Yearly Archives: 2014

• They’re in control…but not quite, or at least not enough. Is that a good thing?

  December 31, 2014

  With some upset vic­to­ries, Cal­i­for­nia Democ­rats knew what it felt like in Con­gress as they lost their super majori­ties in both Cal­i­for­nia hous­es.  When a series of spe­cial elec­tions fin­ish­es next year they will be one vote short in the Sen­ate and two in the Assembly.

• OSHA’s New Reporting and Recordkeeping Rule Goes into Effect on January 1, 2015 | California Employee Benefits

  December 29, 2014

  Tags: OSHA, Recordkeeping, reporting

  www.thinkhr.com

  On Sep­tem­ber 11, 2014, the U.S. Depart­ment of Labor’s Occu­pa­tion­al Safe­ty and Health Admin­is­tra­tion (OSHA) announced a final rule which updates the report­ing and record-keep­ing require­ments for injuries and ill­ness­es, found at 29 C.F.R. 1904. The rule goes into effect on Jan­u­ary 1, 2015.

  Changes to record-keep­ing requirements

  Under OSHA’s record-keep­ing reg­u­la­tion, cer­tain cov­ered employ­ers are required to pre­pare and main­tain records of seri­ous occu­pa­tion­al injuries and ill­ness­es using the OSHA 300 Log. How­ev­er, there are two class­es of employ­ers that are par­tial­ly exempt from rou­tine­ly keep­ing injury and ill­ness records:

  • Employ­ers with 10 or few­er employ­ees at all times dur­ing the pre­vi­ous cal­en­dar year; and
  • Estab­lish­ments in cer­tain low-haz­ard industries.

  The new rule main­tains the exemp­tion for employ­ers with few­er than 10 employ­ees. How­ev­er, the new rule has an updat­ed list of indus­tries that will be par­tial­ly exempt from keep­ing OSHA records. The pre­vi­ous list of par­tial­ly exempt indus­tries was based on the old Stan­dard Indus­tri­al Clas­si­fi­ca­tion (SIC) sys­tem and injury and ill­ness data from the Bureau of Labor Sta­tis­tics (BLS) from 1996, 1997, and 1998. The new list of par­tial­ly exempt indus­tries in the updat­ed rule is based on the North Amer­i­can Indus­try Clas­si­fi­ca­tion Sys­tem (NAICS) and injury and ill­ness data from the Bureau of Labor Sta­tis­tics (BLS) from 2007, 2008, and 2009. As a result, many employ­ers who were once exempt­ed from OSHA’s record­keep­ing require­ments are now required to keep records. A list of new­ly cov­ered indus­tries can be found at www.osha.gov/recordkeeping2014/reporting_industries.html.

  Changes to the report­ing requirements

  In addi­tion to revis­ing the record-keep­ing require­ments, the new rule expands the list of severe injuries and ill­ness­es that employ­ers must report to OSHA. Under the pre­vi­ous rule, employ­ers were required to report the fol­low­ing events to OSHA:

  • All work-relat­ed fatalities.
  • All work-relat­ed hos­pi­tal­iza­tions of three or more employees.

  Under the new rule, employ­ers must report the fol­low­ing events to OSHA:

  • All work-relat­ed fatalities.
  • All work-relat­ed in-patient hos­pi­tal­iza­tions of one or more employees.
  • All work-relat­ed amputations.
  • All work-relat­ed loss­es of an eye.

  For any fatal­i­ty that occurs with­in 30 days of a work-relat­ed inci­dent, employ­ers must report the event with­in eight hours of find­ing out about it.

  For any in-patient hos­pi­tal­iza­tion, ampu­ta­tion, or eye loss that occurs with­in 24 hours of a work-relat­ed inci­dent, employ­ers must report the event with­in 24 hours of learn­ing about it.

  Employ­ers do not have to report an event if the event:

  • Result­ed from a motor vehi­cle acci­dent on a pub­lic street or high­way, except in a con­struc­tion work zone; employ­ers must report the event if it hap­pened in a con­struc­tion work zone.
  • Occurred on a com­mer­cial or pub­lic trans­porta­tion sys­tem (air­plane, sub­way, bus, fer­ry, street car, light rail, train).
  • Occurred more than 30 days after the work-relat­ed inci­dent in the case of a fatal­i­ty or more than 24 hours after the work-relat­ed inci­dent in the case of an in-patient hos­pi­tal­iza­tion, ampu­ta­tion, or loss of an eye.

  Employ­ers do not have to report an in-patient hos­pi­tal­iza­tion if it was for diag­nos­tic test­ing or obser­va­tion only. An in-patient hos­pi­tal­iza­tion is a for­mal admis­sion to the in-patient ser­vice of a hos­pi­tal or clin­ic for care or treatment.

  Employ­ers do have to report an in-patient hos­pi­tal­iza­tion due to a heart attack, if the heart attack result­ed from a work-relat­ed incident.

  What to report

  Employ­ers report­ing a fatal­i­ty, inpa­tient hos­pi­tal­iza­tion, ampu­ta­tion, or loss of an eye to OSHA must report all of the fol­low­ing information:

  • The name of the establishment.
  • The loca­tion of the work-relat­ed incident.
  • The time of the work-relat­ed incident.
  • The type of reportable event (i.e., fatal­i­ty, inpa­tient hos­pi­tal­iza­tion, ampu­ta­tion, or loss of an eye).
  • The num­ber of employ­ees who suf­fered the event.
  • The names of the employ­ees who suf­fered the event.
  • The con­tact per­son and his or her phone number.
  • A brief descrip­tion of the work-relat­ed incident.

  How to report

  Employ­ers can use the fol­low­ing three options to report an event:

  • Call the near­est OSHA Area Office dur­ing nor­mal busi­ness hours.
  • Call the 24-hour OSHA hot­line (800–321-OSHA or 800–321-6742).
  • Report an inci­dent elec­tron­i­cal­ly (OSHA is devel­op­ing a new means of report­ing events elec­tron­i­cal­ly, which will be released soon and will be acces­si­ble on OSHA’s website).

