heart and cancer treatments and the cost of specialty drugs treating hepatitis C.

  • Unexpected E-xchange fallout for E-companies

    July 20, 2015

    eHealth was supposed to reap the whirlwind when the government passed the ACA, as individual plans would surge in enrollment (which they did) mostly due to subsidies (which happened) The nation’s largest online health insurance broker, it was all supposed to be a blessing…but they’ve taken a beating, losing thousands to online exchanges. The firm swung from a $1.7 million profit in 2013 to a $16 million loss in 2014.

  • IRS Releases Draft 2015 Forms for 6055/6056 Reporting | California Employee Benefits

    July 20, 2015

    Tags: , , , ,

    By Danielle Capilla, Chief Compliance Officer at United Benefit Advisors

    Under the Patient Protection and Affordable Care Act (ACA), individuals are required to have health insurance while applicable large employers (ALEs) are required to offer health benefits to their full-time employees. In order for the Internal Revenue Service (IRS) to verify that (1) individuals have the required minimum essential coverage, (2) Health insurance taxesindividuals who request premium tax credits are entitled to them, and (3) ALEs are meeting their shared responsibility (play or pay) obligations, employers with 50 or more full-time or full-time equivalent employees and insurers will be required to report on the health coverage they offer. Reporting will first be due early in 2016, based on coverage in 2015. All reporting will be for the calendar year, even for non-calendar year plans. Mid-size employers (those with 50 to 99 employees) will report in 2016, despite being in a period of transition relief in regard to having to offer coverage. The reporting requirements are in Sections 6055 and 6056 of the ACA.

    Draft 2015 Forms

    The IRS has issued draft 2015 forms, which include a few changes from the 2014 forms. The biggest difference between the 2014 and 2015 versions are on Form 1095-C, which in 2015 will likely include (assuming the draft forms are finalized as they currently appear) a “plan start month” field, allowing a filer to indicate the first month of the ALE’s plan year. The draft instructions indicate this would be optional for 2015. ALEs could use the 2014 format instead of filling out the information, or in the alternative may either fill out the first month of the plan year or fill in “00” rather than the actual first month. Beginning in 2016 this field would be required. Currently it is unclear if employers can use the 2014 forms if they choose to use the 2014 format, or if they should use the 2015 format and leave the field blank.

    In 2016 it is anticipated that for Form 1095-C, there will be two new indicator codes for Line 14. These codes would indicate if an offer of coverage to an employee’s spouse is a conditional offer.

    Continuation sheets have been added to Part III of Form 1095-C and Part IV of Form 1095-B.

    Draft 1094-C (Transmittal/cover sheet)

    Draft 1095-C (Reports to individuals and IRS on coverage offered)

    Draft 1094-B (Transmittal/cover sheet)

    Draft 1095-B (Report to individuals and the IRS on MEC)

    For information on which forms employers should use for self-funded plans and fully insured plans, download UBA’s PPACA Advisor, “IRS Releases Draft 2015 Forms for 6055/6056 Reporting.”

    Our recent blog covers highlights of employer and insurer reporting requirements. A more detailed overview of employer reporting requirements can be found in the UBA document “IRS Issues Final Forms and Instructions for Employer and Insurer Reporting Forms.”

    Topics: PPACA Affordable Care Act, 6055 Reporting, 6056 Reporting, Play or Pay, Individual mandate, employer shared responsibility, Danielle Capilla

    Read More …

  • From New Roles to Falling off the Rolls…drop off in ACA enrollment

    July 15, 2015

    A recent New York Times report shows that 13% of those who signed up for health insurance in 2015 through the Affordable Care Act have become unenrolled, primarily because they failed to pay their share of premiums.   Of the total exchange enrollment as of March 31, there were 10.2 million signed and 8.7 million receiving government subsidies

  • Blue Hawaii…another state exchange is leid waste

    July 8, 2015

    The Hawaii Health Connector will shut down September 30 and ceases new enrollment as of May 31. They will let their 37,000 enrollees re-enroll on the federal health care exchange. Not only are they financially unsustainable, but it was found that they failed to comply with the ACA mandate that state exchanges integrate with Medicaid’s system for determining subsidies and tax credits – if they cannot do this by November, they will lose $1 billion in federal funding

  • Preparation is Key for Department of Labor Audit

    July 6, 2015

    If you are an employer and your group health plan has never been audited, you’d better prepare for it like you’re going to be. That’s the advice of Arrow Benefits Group, which recently created a report called “Don’t Roll the Dice on Department of Labor Audits.” Read entire article here.

  • They’re all on drugs…and their cost is increasing

    July 1, 2015

    More than half a million US patients had medication costs in excess of $50,000 in 2014
    Of these, 25% used at least $100,000 worth of medication
    This is an increase of 63% from 2013 and the total cost for these patients was $52 billion
    Health coverage paid for 97.4% of these prescription drugs
    About 60% of patients in the high claims category were taking at least 10 medications from at least 4 different prescribers

  • Insuring the Health of America’s Emerging Multigenerational Workforce | California Benefits Broker

    June 30, 2015

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    www.newsusa.com

    Jar of Coins Labeled Health Insurance on WhiteFor the first time in modern history, America’s workforce spans four generations. In this new era of multigenerational workers, a “one size fits all” approach to health insurance is a thing of the past.

    The generational gap is as varied as it is immense. There are the young-adult Millennials, the middle-aged Gen Xers, Baby Boomers nearing retirement age and the Silent Generation in their 70s and beyond. Each group has vastly different health insurance needs.

    Take, for example, Millennials. A recent Bankrate survey shows many prefer health plans with lower deductibles and higher premiums. Meanwhile, Pew Research reports that the Baby Boomer population is hyper-focused on long-term care coverage needs and how best to manage associated costs beyond Medicare.

    This workforce shift is unprecedented and poses significant hurdles for businesses as they seek to provide affordable and appropriate health coverage options across employee lifespans. Both large and small group employers are impacted, though companies with 100 or fewer employees are more likely to feel the financial squeeze because there are fewer individuals to spread risk and defray costs.

    Juggling vastly different insurance coverage needs can be quite difficult, especially for the more than 28 million small businesses employing nearly half of all U.S. workers. Affordable Care Act legislation adds further complexity as companies assess their group health plan options, or in some cases whether to offer them at all. So, what are employers to do?

    In response, many are increasingly turning to private healthcare insurance exchange solutions as an effective answer to meet the diversity of benefit needs from Generation Me to Generation We.

    “Private exchanges are marketplaces of health insurance and other related products,” according to management consulting group Booz Allen. They offer access to multiple health plans in a single, unified program and are attractive because they enable workers to individually select the right coverage for their current life needs.

    The private exchange platform provides an ideal bridge across generational divides. For example, a 22-year-old single female starting her first job out of college will likely want a different plan than the 59-year-old manager with a spouse, three children and plans to retire in the near future.

    Employers are moving to these exchanges more quickly than forecasted, according to new data from consulting firm Accenture. The company estimates that some six million individuals signed up for workplace health coverage through private exchanges in 2014 alone, roughly two times the number expected. It’s predicted that private exchange participation will exceed public exchange enrollments by 2018, if not sooner.

    Much of this expansion is driven by the combination of health care reform and a workforce that now spans a 50-plus year spectrum.

    The age of the four-generation workforce has dawned. Owners and small businesses are wise to embrace the private exchange that technology employees have come to rely on, such as online enrollment, as they seek to cost-effectively address the needs of their workforce across all stages of their lives.

    Read More …

  • Preparing for a DOL Audit with a Mock Interview | Petaluma Benefits Broker

    June 25, 2015

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    By Bill Olson
    Chief Marketing Officer at United Benefit Advisors

    auditAs the likelihood of an audit from the U.S. Department of Labor increases, every organization should be prepared so that this potential disaster can be handled with confidence. Conducting a mock audit can be key part of your prevention and preparation strategy.

    As with any major issue of government compliance, it’s often necessary to meet with the appropriate management and staff of a company and familiarize them with the entire audit process. Those who will meet with the auditor should be coached
 to understand that they need to answer any question truthfully, but don’t go any further. Sometimes when people are nervous, they have a tendency to ramble or a need to explain their answer. This should be avoided at all costs. Michael J. Cramer, JD, Compliance Officer at Beneflex Insurance Services (a UBA Partner Firm), says that a great way to help reduce the potential anxiety during an interview by a DOL auditor is to hold a mock interview and that the employer’s attorney and advisor go through this with you. This will help most personnel to feel confident and comfortable during the process. Also, if the auditor asks a question, or requests information that does not pertain to your organization, never hesitate to say that it’s “not applicable.” This is better than trying to make an answer fit or worse, not answering the question at all. Deanna Johnson, Director of Compliance at Benefit Insurance Marketing (a UBA Partner Firm), stresses that if the staff doesn’t understand a question on the audit, or is not sure what the question is truly asking, then they should ask the auditor before they arrive to clarify what they need rather than make an assumption.

    Similar to just answering the question and only the question, Josie Martinez, Senior Partner and General Counsel at EBS Capstone (a UBA Partner Firm), notes to never provide more documentation than what is requested. She adds that once you have all the documentation in place, identify the specific document(s) that responds to the request and then highlight the exact location on that document. After all, what good is giving them a box of documents and telling the auditor, “good luck, it’s in there.” The goal is to get the auditor out of your office as quickly as possible.

    Whether it’s your company’s legal department, senior staff, or any other group of employees, make sure to empathize with their concern during a DOL audit. No matter how well prepared you and your company may be, there is bound to be some trepidation. Assuming you are indeed prepared for a DOL audit, remember that confidence breeds confidence. Show your employees that the situation is well in hand and they have nothing to fear.

    To further prep your team and minimize resource drain, UBA is offering new white paper that can help employers:

    • Learn how to audit-proof your company
    • Avoid the worst mistake you can make
    • Conduct a mock audit
    • Get an auditor out of your office as quickly as possible

    After downloading the new UBA white paper “Don’t Roll the Dice on Department of Labor Audits”, be sure to also request UBA’s audit checklist and sample interview questions!

    Read More …

  • Subsidy smubsidy…the Feds are looking into it…after they wrote it

    June 24, 2015

    The Senate Permanent Subcommittee on Investigations has launched an inquiry into the system for disbursing subsidies. Senator Portman said “I’m concerned that the subsidy eligibility process is so complicated that many consumers believed they were receiving cheaper insurance coverage than they ultimately got”

  • Employers Procrastinating? | CA Benefits Broker

    June 22, 2015

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    By Peter Freska
    Benefits Advisor at The LBL Group
    A UBA Partner Firm

    Employee Benefit News published an article titled, “Employers procrastinating on ACA recordkeeping compliance.” It is an interesting read, as it refers to a recent survey by PricewaterhouseCoopers in which “Only 10% of some 480 employers in 36 industries responding to a recent poll have implemented an in-house or outsourced solution to comply with Affordable Care Act reporting requirements.” This is an alarming number, as employers may be subject to significant penalties for non-compliance.

    To address these concerns, United Benefit Advisor (UBA) Partner Firms, such as The LBL Group, are working with our strategic partners to provide employers with solutions. Employers will need to address the following reporting requirements:

    Our solutions include both stand-alone and integrated tracking, measurement and filing systems so that employers affiliated with UBA Partner Firms can choose the solution that best fits their needs, rather than the needs of the service provider. In addition, our national compliance team continues to monitor and educate our partners on the latest developments, as they happen. These PPACA updates are available to the more than 17,000 plan sponsors working with trusted advisors from UBA.

    In essence, employers are working with multiple data sources, systems, and people. For large and small employers this can be a daunting task. Education, understanding, services and systems, are all great, but having an advisor from a UBA Partner Firm on your team can make all the difference in how employers choose to move forward in complying with the laws of the land.

    For comprehensive information on PPACA reporting requirements including coverage requirements, due dates, special circumstances, controlled groups and how to complete the forms – including sample situations – request UBA’s PPACA Advisor, “IRS Issues Final Forms and Instructions for Employer and Individual Shared Responsibility Reporting Forms”.

    Read More …

  • What can we exchange for an exchange that cannot make change for federal dollars?

    June 17, 2015

    Nearly half of the 17 insurance marketplaces set up by the states and the District under the ACA are struggling financially, which creates even more pressure on the upcoming Supreme Court decision over the federal exchanges. Oregon is already out but Connecticut is succeeding, and there are a lot in between, but mostly leaning toward failure. Signups for the state marketplaces rose a disappointing 12% while those in the federal exchange rose 61%. In Minnesota and Vermont officials are so fed up with costly technical problems that they are considering handing over some or all of their functions to the state or federal governments. In Rhode Island, the legislature is considering a fee on health plans that would rise or fall depending on how costs go, and in Hawaii they already need another $28 million to fund operations until 2022.

  • CPR & AED Training and certification | Arrow Benefits Group

    June 15, 2015

    Tags: , , ,

    petalumahealth

    We’re proud to offer the latest information in health and wellness in our ongoing training series donated to community. We’re partnering with numerous healthcare industry leaders to offer lectures & classes.  Our goal is to offer a variety of tools and techniques that will vastly improve the lives of each of the attendees. The idea for the series was sparked by inquiries from clients looking for support for health related issues.

    Training saves lives

    Are You Prepared?

    When an individual is not breathing or is only occasionally gasping, they are likely experiencing cardiac arrest.

    Sudden Cardiac Arrest (SCA) occurs when the heart stops beating, abruptly and without warning. When this occurs, blood stops flowing to the brain and other vital organs. If a heartbeat is not restored, death follows within minutes.

    SCA is a leading cause of death in the U.S., killing 325,000 adults in the U.S. each year. In fact, SCA claims one life every 90 seconds, taking more lives each year than breast cancer, lung cancer or AIDS. SCA is responsible for half of all heart disease related deaths.

    SCA is the greatest cause of workplace death, killing 10,000 workers every year.

    What: CPR & AED Training and certification
    When: Saturday, June 27th at 9:00 am
    Where: Petaluma Valley Hospital

    For more information or to reserve seats, please call Andrew McNeil at 707-992-3789 or email Andrew at AndrewM@arrowbenefitsgroup.com.

  • Economic Trends and Human Resources | Petaluma Employee Benefits

    June 11, 2015

    Tags: , , , , ,

    By Robin J. Anderson
    Senior Economist, Principal Global Investors

    globaltrendGlobal economic trends have a profound impact on human resource management with effects on everything from talent management, hiring, outsourcing, investment strategies, wages, asset management and business development. As globalization continues to shrink the world, human resource departments are transforming themselves into strategic business partners with senior leaders in order to effectively lead their organizations. A look at current economic trends through the perspective of human resources paints a picture of what matters most to U.S. markets.

    The global and U.S. economies operate in the context of secular themes – trends that may last more than one business cycle. Those secular themes include: the credit cycle in emerging markets, the commodity super cycle, and the return of the U.S. consumer.

    I call these themes “The Great Unwindings.” Let’s take a closer look:

    The Chinese Investment Boom: After years of unprecedented investment in U.S. markets from China, we’re now seeing a slowing in Chinese growth with impacts felt around the world. The relationship between the U.S. and China is shifting, which has an enormous effect not only for those two countries, but the wider global economy.

    The Commodity Super Cycle: Since the start of the year, oil prices have bottomed and rallied, the dollar has moved up and down, and interest rates have fallen to near historic lows only to bounce back. With all the news and data at our fingertips, it is important to decipher what matters for markets and what does not.

    The End of the U.S. Middle Class Squeeze: Since the late ’90s, the U.S. lost 6 million manufacturing jobs. However, we’re finally seeing this trend reverse and have gained 866,000 jobs since 2010. A skilled labor force and increasingly competitive wages mean that Chinese companies are even moving operations to the U.S. More broadly, the labor market is looking more “normal” in the U.S. The unemployment rate is declining quickly and that should hopefully lead to stronger wage growth. Coupled with lower gas prices, real incomes should see the benefit.

    The gain in manufacturing jobs is significant, but it’s important to note that these jobs today are much more sophisticated than those a generation ago. Jobs are more likely to be found in industries involving chemicals, machinery, and transportation equipment than in textiles.

    There remains, however, demand for traditional “blue-collar,” workers and high-skill jobs that can’t be shipped overseas, like plumbers, truck drivers, or electricians. Demand for these types of jobs should pick up especially as boomers retire. Going forward, as robotics and advanced analytics continue to develop, I expect more demand for highly-skilled manufacturing jobs and for statisticians and data scientists in the manufacturing sector.

    So how does the end of the middle class squeeze affect employers and human resource professionals?

    As the unemployment rate has declined, the labor market has shifted from a buyer’s (employer’s) to a seller’s (employee’s/prospective hire’s) market. We have seen wage pressures slowly rise nationally as the unemployment rate has dropped, and that trend should continue. Large firms like Wal-Mart and Target have increased wages for their lowest paid workers to reduce turnover. Tight labor markets mean recruiters have to increase initial offers and, more broadly, HR professionals increasingly have to worry about retention.

    These longer-term trends translate into near-term views for the U.S. and global economic growth, interest rates and inflation, and federal and global central bank action. HR policies, practices, benefits and strategies should be fine-tuned according to market factors facing any business.

    Read More …

  • Covered California Losing its Clothes – and much more as expenses are exposed

    June 10, 2015

    There are a number of things being said, being written and being speculated about the future of the Covered California health care exchange, all surrounding its survival…or its swooning

    1) They have now burned through $1.1 billion and there is no more money available
    2) This money was all from federal grants which do not require any scrutiny
    3) The current fee is $13.95 per employee per month – how much need it increase?
    4) To compensate for losses, they are budgeting a 15% reduction in spending
    5) State law prohibits Sacramento from spending or getting any more money
    6) Exec Director Peter Lee said in December that he questions “long term sustainability”
    7) Enrollment in 2015 fell 300,000 short of their goal – growth rate was only 1%
    8) AP reported Covered California took $184 million in no bid contracts related to Peter Lee
    9) Whistleblower Peter Hill was fired after complaining about waste and cover-ups
    10) YELP has 205 reviews on service for Covered California – 185 were only 1 star
    11) 100,000 Covered California customers got wrong or no tax forms
    12) How can anyone complain about service…when they have nowhere else to go?
    13) Churn rate – one third of 2014 enrollees did not re enroll, but were replaced by the same number that was lost

  • It’s Not a Matter of “If,” But “When” You Get Audited By the U.S. Department of Labor | CA Benefits Broker

    June 9, 2015

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    By Bill Olson, Chief Marketing Officer at United Benefit Advisors

    As the saying goes, an ounce of prevention is worth a pound of cure, and that’s definitely the case when it comes to a health plan audit by the U.S. Department of Labor (DOL). And prevention is certainly warranted, according to Jeff Hadden, Partner at LHD Benefit Advisors (a UBA Partner Firm), because it’s not a matter of “if” you’re getting auditaudited, but “when” you get a letter from the DOL that your company is being audited. Hadden said that 12 of their clients received DOL audits of their group health plans in the past 20 years. However, out of those 12 audits, nine of those clients went through the audit process in just the previous two years. That’s a significant increase and a harbinger that more audits are likely to come from the DOL.

