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  • Local Benefits Group Distributes First $100,000 of AED Machine Donations to Community | CA Benefit Advisors

    August 17, 2017

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    As part of the Arrow Wellness Initiative to donate and distribute $100,000 in AED (Automated External Defibrillator) machines to their local business community, Riverfront Fitness is the first of many recipients vying to receive an AED device from Arrow Benefits Group. AED machines are an integral part of treating those suffering from sudden cardiac arrest in the few vital minutes before emergency medical crews arrive, dramatically increasing the survival rates of the victims of sudden cardiac arrest. Without these machines on hand, the survival rate is under 10%; immediate response with the use of CPR and AED increases sudden cardiac arrest survival rates by as much as 70%. “Having the AED gives both our clients and ourselves the reassurance and comfort of knowing that if a heart attack occurs while using the facility we have the proper equipment available to use until the Fire Department arrives. It brings us a sense of security and assurance that we are providing a lifesaving machine at our fitness facility. It means the value of a life,” says Amy Pontius, Manager at Riverfront Fitness. The AED device donations build on Arrow’s popular Wellness Initiative which provides free CPR and First Aid classes to clients and the community. If you would like to learn more and participate with your company in the procurement of one of the AED machines please contact Andrew McNeil at 707-992-3789 or andrewm@arrowbenefitsgroup.com

    In a life-threatening situation where every second counts, access to these devices can mean the difference between life and death. According to the American Heart Association, for every minute that passes without CPR and defibrillation, the chances of survival decrease by 7–10%. Having an AED on hand makes it possible to respond immediately in emergency situations, and yet the devices remain cost-prohibitive for many small businesses. For Riverfront Fitness and their 45 members, the high price-tag means having an AED device at their facility would be unattainable without the support of the Arrow Wellness Initiative.

    “I can’t thank Arrow enough for their generosity in providing us with an AED. Being a small business, finding the extra funding to purchase such an expensive piece of equipment is difficult. The cost is almost a deterrent. I hope that changes in the future. This piece of equipment saves lives and there should be no price tag on that. We thank Arrow for recognizing our need and bringing the AED to Riverfront Fitness. Of course, we hope to never have to use it, but we are prepared just in case!” The donation is part of Arrow’s ongoing mission to support client health and well-being needs. “We are dedicated to helping our clients take proactive actions to keep their employees healthy and safe,” said Arrow Benefits Group Principal Andrew McNeil.

    About Arrow Benefits Group

    Arrow Benefits Group, the third largest benefits firm in the North Bay, is a proud partner of United Benefit Advisors (UBA), one of the largest benefits consulting and brokerage firms in the country.

    Arrow Benefits Group is the single-source solution for managing the complexities of benefits with expert advice, customized programs, and personalized solutions. Arrow’s innovative programs control costs and give employees a greater sense of financial and emotional security.

    For straight answers to employee benefits call 707-992-3780 or visit http://www.arrowbenefitsgroup.com

  • Wellness Programs – Getting Started and Remaining Compliant | CA Benefit Advisors

    August 15, 2017

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    Where to Start?

    First, expand the usual scope of wellness activity to well-BEING. Include initiatives that support more than just physical fitness, such as career growth, social needs, financial health, and community involvement. By doing this you increase your chances of seeing a return on investment (ROI) and a return on value (ROV). Qualitative results of a successful program are just as valuable as seeing a financial impact of a healthier population.

    Wellness program ROI and ROV

    Source: Katherine Baicker, David Cutler, and Zirui Song, “Workplace Wellness Programs Can Generate Savings,” Health Affairs, February 2010, 29(2): pp 304-311

    To create a corporate culture of well-being and ensure the success of your program, there are a few important steps.

    1. Leadership Support: Programs with leadership support have the highest level of participation. Gain leadership support by having them participate in the programs, give recognition to involved employees, support employee communication, allow use of on-site space, approve of employees spending time on coordinating and facilitating initiatives, and define the budget. Even though you do not need a budget to be successful.
    2. Create a Committee or Designate a Champion: Do not take this on by yourself. Create a well-being committee, or identify a champion, to share the responsibility and necessary actions of coordinating a program.
    3. Strategic Plan: Create a three-year strategic plan with a mission statement, budget, realistic goals, and measurement tools. Creating a plan like this takes some work and coordination, but the benefits are significant. You can create a successful well-being program with little to no budget, but you need to know what your realistic goals are and have a plan to make them a reality.
    4. Tools and Resources: Gather and take advantage of available resources. Tools and resources from your broker and/or carrier can help make managing a program much easier. Additionally, an employee survey will help you focus your efforts and accommodate your employees’ immediate needs.

    How to Remain Compliant?

    As always, remaining compliant can be an unplanned burden on employers. Whether you have a wellness or well-being program, each has their own compliance considerations and requirements to be aware of. However, don’t let that stop your organization from taking action.

    There are two types of programs – Group Health Plans (GHP) and Non-Group Health Plans (Non-GHP). The wellness regulations vary depending on the type of employer and whether the program is considered a GHP or Non-GHP.

    Group health plan compliance table

    Employers looking to avoid some of the compliance burden should design their well-being program to be a Non-GHP. Generally, a well-being program is Non-GHP if it is offered to all employees regardless of their enrollment in the employer’s health plan and does not provide or pay for “medical care.” For example, employees receive $100 for attending a class on nutrition. Here are some other tips to keep your well-being program Non-GHP:

    • Financial: Do not pay for medical services (e.g., flu shots, biometric screenings, etc.) or provide medical care. Financial incentives or rewards must be taxed. Do not provide premium discounts or surcharges.
    • Voluntary Participation: Include all employees, but do not mandate participation. Make activities easily accessible to those with disabilities or provide a reasonable alternative. Make the program participatory (i.e., educational, seminars, newsletters) rather than health-contingent (i.e., require participants to get BMI below 30 or keep cholesterol below 200). Do not penalize individuals for not participating.
    • Health Information: Do not collect genetic data, including family medical history. Any medical records, or information obtained, must be kept confidential. Avoid Health Risk Assessments (i.e. health surveys) that provide advice and analysis with personalized coaching or ask questions about genetics/family medical history.

    By Hope DeRocha
    Originally Posted By www.ubabenefits.com

  • When Grief Comes to Work | CA Benefit Advisors

    August 10, 2017

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    Death and loss touch all of us, usually many times throughout our lives. Yet we may feel unprepared and uncomfortable when grief intrudes into our daily routines. As a manager, when grief impacts your employees it’s helpful to have a basic understanding of what they are going through as well as ways you can help.

    Experiencing Grief

    Although we all experience grief in our own way, there are behaviors, emotions and physical sensations that are a common part of the mourning process. J. William Worden’s “Four Tasks of Mourning” will be experienced in some form by anyone who is grieving. These tasks include accepting the reality of the loss, experiencing and accepting our emotions, adjusting to life without the loved one, and investing emotional energy into a new and different life.

    Commonly experienced emotions are sadness, anger, frustration, guilt, shock and numbness. Physical sensations include fatigue or weakness, shortness of breath, tightness in the chest and dry mouth.

    Manager’s Role

    When employees are mourning, it’s important to create a caring, supportive and professional work environment. In most cases, employees will benefit from returning to work. It allows them to resume a regular routine, focus on something besides their loss and boost their confidence by completing work tasks.

    At the same time, bereaved employees may experience many challenges when returning to work. They may have poor concentration, be extremely tired, feel depressed or have a short temper and uncontrollable emotions.

    As a manager, the best thing you can do is acknowledge the loss and maintain strong lines of communication. Even if you believe someone else is checking in with them, make sure you stay in touch and see if there is anything you can do.

    Developing a Return to Work Plan

    In order to help your employees have a smooth transition back to work you must listen and understand their needs. Some additional questions you’ll want to answer are:

    • What are your company’s policies and procedures for medical and bereavement leave?
    • What information do your employees want their co-workers to have and would they rather share this information themselves?
    • Do they want to talk about their experience or would they rather focus on work?
    • Do they need private time while at work?
    • Does their workload and schedule need to be adjusted?
    • Do they need help at home – child care, meals, house work, etc.?
    • Are there others at work that may be experiencing grief of their own?

    Helpful Responses for Managers

    • Offer specific help – make meals, wash their car, walk their pet, or anything else that will make their life easier.
    • Say something – it can be as simple as, “I’m so sorry for your loss.”
    • Listen – be kind but honest.
    • Respect privacy – honor closed doors and private moments.
    • Expect tears – emotions can hit unexpectedly.
    • Thank your staff – for everything they are doing to help.

    Grieving is a necessity, not a weakness. It is how we heal and move forward. As a manager, being there for your employees during this time is important in helping them through the grieving process.

    An Employee Assistance Program is a great resource for both you and your employees when grief comes to work.

    Originally published by www.ubabenefits.com

  • Employer Strategies for Managing Prescription Drug Costs | CA Benefit Advisors

    August 8, 2017

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    Modern medicines have resulted in longer, more productive lives for many of us. Prescription drugs soothe sore muscles after a strenuous workout or manage the conditions of a chronic disease. Unfortunately, this use of prescriptions drugs can come with a hefty price tag.

    Americans are spending more money on prescription drugs than ever before and the United States as a nation spends more per capita on prescription drugs than any other country. With the cost of some drugs exceeding thousands of dollars for a 30-day supply, this can translate into financial hardship for many Americans.

    For employers sponsoring a medical plan, managing the cost of these prescription drugs is also becoming a task. Insurance companies and employers struggle with the ability to provide affordable medical plans, and the ever-increasing prescription drug costs are a primary driver of this difficulty. As a result, prescription drug plan designs are changing shape – moving to a model that helps push more of the cost of these drugs to the member along with increasing awareness of the true cost of the prescriptions.

    Flat dollar copay plans have become an expected norm in medical plans for almost a decade. However, insurance companies underwriting fully insured medical plans and employers sponsoring self-funded medical programs now need to make modifications to these plan designs to manage the ever-increasing prescription drug costs. As a result, we are seeing more prescription drug plans combining some aspect of coinsurance along with or in place of the flat dollar copayments.

    According to the 2016 UBA Health Plan Survey, copay models are still the most popular, with a three-tier copay structure the most prevalent. Median retail copayments for these three-tier plans are $10 for generic drugs, $35 for preferred brand drugs (drugs on the carrier’s prescription drug list) and $60 for non-preferred brand drugs (drugs not on the carrier’s prescriptions drug list). While 54.5 percent of all prescription plans are copay only, approximately 40 percent of all prescription drug plans have co-insurance along with (or in lieu of) copays–a plan design that is particularly common among four-tier plans.

    Coinsurance models have many unique designs. Some plans are a straight percentage of the cost of the drug; some may involve a maximum or minimum dollar copayment combined with the coinsurance. For example, a plan may require 40 percent coinsurance for a preferred brand drug, but there is a minimum copayment of $30 and a maximum copayment of $50. Typically, we see a higher coinsurance percentage for non-preferred brand drugs and specialty drugs. The member cost of the drug is calculated after any negotiated discounts, so members covered by a coinsurance plan are reaping the benefits of any discounts negotiated with the pharmacy by the pharmacy benefit manager (PBM).

    Coinsurance plans do provide several advantages to managing prescription drug costs. Under a flat dollar copay plan design, members may not truly understand the full cost of the drug they are purchasing. Pharmacies are now disclosing the full cost of drugs on the purchase receipts. Yet, most consumers do not take note of this disclosure, focusing only on the copayment amount. When a member pays a percentage of the cost of the drug as in a coinsurance model, the true cost of the drug becomes much more apparent.

    Another advantage of the coinsurance model is that it automatically increases the member share of the cost as the price of the drug increases. Under the flat dollar copayment model, as the true cost of the drug increases, the member pays a smaller portion of the total cost. When the member’s portion is determined by a coinsurance percentage, the member pays more as the cost of the drug increases.

    As the costs of health care overall continue to increase, we all need to become better consumers of our healthcare. Members covered by a prescription drug plan with a coinsurance model will have a better understanding of the true cost of their prescriptions. As members become more aware of the true costs of their care, they make better health care decisions, managing the overall cost of care.

    We expect to see prescription drug benefit plans change even more as the cost of health care – especially prescription drugs – escalates. These changes will likely result in more of the cost being pushed to the patient. There are resources available to patients for assistance with some of these out-of-pocket costs. It is vital for the patient to understand their costs and know how to maximize their benefits. In a few weeks, the UBA blog will highlight some of these resources and provide information on how to educate employees on maximizing their benefits and the industry resources available to them.

    For all the cost and design trends related to health and prescription drug plan costs by group size, industry and region, download UBA’s Health Plan Survey Executive Summary.

    By Mary Drueke-Collins
    Originally Posted By www.ubabenefits.com

  • Government and Education Employers Offer Richest HSA Plans | CA Benefit Advisors

    August 4, 2017

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    Across most industries, HSA contributions are, for the most part, down or unchanged from three years ago, according to UBA’s Health Plan Survey. The average employer contribution to an HSA is $474 for a single employee (down 3.5 percent from 2015 and 17.6 percent from five years ago) and $801 for a family (down 9.2 percent from last year and 13.7 percent from five years ago). Government and education employers are the only industries with average single contributions well above average and on the rise.

    Government employees had the most generous contributions for singles at $850, on average, up from $834 in 2015. This industry also has the highest employer contributions for families, on average, at $1,595 (though that is down from 1,636 in 2015). Educational employers are the next most generous, contributing $636, on average, for singles and $1,131 for families.

    Singles in the accommodation/food services industries received virtually no support from employers, with average HSA contributions at $166. The same is true for families with HSA plans in the accommodation/food services industries with average family contributions of $174.

    Retail employers also remain among the least generous contributors to single and family HSA plans, contributing $305 and $470, respectively. This may be why they have low enrollment in these plans.

    HSA Plans by Industry

    The education services industry has seen a 109 percent increase in HSA enrollment since 2013 (aided by employers’ generous contributions), catapulting the industry to the lead in HSA enrollment at 23.8 percent. The professional/scientific/tech and finance/insurance industries follow closely at 23.3 percent and 22.1 percent, respectively.

    The mining/oil/gas industry sees the lowest enrollment at 3.8 percent. The retail, hotel, and food industries continue to have some of the lowest enrollment rates despite the prevalence of these plans, indicating that these industries, in particular, may want to increase employee education efforts about these plans and how they work.

    For a detailed look at the prevalence and enrollment rates among HSA and HRA plans by group size and region, view UBA’s “Special Report: How Health Savings Accounts Measure Up”.

    Benchmarking your health plan with peers of a similar size, industry or geography makes a big difference in determining if your plan is competitive. To compare your exact plan with your peers, request a custom benchmarking report.

    For fast facts about HSA and HRA plans, including the best and worst plans, average contributions made by employers, and industry trends, download (no form!) “Fast Facts: HSAs vs. HRAs”.

    For a comprehensive chart that compares eligibility criteria, contribution rules, reimbursement rules, reporting requirements, privacy requirements, applicable fees, non-discrimination rules and other characteristics of account-based plans, request UBA’s Compliance Advisor, “HRAs, HSAs, and Health FSAs – What’s the Difference?”.

    Originally published by www.ubabenefits.com

  • Best Practices for Initial COBRA Notices | CA Benefit Advisors

    August 2, 2017

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    The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires group health plans to provide notices to covered employees and their families explaining their COBRA rights when certain events occur. The initial notice, also referred to as the general notice, communicates general COBRA rights and obligations to each covered employee (and his or her spouse) who becomes covered under the group health plan. This notice is issued by the plan administrator within the first 90 days when coverage begins under the group health plan and informs the covered employee (and his or her spouse) of the responsibility to notify the employer within 60 days if certain qualifying events occur in the future.

    The initial notice must include the following information:

    • The plan administrator’s contact information
    • A general description of the continuation coverage under the plan
    • An explanation of the covered employee’s notice obligations, including notice of
      • The qualifying events of divorce, legal separation, or a dependent’s ceasing to be a dependent
      • The occurrence of a second qualifying event
      • A qualified beneficiary’s disability (or cessation of disability) for purposes of the disability extension)
    • How to notify the plan administrator about a qualifying event
    • A statement that that the notice does not fully describe continuation coverage or other rights under the plan, and that more complete information regarding such rights is available from the plan administrator and in the plan’s summary plan description (SPD)

    As a best practice, the initial notice should also:

    • Direct qualified beneficiaries to the plan’s most recent SPD for current information regarding the plan administrator’s contact information.
    • For plans that include health flexible spending arrangements (FSAs), disclose the limited nature of the health FSA’s COBRA obligations (because certain health FSAs are only obligated to offer COBRA through the end of the year to qualified beneficiaries who have underspent accounts).
    • Explain that the spouse may notify the plan administrator within 60 days after the entry of divorce or legal separation (even if an employee reduced or eliminated the spouse’s coverage in anticipation of the divorce or legal separation) to elect up to 36 months of COBRA coverage from the date of the divorce or legal separation.
    • Define qualified beneficiary to include a child born to or placed for adoption with the covered employee during a period of COBRA continuation coverage.
    • Describe that a covered child enrolled in the plan pursuant to a qualified medical child support order during the employee’s employment is entitled to the same COBRA rights as if the child were the employee’s dependent child.
    • Clarify the consequences of failing to submit a timely qualifying event notice, timely second qualifying event notice, or timely disability determination notice.

    Practically speaking, the initial notice requirement can be satisfied by including the general notice in the group health plan’s SPD and then issuing the SPD to the employee and his or her spouse within 90 days of their group health plan coverage start date.

    If the plan doesn’t rely on the SPD for furnishing the initial COBRA notice, then the plan administrator would follow the U.S. Department of Labor (DOL) rules for delivery of ERISA-required items. A single notice addressed to the covered employee and his or her spouse is allowed if the spouse lives at the same address as the covered employee and coverage for both the covered employee and spouse started at the time that notice was provided. The plan administrator is not required to provide an initial notice for dependents.

    By Danielle Capilla
    Originally Posted By www.ubabenefits.com

     

  • 5 Things Millennials Need to Know About Life Insurance | CA Benefit Advisors

    July 28, 2017

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    Being catapulted into the adult world is a shock to the system, regardless of how prepared you think you are. And these days, it’s more complicated than ever, with internet access and mobile devices being must-have utilities and navigating tax forms when they aren’t as “EZ” as they used to be.

    Maybe you’re still living with your folks while you get established. Or maybe you’re looking forward to moving out of a rental and into a house or to tie the knot. Life insurance might be the last thing on your list of things to deal with or even think about. (You’re not alone.) But here are five things you might not know about life insurance—that you probably should.

    1. Life insurance is a form of protection. If you Google “life insurance” you’ll get a slew of ads telling you how cheap life insurance can be, without nearly enough information about what you need it for. That’s probably because it’s not terribly pleasant to think about: this idea that we could die and someone we care about might suffer financially as a result. Life insurance provides a financial buffer for the people you care about in the event something happens to you. Think just because you’re single, nobody would be left in the lurch? Read the next point.

    2. College debt may not go away. Did someone—like your parents—co-sign your student loans through the bank? If so, the bank won’t discharge that debt upon your death the way that the federal government would with federal student loans. That means your parents, or others who signed the paperwork, would be responsible for paying the full balance—sometimes immediately. Don’t saddle them with the bill!

    3. If you don’t know anything about life insurance, it’s probably better if you don’t buy it off the internet. It’s what we’re used to: You find the thing you need or love on Amazon or Ebay or Etsy, click a few buttons, and POOF. It arrives at your door. But life insurance is a financial planning product, and while it can be as simple as a 20-year term policy for less than a cup of coffee each day (for real!), going through your options with an insurance professional can ensure that you get the right amount for the right amount of time and at a price that fits into your budget. And many people don’t know that an agent will sit down and help you out at no cost.

    4. Social fundraising only goes so far. This relatively recent phenomenon has everyone thinking that they’ll just turn to GoFundMe if things go awry in their lives. But does any grieving person want to spend time administering a social fundraising site? The chances of going viral are markedly slim, and social fundraising sites will take their cut, as will the IRS. And there is absolutely no guarantee about how much—if any—money will be raised.

    5. The best time is now. You’ll definitely never be younger than you are today, and for most of us, the younger we are the healthier we are. Those are two of the most important factors for getting affordable life insurance coverage. So don’t delay.

    By Helen Mosher
    Originally Posted By www.lifehappens.org

  • So everyone is talking about it – what’s in it? Not much except a lot | CA Benefit Advisors

    July 26, 2017

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    California Senate Bill 562 would create the Healthy California program “to provide universal single payer health care coverage and a health care cost control system for the benefit of all residents of the state” with the catch that “this bill would prohibit this act from becoming operative until the Secretary of California (HHS) gives written notice…that the Healthy California Trust Fund has the revenues to fund the costs of implementing the act.”  Which means they need Federal waivers to run their own Medi-Cal and related program reimbursement and also receive federal funds directly for those services, as well as tax revenue, since there will be no premiums charged, copayments, or deductibles to recipients of care under the act.  Essentially “it is further the intent of the Legislature to establish the Healthy California program to provide universal health coverage for every Californian based on his or her ability to pay and funded by broad based revenue”

    What is surprising?

    • That they intend to pay providers on a “capitated” (fixed fee) basis and that they will somehow be able to negotiate not just with all hospital systems but doctors as well. In a later section it discusses payment by fee for service (which by itself has no means of cost control) “until another payment methodology is established by the board”
    • That this includes coverage for Long Term Care – though that is related to taking over Medi-Cal, demands will be made for improvements and thus increased costs
    • “This title does not preempt any city or county from adopting additional health care coverage for residents in that city or county that provides more protections and benefits to California residents than this title”
    • Carriers seem to disappear unless they want to offer coverage that supplements what is offered here. The “good news” however, is that “the board shall provide funds from the Healthy California Trust Fund (or other funds as appropriated) for a program of retraining and assisting job transition for individuals employed or previously employed in the fields of health insurance, health care service plan and other third party payments for health care or those individuals providing services to health care providers to deal with third party payers for health care, whose jobs may be or have been ended as a result of the implementation of the program.”  So…everyone in health insurance – agents, carrier employees, third party administrators – will be given training for new jobs, paid for by taxpayers, while an entirely new bureaucracy is created, again with taxpayer dollars, to administer the new plan?
    • The program is allowed to pay for capital expenditures incurred by any non profit health facilities

    The main line – “every resident of the state shall be eligible and entitled to enroll as a member under the program” and “resident” is defined as “an individual whose primary place of abode is in the state, without regard to the individual’s immigration status”

    Most of the bill is given over the fundamentals of governance, which include appointment of a general board of 9 and then a public advisory committee with 22 assorted members.