  Con­clu­sion

  It is rec­om­mend­ed that employ­ers famil­iar­ize them­selves with the final rule and train per­son­nel accord­ing­ly. All employ­ers under OSHA juris­dic­tion, even those who are exempt from main­tain­ing injury and ill­ness records, are required to com­ply with the new severe injury and ill­ness report­ing requirements.

  Read More …

• When is a medical plan not a medical plan? When it is a dental plan…Exchange counts off

  December 29, 2014

  The Depart­ment of Health and Human Ser­vices has admit­ted that it made a mis­take in count­ing the total enroll­ment under the Afford­able Care Act by 380,000…because it count­ed den­tal plans as med­ical plans.  This allowed them to hit the “mag­ic num­ber” extolled by the admin­is­tra­tion of 7 mil­lion enrollees, thus hit­ting their tar­get and claim­ing enroll­ment a suc­cess.  Sec­re­tary Bur­well apol­o­gized, say­ing “this mis­take was unac­cept­able (but) the fact that we have quick­ly cor­rect­ed the num­bers should give peo­ple confidence”

• Proposed 2016 Benefit and Payment Parameters | California Benefits Broker

  December 26, 2014

  Tags: 2016, Benefit, HHS, Parameters, Payment, UBA PPACA Advisor

  Post­ed by Lin­da Rowings

  The Depart­ment of Health and Human Ser­vices (HHS) has issued its pro­posed Ben­e­fit and Pay­ment Para­me­ters for 2016. While these amounts and dates are not yet final, they may be of help for plan­ning pur­pos­es. At this time, HHS expects:

  • Open enroll­ment for cov­er­age through the Mar­ket­place in 2016 will be from Octo­ber 1 through Decem­ber 15, 2015 (with cov­er­age effec­tive as of Jan­u­ary 1, 2016).
  • The tran­si­tion­al rein­sur­ance fee for 2016 is like­ly to be $27 per cov­ered life. Fil­ing for 2016 would be due Novem­ber 15, 2016, with $21.60 per cov­ered life due Jan­u­ary 15, 2017, and $5.40 per cov­ered life due Novem­ber 15, 2017.
  • The out-of-pock­et lim­its for health plans that are not high deductible plans relat­ed to HSAs would be $6,850 for sin­gle cov­er­age and $13,700 for fam­i­ly cov­er­age (with a max­i­mum out-of-pock­et for any fam­i­ly mem­ber of $6,850).
  • The fed­er­al­ly facil­i­tat­ed exchange fee would remain at 3.5% of premium.
  • A spe­cial enroll­ment peri­od would be avail­able at renew­al for indi­vid­u­als enrolled in non-cal­en­dar year plans.
  • Retirees and COBRA par­tic­i­pants could be cov­ered through a Small Busi­ness Health Options Pro­gram (SHOP) plan.
  • The cur­rent bench­mark plans for essen­tial health ben­e­fits would remain in effect for 2016, with new bench­mark plans based on 2014 ben­e­fits and enroll­ment in effect for 2017.

  A draft of an updat­ed AV cal­cu­la­tor and method­ol­o­gy for 2016 also are avail­able. While this will help you stay for­ward-think­ing, don’t for­get about tak­ing steps to ensure you are pre­pared to meet the Patient Pro­tec­tion and Afford­able Care Act (PPACA) require­ments that begin in 2015 and those which must be com­plet­ed in 2014. For a com­plete check­list, down­load UBA’s PPACA Advi­sor, “Prepar­ing for 2015 — Key PPACA Requirements”.

  Read More …

• It was not well suited to their needs – so they are filing suit against it – GOP vs. Obama

  December 23, 2014

  They didn’t like the bill, now they don’t like the fact that it is not hap­pen­ing fast enough.  Accus­ing Pres­i­dent Oba­ma of “mak­ing up his own laws” (John Boehn­er) by delay­ing the employ­er man­date, the Repub­li­cans are also con­sid­er­ing fil­ing a suit over the recent deci­sion to pro­vide depor­ta­tion relief.  They’re not relat­ed, except inso­far as it con­cerns the Chief Exec­u­tive.  House Minor­i­ty Leader Nan­cy Pelosi was a bit upset : “the fact is, this law­suit is a bald faced attempt to achieve what Repub­li­cans have been unable to achieve through the polit­i­cal process.  The leg­isla­tive branch can­not sue sim­ply because they dis­agree with the way a law passed by a dif­fer­ent Con­gress has been implemented…the law­suit is an embar­rass­ing loser.”

• Hand Washing Helps Defeat the Flu | Petaluma Benefits Broker

  December 22, 2014

  Tags: CDC, flu, influenza, wellness

  www.thinkhr.com

  H3N2 influen­za virus­es led to record num­bers of deaths in the 2004, 2008, and 2013 flu sea­sons. Doc­tors are con­cerned because this type of virus appears to be dom­i­nat­ing the 2015 flu sea­son. Employ­ers should stress opti­mal health and hand-wash­ing behav­iors in their work­places to avoid the threat of flu and keep their work­places healthy and germ-free.

  The Unit­ed States Cen­ters for Dis­ease Con­trol (CDC) reports a major­i­ty of cas­es so far this flu sea­son are H3N2 virus­es. When these types of virus­es are the most preva­lent in a flu sea­son, the result is often more severe ill­ness with greater instances of hos­pi­tal­iza­tion and death. This year the CDC is find­ing that the flu vaccine’s abil­i­ty to pro­tect against H3N2 virus­es is not as strong as was hoped when the vac­cine was being for­mu­lat­ed. This reduced pro­tec­tion is the result of muta­tion in about half of the H3N2 virus­es since the sea­son began. The CDC still rec­om­mends the vac­cine as vac­ci­nat­ed peo­ple will like­ly have a more mild ill­ness if they do become ill. This warn­ing will help employ­ers to see the need to aug­ment vac­ci­na­tion with oth­er pre­ven­tive health measures.