    So what exactly is a DOL audit? According to the DOL, the purpose of an audit is not to rehash past mistakes but to look at past events with a view toward improving future performance. Findings from an audit can be used as a basis for adjusting policies, priorities, structure or procedures in order to make operations as efficient, economical and effective as possible.

    What can trigger a DOL audit? Usually it’s one of two things — either a complaint, which leads to an investigation, or it’s totally random. Regarding the former, any audit is not limited in scope to the area of the complaint. The audit may cover all aspects of plan administration, often going back several years. Michael J. Cramer, JD, Compliance Officer at Beneflex Insurance Services (a UBA Partner Firm) emphasizes that you should try to audit-proof your company as best as possible in order to minimize any issues when and if an audit does happen.

    Whenever you do get that letter from the DOL informing you that you’ve been selected to be audited, the following steps should be taken:

    1. Call the DOL phone number. Call the DOL phone number listed on the letter and request an extension. If granted, this additional time is vital and should be used to your advantage to help prepare.
    2. Get specific information about the audit. Contact the auditor to ascertain specific information about the audit 
he or she is going to perform. An important question to ask is what the focus of the investigation will be.
    3. Call your attorney and your broker.

    As the likelihood of an audit from the U.S. Department of Labor increases, UBA is offering new white paper that can help employers prepare:

    • Learn how to audit-proof your company
    • Avoid the worst mistake you can make
    • Conduct a mock audit
    • Get an auditor out of your office as quickly as possible

    Download “Don’t Roll the Dice on Department of Labor Audits” today.

    Topics: DOL, Department of Labor, white papers, Jeff Hadden, Michael Cramer, Audit

    Read More …

  • Preventive Service Requirement FAQ | CA Employee Benefits

    June 5, 2015

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    By: Danielle Capilla
    Chief Compliance Officer at United Benefit Advisors

    PreventiveCareOn May 11, 2015, the Department of Labor (DOL) along with other federal agencies issued an FAQ regarding the implementation of the Patient Protection and Affordable Care Act (PPACA) that focused on coverage of preventive services. Non-grandfathered group health plans and health insurance offered in the individual or group markets must provide certain listed benefits with no cost-sharing to the beneficiary. The FAQ provided information on some commonly confusing or ambiguous requirements.

    BRCA Testing

    PPACA requires health plans to offer evidence-based services with a rating of A or B in the current recommendations provided by the United States Preventive Services Task Force (USPSTF), as well any additional coverage for women provided in guidelines supported by the Health Resources and Services Administration (HRSA). A 2013 FAQ left confusion as to whether the recommendation to provide BRCA screening applies to women who have had a prior non-BRCA-related breast cancer or ovarian cancer diagnosis, even if they are asymptomatic and cancer-free. The DOL clarified that a plan or issuer must cover (without cost-sharing) genetic counseling and BRCA genetic testing for women who have not been diagnosed with a BRCA-related cancer but previously had breast cancer, ovarian cancer, or other specific cancers.

    Contraception

    The FAQ provided information relating to contraception coverage that is applicable to plan years or policies beginning on or after July 10, 2015 (60 days from issuance of the FAQ). It made clear that if a plan or issuer covers some forms of contraception without cost-sharing, but completely excludes other forms of contraception, it will not be in compliance with regulations. Plans and issuers must cover the full range of FDA-identified methods and must cover without cost-sharing at least one form of contraception in each method identified by the FDA. There are 18 FDA-identified methods of contraception for women. The coverage must include clinical services, including patient education and counseling that is needed for the provision of the contraception method.

    Plans and issuers may utilize reasonable medical management techniques. The plan may discourage the use of brand name pharmacy items over generic pharmacy items, or use cost sharing to encourage the use of one of several FDA-approved intrauterine devices (IUDs) with progestin. When utilizing reasonable medical management techniques the plans and issuers must have an easily accessible, transparent, and sufficiently expedient exceptions process that is not unduly burdensome on either the patient or the provider. If an individual’s attending provider recommends a particular service or FDA-approved item based on medical necessity, the item must be covered without cost-sharing and the plan or issuer must defer to the medical provider.

    Sex-Specific Recommended Preventive Services

    The FAQ made clear that plans or issuers may not limit sex-specific recommended preventive services based on an individual’s sex assigned at birth, gender identity, or recorded gender. The decision regarding the medical appropriateness of a preventive service is to be determined by the individual’s attending provider.

    Well-Woman Preventive Care for Dependents

    Plans or issuers that cover dependent children must cover recommended preventive services related to pregnancy, such as preconception and prenatal care for dependent children, without cost-sharing.

    Colonoscopies and Anesthesia Charges

    Colonoscopies that are scheduled and performed as a preventive screening procedure for colorectal cancer pursuant to USPSTF recommendations may not charge the patient for anesthesia services performed in connection with the colonoscopy.

    For this and other free publications related to PPACA compliance, visit UBA’s Compliance Solutions resource center.

    Read More …

  • We saw it coming…emergency room visits are rising under the Affordable Care Act

    June 3, 2015

    With greater access to health care coming due to guarantees under the ACA, it was expected, and now it has come to fruition, that emergency room visits are up. In a survey of 2,000 emergency room physicians, it is claimed that visits have increased markedly. A spokesman said “there was a grand theory the law would reduce ER visits. Well, guess what, it hasn’t happened. Visits are going up despite the ACA, and in a lot of cases because of it”

  • Question of the Month: How is PPACA’s “IRS Form W-2 safe harbor” regarding affordability calculated? | California Benefits Broker

    June 1, 2015

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    By Danielle Capilla
    Chief Compliance Officer at United Benefit Advisors

    PPACA_QuestionQuestion:

    How is PPACA’s “IRS Form W-2 safe harbor” regarding affordability calculated?

    Answer:

    Under PPACA, coverage is considered affordable if it costs less than 9.5 percent of an employee’s household income. Because employers are often unaware of an employee’s household income, there are three safe harbors that an employer can use to determine affordability. One is the “IRS Form W-2 safe harbor,” and under it coverage is affordable if the employee’s contribution for self-only coverage is less than 9.5 percent of his W-2 (Box 1) income for the current year. Box 1 reports taxable income and might be artificially low for an individual with high 401(k), 403(b) or Section 125 deferrals, or who takes unpaid leave. There are no adjustments to account for this.

    Employers using the W-2 safe harbor may not change an employee’s contribution level (dollar amount or percentage) during the calendar year, or the plan year for non-calendar year plans.

    If the employee is only offered coverage for part of a year, an adjustment to W-2 income is made by multiplying the IRS Form W-2 wages by a fraction equal to the number of calendar months for which coverage was offered over the number of calendar months in the employee’s period of employment during the calendar year. (If coverage is offered for at least one day during the calendar month, or the employee is employed for at least one day during the calendar month, the entire calendar month is counted in determining the applicable fraction.)

    The W-2 safe harbor is considered the most flexible, but it is calculated at the end of the year, which does not give an employer the ability to make necessary adjustments. It has shortcomings for employees with significant pre-tax deductions or who take unpaid leave.
    Employers may use different safe harbors for different employee groups, so long as the employee groups are based on reasonable classifications such as hourly or salaried employees, geographic location, and job category.

    Read More …

  • Allowed and Disallowed – Grumbles about Health Insurance Costs Breed New Solutions

    May 29, 2015

    Despite the promises made by politicians, health care and insurance industry prices continue to rise in the aftermath of the Affordable Care Act’s passage. So how can employers cope with rising prices yet take care of employees and provide the best access and coverage for them? Read entire article here.

  • Stop-loss Contract Periods Explained | Petaluma Benefits Broker

    May 29, 2015

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    By Michael Humphrey, MLHR, Sr.
    Employee Benefits Advisor at The Wilson Agency
    A UBA Partner Firm

    ContractIn last week’s blog, we explained the different types of stop-loss insurance. This week we will go over another important aspect of stop-loss: contract periods. Stop-loss contract periods are perhaps the most complicated aspect of understanding how stop-loss insurance works. A contract term will define the period when a claim is incurred and when it is paid. Contract terms are set up as such because claims incurred within a year are often not paid until the next year due to the lag of time between when they are incurred (have the medical appointment) and when the paperwork gets submitted by the provider’s office. Let’s take a look at the three most common types of contracts:

    12/12 – This covers only claims incurred and paid within the policy year. This type of contract is typically only used for the initial year of coverage.

    12/15 – This covers claims incurred within the policy year and paid within three months after the policy year ends. This type of contract is often referred to as a “run-out policy.”

    15/12 – This covers claims paid within the policy year that are incurred during the policy year and the three months before the policy year begins. This type of contract is often referred to as a “run-in policy.”
    When negotiating the terms of the contract, it is extremely important to ensure that the contract period you have chosen will give you adequate coverage. If not, you may end up with thousands of dollars of uncovered claims. Be sure to work with your benefit advisor to ensure coverage issues such as these are identified and preemptively managed.

    Read More …

  • EAP and COBRA explained | Petaluma Employee Benefits

    May 26, 2015

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    www.thinkhr.com

    Information

    Question:
    Is an employee assistance program (EAP) a COBRA-eligible benefit?

    Answer:
    Employee assistance programs (EAPs) that offer medical benefits such as direct counseling and treatment, rather than just referrals for counseling and treatment, are regulated under the Employee Retirement Income Security Act (ERISA) and therefore subject to reporting and notice requirements under the act. Additionally, if the EAP provides direct counseling or other “medical benefits” to its participants, the plan is subject to the Consolidated Omnibus Budget Reconciliation Act (COBRA). If the EAP does not provide services directly, but provides only referrals and facilitation of obtaining these services, then it is not considered a group health plan and is not subject to COBRA regulations. If the plan is subject, the applicable COBRA premium will be based on cost to provide service and employers may rely on the actuarial method. The applicable premium can include an additional administrative fee of 2 percent allowable under the act.

    Read More …

  • Finally Fixed – Medicare no longer on a year to year basis

    May 20, 2015

    For several years Congress has been forced to fix the Medicare “sustainable growth rate formula” so that doctors could continue to receive a fair amount for services performed. Each year there is a threat, begun with the passage of the Affordable Care Act, that doctor fees will be cut by 21%. Doctors aren’t paid substantially by Medicare as it is, and the 21% pay cut threatened access for patients, as many doctors threatened to stop taking Medicare patients. Congress passed a series of one year “fixes” but now the President has signed a bipartisan bill that eliminates the cut once and for all.

  • Two PPACA Taxes Might Get the Ax | CA Employee Benefits

    May 19, 2015

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    By Jennifer Kupper
    In-house Counsel for iaCONSULTING, a UBA Partner Firtaxm

    Health Insurance Providers Fee

    Section 9010 of the Patient Protection and Affordable Care Act (PPACA) imposes a fee on each covered entity engaged in the business of providing health insurance for United States health risks. This is known as the Health Insurance Providers (HIP) fee or the Health Insurers Tax (HIT) tax. The first filings were due from covered entities by April 15, 2014, and the first fees were due September 30, 2014. Self-insured plans are not covered entities for the purpose of the HIP Fee. The HIP fee is an important revenue source for PPACA, amounting to $8 billion in 2014 and rising to $14.3 billion by 2018. While fully insured plans are not directly responsible for the HIP fee, the Congressional Budget Office was correct when it indicated that it would be “largely passed through to consumers in the form of higher premiums.” Some premiums have increased as much as 4.5%.

    Introduced in the House by Rep. Charles Boustany, Jr. (R-La.) and Rep. Kyrsten Sinema (D-Ariz.) on February 12, 2015, for the third time in as many years, H.R. 928 is titled To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act. The bill has one provision: “The Patient Protection and Affordable Care Act is amended by striking section 9010.” There are currently 225 co-sponsors. A similar measure was introduced in the Senate. S. 183, the Jobs and Premium Protection Act, was referred to the Senate Finance Committee and currently has 31 co-sponsors.

    Cadillac Tax

    Internal Revenue Code Section 4980I imposes an excise tax on “high cost plans” effective 2018. This tax is commonly known as the “Cadillac Tax,” dubbed for its fee on “richer” benefits.

    Generally, and one must speak generally because regulations have not been issued, if a group health plan’s cost for applicable coverage goes beyond the statutory thresholds, then a 40% excise tax will be assessed on the excess amounts. The annual thresholds are $10,200 ($850per month) for individual coverage and $27,500 ($2,291.67 per month) for coverage other than individual coverage. The Cadillac Tax applies to fully insured and self-funded plans.

    It is reported that nearly half of employer-sponsored health plans could trigger the tax. One reason for this is that larger groups must sponsor a base plan that meets minimum value in order to avoid a potential PPACA Employer Shared Responsibility tax (IRC Section 4980H(b)). Another reason is that “applicable coverage” includes major medical coverage, including prescription drug costs; contributions to medical flexible spending accounts (FSAs), health savings accounts (HSAs), health reimbursement arrangements (HRAs), and Archer medical savings accounts (MSAs), if certain conditions are met; coverage for on-site medical clinics; retiree coverage; coverage only for a specified disease or illness; and hospital indemnity or other fixed indemnity insurance.

    On February 11, 2015, Rep. Frank Guinta (R-N.H.) introduced H.R. 879, Ax the Tax on Middle Class Americans’ Health Plans Act. The bill has 31 co-sponsors and was referred to the House Ways and Means Committee.

    Read More …

  • Proposed Rule on Wellness Programs under the Americans with Disabilities Act | CA Benefits Broker

    May 14, 2015

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    By Danielle Capilla,
    Chief Compliance Officer at United Benefit Advisors

    apple and tapeFederal agencies recently released a Proposed Rule to amend regulations and provide guidance on implementing Title I of the Americans with Disabilities Act (ADA) as it relates to employer wellness programs.

    Title I of the ADA applies to employers with 15 or more employees, prohibits discrimination against people with disabilities, and requires equal opportunity in promotion and benefits, among other things. Under the Proposed Rule, wellness programs that are part of or are provided by a group health plan or by a health insurance issuer (carrier) offering group health insurance in conjunction with a group health plan are required to provide a notice and describe the use of incentives. In the Proposed Rule, “group health plan” refers to both insured and self-insured group health plans. All of the other proposed changes relate to “health programs,” which include wellness programs regardless of whether they are offered as part of or outside of a group health plan or group health insurance coverage. The term “incentives” includes financial and in-kind incentives for participation such as awards of time off, prizes, or other items of value.

    Rules for wellness programs have been in effect since 2007, with additional rules that went into effect for the 2014 plan year under the Patient Protection and Affordable Care Act (PPACA). Wellness programs are either “participatory” or “health-contingent.” A participatory program is one that either has no reward or penalty (such as providing free flu shots) or simply rewards participation (such as a program that reimburses the cost of a membership to a fitness facility or the cost of a seminar on nutrition). As long as a participatory program is equally offered to all similar employees, no special requirements will apply to the program.

    Health-contingent wellness programs are either classified as “activity only” or “outcome based.” Health-contingent wellness programs are programs that base incentives or requirements in any way on an employee’s health status. Health status includes things like body mass index (BMI), blood glucose level, blood pressure, cholesterol level, fitness level, regularity of exercise, and nicotine use. A wellness program with health-contingent requirements must meet all of these requirements:

    • Give employees a chance to qualify for the incentive at least once a year
    • Cap the incentive at 30 percent of the total cost of employee-only coverage under the plan, including both the employee and employer contributions, with a 50 percent cap for tobacco cessation or reduction
    • Be reasonably designed to promote health or prevent disease
    • Provide that the full reward must be available to all similarly situated individuals with a “reasonable alternative” method of qualifying for the incentive for some individuals
    • Describe the availability of the alternative method of qualifying for the incentive in written program materials

    The ADA restricts employers from obtaining medical information from employees by generally prohibiting them from making disability-related inquiries or requiring medical examinations, with an exception for voluntary medical examinations for wellness programs. The Proposed Rule announced that federal agencies decided that allowing certain incentives related to a wellness program, while limiting them to prevent economic coercion that could make the program involuntary, is the best way to achieve the purposes of the wellness program provisions of both the ADA and HIPAA.

    Download UBA’s PPACA Advisor, “Proposed Rule on Wellness Programs Under the Americans with Disabilities Act” for comprehensive information on how the Proposed Rule:

    • Defines “voluntary”
    • Addresses the disclosure of medical information
    • Limits incentives
    • Defines when smoking cessation programs would be subject to incentive limitations
    • Would protect individually identifiable health information

    The Proposed Rule requested comments from the industry on wellness programs generally as well as providing a list of specific topics on which it seeks input.

    Read More …

  • Wellness rules…well, we had them but EEOC went back to the well

    May 13, 2015

    The EEOC has made a series of proposed rules, attempting to clarify what does and does not constitute a permissible wellness program in light of ADA (Americans with Disabilities Act) and due to a recent series of dustups where the EEOC has ruled that the wellness programs run by some companies were not meeting what they considered to be proper standards. The proposal makes some changes to current rules:

    1) Program must be reasonably designed to promote health or prevent disease – thus it must not be overly burdensome or a subterfuge for violating the ADA

    2) To be truly voluntary an employer cannot require an employee to participate in such a program and may not deny coverage under any of its group health plans or limit the extent of such coverage, nor take any adverse action against employees who refuse to participate

    3) Employer must provide a notice clearly explaining what medical information will be obtained, how used, who will receive it and the methods used to prevent disclosure

    4) Incentives for participation are acceptable provided the total allowable incentive available under all programs does not exceed 30% of the total cost of employee only coverage which generally is the maximum allowable incentive available under HIPAA and the ACA

    5) Medical information collected through an employee health programs may only be provided to a covered entity under the ADA in aggregate terms so as to protect the identity of specific individuals

  • Region Matters When It Comes to HSA Funding, CDHP Adoption | CA Employee Benefits

    May 12, 2015

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    By Bill Olson
    Chief Marketing Officer at United Benefit Advisors

    regionWe’ve already discussed Health Savings Account (HSA) activity at length, looking first at the correlation between generous HSA contributions and increased enrollment in consumer-driven health plans (CDHPs). Second, we looked at how HSAs have performed in recent years across different industries. Now, we’ll look closer at HSA activity across different regions of the country, based on the results of the 2014 UBA Health Plan Survey.