    That’s it.  Twenty pages.  The projection of a $400 billion cost to enact and implement.  Details to follow…but when, how and what will they show?  And isn’t it a political truism that any projected cost will almost always double when it is a government project?  Money which, by the way, California does not have.

  • Small Employers Ask about Form 5500 | CA Benefit Advisors

    July 21, 2017

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    UBA’s compliance team leverages the collective expertise of its independent partner firms to advise 36,000 employers and their 5 million employees. Lately, a common question from employers is: If a health and welfare benefit plan has fewer than 100 participants, then does it need to file a Form 5500?

    If a plan is self-funded and uses a trust, then it is required to file a Form 5500, no matter how many participants it has.

    Whether the plan must file a Form 5500 depends on whether or not the plan is “unfunded” (where the money comes from to pay for the self-funded claims).

    Currently, group welfare plans generally must file Form 5500 if:

    • The plan is fully insured and had 100 or more participants on the first day of the plan year (dependents are not considered “participants” for this purpose unless they are covered because of a qualified medical child support order).
    • The plan is self-funded and it uses a trust, no matter how many participants it has.
    • The plan is self-funded and it relies on the Section 125 plan exemption, if it had 100 or more participants on the first day of the plan year.

    There are several exemptions to Form 5500 filing. The most notable are:

    • Church plans defined under ERISA Section 3(33)
    • Governmental plans, including tribal governmental plans
    • Top hat plans which are unfunded or insured and benefit only a select group of management or highly compensated employees
    • Small insured or unfunded welfare plans. A welfare plan with fewer than 100 participants at the beginning of the plan year is not required to file an annual report if the plan is fully insured, entirely unfunded, or a combination of both.

    A plan is considered unfunded if the employer pays the entire cost of the plan from its general accounts. A plan with a trust is considered funded.

    For smaller groups that are self-funded or partially self-funded, you’d need to ask them whether the plan is funded or unfunded.

    If the employer pays the cost of the plan from general assets, then it is considered unfunded and essentially there is no trust.

    If the employer pays the cost of the plan from a specific account (in which plan participant contributions are segregated from general assets), then the plan is considered funded. For example, under ERISA, pre-tax salary reductions under a cafeteria plan are participant contributions and are considered plan assets which must generally be held in trust based on ERISA’s exclusive benefit rule and other fiduciary duty rules.

    Originally published by www.ubabenefits.com

  • Extension of Maximum COBRA Coverage Period | CA Benefit Advisors

    July 19, 2017

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    The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires employers to offer covered employees who lose their health benefits due to a qualifying event to continue group health benefits for a limited time at the employee’s own cost. The length of the COBRA coverage period depends on the qualifying event and is usually 18 or 36 months. However, the COBRA coverage period may be extended under the following five circumstances:

    1. Multiple Qualifying Events
    2. Disability
    3. Extended Notice Rule
    4. Pre-Termination or Pre-Reduction Medicare Entitlement
    5. Employer Extension; Employer Bankruptcy

    In this blog, we’ll examine the first circumstance above. For a detailed discussion of all the circumstances, request UBA’s Compliance Advisor, “Extension of Maximum COBRA Coverage Period”.

    When determining the coverage period under multiple qualifying events, the maximum coverage period for a loss of coverage due to a termination of employment and reduction of hours is 18 months. The maximum coverage period may be extended to 36 months if a second qualifying event or multiple qualifying events occur within the initial 18 months of COBRA coverage from the first qualifying event. The coverage period runs from the start of the original 18-month coverage period.

    The first qualifying event must be termination of employment or reduction of hours, but the second qualifying cannot be termination of employment, reduction of hours, or bankruptcy. In order to qualify for the extension, the second qualifying event must be the covered employee’s death, divorce, or child ceasing to be a dependent. In addition, the extension is only available if the second qualifying event would have caused a loss of coverage for the qualified beneficiary if it occurred first.

    The extended 36-month period is only for spouses and dependent children. In order to qualify for extended coverage, a qualified beneficiary must have elected COBRA during the first qualifying event and must have been receiving COBRA coverage at the time of the second event. The qualified beneficiary must notify the plan administrator of the second qualifying event within 60 days after the event.

    Example: Jim was terminated on June 3, 2017. Then, he got divorced on July 6, 2017. Jim was eligible for COBRA continuation coverage for 18 months after his termination of employment (the first qualifying event). However, his divorce (the second qualifying event) extended his COBRA continuation coverage to 36 months because it occurred within the initial 18 months of COBRA coverage from his termination (the first qualifying event).

    The health plan should indicate when the coverage period begins. The plan may provide that that the plan administrator be notified when plan coverage is lost as opposed to when the qualifying event occurs. In that case, the 36-month coverage period would begin on the date coverage was lost.

    Originally published by www.ubabenefits.com

  • Why you can never trust the numbers – they’re in, they’re out, follow the bouncing results | CA Benefit Advisors

    July 14, 2017

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    Almost two million people who signed up for health plans on the ACA Exchange during the 2016/17 open enrollment dropped their coverage from January 31 through March 15.

  • How to Be a Magnetic Organization | CA Benefit Advisors

    July 13, 2017

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    When we hear something’s magnetic, it’s likely the first thought that comes to mind is attraction. By definition, a magnetic force is the attraction or repulsion that arises between electrically charged particles because of their motion. What perfect framing for an organization – the desire to attract (or repel) people to help advance your organization. With this framing comes the assumption that there’s motion, which is, hopefully, a result of intentional action.

    If we follow the thought of intentional action, there are seven steps (and many more details for each step that would be too lengthy to include here) that attract what’s desired and repel what’s not desired.

    Seven Steps to Being a Magnetic Organization

    1.  Decide what you want for the company

    Simple, right? Yes. However, often an assumption is made that everybody knows what’s wanted. The best way to determine if you know what’s wanted is to ask the question, “Can I paint a clear, colorful and compelling story of the future?” This is one of the most important roles of leadership in an organization. Create, and tell a compelling story worthy of the effort it will take to get there.

    2.  Get 100 percent buy-in from top leadership

    It’s not enough for the CEO or owner to own the future story, every top leader who’s responsible for the performance and experience of employees and customers needs to be 100 percent committed to the future. This is perhaps the most telling test of how quickly and assuredly you will achieve the goals to support the future state. It’s critical to check for this buy-in up front as well as at key milestone points along the way.

    3.  Communicate

    As important as the first two steps are, a pinnacle point in the process is sharing with your employees, customers, and other stakeholders what you intend to do.

    This is a step that is often overlooked and undervalued. If you ascribe to the rule of seven for marketing, it takes at least seven exposures for a person to hear something with the likelihood of remembering the message. Communicate often and keep your message clear and consistent. Also, keep in mind that people absorb information differently. This absorption is relative to learning styles. Presenting information will be accepted differently if someone is visual, aural, verbal, physical, logical, social, or solitary in their learning style.

    As you design your communication plan, explore not only what you’ll share, but how you’ll promote the messages.

    4.  Build Your Culture

    This speaks to the actions necessary to achieve desired outcomes. It’s intentionally ordered after communication. Reinforce the mission of the company, or roll it out if it’s newly created. To move forward, you need every employee to be aware of the direction and expectations for the organization. Share organizational goals and keep leaders accountable to create alignment for their teams, including working with each person on their team to understand how his or her unique role fits into the overall picture. This will drive interactions that contribute to, or detract from, success.

    Involve employees in the early phases of culture change and share quick wins. Consider including stories and testimonials from employees that show how the company is already making strides to get to the future vision.

    Assure the right fit of employees. Clearly identify the top three expectations for each role and then find people who will be on fire to do these things well.

    David Pink, in his book Drive, explores exactly what motivates people and claims that true motivation consists of: 1) autonomy, the desire to direct our own lives; 2) mastery, the desire to continually improve at something that matters; and 3) purpose, the desire to do things in service of something larger than ourselves.

    In addition, make a habit of catching people doing the right things right. Recognition of work well done continuously reinforced will add fuel to building a positive culture. Finally, allow people to be who they are and find ways to insert moments of fun.

    5.  Evaluate

    There are many evaluation tools to help identify what’s happening. Asking for feedback from employees and customers can be a highly effective way to help understand where the best practices exist and where improvements are needed. Measuring what’s happening on a regular basis offers identification of value in processes and with products.

    According to the Predictions for 2017 Bersin by Deloitte report, “Driven by the need to understand and improve engagement, and the continuous need to measure and improve employee productivity, real time feedback and analytics will explode.”

    6.  Assess

    The intention of assessment is to determine how things are going and then focus on improvement. The people who know the operations the best are the ones working the business. Trust your employees. As you understand the frustrations and barriers employees encounter, there’s an opportunity to reengineer how to tailor processes, deliver services, and provide products to support the changing needs of the customer.

    7.  Adjust

    When you identify what’s working and what needs to be changed – act with a sense of urgency to make the necessary changes. The organizations who adapt are the ones who have the greatest longevity. Market changes are constant and the ability to understand what’s happening and move toward what will occur in the future is not only admirable, but necessary for sustainability.

    It’s obvious how these steps attract people with desired talents and attitudes to help advance your organization, but how will these same actions repel those who don’t align? When there’s consistent reinforcement of the culture, those who don’t fit will have a sense that your company just isn’t the right place for them, like trying to fit into a jacket that is too small or too large. This will be true for current employees and potential employees.

    Not getting the results you want? Consider revisiting these actions – one step at a time.

    How to Be a Magnetic Organization

    Originally published by www.ubabenefits.com

  • Are they serious about Single Payer? It appears to be the case… | CA Benefit Advisors

    July 12, 2017

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    It’s not just California, but a number of states are looking to find a solution to the “problem” supposedly caused by The Affordable Care Act.  The ACA didn’t cause the problems – it merely rode the coattails of problems that have always existed.  Some blame the insurance companies, but in fact while they don’t really help they also are not the cause – costs are up, thus rates are up, and carriers have no apparent handle on any of this.  Will the government?  At least carriers are driven by a profit motive (even the nonprofits) while the government is driven more by social motives which, of themselves, aren’t bad, but they can be so inclusive as to drive costs up even more as they accommodate all the claims and demands made on the system.  The alternative, of course, is that the government is less accommodating, in which case you have a situation with cost controls that can’t be appealed and no option if you don’t like them.

    OK, here are the basics in California – the Senate has have passed a bill but now they have to figure how to pay for it (that means replacing premiums with taxes).  Initial estimates are a system cost of $400 billion, which we ain’t got.  There are proponents who counter, however, that the amount of money that will be saved from installing a Single Payer system will counteract these costs – but how?  Thus cost is the ultimate conundrum…and will determine how, if or how well a Single Payer system may work here.

    Oh, and the bill is only twenty pages…the Affordable Care Act was 2,000 (to start).  So…

  • TeleMedicine | CA Benefit Advisors

    July 7, 2017

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    It’s not surprising that 2017 stands to be the year many will have an experience to share using a Telemedicine or a Virtual Doctor service. With current market trends, government regulations, and changing economic demands, it’s fast becoming a more popular alternative to traditional healthcare visits.  And, as healthcare costs continue to rise and there are more strategic pricing options and digital models available to users, the appeal for consumers, self-insured employers, health systems and health plans to jump on board is significant.

    Watch this short video to learn more.

     

  • A Country Polarized? Make Sure Your Office Isn’t | CA Benefit Advisors

    July 6, 2017

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    One of the latest things trending right now in business is the importance of office culture. When everyone in the office is working well together, productivity rises and efficiency increases. Naturally, the opposite is true when employees do not work well together and the corporate culture suffers. So, what are these barriers and what can you do to avoid them?

    According to an article titled, “8 ways to ruin an office culture,” in Employee Benefit News, the ways to kill corporate culture may seem intuitive, but that doesn’t mean they still don’t happen. Here’s what organizations SHOULD do to improve their corporate culture.

    Provide positive employee feedback. While it’s easy to criticize, and pointing out employees’ mistakes can often help them learn to not repeat them, it’s just as important to recognize success and praise an employee for a job well done. An “attaboy/attagirl” can really boost someone’s spirits and let them know their work is appreciated.

    Give credit where credit is due. If an assistant had the bright idea, if a subordinate did all the work, or if a consultant discovered the solution to a problem, then he or she should be publicly acknowledged for it. It doesn’t matter who supervised these people, to the victor go the spoils. If someone had the guts to speak up, then he or she should get the glory. Theft is wrong, and it’s just as wrong when you take someone’s idea, or hard work, and claim it as your own.

    Similarly, listen to all ideas from all levels within the company. Every employee, regardless of their position on the corporate ladder, likes to feel that their contributions matter. From the C-suite, all the way down to the interns, a genuinely good idea is always worth investigating regardless of whether the person who submitted the idea has an Ivy League degree or not. Furthermore, sometimes it takes a different perspective – like one from an employee on a different management/subordinate level – to see the best way to resolve an issue.

    Foster teamwork because many hands make light work. Or, as I like to say, competition breeds contempt. You compete to get your job, you compete externally against other companies, and you may even compete against your peers for an award. You shouldn’t have to compete with your own co-workers. The winner of that competition may not necessarily be the best person and it will often have negative consequences in terms of trust.

    Get rid of unproductive employees. One way to stifle innovation and hurt morale is by having an employee who doesn’t do any work while everyone else is either picking up the slack, or covering for that person’s duties. Sometimes it’s necessary to prune the branches.

    Let employees have their privacy – especially on social media. As long as an employee isn’t conducting personal business on company time, there shouldn’t be anything wrong with an employee updating their social media accounts when they’re “off the clock.” In addition, as long as employees aren’t divulging company secrets, or providing other corporate commentary that runs afoul of local, state, or federal laws, then there’s no reason to monitor what they post.

    Promote a healthy work-life balance. Yes, employees have families, they get sick, or they just need time away from the workplace to de-stress. And while there will always be times when extra hours are needed to finish a project, it shouldn’t be standard operating procedure at a company to insist that employees sacrifice their time.

    Originally published by www.ubabenefits.com

  • The CBO and the JCT weigh in – acronyms determine fate of the American Health Care Act | CA Benefit Advisors

    July 5, 2017

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    Tweets began early after the CBO and JCT published their joint findings about the long term effects of the AHCA as proposed by the House (the Senate has yet to conjure up a vision).  They do say that there will be savings (mostly due to changes in subsidies) of $32 billion net.  The tax credits will offset some of the “losses” expected in coverage but overall they are dealing with some huge numbers – $1.11 trillion in reduced direct spending (tax savings and a change in Medicaid) vs. a revenue reduction (tax cuts) of $992 billion.  What if their calculations are off just a few percentage points?

    The nongroup market is expected to remain stable, even in those states that request waivers from market regulations…until 2020, after which they expect some instability in that market.  There are still a lot of assumptions, including the idea that younger people will buy insurance

    more often (without a mandate?) and that many states would make moderate changes to market regulations.  The biggest potential problem, and again subject to a lot of math with which many already disagree, is that 23 million more Americans would be uninsured under the AHCA.

  • What Qualifying Events Trigger COBRA? | CA Benefit Advisors

    June 30, 2017

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    The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires employers to offer covered employees who lose their health benefits due to a qualifying event to continue group health benefits for a limited time at the employee’s own cost. Per regulation, qualifying events are specific events that cause or trigger an individual to lose health coverage. The type of qualifying event determines who the qualified beneficiaries are and the maximum length of time a plan must offer continuation coverage. A group health plan may provide longer periods of continuation coverage beyond the maximum 18 or 36 months required by law.

    There are seven triggering events that are qualifying events for COBRA coverage if they result in loss of coverage for the qualified beneficiaries, which may include the covered employee, the employee’s spouse, and dependent children.

    Triggering event plus loss of coverage equals COBRA coverage

    The following quick reference chart indicates the qualifying event, the individual who is entitled to elect COBRA, and the maximum length of COBRA continuation coverage.

    COBRA qualifying events

    For an extensive discussion of each qualifying event and the conditions when it is not a triggering event (including examples), request UBA’s Compliance Advisor, “What Qualifying Events Trigger COBRA?’.

    Originally published by www.ubabenefits.com

     

  • Just when you thought things weren’t complicated enough – let’s do Single Payer | CA Benefit Advisors

    June 30, 2017

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    Everyone’s favorite solution.  Eliminate the insurance carriers and health care reform, the legacy of President Obama and the idea of free market enterprise being able to work with health coverage and you have the stage set for…a government run program.  Bernie Sanders proposed it, and he wasn’t the first, but it’s not ready for prime time.  Regionally, however, California has always wanted to promote it, even if they were the only one who would have it.  Stephen Shortell of the UC School of Public Health says “single payer has its pros and cons, but if it’s built on the foundation of fee for service (doctors paid as they provide care) it will be a disaster.  It would be a huge step backwards in delivering health care”  Of course, the other challenge is that the estimated cost of the bill would be $400 billion – a new study refutes this, of course, with funding provided by the side favoring single payer, so in the end…who knows?  Except are you sure you want the government running this thing?

  • Meanwhile, as the Federal government was doing nothing…California passed some laws | CA Benefit Advisors

    June 27, 2017

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    Employment Protections for Victims of Domestic Violence, Sexual Assault or Stalking

    July 1, 2017 – groups of 25 or more employees – must provide specific information in writing to new employees upon hire and to others upon request of their rights to take leave with regard to being a victim of domestic violence, sexual assault or stalking.  The Labor Commissioner is to develop a form for making this request

    Protection for Patients from Surprise Medical Bills

    July 1, 2017 – patients who receive care in “in network” facilities will have to pay only in network cost sharing.  The law also says that health plans pay non contracting health care providers the plan’s average contracted rate or 125% of the Medicare rate, whichever is greater.

    Comment – not much effect here as the average contracted rate is higher than 125% of Medicare – it is still a major mistake to see someone not on the provider list due to the severe cutbacks in payment allowance (the patient always pays the difference between the billed charges and the allowed amount) and, as with many contracts, the separate deductible and co insurance tracking.

    San Francisco – Employer Paid Parental Leave

    July 1, 2017 – groups of 35 or more employees – must provide six weeks of paid parental leave Must pay eligible employees 45% of weekly gross wages up to a maximum of $924 per week Cap based on the California Paid Family Leave Act which shows 55% and $1,129 per week For part time and temporary as well as full time – must be employed at least 180 days To determine eligibility, employers use a three month “look back” period Employer can require employees to use up to 2 weeks of unused accrued vacation first This vacation time can be counted toward the six week paid parental leave period

    Eligible employees must also work at least 8 hours per week in San Francisco, with at least 40% of their weekly hours in San Francisco and be eligible for California Paid Leave

  • It May not be a law, but Trump is still getting his way | CA Benefit Advisors

    June 26, 2017

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    The rise of the Trump Ryan express may have slowed, as the Senate sorts its issues, but that doesn’t mean the President doesn’t have an opportunity to change the law.  The Administration has now proposed that, beginning in 2018, small businesses would no longer be able to enroll workers in health insurance plans through the federal exchange.  Not too surprising, since it has not been a big winner since its inception, but still…

  • AHCA and the Preexisting Conditions Debate—What Employers Can Do During Uncertainty | CA Benefit Advisors

    June 22, 2017

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    Preexisting conditions. While it’s no doubt this term has been a hot topic in recent months—and notably misconstrued—one thing has not changed; insurers cannot deny coverage to anyone with a preexisting condition.  Now that House Resolution 1628 has moved to the Senate floor, what can employers and individuals alike expect? If passed by the Senate as is and signed into law; some provisions will take place as early as 2019—possibly 2018 for special enrollment cases. It’s instrumental for companies to gear up now with a plan on how to tackle open enrollment; regardless of whether your company offers medical coverage or not.

    Under the current proposed American Health Care Act (AHCA) insurance companies can:

    • Price premiums based on health care status/age. The AHCA will provide “continuous coverage” protections to guarantee those insured are not charged more than the standard rate as long as they do not have a break in coverage. However, insurers will be allowed to underwrite certain policies for those that do lapse—hence charging up to 30% more for a preexisting condition if coverage lapses for more than 63 days. This is more common than not, especially for those who are on a leave of absence for illness or need extensive treatment. In addition, under current law, insurers are only allowed to charge individuals 50 and older 3 times as much than those under this age threshold. This ratio will increase 5:1 under AHCA.
    • Under the ACA’s current law employers must provide coverage for 10 essential health care benefits. Under AHCA, beginning as early as 2020, insurers will allow states to mandate what they consider essential benefit requirements. This could limit coverage offered to individuals and within group plans by eliminating high cost care like mental health and substance abuse. Not that it’s likely, but large employers could eventually opt out whether they want to provide insurance and/or choose the types of coverage they will provide to their employees.

    It’s important to note that states must apply for waivers to increase the ratio on insurance premiums due to age, and determine what they will cover for essential health benefits. In order to have these waivers granted, they would need to provide extensive details on how doing so will help their state and the marketplace.

    So what can employers do moving forward? It’s not too soon to think about changing up your benefits package as open enrollment approaches, and educating yourself and your staff on AHCA and what resources are out there if you don’t offer health coverage.

    • Make a variety of supplemental tools available to your employees. Anticipate the coming changes by offering or adding more supplemental insurance and tools to your benefits package come open enrollment. Voluntary worksite benefits, such as Cancer, Critical Illness, and Accident Insurance handle a variety of services at no out-of-pocket cost to the employer. HSA’s FSA’s and HRA’s are also valuable supplemental tools to provide your employees if you’re able to do so. Along with the changes listed above, the AHCA has proposed to also increase the contribution amounts in these plans and will allow these plans to cover Over-the-Counter (OTC) medications.
    • Continue to customize wellness programs. Most companies offer wellness programs for their employees. Employers that provide this option should continue advancing in this area. Addressing the specific needs of your employees and providing wellness through various platforms will result in the greatest return on investment; and healthier employees to boot. Couple this with frequent evaluations from your staff on your current program to determine effectiveness and keep your wellness programs on point.
    • Educate, educate, educate—through technology. Regardless if you employ 10 or 10,000, understanding benefit options is vital for your employees; what you have to offer them and what they may need to know on their own. Digital platforms allow individuals to manage their healthcare benefits and stay in the know with valuable resources at their fingertips. There’s no limit on the mediums available to educate your employees on upcoming changes. Partnering with a strong benefit agency to maximize these resources and keep your employees “in the know” during a constantly changing insurance market is a great way to start.