  Effec­tive hand wash­ing is essen­tial to pre­vent the spread of infec­tious dis­ease. The bac­te­ria, virus­es, and oth­er microbes that spread infec­tion usu­al­ly are not vis­i­ble to the naked eye. Every­one should care about the spread of harm­ful organ­isms because every­one has the poten­tial to unknow­ing­ly spread them to a per­son with a com­pro­mised immune sys­tem. Exam­ples of those with com­pro­mised immune sys­tems include fam­i­ly mem­bers, par­tic­u­lar­ly chil­dren and the elder­ly, or co-work­ers cop­ing with ill­ness­es like can­cer, heart dis­ease, or diabetes.

  Hands should be washed fre­quent­ly. You may be sur­prised to dis­cov­er how many times you inad­ver­tent­ly touch your face in the course of a day, which is often the method that intro­duces con­t­a­m­i­nates to our bod­ies through our eyes, nose, or mouth. At a min­i­mum, wash your hands sev­er­al times per day to lessen the risk of inad­ver­tent­ly spread­ing harm­ful organisms.

  Wash hands both before, dur­ing, and after food prepa­ra­tion as well as before eat­ing, treat­ing a wound, or adjust­ing con­tact lens­es. Hands may need to be washed mul­ti­ple times dur­ing food prepa­ra­tion. For exam­ple, Sal­mo­nel­la is a bac­te­ria that can be found on raw meats and veg­eta­bles, and is a seri­ous con­cern in the Unit­ed States. Accord­ing to the CDC, each year over one mil­lion peo­ple acquire the ill­ness, lead­ing to 19,000 hos­pi­tal­iza­tions and 380 deaths. In addi­tion to cook­ing food prop­er­ly and clean­ing work sur­faces, Sal­mo­nel­la  abate­ment requires hands to be cleaned before han­dling cooked meat or oth­er ingre­di­ents to pre­vent the trans­fer of organ­isms from raw items.

  To min­i­mize the spread of res­pi­ra­to­ry infec­tions and diar­rheal ill­ness, wash hands after using the toi­let, cough­ing, blow­ing your nose, chang­ing a dia­per, or touch­ing garbage, soiled laun­dry, shoes, an ani­mal, or any­thing touched by an ani­mal. This pre­ven­tive step lessens the amount of germs trans­ferred to key boards, handrails, door knobs, or toys.

  Soap and Water

  Soap and clean run­ning water are two ele­ments of opti­mal hand wash­ing. The sur­fac­tants in soap lift soil and microor­gan­isms from the hands, enabling the run­ning water to car­ry the unde­sir­able ele­ments away with­out pos­ing the risk of recon­t­a­m­i­na­tion caused by stand­ing water. Water of cool or warm tem­per­a­ture works equal­ly well in remov­ing unde­sir­able organ­isms. Anoth­er help­ful part of the process is the mechan­i­cal action cre­at­ed when hands are scrubbed or rubbed togeth­er continuously.

  Best prac­tice for hand wash­ing requires wet­ting the hands, turn­ing the water off to pre­vent waste, apply­ing soap, and spread­ing the soap across all sur­faces of your hands for 20 sec­onds, being sure to include fin­ger­nails, back of hands, and wrists. Impor­tant­ly, don’t rush the hand-wash­ing process. Often par­ents will teach chil­dren to wash hands to the time it takes to sing the A‑B-C song or anoth­er jin­gle that reli­ably takes 20 sec­onds. After scrub­bing for 20 sec­onds, rinse hands thor­ough­ly under run­ning water. If the faucet is not oper­at­ed by a sen­sor, use a tow­el or your elbow to turn it off in a man­ner avoid­ing hand recon­t­a­m­i­na­tion. Final­ly, dry hands with a clean cloth, new dis­pos­able tow­el, or air blower.

  Alco­hol as an Alternative

  An alco­hol-based san­i­tiz­er can be an effec­tive alter­na­tive to soap and water where a sink or clean water is unavail­able. Exam­ples of loca­tions where san­i­tiz­er may be prac­ti­cal include con­fer­ence rooms, break rooms, recep­tion areas, or just out­side of restroom doors.

  Accord­ing to the CDC, effec­tive use of water­less hand san­i­tiz­er requires an alco­hol-based solu­tion con­tain­ing at least 60 per­cent alco­hol. For hand san­i­tiz­ers to be effec­tive, it’s impor­tant that enough solu­tion is used, that it stays on the skin and is not wiped or washed off pre­ma­ture­ly, and that the solu­tion is allowed to thor­ough­ly dry on the skin.

  Sim­i­lar to the use of soap and water, mechan­i­cal action or fric­tion caused by scrub­bing or rub­bing hands togeth­er is essen­tial for water­less hand san­i­tiz­er to stop the spread of microor­gan­isms. Addi­tion­al­ly, the hands must be free of organ­ic mat­ter pri­or to apply­ing hand san­i­tiz­er. Using the appro­pri­ate amount of san­i­tiz­er requires plac­ing enough san­i­tiz­er to cov­er a dime in the palm of one hand. Hands must then be rubbed togeth­er in a man­ner that cov­ers all sur­faces, includ­ing the back of the hands, until they are dry.