    New England, which typically has the most generous health care packages overall, sees only average HSA contributions of $685 for singles and $1,342 for families. California, on the other hand, has the most generous HSA contributions for singles at $808, yet the lowest enrollment in CDHPs: only 11.3 percent of plans in California were CDHP plans and only 8.1 percent of employees were enrolled in them.

    “Market dominance of Kaiser and a strong HMO preference in California offsets the rate relief offered by CDHPs, making the high deductible not worthwhile,” says Brian M. Goff, President & CEO of Insurance Solutions, a UBA Partner Firm.

    Moving to the middle of the country, we find the lowest HSA employer contributions in the South Central region: $360 for singles and $554 for families. North Central states, which have the highest offering of CDHP plans in the country at 36 percent with more than 40 percent of employees enrolled in such plans, also saw average HSA contributions, although still more than South Central.

    “Since the North Central region is largely comprised of Anthem BCBS states, carrier motivations play into these stats,” says Mark Sherman, Principal of LHD Benefit Advisors, another UBA Partner Firm. “Specifically, low regional interest in HMOs and Anthem BCBS’ purchase of Lumenos, a CDHP marketing specialist, made it easy for employers to move from a PPO to a CDHP.”

    “In the Midwest, we still see some employers continuing to offer higher HSA contributions or lower premium contributions as a way to entice employees to these cost-saving plans,” says Andrea Kinkade, President/Benefit Advisor at UBA Partner Firm Kaminsky & Associates, Inc. “At the end of the day, employers typically have a budget that they work within,” says Kincade. “Either employee payroll deductions (premiums) increase or employer HSA contributions decrease to keep benefit costs within the budget.”

    For the latest health plan cost trends, download the UBA Health Plan Survey Executive Summary. To benchmark your plan to others in your region, industry or size bracket, contact a UBA Partner near you to run a custom benchmarking report.

    Read More …

  • Integrated Community Services | Arrow Benefits Group

    May 7, 2015

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    ICS

    We are very excited to announce that Arrow Benefits Group was one of the sponsors in the recent Blue Jean Ball fundraiser at the San Rafael Marin JCC recently.  The Integrated Community Services’ mission is to provide a wide range of community based services for individuals with disabilities.  They help with employment, housing, recreation or simply just information. ICS are a distinguished local non profit agency with whom Arrow Benefits are proud to be in partnership with.

    If you would like to learn more about what the ICS accomplishes or if you would like to donate to help them continue their work, please click here.

  • Top 5 Questions about Medicare Secondary Payer Rules | California Benefits Broker

    May 4, 2015

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    By Danielle Capilla
    Chief Compliance Officer at United Benefit Advisors

    medicareUnder federal regulations, Medicare is a secondary payer for many individuals who have an employer group health plan available to them, either as an employee or the dependent spouse or child of the employee. Generally the Medicare Secondary Payer rules prohibit employers with more than 20 employees from in any way incentivizing an active employee age 65 or older to elect Medicare instead of the group health plan, which includes offering a financial incentive. Although premium payment arrangement rules under the Patient Protection and Affordable Care Act (PPACA) provide a limited circumstance for reimbursing Medicare premiums, this option is not feasible for employers with more than 20 employees due to Medicare Secondary Payer rules.

    Q1. Who is affected by Medicare Secondary Payer rules?

    A1. Medicare-eligible individuals age 65 or over whose employer group health plan is based on the current employment of the individual or spouse, by an employer that employs 20 or more employees, are protected by the Medicare Secondary Payer rules unless the active employee elects Medicare. Health insurance plans for retirees, or spouses of retirees, are not affected because retirement is not “current employment.” Individuals who are eligible for Medicare based on disability or end-stage renal disease (ESRD) are also affected.

    Q2. What are employers with 20 or more employees required to offer their Medicare-eligible older employees?

    A2. Employers are required to offer employees age 65 or over the same group health plan coverage offered to younger workers. Workers with Medicare-eligible spouses must be offered the same spousal benefits as employees with spouses that are not Medicare-eligible.

    Q3. Are employees who are Medicare eligible required to elect their group health coverage or Medicare?

    A3. Employees can elect, at their discretion, Medicare or the group health plan as their primary health insurer. Employees that elect their group health plan will then have secondary Medicare coverage if they enroll in Medicare. Their employer cannot induce them or provide incentives to select Medicare as their primary coverage.

    Q4. If an employee elects Medicare as his or her primary insurer, may the employee enroll in a group health plan for secondary coverage?

    A4. No, this is prohibited.

    Q5. How does Medicare know if an individual has the option of enrolling in a group health plan through their employer?

    A5. The Centers for Medicare and Medicaid (CMS) mails questionnaires to individuals before they become entitled to benefits under Medicare Part A or enroll in Medicare Part B to determine if they are eligible for primary coverage under another plan.

    For more of the top questions and answers about reporting requirements, determining if you have 20 employees for Medicare Secondary Payer purposes, whether you can reimburse Medicare premiums, and penalties for rule violations, view UBA’s PPACA Advisor, “What You Need To Know About Medicare Secondary Payer Rules”.

    Read More …

  • Wraparound Excepted Benefits to Launch with Two Pilot Programs | CA Employee Benefits

    April 27, 2015

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    By Danielle Capilla
    Chief Compliance Officer at United Benefit Advisors

    ChangesAheadHealth plan sponsors would be permitted to offer wraparound coverage to employees purchasing individual health insurance in the private market, including the Marketplace, in limited circumstances, under a new Final Rule issued by the Department of Labor (DOL) and other federal agencies. The Final Rule, published March 18, 2015, sets forth two narrow pilot programs for the limited wraparound coverage. One pilot program allows wraparound benefits only for multi-state plans (MSPs) in the Health Insurance Marketplace. The second pilot program allows wraparound benefits for part-time workers who enroll in an individual policy or in Basic Health Plan (BHP) coverage for low-income individuals, which was established under the Patient Protection and Affordable Care Act (PPACA). The wraparound coverage would be an excepted benefit. Excepted benefits are generally exempt from certain requirements of federal laws, including ERISA, the IRS Code, and parts of PPACA.

    General requirements. To be allowable by either pilot program, the wraparound coverage must be specifically designed to provide meaningful benefits such as: (1) coverage for expanded in-network medical clinics or providers; (2) reimbursement for the full cost of primary care; or (3) coverage of the cost of prescription drugs not on the formulary of the primary plan. The limited wraparound coverage must not provide benefits only under a coordination-of-benefits provision and must not consist of account-based reimbursement arrangements.

    The annual cost of coverage per employee (and any covered dependent, defined as any individual who is or may become eligible for coverage under terms of a group health plan because of a relationship to a participant) must not exceed the greater of: (1) the maximum permitted annual salary reduction contribution toward health flexible spending arrangements (FSAs) ($2,550 for 2015); or (2) 15 percent of the cost of coverage under the primary plan, including both employer and employee contributions toward coverage. The wraparound coverage is also subject to non-discrimination rules that prohibit preexisting condition exclusions, favoring of highly compensated individuals, and discrimination based on health status.
    For more information on MSP coverage standards, part-time employee standards, reporting and qualifying dates for the pilot programs, download UBA’s free PPACA Advisor, “Wraparound Excepted Benefits to Launch with Two Pilot Programs”.

    Read More …

  • Industry Differences Among Health Savings Accounts | CA Benefits Broker

    April 24, 2015

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    By Bill Olson
    Chief Marketing Officer at United Benefit Advisors

    While recent survey data shows that, on average, employers are decreasing the amount they’re willing to contribute to employee Health Savings Accounts (HSAs), there are some industries that have not seen such trends.

    On average, employees saw a 10 percent decrease in their average single HSA employer contribution from the previous year, from $574 in 2013 to $515 in 2014. Employees in the public and government sectors, however, continued to have the most generous HSA contributions, at $791 for singles and $1,431 for families. Conversely, workers in the following industries see the lowest average single employer contributions toward HSAs: food services ($279), retail ($323), wholesale ($398), construction ($434), health care/social assistance ($472), and mining/oil and gas extraction ($831).

    Some may see these trends as counterintuitive. However, upon further examination, it becomes clear how employers are using HSAs to supplement plans and drive employees where they ultimately want them, which is toward cost-saving consumer driven health plans (CDHPs). The link between CDHPs and HSAs helps explain industry differences in health plan costs, but demographic differences are also a part of the story.

    “Construction companies typically hire young men who demographically don’t place a lot of value in benefits. Government, on the other hand, has traditionally substituted salary for benefits; one way to move those employees off an expensive plan is to fully fund their deductible,” says Brian M. Goff, President & CEO of Insurance Solutions, a UBA Partner Firm. “But carrier motivations can also be at play. Some carriers give a certain premium discount to go to the high deductible plan. So if you have a low premium, i.e., construction because of a young male demographic, the premium may only come down $800 a year to add a $1,500 deductible. On the other hand, take a nursing home that has expensive premiums, the savings may be $1,700 to add a $1,500 deductible, making it a no-brainer to switch to an HSA plan.”

    The strategy of attracting employees to CDHP plans with generous HSA contributions has worked in the finance and insurance industry as well, where 32.3 percent of plans are CDHPs (the highest of any industry) and enrollment is 32.1 percent (also the highest enrollment of any industry). HSA contributions in the finance and insurance industry are at $634 for singles and $1,074 for families, 20.7 percent and 18.7 percent above average, respectively.

    The opposite trend can be seen in the mining/oil and gas extraction industry, however, where only 16.7 percent of plans offered are CDHPs, and employer HSA contributions are also among the lowest. Correspondingly, CDHP enrollment in this industry is a mere 8.5 percent.

    HSAFunding

    For the latest health plan cost trends, download the UBA Health Plan Survey Executive Summary. To benchmark your plan to others in your region, industry or size bracket, contact a UBA Partner near you to run a custom benchmarking report.

    Read More …

  • Health Checklist for Men Over 40 | California Employee Benefits

    April 21, 2015

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    By Stacey Anderson
    www.livestrong.com

    ripe red apple with green leaf isolated on whiteCompared to women, men tend to drink more, suffer more from stress and seek medical advice less often. However, men are also living longer and their lifespan is catching up to women. Make sure that your later years are as healthy as possible. As you age past 40, following health recommendations from organizations like the National Institutes of Health is a good way to take control of your health.

    Vaccinations

    Vaccinations are not just for the young, according to MedlinePlus. Consider a one-time vaccination for herpes zoster, which can cause shingles, after age 60. Your doctor might suggest a yearly flu vaccine over the age of 50 and a one-time pneumococcal vaccine after age 65. This latter vaccine protects against the most common cause of pneumonia in older individuals. Health officials recommend booster shots for tetanus-diptheria-pertussis every 10 years.

    Abdominal Aortic Aneurysm

    If you have smoked more than 100 cigarettes in your lifetime, schedule an abdominal ultrasound at age 65 to screen for an abdominal aortic aneurysm. Using high-frequency sound waves, the ultrasound can look for bulges in the main artery in your abdomen. This bulge can indicate an aneurysm. Treatment varies from watchful monitoring of the aneurysm to emergency surgery, depending on its size.

    Heart Health

    High blood pressure and high cholesterol raise your risk for heart disease and strokes. Normal blood pressure is less than 120 systolic and 80 diastolic, or 120/80. Have your blood pressure checked at least every two years if it is in this range. If your blood pressure is higher than 140/90, see your doctor as often as he recommends. Your doctor will likely recommend a blood test for cholesterol after age 40, especially if you have a family history of high cholesterol or heart disease. Your doctor may also include a measurement of your triglyceride levels. Repeat your cholesterol tests every 5 years, according to MedlinePlus.

    Colon Cancer Screening

    Unless you have a family history of colon cancer or personal risk factors like polyps or inflammatory bowel disease, screening for colon or rectal cancer typically begins at age 50. A number of screening tests are available to look for cancer or for treatable precancerous changes. This includes testing a stool sample looking for blood, the fecal occult blood test, or for DNA mutations, also known as a stool DNA test. Using a colonoscopy or sigmoidoscopy your doctor views the colon to look for suspicious areas and take samples for biopsy.

    Prostate Exam

    Enlargement of the prostate can cause urinary problems as one of the first symptoms. This enlargement can be benign, or a sign of prostate cancer. After age 40, your doctor will recommend a yearly digital rectal exam to feel the prostate gland and check for abnormalities. The prostate-specific antigen, or PSA, test is another screening method. This blood test measures levels of PSA, with high levels possibly indicating cancer.

    Diabetes

    As you age your risk for Type II diabetes increases. Screening for diabetes, using a fasting blood glucose test or blood A1C test, should begin at age 45. Generally, repeat screening is every 3 years although your doctor might recommend a more frequent screening schedule depending on your risk factors.

    Other Screening Tests

    Get your hearing tested every 10 years after age 40 and every 3 years after age 50. Mental health screening for dementia and Alzheimer’s disease is available if you or your family is concerned about your decision-making ability or possible memory loss. Over the age of 40, you might find yourself divorced and newly dating. Discuss sexually transmitted disease screening, including an HIV test, with your doctor. This is especially important if you are going to begin a new sexual relationship.

    Eye Health

    Treatable eye diseases can cause blindness if you ignore symptoms for too long. In addition to checking your visual acuity, your eye specialist will examine your eyes for signs of glaucoma, macular degeneration and cataracts. Your risk for these eye conditions increases after age 40. The recommendations for eye checkups are every 2 years after age 40, according to MedlinePlus.

    Read More …

  • Arrow Benefits Group Wellness Series Makes the News

    April 17, 2015

    Andrew McNeilArrow Benefits Group principal Andrew McNeil was interviewed in an article for The North Bay Business Journal about a collaboration with St. Joseph Health, Petaluma Health Care District, and Whole Foods to offer free wellness programs.

     

     

     

     

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  • Congress Taking (Small) Steps for Employee Wellness Programs | CA Benefits Broker

    April 9, 2015

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    By Jennifer Kupper

    The Patient Protection and Affordable Care Act (PPACA) specifically encourages and promotes the expansion of wellness programs in both the individual and group markets. In the individual market, the secretaries of the Capitol Building, Washington DCdepartments of Health and Human Services (HHS), Treasury, and Labor are directed to establish a pilot program to test the impact of providing at-risk populations who utilize community health centers an individualized wellness plan that is designed to reduce risk factors for preventable conditions as identified by a comprehensive risk-factor assessment. Results will be compared against a controlled group.

    In the group market, the secretaries are directed to establish a multi-state, employer-sponsored, health-contingent wellness program demonstration project. The objectives are to determine the effectiveness of employer-sponsored, health-contingent wellness programs, the impact of wellness programs on the affordability and access to care for participants versus non-participants, the impact of cost-sharing and incentives on participant behavior, and the effectiveness of other types of rewards.

    There is, however, a huge disconnect within the administration. This is exemplified by the Equal Employment Opportunity Commission’s (EEOC) revived attacks and recent litigation against employers who sponsor presumably PPACA-compliant wellness programs. Employers are waking up to the sad facts that the risk in sponsoring health-contingent wellness programs is mounting, the EEOC remains silent in providing guidance*, and the corporate wellness industry is in quandary.

    In response to the recent litigation, two parallel bills were introduced the first week of March (S. 620/H.R. 1189). With less than a 2% chance of being enacted, Mr. Lamar Alexander (R-Tenn.) of the Senate and Mr. Jon Kline (R-Minn.) of the House introduced the Preserving Employee Wellness Programs Act (the legislation). The purpose of the legislation is “[t]o clarify rules relating to nondiscriminatory employer wellness programs as such programs relate to premium discounts, rebates, or modifications to otherwise applicable cost sharing under group health plans.”

    The legislation would allow employers to implement workplace wellness programs or employer-sponsored, health-contingent programs without the fear of running afoul of the Americans with Disabilities Act (ADA) and its amendments (ADAAA) or Genetic Information Nondiscrimination Act (GINA), so long as the wellness programs operated pursuant to the Health Insurance Portability and Accountability Act (HIPAA) nondiscrimination and wellness regulations.

    The legislation also provides that a sponsoring employer can establish a deadline of up to 180 days for employees to request and complete a reasonable alternative standard (or waiver of the otherwise applicable standard). Further, the legislation affirms that the employees’ spouse and family members can participate and would have the same protections afforded as an employee-participant. In other words, medical history and biometric information of participating family members would not be an unlawful acquisition under GINA.

    * On March 20, 2015, the EEOC voted to send a Notice of Proposed Rulemaking (NPRM) on the interplay of the ADA and PPACA with respect to wellness programs to the White House Office of Management and Budget (OMB) for clearance.

    For more data on wellness program features employers are using, download the 2014 Health Plan Executive Summary. This survey – which has been conducted every year since 2005 – is the nation’s largest health plan survey and provides more accurate benchmarking data than any other source in the industry. You can also contact a UBA Partner Firm for a customized benchmark report based on industry, region and business size.

    Topics: wellness, employee benefits, wellness programs, PPACA Affordable Care Act, 2014 Health Plan Survey

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  • Keith McNeil Quoted in Business Journal

    April 6, 2015

    Published today in The North Bay Business Journal, Arrow Benefits Group Partner Keith McNeil is quoted in an article about the rising trend of workplace wellness programs.

    “…

    Providing wellness programs for employees is also a way for larger companies to lower their insurance rates.

    “Once you get over 50 employees, the insurance company will look at the claims and lower the rate,” said Andrew McNeil, principal with Arrow Benefits Group in Petaluma. “It takes between three and five years of offering the programs to see any return on investment, however, and that can be an eternity for small employers.”

    The majority of larger companies Arrow works with have wellness programs in place, McNeil said. Many small businesses (under 50 employees) don’t implement wellness programs as the program itself cannot directly affect the monthly health insurance premium. That’s because the premiums are a pooled risk, and filed by the health plans with the State of California. (The under 50 employees definition changes to under 100 employees in 2016.)

    Still, while small employers that offer a wellness program can’t impact the cost of their group health insurance, a well-designed wellness program has the potential for reducing absenteeism as well as increasing employee morale. Larger employers that offer a wellness program may see over time a reduction in their medical rates (assuming the wellness program is implemented correctly) as the medical rates are tied to the overall health risk of the employees and their covered dependents, especially if the wellness program is targeted to specific medical problems such as obesity.