  • How much are we really paying for medications? Is there a prescription for this mess? | CA Benefit Advisors

    June 19, 2017

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    Anthem Blue Cross, the biggest customer of Express Scripts, has changed their supplier. What is interesting is that Express Scripts offered Anthem $1 billion in price concessions. Does this mean they were overcharging by at least $1 billion in the first place?  And that Anthem, which merely passes this on to its customers, approved of this?  Why did it take so long for Anthem to make a change to a less expensive provider?  And why is there such a gap between the new provider and Express Scripts?  Are we dealing with quality issues? So many questions, and so much money…

  • Arrow Benefits Group gives $100K for North Bay businesses’ AEDs

    June 14, 2017

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    The latest effort to reduce Sonoma County deaths from cardiac arrest comes from a Petaluma company that recently pledged $100,000 to purchase automated external defibrillators for North Bay businesses.  Stacy Gibbons, executive director of American Heart Association North Bay, called the move by Arrow Benefits Group “unprecedented.”

    Arrow Benefits Group’s first foray into reducing cardiac arrest deaths was in late 2014, when the company asked the Petaluma Health Care District to teach its employees hands-only CPR.

    Read entire article here.

  • New HSA Limits – unless the Trump administration decides to raise and make you flush | CA Benefit Advisors

    June 14, 2017

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    New limits for these accounts in 2018 will be $3,450 for a single covered employee and $6,900 for an employee covered with dependents.  There is consideration of other limits in the American Health Care Act, recently passed by the House of Representatives, but it is not much different.  There are some expanded provisions there, as well, but it is not clear whether the Senate will come up with a different version and if the joint committee will come up with an acceptable compromise, and if President Trump will sign it, etc. etc.

  • Answers to the Top 4 Questions about Section 105(h) Nondiscrimination Testing | CA Benefit Advisors

    June 12, 2017

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    Under Internal Revenue Code Section 105(h), a self-insured medical reimbursement plan must pass two nondiscrimination tests. Failure to pass either test means that the favorable tax treatment for highly compensated individuals who participate in the plan will be lost. The Section 105(h) rules only affect whether reimbursement (including payments to health care providers) under a self-insured plan is taxable.

    When Section 105(h) was enacted, its nondiscrimination testing applied solely to self-insured plans. Under the Patient Protection and Affordable Care Act (ACA), Section 105(h) also applies to fully-insured, non-grandfathered plans. However, in late 2010, the government delayed enforcement of Section 105(h) against fully-insured, non-grandfathered plans until the first plan year beginning after regulations are issued. To date, no regulations have been issued so there is currently no penalty for noncompliance.

    Practically speaking, if a plan treats all employees the same, then it is unlikely that the plan will fail Section 105(h) nondiscrimination testing.

    What Is a Self-Insured Medical Reimbursement Plan?

    Section 105(h) applies to a “self-insured medical reimbursement plan,” which is an employer plan to reimburse employees for medical care expenses listed under Code Section 213(d) for which reimbursement is not provided under a policy of accident or health insurance.

    Common self-insured medical reimbursement plans are self-funded major medical plans, health reimbursement arrangements (HRAs), and medical expense reimbursement plans (MERPs). Many employers who sponsor an insured plan may also have a self-insured plan; that self-insured plan is subject to the Section 105 non-discrimination rules. For example, many employers offer a fully insured major medical plan that is integrated with an HRA to reimburse expenses incurred before a participant meets the plan deductible.

    What If the Self-Insured Medical Reimbursement Plan Is Offered Under a Cafeteria Plan?

    A self-insured medical reimbursement plan (self-insured plan) can be offered outside of a cafeteria plan or under a cafeteria plan. Section 105(h) nondiscrimination testing applies in both cases.

    Regardless of grandfathered status, if the self-insured plan is offered under a cafeteria plan and allows employees to pay premiums on a pre-tax basis, then the plan is still subject to the Section 125 nondiscrimination rules. The cafeteria plan rules affect whether contributions are taxable; if contributions are taxable, then the Section 105(h) rules do not apply.

    What Is the Purpose of Nondiscrimination Testing?

    Congress permits self-insured medical reimbursement plans to provide tax-free benefits. However, Congress wanted employers to provide these tax-free benefits to their regular employees, not just to their executives. Nondiscrimination testing is designed to encourage employers to provide benefits to their employees in a way that does not discriminate in favor of employees who are highly paid or high ranking.

    If a plan fails the nondiscrimination testing, the regular employees will not lose the tax benefits of the self-insured medical reimbursement plan and the plan will not be invalidated. However, highly paid or high ranking employees may be adversely affected if the plan fails testing.

    What Are the Two Nondiscrimination Tests?

    The two nondiscrimination tests are the Eligibility Test and Benefits Test.

    The Eligibility Test answers the basic question of whether there are enough regular employees benefitting from the plan. Section 105(h) provides three ways of passing the Eligibility Test:

    1. The 70% Test – 70 percent or more of all employees benefit under the plan.
    2. The 70% / 80% Test – At least 70 percent of employees are eligible under the plan and at least 80 percent or more of those eligible employees participate in the plan.
    3. The Nondiscriminatory Classification Test – Employees qualify for the plan under a classification set up by the employer that is found by the IRS not to be discriminatory in favor of highly compensated individuals.

    The Benefits Test answers the basic question of whether all participants are eligible for the same benefits.

    For information on who is a highly compensated individual, how the tests are applied, when to test, and what to do if you fail the test (including excess reimbursement examples), request UBA’s Compliance Advisor, “Section 105(h) Nondiscrimination Testing”.

    Originally published by www.ubabenefits.com

  • Speaking of which…yes, you heard the news about the American Health Care Act | CA Benefit Advisors

    June 9, 2017

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    The first vote was almost in and then was not in and then there was another vote and then and then…they sent it to the Senate, where the process will start again.  So don’t change your plans at this point – Congress hasn’t and it may not do so for a while.  Until then, the Affordable Care Act remains the law of the land and will through 2017.

  • HSAs and Employer Responsibilities | CA Benefit Advisors

    June 2, 2017

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    It’s no secret that one of the primary agenda items of the new Republican administration is to repeal the Patient Protection and Affordable Care Act (ACA) and to sign into law a plan that they feel will be more effective in managing health care costs. Their initial attempt at a new plan, called the American Health Care Act (AHCA), included an increased focus on leveraging health savings accounts (HSAs) to accomplish this goal. As the plan gets debated and modified in Congress, we do not know whether the role of HSAs will be expanded or not, but they will continue to be a part of the landscape in some shape or form.

    HSAs first came into existence in 2003 and they have been gaining momentum as a way to deal with increasing health care costs ever since. If you, as a plan sponsor, do not already offer a health plan compatible with an HSA, chances are you’ve at least discussed them during your annual plan reviews. So, what exactly is an HSA and what is an employer’s responsibility relating to one?

    An HSA is a tax-favored account established by an individual to pay for certain medical expenses incurred by account holders and their spouses and tax dependents. Anyone can make a contribution to an eligible Individual’s HSA. This includes the individual’s employer. However, if employers contribute to participant HSAs, employers must:

    1. Ensure their health plan meets high-deductible health plan (HDHP) requirements,
    2. Determine eligibility,
    3. Establish contribution method,
    4. Provide W-2 reporting, and
    5. Confirm employer involvement in the HSA does not create an ERISA plan, or cause a prohibited transaction.

    High-Deductible Health Plan Requirements

    Plan sponsors should make sure their plan meets certain HDHP requirements before making contributions to participants’ HSAs.

    Characteristics of an HDHP

    An HDHP is a health plan that has statutorily prescribed minimum deductible and maximum out-of-pocket limits. The limits are adjusted annually for inflation.

    For example, for 2017, the limits for self-only coverage are:

    • Minimum Deductible: $1,300
    • Maximum Out-of-Pocket: $6,550

    The limits for family coverage (i.e., any coverage other than self-only coverage) are twice the applicable amounts for self-only coverage. The limits are adjusted annually for inflation and, for a given year, are published by the IRS no later than June 1 of the preceding year. In addition, an HDHP cannot pay any benefits until the deductible is met. The only exception to this rule is benefits for preventive care.

    Eligibility

    Eligible Individuals can make or receive contributions to their HSAs. A person is an eligible individual if he or she is covered by an HDHP and is not covered by any other plan that pays medical benefits, subject to certain exceptions.

    Employer Contribution Methods

    Employers that contribute to the HSAs of their employees may do so inside or outside of a cafeteria (Section 125) plan. The contribution rules are different for each option.

    Contributions Outside of a Cafeteria Plan

    When contributing to any employee’s HSA outside of a cafeteria plan, an employer must make comparable contributions to the HSAs of all comparable participating employees.

    Contributions Made Through a Cafeteria Plan

    HSA contributions made through a cafeteria plan do not have to satisfy the comparability rules, but are subject to the Section 125 non-discrimination rules for cafeteria plans. HSA employer contributions will be treated as being made through a cafeteria plan if the cafeteria plan permits employees to make pre-tax salary reduction contributions.

    Employer HSA Contribution Amounts

    Contributions from all sources cannot exceed certain annual limits prescribed by the IRS. Although employer contributions cannot exceed the applicable limits, employers are only responsible for determining the following with respect to an employee’s eligibility and maximum annual contribution limit on HSA contributions:

    • Whether the employee is covered under an HDHP or low-deductible health plan, or plans (including health flexible spending accounts (FSAs) and health reimbursement arrangements (HRAs) sponsored by that employer; and
    • The employee’s age (for catch-up contributions). The employer may rely on the employee’s representation as to his or her date of birth.

    When employers contribute to the HSAs of their employees and retirees, the amount of the contribution is excludable from the eligible individual’s income and is deductible by the employer provided they do not exceed the applicable limit. Withholding for income tax, FICA, FUTA, or RRTA taxes is not required if, at the time of the contribution, the employer reasonably believes that contribution will be excludable from the employee’s income.

    Employer Reporting Requirements

    An employer must report the amount of its contribution to an employee’s HSA in Box 12 of the employee’s W-2 using code W.

    Design and Operational Considerations

    Employers should make sure that their involvement in the HSA does not create an ERISA plan, or cause them to become involved in a prohibited transaction. To ensure that contributions will not cause the health plan to become subject to ERISA, certain restrictions exist that employers should be aware of and follow. Employer contributions to an HSA will not cause the employer to have established a health plan subject to ERISA provided:

    • The establishment of the HSA is completely voluntary on the part of the employees; and
    • The employer does not:
      • limit the ability of eligible individuals to move their funds to another HSA or impose conditions on utilization of HSA funds beyond those permitted under the code;
      • make or influence the investment decisions with respect to funds contributed to an HSA;
      • represent that the HSA is an employee welfare benefit plan established or maintained by the employer;
      • or receive any payment or compensation in connection with an HSA.

    Originally published by www.ubabenefits.com

  • Factor Emerging Trends, Generational Needs Into Wellness Programs | CA Benefit Advisors

    May 30, 2017

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    Your wellness program seems to have it all – biometric screenings, lunch and learns, and weight loss challenges. So, why do you struggle with engagement, or to see any real results? While traditional wellness components are still a large part of plans today, emerging trends, coupled with generational differences, make for challenges when designing an impactful program.

    As wellness programs begin to be viewed as a part of the traditional benefits package, the key differentiator is creating a culture and environment that supports overall health and well-being. Visible engagement and support from front-line and senior leadership drives culture change. By prioritizing health through consistent communication, resource allocation, personnel delegation, and role modeling/personal health promotion practices, employers gain the trust of their employees and develop an environment situated around wellness. When employees recognize the importance of wellness in the overall company strategy and culture, and feel supported in their personal goals, healthy working environments begin to develop, resulting in healthier employees.

    Looking beyond traditional wellness topics and offering programs that meet the goals of your employees also leads to higher engagement. The American Heart Association CEO Roundtable Employee Health Survey 2016 showed improving financial health, getting more sleep, and reducing stress levels are key focus areas for employees as part of overall wellness. More so, employees see the benefits of unplugging and mentoring, two new topics  in the area of overall well-being. While most employers feel their employees are over surveyed, completing an employee needs or preference survey will ensure your programs align with your employees’ health and wellness goals – ultimately leading to better engagement.

    Wellness programs are not immune to generational differences, like most other facets of business. While millennials are most likely to participate and report that programs had an overall impact, they prefer the use of apps and trackers along with social strategies and team challenges. Convenience and senior level support are also important within this group. Generation X and baby boomers show more skepticism toward wellness programs, but are more likely to participate when the programs align with their personal goals. Their overall top health goal is weight loss. Ultimately, addressing the specific needs of your member population and providing wellness through various modalities will result in the greatest reward of investment.

    Evaluation and data are the lynchpins that hold a successful program together. Consistent evaluation of the effectiveness of programs to increase participation, satisfaction, physical activity, and productivity – all while reducing risk factors – allow us to know if our programs are hitting the mark and allow for additional tailoring as needed.

    Originally published by www.ubabenefits.com

     

     

  • Why some companies offer an HRA | CA Benefit Advisors

    May 26, 2017

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    In a world of insurance and acronyms, the term “HRA” is thrown around a lot, but it has a variety of meanings.

    HRA can mean health reimbursement account, heath reimbursement arrangement, or health risk assessment, and all of those mean something different. I want to be clear that in the following article I am going to be discussing the use of health reimbursement accounts with fully-insured health plans. We can leave the other meanings of HRA for another time.

    An HRA can be “wrapped” with a high-deductible, fully-insured health plan and this can lead to savings for an employer over offering a traditional health plan with a lower deductible.

    Offering a high-deductible health plan and self-funding, the first $2,000, or $3,000, in claims on behalf of the employees can translate to significant savings because the employer is taking on that initial risk instead of the insurance carrier. Unlike a consumer-driven health plan (CDHP) that has a high deductible and can be paired with a health savings account (HSA) where an employer can contribute funds to an employee’s HSA account that can be used to pay for qualified medical expenses, an employer only has to pay out of the HRA if there is a claim.

    With an HSA that is funded by the employer, the money goes into the HSA for their employees and then those funds are “owned” by the employee. The employer never sees it again. Under an HRA, if there are no claims, or not a high number of claims, the employer keeps those unused dollars in their pocket.

    An HRA component to a health plan is subject to ERISA and non-discrimination rules, meaning everyone that is eligible should be offered the plan, and the benefits under the HRA should be the same for everyone enrolled. It is advisable that an HRA be administered by a third-party that pays the claims to the providers, or reimburse plan enrollees under the terms of the plan, in order to keep employees’ and their dependents’ medical information private from the employer as to avoid potential discrimination.

    The HRA component of a health plan is essentially self-funded by the employer, which gives the employer a lot of flexibility and can be tailored to their specific needs or desired outcomes. The employer can choose to fund claims after the employee pays the first few hundred dollars of their deductible instead of the employer paying the claims that are initially subject to the high deductible. An employer can have a step arrangement, for example, the employer pays the first $500, the employee the second $500, the employer pays the next $500, and the employee pays the final $500 of a $2,000 deductible.

    If an employer has a young population that is healthy, they may want to use the HRA to pay for emergency room visits and hospital in-patient stays, but not office visits so they can help protect their employees from having to pay those “large ticket items,” but not blow their budget. While an employer with a more seasoned staff, or diverse population, may want to include prescription drugs as a covered benefit under the HRA, as well as office visits, hospital in-patient stays, outpatient surgery, etc. Or, if an employer needs to look at cost-saving measures, they may want to exclude prescriptions from being eligible under the HRA.

    Keep in mind, all of these services are essential health benefits and would be covered by the insurance carrier under the terms of the contract, but an employer can choose not to allow the HRA to be used to pay for such services, leaving the enrollee to pay their portion of the claims. In any case, the parameters of what is eligible for reimbursement from the HRA is decided and outlined at the beginning of the plan year and cannot be changed prior to the end of the plan year.

    If you are thinking about implementing a high-deductible health plan with an HRA for your employees, be sure you are doing it as a long-term strategy. As is the case with self-funding, you are going to have good years and bad years. On average, a company will experience a bad, or high claims, year out of every four to five years. So, if you implement your new plan and you have a bad year on the first go-round, don’t give up. Chances are the next year will be better, and you will see savings over your traditional low-deductible plan options.

    With an HRA, you cap the amount you are going to potentially spend for each enrollee, per year. So, you know your worst-case scenario. While it is extremely unlikely that every one of your employees will use the entire amount allotted to them, it is recommended that you can absorb or handle the worst case scenario. Don’t bite off more than you can chew!

    HRA administrators usually charge a monthly rate per enrollee for their services, and this should be accounted for in the budgeting process. Different HRA third-party administrators have different claims processes, online platforms, debit cards, and business hours. Be sure to use one that offers the services that you want and are on budget.

    Another aspect of offering a high-deductible plan with an HRA that is often overlooked is communication. If an employee does not know how to utilize their plan, it can create confusion and anger, which can hurt the overall company morale. The plan has to be laid out and explained in a way that is clear, concise, and easy to understand.

    In some cases, the HRA is administered by someone other than the insurance carrier, and the plan administrator has to make sure they enroll all plan enrollees with the carrier and the third-party administrator.

    The COBRA administrator also has to offer the HRA as part of the COBRA package, and the third-party administrator must communicate the appropriate premium for the HRA under COBRA. Most COBRA enrollees will not choose to enroll in the HRA with their medical plan, as they are essentially self-funding their deductible and plan costs through the HRA instead of paying them out of their pocket, but many plan administrators make the mistake of not offering the HRA under COBRA, as it is mandated by law.

    Offering a high-deductible plan with an HRA is a way for small employers to save over offering a low-deductible health plan, and can be a way for an employer to “test the waters” to see if they may want to move to a self-funded plan, or level-funded plan, in the future.

    To any employer looking to implement an HRA with a medical plan, you want a seasoned advisor, or consultant, on your side to walk you through the costs, pros, and cons, potential savings, and risks. Your local UBA Partner Firm is a great place to start.

    For a comprehensive chart that compares eligibility criteria, contribution rules, reimbursement rules, reporting requirements, privacy requirements, applicable fees, non-discrimination rules and other characteristics of account-based plans, request UBA’s Compliance Advisor, “HRAs, HSAs, and Health FSAs – What’s the Difference?”.

    For information on modest contribution strategies that are still driving enrollment in HSA and HRA plans, read our breaking news release.

    For a detailed look at the prevalence and enrollment rates among HSA and HRA plans by industry, region and group size, view UBA’s “Special Report: How Health Savings Accounts Measure Up”, to understand which aspects of these accounts are most successful, and least successful.

    For fast facts about HSA and HRA plans, including the best and worst plans, average contributions made by employers, and industry trends, download (no form!) “Fast Facts: HSAs vs. HRAs”.

    Originally published by www.ubabenefits.com

  • HSAs vs. HRAs: Things Employers Should Consider | CA Benefit Advisors

    May 24, 2017

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    With health care costs and insurance premiums continuing to rise, employers are looking for ways to reduce their insurance expenses. That usually means increasing medical plan deductibles. According to the latest UBA Health Plan Survey, the average in-network single medical plan deductible increased from $2,031 in 2015 to $2,127 in 2016. But shifting costs to employees can be detrimental to an employer’s efforts to attract and retain top talent. Employers are looking for solutions that reduce their costs while minimizing the impact on employees.

    One way employers can mitigate increasing deductibles is by packaging a high-deductible health plan with either a health savings account (HSA) contribution or a health reimbursement arrangement (HRA). Either can be used to bridge some or all of the gap between a lower deductible and a higher deductible while reducing insurance premiums, and both offer tax benefits for employers and employees. However, there are advantages and disadvantages to each approach that employers need to consider.

    Health Savings Account (HSA) General Attributes

    • The employee owns the account and can take it when changing jobs.
    • HSA contributions can be made by the employer or employee, subject to a maximum contribution established by the government.
    • Triple tax advantage – funds go in tax-free, accounts grow tax-free, and withdrawals are tax-free as long as they are for qualified expenses (see IRS publication 502).
    • Funds may accumulate for years and be used during retirement.
    • The HSA must be paired with an IRS qualified high-deductible health plan (QHDHP); not just any plan with a deductible of $1,300 or more will qualify.

    HSA Advantages

    • Costs are more predictable as they are not related to actual expenses, which can vary from year to year; contributions may also be spread out through the year to improve cash flow.
    • Employees become better consumers since there is an incentive to not spend the money and let it accumulate. This can result in an immediate reduction in claims costs for a self-funded plan.
    • HSAs can be set up with fewer administration costs; usually no administrator is needed, and no ERISA summary plan description (SPD) is needed.
    • The employer is not held responsible by the IRS for ensuring that the employee is eligible and that the contribution maximums are not exceeded.

    HSA Disadvantages

    • Employees cannot participate if they’re also covered under a non-qualified health plan, which includes Tricare, Medicare, or even a spouse’s flexible spending account (FSA).
    • Employees accustomed to copays for office visits or prescriptions may be unhappy with the benefits of the QHDHP.
    • IRS rules can be confusing; IRS penalties may apply if the employee is ineligible for a contribution or other mistakes are made, which might intimidate employees.
    • Employees may forgo treatment to avoid spending their HSA balance or if they have no HSA funds available.

    Health Reimbursement Arrangement (HRA) General Attributes

    • Only an employer can contribute to an HRA; employees cannot.
    • The employer controls the cash until a claim is filed by the employee for reimbursement.
    • HRA contributions are tax deductible to the employer and tax-free to the employee.
    • To comply with the Patient Protection and Affordable Care Act (ACA), an HRA must be combined with a group medical insurance plan that meets ACA requirements.

    HRA Advantages

    • HRAs offer more employer control and flexibility on the design of the HRA and the health plan does not need to be HSA qualified.
    • The employer can set it up as “use it or lose it” each year, thus reducing funding costs.
    • An HRA is compatible with an FSA (not just limited-purpose FSA).
    • Depending on the employer group, HRAs can sometimes be less confusing for employees, particularly if the plan design is simple.
    • HRA funds revert to the employer when an employee leaves – which might increase employee retention.

    HRA Disadvantages

    • Self-employed individuals cannot participate in HRA funding.
    • There is little or no incentive for employees to control utilization since funds may not accumulate from year to year.
    • More administration may be necessary – HRAs are subject to ERISA and COBRA laws.
    • HRAs could raise HIPAA privacy concerns and create the need for policies and testing.

    Both HSAs and HRAs can be of tremendous value to employers and employees. As shown, there are, however, a number of considerations to determine the best program and design for each situation. In some cases, employers may consider offering both, allowing employees to choose between an HSA contribution and a comparable HRA contribution, according to their individual circumstances.