  Read More …

• Gruber stake is Uber mistake…Obamacare architect shares too much

  December 22, 2014

  A series of videos have been released of var­i­ous con­fer­ences and con­ver­sa­tions involv­ing Jonathan Gru­ber, who was one of the writ­ers of the orig­i­nal ACA leg­is­la­tion, and they are not flattering…to any­one involved.  A sampling:

  “Lack of trans­paren­cy is a huge polit­i­cal advan­tage.  Basi­cal­ly, call it the stu­pid­i­ty of the Amer­i­can vot­er of what­ev­er, but basi­cal­ly that was real­ly, real­ly crit­i­cal to get­ting things to pass”

  “This bill was writ­ten in a tor­tured way to make sure the Con­gres­sion­al Bud­get Office did not score the man­date as tax­es (because) if CBO scored the man­date as tax­es, the bill dies” (even though Pres­i­dent Oba­ma kept insist­ing the man­date was not a tax)

  “If you had a law which…made explic­it that healthy peo­ple pay in and sick peo­ple get mon­ey, it would not have passed”

  “If you’re a state and you don’t set up an exchange, that means your cit­i­zens don’t get tax cred­its” (which is enlight­en­ing giv­en that the Supreme Court is hear­ing on this issue right now, while the Oba­ma admin­is­tra­tion is insist­ing that the Fed­er­al Exchange can offer subsidies)

  “It turns out polit­i­cal­ly (the employ­er sub­sidy) is real­ly hard to get rid of…and the only way we could get rid of it was first by mis­la­bel­ing it, call­ing it a tax on insur­ance plans (refer­ring to the nascent Cadil­lac tax) rather than a tax on peo­ple when we all know it’s a tax on peo­ple who hold those insur­ance plans”  “What that means is the tax that starts out hit­ting only 8% of the insur­ance plans essen­tial­ly amounts over the next 20 years essen­tial­ly get­ting rid of the exclu­sion for employ­er spon­sored plans…this was the only polit­i­cal way we were ever going to take on one of the worst pub­lic poli­cies in America”

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

  December 18, 2014

  Tags: 2015, Adjustments, Cost-of-Living, IRS, Social Security Administration

  Post­ed by Lin­da Rowing

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

  Lim­its of par­tic­u­lar inter­est to employ­ers include the following.

  For health and Sec­tion 125 plans:

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

  For qual­i­fied plans:

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

  Social Security/Medicare Withholding:

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

  Request a quick ref­er­ence chart from your local UBA Part­ner Firm.

  Read More …

• SHOP until you drop…it…sales are not what were expected on Exchange group plan

  December 18, 2014

  The atten­tion was all paid to the indi­vid­ual plans that sud­den­ly made health care “afford­able” – if you received a sub­sidy (from which the fed­er­al gov­ern­ment is backpedal­ing furi­ous­ly).  But along­side the indi­vid­ual plans the gov­ern­ment decid­ed that doing group insur­ance was a necessity…and it is the only vehi­cle that allows for the receipt of the small group health insur­ance tax cred­it.  This was sup­posed to help sales, even though the first two years of the pro­gram qual­i­fi­ca­tion was open for any plan, and bare­ly tak­en (espe­cial­ly in Cal­i­for­nia).  So now there is no sur­prise to find that the sale of the SHOP plan has not met expec­ta­tions.  Dif­fi­cul­ty in ser­vice, the lack of flex­i­bil­i­ty in choice, nar­row net­works and oth­er prob­lems do not make it palat­able in the mar­ket, and thus less than 12,000 busi­ness­es signed up in the first 8 months.

• Identify yourself…unless of course you can’t figure out how to do it – HIPD suspended

  December 17, 2014

  It seemed like a good idea at the time…have all plans of a cer­tain size set up a Health Plan Iden­ti­fi­ca­tion Num­ber.  But then, the day before it was to go into effect, the fed­er­al gov­ern­ment sus­pend­ed action.  It appears even the sharpest busi­ness peo­ple who tried to sim­ply reg­is­ter a num­ber had too much dif­fi­cul­ty in doing so.  A report was made to the DOL say­ing that it should be set up for addi­tion­al con­sid­er­a­tion.  More ACA delays…

• Premium Reimbursement Arrangements Redux – the closing of an old loophole

  December 16, 2014

  For many years, some “con­sul­tants” (and one in par­tic­u­lar) have been telling employ­ers that they can can­cel their group poli­cies, set up a Code Sec­tion 105 (IRC 105(h)) reim­burse­ment plan that works with bro­kers to help select indi­vid­ual health poli­cies and get the pre­mi­um tax cred­its for Mar­ket­place cov­er­age.  This is NOT per­mis­si­ble accord­ing to the new FAQ issued by the Depart­ment of Labor.  There are sev­er­al rea­sons giv­en, which should final­ly close the door:

  1)    The arrange­ments are con­sid­ered to be group health plans and thus no tax cred­it allowed

  2)    Just because an employ­er is not involved with plan selection/purchase does not pre­vent the arrange­ment from being a group health plan

  3)    Such arrange­ments are sub­ject to mar­ket reform (under four sep­a­rate notices) which pro­hibits annu­al lim­its and requires pre­ven­tive care be offered with­out cost shar­ing.  “Such employ­er health care arrange­ments can­not be inte­grat­ed with indi­vid­ual mar­ket poli­cies to sat­is­fy the mar­ket reforms and, there­fore, will vio­late PHS Act sec­tions 2711 and 2713 among oth­er pro­vi­sions which can trig­ger penal­ties such as an excise tax.

• Supreme Court Agrees to Rule on Availability of Premium Tax Credits | CA Benefits Broker

  December 15, 2014

  Tags: IRS, PPACA, Premium Tax Credits, Supreme Court

  Post­ed by Lin­da Rowings

  Pre­mi­um tax cred­its are only avail­able to indi­vid­u­als who obtain health cov­er­age through a Mar­ket­place. A dis­pute has arisen as to whether the IRS has the abil­i­ty to inter­pret PPACA to allow the sub­sidy to indi­vid­u­als who obtain cov­er­age through any Mar­ket­place, or whether the lan­guage of PPACA lim­its eli­gi­bil­i­ty to those who have obtained cov­er­age through a state Mar­ket­place. The U.S. Supreme Court has agreed to rule on whether pre­mi­um tax cred­its may only be avail­able to indi­vid­u­als who receive tax sub­si­dies as a result of being enrolled in a state exchange. In the mean­time, the IRS has stat­ed that it will con­tin­ue to issue tax cred­its to indi­vid­u­als in both state and fed­er­al­ly-run Marketplaces.