    …”

  • Supreme Court Hears Oral Argument in Subsidy Eligibility Battle | CA Health Insurance

    April 6, 2015

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    By Danielle Capilla, Chief Compliance Officer at United Benefit Advisors

    On March 4, 2015, the U.S. Supreme Court heard oral arguments in King v. Burwell, a case that centers on the meaning of statutory language in the Patient Protection and Affordable Care Act (PPACA). At question in the case is http://ubabenefits.hs-sites.com/blog/supreme-court-hears-oral-argument-in-subsidy-eligibility-battlewhether or not the Internal Revenue Service (IRS) may issue regulations to extend tax-credit subsidies to coverage purchased through health Exchanges established by the federal government via the Department of Health and Human Services (HHS) under Section 1321 of PPACA.

    The ruling from the court is expected in late May or June of 2015. The case involves challenges to the IRS ruling that individuals are eligible for the premium subsidy regardless of whether their state has a state-run or federally-run Marketplace or Exchange. In King, a lower court held that the current IRS interpretation of Section 36B, which provides for premium tax credits to anyone who purchases insurance on any Exchange, is reasonable. Conversely, another court, in a case called Halbig v. Burwell, held that, based on the way the law is written, the subsidies should only be available to people living in a state with a state-run exchange. As we await the decision, employees will still receive premium subsidies and employers should continue preparations to meet the employer-shared responsibility/”play or pay” requirements.

    For more information on this case, download UBA’s free PPACA Advisor, “Supreme Court Hears Oral Argument in Subsidy Eligibility Battle“.

    For upcoming analysis on this case by UBA Partners, subscribe to the UBA blog.

    Topics: health insurance exchanges, PPACA Affordable Care Act, Play or Pay, health care subsidies, employer shared responsibility, tax-credit subsidy

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  • We’re in the Top 500!

    April 2, 2015

    NorthBayBiz2015-1

    We’re really proud to be included in this year’s NorthBay biz’s “The Top 500 Annual Listing of Top Ranking Businesses” in Napa, Marin, and Sonoma Counties.

    Here’s the link to the complete list The Top 500.

  • Republicans feel that the Democrats hatched a conspiracy and lost too much on the ACA | California Employee Benefits

    April 1, 2015

    Orrin Hatch, the chairman of the Senate Finance Committee, says they have found at least $5.7 billion inn wasted ACA related spending over the last five years. The analysis includes an estimated $2 billion it took to repair HealthCare.gov, $1.3 billion spent on now defunct state exchanges and a $2.4 billion co op program, which included 24 plans but saw little success with sign ups.

    Jordan Shields

  • Growing Pains: Why Adolescence Is About To Get That Much Harder | Arrow Benefits Group

    March 24, 2015

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    By Elizabeth Kay, Compliance & Retention Analyst, AEIS Advisors

    Employers that are growing up, and are in the awkward teenage years, are about to get a big surprise, and not the good kind.

    When a company first opens, they are excited when they first implement their benefit plans for their handful of employees. They offer one or two medical plans, perhaps some dental and vision, and a small life insurance policy. thinking manThe company knows that the small group rates will be high, but not much can be done, so they live with it. The rates are based on the employee’s age and where the company is located. They rely on their broker to show them the different options and help them offer plans with the best value to their employees.

    Then the company starts to grow. They hire a few more employees, they have to look at making their benefit offerings richer so they can be leveraged to recruit new talent and retain the talent they have, and they have to begin concerning themselves with additional requirements such as the Consolidated Omnibus Budget Reconciliation Act (COBRA). The rates are still the rates; still high, but manageable. They may experience some discomfort that comes with growing up, but nothing that they are not able to overcome.

    As the company ages and continues to grow, they may come to the awkward teenage years; when they are almost up to 50 employees, or slightly more than 50 employees. Not really a “young” company, but not yet a well-established “adult,” and the growing pains become more noticeable. Now they have to be concerned with the Family and Medical Leave Act (FMLA), sexual harassment prevention training, and whether or not to move to an online human resource information system (HRIS) and benefits enrollment system to make onboarding of employees easier.

    In addition, once they exceed 50 employees, they can move away from small group medical insurance to mid-market or large group medical insurance plans. These plans are composite rated instead of rated on the employee’s age. And once a group is that size the carrier can collect more claims data and rate their plans based on that data, instead of the larger pool of clients/members that are used to rate small groups, which may lead to lower rates.

    The Patient Protection and Affordable Care Act (PPACA) has changed the rules slightly and it will mean the growing pains of adolescence for these companies are going to last even longer and require some strategic planning for 2015 and 2016. The PPACA is changing the classification of small group from 2 to 50 employees to 2 to 99 employees beginning in 2016. Employers of 50 or more employees still have to comply with the employer-shared mandate (“play or pay”), even though they will be considered to be a small group. But that is not the biggest growing pain.

    For those companies that currently have more than 50 employees, and have a medical plan with composite rates, they will be moved back to rates based on the employee’s age and location of the company at their plan’s renewal in 2016. Now, why is this such a big deal? They have experienced age banded rates before, right?

    Well, for companies with a diverse workforce, with some younger employees, and others that are more seasoned, they are now going to be paying very different premiums for each demographic where they used to pay the same rate, no matter their age. In addition, community rating under PPACA is different from the age banded rating they had before. Previously, employee rates were determined by the age band the employee fell into. For example, 30 to 39, 40 to 49, 50 to 54, etc. Then, if the employee enrolled any dependents, there was a rate for their dependents that was generated based on the age bracket the employee fell into, and an employee with their spouse and one child had the same rate as an employee with their spouse and three children if the employees were in the same age bracket.

    But community rating means that every employee is rated based on their actual age, not on a range of years, and each dependent in a family has their own rate, based on their individual age as well. There is one rate for ages 0 to 18, an individual rate for ages 19 to 64, and one rate for ages 65 and older. Please see the examples of John Doe and Jane Smith below comparing pre-PPACA age banded rating to PPACA community rating.

    Name / Age Pre-PPACA
    Rating
    Employee +
    Family Age
    40 to 49
    PPACA
    Community
    Rating
    Name / Age Pre-PPACA
    Rating
    Employee +
    Family Age
    40 to 49
    PPACA
    Community
    Rating
    John / 43    $900      $356 Jane / 45    $900      $365
    Spouse / 40     N/A      $349 Spouse / 49     N/A      $400
    Child #1 / 12     N/A      $250 Child #1 / 20     N/A      $275
    Child #2 / 10     N/A      $250 Child #2 / 17     N/A      $250
    Child #3 / 15     N/A      $250
    Total
    Premium
       $900    $1,205 Total
    Premium
       $900    $1,540

     

    As you can see, under the old age banded rating, both John and Jane were paying the same rate, as they both had families, and each were in the 40 to 49 age bracket.

    Under the PPACA community rating for small groups, their rates become very different because they are rated not only on their individual ages, but are also paying a separate rate for each dependent based on their ages.

    Now, let’s look at it from another angle. Michael and Jennifer worked for a company that moved from age banded rates in 2014, to a composite rated plan in 2015, when they grew to have more than 50 employees. Jennifer was happy, but Michael was not. Let’s see why in the example below.

    Name / Age Pre-PPACA
    Rating
    Employee +
    Family Age
    30 to 39
    Composite
    Rating
    Name / Age Pre-PPACA
    Rating
    Employee +
    Family Age
    50 to 54
    Composite
    Rating
    Michael / 31     $950    $1,150 Jennifer / 53    $1,450   $1,150

     

    As a result of the averaged rating under composite rates, Michael had a rate increase and Jennifer had a rate decrease.

    Now, imagine being Michael or Jennifer, working for a company that is still in its “adolescence.” The company is still growing, but not yet to a size of 100 employees going into 2016. So they moved from age banded rates in 2014 to composite in 2015, only to have to move back to community rating in 2016. Talk about feeling like a yo-yo!

    Then to add insult to injury, they will most likely have to pay even more in premiums as they will be rated on each individual of their family that they enroll in the plan.

    It is because of these changes in the insurance industry that make having a trusted advisor to walk companies through these significant changes, and to help strategize and prepare for them, is so important. Many businesses are being blindsided by the significant increase in premiums the community rating structure is causing and employees who are required to pay a portion of their premiums are being blindsided as well.

    For companies who are still in those awkward teenage years in 2015, where they have more than 50 employees, but fewer than 100, they will need to determine if they want to risk moving to a composite rated plan for 2015. Will they be at 100 employees or more at their renewal in 2016? If it is not clear they will be that large, they may want to stay on an age rated, mid-market plan for another year, or risk major disruption for their employees in 2016.

    For those companies in a state where composite rates are the norm, even for small group, they will need to plan ahead. The employer contribution strategy will most likely need to change from a flat contribution to a percentage so that older employees are not hit with a higher rate increase than the younger employees. The employees of companies with 2 to 100 employees should be educated by their employer about what is coming down the line so that they can have time to prepare themselves and their families.

    As an advisor to our clients, we may not always deliver the news that our clients want to hear, but knowledge is power, and it is our duty to give them the information they need to make the necessary decisions, and to plan ahead for the sustainability and growth of their companies so they can mature into adulthood.

    For information to help you determine if you are a small or large employer under PPACA, request UBA’s PPACA Advisor: “Counting Employees Under PPACA

    Topics: ACA, employee benefits, PPACA, COBRA, The Patient Protection and Affordable Care Act, community rating, composite rating, small group insurance

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  • From Keith’s Keyboard | Taking Part in the Healthcare Solution March 2015

    March 13, 2015

    Washington, D.C.—I recently attended the National Association of Health Underwriters (NAHU) annual “fly in” event, where employee benefits specialists meet for two days and then see the offices of their respective Senators and members of Congress. In reality, it is rather rare to actually meet the member, but instead, the meeting is usually with one of the administrative aides. That can actually be a good thing, since the aides often have more expertise on the subject at hand.

    The preliminary NAHU meetings often have high-level members of Congress and the Administration in attendance, and it is thus possible to get a closer look at the employee benefits laws as they are considered and debated in Washington.

    Keynote speaker, Senator Tim Scott (R-SC), a former insurance broker, gave an excellent talk on the role of the agent in healthcare reform. There were a number of excellent breakout talks including one by Dr. Tim Church, Chief Medical Officer of ACAP Health Consulting. His expertise on the importance of structured weight loss in any wellness plan was well presented. The potential medical costs due to the obesity epidemic are frightening, and his company specializes in that phase of overall employee wellness.

    “How We Can Offer More Transparency in Medical Costs” was a key conference topic. Suzanne Delbanco of Catalyst for Payment Reform spoke about what is being done nationally and how far we have to go. We are still at the beginning stages of this national debate, but progress is being made. As more and more Americans purchase high deductible health plans with Health Savings Accounts (HSAs), the need for accurate, comparative health cost data is more important than ever.

    After the meetings, we headed off to Capitol Hill. I met with one of the legislative aides for Congressman Jared Huffman. It is a small world, because the legislative aide is the nephew of an Arrow client. Beyond discussing legislative issues of the day, we offered our services to their constituents who may need help navigating the maze of healthcare reform today. In the past, I have also met with the legislative aides of Congressman Mike Thompson. But, the timing did not work to see them this trip, so I left the information for them.

    Walking the halls of Congress is really an eye-opening experience; the offices are actually fairly small, situated in buildings with names such as Longworth, Cannon, Russell, and Rayburn. Once past security, it is possible to travel underground to other buildings through tunnels. Nearby is the Supreme Court, the Library of Congress, and of course, the United States Capitol building.

    Back home we deal with healthcare issues every day but it is helpful, I believe, to annually visit Washington, D.C., to try to be part of the solution at the political level as well.

  • HR/Benefits Group First to Launch Wellness Trainings Donated to Community

    March 11, 2015

    For Immediate Release
    Contact: Jenny Kaplan, JKC
    Kaplan@jkaplanpr.com
    707-578-1336

    Partners with St. Joseph Health, Whole Foods Market and Petaluma Health Care District

    Petaluma, CA – Arrow Benefits Group, the 3rd largest HR/benefits Company in the North Bay, announces its Community Wellness Series. They are the first local business to partner with healthcare industry leaders to donate trainings and lectures on health and wellbeing. Their goal is to offer a variety of tools and techniques that will vastly improve the lives of the attendees. They’ve partnered with St. Joseph Health for one-of-a-kind Work@Health® lectures focused on teaching a variety of proven methods for vastly improving overall health at work. The event will be a fun and engaging evening including delicious wine and refreshments. The lively presentation will be led by Jeannie Calverley, Director of Employer and Community Relations and Teresa Scott, Population Health Specialist for St. Joseph Health on Tuesday March 24th, 2015 at 4:00 – 5:30 PM in the new Arrow Benefits training room. Space is limited and first come first serve – please contact Andrew McNeil at 707-992-3789 or AndrewM@arrowbenefitsgroup.com ASAP for details and to reserve seats.

    The idea for the Wellness Series was sparked by inquiries from clients who were looking for support for health related issues. “Arrow Benefits Group is excited to launch this Wellness Series and we’re especially honored to have St. Joseph Health partner with us,” says Andrew McNeil, Principal at Arrow Benefits Group. “We started this program because we’re interested in supporting the community and we’ve planned numerous trainings throughout the year with both St. Joseph and several other industry experts.” In May, Arrow will welcome Whole Foods Market Healthy Eating Specialist, Sharon Bowen, who will discuss nutrition and the Four Pillars of Health. The entire series began with CPR training and certification with the Petaluma Health Care District which continues throughout 2015.

    About St. Joseph Health

    St. Joseph’s Work@Health® Program was developed by the Center for Disease Control and Prevention that provides employers with free access to professional-level training in worksite wellness. The training is comprehensive and science-based, designed to give employers the necessary knowledge and resources to customize a plan for worksite wellness that will be sustainable and achieve results. It isdesigned to train employers how to establish, expand and improve science- and practice-based health promotion strategies that will lead to specific, measureable means to reduce chronic disease rates in the workplace. It provides knowledge and tools to promote good health and prevent or reduce chronic illness and disability. This lecture is sponsored by Western Health Advantage in partnership with St. Joseph Health and Arrow Benefits Group.

    About Arrow Benefits Group

    Arrow Benefits Group, located north of San Francisco, is a proud partner of United Benefit Advisors (UBA), one of the largest benefits consulting and brokerage firms in the country. With more than 200 UBA offices throughout North America and the United Kingdom, we offer global reach with local support. Arrow Benefits Group is your single-source solution for managing the complexities of benefits with expert advice, customized programs, and personalized HR solutions.  Our innovative programs contribute true value to your company, helping you control costs and giving your employees a greater sense of financial and emotional security. We are more than benefits, we are The Human Resource. For straight answers to employee benefits or HR questions, call 707.992.3780 or visit www.arrowbenefitsgroup.com.

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  • Think 2014 tax forms are bad? Here come the 1094 and 1095 for 2015! | California Employee Benefits

    March 11, 2015

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    By Bill Olson, Chief Marketing Officer at United Benefit Advisors

    Our recent blog reviewed the highlights of the new employer and insurer reporting requirements. UBA has created this quick reference chart to help you sort out who should use which form, and when:

    030515BlogPost

    For comprehensive information on coverage requirements, due dates, special circumstances, controlled groups and how to complete the forms—including sample situations—request UBA’s PPACA Advisor, “IRS Issues Final Forms and Instructions for Employer and Individual Shared Responsibility Reporting Forms”.

    Read More …

  • IRS Provides 2015 Mileage Rates and Guidance on Retroactive Transit Benefit Increase| Petaluma Benefits Broker

    March 9, 2015

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    By Bill Olson, Chief Marketing Officer at United Benefit Advisors

    On December 10, 2014 the IRS released the optional standard mileage rates for 2015. Beginning on January 1, 2015, the standard rates for the use of a car, van, pickup or panel truck are: guage

    • 57.5 cents per mile for business miles, up from 56 cents in 2014
    • 23 cents per mile for medical or moving purposes, down half a cent from 2014

    Taxpayers may instead claim deductions based on the actual costs of using a vehicle rather than the standard mileage rates if they prefer.

    The Tax Increase Prevention Act of 2014 (TIPA) retroactively increases the 2014 combined limit for transit passes and vanpooling benefits provided under a qualified transportation plan to equal the $250 per month limit for qualified parking benefits.  This increase only applies to 2014 – for 2015 the limits for transit passes and vanpooling benefits will again reduce to the pre-TIPA levels of $130 per month for transit passes and $25 per month for qualified parking unless Congress passes another extension bill.

    Because this increase occurred so late in the year, it is of limited value to most employers and employees. Employers able to take advantage of the increased limit have raised questions about how to handle and report it. On January 9, 2015 the IRS issued Notice 2015-2.  This notice provides a special process for employers that provide additional tax-exempt benefits to make corresponding adjustments to Federal Insurance Contributions Act (FICA) withholding and reporting.  Any excess withholding of federal income tax will not be adjusted by the employer, but may be claimed by the employee when the Form 1040 is filed. The Notice states that employers may not simply contribute or allow employees to contribute amounts above the monthly limit to recoup the 2014 amounts. Employers may use the normal refund process that applies when FICA is withheld in error if they prefer.

    For more information on this Notice, download UBA’s PPACA Advisor, “IRS Provides Process to Address Retroactive Increase in Excludable Transit Benefits”.

    Read More …

  • Wellness Programs Feeling the Heat as the EEOC Increases Its Efforts – Part 2, Federal Regulations |California Benefits Broker

    March 3, 2015

    Tags: , , , ,

    As mentioned in the first posting, wellness programs must be analyzed under a myriad of laws and regulations. This post will discuss generally the wellness program landscape in light of the Americans with Disabilities Act (ADA)/Americans with Disabilities Act Amendments Act (ADAAA), the Genetic Information Non-Discrimination Act (GINA), the Patient Protection and Affordable Care Act (PPACA), and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Nondiscrimination Regulations. This is a 30,000-foot overview of laws and regulations that are in need of microscopic scrutiny when applying them to a wellness program.therm

    ADA/ADAAA

    The ADA/ADAAA generally prohibits discrimination in employment against a qualified individual on the basis of a disability in regard to employee compensation and other terms, conditions, and privileges of employment. Further is a prohibition from requiring a medical examination and making inquiries of an employee as to whether he or she has a disability, or as to the nature or severity of a disability, unless such examination or inquiry is shown to be job-related and consistent with business necessity.

    However, there is a statutory safe harbor that exempts certain insurance plans from the ADA’s general prohibitions. The “benefit plan exception” states that the ADA shall not be construed as prohibiting an employer from establishing, sponsoring, observing, or administering the terms of a bona fide benefit plan that are based on underwriting risks, classifying risks, or administering such risks that are based on, or not inconsistent with, state law or where the plan is not subject to state law (a self-funded benefit plan) so long as the exemption is not used as a subterfuge for discrimination. As such, voluntary medical examinations and/or histories, which are part of a group wellness program, are permissible so long as strict confidential processes are followed.