    For a comprehensive chart that compares eligibility criteria, contribution rules, reimbursement rules, reporting requirements, privacy requirements, applicable fees, non-discrimination rules and other characteristics of account-based plans, request UBA’s Compliance Advisor,  “HRAs, HSAs, and Health FSAs – What’s the Difference?”.

    For information on modest contribution strategies that are still driving enrollment in HSA and HRA plans, read our breaking news release.

    For a detailed look at the prevalence and enrollment rates among HSA and HRA plans by industry, region and group size, view UBA’s “Special Report: How Health Savings Accounts Measure Up”, to understand which aspects of these accounts are most successful, and least successful.

    For fast facts about HSA and HRA plans, including the best and worst plans, average contributions made by employers, and industry trends, download (no form!) “Fast Facts: HSAs vs. HRAs”.

    Originally published by www.ubabenefits.com

  • Is Your Wellness Program Compliant with the ACA, GINA and EEOC? | CA Benefit Advisors

    May 20, 2017

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    Workplace wellness programs have increased popularity through the years. According to the most recent UBA Health Plan Survey, 49 percent of firms with 200+ employees offering health benefits in 2016 offered wellness programs. Workplace wellness programs’ popularity also brought controversy and hefty discussions about what works to improve population health and which programs comply with the complex legal standards of multiple institutions that have not really “talked” to each other in the past. To “add wood to the fire,” the Equal Employment Opportunity Commission (EEOC) made public some legal actions that shook the core of the wellness industry, such as EEOC vs. Honeywell International, and EEOC vs. Orion Energy Systems.

    To ensure a wellness program is compliant with the ACA, GINA and the EEOC, let’s first understand what each one of these institutions are.

    The Affordable Care Act (ACA) is a comprehensive healthcare reform law enacted in March 2010 during the Obama presidency. It has three primary goals: to make health insurance available to more people, to expand the Medicaid program, and to support innovative medical care delivery methods to lower the cost of healthcare overall.1 The ACA carries provisions that support the development of wellness programs and determines all rules around them.

    The Genetic Information Nondiscrimination Act of 2008 (GINA) is a federal law that protects individuals from genetic discrimination in health insurance and employment. GINA relates to wellness programs in different ways, but it particularly relates to the gathering of genetic information via a health risk assessment.

    The U.S. Equal Employment Opportunity Commission (EEOC) is a federal agency that administers and enforces civil rights laws against workplace discrimination. In 2017, the EEOC issued a final rule to amend the regulations implementing Title II of GINA as they relate to employer-sponsored wellness program. This rule addresses the extent to which an employer may offer incentives to employees and spouses.

    Here is some advice to ensure your wellness program is compliant with multiple guidelines.

    1. Make sure your wellness program is “reasonably designed” and voluntary – This means that your program’s main goal should be to promote health and prevent disease for all equally. Additionally, it should not be burdensome for individuals to participate or receive the incentive. This means you must offer reasonable alternatives for qualifying for the incentive, especially for individuals whose medical conditions make it unreasonably difficult to meet specific health-related standards. I always recommend wellness programs be as simple as possible, and before making a change or decision in the wellness program, identify all difficult or unfair situations that might arise from this change, and then run them by your company’s legal counsel and modify the program accordingly before implementing it. An example of a wellness program that is NOT reasonably designed is a program offering a health risk assessment and biometric screening without providing results or follow-up information and advice. A wellness program is also NOT reasonably designed if exists merely to shift costs from an employer to employees based on their health.
    2. Do the math! – Recent rules implemented changes in the ACA that increased the maximum permissible wellness program reward from 20 percent to 30 percent of the cost of self-only health coverage (50 percent if the program includes tobacco cessation). Although the final rules are not clear on incentives for spouses, it is expected that, for wellness programs that apply to employees and their spouses, the maximum incentive for either the employee or spouse will be 30 percent of the total cost of self-only coverage. In case an employer offers more than one group health plan but participation in a wellness program is open to all employees regardless of whether they are enrolled in a plan, the employer may offer a maximum incentive of 30 percent of the lowest cost major medical self-only plan it offers. As an example, if a single plan costs $4,000, the maximum incentive would be $1,200.
    3. Provide a notice to all eligible to participate in your wellness program – The EEOC made it easy for everyone and posted a sample notice online at https://www.eeoc.gov/laws/regulations/ada-wellness-notice.cfm. Your notice should include information on the incentive amount you are offering for different programs, how you maintain privacy and security of all protected health information (PHI) as well as who to contact if participants have question or concerns.
    4. If using a HRA (health risk assessment), do not include family medical history questions – The EEOC final rule, which expands on GINA’s rules, makes it clear that “an employer is permitted to request information about the current or past health status of an employee’s spouse who is completing a HRA on a voluntary basis, as long as the employer follows GINA rules about requesting genetic information when offering health or genetic services. These rules include requirements that the spouse provide prior, knowing, written, and voluntary authorization for the employer to collect genetic information, just as the employee must do, and that inducements in exchange for this information are limited.”2 Due to the complexity and “gray areas” this item can reach, my recommendation is to keep it simple and to leave genetic services and genetic counseling out of a comprehensive wellness program.

    WellSteps, a nationwide wellness provider, has a useful tool that everyone can use. Their “wellness compliance checker” should not substituted for qualified legal advice, but can be useful for a high level check on how compliant your wellness program is. You can access it at https://www.wellsteps.com/resources/tools.

    I often stress the need for all wellness programs to build a strong foundation, which starts with the company’s and leaders’ messages. Your company should launch a wellness program because you value and care about your employees’ (and their families’) health and well-being. Everything you do and say should reflect this philosophy. While I always recommend companies to carefully review all regulations around wellness, I do believe that if your wellness program has a strong foundation based on your corporate social responsibility and your passion for building a healthy workplace, you most likely will be within the walls of all these rules. At the end, a workplace that does wellness the right way has employees who are not motivated by financial incentives, but by their intrinsic motivation to be the best they can be as well as their acceptance that we all must be responsible for our own health, and that all corporations should be responsible for providing the best environment and opportunities for employees to do so.

    Originally published by www.ubabenefits.com

  • Financial Wellness Benefits – Adapting Them In The New Workforce | CA Benefit Advisors

    May 17, 2017

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    Over the past few years, we’ve seen tremendous growth in Financial Wellness Programs. Actually, as indicated in a recent report by Aon Hewitt, 77% of mid- to large-size companies will provide at least one financial wellness service in 2017; with 52% of employers providing services in more than 3 financial categories. So what are the advantages of these programs and how can the current workforce make the most out of them?

    Program Advantages

    • They educate employees on financial management. It’s no doubt, poor income management and cash-flow decisions increase financial stress. This stress has a direct impact on an employee’s physical, mental and emotional state—all which can lead to productivity issues, increased absenteeism, and rising healthcare costs. Financial wellness tools in the workplace can not only support employees in various areas of their finances by expanding income capacity, but can create long-lasting changes in their financial habits as well.
    • They give a foothold to the employer. As more employers are recognizing the effect financial stress has on their employees in the workplace, they’re jumping on board with these programs. As people are extending the length of their careers, benefits like these are an attractive feature to the workforce and new job seekers alike. In fact, according to a recent survey by TIAA, respondents were more likely to consider employment with companies who provide free financial advice as part of their benefit package.

    Program Credentials

    While financial wellness benefits may differ among companies, one thing is certain—there are key factors employers should consider when establishing a successful program. They should:

    • Give sound, unbiased advice. Financial wellness benefits should be free to the employee—no strings attached. Employees should not be solicited by financial institutions or financial companies that only want to seek a profit for services. Employers should research companies when shopping these programs to determine the right fit for their culture.
    • Encompass all facets. A successful program should cover all aspects of financial planning, and target all demographics. These programs should run the gamut, providing resources for those with serious debt issues to those who seek advanced estate planning and asset protection. Services should include both short-term to long-term options that fit with the company’s size and culture. Popular programs implement a variety of tools. Employers should integrate these tools with other benefits to make it as seamless as possible for their employees to use.
    • Detail financial wellness as a process, not an event. Strengthening financial prosperity is a process. When determining the right fit for your company, continued coaching and support is a must. This may require evaluating the program and services offered every year. Employees need to know that while they have the initial benefit of making a one-time change, additional tools are at their disposal to shift their financial mindset; strengthening their financial habits and behaviors down the road.

    Employees must understand the value Financial Wellness Programs can provide to them as well. If your company offers these benefits, keep a few things in mind:

    • Maximize the program’s services. Utilize your financial workplace benefits to tackle life’s financial challenges. Most programs offer financial mentoring through various mediums. Seek advice on your financial issues and allow a coach/mentor to provide you with practical strategies, alternatives and actionable steps to reduce your financial stress.
    • Take advantage of other employee benefits. Incorporate other benefits into your financial wellness program. Use financial resources to help you run projections and monitor your 401k. Budget your healthcare costs with these tools. Research indicates those who tap into these financial wellness programs often are more likely to stay on track than those who don’t.
    • Evaluate your progress. Strengthening your financial well-being is a process. If your employer’s financial wellness program provides various tools to monitor your finances, use them. Weigh your progress yearly and take advantage of any support groups, webinars, or individual one-on-one counseling sessions offered by these programs.

    As the workforce continues to evolve, managing these programs and resources effectively is an important aspect for both parties. Providing and utilizing a strong, effective Financial Wellness Benefits Program will set the foundation for a lifetime of financial well-being.

     

  • Is company culture the new frontier of benefits?

    May 11, 2017

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    Once Our Culture Insights Program Launched our Industry Leading Magazine Interviewed Andrew McNeil for an in-depth piece on the program!

    With the increasing commoditization of employee benefits, how can companies in tight labor markets win the war on talent?  At least one brokerage known for pushing the envelope believes it has the answer.

    Arrow Benefits Group’s HR division is rolling out Culture Insights, which develops a personalized plan for employers to operate at their highest potential from six key angles. They include corporate purpose, mission, values, culture, HR and employee benefits. The program, which doesn’t have any paid customers yet, was inspired by a 2016 tour of Zappos.com by Andrew McNeil, an adviser with Arrow Benefits Group. Another source of motivation was a survey the firm did of millennials, Gen-Xers and baby boomers.

    “People want to work for a place where they feel valued and are aligned with the mission and purpose of that organization,” he explains, regardless of their age or industry. “They don’t just want a paycheck.” …There’s also a larger purpose behind the Culture Insights program. In all his email correspondence, McNeil now includes the following philosophical statement: “We believe we can build a stronger community by building stronger employers. Stronger employers translate into a stronger local economy and happier, more productive citizens.”

    Read entire article here.

     

    By Bruce Shelton
    Published April 28, 2017

     

  • Arrow is a proud supporter of Social Advocates For Youth (SAY) | CA Benefit Advisors

    May 9, 2017

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    We are so proud to support the SAY team Santa Rosa and had a blast at the fundraiser tonight.  Everyone worked so hard and raised awareness and big money to support homeless children in Sonoma County!!!! Here’s our Mariah Shields with the lovely Sarah Scudder, another great SAY supporter!  If you’d like to support too, please visit: https://www.saysc.org/

  • House Passes AHCA Bill in First Step to Repeal and Replace the ACA | CA Benefit Advisors

    May 6, 2017

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    On May 4, 2017, the U.S. House of Representatives passed House Resolution 1628, a reconciliation bill aimed at “repealing and replacing” the Patient Protection and Affordable Care Act (ACA). The bill, titled the “American Health Care Act of 2017” or “AHCA,” will now be sent to the Senate for debate, where amendments can be made, prior to the Senate voting on the bill.

    It is widely anticipated that in its current state the AHCA is unlikely to pass the Senate. Employers should continue to monitor the text of the bill and should refrain from implementing any changes to group health plans in response to the current version of the AHCA.

    The AHCA makes numerous changes to current law, much of which impact the individual market, Medicare, and Medicaid. Some provisions in the AHCA also impact employer group health plans. For example, the AHCA removes both the individual and the employer shared responsibility penalties. The AHCA also pushes implementation of the Cadillac tax to 2025 and permits states to waive essential health benefit (EHB) requirements.

    The AHCA removes the $2,500 contribution limit to flexible health spending accounts (FSAs) for taxable years beginning after December 31, 2017. It also changes the maximum contribution limits to health savings accounts (HSAs) to the amount of the accompanying high deductible health plan’s deductible and out-of-pocket limitation. The AHCA also provides for both spouses to make catch-up contributions to HSAs.

    The AHCA provides for a “continuous health insurance coverage incentive,” which will allow health insurers to charge policyholders an amount equal to 30 percent of the monthly premium in the individual and small group market, if the individual failed to have creditable coverage for 63 or more days during an applicable 12-month look-back period. This provision is slated to begin in 2019, or in the case of a special enrollment period, beginning in plan year 2018. The AHCA also allows states to obtain a waiver and underwrite policies for individuals who do not maintain continuous coverage.

    The AHCA would also return permissible age band rating (for purposes of calculating health plan premiums) to the pre-ACA ratio of 5:1, rather than the ACA’s 3:1. This allows older individuals to be charged up to five times more than what younger individuals pay for the same policy, rather than up to the ACA limit of three times more.

    It is unknown at this time if the AHCA can pass the Senate, or what might be changed in the text of the bill in order to earn votes in an attempt to pass the bill.

    By Danielle Capilla
    Originally published by www.ubabenefits.com

  • We have no value – there is no need – everyone for themselves – in the individual market | CA Benefit Advisors

    May 2, 2017

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    Individual health insurance coverage is now readily available, on a guaranteed basis and without any penalties for covering pre-existing medical conditions.  That makes things easier, along with the fact that the available plan designs fall into neatly configured categories.  So who needs agents?  The carriers have cut commissions, and now many are not paying commissions at all.  The assumption, of course, is that agents in the individual market are not required – people can make decisions on their own with what is made available on line.  Funny…the time we spend in counseling current and potential clients about their individual options and some of the nuances of coverage and provider networks seems to take us just as much time as before, with follow-up service calls and needs, keeping clients current, arguing with carriers and providers.  So really, there is no value here?  And still, over 50% of those who enroll through the Exchanges are enrolled through agents…guess they don’t know any better…

  • Department of Labor Delays Enforcement of the Fiduciary Duty Rule | CA Benefit Advisor

    April 28, 2017

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    On April 4, 2017, the Department of Labor (DOL) announced that the applicability date for the final fiduciary rule will be extended, and published its final rule extending the applicability date in the Federal Register on April 7. This extension is pursuant to President Trump’s February 3, 2017 presidential memorandum directing the DOL to further examine the rule and the DOL’s proposed rule to extend the deadline released on March 2, 2017.

    The length of the extension differs between certain requirements and/or components of the rule.  Below are the components and when and how applicability applies:

    • Final rule defining who is a “fiduciary”: Under the final rule, advisors who are compensated for providing investment advice to retirement plan participants and individual account owners, including plan sponsors, are fiduciaries. The applicability date for the final rule is extended 60 days, from April 10 until June 9, 2017. Fiduciaries will be required to comply with the impartial conduct or “best interest” standards on the June 9 applicability date.
    • Best Interest Contract Exemption: Except for the impartial conduct standards (applicable June 9 per above), all other conditions of this exemption for covered transactions are applicable January 1, 2018. Therefore, fiduciaries intending to use this exemption must comply with the impartial conduct standard between June 9, 2017 and January 1, 2018.
    • Class Exemption for Principal Transactions: Except for the impartial conduct standards (applicable June 9 per above), all other conditions of this exemption for covered transactions are applicable January 1, 2018. Therefore, fiduciaries intending to use this exemption must comply with the impartial conduct standard between June 9, 2017 and January 1, 2018 and thereafter.
    • Prohibited Transaction Exemption 84-24 (relating to annuities): Except for the impartial conduct standard (applicable June 9 per above), the amendments to this exemption are applicable January 1, 2018.
    • Other previously granted exemptions: All amendments to other previously granted exemptions are applicable on June 9, 2017.

    By Nicole Quinn-Gato, JD
    Originally Published By www.thinkhr.com

  • Getting the Most Out of an Employee Assistance Program (EAP) | CA Benefit Consultants

    April 25, 2017

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    Many employers understand the value of having an Employee Assistance Program (EAP) since the heart and soul of organizations are employees. Employees who are physically and mentally healthy, highly productive, engaged in their work, and loyal to their employer contribute positively to their employer’s bottom line. Fortunately, most employees are positive contributors, yet even the best of employees can occasionally have issues or circumstances arise that may inadvertently impact their jobs in a negative way. Having an EAP in place that can address these issues early may mitigate any negative impact to the workplace. This is a win-win for both employees and employers.

    A key component of EAP services lies in “catching things early” by assisting employees and helping them address and resolve issues before they impact the workplace. Most employees will use EAP services on a voluntary, self-referred basis that is completely confidential. Some employers may wonder if services are even being used by employees because it won’t be all that apparent, but most EAPs provide a utilization or usage report that will show the number of people served, and possibly the types of reasons services were requested.

    If employee issues do begin to appear in the workplace—related to performance, attendance, behavior, or safety—it is important for managers, supervisors, and human resources to also have access to EAP services. They may wish to consult with an employee assistance professional that can provide guidance and direction leading to problem identification and resolution. These issues have the potential to become very costly for the organization—and again, the earlier they can be addressed, the greater chance of success for both employee and employer, with minimal negative impact to the company’s bottom line.

    The key to getting the most out of an EAP is to make it easily accessible to employees, safe to use, and visible enough they remember to use it. It is important that employees understand using the EAP is confidential and their identity will not be disclosed to anyone in their organization. Promoting the EAP services with materials such as flyers, posters, or website information with EAP contact information will also increase the likelihood of employees accessing services.

    By Nancy Cannon
    Originally published by www.ubabenefits.com

  • Arrow’s Wellness Initiative CPR/First -aid community classes in the News!

    April 21, 2017

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    As brokerages continue to look for ways to stand out from the competition, two agencies are giving back to their communities and helping those areas become healthier in the process. Arrow Benefits Group in Petaluma, Calif., created the Arrow Community Wellness Initiative. The initiative each month offers CPR and automated defibrillator (AED) training and certification with first -aid, instructed by the Petaluma Health Care District, free to the community. Read entire article here.

  • Flex Work: Advantages in the New Workforce | CA Benefit Advisors

    April 19, 2017

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    Flex Work. No doubt you’ve heard this term (or some variation) floating around the last decade or so, but what exactly does it mean? Flexible work can vary by definition depending on who you ask, but one thing is for sure, it’s here to stay and changing the way we view the workforce. According to a recent study by Randstad, employer commitment to increase the amount of flex workers in their companies has increased 155% over the last four years. If fact, 68% of employers agree that the majority of the workforce will be working some sort of flexible arrangement by 2025.

    So then, since the landscape of a traditional office setting is changing, what exactly is Flex Work? Simply stated, it’s a practice employers use to allow their staff some discretion and freedom in how to handle their work, while making sure their schedules coordinate with colleagues. Parameters are set by the employer on how to get the work accomplished.  These guidelines may include employees working a set number of hours per day/week, and specifying core times when they need to be onsite. No matter how it’s defined, with a new generation entering the workforce and technology continuing to advance, employers will need to explore this trend to stay competitive.

    Let’s take a look at how this two-fold benefit has several advantages for employers and employees alike.

    Increases Productivity

    When employees work a more flexible schedule, they are more productive. Many will get more done in less time, have less distractions, take less breaks, and use less sick time/PTO than office counterparts. In several recent studies, employees have stated they’re more productive when not in a traditional office setting. In a recent article published by Entrepreneur.com, Sara Sutton, CEO and Founder of FlexJobs wrote that 54% of 1500 employees polled in one of their surveys would choose to undertake important job-related assignments from home rather than the office. And 18% said that while they would prefer to complete assignments at the office, they would only do so before or after regular hours. A mere 19% said they’d go to the office during regular hours to get important assignments done.

    Flexible workplaces allow employees to have less interruptions from impromptu meetings and colleagues, while minimizing the stress of office chatter and politics—all of which can drain productivity both at work and at home. What’s more, an agile setting allows your employees to work when their energy level is at peak and their focus is best. So, an early-riser might benefit from working between the hours of 4:30 and 10 a.m., while other staff members excel in the evening; once children are in bed.

    Reduces Cost Across the Board

    Think about it, everything we do costs us something. Whether we’re sacrificing time, money, or health due to stress, cost matters. With a flexible work environment, employees can tailor their hours around family needs, personal obligations and life responsibilities without taking valuable time away from their work. They’re able to tap into work remotely while at the doctor, caring for a sick child, waiting on the repairman, or any other number of issues.

    What about the cost associated with commuting? Besides the obvious of fuel and wear and tear on a vehicle, an average worker commutes between 1-2 hours a day to the office. Tack on the stress involved in that commute and an 8 hour workday, and you’ve got one tired, stressed out employee with no balance. Telecommuting reduces these stressors, while adding value to the company by eliminating wasted time in traffic. And, less stress has a direct effect – healthier and happier employees.

    Providing a flexible practice in a traditional office environment can reduce overhead costs as well. When employees are working remotely, business owners can save by allowing employees to desk or space share. Too, an agile environment makes it easier for businesses to move away from traditional brick and mortar if they deem necessary.

    Boosts Loyalty, Talent and the Bottom Line

    We all know employees are the number one asset in any company. When employees have more control over their schedule during the business day, it breeds trust and reduces stress. In fact, in a recent survey of 1300 employees polled by FlexJobs, 83% responded they would be more loyal to their company if they offered this benefit. Having a more agile work schedule not only reduces stress, but helps your employees maintain a good work/life balance.

    Offering this incentive to prospective and existing employees also allows you to acquire top talent because you aren’t limited by geography. Your talent can work from anywhere, at any time of the day, reducing operational costs and boosting that bottom line—a very valuable asset to any small business owner or new start-up.

    So, what can employers do?   While there are still companies who view flexible work as a perk rather than the norm, forward-thinking business owners know how this will affect them in the next few years as they recruit and retain new talent. With 39% of permanent employees thinking to make the move to an agile environment over the next three years, it’s important to consider what a flexible environment could mean for your company.  Keep in mind there are many types that can be molded to fit your company’s and employees’ needs. Flexible work practices don’t have to be a one-size-fits-all approach. As the oldest of Generation Z is entering the workforce, and millennials are settling into their careers, companies are wise to figure out their own customized policies. The desire for a more flexible schedule is key for the changing workforce—often times over healthcare, pay and other benefits. Providing a flexible arrangement will keep your company competitive.