  If the Supreme Court decides the IRS rule that tax cred­its are avail­able regard­less of what type of Mar­ket­place is in place, the cur­rent sys­tem will remain in effect. How­ev­er, if it rules that tax cred­its are only legal­ly avail­able to indi­vid­u­als enrolled in state Mar­ket­places, that deci­sion will have sig­nif­i­cant con­se­quences, since only about one-third of the states are run­ning their own Mar­ket­place, while the fed­er­al gov­ern­ment runs the Mar­ket­place for the remain­ing states. If pre­mi­um tax cred­its are only allowed in states with their own Mar­ket­place, most Amer­i­cans will become inel­i­gi­ble to receive the tax cred­its. Well over half of the peo­ple cur­rent­ly enrolled in a Mar­ket­place are receiv­ing a tax cred­it. Addi­tion­al­ly, an employ­er owes the play or pay penal­ty only if an employ­ee receives a tax credit.

  If the Supreme Court rules that pre­mi­um tax cred­its are only avail­able to indi­vid­u­als enrolled in state Mar­ket­places, employ­ers should expect that states that have cho­sen to pro­vide cov­er­age through the fed­er­al­ly-run Mar­ket­places will be under pres­sure to tran­si­tion to state Mar­ket­places from those who have ben­e­fit­ed from the sub­si­dized Mar­ket­places. Those that are ben­e­fit­ing from sub­si­dized cov­er­age include the indi­vid­u­als receiv­ing pre­mi­um tax cred­its, hos­pi­tals that are expe­ri­enc­ing less unre­im­bursed care, and insur­ers that have invest­ed in pro­vid­ing cov­er­age through the Mar­ket­places. Sim­i­lar­ly, states that have state Mar­ket­places may be pres­sured to move to a fed­er­al­ly-run Mar­ket­place by employ­ers try­ing to avoid penal­ties. Debate is already occur­ring as to what, exact­ly, is need­ed to qual­i­fy as a state Mar­ket­place should a state wish to move in that direc­tion. Employ­ers with employ­ees locat­ed in mul­ti­ple states could have to man­age a sit­u­a­tion in which some employ­ees are eli­gi­ble for tax cred­its and oth­ers are not.

  The deci­sion of the Supreme Court is expect­ed in late June 2015.

  To get the lat­est infor­ma­tion on oth­er fed­er­al devel­op­ments includ­ing plan designs being disallowed—such as employ­er reim­burse­ment of pre­mi­ums for indi­vid­ual cov­er­age, incen­tiviz­ing employ­ees in poor health to enroll in the mar­ket­place, and more—down­load UBA’s PPACA Advi­sor, “Agen­cies Dis­al­low Sev­er­al Plan Designs; Oth­er Fed­er­al Developments”.

  Read More …

• Premium Reimbursement under the Affordable Care Act – DOL issues FAQs about the rules

  December 15, 2014

  First there was no prob­lem.  Then the ACA was passed.  Still no prob­lem.  Then some­one real­ized that employ­ers and employ­ees may be tak­ing advan­tage of exist­ing rules that allowed a tax exemp­tion for the pay­ment or receipt of indi­vid­ual health insur­ance.  So on Sep­tem­ber 13, 2013 the IRS and DOL issued “guid­ance” (inter­pre­ta­tion) about what was going to be allowed…and what was not.  The new rules basi­cal­ly said that an HRA could not be used to pay for indi­vid­ual health insur­ance pre­mi­ums, Flex­i­ble Spend­ing Accounts could not be used for the same rea­son, and any pre­mi­um paid direct­ly by an employ­er for an employ­ee would be a tax­able event.  Not so good…but they weren’t done.  Now the Depart­ment of Labor has gone fur­ther (and why?) and issued two new FAQs in this regard…
  Under the newest new rules, even where an employ­er offers employ­ees the cash to reim­burse for the pur­chase of an indi­vid­ual mar­ket pol­i­cy, it is now in vio­la­tion of ACA mar­ket reforms.  In oth­er words, it is not only a tax­able event, but is con­sid­ered a part of a plan and thus must meet require­ments under ERISA and thus Pub­lic Health Ser­vice laws…which means that vio­la­tion of the law now also means the pay­ment of an excise tax.

  In a fur­ther note, the DOL has made it clear that an employ­er who offers an employ­ee with high risk claims the choice between enroll­ment in its stan­dard plan and cash is in vio­la­tion of the Afford­able Care Act, HIPAA, and ERISA…a triple threat.  It con­sti­tutes dis­crim­i­na­tion (no kid­ding)  “In the Department’s view, cash or cov­er­age arrange­ments offered only to employ­ees with a high claims risk are not per­mis­si­ble benign dis­crim­i­na­tion”  The dis­crim­i­na­tion rule applies whether the cash pay­ment is pre or post tax, the employ­er is involved in the selec­tion or pur­chase of a prod­uct or not, or even if the employ­ee obtains any indi­vid­ual health insurance.

• And they stay busy…Supreme Court also weighs in on retiree health benefits

  December 12, 2014

  Retirees are being promised that they will be able to con­tin­ue their health cov­er­age for the rest of their lives, or until they turn 65 and qual­i­fy for Medicare…or until the employ­er changes their mind.  In the case M&G Poly­mers USA LLC vs. Tack­ett the col­lec­tive bar­gain­ing agree­ment allow­ing for life­time cov­er­age has been chal­lenged.  Rules about what must be said or what must be inferred when the agree­ment is oth­er­wise silent are all under con­sid­er­a­tion here.

• Medicine Safety Reminders for Cold and Flu Season | CA Employee Benefits

  December 11, 2014

  Tags: acetaminophen, cold, drug safety, flu

  (New­sUSA)

  Amer­i­cans catch approx­i­mate­ly 1 bil­lion colds each year, and the Cen­ters for Dis­ease Con­trol and Pre­ven­tion esti­mates that as many as 20 per­cent of peo­ple in the U.S. will get the flu this cold and flu sea­son. A major­i­ty of peo­ple (sev­en in 10) will use over-the-counter (OTC) med­i­cines to treat their symp­toms, and many of these med­i­cines con­tain acetaminophen.