    What does it mean to be voluntary? There is no short answer, but the abbreviated answer is that a wellness program may be voluntary if the employer neither requires participation, nor penalizes employees who do not participate. The U.S. Equal Employment Opportunity Commission (EEOC) once posited that a health reimbursement arrangement (HRA) administered as part of a wellness program that meets the incentive limitations of HIPAA wellness regulations – no more than a (then) 20% reward – would be deemed voluntary and would not violate the ADA. Unfortunately, this portion of the opinion letter was withdrawn because it was outside the scope of the request. The position currently held by the EEOC is that an incentive is a veiled penalty, which, in essence, makes the program involuntary and, thus, violates the ADA. However, this is in conflict with the “benefit plan exception,” noted above.

    GINA

    Generally, GINA prohibits both the acquisition of genetic information as well as the use of genetic information by employers in employment decisions. As it applies to group health plans, Title I prohibits discrimination in health insurance premiums based on genetic information and places limitations on genetic testing and the collection of genetic information. Title II prohibits the use of genetic information in the employment context, restricts employers from requesting, requiring, or purchasing genetic information, and strictly limits employers from disclosing genetic information.

    In general, Title II limits the conditions under which an employer might lawfully collect genetic information pursuant to an employer-sponsored wellness program and it requires those employers to follow strict privacy and confidentiality mandates. Under GINA, it is unlawful for an employer to request, require, or purchase genetic information with respect to an employee or an employee’s family member. There is an exception if the information is part of a wellness program, subject to strict adherence of the following three requirements:

    1. The employee provides prior, knowing, voluntary, and written authorization;
    2. Only the employee (or family member if the family member is receiving genetic services) and the licensed health care professional, or board certified genetic counselor involved in providing such services, receive individually identifiable information concerning the results of such services; and
    3. Any individually identifiable genetic information provided in connection with the services is only available for purposes of such services and shall not be disclosed to the employer except in aggregate terms that do not disclose the identity of specific employees.

    Again, what does it mean to be voluntary? In the preamble to the 2010 final regulations implementing Title II, the EEOC concluded that a wellness program is voluntary if the program neither requires participation, nor penalizes employees for non-participation. The EEOC concluded that it would not violate Title II for an employer to offer individuals an inducement for completing an HRA that includes questions about family medical history, or other genetic information, as long as the employer specifically identifies those questions and makes clear, in language reasonably likely to be understood by those completing the HRA, that the individual need not answer the questions that request genetic information in order to receive the inducement. The EEOC specifically declined to take the approach taken in HIPAA regulations – no more than a (then) 20% reward – and, instead, added that adherence to Title II of GINA does not guarantee adherence to Title I of GINA, ADA, or HIPAA.

    HIPAA and PPACA

    The general rule pursuant to HIPAA nondiscrimination provisions is that a plan or issuer is prohibited from charging similarly situated individuals different premiums or contributions on the basis of a “health factor.” However, there is an exception to the general rule if the reward, i.e., premium discount, is based on participation in a program reasonably designed to promote health or prevent disease, i.e., a “wellness program.”

    When analyzing a wellness program under PPACA and HIPAA, the first step is to determine whether the wellness program – or, as it may be the case, which part of the wellness program – is “participatory” or “health-contingent.” Participatory wellness programs are not required to follow HIPAA nondiscrimination provisions, discussed below. However, and to the point of this blog series, participatory (and health-contingent) wellness programs should be reviewed and scrutinized against the provisions of GINA, ADA, the Employee Retirement Income Security Act (ERISA), Internal Revenue Code (IRC), and other federal and state laws.

    Participatory wellness programs are defined under HIPAA nondiscrimination final regulations as programs that either do not provide a reward, or do not include any conditions for obtaining a reward that are based on an individual satisfying a standard that is related to a health factor. Examples include a program that reimburses employees for all or part of the cost of membership in a fitness center, a diagnostic testing program that provides a reward for participation and does not base any part of the reward on outcomes, and a program that provides a reward to employees for attending a monthly, no-cost health education seminar.

    If the wellness program, or a piece of the wellness program, is participatory, it does not have to follow HIPAA nondiscrimination regulations. However, if the wellness program, or a portion thereof, is health-contingent, then the program must be analyzed pursuant to HIPAA nondiscrimination regulations.

    HIPAA Nondiscrimination Provisions and the Wellness Program Exception

    Health-contingent wellness programs, in contrast to participatory programs, require an individual to satisfy a standard related to a health factor to obtain a reward or require an individual to undertake more than a similarly situated individual based on a health factor in order to obtain the same reward. The standard may be performing or completing an activity relating to a health factor, or it may be attaining or maintaining a specific health outcome. The final regulations further subdivided health-contingent programs into (1) activity-only wellness programs, and (2) outcome-based wellness programs. While there are some differences, both types are permissible only if the program adheres to the five prongs:

    1. Be reasonably designed to promote health or prevent disease (the same rules apply to activity-only and outcome-based programs);
    2. Give employees a chance to qualify for the incentive at least once a year (the same rules apply to activity-only and outcome-based programs);
    3. Cap the reward or penalty at 50% of the total cost of coverage for avoiding tobacco and at 30% for all other types of wellness incentives (the same rules apply to activity-only and outcome-based programs);
    4. Provide an alternative way to qualify for the incentive for those who have medical conditions (different rules apply to activity-only and outcome-based programs); and
    5. Describe the availability of the alternative method of qualifying for the incentive in written program materials (the same rules apply to activity-only and outcome-based programs).

    These rules set forth criteria for an affirmative defense that can be used by plans and issuers in response to a claim that the plan or issuer discriminated under HIPAA nondiscrimination provisions.

    This is not the end…

    The above is merely a general overview of the innate tension created by conflicting regulations, compounded by the lack of guidance from the commission, which is confronting concerned employers who have chosen to be proactive in combating the costs of health care and improving consumers’ lives. The next part of the series will discuss the movements in the courts, the backlash felt by the EEOC, and steps employers should take.

    For more data on wellness programs and other plan design trends, download the 2014 Health Plan Executive Summary. This survey – which has been conducted every year since 2005 – is the nation’s largest health plan survey and provides more accurate benchmarking data than any other source in the industry. You can contact a UBA Partner Firm for a customized benchmark report based on industry, region and business size.

    Read More …

  • Why Buy Group Health Insurance through a Broker? | Petaluma Benefits Broker

    February 26, 2015

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    By Terry Allard, CEBS, Sr. Benefits Advisor at The Wilson Agency

    Employers have a lot of choices when it comes to buying group health insurance, including going directly to a carrier (or one of its agents), buying online, or going through a broker. Direct-to-carrier paths make it more difficult to shop the market across product lines, and buying online can leave the employer responsible for navigating Pros and cons“representative” quotes, difficult terminology, Patient Protection and Affordable Care Act (PPACA) compliance and ongoing service issues. Good brokers, on the other hand, have the market, compliance, and product knowledge to help employers save money and appropriately manage risk. They will typically offer hands-on experience, free top tools and resources, and a one-stop shop for programs and services. United Benefit Advisors (UBA) is a partnership of the country’s leading independent brokers, a unique model that offers the “Wall Street” savings, resources, and efficiencies of a large centralized company along with the “Main Street” personalized service and entrepreneurial spirit of a local business. In fact, that’s why we like to call UBA Partners “advisors,” not “brokers.” There are many questions you should ask before hiring an advisor, but first and foremost, benefit advisors should have the heart of a teacher in order to effectively guide you through the complex maze of regulations, legalities, coverages, plans, and options.

    A benefit advisor’s primary job is to orchestrate the competition of insurance carriers by compiling a complete and accurate submission of what your company is looking for, and making sure each carrier in the market receives the same information. Consider them to be like your own personal shopper. They present your business to insurers in the most effective fashion and use their marketplace knowledge and carrier relationships to negotiate the most favorable terms and conditions for your company. In addition, a good broker can provide additional insights to you on the carrier’s strengths, weaknesses, and past performance. But, wait! There’s more.

    An advisor’s service to the client should continue after the bid process. Depending on the broker and the relationship, brokers will assist their clients with claim difficulties, employee communications, notify and explain upcoming and current regulations, risk management and all other areas relating to benefits and compensation. In our business, we also provide many tools and resources to help your human resource department or tasks because benefits and HR go together. When one is functioning at a high level, it supports the efforts of the other.

    Even before the bidding process, your benefit advisor can help you decide what benefits are important to you, how you want to structure your total compensation, your budget, and your requirements. They in turn present all of this information to the most appropriate carriers and return to you with the best options for your business, saving you lots of time. This two-step approach allows independent evaluation of the most beneficial relationships for your company to pursue.

    Competition among brokerage firms and among insurance companies are essential tools in helping businesses learn what the marketplace has to offer. A structured advisor evaluation and selection process is the best way for employers to ensure they receive optimum value and gain the competitive advantage and long-term cost management they are striving to achieve. Advice and service are widely available, but the question is: Are you getting good advice and service? Make the right choice.

    To learn more about choosing the right benefit advisor, download the brochure “A benefit broker prepares cost estimates. Your benefit advisor performs cost management.”

    Read More …

  • 2015 Cost-of-Living Adjustments | California Employee Benefits

    February 23, 2015

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    By Linda Rowings

    Many employee benefit limits are automatically adjusted each year for inflation (this is often referred to as an “indexed” limit). The Internal Revenue Service and the Social Security Administration have released a number of indexed figures for 2015.

    Limits of particular interest to employers include the following.Money

    For health and Section 125 plans:

    • The health flexible spending account (HFSA) maximum employee contribution is increasing to $2,550.
    • The maximum out-of-pocket limit that applies to non-grandfathered group health plans that are not coupled with a health savings account (HSA) will be $6,600 per individual and $13,200 per family.
    • The maximum out-of-pocket for a high deductible health plan coupled with an HSA will increase to $6,450 per individual and $12,900 per family.
    • The minimum deductible for a high deductible health plan coupled with a health savings account (HSA) will increase to $1,300 per individual and $2,600 per family.
    • The maximum HSA contribution will increase to $3,350 for individual coverage and $6,650 for family coverage. The catch-up contribution (available to those aged 55 and older) remains at $1,000.

     For qualified plans:

    • The annual deferral for 401(k), 403(b), and most 457(b) plans will increase to $18,000.
    • The catch-up contribution limits (available to those aged 50 and older) will increase to $6,000.
    • The threshold for “highly compensated employees” will increase to $120,000.
    • The threshold for an officer to have “key employee” status remains at $170,000
    • The annual compensation limit will increase to $265,000

     Social Security/Medicare Withholding:

    • The taxable wage base will increase to $118,500
    • The OASDI tax rate remains at 6.2%
    • The Medicare tax rate remains at 1.45%

    Read More …

  • Petaluma a healthy role model | Arrow Benefits Group

    February 19, 2015

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    Strategies in Petaluma draw attention of state health department
    By Jeff Quackenbush, Business Journal Staff Reporter

    The Petaluma Health Care District has drawn the attention and praise of a top California health official for its community programs.
    northBay
    “This is a model for other communities,” said California Department of Health Care Services Chief Medical Officer Dr. Neal Kohatsu, who was impressed with what he saw during a daylong site visit to Petaluma. “They’ve done good work developing their health care system, with quality strategies fostering a healthy community. Great work all around.”

    DHCS was particularly impressed with that community’s health model, which includes services and funding administered outside of Petaluma Valley Hospital. They requested to visit Petaluma because they wanted to see the hands-on efforts that health care districts can play in communities, beyond acute care and hospitals.

    Dr. Kohatsu said his team will take what they learned from the day and work with other counties state-wide on issues of education and social services, making sure people can find healthcare services available to them.

    The visit took DHCS attendees to McDowell Elementary School, Petaluma Community Center, Petaluma Health Center, meeting with childcare specialists, the Petaluma Police Department, PHCD’s CEO Ramona Faith, community outreach representatives and the Heartsafe Community program.

    “The overall theme that jumped out at me throughout the day was how the PHCD is the “glue” that fosters business and nonprofit collaboration to tackle health issues in the community. It identifies community health needs through its assessments, feedback, etc. and then brings the right groups to the table to launch initiatives to address issues,” said Melinda Hepp, spokesperson for PHCD.

    One of those groups is the Healthy Community Consortium (HC2), which has been collaborating with the community for over 20 years. It has a history of dealing with youth issues and have developed strategies to reduce high rates of alcohol, tobacco and marijuana use.

    The root of the problem, they found, was easy social and commercial access, low perception of risks and an over concentration of alcohol outlets. While the state average is one alcohol serving establishment for every 558 residents, Petaluma’s rate is 1 for every 279.

    Petaluma also historically had a high number of adults, hosting parties with underage drinking, the group found. HC2 worked to institute fines and possible arrest for anyone hosting such a party and since then police responses to such gatherings have been greatly reduced, said Diane Davis, HC2 program coordinator.

    “Change takes time. You have to change attitudes and behavior. It takes a while but we’re getting there,” she said.

    HC2 also worked to established a free “responsible beverage service” training which is now required every three years for establishments serving alcohol.

    The group has also handed out packets to students at the beginning of the school year including a pledge against drugs for them and their parents to sign.

    As a sign of their success in teen smoking, in 2008 Petaluma had one of the highest teen smoking rates in the state. In 2013, the number was down by 10 percent. HC2 has also proposed passing an ordinance banning smoking from multi-unit housing, hotels, outdoor dining and business entryways, and banning e-cigarettes in eating and drinking establishments.

    PHCD is a public agency committed to improving the health and well-being of Southern Sonoma County. It was formed in 1946. PHCD owns Petaluma Valley Hospital and leases its operation to St. Joseph Health.

    In other efforts PHCD is:

    • Working with partners to increase the number of 3 to 4-year olds who attend preschool by expanding facilities, leveraging funds and dedicating local funding.
    • Partnering with mental and behavioral health groups in Sober Circle linking the chronically inebriated homeless to sobriety services and social support programs.
    • Increasing consumption of locally produced fruits and vegetables among Calfresh recipients by providing a $10 matching incentive at Petaluma Farmers Markets.
    • Partnering with Heartsafe Community to increase survival rates from cardiac emergencies through training and AED installations.

    HeartSafe Community (HSC)’s goal is to increase survival rates from cardiac emergencies through CPR/AED training, and strategic AED installations in the workplace. The group partners with local police and other entities in the community.

    Most recently, Arrow Benefits has volunteered to conduct CPR classes and provide referrals for AED equipment. The first class was Feb. 11. Andrew McNeil, principal at Arrow, will be facilitating classes each quarter, and is spearheading other community health related trainings with St. Joseph’s and Whole Foods. Arrow is also in the process of booking other speakers to present on other health related topics such as eating healthy and cancer prevention.

    “The goal is making people more health conscious in general. We discovered the community as a whole is interested in looking at ways to do that,” Mr. McNeil said.

    Read More …

  • The President is in the Act – of Paid Leave Proposals

    February 17, 2015

    The states are moving ahead, so just in time to be behind President Obama announced in his State of the Union address and then proposed the Healthy Families Act which would allow working Americans to earn up to seven days per year of paid sick time.  Key elements:

    1)    Applies to groups of 15 or more employees
    2)    Provides accrual of one hour of sick time for every 30 hours worked – up to 56 hours
    3)    Provide employees with the ability to use leave after 60 days of employment
    4)    Carry over leave from year to year
    5)    Allow the use of sick leave for employee illness as well as sick family member
    6)    Allow use to deal with domestic violence (e.g. medical treatment or going to court)
    7)    Require reinstatement of unused sick leave if the employee is rehired within a year

    Unfortunately, the final law will not pre empt state or local laws, so administration will be tricky.

  • How Businesses Can Apply for Tax Credits: GO-Biz California Competes Workshop in Petaluma | Arrow Benefits Group

    February 16, 2015

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    FREE Seminar!

    CA_TAXThe Governor’s Office of Business and Economic Development (GO-Biz) is hosting a workshop on the California Competes Tax Credit.

    Small, medium and large businesses are encouraged to attend the workshop and receive instruction on how to apply for this tax credit program available from the State.

    Come and learn how your business can apply for millions in available tax credits.

    The workshop and the program are both free and available to businesses of all sizes.

    Location:
    Governor’s Office of Business and Economic Development (GO-Biz)
    Meeting Room A-D

    Date:
    Tuesday, February 24, 2015

    Time:
    from 9:00 AM to 10:00 AM (PST

    Parking:
    Free surface lot adjacent to building

    Workshop Co-Hosts:
    Sonoma County Economic Development Board

    Petaluma Chamber of Commerce

    Read More …

  • Benefit Survey Results – How do you Compare?

    February 13, 2015

    The latest survey of the International Foundation of Employee Benefits has been published, the result of interviews with 571 organizations of all sizes.  For the plan year 2014, the results are:

    The average cost of benefits as a percentage of payroll costs is 32% — of those surveyed, 21 to 25% pay 13%, 26- 35% pay 19% and 36-40% pay 17%

    For health plans offered, 98% write medical, 92% dental, 73% vision, 84% life insurance, 61% long term disability, 98% paid holidays and paid vacation and 93% paid sick leave

  • Will Health Insurance Soon Become Health Memberships? | California Employee Benefits

    February 12, 2015

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    By Elizabeth Kay, Compliance & Retention Analyst
    AEIS Advisors

    healthmoneyWith the passage of the Patient Protection and Affordable Care Act (PPACA), we saw a number of hospitals and provider groups being bought and merged with larger provider groups. This was done for two reasons. One, in part to make sure that they were able to establish more buying power, or bargaining chips to bring to the contract negotiating table. Two, with less competition, they have more control over how much they can charge for services.

    So now that we are into year five of PPACA, and going into year three of the medical loss ratio enforcement that was enacted as part of PPACA (small group and individual plans must use 80% of premiums collected to pay claims, leaving 20% for administration and re-investment, 85%/15% for large group plans) we are seeing the insurance carriers and provider groups have more and more contract disputes.

    We are seeing more and more contracts expire before a new contract can be agreed on between the two parties, and overnight the insured can no longer see their regular doctors and providers, causing major disruptions for patients.

    There have been many instances where the contract negotiations are successful and the new contract effective date is retroactive back to when the previous contract was terminated, but not before the insured population has had to scramble to find in-network care elsewhere, to get medical records transferred to new providers, deal with claims being re-submitted, and overall being left with a rather poor taste in their mouths.