  • The Trump Effect: Potential Changes on the Employee Benefits Horizon

    April 17, 2017

    Exclusive Webinar Invitation from Arrow!

    Wednesday, May 3, 2017
    11:00 a.m. PT

    As President Trump challenges the status quo in Washington, D.C., CEOs, CFOs and HR decision-makers are preparing for how his administration could impact the employee benefits industry. James Slotnick, AVP, Government Relations, for Sun Life Financial will provide insight into what changes are most likely to make it through Congress. His discussion will focus on the current state of repealing and replacing the Patient Protection and Affordable Care Act (ACA), the likelihood of corporate and individual tax reform, how federal paid family leave could become a reality, and other important issues.

    Simply fill out the online form by clicking here, and enter Discount Code “UBA465” to waive the associated fee.

     

  • Petaluma teen saves a life with CPR | CA Benefit Advisors

    April 12, 2017

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    We’re proud to be in partnership with the HeartSafe Community, an initiative of the Petaluma Health Care District, and will continue to offer free CPR/First-Aid classes to the open public. What an incredibly impactful program for our community – this is the third reported incident where someone who learned the CPR procedure saved a life!

    Click here for more information.

     

  • What is “the Republican way” – who knows, as they’ve lost their say regarding ACA | CA Benefit Advisors

    April 10, 2017

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    There are now several pieces of draft legislation floating through Capitol Hill that propose a repeal and replacement of the Affordable Care Act.  The latest is being written by Darrell Issa of California who sits on the House Ways and Means Committee.  What they have in common:

    No mandates
    No subsidies
    A new tax strategy to make coverage more affordable
    More focus on strengthening the value of Health Savings Accounts
    The possibility of a tax on the value of coverage over a certain threshold

  • Employee Benefit Trends of 2017 | CA Benefit Advisors

    April 7, 2017

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    Customization of benefits is becoming more popular.  The process of personalizing employee benefits allows for individuals to choose from an array of options, and increases employee satisfaction.

  • Self-Funding Dental: Leave No Stone Unturned | CA Benefit Advisors

    April 4, 2017

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    With all of the focus that is put into managing and controlling health care costs today, it amazes me how many organizations still look past one of the most effective and least disruptive cost-saving strategies available to employers with 150 or more covered employees – self-funding your dental plan. There is a reason why dental insurers are not quick to suggest making a switch to a self-funded arrangement … it is called profit!

    Why self-fund dental?

    We know that the notion of self-funding still makes some employers nervous. Don’t be nervous; here are the fundamental reasons why this requires little risk:

    1. When self-funding dental, your exposure as an employer is limited on any one plan member. Benefit maximums are typically between $1,000 and $2,000 per year.
    2. Dental claims are what we refer to as high frequency, low severity (meaning many claims, lower dollars per claim), which means that they are far less volatile and much more predictable from year to year.
    3. You pay for only what you use, an administrative fee paid to the third-party administrator (TPA) and the actual claims that are paid in any given month. That’s it!

    Where do you save when you self-fund your dental?

    Trend: In our ongoing analysis over the years, dental claims do not trend at anywhere near the rate that the actuaries from any given insurance company project (keep in mind these are very bright people that are paid to make sure that insurance companies are profitable). Therefore, insured rates are typically overstated.

    Claims margin: This is money that insurance companies set aside for “claims fluctuation” (i.e., profit).  For example, ABC Insurer (we’ll keep this anonymous) does not use paid claims in your renewal projection. They use incurred claims that are always somewhere between three and six percent higher than your actual paid claims. They then apply “trend,” a risk charge and retention to the overstated figures. This factor alone will result in insured rates that are overstated by five to eight percent on insured plans with ABC Insurer, when compared to self-funded ABC Insurer plans.

    Risk charges: You do not pay them when you self-fund! This component of an insured rate can be anywhere from three to six percent of the premium.

    Reserves: Money that an insurer sets aside for incurred, but unpaid, claim liability. This is an area where insurance companies profit. They overstate the reserves that they build into your premiums and then they earn investment income on the reserves. When you self-fund, you pay only for what you use.

    Below is a recent case study

    We received a broker of record letter from a growing company headquartered in Massachusetts. They were hovering at about 200 employees enrolled in their fully-insured dental plan. After analyzing their historical dental claims experience, we saw an opportunity. After presenting the analysis and educating the employer on the limited amount of risk involved in switching to a self-funded program, the client decided to make the change.

    After we had received 12 months of mature claims, we did a look back into the financial impact of the change. Had the client accepted what was historically a well-received “no change” fully-insured dental renewal, they would have missed out on more than $90,000 added to their bottom line. Their employee contributions were competitive to begin with, so the employer held employee contributions flat and was able to reap the full financial reward.

    This is just one example. I would not suggest that this is the norm, but savings of 10 percent are. If you are a mid-size employer with a fully-insured dental plan, self-funding dental is a cost-savings opportunity you and your consultant should be monitoring at every renewal.

    By Gary R. Goodhile
    Originally published by www.ubabenefits.com

  • TeleMedicine – The NextGen Benefit of Minor Healthcare | CA Benefit Advisors

    March 31, 2017

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    It’s not surprising that 2017 stands to be the year many will have an experience to share using a Telemedicine or a Virtual Doctor service. With current market trends, government regulations, and changing economic demands, it’s fast becoming a more popular alternative to traditional healthcare visits.  And, as healthcare costs continue to rise and there are more strategic pricing options and digital models available to users, the appeal for consumers, self-insured employers, health systems and health plans to jump on board is significant.

    In a recent study conducted by the Aloft Group on the state of Telemedicine, 47.7% of respondents weren’t sure about what Telemedicine meant, but it’s possible they may have experienced it, as 52.4% have had interaction with a physician or clinician via email or text. Further, 78.5% of respondents indicated they would be comfortable talking with a physician using an online method.

    Dr. Tony Yuan, an experienced ER doctor in San Diego, who also consults for Doctor on Demand, provides insight into this increasing trend during a recent Q and A session. Currently, over half of the patients he sees in his ER could utilize a digital healthcare model. In fact, 90% of patients who head to the ER for minor illnesses can be treated through this service. So, the next sinus, ear infection, or other minor health issue just may provide you and your family the chance to try what will become the new standard in minor healthcare.

    Here are few benefits TeleMedicine has to offer:

    It’s Fast and Simple

    There’s no question apps are available for everything to make our lives easier—and TeleMed is no exception. Within minutes, standard first time users can set up an account, complete a few medical profile questions, then create and save a session. Having the ability to log on with a board-certified physician or clinician 24/7/365, using any PC, smart device, and even phone in some cases, saves time and money. Many services, like Teledoc and MDLive, will connect you with a licensed doctor or clinician online in just a few minutes – no scheduling or wait required. Once on, you can discuss your healthcare needs confidentially. After the visit, the doctor will update his/her records, notify your primary care physician of the call, and send an electronic prescription to the pharmacy of your choice, if necessary—all in the time it takes for a lunch break.

    It’s Flexible

    The ability to connect with a professional whether you are at home, work, or traveling makes getting the care you need invaluable. How often have you experienced the symptoms—or the full blown-effect—of getting sick while traveling? Many, no doubt, have had to adjust flight/travel plans to get the help needed from their PCP, in order to avoid getting worse.  By using an app or online service from your smart phone or laptop, you’re able to get the antibiotics you need quicker without cutting trips short or missing work to do so.

    In addition, patients in smaller communities without the resources available of classically- trained, emergency-med physicians, see the benefit and flexibility of tapping into these online doctor services. Not only is it a plus for the patient to access more advanced care if needed, doctors in these rural areas value this as well. These digital healthcare models provide immediate, life-saving tools for both doctors and their patients who may not have access to higher, acute facilities.

    It’s Affordable

    Many TeleMedicine services now accept insurance, making a patient’s visit free, or at minimum the same as most deductible or co-insurance amounts for office visits; around $40. For those on a high-deductible plan, paying $40 for an online doctor service is a much cheaper alternative than paying $150 or more for an Urgent Care visit, or over $1200 for a trip to the ER. For employers, group options are low cost and can be a clear asset when creating solutions EEs will value.

    It’s Beneficial to Employers

    Today, 3 of 5 corporations, or 59% of employers provide digital healthcare benefits to their employees. As an employer, the benefits are straightforward. First, employees can participate in professional consultations for their family members or themselves without taking away from productivity. Second, when employers incorporate these services into their benefit plans, non-emergency care is redirected from expensive ER visits, ultimately saving thousands of dollars or more to the bottom line. Additionally, TeleHealth services offer frequent monitoring from clinicians for those employees who may need regular support due to more chronic issues, reducing trips to the hospital. Reducing these costs have a direct ROI for the employer and relieves the stress on the employee’s pocketbook. Third, many companies are now adding this digital benefit to their packages as a way to recruit new talent.

    There’s no doubt 2017 will see a greater opportunity for all to experience the increasing trend of Telemed. Creating a clear communication strategy to make sure employees know how to find, access and utilize this service to the highest potential is key.

  • North Bay’s Forty Under 40 remarkable young professionals of 2017 | CA Benefit Advisors

    March 29, 2017

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    We’re so proud of our managing partner Stephen McNeil for winning the 40 under 40 accolade from the North Bay Business Journal!

     Stephen truly exudes professional growth and tremendous leadership abilities at such a young age. He is leading our team into the future with his industry expertise, innovation, and ability to communicate across all dividers.  Stay tuned for more on his work and the award when the Journal interviews him in April.   For now you can see him and his 40 under 40 colleagues here…  

     

  • Indecision and delay, it’s becoming the American way…as the ACA is hung out to dry | CA Benefit Advisors

    March 24, 2017

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    OK, the Trump campaign said the first act in office would be the repeal of the Affordable Care Act.  The Republicans, which have since day one asked for its removal, lined up behind this.

    Then reality set in and they decided to determine what a replacement would look like…and they don’t know.  And they still don’t know.  And they’re still discussing it.  In the meantime, there is a lot of jockeying for position.  What the administration did do was issue an Executive Order that suspended enforcement activity (the mandates) and now the debate is over the subsidies.  The most recent notice is from new HHS Secretary Tom Price who said this will require an additional “three months to come to a resolution”.

  • The Overtime Rule Saga Continues… CA Benefit Consultants

    March 21, 2017

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    All the hullabaloo about the potential new Department of Labor overtime rules was for naught as the implementation of the law has been delayed again. President Trump’s Department of Justice (DOJ) requested extensions to the appeal process to determine its strategy and finalize its standpoint on the proposed regulations. Some political experts theorize that the need for an extension is the result of delays in President Trump’s appointment of a Secretary of Labor. The President’s first nominee, Andrew Puzder, withdrew and confirmation hearings for his second nominee, Alexander Acosta, have not been scheduled.

    Here’s where we are so far:

    • December 2016 was the effective date, but it was delayed by court order in November 2016.
    • Obama’s DOJ requested expedited review to get the law pushed through but Trump’s DOJ requested an extension; extension granted.
    • Trump’s DOJ requested another extension, unopposed, and it was granted.

    In the legal world the result of these delays is that the appeal will not be fully briefed until May 1, 2017. This means the law is to enactment as Warren Beatty is to envelopes — no one knows what’s going on (at least until May) and the confusion may continue to go unresolved with no clear date of resolution.

    What to Do Now

    In the meantime, employers should be informed about how the rule, if implemented, would impact their workplace. You can read our blog post to learn more. As always, ensure that your company maintains compliance with current overtime rules and regulations, and use this time of legal indecision as an opportunity to review your practices and policies in accordance with state and federal wage payment laws.

    By Samantha Yurman, JD
    Originally published by www.thinkhr.com

  • Long-Awaited Repeal and Replacement Plan for ACA Unveiled | CA Benefit Consultants

    March 17, 2017

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    On March 6, 2017, the U.S. House of Representatives Ways and Means Committee released a proposed budget reconciliation bill, entitled the American Health Care Act, to replace portions of the Affordable Care Act (ACA). If enacted, the American Health Care Act would provide some relief from provisions of the ACA for employers and make other significant changes to employee benefits. While the proposal is 53 pages long and covers a range of tax and benefit changes, below is a summary of key provisions impacting employers and employee benefits.

    Employer and Individual Mandates

    The proposal effectively eliminates the employer and individual mandate by zeroing out penalties for an employer’s failure to offer, and an individual’s failure to obtain, minimum essential coverage retroactive to January 1, 2016.

    Health Care Related Taxes

    The proposal extends the applicable date for the “Cadillac tax” from 2020 to 2025 and repeals the medical device tax, over the counter medication tax, indoor tanning sales tax, and Medicare hospital insurance surtax beginning in 2018.

    Reporting Requirements

    Because the proposal is through a budget reconciliation process, employer reporting requirements for reporting offers of coverage on employees’ W-2s cannot be repealed; however, the proposal creates a simplified process for employers to report this information that, according to the House Ways and Means Committee’s section-by-section summary, makes the current reporting redundant and allows the  Secretary of the Treasury to cease enforcing reporting that is not needed for taxable purposes.

    Contribution Limits

    Additionally, the proposal eliminates the cap on contributions to flexible spending accounts (FSAs) and almost doubles the maximum allowable contributions to health savings accounts (HSAs) by allowing contributions of $6,550 for individuals and $13,100 for families beginning in 2018. This aligns the HSA contribution amount with the sum of the annual deductible and out-of-pocket cost expenses permitted under a high deductible health plan. The proposal also allows both spouses to make catch-up contributions to one HSA beginning in 2018.

    Patient Protection Provisions

    Finally, the proposal retains some key patient protection provisions of the ACA by continuing to prohibit insurers from excluding individuals with pre-existing conditions from obtaining or paying more for coverage and continuing to allow children to stay on their parent’s plan to age 26.

    What Employers Should Know Now

    We are still in the first round of the new government’s strategy to repeal and replace the ACA. The Congressional Budget Office will next review and score the plan before it goes back to the House and the Senate for full votes before making it to President Trump’s desk for approval. This will take time.

    In the interim, the provisions of the ACA still apply. While applicable large employers may not be assessed penalties for failing to offer minimum essential coverage to employees if the proposal is eventually enacted, please note that employers are still obligated to report offers of coverage and should finalize their ACA reporting for the 2016 tax year if they have not completed their e-filing with the IRS (due March 31, 2017).

    By Nicole Quinn-Gato, JD
    Originally published by www.thinkhr.com

  • The “Line 22” Question: Which Box(es) Do I Check? | CA Benefit Consultants

    March 14, 2017

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    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) 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. Similarly, insurers and employers with less than 50 full time employees but that have a self-funded plan also have reporting obligations. All of this reporting is done on IRS Forms 1094-B, 1095-B, 1094-C and 1095-C.

    Final instructions for both the 1094-B and 1095-B and the 1094-C and 1095-C were released in September 2015, as were the final forms for 1094-B, 1095-B, 1094-C, and 1095-C.

    Form 1094-C is used in combination with Form 1095-C to determine employer shared responsibility penalties. It is often referred to as the “transmittal form” or “cover sheet.” IRS Form 1095-C will primarily be used to meet the Section 6056 reporting requirement, which relates to the employer shared responsibility/play or pay requirement. Information from Form 1095-C will also be used in determining whether an individual is eligible for a premium tax credit.

    Form 1094-C contains information about the ALE, and is how an employer identifies as being part of a controlled group. It also has a section labeled “Certifications of Eligibility” and instructs employers to “select all that apply” with four boxes that can be checked. The section is often referred to as the “Line 22” question or boxes. Many employers find this section confusing and are unsure what, if any, boxes they should select. The boxes are labeled:

    1. Qualifying Offer Method
    2. Reserved
    3. Section 4980H Transition Relief
    4. 98% Offer Method

    Different real world situations will lead an employer to select any combination of boxes on Line 22, including leaving all four boxes blank. Practically speaking, only employers who met the requirements of using code 1A on the 1095-C, offered coverage to virtually all employees, or qualified for transition relief in 2015 and had a non-calendar year plan will check any of the boxes on Line 22. Notably, employers who do not use the federal poverty level safe harbor for affordability will never select Box A, and corresponding with that, will never use codes 1A or 1I on Line 14 of a 1095-C form.

    By Danielle Capilla
    Originally published by www.ubabenefits.com

  • Arrow Wins North Bay Business Journal Philanthropy Award 2017! | CA Benefit Consultants

    March 10, 2017

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    Arrow Benefits Principal Mariah Shields founded her local chapter of 100 Sonoma County People Who Care – She and Arrow won the North Bay Business Journal Philanthropy award for this and all their good charitable work. Mariah is shown here presenting one of the checks for funds raised by the organization in support of local non-profits that support the community. Read the entire article here.

  • Gig Economy 101 | CA Benefit Advisors

    March 7, 2017

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    What is a Gig Economy?

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    By Nicole Federico, eTekhnos Benefits Technology

  • Top Five Compliance Assessment Surprises | CA Benefit Advisors

    March 1, 2017

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    Our Firm is making a big push to provide compliance assessments for our clients and using them as a marketing tool with prospects. Since the U.S. Department of Labor (DOL) began its Health Benefits Security Project in October 2012, there has been increased scrutiny. While none of our clients have been audited yet, we expect it is only a matter of time and we want to make sure they are prepared.

    We knew most fully-insured groups did not have a Summary Plan Description (SPD) for their health and welfare plans, but we have been surprised by some of the other things that were missing. Here are the top five compliance surprises we found.

    1. COBRA Initial Notice. The initial notice is a core piece of compliance with the Consolidated Omnibus Budget and Reconciliation Act (COBRA) and we have been very surprised by how many clients are not distributing this notice. Our clients using a third-party administrator (TPA), or self-administering COBRA, are doing a good job of sending out the required letters after qualifying events. However, we have found that many clients are not distributing the required COBRA initial notice to new enrollees. The DOL has recently updated the COBRA model notices with expiration dates of December 31, 2019. We are trying to get our clients to update their notices and, if they haven’t consistently distributed the initial notice to all participants, to send it out to everyone now and document how it was sent and to whom.
    2. Prescription Drug Plan Reporting to CMS. To comply with the Medicare Prescription Drug Improvement and Modernization Act, passed in 2003, employer groups offering prescription benefits to Medicare-eligible individuals need to take two actions each year. The first is an annual report on the Centers for Medicare & Medicaid Services (CMS) website regarding whether the prescription drug plan offered by the group is creditable or non-creditable. The second is distributing a notice annually to Medicare-eligible plan members prior to the October 15 beginning of Medicare open enrollment, disclosing whether the prescription coverage is creditable or non-creditable. We have found that the vast majority (but not 100 percent) of our clients are complying with the second requirement by annually distributing notices to employees. Many clients are not complying with the first requirement and do not go to the CMS website annually to update their information. The annual notice on the CMS website must be made within:
    • 60 days after the beginning of the plan year,
    • 30 days after the termination of the prescription drug plan, or
    • 30 days after any change in the creditability status of the prescription drug plan.
    1. ACA Notice of Exchange Rights. The Patient Protection and Affordable Care Act (ACA) required that, starting in September 2013, all employers subject to the Fair Labor Standards Act (FLSA) distribute written notices to all employees regarding the state exchanges, eligibility for coverage through the employer, and whether the coverage was qualifying coverage. This notice was to be given to all employees at that time and to all new hires within 14 days of their date of hire. We have found many groups have not included this notice in the information they routinely give to new hires. The DOL has acknowledged that there are no penalties for not distributing the notice, but since it is so easy to comply, why take the chance in case of an audit?
    2. USERRA Notices. The Uniformed Services Employment and Reemployment Rights Act (USERRA) protects the job rights of individuals who voluntarily or involuntarily leave employment for military service or service in the National Disaster Medical System. USERRA also prohibits employers from discriminating against past and present members of the uniformed services. Employers are required to provide a notice of the rights, benefits and obligations under USERRA. Many employers meet the obligation by posting the DOL’s “Your Rights Under USERRA” poster, or including text in their employee handbook. However, even though USERRA has been around since 1994, we are finding many employers are not providing this information.
    3. Section 79. Internal Revenue Code Section 79 provides regulations for the taxation of employer-provided life insurance. This code has been around since 1964, and while there have been some changes, the basics have been in place for many years. Despite the length of time it has been in place, we have found a number of groups that are not calculating the imputed income. In essence, if an employer provides more than $50,000 in life insurance, then the employee should be paying tax on the excess coverage based on the IRS’s age rated table 2-2. With many employers outsourcing their payroll or using software programs for payroll, calculating the imputed income usually only takes a couple of mouse clicks. However, we have been surprised by how many employers are not complying with this part of the Internal Revenue Code, and are therefore putting their employees’ beneficiaries at risk.

    There have been other surprises through this process, but these are a few of the more striking examples. The feedback we received from our compliance assessments has been overwhelmingly positive. Groups don’t always like to change their processes, but they do appreciate knowing what needs to be done.

    Audit-proof your company with UBA’s latest white paper: Don’t Roll the Dice on Department of Labor Audits. This free resource offers valuable information about how to prepare for an audit, the best way to acclimate staff to the audit process, and the most important elements of complying with requests.

    By Bob Bentley
    Originally published by www.ubabenefits.com

  • Keeping Pace with the Protecting Affordable Coverage for Employees Act | CA Benefit Advisors

    February 25, 2017

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    Last fall, President Barack Obama signed the Protecting Affordable Coverage for Employees Act (PACE), which preserved the historical definition of small employer to mean an employer that employs 1 to 50 employees. Prior to this newly signed legislation, the Patient Protection and Affordable Care Act (ACA) was set to expand the definition of a small employer to include companies with 51 to 100 employees (mid-size segment) beginning January 1, 2016.

    If not for PACE, the mid-size segment would have become subject to the ACA provisions that impact small employers. Included in these provisions is a mandate that requires coverage for essential health benefits (not to be confused with minimum essential coverage, which the ACA requires of applicable large employers) and a requirement that small group plans provide coverage levels that equate to specific actuarial values. The original intent of expanding the definition of small group plans was to lower premium costs and to increase mandated benefits to a larger portion of the population.

    The lower cost theory was based on the premise that broadening the risk pool of covered individuals within the small group market would spread the costs over a larger population, thereby reducing premiums to all. However, after further scrutiny and comments, there was concern that the expanded definition would actually increase premium costs to the mid-size segment because they would now be subject to community rating insurance standards. This shift to small group plans might also encourage mid-size groups to leave the fully-insured market by self-insuring – a move that could actually negate the intended benefits of the expanded definition.