  Aceta­minophen is the most com­mon drug ingre­di­ent in Amer­i­ca, found in more than 600 pre­scrip­tion (Rx) and OTC med­i­cines, includ­ing pain reliev­ers, fever reduc­ers and many cough, cold and flu med­i­cines. It’s safe and effec­tive when used as direct­ed, but tak­ing more than the max­i­mum dai­ly dose of 4,000 mil­ligrams is an over­dose and can lead to liv­er damage.

  The Aceta­minophen Aware­ness Coali­tion (AAC), a group of lead­ing health, health care provider and con­sumer orga­ni­za­tions, is remind­ing con­sumers to dou­ble-check their med­i­cine labels to avoid dou­bling up on aceta­minophen this winter.

  “Cold and flu sea­son is a very impor­tant time to remind patients to be dili­gent about read­ing their med­i­cine labels and know­ing the ingre­di­ents in their med­i­cines,” said Anne Nor­man, APRN, DNP, FNP-BC, Asso­ciate Vice Pres­i­dent of Edu­ca­tion at the Amer­i­can Asso­ci­a­tion of Nurse Prac­ti­tion­ers, a found­ing orga­ni­za­tion of the AAC. “Peo­ple may use a med­i­cine to treat their cold or flu symp­toms on top of a med­i­cine they are already tak­ing, not real­iz­ing that both might con­tain acetaminophen.”

  The AAC’s Know Your Dose cam­paign reminds con­sumers to fol­low four med­i­cine safe-use steps:

  1. Always read and fol­low the med­i­cine label.

  2. Know if med­i­cines con­tain aceta­minophen, which is list­ed on the front pan­el of pack­ag­ing and in bold type or high­light­ed in the “active ingre­di­ents” sec­tion of OTC med­i­cine labels, and some­times list­ed as “APAP” or “acetam” on Rx labels.

  3. Nev­er take two med­i­cines that con­tain aceta­minophen at the same time.

  4. Ask your health care provider or a phar­ma­cist if you have ques­tions about dos­ing instruc­tions or med­i­cines that con­tain acetaminophen.

  Read More …

• It’s not just politics – the Supremes may be singing the same tune soon

  December 10, 2014

  The Supreme Court has agreed to review a chal­lenge to the tax sub­si­dies allowed under the Afford­able Care Act.  There have been a num­ber of low­er court deci­sions which have tak­en both sides of the issues, so the wis­dom of Solomon (or our own Supreme being) will be called upon to decide whether or not the sub­si­dies called for in the ACA are legal or not.  At issue is the word­ing of the health care reform law say­ing that indi­vid­u­als qual­i­fy for tax cred­its only when they buy insur­ance on a mar­ket­place “estab­lished by the state”  Thus those in Cal­i­for­nia are legal, but those writ­ten through the fed­er­al exchange mar­ket­place may not be.  The IRS issued a rule say­ing that con­sumers can claim tax cred­its no mat­ter where they live and the Oba­ma admin­is­tra­tion says the IRS approach is con­sis­tent with the law’s aims.  OK.  For now, how­ev­er, the ACA stays in place…the court is expect­ed to file their deci­sion in June 2015.

• The “Play or Pay” Package | California Benefits Broker

  December 8, 2014

  Tags: employers, mid-sized, Play or Pay

  Post­ed by Lin­da Rowings

  The employ­er-shared respon­si­bil­i­ty (“play or pay”) require­ments do not apply to small employ­ers and have been delayed until 2016 for most mid-sized employ­ers. This rais­es the ques­tion – what exact­ly is includ­ed in the play or pay require­ment, which a small employ­er may be able to ignore and that mid-size employ­er may not need to meet until later?

  Employ­er-shared respon­si­bil­i­ty includes five basic require­ments that must be met by a large employ­er to avoid penalties:

  1. The employ­er must offer min­i­mum essen­tial cov­er­age to at least 95% of its full-time employ­ees (under a tran­si­tion rule, for 2015 the require­ment is to offer min­i­mum essen­tial cov­er­age to 70% of full-time employees).
  2. The employ­er must offer afford­able, min­i­mum val­ue cov­er­age to its full-time employees.
  3. The employ­er must con­sid­er an employ­ee as full-time for health cov­er­age pur­pos­es if the employ­ee aver­ages 30 or more hours work per week.
  4. The employ­er must offer min­i­mum essen­tial cov­er­age to nat­ur­al and adopt­ed depen­dent chil­dren until the end of the month in which the child reach­es age 26 (under a tran­si­tion rule, this require­ment is gen­er­al­ly delayed to 2016).
  5. The employ­er must offer employ­ees the oppor­tu­ni­ty at least once a year to elect or decline cov­er­age under the group health plan (with an excep­tion to the required oppor­tu­ni­ty to decline cov­er­age for par­tic­u­lar­ly gen­er­ous coverage).

  Employ­ers that are small enough that the play or pay require­ments do not apply, or have been delayed, still must meet many require­ments under the Patient Pro­tec­tion and Afford­able Care Act, such as the lim­it on wait­ing peri­ods, but they need not meet the cri­te­ria of the play or pay pack­age to avoid penal­ties. Cau­tion: ful­ly insured plans must meet both state and fed­er­al require­ments, so small and mid-size employ­ers with insured plans should make sure that their plans meet state insur­ance law require­ments. For exam­ple, some states have adopt­ed the 30-hour thresh­old for eli­gi­bil­i­ty, and some require that cov­er­age be offered to spous­es and children.

  Note: for pur­pos­es of this blog piece, “small” means that the employ­er had few­er than 50 full-time or full-time equiv­a­lent employ­ees in its con­trolled group dur­ing the pri­or cal­en­dar year. “Mid-size” means the employ­er had 50 to 99 full-time or full-time equiv­a­lent employ­ees in its con­trolled group dur­ing the 2014 cal­en­dar year and has not mate­ri­al­ly reduced ben­e­fits, eli­gi­bil­i­ty or con­tri­bu­tions from the lev­el in effect on Feb­ru­ary 9, 2014. Mid-size employ­ers will need to pro­vide report­ing on avail­able cov­er­age for 2015, even though the actu­al employ­er shared respon­si­bil­i­ty require­ments gen­er­al­ly will not be effec­tive for mid-size employ­ers until 2016.