    In recent months there have been times when these contract disputes have taken a nasty turn with one (or both) sides speaking poorly of the other publicly, trying to bully the other party into submission; when the reality is, they both need each other.

    But I find myself wondering, why would a large provider network want to make an insurance carrier look badly in the eyes of their members? What purpose does that serve the provider network? And why would one or two provider networks seem to repeatedly have contract disputes with multiple insurance carriers, when other provider networks don’t have the same experience?

    Well, my first thought is that this large provider network has a large market share, and is charging more for services than other providers, causing the insurance carriers to drive a harder bargain because their goal is to keep their plans affordable for their members. And as we all know, insurance premiums are not pulled out of thin air, they are based on the cost of medical care and services. If the cost for services goes up, so do insurance premiums.

    My second thought is, what if this is part of a bigger scheme, or plan? What would happen if one day down the road the provider network decided to let all of their insurance contracts lapse, and then invite all of their patients to purchase a ”membership” to their provider network that would enable them to use their providers for a simple copay for doctor visits and lab tests, for example, and then encourage their ”members” to purchase low cost, simple catastrophic insurance plans to cover the cost of the high ticket items such as hospital in-patient stays, surgeries, etc.?

    This would solve a couple of problems for the providers. One, they would have far less administrative work and costs if they did not have to submit claims to the insurance carriers for the small stuff (office visits, X-rays, lab tests). They would not have to concern themselves with contract negotiations year after year, and they could better control their prices (note I said prices, not costs) for services. We have seen more and more doctors move to a concierge medicine model for these very reasons. Why not the big guys, too?

    From a patient’s point of view, would they prefer to pay for a monthly membership if it meant they knew they could see the doctors they wanted to see, without being concerned that their contract may expire without warning? Would it be worth it not to have to call the insurance carrier to find out why they did not pay their provider correctly for services rendered?

    As a patient, if I can see my regular doctors without interruption, carry a catastrophic medical insurance plan to protect my families assets should something happen where I needed extensive or expensive medical treatment, and not be penalized on my taxes because my catastrophic plan meets the minimum essential coverage requirements under PPACA, would that be a win for me?

    Could the provider network take it one step further and promise to only charge me based on in-network costs for those times when they need to charge my catastrophic insurance plan, even if they are not a part of the network, and write off whatever costs my insurance plan does pay to them as a loss?

    As employers are looking for more innovative ways to curb the increasing costs of medical insurance for their employees, would they be able to offer a catastrophic group plan with high deductibles if they could then pay for employees to have a ”membership” to their favorite provider networks? Could it be that simple for an employer to never have to worry about some of their employees being dissatisfied because their provider is not in-network with the new health plan?

    And would the U.S. Department of Labor allow an employer to pay for an employee’s individual ”membership” to a provider network since it would not qualify as an insurance policy? Some employers pay for, or subsidize, gym memberships for their employees. Would this be considered any different?

    Could this be the plan, and the reason why a large provider network is looking to drive a wedge between their patients and their insurance carriers?

    Are health memberships the next evolutionary step in health care reform?

    Read More …

  • PCORI fee increase – annual update

    February 10, 2015

    The Patient Centered Outcomes Research Institute “tax” (which is not a tax) runs from 2012 through 2019.  The tax amount per covered member per year is $2.08 for policy and plan years ending on or after October 1, 2014 and before October 1, 2015

  • The President is in the Act – of Paid Leave Proposals

    February 9, 2015

    The states are moving ahead, so just in time to be behind President Obama announced in his State of the Union address and then proposed the Healthy Families Act which would allow working Americans to earn up to seven days per year of paid sick time.  Key elements:

    1)    Applies to groups of 15 or more employees
    2)    Provides accrual of one hour of sick time for every 30 hours worked – up to 56 hours
    3)    Provide employees with the ability to use leave after 60 days of employment
    4)    Carry over leave from year to year
    5)    Allow the use of sick leave for employee illness as well as sick family member
    6)    Allow use to deal with domestic violence (e.g. medical treatment or going to court)
    7)    Require reinstatement of unused sick leave if the employee is rehired within a year

    Unfortunately, the final law will not pre empt state or local laws, so administration will be tricky.

  • Weight Loss Retreats in Northern California | Arrow Benefits Group

    February 9, 2015

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    By Erin Harty

    ripe red apple with green leaf isolated on whiteWeight loss retreats have become a popular way to lose weight and get healthy, all while staying in luxury accommodations and getting personalized care. Northern California, with its healthy lifestyle mindset, is the perfect place to learn about nutrition, meditate, exercise and relax in beautiful rolling hills, hot springs and valley vineyards. Retreats vary in price and length, offering single day to up to a month packages that cost anywhere from $250 to more than $10,000.

    Food

    Weight loss retreats usually offer full meals in their packages and all of them are a little different. In some areas, the local restaurants cater to you by offering special menu items specific to their programs. Some Northern California retreats focus on specific kinds of diets, like vegetarian, organic, raw-food or popular low-carbohydrate diet plans. Cooking classes supplement the diet information and as a guest you leave with books, recordings and journals to help you record what you eat, get motivation and maintain weight loss after you leave the facility. Retreats often have their own chefs and pride themselves on the quality and nutritional value of their food.

    Fitness

    Weight loss retreats would not be successful if not for the exercise. Retreat packages vary from relaxing yoga to intense hiking and cardio. Many Northern California retreats are located in beautiful wine country and near hot springs where you can enjoy the outdoors while raising your heart rate and burning calories. On-site fitness centers provide you with round-the-clock access to equipment, and many retreats include salsa and other dance lessons in their programs.

    Overall Health

    Whole-body weight loss retreats have the advantage of focusing on overall health as well as weight loss. Many of these retreats, like Transformation Weight Loss Retreat at St. Helena’s Center for Health in Napa Valley, are physician-assisted programs that offer medical assessments before the program begins. These retreats will help with weight loss as well as reducing cholesterol and triglyceride readings. The focus is on teaching you how to maintain weight loss and health after you leave. Workshops covering nutrition, fitness and mental health are often a big part of the programs.

    Personalized Programs

    Pre-organized retreats aren’t for everyone, and you may prefer an experience that is specific to you. Many weight loss retreats offer personalized programs that target your needs in more specialized ways. Detoxification diets, clinical psychological counseling, and intense fitness routines are among some of the ways you can get what you need out of a retreat. Personalized retreats are helpful if you have specific nutrition requirements, for example if you’re diabetic, and if you have physical limitations or issues.

    Boot Camp

    For a more intense weight loss and fitness experience, Northern California has a few weight loss retreats that are billed as boot camps. These programs, which are usually not as long as the average one to two week retreats, are meant to get you in shape quickly and rigorously. Retreats include fitness regimes like power yoga, intense hikes and body sculpting exercises. Some of these retreats are for women only and most of them have fewer than a dozen participants at one time.

    Read More …

  • Not all that well with wellness – EEOC actions and the consequences

    February 6, 2015

    There are three actions currently under review in one district of the Equal Employment Opportunity Commission, though their focus is mostly on ADA and GINA and not the ACA (yes it helps to know all the acronyms, but the bottom line is they have concerns).  While no final action has been taken, nor is it certain what action, if any, may be taken, there are warnings signaled by the fact that these actions took place, and employers should consider:

    1)    Offering a penalty as opposed to a reward – the reverse will be viewed more favorably
    2)    Offering rewards or penalties equal to 100% of the premium for failure – too much?
    3)    Dropping employees from coverage if participant does not meet requirements – too harsh?
    4)    Omitting an option for appeal or an alternative for those on leave – that’s a mistake

  • IRS Provides 2015 Mileage Rates and Guidance on Retroactive Transit Benefit Increase | Petaluma Benefits Broker

    February 5, 2015

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    By Bill Olson

    mileageOn December 10, 2014 the IRS released the optional standard mileage rates for 2015. Beginning on January 1, 2015, the standard rates for the use of a car, van, pickup or panel truck are:

    • 57.5 cents per mile for business miles, up from 56 cents in 2014
    • 23 cents per mile for medical or moving purposes, down half a cent from 2014

    Taxpayers may instead claim deductions based on the actual costs of using a vehicle rather than the standard mileage rates if they prefer.

    The Tax Increase Prevention Act of 2014 (TIPA) retroactively increases the 2014 combined limit for transit passes and vanpooling benefits provided under a qualified transportation plan to equal the $250 per month limit for qualified parking benefits. This increase only applies to 2014 – for 2015 the limits for transit passes and vanpooling benefits will again reduce to the pre-TIPA levels of $130 per month for transit passes and $25 per month for qualified parking unless Congress passes another extension bill.

    Because this increase occurred so late in the year, it is of limited value to most employers and employees. Employers able to take advantage of the increased limit have raised questions about how to handle and report it. On January 9, 2015 the IRS issued Notice 2015-2. This notice provides a special process for employers that provide additional tax-exempt benefits to make corresponding adjustments to Federal Insurance Contributions Act (FICA) withholding and reporting. Any excess withholding of federal income tax will not be adjusted by the employer, but may be claimed by the employee when the Form 1040 is filed. The Notice states that employers may not simply contribute or allow employees to contribute amounts above the monthly limit to recoup the 2014 amounts. Employers may use the normal refund process that applies when FICA is withheld in error if they prefer.

    For more information on this Notice, download UBA’s PPACA Advisor, “IRS Provides Process to Address Retroactive Increase in Excludable Transit Benefits”.

    Read More …

  • Reimbursement Changes – How medical insurance may work in the future

    February 3, 2015

    Carriers paid according to Reasonable and Customary fees.  Then they negotiated discounts and called them Preferred Provider Organizations.  Now they are taking advantage of a new trend toward value based reimbursement.  UnitedHealth, the largest medical insurance carrier in the country, has announced that they will increase value based payments to doctors and hospitals by 20% – which translates to more than $43 billion.  Value based payments include pay for performance, patient centered medical homes and Accountable Care Organizations, all of which have been gaining favor on their own – now UnitedHealth can use all of them.  The changes keep on coming…along with provider pressure.

  • Top 5 Questions About The “Cadillac” Tax | Petaluma Employee Benefits

    February 2, 2015

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    By Linda Rowings
    cadillacThe excise tax on high cost plans (also referred to as the Cadillac tax and the 4980I tax) is scheduled to take effect in 2018. To date, regulations have not been issued, so many of the details about how the tax will operate are unclear. (The regulatory agencies are responsible for interpreting the law, adding needed details, and reconciling any parts of the law that may be inconsistent.) Based upon how the law itself is written, this is what is known and expected.

    1. How much is the tax?

    The tax is 40% of the cost of health coverage that exceeds a threshold.

    2. What is the threshold?

    For 2018 the base threshold is $10,200 per year ($850 per month) for self-only coverage and $27,500 per year ($2,291.67 per month) for all other levels of coverage. Plans that cover “qualified retirees” or which primarily cover those in a “high-risk profession” are allowed an additional $1,650 per year for single coverage in 2018 and $3,450 per year for all other levels of coverage.

    “High-risk profession” means law enforcement officers, firefighters, emergency medical technicians, paramedics, first-responders, longshoremen; individuals in the construction, mining, agriculture (but not food-processing), forestry, and fishing industries; those who install or repair electrical or telecommunications lines, and employees who retired from a high-risk profession if the employee was in a high-risk profession for at least 20 years.

    It appears that the additional allowance will apply to each qualified retiree (but not to any active employees) in the plan. The additional allowance for high-risk professions will be available only if the plan primarily covers those in a high-risk profession; in that case, the additional allowance will be available to all plan participants.

    3. Are there cost of living increases in the thresholds?

    A3: Yes. Starting in 2019, the base thresholds and the adjustments for qualified retirees and those in high-risk professions will be increased by the Consumer Price Index for all Urban Consumers (CPI-U) – not medical inflation. In addition, if health inflation is higher than expected between now and 2018 (based on the cost of standard BlueCross/Blue Shield coverage under the federal employees’ health plan), the 2018 base amounts will be increased.

    4. Are there adjustments for high cost areas of the country or for employers with a higher risk workforce?

    There are no adjustments based on the part of the country in which the employer or employees are located.

    There will be an adjustment allowed for age and gender for plans that are higher than the national average. Details on how that will work are not yet available.

    Multiemployer plans may use the family threshold with all employees, even if the employee actually has single coverage.

    5. What types of plans are subject to the tax?

    The tax applies to “applicable employer-sponsored coverage,” which includes both insured and self-funded plans. The tax applies to grandfathered plans. It applies to all types of employers – private, government, church, and not-for profit. Retiree plans – even retiree-only plans – are subject to the tax. Multiemployer plans are subject to the tax. The tax applies to coverage provided to active employees, self-employed individuals covered by the group health plan, former employees (presumably including COBRA participants) and surviving spouses.

    For more information about inclusions/exclusions, cost of coverage calculations, changes in coverage and more, download UBA’s PPACA Advisor: Highlights of the Excise Tax on High-Cost Plans (the “Cadillac Tax”).

    Read More …

  • Local Business First to Partner with Petaluma Health Care District to Provide CPR/AED Training

    January 31, 2015

    Tags:

    For Immediate Release
    Contact: Jenny Kaplan, JKC
    Kaplan@jkaplanpr.com
    415-342-2209

    Petaluma, CA – Arrow Benefits Group, the 3rd largest HR/benefits Company in the North Bay, announces it will be the first local business to partner with the Petaluma Health Care District’s (PHCD) Healthquest Training Center to provide CPR/AED training and certification. Launched in collaboration with many of PHCD’s community partners, the HeartSafe Community Program (HSC) seeks to strengthen Southern Sonoma County’s response to cardiac emergencies through CPR/AED training, strategic installation and maintenance of equipment and by providing heart health education. Arrow has committed to facilitate the classes quarterly in order to help the city of Petaluma and as part of its mission to support the well-being of its clients and community. The first class is Wednesday, February 11, 2015 at 2PM in the new Arrow Benefits training room. Space is limited and first come first serve – please contact Andrew McNeil at 707-992-3789 or AndrewM@arrowbenefitsgroup.com ASAP for details and to reserve seats.

    “Through the American Heart Association, we know that more than 300,000 Americans will be victims of Sudden Cardiac Arrest this year and that it is the number one cause of death in the workplace,” said PHCD CEO Ramona Faith. “We launched HeartSafe Community because we also know that if CPR is administered and an AED deployed within three to five minutes of a collapse, Sudden Cardiac Arrest survival rates increase by as much as 70 percent. These statistics are powerful and we hope that other businesses join in Arrow Benefit Groups’ footsteps toward creating a healthier community. The benefits of this training extend well beyond the workplace and can truly help save lives.”

    HSC attendees will learn how to respond to cardiac and breathing emergencies until more advanced medical personnel can arrive to the scene. Upon successful completion of the course, participants will receive the American Heart Association 2-year Certification card and a copy of the AHA Heartsaver CPR/AED course manual.

    About Petaluma Health Care District

    The Petaluma Health Care District (PHCD) is dedicated to improving the health and well-being of the Southern Sonoma County community through leadership, advocacy, support, partnerships and education. Its vision is to foster a healthier community, a thriving hospital and local access to comprehensive health and wellness services. PHCD has served the health and wellness needs of the community for more than 65 years and is a public agency managed by the community for the community. For more information, please visit www.phcd.org.

    About HeartSafe Community Program

    Launched in 2013, the Petaluma Health Care District (PHCD) collaborated with local police and fire, Coastal Valleys Emergency Medical Services, Petaluma Valley Hospital, St. Joseph Health Systems, Rancho Adobe Fire District, Petaluma City Schools and local non-profits and the American Heart Association to develop the HeartSafe Community Program (HSC). HSC utilizes a national framework to develop a unique community-based program that provides residents, local businesses and organizations with CPR/AED certification, hands-only CPR training, heart health education and access to life-saving equipment to best respond to cardiac emergencies. HSC is a program of PHCD and is managed by Healthquest CPR, an authorized training center of the American Heart Association. For more information, please call 707-766-9226 or email healthquest@phcd.org.

    About Arrow Benefits Group

    Committed to the community and elevating the industry – Arrow Benefits Group is the North Bay office of United Benefit Advisors (UBA), just north of San Francisco. UBA is one of the largest benefits consulting and brokerage firms in the country, with over 200 offices throughout North America and the United Kingdom. We provide a global reach with local support.

    We work very personally as advisors determining specific needs, prioritizing goals, and providing technology tools that will streamline costs and improve overall benefits packages. The Arrow Benefits Group employs a formal and sophisticated process, supported by data and HR analytics that save time and money while building a blueprint and living benefit model, continually adaptable to changing needs. Known as the Human Resource – for more information on unique solutions to Benefit/HR queries please visit www.arrowbenefitsgroup.com or call 707.992.3780.

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  • Proposed Changes to Summary of Benefits and Coverage (SBC) | CA Employee Benefits

    January 29, 2015

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    By Linda Rowings

    buildingThe Department of Labor (DOL), the Department of Health and Human Services (HHS), and the Internal Revenue Service (IRS) have issued proposed regulations that would update the summary of benefits and coverage (SBC) requirement, including the SBC template, instructions, example calculator, and uniform glossary. If adopted, the revised form would be used for open enrollments beginning on or after September 1, 2015, and for plan years beginning on or after September 1, 2015, for plans that do not have an open enrollment.

    The basic SBC distribution requirements would remain in effect, and a plan administrator that has multiple service providers, such as a major medical provider and a prescription drug provider, would still be allowed to provide multiple SBCs if it notified participants that the SBCs need to be considered together.

    Under the proposal, information about the plan’s status as providing minimum essential and minimum value coverage would need to be included on the SBC itself and could no longer be provided separately. The SBC also would be required to state whether elective abortion is covered.

    The SBC template itself would be shorter (about five pages compared to the current eight) to allow additional space for plans that need more room to adequately explain their benefits. A new example, involving emergency department care for a foot fracture, would be required, in addition to the current examples of a normal birth and diabetes management. The examples would still be based on figures supplied by HHS, and not actual plan data, although the figures in the HHS calculator have been updated. Most of the deletions from the SBC template involve text, not benefit information. The uniform glossary would be expanded, however.

    Comments on the proposed changes are due March 2, 2015, which means that the final version of the template to be used starting this fall likely will not be available until early this summer.

    Read More …

  • Are Supplemental Accident Insurance Payouts Taxable? | CA Benefits Broker

    January 26, 2015

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    By Jeannine Mancini

    moneyMost health insurance plans cover emergency treatment, hospital stays and medical exams. If you are injured in an accident, your health insurance plan might not pay for all the incurred medical expenses. Supplemental accident insurance coverage pays cash benefits for illnesses or injuries caused by an accident, including fractures and physical therapy. The coverage is designed to help alleviate the burden of unexpected costs. Depending on how the policy is paid, the payouts may be classified as taxable income.