    Another issue with the ACA’s expanded definition of small group plans was that it would have resulted in a double standard for the mid-size segment. Not only would they be subject to the small group coverage requirements, but they would also be subject to the large employer mandate because they would meet the ACA’s definition of an applicable large employer.

    Note: Although this bill preserves the traditional definition of a small employer, it does allow states to expand the definition to include organizations with 51 to 100 employees, if so desired.

    By Vicki Randall
    Originally published by www.ubabenefits.com

  • Top 3 Questions to Make the Most out of your Dental Plan – by Jennifer Wardell & Stephen McNeil

    February 21, 2017

    For many dental patients, dental insurance annual maximums replenish on January 1.  To make sure you get the most bang for your buck on your dental plan, we recommend you ask these three vital questions before having any upcoming procedures.  Read entire article here…

    NorthBayBiz Magazine – February 2017

    Stephen McNeil

     

     

     

     

     

     

     

     

     

     

     

    Jennifer Wardell

  • The IRS Clarifies Tax Treatment of Fixed-Indemnity Health Plans | CA Benefit Advisors

    February 16, 2017

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    While many Americans will remember January 20, 2017 as the day the 45th President of the United States was sworn into office, employee benefits experts will also remember it as the day the IRS Office of Chief Counsel (OCC) released this memorandum that clarifies, among other things, the tax treatment of benefits paid by fixed-indemnity plans.

    Fixed indemnity plans are generally voluntary benefits employers offer to complement or supplement group health insurance, such as a hospital indemnity plan that pays a fixed dollar amount for days in the hospital. The plans do not meet minimum essential coverage standards and are exempt from the Affordable Care Act.

    In the memorandum, the IRS clarified that if an employer pays the fixed-indemnity premiums on behalf of employees and the value is excluded from employees’ gross income and wages or allows employees to pay premiums pre-tax through the employer’s cafeteria plan, the amount of any benefits paid to an employee under the plan will be included in the employee’s gross income and wages. On the other hand, if employees pay the premiums with after-tax dollars, then the benefits are not included in the employees’ gross income and wages.

    While this creates a tax burden for the employee, it also creates a burden for employers, as they are tasked with determining whether an employee has received a benefit and the amount of the benefit to determine wages and applicable employment taxes.

    Employers that offer employer-paid fixed indemnity plans or allow employees to pay for plans pre-tax are encouraged to work with their counsel, broker, carrier, or other trusted advisor to address their current practices and determine if any changes should be made.

    By Nicole Quinn-Gato, JD
    Originally published by www.thinkhr.com

  • Good Sense Guide to Minimum Essential Coverage Forms 1094-C and 1095-C | CA Benefit Advisors

    February 14, 2017

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    If you are an Applicable Large Employer (ALE), you may still be catching your breath from 2015 Patient Protection and Affordable Care Act (ACA) reporting. However, in a couple of weeks the process starts all over again as you prepare for the 2016 reporting cycle. As with all new requirements, the first filing cycle had some bumps as there was little guidance for some of the questions and issues that arose. In preparation for 2017, let’s take a look at the “C” forms and discuss areas of the forms that may have been confusing.

    To refresh, the C forms are used by ALEs to report information about their offers of health coverage as required under Section 6056. For self-insured ALEs, the C forms are also used to report coverage information for individuals enrolled in the ALE’s health plan as required under Section 6055. All ALEs are required to file 1094/1095-C forms regardless of what kind of coverage, if any, they offer. ALEs with self-insured plans or fully-insured plans, as well as, ALEs that offer no plan are subject to Section 6056 reporting. See my blog “Making Sense of Form 1095 Minimum Essential Coverage Reporting.”

    The 1094-C is the transmittal form that goes along with all of your 1095-C forms when you submit them to the IRS. It has four parts and in general, the 1094-C is pretty straightforward. However, Line 22, located in Part II of the form, deserves some discussion. Line 22 is used to indicate when an ALE is eligible for one or more types of reporting relief. A response is not mandatory and is only necessary if an ALE wishes to take advantage of one of the relief options.

    It probably seems obvious, and this will sound a bit like a tongue twister, but it may be helpful to review the relief that is provided prior to going to the effort of determining whether you meet the requirements of the relief. Said differently, if the relief for meeting certain requirements isn’t of value to you, there is little value in taking the time to determine if you qualify for the relief. The table below provides a summary of the relief options available for selection on Line 22.

    Summary of line 22 reporting relief

    The 1095-C is employee/participant specific and one is generated for all full-time employees. In addition, if it is a self-insured plan, a 1095-C is also generated for any non-full-time individual who enrolled in the plan.

    An area of confusion on the 1095-C is Part II. This area requires that you understand the different codes used to report the various “offer” situations that might exist. Deciphering these different situations can be somewhat like playing a game of Twister as multiple codes may be applicable

    Line 14 – Offer of Coverage Code

    This line captures the code that reflects the offer an ALE made to the employee on a month-by-month basis. For some employees, this may be straightforward. For example, the employee may have been employed for the entire year and may have received an offer at the beginning of the year, which covered all 12 months and no changes occurred with regard to that employee’s offer throughout the year. Therefore, one code can be used for all 12 months. However, when an employee is hired or terminated, the code will not be the same for the entire year. Throw in situations where employees go from part-time to full-time, or perhaps you have a rehire situation, and it can become quite complicated.

    In 2016, there were 11 different offer codes. However, one of these codes (1I) is not to be used, so essentially there are 10 options available.

    Offer codes for line 14

    Line 14 is mandatory and should always have a code entered.

    *If used on Line 14, then line 15 must be completed.

    Line 15 – Employee Required Contribution

    This line captures the amount the employee would be required to contribute for the lowest cost minimum value coverage that was offered by the ALE. Note: This is not necessarily what the employee enrolled in. Line 15 is used by the IRS to determine if the minimum value coverage that was offered meets the affordability requirement. NOTE: Line 15 is only to be completed when the code on Line 14 is 1B, C, D, E, J or K. When any of the other codes are used on Line 14, line 15 is to be left blank because the IRS does not need to ascertain affordability.

    Line 16 – Section 4980H Safe Harbor and Other Relief Codes

    This line is used to provide a reason why an ALE member should not be liable for a 4980H(b) penalty. Line 16 provides additional information to substantiate why a penalty should not apply to that particular employee’s offer, or lack of an offer. Line 16 is not mandatory, so depending on the code used on Line 14, you may, or may not, need to provide a code on this line. Examples where you may wish to provide a code include:

    • Codes 2A, B, D, or E could be used to explain why an offer was not required for an employee. For example, Code 2A is used for months in which a terminated employee has COBRA.
    • Codes 2F, G, or H might be used in situations where affordability of the offer is questionable based on the figure on line 15.
    • Code 2C is applicable if the employee enrolled in the coverage for each day of the month and was full-time for at least one month during the year.

    Section 4980H Safe Harbor and Other Relief Codes for Line 16

    Those are the areas of the 1094-C and 1095-C that seemed to be the most confusing for many ALEs. Although the information presented here by no means extinguishes this confusion, our intent was to help explain the purpose of the more confusing parts and how certain responses can prove beneficial so that determining those responses is less frustrating.

    By Vicki Randall
    Originally published by www.ubabenefits.com

  • National Rising Star Award

    February 10, 2017

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    The entire team at Arrow Benefits Group congratulates our Andrew McNeil, Principal for winning the Employee Benefits Adviser National Rising Star Award! The award is well deserved and Andrew is someone truly concerned with the growth and well-being of all his clients and community at large. His continuous innovations in the industry are being well-recognized and we agree!

  • UBA Health Plan Survey – 2016 | CA Benefit Advisors

    February 9, 2017

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    Employer-sponsored health insurance is greatly affected by geographic region, industry, and employer size. While some cost trends have been fairly consistent since the Patient Protection and Affordable Care Act (ACA) was put in place, United Benefit Advisors (UBA) finds several surprises in their 2016 Health Plan Survey.

    Based on responses from more than 11,000 employers, UBA announces the top five best and worst states for group health care costs.

    Check out this short video and contact us with how this Survey impacts you and your business!

  • Here’s What You Need to Know About a Long-Term Care Insurance Policy | CA Benefit Advisors

    February 6, 2017

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    So you’ve made the decision to learn more about long-term care insurance. That’s smart, as neither health insurance nor Medicare would pay for extended long-term care services in the event that you needed them in the future. Plus, there’s about a 70% chance you’ll need some type of long-term care after age 65, according to government stats. And given that the cost of long-term care can quickly deplete your life’s savings, it just makes sense to add it your financial plan.

    When you prepare for any upcoming investment or purchase, you probably run into some unfamiliar language or terminology in your research, which can be frustrating and downright confusing.

    Searching for a long-term care insurance policy is no different. A long-term care insurance policy describes coverage under the policy, exclusions and limitations—and can be laden with industry jargon. Here’s a breakdown of the fundamentals:

    There are four primary components that determine your long-term care benefits and influence your monthly cost.

    1. How much. This is the total maximum benefit available under any policy. There are many maximums to choose from, ranging from $100,000 to $250,000, $500,000 or more. Benefits are available until you have received your maximum benefit in total.

    2. How fast. This is the monthly limit you can access from your total maximum benefit. Insurance companies do not pay out your “how much” in a single lump sum. Rather, you access your benefits in smaller amounts on a monthly basis up to a predetermined monthly maximum.

    Depending on the carrier you choose, your monthly maximum could range from $1,500 to $10,000 a month. The “how much” and “how fast” components work together to determine how long your coverage will last. If your monthly maximum (“how fast”) is $5,000 and your total policy maximum (“how much”) is $250,000, it would take 50 months (four years, two months) before your exhaust your policy benefits. If you needed $2,000 a month to pay for home care, as an example, it could take more than 10 years to exhaust a $250,000 policy. The greater your “how much” and “how fast,” are the higher your premium will be.

    3. Growth rate. This determines how your benefit grows over time. The most common growth rate today is 3%. If your policy started with $176,000 in your “how much” and $4,500 in your “how fast,” a 3% annual growth rate would double your benefits in 24 years to $352,000 total maximum benefit and $9,000 monthly maximum respectively.
    You also have the option of choosing a growth rate other than 3% or to increase your maximums upfront and forgo a growth rate all together. A specialist can help you identify the growth rate that best suits your goals and budget.

    4. Deductible. Long-term care insurance has an elimination period that, like a deductible, determines how much you may have to pay out of your pocket before benefits are paid. One distinction to note is that an elimination period is stated in days, not dollars. The most commonly selected elimination period is 90 days. This typically means that you must receive 90 days of care that you pay for out of your pocket before benefits are available.

    Not that difficult when put simply, right? I hope you feel better prepared in your search for the right policy and that I have also remove some of the confusion. Long-term care insurance is here to help you live the lifestyle you want 10, 20, even 30 years down the road.

    By Matt Dean
    Originally published by www.lifehappens.org

  • President Trump Makes First Moves Towards ACA Repeal – What Employers and Plan Sponsors Should Know Now | CA Benefit Advisors

    February 2, 2017

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    One of President Donald Trump’s first actions in office was to make good on a campaign promise to move quickly to repeal the Affordable Care Act (ACA). He issued Executive Order 13765, Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal. The one-page executive order (EO) is effective immediately and very light on details, with the goal to minimize the financial and regulatory burdens of the ACA while its repeal is pending. The EO directs the Executive Branch agency heads (those in the departments of Labor, Health and Human Services, and the Treasury) in charge of enforcing the ACA to “exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications.”

    While Congress works on the ACA repeal through budget reconciliation, which allows for quick consideration of tax, spending, and debt limit legislation, President Trump is tackling the regulatory enforcement actions of the law. The practical impact of the EO is limited to agency enforcement discretion and requires agencies to implement the EO in a manner consistent with current law, including assuring that any required changes to applicable regulations will follow all administrative requirements for notice and comment periods.

    The bottom line is that until the agency heads in Labor, Health and Human Services, and the Treasury are confirmed and take charge of their departments, there will probably be little change in agency enforcement action right away. The broader changes to amend or repeal the ACA will take even more time to implement.

    What Employers and Plan Sponsors Should Know Now

    While the EO does not specifically refer to the ACA compliance burdens on employers or plan sponsors, such as the employer or individual mandates, required health benefits coverage, reporting or employee notification requirements, the language addresses the actions that the federal agencies can take to soften enforcement until the repeal is accomplished. It does direct the government to address the taxes and penalties associated with the ACA. So what does that mean for employers and plan sponsors now?

    IRS employer reporting delay? Not yet. The top concern of employers is whether or not those subject to the shared responsibility provisions of the law would need to submit their 1094/1095 reports of coverage to the IRS by February 28 (or March 31, if filing electronically) and provide their employees with individual 1095-C statements by March 2. These reports are essential for the IRS to assess penalties under the law, and this reporting has been a burden for employers. Unfortunately for employers, the order did not mention delaying or eliminating this reporting requirement.

    What employers should do now:

    • Applicable large employers (ALEs) subject to the employer mandate should plan to comply with their 1094/1095 reporting obligations this year.
    • All employers should continue to comply with all current ACA requirements until there is further guidance from the lawmakers.

    We’ve Got You Covered

    We’ll be monitoring President Trump’s actions to reduce regulatory burdens on American businesses along with Congressional legislative actions that can impact your business operations. Look for ThinkHR’s practical updates where we’ll analyze these developments and break them down into actionable information you need to comply with the changing laws and regulations.

    By Laura Kerekes, SPHR, SHRM-SCP
    Originally published by www.thinkhr.com

  • Who Are You Benchmarking Your Health Plan Against? | CA Benefit Advisors

    January 31, 2017

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    Many employers benchmark their health plan against carrier provided national data. While that is a good place to start, regional cost averages vary, making it essential to benchmark both nationally and regionally—as well as state by state. For example, a significant difference exists between the cost to insure an employee in the Northeast versus the Central U.S.—plans in the Northeast continue to cost the most since they typically have lower deductibles, contain more state-mandated benefits, and feature higher in-network coinsurance, among other factors.

    UBA Health Plan Survey Costs by Region

    Drilling down even more, comparing yourself to your industry peers can tell a very different story.

    UBA Health Plan Survey Costs by Industry

    Consider a manufacturing plant in Georgia that offers a PPO. Its premium cost for single coverage is $507 per month. Compare this with the benchmarks for all plans and you can see that it is $2 per month less than the national average. When compared with other PPOs in the Southeast region, this employer’s cost is actually $2 more than the average. This employer’s cost appears to be higher or lower compared with national and regional benchmarks, depending on which benchmark is used. Yet this employer’s cost is actually higher than its closest peers’ costs when using the state-specific benchmark, which in Georgia is $468. Bottom line, this employer’s monthly single premium is actually $39 more than its competitors in the state.UBA Health Plan Survey Plan Comparison

    As our CEO, Les McPhearson, recently stated, “Benchmarking by state, region, industry, and group size is critical. We see it time and time again, especially with new clients. An employer benchmarks their rates nationally and they seem at or below average, but once we look at their rates by plan type across multiple carriers and among their neighboring competitors or like-size groups, we find many employers leave a lot on the bargaining table.”

    By RJ Nelson|
    Originally published by www.ubabenefits.com

     

  • DOL Increases Penalty Amounts to Adjust for Inflation | California Benefit Advisors

    January 25, 2017

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    For the second time in less than a year the Department of Labor (DOL) has increased the civil monetary penalties assessed or enforced by the DOL. The increases were announced in a final rule issued by the DOL on January 18, 2017. The increases were made pursuant to the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, which requires federal agencies to annually adjust their civil money penalties for inflation, based on the Consumer Price Index for All Urban Consumers (CPI-U), no later than January 15 of each year. The inflation adjustment for 2017 was based on the percentage change between the October 2016 CPI-U and the October 2015 CPI-U. The penalties were last increased on August 1, 2016.

    The increased penalties apply to a broad range of laws enforced by the DOL including:

    • The Black Lung Benefits Act.
    • The Contract Work Hours and Safety Standards (CWHSSA).
    • The Employee Polygraph Protection Act (EPPA).
    • The Employee Retirement Income Security Act (ERISA).
    • The Fair Labor Standards Act (FLSA).
    • The Family and Medical Leave Act (FMLA).
    • The Federal Mine and Safety Health Act.
    • The Immigration and Nationality Act.
    • The Longshore and Harbor Workers’ Compensation Act.
    • The Migrant and Seasonal Agricultural Worker Protection Act (MSPA).
    • The Occupational Safety and Health Act (OSH Act).
    • The Walsh-Healey Public Contracts Act (PCA).

    The new penalties apply to violations that occurred after November 2, 2015, and for which penalties were assessed after January 13, 2017. View the updated penalties for violations of laws enforced by the Wage and Hour Division of the DOL.

     

    By Rick Montgomery, JD – Originally published by ThinkHR – Read More

  • 2017 Annual Limits Card Back by Popular Demand | CA Benefit Advisors

    January 23, 2017

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    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 2017 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 a section of the 2017 health plan limits; be sure to request the complete chart from a UBA Partner.

    2017 health plan limits

     

    By Danielle Capilla, Originally published by United Benefit Advisors – Read More

  • Department of Labor Form 5500’s Time-Intensive and Expensive Reporting Requirements Painful for Small Employers | CA Benefit Advisors

    January 20, 2017

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    Proposed regulations for revising and greatly expanding the Department of Labor (DOL) Form 5500 reporting are set to take effect in 2019. Currently, the non-retirement plan reporting is limited to those employers that have more than 100 employees enrolled on their benefit plans, or those in a self-funded trust. The filings must be completed on the DOL EFAST2 system within 210 days following the end of the plan year.

    What does this expanded number of businesses required to report look like? According to the 2016 United Benefit Advisors (UBA) Health Plan Survey, less than 18 percent of employers offering medical plans are required to report right now. With the expanded requirements of 5500 reporting, this would require the just over 82 percent of employers not reporting now to comply with the new mandate.

    While the information reported is not typically difficult to gather, it is a time-intensive task. In addition to the usual information about the carrier’s name, address, total premium, and payments to an agent or broker, employers will now be required to provide detailed benefit plan information such as deductibles, out-of-pocket maximums, coinsurance and copay amounts, among other items. Currently, insurance carriers and third party administrators must produce information needed on scheduled forms. However, an employer’s plan year as filed in their ERISA Summary Plan Description, might not match up to the renewal year with the insurance carrier. There are times when these schedule forms must be requested repeatedly in order to receive the correct dates of the plan year for filing.

    In the early 1990s small employers offering a Section 125 plan were required to fill out a 5500 form with a very simple 5500 schedule form. Most small employers did not know about the filing, so noncompliance ran very high. The small employer filings were stopped mainly because the DOL did not have adequate resources to review or tabulate the information.

    While electronic filing makes the process easier to tabulate the information received from companies, is it really needed? Likely not, given the expense it will require in additional compliance costs for small employers. With the current information gathered on the forms, the least expensive service is typically $500 annually for one filing. Employers without an ERISA required summary plan description (SPD) in a wrap-style document, would be required to do a separate filing based on each line of coverage. If an employer offers medical, dental, vision and life insurance, it would need to complete four separate filings. Of course, with the expanded information required if the proposed regulations hold, it is anticipated that those offering Form 5500 filing services would need to increase with the additional amount of information to be entered. In order to compensate for the additional information, those fees could more than double. Of course, that also doesn’t account for the time required to gather all the data and make sure it is correct. It is at the very least, an expensive endeavor for a small business to undertake.

    Even though small employers will likely have fewer items required for their filings, it is an especially undue hardship on many already struggling small businesses that have been hit with rising health insurance premiums and other increasing costs. For those employers in the 50-99 category, they have likely paid out high fees to complete the ACA required 1094 and 1095 forms and now will be saddled with yet another reporting cost and time intensive gathering of data.

    Given the noncompliance of the 1990s in the small group arena, this is just one area that a new administration could very simply and easily remove this unwelcome burden from small employers.

     

    By Carol Taylor, Originally published by United Benefit Advisors – Read More

  • 2017: What HR Can Do to Prepare for a Big Year of Change | California Employee Benefits

    January 18, 2017

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    Employers saw unprecedented changes to human resources management in 2016, including Affordable Care Act (ACA) compliance, new Fair Labor Standards Act (FLSA) regulations, parental leave laws and a push for equal pay. With a new year and a new president taking office, 2017 is sure to usher in some major changes and HR challenges that could have significant impact on businesses large and small. Here are a few of the hot button issues to keep on your radar and how to prepare for them:

    Keep current on ACA changes
    With President-elect Trump taking office, the ACA finds itself once again in the national spotlight, this time standing on more uncertain ground than ever before. Whether the ACA will be repealed fully, partially, or left as is, it’s important for employers to stay current on compliance to avoid penalties and fees. For more information, seek out the helpful questions and answers on the ACA reporting requirements that the IRS provides here.

    Don’t assume the law is barred
    In November 2016, a federal judge in Texas issued an injunction blocking the new overtime regulations slated to go into effect the first of December. This would have doubled the FLSA’s salary threshold for exemption from overtime pay. Despite the injunction, many employers have already adjusted workers’ salaries or reclassified their employees. While we wait to see what comes from the Department of Labor’s appeal, it is a safe bet for employers to leave their decisions in place, and not assume the law will be permanently barred.

    Make a good (and fair) recruitment process a priority
    Finding the best employees is one of the most critical aspects to your business. 2016 saw big pushes with diversity initiatives and blind hiring, a practice which means being hired without disclosing your name, educational background or work experience to your future employer. While we expect these trends to carry over in 2017, we also predict a renewed focus on improving the overall job candidate experience. A recent study found that 60 percent of job seekers have had at least one bad recruitment experience, and 72 percent of those report having shared their experience with a recruiter or career websites. In order to ensure that it’s a productive experience for all, employers should maintain consistent communications during the hiring process and be prepared to share tailored feedback should the candidate request it.

    Consider updating your performance review process
    We’ve all done them, and it’s likely we’ve all dreaded them at least once. One study found that a quarter of employees surveyed found their annual performance reviews were ineffective and didn’t actually help their performance. 2016 saw plenty of conversations about how to improve the outdated process and we expect this to continue in 2017. One strategy that we see gaining popularity in 2017 is building out the review process to include biannual or even quarterly reviews. More frequent reviews may help build rapport between managers and their employees and encourage all parties to stay on track with their goals and objectives for the year.