  To help employ­ers under­stand the pay or play pro­vi­sions of the PPACA, down­load UBA’s white paper, “The Employer’s Guide to Play or Pay”. For help fur­ther help mak­ing pay or play deci­sions under PPACA, request UBA’s com­pli­ance and deci­sion guides for small and large employ­ers.

  Read More …

• What Might They Do – Congress Progress or Regress or Simply Recess the ACA

  December 8, 2014

  Revis­it the employ­er man­date – not likely
  Revis­it the indi­vid­ual man­date – less like­ly than that
  Repeal the med­ical device tax (now 2.3% of the cost of devices
  Revis­it what con­sti­tutes “full time” employment
  Repeal fed­er­al reim­burse­ments for com­pa­nies who lose mon­ey on the ACA
  Elim­i­nate the Inde­pen­dent Pay­ment Advi­so­ry Board (once known as the death panels)
  Low­er the sub­si­dies being offered for “afford­able” indi­vid­ual health coverage
  Cre­ation of a new cop­per plan (we don’t have enough met­als now)
  Pro­vide alter­na­tives (since they are in a lead­er­ship position)

• The Elections, New Selections and Directions

  December 5, 2014

  The­o­ries now abound, about what was lost, why, who will care and who will not and what this will por­tend for the 2016 Pres­i­den­tial race.  Pres­i­dent Oba­ma lost a major­i­ty in the House in the last mid terms, and now he has lost a major­i­ty in the Sen­ate, but not a super major­i­ty (which would be required to over­turn the Afford­able Care Act).  Repub­li­cans are now in what should be a hap­py spot, but it is also a rough one.  Now it is not enough to just crit­i­cize what comes from the White House – they must make pro­pos­als of their own, and they must be sub­stan­tive.  So will we see a rad­i­cal change on immi­gra­tion pol­i­cy, health care, and oth­er hot but­ton issues?  Not like­ly, but then there is always the strat­e­gy of  “death by a thou­sand cuts” – and it is like­ly that Repub­li­cans will do what they can to weak­en the ACA at the very least.  It’s the least they can do.

• UBA 2014 Health Plan Survey Executive Summary Now Available | California Employee Benefits

  December 5, 2014

  Tags: 2014, Executive Summary, HPS, UBA

  Post­ed by Bill Olson

  Since 2005, Unit­ed Ben­e­fit Advi­sors® (UBA) has sur­veyed thou­sands of employ­ers across the nation regard­ing their health plan offer­ings, their ongo­ing plan deci­sions in the face of sig­nif­i­cant leg­isla­tive and mar­ket­place changes, and the impact of these changes on their employ­ees and busi­ness­es. The UBA sur­vey rep­re­sents the nation’s largest health plan bench­mark­ing sur­vey and the most com­pre­hen­sive source of reli­able bench­mark­ing data.

  As always, the sur­vey revealed sev­er­al note­wor­thy trends and devel­op­ments that bear scruti­ny and the ongo­ing atten­tion of employ­ers inter­est­ed in mak­ing the most informed health care plan deci­sions pos­si­ble. For exam­ple, among the most strik­ing trends revealed by the sur­vey, employ­ers have over­whelm­ing­ly opt­ed for ear­ly renewals of their plans—a delay tac­tic that helped them avoid cost­ly Patient Pro­tec­tion and Afford­able Care Act (PPACA)-compliant plans and man­age costs. Anoth­er cost man­age­ment tac­tic employ­ers are using is to increase out-of-pock­et costs for employ­ees, with a “new nor­mal” emerg­ing for these high­er cost thresholds.

  Employ­ers typ­i­cal­ly con­tin­ue to offer one pre­ferred provider orga­ni­za­tion (PPO) health plan option to employ­ees, while also still wide­ly offer­ing fam­i­ly cov­er­age. In addi­tion, well­ness pro­gram adop­tion seems to be in a hold­ing pat­tern, as pend­ing lit­i­ga­tion and reg­u­la­to­ry changes swirl on these offer­ings. Among employ­ers pro­vid­ing well­ness pro­grams, health risk assess­ments and incen­tives are increas­ing­ly com­mon offerings.

  Plans in the North­east U.S. con­tin­ue to be the richest—and most expensive—and are at risk of being sub­ject to the loom­ing Cadil­lac tax. Gov­ern­ment employ­ees have the most gen­er­ous plans with the high­est costs—and they pay the least toward their over­all cov­er­age costs. Con­verse­ly, con­struc­tion indus­try employ­ees cost the least to cov­er but those employ­ees pay the most toward costs.

  Regard­ing cost increas­es, the small­est employ­ers (0 to 49 employ­ees) saw the low­est increas­es, a sur­pris­ing break for them due to an unusu­al option they had over larg­er employ­ers to remain with non-PPACA-com­pli­ant plans. In short, this was a reprieve for a group that usu­al­ly faces the high­est increas­es. Self-fund­ing of plans, par­tic­u­lar­ly among small employ­ers, has not yet surged, but is still antic­i­pat­ed to do so as employ­ers run out of oth­er avoid­ance strategies.

  The preva­lence of con­sumer-dri­ven health plans (CDH­Ps) con­tin­ues to grow, as does employ­ee enroll­ment in these plans, despite low­er con­tri­bu­tions to health sav­ings accounts (HSAs)?(which are often tied to CDH­Ps to entice par­tic­i­pa­tion). And, final­ly, pre­scrip­tion drug plans are increas­ing­ly offer­ing four or more tiers, along with ever-increas­ing copays—a trend that might fall off as they must all even­tu­al­ly tie to out-of-pock­et max­i­mums under PPACA.