    How it Works

    Accident insurance coverage generally covers death or injuries caused by accidents on or off the job. There are a variety of coverage options available. Some employers offer the accidental coverage as a voluntary supplemental plan. You can also purchase private accident insurance to protect yourself if the coverage is not offered through your employer.

    Self-Paid Plans

    According to the IRS, if you paid the premiums on an accident or health insurance policy, the benefits are not taxable. Payouts from an insurance policy taken out through the employer are not taxed if you paid the premiums with after-tax dollars. If you pay the premiums of an accident insurance plan through a cafeteria plan, the premium was not included as taxable income and is considered paid by the employer and therefore the benefits are taxable.

    Employer-Paid Plans

    Accidental insurance payouts are taxable if the employer paid for the insurance plan. If you paid for an accidental insurance plan through the employer using pre-tax dollars, your benefits are taxable income. Any benefits received from your employer while injured are considered salary or wages and taxable as ordinary income. Additional taxable disability benefits include income from a welfare fund, state sickness or disability fund and association of employers or employees.

    Withholding and Reporting

    Report any taxable insurance payouts as wages, salaries, tips, etc., on your taxes. If you are suffering a long-term disability and receive taxable benefits, avoid a hefty tax bill by submitting a Form W-4S, Request for Federal Income Tax Withholding From Sick Pay, to the insurance company.
    Read More …

  • 5 Important Tips for Choosing a Medicare Health Plan | California Employee Benefits

    January 20, 2015

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    (NewsUSA)

    old_manAs baby boomers retire in record numbers — 10,000 Americans a day — more seniors than ever will be asking themselves, “How do I choose a Medicare health plan that’s right for me?”

    “Seniors should look for a high-quality health plan that has a team of doctors and specialists, who work together to coordinate your care and keep you healthy,” said Patrick Courneya, M.D., medical director, Kaiser Permanente Medicare Health Plans.

    Dr. Courneya offers these five important tips to help older adults make an informed decision for a healthy future:

    1. Know when to enroll. Anyone who first becomes eligible for Medicare as they turn 65 can enroll during the three-month period before or after their 65th birthday. Those who choose to enroll after this window of time may pay a late-enrollment penalty. Medicare-eligible members may join or change plans during open enrollment from Oct. 15 to Dec. 7 each year, or they can join a Medicare five-star quality-rated plan nearly all year long. See tip four for star ratings details.

    2. Know the difference between Medicare and Medicare Advantage. Medicare is the national health insurance program that began in 1965 and covers millions of Americans who are 65 and older, and those with certain disabilities. Medicare Advantage plans are offered by private organizations and approved by Medicare. Some Medicare Advantage plans offer extra benefits such as vision. Enrollment trends show that nearly one in three people who have Medicare are enrolled in a Medicare Advantage plan.

    3. Confirm health plan doctors accept new Medicare members. Choose a Medicare health plan that offers a network of doctors and specialists who accept new Medicare members. Some physicians are opting out of caring for Medicare members. Also, keep in mind, as Medicare members age, they may need access to more specialists who accept Medicare members.

    4. Use the Medicare 5-star Quality Ratings Tool. The Medicare Star Quality Ratings system was created by the Centers for Medicare & Medicaid Services to help beneficiaries choose high-quality Medicare health plans. Plans receive an overall rating from one to five stars, with five being the highest for quality and service. Medicare members have the benefit of joining a five-star plan nearly all year — from Dec. 8 through Nov. 30 of the next year. They must be eligible and live where a five-star plan is offered.

    5. Review your health care needs annually. A Kaiser Family Foundation survey found that many beneficiaries — once enrolled in a Medicare health plan — don’t often feel confident they made the right choice, and don’t review their plan if their health care needs change. Medicare enrollees can use the Medicare star ratings to help them feel confident about choosing a high-quality plan.

    Read More …

  • We ignored it…and then it was too late…Medi-Cal cuts finally go into effect

    January 14, 2015

    As if doctors were not getting paid enough already, the Affordable Care Act promised a boost to their earnings, but with a deadline, at which time it would not only be taken away but further cuts would be applied.  Just at the time when millions more people are enrolling in Medi-Cal, a recent study by the Urban Institute estimated fee reductions will average about 40% nationwide.  In large states like California, New York, New Jersey and Illinois, the cuts could exceed 50%  The original temporary program increased fees for 2013 and 2014 but that has now been removed, and attempts to get Congress to extend it have been rebuffed.    So what happens now?  Doctors might not drop their current Medi-Cal load, but what are the expectations (and what is appropriate from a revenue standpoint) for their accepting new Medi-Cal patients?

  • Committee On The Shelterless | Arrow Benefits Group

    January 12, 2015

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    COTS

     

     

     

     

    Committee On The Shelterless (COTS) is powerful blend of nurturing and structure, they have helped thousands get back under a roof of their own. They provide almost 350 beds every nightand their Petaluma Kitchen serves over 124,000 meals a year and delivers over 750,000 pounds of food annually. The award-winning programs have helped thousands to rebuild their lives. COTS is a tax-exempt 501(c)3 organization.

    Address:
    900 Hopper Avenue
    Petaluma, CA 94952
    (707) 778-6380

    Services:
    Serves a no-cost mid-day meal seven days a week, 365 days a year for low and very-low income men, women and children.Food donations accepted daily, 7AM to 2PM Petaluma Kitchen Food Box Program is an adjunct to the Petaluma Kitchen’s daily meal program, food is delivered each week to very-low income seniors and families in Petaluma. A lifeline to help prevent a family or senior from slipping into homelessness.In addition to providing nourishment to those in need, staff at the Kitchen are often the first contact for families or individuals who need referrals to other community resources, such as housing, clothing, or medical care.Volunteer food sorters, packers and drivers meet every Saturday morning at the Kitchen to prepare and deliver emergency food to families and seniors who are referred by local churches, social service agencies and concerned friends or family.

    Hours:
    Lunch served Daily 11:30am-1:00pm Food Donations 7AM to 2PM daily Sign ups for Food Box Sun to Thurs 9:30AM to 11AM

    Eligibility:
    Must meet income requirement, be a resident of Petaluma

    Read More …

  • Top 2014 UBA Publications for Employers | Petaluma Employee Benefits

    January 9, 2015

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    Posted by Bill Olson

    papersUBA publishes many white papers, an executive summary of its annual Health Plan Survey, and custom reports. Below are the publications that garnered the most traffic and requests in 2014.

    1.  The Employer’s Guide to “Play or Pay”.

    With every day that goes by, the nation’s employers move a step closer to having to make “Play or Pay” decisions. The decisions are far from easy…and the clock is ticking. Download publication.

    2.  2014 Health Plan Survey Executive Summary.

    As employers consider their health insurance solutions in the face of health care reform, benefits benchmarking data is vital to accurately evaluate costs and determine if a plan is competitive. The 2014 UBA Health Plan Survey Executive Summary provides the latest trends in health plan costs, design, and plan type, plus information on wellness programs and the impact of the Patient Protection and Affordable Care Act (PPACA). Download publication.

    3.  A Business Case for Benefits Communications.

    As the cost of employer-sponsored health insurance continues to rapidly outpace wages and inflation, now more than ever employers are looking for ways to keep costs down. One way to do so (that requires very modest investment) is by improving benefits communication, a critical component of your employee engagement strategy. Download publication.

    4.  Counting Employees Under PPACA.

    As you likely know, the “employer mandate” section of the Affordable Care Act requires companies with 50 or more employees to either provide adequate and affordable coverage to their workers or pay tax penalties. But just how are those 50 to be counted? Request publication.

    5.  Custom UBA Health Plan Benchmarking Report.

    Employers are increasingly challenged to find accurate information that will help them evaluate their health plan design, manage rising costs and prepare for the future of health care. Making the right strategic business decisions starts with having all the facts. The UBA Health Plan Survey is the most comprehensive benchmarking survey of plan design and cost ever conducted, providing employers of all sizes more detailed — and therefore more meaningful — benchmarks and trends than any other source. Get a competitive edge in recruiting and retention of a superior workforce and planning for health care reform by evaluating and comparing your health plan to other companies. Request a report.

    Read More …

  • Source of Injury Restrictions and Group Health Plans | CA Benefits Broker

    January 5, 2015

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    www.thinkhr.com

    gardenQuestion:

    Our self-funded plan includes exclusions for hazardous activities and hobbies, including injury or illness arising from use of snowmobiles, personal aircraft, personal watercraft, four wheel recreational vehicles, etc. Does the Affordable Care Act (ACA) prohibit this type of exclusion or limitation for grandfathered and nongrandfathered plans?

    Answer:

    Federal regulations under the Health Insurance Portability and Accountability Act (HIPAA) pertain to these types of benefit exclusions, which are called “source of injury restrictions.” Under HIPAA, a group health plan may exclude benefits for the treatment of certain injuries based on the source of that injury, except that the plan may not exclude benefits otherwise provided for treatment of an injury if the injury results from an act of domestic violence or a medical condition. The Department of Labor guidance on this matter provides the following examples:

    • Example of a permissible source-of-injury restriction: A plan provision that provides benefits for head injuries generally, but excludes benefits for head injuries sustained while participating in bungee jumping, as long as the injuries do not result from a medical condition or domestic violence.
    • Example of an impermissible source-of-injury restriction: A plan provision that generally provides coverage for medical/surgical benefits, including hospital stays that are medically necessary, but excludes benefits for self-inflicted injuries or attempted suicide. This is impermissible because the plan provision excludes benefits for treatment of injuries that may result from a medical condition (depression).

    The next issue is whether source of injury restrictions that comply with HIPAA also comply with the Affordable Care Act (ACA) provisions for essential health benefits. Essential health benefits (EHBs) are health care items and services within 10 benefit categories, such as “emergency services” and “hospitalization.” Large group insured plans and self-funded plans are not required to cover EHBs. If an EHB is covered by the plan, however, the coverage must conform to applicable ACA provisions, including the ACA’s prohibition against lifetime and annual dollar limits (and, if nongrandfathered, the ACA’s limits on patient cost-sharing).

    The regulatory guidance currently available regarding EHBs and self-funded health plans does not specifically address source of injury restrictions. It appears that restrictions permitted under HIPAA (if designed appropriately) would also be considered compliant with the ACA, but there is no specific guidance for confirmation.

    Please note that plan provisions must be applied and administered consistently for all similarly situated individuals. Many claims administrators find source of injury restrictions very difficult to administer. You should ensure that claims can be administered effectively before deciding to implement any source of injury restrictions. Claims denied in whole or in part based on a source of injury restriction are deemed an adverse benefit determination under the Department of Labor’s claim appeal and review guidelines for group health plans.

    Please work with your benefits legal counsel and/or pose this question to one of the carriers marketing large group insured plans in your state. If the source of injury restriction would be permissible for the carrier’s insured business, then it would also be permissible for your self-funded plan.

    Read More …

  • Wellness Programs Feeling the Heat as the EEOC Increases Its Efforts – Part 2, Federal Regulations | CA Employee Benefits

    January 2, 2015

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    Posted by Jennifer Kupper

    HeatAs mentioned in the first posting, wellness programs must be analyzed under a myriad of laws and regulations. This post will discuss generally the wellness program landscape in light of the Americans with Disabilities Act (ADA)/Americans with Disabilities Act Amendments Act (ADAAA), the Genetic Information Non-Discrimination Act (GINA), the Patient Protection and Affordable Care Act (PPACA), and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Nondiscrimination Regulations. This is a 30,000-foot overview of laws and regulations that are in need of microscopic scrutiny when applying them to a wellness program.

    ADA/ADAAA

    The ADA/ADAAA generally prohibits discrimination in employment against a qualified individual on the basis of a disability in regard to employee compensation and other terms, conditions, and privileges of employment. Further is a prohibition from requiring a medical examination and making inquiries of an employee as to whether he or she has a disability, or as to the nature or severity of a disability, unless such examination or inquiry is shown to be job-related and consistent with business necessity.

    However, there is a statutory safe harbor that exempts certain insurance plans from the ADA’s general prohibitions. The “benefit plan exception” states that the ADA shall not be construed as prohibiting an employer from establishing, sponsoring, observing, or administering the terms of a bona fide benefit plan that are based on underwriting risks, classifying risks, or administering such risks that are based on, or not inconsistent with, state law or where the plan is not subject to state law (a self-funded benefit plan) so long as the exemption is not used as a subterfuge for discrimination. As such, voluntary medical examinations and/or histories, which are part of a group wellness program, are permissible so long as strict confidential processes are followed.

    What does it mean to be voluntary? There is no short answer, but the abbreviated answer is that a wellness program may be voluntary if the employer neither requires participation, nor penalizes employees who do not participate. The U.S. Equal Employment Opportunity Commission (EEOC) once posited that a health reimbursement arrangement (HRA) administered as part of a wellness program that meets the incentive limitations of HIPAA wellness regulations – no more than a (then) 20% reward – would be deemed voluntary and would not violate the ADA. Unfortunately, this portion of the opinion letter was withdrawn because it was outside the scope of the request. The position currently held by the EEOC is that an incentive is a veiled penalty, which, in essence, makes the program involuntary and, thus, violates the ADA. However, this is in conflict with the “benefit plan exception,” noted above.

    GINA

    Generally, GINA prohibits both the acquisition of genetic information as well as the use of genetic information by employers in employment decisions. As it applies to group health plans, Title I prohibits discrimination in health insurance premiums based on genetic information and places limitations on genetic testing and the collection of genetic information. Title II prohibits the use of genetic information in the employment context, restricts employers from requesting, requiring, or purchasing genetic information, and strictly limits employers from disclosing genetic information.

    In general, Title II limits the conditions under which an employer might lawfully collect genetic information pursuant to an employer-sponsored wellness program and it requires those employers to follow strict privacy and confidentiality mandates. Under GINA, it is unlawful for an employer to request, require, or purchase genetic information with respect to an employee or an employee’s family member. There is an exception if the information is part of a wellness program, subject to strict adherence of the following three requirements:

    1. The employee provides prior, knowing, voluntary, and written authorization;
    2. Only the employee (or family member if the family member is receiving genetic services) and the licensed health care professional, or board certified genetic counselor involved in providing such services, receive individually identifiable information concerning the results of such services; and
    3. Any individually identifiable genetic information provided in connection with the services is only available for purposes of such services and shall not be disclosed to the employer except in aggregate terms that do not disclose the identity of specific employees.

    Again, what does it mean to be voluntary? In the preamble to the 2010 final regulations implementing Title II, the EEOC concluded that a wellness program is voluntary if the program neither requires participation, nor penalizes employees for non-participation. The EEOC concluded that it would not violate Title II for an employer to offer individuals an inducement for completing an HRA that includes questions about family medical history, or other genetic information, as long as the employer specifically identifies those questions and makes clear, in language reasonably likely to be understood by those completing the HRA, that the individual need not answer the questions that request genetic information in order to receive the inducement. The EEOC specifically declined to take the approach taken in HIPAA regulations – no more than a (then) 20% reward – and, instead, added that adherence to Title II of GINA does not guarantee adherence to Title I of GINA, ADA, or HIPAA.

    HIPAA and PPACA

    The general rule pursuant to HIPAA nondiscrimination provisions is that a plan or issuer is prohibited from charging similarly situated individuals different premiums or contributions on the basis of a “health factor.” However, there is an exception to the general rule if the reward, i.e., premium discount, is based on participation in a program reasonably designed to promote health or prevent disease, i.e., a “wellness program.”

    When analyzing a wellness program under PPACA and HIPAA, the first step is to determine whether the wellness program – or, as it may be the case, which part of the wellness program – is “participatory” or “health-contingent.” Participatory wellness programs are not required to follow HIPAA nondiscrimination provisions, discussed below. However, and to the point of this blog series, participatory (and health-contingent) wellness programs should be reviewed and scrutinized against the provisions of GINA, ADA, the Employee Retirement Income Security Act (ERISA), Internal Revenue Code (IRC), and other federal and state laws.

    Participatory wellness programs are defined under HIPAA nondiscrimination final regulations as programs that either do not provide a reward, or do not include any conditions for obtaining a reward that are based on an individual satisfying a standard that is related to a health factor. Examples include a program that reimburses employees for all or part of the cost of membership in a fitness center, a diagnostic testing program that provides a reward for participation and does not base any part of the reward on outcomes, and a program that provides a reward to employees for attending a monthly, no-cost health education seminar.

    If the wellness program, or a piece of the wellness program, is participatory, it does not have to follow HIPAA nondiscrimination regulations. However, if the wellness program, or a portion thereof, is health-contingent, then the program must be analyzed pursuant to HIPAA nondiscrimination regulations.

    HIPAA Nondiscrimination Provisions and the Wellness Program Exception

    Health-contingent wellness programs, in contrast to participatory programs, require an individual to satisfy a standard related to a health factor to obtain a reward or require an individual to undertake more than a similarly situated individual based on a health factor in order to obtain the same reward. The standard may be performing or completing an activity relating to a health factor, or it may be attaining or maintaining a specific health outcome. The final regulations further subdivided health-contingent programs into (1) activity-only wellness programs, and (2) outcome-based wellness programs. While there are some differences, both types are permissible only if the program adheres to the five prongs:

    1. Be reasonably designed to promote health or prevent disease (the same rules apply to activity-only and outcome-based programs);
    2. Give employees a chance to qualify for the incentive at least once a year (the same rules apply to activity-only and outcome-based programs);
    3. Cap the reward or penalty at 50% of the total cost of coverage for avoiding tobacco and at 30% for all other types of wellness incentives (the same rules apply to activity-only and outcome-based programs);
    4. Provide an alternative way to qualify for the incentive for those who have medical conditions (different rules apply to activity-only and outcome-based programs); and
    5. Describe the availability of the alternative method of qualifying for the incentive in written program materials (the same rules apply to activity-only and outcome-based programs).

    These rules set forth criteria for an affirmative defense that can be used by plans and issuers in response to a claim that the plan or issuer discriminated under HIPAA nondiscrimination provisions.

    This is not the end…

    The above is merely a general overview of the innate tension created by conflicting regulations, compounded by the lack of guidance from the commission, which is confronting concerned employers who have chosen to be proactive in combating the costs of health care and improving consumers’ lives. The next part of the series will discuss the movements in the courts, the backlash felt by the EEOC, and steps employers should take.