    Focus on company culture and brand
    In line with recruiting and employee feedback strategies, employee engagement continues to be a hot button issue. Retaining employees is critical to a business’ success and the last year brought this to light—85% of executives surveyed in the 2016 Deloitte Human Capital Trends report ranked employee engagement as a top priority. We expect to see this trend carry over into 2017 with an added emphasis on wellness programs and work-life balance. As a company’s brand and culture becomes more critical than ever, it’s important to make concerted efforts to keep employees happy, healthy, and engaged.

    One of the many keys to a company’s success is being aware of the constantly changing work landscape. As you enter 2017, keep these predictions and actions in mind and we’ll do our best to keep you up to date on the latest.

     

    Originally published by ThinkHR – Read More

  • How Paid Parental Leave is Changing the Benefits Landscape | California Employee Benefits

    January 13, 2017

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    When you hear the term “paid parental leave”, what do you think of? Here in the U.S., paid leave benefits are somewhat of a luxury. Although the Family and Medical Leave Act (FMLA) has made it possible for parents working at companies with 50 or more employees to secure 12 weeks of unpaid leave, the U.S. is one of only three countries on a list of 185 that does not mandate a period of paid parental leave. This leaves the country ranked below Iran and Mexico, who both offer 12 weeks of paid parental leave. On the other end of the spectrum, employees in the UK benefit from up to 40 weeks of paid leave.

    As a result of having no mandated paid parental leave policy, approximately a quarter of U.S. women who become pregnant while employed quit their jobs upon giving birth, one third of women are forced to borrow money or withdraw from savings to cover time off from work, and 15% utilize public assistance. The June 2015 Enforcement Guidance on Pregnancy Discrimination from the Equal Employment Opportunity Commission (EEOC) was the first legislation to make a case for offering equal parental leave to mothers and fathers, setting a new precedent for the evolution of the paid leave benefit.

    Why Should You Offer Paid Parental Leave to Employees?

    The EY & Peterson Institute for International Economics recently released a study revealing that 38% of millennials would move to a new country if they would be afforded better paid parental leave benefits. Millennials now make up the largest demographic in the American workforce, and companies will need to increasingly take statistics like this into account when building benefit plans that will attract and retain top talent.

    Aside from talent acquisition, the study goes on to show the positive impacts a paid parental leave benefit can have on keeping women in the C-Suite, as men who would usually be considered secondary caregivers take advantage of the time off and allow women to get back to work more quickly. In addition, change.org, who has implemented a generous paid parental leave policy, observed that dads who took leave in their company encouraged other new fathers to take advantage of the benefits as well, creating a culture of safety in which to utilize leave and invest more fully in their family life.

    Ultimately, employees are happier and are empowered to do better work when they are allowed to honor their priorities. Whether this means a new mother is allowed to take stress-free, paid time off to bond with her child, or a father takes advantage of leave to be with his family or allow his partner to return to work, the ability to balance work and life is of the utmost importance to younger generations.

    Case Studies – Top Companies Doing it Right

    American Express

    American Express recently announced that they were changing their paid parental leave policy from three months for primary caregivers and two weeks for secondary caregivers to five months of paid parental leave for all full-time and part-time employees.

    All genders are eligible for the benefit, and employees may become parents via birth, adoption or surrogacy. In addition, American Express offers up to $35,000 for adoption or surrogacy fees with a limit of two events.  A lifetime maximum of $35,000 is also allotted for fertility treatments.

    The company also announced a unique supplemental benefit of 24-hour lactation consultants available to nursing mothers, and a breast milk shipment program available to mothers traveling for business who need to send milk home.

    Bank of America

    Bank of America offers 16 weeks of paid leave for biological and adoptive parents. A unique feature of their policy allows parents to take leave any time during the first year of the child’s life, enabling partners to take overlapping or subsequent time off, whichever best fits their family’s needs. The company values providing this option, as they see almost half of parents in today’s society raising their kids together at home while both holding jobs.

    The banking giant also tries to make life after baby easier for working parents by offering a more flexible work-from-home program and providing $240 in monthly childcare reimbursement for employees whose household income comes in under $100,000 annually.

    Netflix

    Netflix took the spotlight when it comes to paid parental leave benefits when they announced that the company would offer unlimited paid leave with no loss of benefits during the first year after a child’s arrival. Leave can be taken at any time during the year, and employees may choose to work part-time, or come back to work and then leave again if desired.

    Netflix chief talent officer, Tawni Cranz, said of the monumental decision, “Experience shows people perform better at work when they’re not worrying about home.”

    Twitter

    While Twitter offers 20 weeks of paid leave for mothers and 10 for fathers and adoptive parents, the most innovative benefits this company offers come through its pre and post-natal programs for parents. Twitter offers quarterly “New Moms and Moms-To-Be” roundtables, a Mommy Mentor Program, Working Mom lunches and most lately, “Dads on Leave” roundtables. In-house support for employees when it comes to family life provides a safe place to embrace new roles as parents while still progressing in their careers.

    How Can You Adopt This Benefit?

    Job participation by women in peak years is declining, and paid parental leave is a way to help remove barriers in the workplace that leave women in only 5% of CEO positions at Fortune 500 companies. Karyn Twaronite, EY global diversity and inclusiveness officer, said, “Companies that view parental leave as something solely for mothers are becoming extinct, as more modern and enlightened companies are realizing that many people, especially millennials, are even more interested in co-parenting given most are part of dual career couples.”

    If your company is unable to keep up with the generous paid leave packages larger businesses can afford, consider taking a page out of Twitter’s book and offering mentoring programs and support groups for new parents. Budget for childcare reimbursement costs like Bank of America. Even smaller changes that are made thoughtfully, with the employee in mind, will increase the appeal of your benefits package.

    As the benefits landscape changes with shifting demographics, consider carefully how offering paid parental leave could positively impact your employees, and ultimately, your bottom line as workers are motivated to work harder and smarter, knowing things are taken care of at home.

     

    By Kate McGaughey, eTekhnos

  • Identify and Evaluate the Impact of Your Wellness Program | California Benefit Advisors

    January 11, 2017

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    Measuring program value, or return on investment, is critical and imperative in managing a healthy wellness program. Further, clearly identifying and objectively evaluating the impact helps keep the vendor focused on what is critical for the employer. If these programs are not having the impact intended, then the cost of those services is only adding to medical spending waste.

    When adding wellness services to any employer benefits package, it is imperative to clearly identify the intended impact and outcome. Outcomes fall into three general categories:

    1. Employee satisfaction with the employer, which adds to recruitment and retention
    2. Reducing biometric risk and improving the health of the population
    3. Reducing medical spending

    Employee Satisfaction

    In the book, Shared Values, Shared Results by Dee W. Eddington, Ph.D., and Jennifer S. Pitts, Ph.D., the value of employees appreciating the benefits an employer offers is clearly outlined as a win-win strategy. If an employer’s intent in providing wellness services is to improve the support for its employees, then measuring the satisfaction related to those outcomes is critical. Employee surveys are typically the best approach to gather outcomes related to these intended programs. Some key questions to ask may include:

    • Is working at this organization beneficial for my health? (“Strongly Agree” to “Disagree” responses)
    • Do I trust that my organization cares about me? (“Strongly Agree” to “Disagree” responses)
    • Which of the following wellness program initiatives do you find to be valuable? (list all programs offered)

    Collecting employee, or spouse, feedback on these programs will provide insight to allow an employer/ consultant to know if programs are appreciated, or if modifications are required in order to achieve the desired outcomes.

    Reducing Biometric Risk and Controlling Disease

    If the intent of a wellness program is to help improve the health of individuals so that future medical spending will be reduced, then it is critical to determine if the program is engaging the correct members and then measure the impact on their risk. At Vital Incite, we utilize Johns Hopkins’ risk indexing along with biometric risk migration to provide feedback to vendors and employers of the impact of their programs. Some suggested goals may include:

    • Engaging 80 percent of persons with high risk biometrics
    • Reduction in weight of persons overweight or obese by greater than 5 percent in 30 percent of the engaged population
    • Of diabetics with an A1c greater than 7 percent, 80 percent will reduce their A1c by 1 percent in one year
    • Of persons with blood pressure in the high-risk range, 40 percent will have achieved controlled blood pressure without adding medications in one year
    • Of persons who take fewer than 10,000 steps per day, 70 percent will increase their average step count by 20 percent or more

    These goals need to be very specific and targeted to address the exact needs of your population, measuring what is most likely to have an impact on a person’s long-term health. This provides specific direction for your wellness providers, but allows an employer/consultant to monitor the impact throughout the year to continue to redirect communication and services to help provide the best outcomes.

    The first step in any program is to engage the intended audience. UBA’s Health Plan Survey finds that 54.6 percent of employers with wellness programs use components such as on-site or telephone coaching for high-risk employees, an increase of 7.5 percent from last year. Once you target the intended audience, engagement of those at risk is critical. Monitoring this subset of data can make sure the vendor resources are directed appropriately and, many times, identify areas where the employer may be able to help.

    Engagement of High Risk Individuals in CoachingOf course, engagement is only the first step and the intended outcome is to reduce risk or slow down the progression of risk increasing, that is really the final outcome desired. The following illustration allows employers and the vendor solution to monitor the true impact of the program by reviewing the risk control, or improvement based on program participation.

    Participant vs non-participant results

    Reducing Medical Spending

    Although many employers are interested in helping their employees become healthier, the reality is these efforts have to help reduce medical costs or increase productivity so these efforts are sustainable. Since, to date, few employers have data on productivity, the analysis then is focused on reducing medical spending. The correct analysis depends on the size of your population and the targeted audience, but a general analysis to determine if those engaged are costing less than persons who have similar risk on your plan would look something like the analysis below.

    participant engagement chart

    If your program is targeted specifically on a disease state, then the impact on the cost to care for that disease state may be more appropriate. In the example below, the employer instituted a program to help asthmatics, and therefore, the analysis is related to the total cost to care for asthma comparing the year prior to the program to the year of the program. In this analysis, the impact is very clear.

    Impact of Program on Cost for all ID-Asthma

    The employer anticipated first year savings due to high emergency room (ER) utilization for persons with asthma and the report proved that along with ER utilization declining, the total cost of care for asthma significantly declined.

    Summary

    In summary, having a clear understanding of the expectation and desired outcomes and monitoring that impact throughout the year, we believe, drives better outcomes. When we first started analyzing outcomes of programs, the impact of many programs were far less impressive than vendor reports would allow us to believe. That false sense of security is not because they were trying to falsify information, but the reports did not provide enough detail to fully illustrate the impact. Most vendor partners don’t have access to all of the data to provide a full analysis and others will only show what makes them look good. But, if you identify the impact you need in order to achieve success, all parties involved focus on that priority and continually work to improve that impact. We believe that wellness programs can have an impact on a population culture, health and cost of care if appropriately managed.

     

    By Mary Delaney, Originally published by United Benefit Advisors – Read More

  • No On-Call Paid Rest Periods in California | California Benefit Advisors

    January 5, 2017

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    On December 22, 2016, the California Supreme Court, in Augustus v. ABM Security Services, Inc., held that employers cannot require employees to remain on call during paid rest periods. The court reiterated the standard established in Brinker Restaurant Corp. v. Superior Court, 53 Cal. 4th 1004 (2012), which clarified that during rest periods employees must be relieved of all duties and be free from employer control as to how they spend their time. However, Augustus went even further by holding that if employees are required to remain on call and available for possible interruption during the break, then it is not a true rest period nor is such a policy compliant with California law. According to the court, the mere requirement of an employee to remain available for interruption invalidates the rest period, regardless of the employee being compensated for his or her time. As a result, employers must review their current workplace policies dealing with paid rest periods and ensure employees are not required to remain on call or on duty during paid rest periods.

    Realistically, rest periods may get interrupted and this interruption necessitates an employer’s remedial action. For instance, after an interruption an employer may allow the employee to restart his or her uninterrupted paid rest period. Or if the rest period is missed then, as required by law, an employer must make sure to pay the employee one hour of pay in his or her next paycheck for each workday that the rest period was not provided. The key to the Augustus decision is that employees cannot be required to remain on call. Of note, the decision does not prevent employers from requiring employees to remain on premises during paid rest periods, but rather that employees cannot be on call.

     

    Originally published by ThinkHR – Read More

  • Officials Provide New ACA Guidance in FAQ #35 | California Benefit Advisors

    January 3, 2017

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    On December 20, 2016, federal officials released FAQs About Affordable Care Act Implementation Part 35 (FAQ #35) in an ongoing series of informal guidance regarding the Affordable Care Act (ACA). This FAQ addresses several topics:

    • Special enrollment rules.
    • Preventive services.
    • Qualified small employer health reimbursement arrangements.

    A summary of the key points from FAQ #35 follows.

    Special Enrollment Rules

    Group health plans are subject to rules under the Health Insurance Portability and Accountability Act (HIPAA) requiring plans to offer a special enrollment (mid-year enrollment) opportunity for persons who are not enrolled when first eligible but then experience certain events. Examples of qualifying events include acquiring a new dependent through marriage, birth or adoption (including placement for adoption) of a child, or losing coverage under another plan. The requirements are referred to as the HIPAA special enrollment rules.

    One of the events triggering a special enrollment opportunity is the involuntary loss of other coverage, such as losing coverage under the spouse’s plan, unless the loss is for cause or due to failure to pay premiums.

    UPDATE: FAQ #35 confirms that persons are entitled to a special enrollment if they are otherwise eligible for the group plan, had other coverage (including individual insurance obtained inside or outside of a Marketplace) when the group plan coverage was previously offered, and now have lost eligibility for that other coverage. Further, the special enrollment rule applies whether or not the individual is eligible for other individual market coverage, though or outside of a Marketplace.

    Coverage of Preventive Services

    The Affordable Care Act (ACA) requires that nongrandfathered health plans provide 100 percent coverage without deductibles or co-pays for certain preventive services. Some exceptions are allowed regarding services received outside the network when they are available from in-network providers and for brand-name drugs when equivalent generics are available (unless the physician determines a medical necessity). See the following current lists of required preventive services:

    For women’s health services, the current list of required preventive services includes prescribed contraceptives (including sterilization procedures, and patient education and counseling). At this time, there are 18 FDA-approved contraceptive methods and the plan must cover at least one item in each method at 100 percent. Plans also must have an “exceptions process” to ensure 100 percent coverage of any item within the method based on medical necessity as determined by the physician.

    The preventive services requirements are developed based on recommendations from the U.S. Preventive Services Task Force (USPSTF), the Centers for Disease Control (CDC), the Health Resources and Services Administration (HRSA), and others, and are subject to change from time to time.

    UPDATE: FAQ #35 explains that updated HRSA recommendations for women’s preventive services will apply for plan years beginning on or after December 20, 2017 (e.g., January 1, 2018 for calendar-year plans). Plans may adopt the new guidelines earlier if they choose. The updated guidelines address several women’s health services, including breast cancer screening, cervical cancer screening, gestational diabetes, breastfeeding services and supplies, and well-woman preventive visits.

    The new guidelines also will require plans to cover all 18 of the FDA-approved contraceptive methods. Plans may continue to impose cost-sharing requirements on branded drugs for which generic equivalents are available. Note that the ACA provides certain exceptions regarding contraceptives with respect to plans sponsored by religious employers and nonprofit religious-affiliated employers; those exceptions will continue.

    See the HRSA’s Women’s Preventive Services Guidelines for more information.

    Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs)

    Section 18001 of the recently-enacted 21st Century Cures Act creates an opportunity for small employers to offer a new type of health reimbursement arrangement for their employees’ healthcare expenses, including individual insurance premiums.

    Employers of all sizes currently are prohibited from making or offering any form of payment to employees for individual health insurance, whether through premium reimbursement or direct payment. Employers also are prohibited from providing cash or compensation to employees if the money is conditioned on the purchase of individual health insurance. (Some exceptions apply; e.g., retiree-only plans, dental/vision insurance.) Violations can result in excise taxes of $100 per day per affected employee.

    The new law does not repeal the existing prohibition, but rather it provides an exception for a new type of tax-free benefit called a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA). Small employers meeting certain conditions may begin offering QSEHRAs in 2017. Our December 9, 2016 blog post, New Law Allows Small Employers to Pay Premiums for Individual Policies, summarized the requirements for small employers to offer QSEHRAs.

    Separately, the 21st Century Cures Act offers small employers certain relief from excise taxes for violating the existing prohibition against employer payment of individual health insurance. The relief applies retroactively and continues through the 2016 plan year (whether or not the employer offers QSEHRAs in 2017), but certain conditions must be met. FAQ #35 clarifies the conditions for tax relief, as follows:

    • The relief applies only to plan years beginning on or before December 31, 2016;
    • The relief applies only to employers that employed on average fewer than 50 full-time and full-time-equivalent employees. In other words, for the relevant period, the employer must not have been an applicable large employer (ALE) as defined under the ACA; and
    • The relief is limited to employer arrangements that pay or reimburse only individual health insurance premiums (or Medicare Part B or D premiums, in some cases). The relief does not extend to stand-alone health reimbursement arrangements that pay or reimburse medical expenses other than individual health insurance premiums.

    Lastly, note that an employer arrangement that qualifies for relief from excise taxes generally will be considered minimum essential coverage and preclude covered persons from qualifying for premium tax credits (subsidies) at a Marketplace (Exchange).

    More Information

    Employers and their advisors are encouraged to review the complete FAQ #35 to ensure their group health plans continue to comply with the ACA’s requirements. The special enrollment rule merely confirms existing HIPAA requirements. For preventive services, the update regarding women’s health services applies for plan years beginning on or after December 20, 2017 (e.g., January 1, 2018 for calendar-year plans). Lastly, small employers may want to consider the new option for QSEHRAs starting in 2017.

     

    By Laura Kerekes, Originally published by ThinkHR – Read More

  • Local Benefits Group Distributes First $100,000 of AED Machine Donations to Community | CA Benefit Advisors

    August 17, 2017

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    As part of the Arrow Wellness Initiative to donate and distribute $100,000 in AED (Automated External Defibrillator) machines to their local business community, Riverfront Fitness is the first of many recipients vying to receive an AED device from Arrow Benefits Group. AED machines are an integral part of treating those suffering from sudden cardiac arrest in the few vital minutes before emergency medical crews arrive, dramatically increasing the survival rates of the victims of sudden cardiac arrest. Without these machines on hand, the survival rate is under 10%; immediate response with the use of CPR and AED increases sudden cardiac arrest survival rates by as much as 70%. “Having the AED gives both our clients and ourselves the reassurance and comfort of knowing that if a heart attack occurs while using the facility we have the proper equipment available to use until the Fire Department arrives. It brings us a sense of security and assurance that we are providing a lifesaving machine at our fitness facility. It means the value of a life,” says Amy Pontius, Manager at Riverfront Fitness. The AED device donations build on Arrow’s popular Wellness Initiative which provides free CPR and First Aid classes to clients and the community. If you would like to learn more and participate with your company in the procurement of one of the AED machines please contact Andrew McNeil at 707-992-3789 or andrewm@arrowbenefitsgroup.com

    In a life-threatening situation where every second counts, access to these devices can mean the difference between life and death. According to the American Heart Association, for every minute that passes without CPR and defibrillation, the chances of survival decrease by 7–10%. Having an AED on hand makes it possible to respond immediately in emergency situations, and yet the devices remain cost-prohibitive for many small businesses. For Riverfront Fitness and their 45 members, the high price-tag means having an AED device at their facility would be unattainable without the support of the Arrow Wellness Initiative.

    “I can’t thank Arrow enough for their generosity in providing us with an AED. Being a small business, finding the extra funding to purchase such an expensive piece of equipment is difficult. The cost is almost a deterrent. I hope that changes in the future. This piece of equipment saves lives and there should be no price tag on that. We thank Arrow for recognizing our need and bringing the AED to Riverfront Fitness. Of course, we hope to never have to use it, but we are prepared just in case!” The donation is part of Arrow’s ongoing mission to support client health and well-being needs. “We are dedicated to helping our clients take proactive actions to keep their employees healthy and safe,” said Arrow Benefits Group Principal Andrew McNeil.

    About Arrow Benefits Group

    Arrow Benefits Group, the third largest benefits firm in the North Bay, is a proud partner of United Benefit Advisors (UBA), one of the largest benefits consulting and brokerage firms in the country.

    Arrow Benefits Group is the single-source solution for managing the complexities of benefits with expert advice, customized programs, and personalized solutions. Arrow’s innovative programs control costs and give employees a greater sense of financial and emotional security.

    For straight answers to employee benefits call 707-992-3780 or visit http://www.arrowbenefitsgroup.com

  • Wellness Programs – Getting Started and Remaining Compliant | CA Benefit Advisors

    August 15, 2017

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    Where to Start?

    First, expand the usual scope of wellness activity to well-BEING. Include initiatives that support more than just physical fitness, such as career growth, social needs, financial health, and community involvement. By doing this you increase your chances of seeing a return on investment (ROI) and a return on value (ROV). Qualitative results of a successful program are just as valuable as seeing a financial impact of a healthier population.

    Wellness program ROI and ROV

    Source: Katherine Baicker, David Cutler, and Zirui Song, “Workplace Wellness Programs Can Generate Savings,” Health Affairs, February 2010, 29(2): pp 304-311

    To create a corporate culture of well-being and ensure the success of your program, there are a few important steps.

    1. Leadership Support: Programs with leadership support have the highest level of participation. Gain leadership support by having them participate in the programs, give recognition to involved employees, support employee communication, allow use of on-site space, approve of employees spending time on coordinating and facilitating initiatives, and define the budget. Even though you do not need a budget to be successful.
    2. Create a Committee or Designate a Champion: Do not take this on by yourself. Create a well-being committee, or identify a champion, to share the responsibility and necessary actions of coordinating a program.
    3. Strategic Plan: Create a three-year strategic plan with a mission statement, budget, realistic goals, and measurement tools. Creating a plan like this takes some work and coordination, but the benefits are significant. You can create a successful well-being program with little to no budget, but you need to know what your realistic goals are and have a plan to make them a reality.
    4. Tools and Resources: Gather and take advantage of available resources. Tools and resources from your broker and/or carrier can help make managing a program much easier. Additionally, an employee survey will help you focus your efforts and accommodate your employees’ immediate needs.

    How to Remain Compliant?

    As always, remaining compliant can be an unplanned burden on employers. Whether you have a wellness or well-being program, each has their own compliance considerations and requirements to be aware of. However, don’t let that stop your organization from taking action.