    For more data on wellness programs and other plan design trends, download the 2014 Health Plan Executive Summary. This survey – which has been conducted every year since 2005 – is the nation’s largest health plan survey and provides more accurate benchmarking data than any other source in the industry. You can contact a UBA Partner Firm for a customized benchmark report based on industry, region and business size.

    Read More …

  • The exchanges are working, except for those for whom they are not working…the carriers

    December 30, 2015

    United Health Care is the largest carrier in the country for the moment…and the first one to decide to pull out of the health insurance marketplaces (exchanges). They can’t make money (and they are not the only ones) in a regulated environment and where they have to take even unhealthy individuals on a guaranteed basis or any number of people on group plans when there could easily be a case of adverse selection. Who can make money in this environment? One major carrier is saying they can’t.

  • Agencies Issue Final Rule on Grandfathered Health Plans and Other Initiatives | Petaluma Employee Benefits

    December 29, 2015

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    By Danielle Capilla
    Chief Compliance Officer at United Benefit Advisors

    Capitol Building, Washington DCFederal agencies recently issued a final rule that essentially combined a variety of interim final rules and non-regulatory guidance on a variety of Patient Protection and Affordable Care Act (ACA) initiatives such as grandfathered health plans, preexisting condition exclusions, internal and external appeals, rescission’s of coverage, lifetime and annual limits, emergency care access and dependent coverage. The final rule was very similar to the previous guidance it consolidated. The final rule goes into effect on January 1, 2017. At that time all of the prior interim rules will be superseded.

    The final rule also noted that various transitional rules are now void, such as the allowance of grandfathered health plans to exclude children under age 26 who were eligible for other group health plan coverage, and rules that provided a special enrollment period for children under age 26 who had been excluded from coverage.

    Information on grandfathered health plans is shared below. For more information on the final rules related to pre-existing conditions, lifetime and annual coverage limits, rescission’s, adult children, appeals, designation of a primary care provider and access to emergency care, download UBA’s free ACA Advisor, “Agencies Issue Final Rule on Grandfathered Health Plans and Other Initiatives.”

    The final rule reaffirmed that grandfathered status applies separately with respect to each benefit package. For example, a group health plan with a preferred provider organization (PPO) plan, a point of service (POS) arrangement, and a health maintenance organization (HMO) option would each carry grandfathered status (or not) separately. Requirements for grandfathered status notification remain the same — plans must include a statement that the plan or health insurance coverage believes it is a grandfathered health plan in any summary of benefits provided under the plan. The model disclosure notice remains the same.

    Grandfathered plans have been governed by anti-abuse rules, to prevent plans from maintaining grandfathered status when employees transferred into the plan are from a transferee plan that would have caused the transferor plan to lose grandfathered status if its terms were adopted. There is an exception for bona fide reasons for employee transfers, such as a plan being eliminated by the carrier.

    The final rule noted that a plan that eliminated substantially all benefits needed to diagnose a condition would cause a plan to lose its grandfathered status, but purposefully declined to provide a bright line rule to interpret the requirement. Excessive increases to a single or limited number of copayments would cause a plan to lose grandfathered status, even if the remaining copayments remained the same.

    Plans that add additional tiers (such as individual plus one, individual plus two) will not lose grandfathered status if the contribution rate for the new tiers is not below the previous non-self-only tier by more than five percent. Employers with grandfathered health plans that offer wellness programs should take great caution if the wellness program imposes penalties for failing to meet standards, this could put the plan’s grandfathered status at risk. Finally, grandfathered health plans may move brand-name versions of drugs that become generic to a higher cost-sharing tier.

    For more information on the final rules related to pre-existing conditions, lifetime and annual coverage limits, rescission’s, adult children, appeals, designation of a primary care provider and access to emergency care, download UBA’s free ACA Advisor, “Agencies Issue Final Rule on Grandfathered Health Plans and Other Initiatives

    Read More …

  • Proposed Benefit Payment and Parameters Rule Released | CA Employee Benefits

    December 24, 2015

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    By Danielle Capilla
    Chief Compliance Officer at United Benefit Advisors

    ProposedPaymentFederal agencies have released the proposed rule for the 2017 Benefit Payment and Parameters. Among other items, it provides updates and annual provisions relating to:

    • Risk adjustments, reinsurance, and risk corridors programs
    • Cost-sharing parameters and cost-sharing reductions
    • User fees for Federally-Facilitated Exchanges (FFEs)
    • The standards for open enrollment for the individual market for the 2017 benefit year
    • Updates to the Small Business Health Options Program (SHOP)
    • Definitions of large and small employer
    • Guaranteed availability
    • Medical loss ratio (MLR) program

    The Benefit Payment and Parameters rule is typically finalized in the first quarter of the year following the release of the proposed version. Comments on the proposed rule are due by December 21, 2015 (today).

    The proposed rule would set cost sharing for the 2017 calendar year for self-only coverage at $7,150 and $14,300 for other than self-only coverage. The 2017 open enrollment period would be from November 1, 2016, to January 31, 2017.

    The proposed rule suggests amending the regulatory definitions of “large” and “small” employers to match the definition set by the Protecting Affordable Coverage for Employees Act (PACE Act). The definitions would be revised to define a large employer as one that averages at least 51 employees in the previous year, but states may elect to define large employers as those with 101 or more employees. Similarly, the definition of small employer would change to an employer with an average of at least one but not more than 50 employees on business days during the preceding calendar year. States may elect to define a small employer as one with 100 or fewer employees. The rule would also provide that, for an employer not in existence the preceding calendar year, its size should be determined by its reasonable expectation of the average number of employees during the year.

    Download UBA’s ACA Advisor for additional detail on proposed rules related to:

    • The rating area for a small group plan
    • Availability of small group coverage based on employer contribution or group participation rules
    • Standards of conduct for agents and brokers
    • Special enrollment periods
    • Employer appeals of an employee’s eligibility
    • “Vertical choice” options

    Read More …

  • What’s the cost of a Cadillac? No, they can’t just repeal the tax

    December 23, 2015

    Once everyone finally saw what the Cadillac tax would do, there was predictable outrage. After all, it is outrageous, especially when they set numbers in 2010 that would not take effect until 2018. So there has been huffing and puffing in the past year and Democrats and Republicans alike trying to junk this heap. But they can’t do it easily, as a little recognized aspect of the ACA requires that the money the Cadillac tax was supposed to raise has to be raised somewhere else. No one has any suggestions at this point…

  • Use These Effective Time Management Strategies | Petaluma Benefits Broker

    December 21, 2015

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    by: Merrie C. Weeks

    BUSYIf you desire to have good time management then you need to have a strategy or an action plan. Following these strategies will help you get the most out of your days.

    First thing to do is Prioritize your work.

    Start each day by ranking the things that you much do. Starting with the most important and unpleasant tasks first, then go from there. Those things that can wait for later that day should be listed towards the bottom of your list. Don’t make your list too long because there are only so many hours in a day and you don’t want to feel like you will never get it all accomplished.

    Second thing is to Assign Work Time Frame for each task.

    At first this might not seem realistic but it is mostly so that you will have some sort of idea how long it will take to finish each task. You will find that once you start a task, it won’t really take very long unless it is a big project. If so, then break it down so that you can see some progress.

    Third Be Flexible.

    Unexpected things come up from time to time so if you have to stop to take care of some other matter, do not worry and stress out if you don’t accomplished a certain task in the time frame you set. Just like the saying goes, “Rome wasn’t built in a day” so make sure you allow for those time when things come up. Don’t let these things such as phone calls, important emails,kids and life in general frustrate you, the important thing to remember is that you are making progress on your list.

    Fourth thing is to Say No if it isn’t important.

    Whether you work from home or out of the home there are things that can distract us and waste time. Limit small talk with co-workers, family, friends, etc. while you are working. Respect your decision to make a plan and stick to it. Others will need to understand that if it isn’t something that needs to be taken care of right this minute then it can wait.

    Fifth is to Delegate.

    Remember that you probably can’t do everything yourself so if there is a task that you might not be very good at or like doing and there is someone that can do the task then by all means pass it on. In this way the task will get done and you won’t waste time putting it off because you can’t accomplish it yourself.

    Compromise when necessary.

    As your day progresses the urgency of a task may also change. There may be times when your tasks will need to be re-prioritized, rescheduled, postponed or dropped altogether, making adjustments if things come up that needs your attention is important.

    Everyone has limitations and if you realize what those are then you will know what you can work on later to improve those skills or know in advance what tasks you will need help with.

    Learning to manage your time is not to stress your day so remember to relax and learn as you go. The more you practice managing your time, the better you will get at it. Time management is so that you will take control of your days and see how much you really can accomplish each day and then enjoy some time with family and friends. This is your only viable option no matter where you are working, this is the only way to accomplish anything worthwhile.

    Read More …

  • Negotiating over COBRA Coverage – Use EXTREME CAUTION! | California Benefits Broker

    December 17, 2015

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    By Elizabeth Kay, Compliance & Retention Analyst
    AEIS Advisors
    A UBA Partner Firm

    CautionHave you ever overheard the new employee in the break room, bragging about how good their health insurance was with their previous employer, and how much less expensive it was than the coverage they are currently being offered?

    You may think ”If it was so good, then why give it up?” There are always a number of factors that can lead to someone making a job change, but what happens when COBRA becomes a part of the negotiating process when they are working out the terms of employment with the new company?

    We know that, as of November 2014, the Department of Labor (DOL) made it very clear that an employer cannot pay the premium for an individual plan of an employee or an employee’s dependents, period. If they do, the employer could pay an excise tax of $100 per day they are out of compliance per employee affected. That could be up to $36,500 for ONE employee, for ONE year!

    But what if a prospective employee were coming to work for you, and the plan with their current employer had similar coverage but lower premiums because the employer was a larger company, the employees were in very good health overall and the employer had negotiated very low rates with its carrier as a result, or the employer was based in a different state where health care costs were lower? What if that prospective employee tells you that you could pay their COBRA premiums and pay less premium for them than if they enroll in your plan? Many employers would love to save $500 a month for one employee. But the deal is not nearly as sweet as it sounds, and here’s why.

    While it is not illegal for an employer to pay for COBRA premiums, if it is for a group plan and not an individual plan, it can create other problems with regard to ERISA and COBRA compliance.

    As soon as an employer pays the premium on a pre-tax basis on behalf of an employee for its company policy or another policy, an employer-sponsored plan is created, and is therefore subject to both ERISA and COBRA regulations.

    ERISA requires that the plan sponsor distribute notifications to enrollees of the plan, including a Summary Plan Description, and other documents that contain specific plan details. If the employee’s plan benefits were under another employer’s plan, it may be difficult to get that information and distribute it to your employee.

    Federal COBRA regulation requires that the employee have access to the same coverage for up to 18 months after he or she loses eligibility for the plan due to termination of employment, for example. What happens if the COBRA plan terminates because that previous company goes out of business and its group plan dissolves? Now the current employer is obligated to continue the employee’s coverage, perhaps without a means to do so.

    Or, what if this employee terminates from your company after 12 months? It now becomes your responsibility to provide the employee with 18 months of COBRA coverage, except the employee has already used a portion of his or her COBRA eligibility while under your employment. Since COBRA is an employer obligation, you could be responsible for providing COBRA coverage to an employee who was never enrolled in your company’s group policy in the first place.

    It becomes a sticky mess, indeed!

    On the flip side, what about negotiating an employee’s severance package? If an employee is leaving your company and you are putting together a severance package, be careful when including paying for the employee’s COBRA continuation coverage. Many employers will offer to pay for three, six or 12 months of COBRA premiums on behalf of the terminated employee.

    While this can be done, be careful how you word it in the severance agreement. Most employer sponsored plans are on a 12 month contract. If you make a very general statement saying you will pay to continue the employee’s COBRA coverage at your expense for 12 months, and your premiums skyrocket at renewal, or if you change carriers, and the terminated employee chooses a more expensive plan with richer benefits, you could be on the hook for the increase in premiums.

    If you are clear in the severance agreement about the amount you will commit to pay on the employee’s behalf, or clear about the level of coverage to be provided (platinum, gold, silver, or bronze level plan, for example), then you will be better protected.

    If you are paying COBRA premiums on a tax-exempt basis for a current employee, or you are concerned about a severance agreement that you made with a terminated employee, please seek advice from your ERISA or employment law attorney.

    Read More …

  • They keep amending it, but they cannot kill it…another change in the Affordable Care Act

    December 16, 2015

    Republicans continue to beat their breasts, but there are certain aspects that remain pests, and these keep failing to meet the tests…of credulity and practicability. In the recent Bipartisan Budget Act of 2015, President Obama quietly erased the “auto enrollment” feature that was supposed to help employers, who didn’t want the help. Another one bites the dust…but there are plenty of provisions left

  • Cadillac Tax – Should employers be making changes now? | California Employee Benefits

    December 14, 2015

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    By Elizabeth Kay, Compliance & Retention Analyst
    AEIS Advisors
    A UBA Partner Firm

    ChangeAheadThe Affordable Care Act (ACA) has brought about many changes in employee benefits. Plans have been eliminated, benefits added, rules changed, and rules have been delayed.

    The ACA has always been a heavily debated topic between the Republicans and Democrats, and now that we are coming up to another presidential election we know that we can expect it to be talked about quite a lot.

    Some speculate that the Republicans will attempt to repeal the law, again, but the truth of the matter is that the ACA is bringing in too much revenue for a repeal to be successful. The Congressional Budget Office (CBO) projections there will be $353 billion dollars in revenue from the ACA over the next 10 years.

    This means that in order for the Republicans to be successful in repealing any part of the law that generates revenue, they will need to find a way to replace that lost revenue.

    Looking at the projected cost increases based on its annual Health Plan Survey of over 18,000 health, plans offered by nearly 11,000 employers nationwide, UBA estimates that nearly three out of four U.S. employers will be hit with the Cadillac tax by 2022. With alarm bells sounding, many employers are planning benefit cuts to avoid the tax and, as a result, the CBO actually expects the ACA’s Cadillac tax (and Medical Device Tax) won’t generate the most revenue. Instead they are counting heavily on the second largest source of expected revenue from the ACA: $209 billion dollars from ”other sources.”

    What are ”other sources?” The CBO believes that there will be an increase in income taxes due to employers that reduce employee health plans in order to avoid having to pay the Cadillac tax, and in turn raise their employees’ wages to compensate.

    If this scenario were realistic (although reducing benefits due to the rising cost of premiums without any increase in wages seems to be more realistic), we should see employers begin to modify their plans in anticipation of the Cadillac tax in 2018, and then a significant increase in salaries. But will employers act sooner? If the Cadillac tax were to be repealed by Congress, it would most likely happen in 2017 after the presidential election. The question then becomes when should employers make these changes? Do they make them now, live with the potential for the Cadillac tax to be eliminated, and their payroll will just remain higher? Or do they wait to make those changes until 2017, the year before the tax goes into effect?

    As if another tax were not bad enough, the 2015 UBA Benefits Survey shows that, if some employers were to reduce benefits to avoid the Cadillac tax, they would no longer be able to offer a plan that meets the ACA minimum value requirement. It seems hard to believe that a plan could have premiums that are more than $10,200 annually for one person yet have an actuarial value of only 60 percent. And with the ever-increasing cost of health care, premiums will only continue to rise over the next three years. More and more employers will have to make difficult decisions about their benefit plans.

    There is hope that legislators will add an actuarial value safe harbor into the Cadillac tax provision so that employers who are offering a plan that meets an actuarial value of less than 90 percent will be exempt from the Cadillac tax. Otherwise, an applicable large employer that is subject to the ACA’s “play or pay” rules may have to pay the Cadillac tax, and will also be fined for not offering a plan that meets the minimum value requirements.

    Read UBA’s latest press release for the percentages of employers likely to be subject to the Cadillac tax broken down by actuarial value.

    Download the free 2015 Health Plan Survey Executive Summary for additional information on health plan cost trends across the U.S., including employer contributions and costs for employees.

    To benchmark your plan against others in your region, industry or size bracket, contact a UBA Partner near you to run a custom benchmarking report.

    Read More …

  • More CO OPS fly the coop…continuing failure of an ACA experiment

    December 11, 2015

    Then Arizona and then Michigan, which became the 12th co op failure of the year, which now makes it half of all of these non profits who have failed to provide adequate coverage for a reasonable length of time…at considerable taxpayer cost. As of the end of the third quarter this year, the remaining surviving 11 co ops have lost $200 million, which is triple the losses they reported at the end of June.

  • Holiday Health Check-List: Use It or Lose It | Petaluma Employee Benefits

    December 10, 2015

    Tags: , , ,

    www.newsusa.com

    fsa2016As the end of the year nears, many of us are preoccupied with holiday parties, searching for the perfect gift for loved ones or making lists of things to accomplish before the new year begins. During this busy time, one important task is often forgotten on the to-do list: Make sure to use flexible spending account (FSA) funds before it’s too late.

    Some employers will allow you to roll over $500 of your FSA funds into the next year. However, for those who are not permitted a carryover, these funds must be used by the end of the benefits year, which for most people is Dec.31. Otherwise the funds will be forfeited back to your employer. In fact, each year more than $400 million in tax-free income is wasted when FSA holders don’t spend these funds or fail to submit expenses to be reimbursed.

    That said, it’s not too late to create a health care checklist to keep you and your family on a healthy track during these last few weeks of the year. Here are five ways to ensure you get the most out of your benefits dollars:

    1. Schedule annual check-ups with ALL physicians. Visit important specialists, such as an optometrist, dentist, dermatologist or gynecologist, along with your primary care physician.

    2. Don’t forget about eye care/medical aids. Consider whether you need an additional pair of eyeglasses, contact lenses or even orthotic shoe inserts to help utilize FSA funds.

    3. Consider purchasing low-cost health care items. Stock up on items for year-round and emergency use, such as first-aid kits, contact solution, thermometers, neck/wrist/joint braces, aspirin and other pain relievers.

    4. Ask employers about unique FSA offerings. Find out whether Lasik eye surgery, massages, acupuncture treatments, and other unique procedures or treatments are included in your FSA plans.

    5. Submit receipts. If spending your entire FSA funds still seems unrealistic after any last-minute checkups and first-aid purchases, double-check to make sure you’ve submitted past receipts for eligible out-of-pocket health care purchases so you can be reimbursed.

    “It’s important to review your out-of-pocket expenses from the past year and consider any changes that may occur to gain a better idea of how much to contribute to an FSA in the coming year,” says Matthew Owenby, senior vice president and chief human resources officer at Aflac.

    By creating a list, and checking it twice, you can ensure that you don’t leave money on the table as you prepare for a new year.

    Read More …

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