    There are two types of programs – Group Health Plans (GHP) and Non-Group Health Plans (Non-GHP). The wellness regulations vary depending on the type of employer and whether the program is considered a GHP or Non-GHP.

    Group health plan compliance table

    Employers looking to avoid some of the compliance burden should design their well-being program to be a Non-GHP. Generally, a well-being program is Non-GHP if it is offered to all employees regardless of their enrollment in the employer’s health plan and does not provide or pay for “medical care.” For example, employees receive $100 for attending a class on nutrition. Here are some other tips to keep your well-being program Non-GHP:

    • Financial: Do not pay for medical services (e.g., flu shots, biometric screenings, etc.) or provide medical care. Financial incentives or rewards must be taxed. Do not provide premium discounts or surcharges.
    • Voluntary Participation: Include all employees, but do not mandate participation. Make activities easily accessible to those with disabilities or provide a reasonable alternative. Make the program participatory (i.e., educational, seminars, newsletters) rather than health-contingent (i.e., require participants to get BMI below 30 or keep cholesterol below 200). Do not penalize individuals for not participating.
    • Health Information: Do not collect genetic data, including family medical history. Any medical records, or information obtained, must be kept confidential. Avoid Health Risk Assessments (i.e. health surveys) that provide advice and analysis with personalized coaching or ask questions about genetics/family medical history.

    By Hope DeRocha
    Originally Posted By www.ubabenefits.com

  • When Grief Comes to Work | CA Benefit Advisors

    August 10, 2017

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    Death and loss touch all of us, usually many times throughout our lives. Yet we may feel unprepared and uncomfortable when grief intrudes into our daily routines. As a manager, when grief impacts your employees it’s helpful to have a basic understanding of what they are going through as well as ways you can help.

    Experiencing Grief

    Although we all experience grief in our own way, there are behaviors, emotions and physical sensations that are a common part of the mourning process. J. William Worden’s “Four Tasks of Mourning” will be experienced in some form by anyone who is grieving. These tasks include accepting the reality of the loss, experiencing and accepting our emotions, adjusting to life without the loved one, and investing emotional energy into a new and different life.

    Commonly experienced emotions are sadness, anger, frustration, guilt, shock and numbness. Physical sensations include fatigue or weakness, shortness of breath, tightness in the chest and dry mouth.

    Manager’s Role

    When employees are mourning, it’s important to create a caring, supportive and professional work environment. In most cases, employees will benefit from returning to work. It allows them to resume a regular routine, focus on something besides their loss and boost their confidence by completing work tasks.

    At the same time, bereaved employees may experience many challenges when returning to work. They may have poor concentration, be extremely tired, feel depressed or have a short temper and uncontrollable emotions.

    As a manager, the best thing you can do is acknowledge the loss and maintain strong lines of communication. Even if you believe someone else is checking in with them, make sure you stay in touch and see if there is anything you can do.

    Developing a Return to Work Plan

    In order to help your employees have a smooth transition back to work you must listen and understand their needs. Some additional questions you’ll want to answer are:

    • What are your company’s policies and procedures for medical and bereavement leave?
    • What information do your employees want their co-workers to have and would they rather share this information themselves?
    • Do they want to talk about their experience or would they rather focus on work?
    • Do they need private time while at work?
    • Does their workload and schedule need to be adjusted?
    • Do they need help at home – child care, meals, house work, etc.?
    • Are there others at work that may be experiencing grief of their own?

    Helpful Responses for Managers

    • Offer specific help – make meals, wash their car, walk their pet, or anything else that will make their life easier.
    • Say something – it can be as simple as, “I’m so sorry for your loss.”
    • Listen – be kind but honest.
    • Respect privacy – honor closed doors and private moments.
    • Expect tears – emotions can hit unexpectedly.
    • Thank your staff – for everything they are doing to help.

    Grieving is a necessity, not a weakness. It is how we heal and move forward. As a manager, being there for your employees during this time is important in helping them through the grieving process.

    An Employee Assistance Program is a great resource for both you and your employees when grief comes to work.

    Originally published by www.ubabenefits.com

  • Employer Strategies for Managing Prescription Drug Costs | CA Benefit Advisors

    August 8, 2017

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    Modern medicines have resulted in longer, more productive lives for many of us. Prescription drugs soothe sore muscles after a strenuous workout or manage the conditions of a chronic disease. Unfortunately, this use of prescriptions drugs can come with a hefty price tag.

    Americans are spending more money on prescription drugs than ever before and the United States as a nation spends more per capita on prescription drugs than any other country. With the cost of some drugs exceeding thousands of dollars for a 30-day supply, this can translate into financial hardship for many Americans.

    For employers sponsoring a medical plan, managing the cost of these prescription drugs is also becoming a task. Insurance companies and employers struggle with the ability to provide affordable medical plans, and the ever-increasing prescription drug costs are a primary driver of this difficulty. As a result, prescription drug plan designs are changing shape – moving to a model that helps push more of the cost of these drugs to the member along with increasing awareness of the true cost of the prescriptions.

    Flat dollar copay plans have become an expected norm in medical plans for almost a decade. However, insurance companies underwriting fully insured medical plans and employers sponsoring self-funded medical programs now need to make modifications to these plan designs to manage the ever-increasing prescription drug costs. As a result, we are seeing more prescription drug plans combining some aspect of coinsurance along with or in place of the flat dollar copayments.

    According to the 2016 UBA Health Plan Survey, copay models are still the most popular, with a three-tier copay structure the most prevalent. Median retail copayments for these three-tier plans are $10 for generic drugs, $35 for preferred brand drugs (drugs on the carrier’s prescription drug list) and $60 for non-preferred brand drugs (drugs not on the carrier’s prescriptions drug list). While 54.5 percent of all prescription plans are copay only, approximately 40 percent of all prescription drug plans have co-insurance along with (or in lieu of) copays–a plan design that is particularly common among four-tier plans.

    Coinsurance models have many unique designs. Some plans are a straight percentage of the cost of the drug; some may involve a maximum or minimum dollar copayment combined with the coinsurance. For example, a plan may require 40 percent coinsurance for a preferred brand drug, but there is a minimum copayment of $30 and a maximum copayment of $50. Typically, we see a higher coinsurance percentage for non-preferred brand drugs and specialty drugs. The member cost of the drug is calculated after any negotiated discounts, so members covered by a coinsurance plan are reaping the benefits of any discounts negotiated with the pharmacy by the pharmacy benefit manager (PBM).

    Coinsurance plans do provide several advantages to managing prescription drug costs. Under a flat dollar copay plan design, members may not truly understand the full cost of the drug they are purchasing. Pharmacies are now disclosing the full cost of drugs on the purchase receipts. Yet, most consumers do not take note of this disclosure, focusing only on the copayment amount. When a member pays a percentage of the cost of the drug as in a coinsurance model, the true cost of the drug becomes much more apparent.

    Another advantage of the coinsurance model is that it automatically increases the member share of the cost as the price of the drug increases. Under the flat dollar copayment model, as the true cost of the drug increases, the member pays a smaller portion of the total cost. When the member’s portion is determined by a coinsurance percentage, the member pays more as the cost of the drug increases.

    As the costs of health care overall continue to increase, we all need to become better consumers of our healthcare. Members covered by a prescription drug plan with a coinsurance model will have a better understanding of the true cost of their prescriptions. As members become more aware of the true costs of their care, they make better health care decisions, managing the overall cost of care.

    We expect to see prescription drug benefit plans change even more as the cost of health care – especially prescription drugs – escalates. These changes will likely result in more of the cost being pushed to the patient. There are resources available to patients for assistance with some of these out-of-pocket costs. It is vital for the patient to understand their costs and know how to maximize their benefits. In a few weeks, the UBA blog will highlight some of these resources and provide information on how to educate employees on maximizing their benefits and the industry resources available to them.

    For all the cost and design trends related to health and prescription drug plan costs by group size, industry and region, download UBA’s Health Plan Survey Executive Summary.

    By Mary Drueke-Collins
    Originally Posted By www.ubabenefits.com

  • Government and Education Employers Offer Richest HSA Plans | CA Benefit Advisors

    August 4, 2017

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    Across most industries, HSA contributions are, for the most part, down or unchanged from three years ago, according to UBA’s Health Plan Survey. The average employer contribution to an HSA is $474 for a single employee (down 3.5 percent from 2015 and 17.6 percent from five years ago) and $801 for a family (down 9.2 percent from last year and 13.7 percent from five years ago). Government and education employers are the only industries with average single contributions well above average and on the rise.

    Government employees had the most generous contributions for singles at $850, on average, up from $834 in 2015. This industry also has the highest employer contributions for families, on average, at $1,595 (though that is down from 1,636 in 2015). Educational employers are the next most generous, contributing $636, on average, for singles and $1,131 for families.

    Singles in the accommodation/food services industries received virtually no support from employers, with average HSA contributions at $166. The same is true for families with HSA plans in the accommodation/food services industries with average family contributions of $174.

    Retail employers also remain among the least generous contributors to single and family HSA plans, contributing $305 and $470, respectively. This may be why they have low enrollment in these plans.

    HSA Plans by Industry

    The education services industry has seen a 109 percent increase in HSA enrollment since 2013 (aided by employers’ generous contributions), catapulting the industry to the lead in HSA enrollment at 23.8 percent. The professional/scientific/tech and finance/insurance industries follow closely at 23.3 percent and 22.1 percent, respectively.

    The mining/oil/gas industry sees the lowest enrollment at 3.8 percent. The retail, hotel, and food industries continue to have some of the lowest enrollment rates despite the prevalence of these plans, indicating that these industries, in particular, may want to increase employee education efforts about these plans and how they work.

    For a detailed look at the prevalence and enrollment rates among HSA and HRA plans by group size and region, view UBA’s “Special Report: How Health Savings Accounts Measure Up”.

    Benchmarking your health plan with peers of a similar size, industry or geography makes a big difference in determining if your plan is competitive. To compare your exact plan with your peers, request a custom benchmarking report.

    For fast facts about HSA and HRA plans, including the best and worst plans, average contributions made by employers, and industry trends, download (no form!) “Fast Facts: HSAs vs. HRAs”.

    For a comprehensive chart that compares eligibility criteria, contribution rules, reimbursement rules, reporting requirements, privacy requirements, applicable fees, non-discrimination rules and other characteristics of account-based plans, request UBA’s Compliance Advisor, “HRAs, HSAs, and Health FSAs – What’s the Difference?”.

    Originally published by www.ubabenefits.com

  • Best Practices for Initial COBRA Notices | CA Benefit Advisors

    August 2, 2017

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    The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires group health plans to provide notices to covered employees and their families explaining their COBRA rights when certain events occur. The initial notice, also referred to as the general notice, communicates general COBRA rights and obligations to each covered employee (and his or her spouse) who becomes covered under the group health plan. This notice is issued by the plan administrator within the first 90 days when coverage begins under the group health plan and informs the covered employee (and his or her spouse) of the responsibility to notify the employer within 60 days if certain qualifying events occur in the future.

    The initial notice must include the following information:

    • The plan administrator’s contact information
    • A general description of the continuation coverage under the plan
    • An explanation of the covered employee’s notice obligations, including notice of
      • The qualifying events of divorce, legal separation, or a dependent’s ceasing to be a dependent
      • The occurrence of a second qualifying event
      • A qualified beneficiary’s disability (or cessation of disability) for purposes of the disability extension)
    • How to notify the plan administrator about a qualifying event
    • A statement that that the notice does not fully describe continuation coverage or other rights under the plan, and that more complete information regarding such rights is available from the plan administrator and in the plan’s summary plan description (SPD)

    As a best practice, the initial notice should also:

    • Direct qualified beneficiaries to the plan’s most recent SPD for current information regarding the plan administrator’s contact information.
    • For plans that include health flexible spending arrangements (FSAs), disclose the limited nature of the health FSA’s COBRA obligations (because certain health FSAs are only obligated to offer COBRA through the end of the year to qualified beneficiaries who have underspent accounts).
    • Explain that the spouse may notify the plan administrator within 60 days after the entry of divorce or legal separation (even if an employee reduced or eliminated the spouse’s coverage in anticipation of the divorce or legal separation) to elect up to 36 months of COBRA coverage from the date of the divorce or legal separation.
    • Define qualified beneficiary to include a child born to or placed for adoption with the covered employee during a period of COBRA continuation coverage.
    • Describe that a covered child enrolled in the plan pursuant to a qualified medical child support order during the employee’s employment is entitled to the same COBRA rights as if the child were the employee’s dependent child.
    • Clarify the consequences of failing to submit a timely qualifying event notice, timely second qualifying event notice, or timely disability determination notice.

    Practically speaking, the initial notice requirement can be satisfied by including the general notice in the group health plan’s SPD and then issuing the SPD to the employee and his or her spouse within 90 days of their group health plan coverage start date.

    If the plan doesn’t rely on the SPD for furnishing the initial COBRA notice, then the plan administrator would follow the U.S. Department of Labor (DOL) rules for delivery of ERISA-required items. A single notice addressed to the covered employee and his or her spouse is allowed if the spouse lives at the same address as the covered employee and coverage for both the covered employee and spouse started at the time that notice was provided. The plan administrator is not required to provide an initial notice for dependents.

    By Danielle Capilla
    Originally Posted By www.ubabenefits.com

     

  • 5 Things Millennials Need to Know About Life Insurance | CA Benefit Advisors

    July 28, 2017

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    Being catapulted into the adult world is a shock to the system, regardless of how prepared you think you are. And these days, it’s more complicated than ever, with internet access and mobile devices being must-have utilities and navigating tax forms when they aren’t as “EZ” as they used to be.

    Maybe you’re still living with your folks while you get established. Or maybe you’re looking forward to moving out of a rental and into a house or to tie the knot. Life insurance might be the last thing on your list of things to deal with or even think about. (You’re not alone.) But here are five things you might not know about life insurance—that you probably should.

    1. Life insurance is a form of protection. If you Google “life insurance” you’ll get a slew of ads telling you how cheap life insurance can be, without nearly enough information about what you need it for. That’s probably because it’s not terribly pleasant to think about: this idea that we could die and someone we care about might suffer financially as a result. Life insurance provides a financial buffer for the people you care about in the event something happens to you. Think just because you’re single, nobody would be left in the lurch? Read the next point.

    2. College debt may not go away. Did someone—like your parents—co-sign your student loans through the bank? If so, the bank won’t discharge that debt upon your death the way that the federal government would with federal student loans. That means your parents, or others who signed the paperwork, would be responsible for paying the full balance—sometimes immediately. Don’t saddle them with the bill!

    3. If you don’t know anything about life insurance, it’s probably better if you don’t buy it off the internet. It’s what we’re used to: You find the thing you need or love on Amazon or Ebay or Etsy, click a few buttons, and POOF. It arrives at your door. But life insurance is a financial planning product, and while it can be as simple as a 20-year term policy for less than a cup of coffee each day (for real!), going through your options with an insurance professional can ensure that you get the right amount for the right amount of time and at a price that fits into your budget. And many people don’t know that an agent will sit down and help you out at no cost.

    4. Social fundraising only goes so far. This relatively recent phenomenon has everyone thinking that they’ll just turn to GoFundMe if things go awry in their lives. But does any grieving person want to spend time administering a social fundraising site? The chances of going viral are markedly slim, and social fundraising sites will take their cut, as will the IRS. And there is absolutely no guarantee about how much—if any—money will be raised.

    5. The best time is now. You’ll definitely never be younger than you are today, and for most of us, the younger we are the healthier we are. Those are two of the most important factors for getting affordable life insurance coverage. So don’t delay.

    By Helen Mosher
    Originally Posted By www.lifehappens.org

  • So everyone is talking about it – what’s in it? Not much except a lot | CA Benefit Advisors

    July 26, 2017

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    California Senate Bill 562 would create the Healthy California program “to provide universal single payer health care coverage and a health care cost control system for the benefit of all residents of the state” with the catch that “this bill would prohibit this act from becoming operative until the Secretary of California (HHS) gives written notice…that the Healthy California Trust Fund has the revenues to fund the costs of implementing the act.”  Which means they need Federal waivers to run their own Medi-Cal and related program reimbursement and also receive federal funds directly for those services, as well as tax revenue, since there will be no premiums charged, copayments, or deductibles to recipients of care under the act.  Essentially “it is further the intent of the Legislature to establish the Healthy California program to provide universal health coverage for every Californian based on his or her ability to pay and funded by broad based revenue”

    What is surprising?

    • That they intend to pay providers on a “capitated” (fixed fee) basis and that they will somehow be able to negotiate not just with all hospital systems but doctors as well. In a later section it discusses payment by fee for service (which by itself has no means of cost control) “until another payment methodology is established by the board”
    • That this includes coverage for Long Term Care – though that is related to taking over Medi-Cal, demands will be made for improvements and thus increased costs
    • “This title does not preempt any city or county from adopting additional health care coverage for residents in that city or county that provides more protections and benefits to California residents than this title”
    • Carriers seem to disappear unless they want to offer coverage that supplements what is offered here. The “good news” however, is that “the board shall provide funds from the Healthy California Trust Fund (or other funds as appropriated) for a program of retraining and assisting job transition for individuals employed or previously employed in the fields of health insurance, health care service plan and other third party payments for health care or those individuals providing services to health care providers to deal with third party payers for health care, whose jobs may be or have been ended as a result of the implementation of the program.”  So…everyone in health insurance – agents, carrier employees, third party administrators – will be given training for new jobs, paid for by taxpayers, while an entirely new bureaucracy is created, again with taxpayer dollars, to administer the new plan?
    • The program is allowed to pay for capital expenditures incurred by any non profit health facilities

    The main line – “every resident of the state shall be eligible and entitled to enroll as a member under the program” and “resident” is defined as “an individual whose primary place of abode is in the state, without regard to the individual’s immigration status”

    Most of the bill is given over the fundamentals of governance, which include appointment of a general board of 9 and then a public advisory committee with 22 assorted members.

    That’s it.  Twenty pages.  The projection of a $400 billion cost to enact and implement.  Details to follow…but when, how and what will they show?  And isn’t it a political truism that any projected cost will almost always double when it is a government project?  Money which, by the way, California does not have.

  • Small Employers Ask about Form 5500 | CA Benefit Advisors

    July 21, 2017

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    UBA’s compliance team leverages the collective expertise of its independent partner firms to advise 36,000 employers and their 5 million employees. Lately, a common question from employers is: If a health and welfare benefit plan has fewer than 100 participants, then does it need to file a Form 5500?

    If a plan is self-funded and uses a trust, then it is required to file a Form 5500, no matter how many participants it has.

    Whether the plan must file a Form 5500 depends on whether or not the plan is “unfunded” (where the money comes from to pay for the self-funded claims).

    Currently, group welfare plans generally must file Form 5500 if:

    • The plan is fully insured and had 100 or more participants on the first day of the plan year (dependents are not considered “participants” for this purpose unless they are covered because of a qualified medical child support order).
    • The plan is self-funded and it uses a trust, no matter how many participants it has.
    • The plan is self-funded and it relies on the Section 125 plan exemption, if it had 100 or more participants on the first day of the plan year.

    There are several exemptions to Form 5500 filing. The most notable are:

    • Church plans defined under ERISA Section 3(33)
    • Governmental plans, including tribal governmental plans
    • Top hat plans which are unfunded or insured and benefit only a select group of management or highly compensated employees
    • Small insured or unfunded welfare plans. A welfare plan with fewer than 100 participants at the beginning of the plan year is not required to file an annual report if the plan is fully insured, entirely unfunded, or a combination of both.

    A plan is considered unfunded if the employer pays the entire cost of the plan from its general accounts. A plan with a trust is considered funded.

    For smaller groups that are self-funded or partially self-funded, you’d need to ask them whether the plan is funded or unfunded.

    If the employer pays the cost of the plan from general assets, then it is considered unfunded and essentially there is no trust.

    If the employer pays the cost of the plan from a specific account (in which plan participant contributions are segregated from general assets), then the plan is considered funded. For example, under ERISA, pre-tax salary reductions under a cafeteria plan are participant contributions and are considered plan assets which must generally be held in trust based on ERISA’s exclusive benefit rule and other fiduciary duty rules.

    Originally published by www.ubabenefits.com

  • Extension of Maximum COBRA Coverage Period | CA Benefit Advisors

    July 19, 2017

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    The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires employers to offer covered employees who lose their health benefits due to a qualifying event to continue group health benefits for a limited time at the employee’s own cost. The length of the COBRA coverage period depends on the qualifying event and is usually 18 or 36 months. However, the COBRA coverage period may be extended under the following five circumstances:

    1. Multiple Qualifying Events
    2. Disability
    3. Extended Notice Rule
    4. Pre-Termination or Pre-Reduction Medicare Entitlement
    5. Employer Extension; Employer Bankruptcy

    In this blog, we’ll examine the first circumstance above. For a detailed discussion of all the circumstances, request UBA’s Compliance Advisor, “Extension of Maximum COBRA Coverage Period”.

    When determining the coverage period under multiple qualifying events, the maximum coverage period for a loss of coverage due to a termination of employment and reduction of hours is 18 months. The maximum coverage period may be extended to 36 months if a second qualifying event or multiple qualifying events occur within the initial 18 months of COBRA coverage from the first qualifying event. The coverage period runs from the start of the original 18-month coverage period.

    The first qualifying event must be termination of employment or reduction of hours, but the second qualifying cannot be termination of employment, reduction of hours, or bankruptcy. In order to qualify for the extension, the second qualifying event must be the covered employee’s death, divorce, or child ceasing to be a dependent. In addition, the extension is only available if the second qualifying event would have caused a loss of coverage for the qualified beneficiary if it occurred first.

    The extended 36-month period is only for spouses and dependent children. In order to qualify for extended coverage, a qualified beneficiary must have elected COBRA during the first qualifying event and must have been receiving COBRA coverage at the time of the second event. The qualified beneficiary must notify the plan administrator of the second qualifying event within 60 days after the event.

    Example: Jim was terminated on June 3, 2017. Then, he got divorced on July 6, 2017. Jim was eligible for COBRA continuation coverage for 18 months after his termination of employment (the first qualifying event). However, his divorce (the second qualifying event) extended his COBRA continuation coverage to 36 months because it occurred within the initial 18 months of COBRA coverage from his termination (the first qualifying event).

    The health plan should indicate when the coverage period begins. The plan may provide that that the plan administrator be notified when plan coverage is lost as opposed to when the qualifying event occurs. In that case, the 36-month coverage period would begin on the date coverage was lost.

    Originally published by www.ubabenefits.com

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