  For more infor­ma­tion to help you bench­mark your health plan, down­load the 2014 UBA Health Plan Sur­vey Exec­u­tive Sum­ma­ry or con­tact a local UBA Part­ner for a cus­tomized bench­mark­ing report.

  Read More …

• Surprise! With more people being covered, more are using insurance…for emergencies

  December 4, 2014

  The law of unin­tend­ed consequences…always the most dan­ger­ous legal game. This time we are hap­py that the Afford­able Care Act has caused an increase in the num­ber of insured indi­vid­u­als, who have prompt­ly tak­en advan­tage of their new found cov­er­age, and caused a major increase in the use of emer­gency rooms. While this is a nation­wide trend (The Amer­i­can Col­lege of Emer­gency Physi­cians said near­ly half of those ER docs queried showed a rise in the num­ber of ER vis­its this year and 86% expect an increase over the next three years), there are also more detailed local results. In Orange Coun­ty the ER patient load has risen by an aver­age 4.4% since Jan­u­ary 2014, while it had been flat the pre­vi­ous 4 years. UC Irvine is up 10.9%, Kaiser Orange Coun­ty up 11% and Foun­tain Val­ley 7.6%. Many of these are Medi Cal, many are with pri­vate insur­ance, but it is all up, all over…One tem­po­riz­ing thought came from Marc Futer­nick, pres­i­dent elect of the Cal­i­for­nia Chap­ter of the Amer­i­can Col­lege of Emer­gency Physi­cians. “Some of this may be a tem­po­rary phe­nom­e­non and could change as peo­ple begin to use their cov­er­age better…but to the extent that the health plans and net­works are send­ing peo­ple to the ER it’s not going to change”

• Supreme Indifference…Same Sex marriage proceeds because the USSC is not wedded to the idea of a declaration of their intentions

  December 3, 2014

  Sev­en rul­ings from three fed­er­al cir­cuit Courts of Appeals addressed same sex mar­riage in five states, and this was bun­dled for con­sid­er­a­tion to the Unit­ed States Supreme Court. In Octo­ber, just after con­ven­ing for their new term, the Supreme Court declined to address these issues, and thus the orig­i­nal appel­late rul­ings remain in force.

• Nondiscrimination Rules for Benefits Plans | Petaluma Benefits Broker

  December 3, 2014

  Tags: employee benefits, erisa, health care reform

  Ques­tion:
  What are the Employ­ee Retire­ment Income Secu­ri­ty Act (ERISA) rules about nondis­crim­i­na­tion in ben­e­fits plan designs to assist with cre­at­ing ben­e­fit class carve-outs?

  Answer:
  Under the Health Insur­ance Porta­bil­i­ty and Account­abil­i­ty Act (HIPAA, which is gov­erned by ERISA) and I.R.C. § 125 plan rules, employ­ers are allowed to offer dif­fer­ent con­tri­bu­tion lev­els or ben­e­fit cov­er­age lev­els based upon legit­i­mate nondis­crim­i­na­to­ry busi­ness classifications.

  For exam­ple, part-time and full-time employ­ees, employ­ees work­ing in dif­fer­ent geo­graph­ic loca­tions, and employ­ees with dif­fer­ent dates of hire or lengths of ser­vice can be treat­ed as dif­fer­ent groups (ben­e­fit class­es) of sim­i­lar­ly sit­u­at­ed indi­vid­u­als. Plans that favor high­ly com­pen­sat­ed employ­ees may vio­late the nondis­crim­i­na­tion pro­vi­sions that § 125 cafe­te­ria plans are sub­ject to or I.R.C. § 105(h) if the plans are self-fund­ed. Addi­tion­al­ly, employ­ers must keep in mind whether any carve-outs they are con­sid­er­ing could cre­ate an unin­tend­ed dis­crim­i­na­to­ry impact. The onset of the Afford­able Care Act has added new reg­u­la­tions for insured plans, mir­ror­ing those cur­rent­ly found in § 105(h) regard­ing nondis­crim­i­na­tion in health and wel­fare plans but these reg­u­la­tions are on hold pend­ing addi­tion­al guid­ance from the Inter­nal Rev­enue Service.

  Due to the com­plex­i­ty of test­ing plans for com­pli­ance with the nondis­crim­i­na­tion rules of I.R.C. § 105(h), any employ­er con­sid­er­ing offer­ing health ben­e­fits to only cer­tain class­es of employ­ees should care­ful­ly review all of the pro­vi­sions of that sec­tion and its accom­pa­ny­ing reg­u­la­tions, work close­ly with the ben­e­fits bro­ker to struc­ture the plan design and seek the advice of a knowl­edge­able ben­e­fits law attor­ney for spe­cif­ic guid­ance on its par­tic­u­lar plan.

  Read More …

• The Tail Wagging the Dog…Why does Covered California continue to get preferred treatment?

  December 2, 2014

  It is set up with the endorse­ment and coop­er­a­tion of the Cal­i­for­nia gov­ern­ment. They were allowed to dic­tate the terms of cov­er­age that car­ri­ers could offer. They were allowed to bul­ly the car­ri­ers into keep­ing their costs down, which result­ed in a “nar­row­ing” of net­works, which has caused all sorts of con­fu­sion in the mar­ket. And now…they are fac­ing calls for a state inves­ti­ga­tion of its con­tract­ing prac­tices, after dis­clo­sure of the release of $184 mil­lion in con­tracts that did NOT involve com­pet­i­tive bidding.

  Cov­ered Cal­i­for­nia was giv­en the abil­i­ty to nego­ti­ate no bid con­tracts to meet nec­es­sary dead­lines in 2010…but now it is 2014 and they are con­tin­u­ing to use this abil­i­ty to meet “dead­lines” – but what are they? Recent­ly, Cov­ered Cal­i­for­nia award­ed $184 mil­lion in no bid con­tracts, which coin­ci­den­tal­ly includ­ed deals worth mil­lions to a firm with work­ers hav­ing strong ties to the Cov­ered Cal­i­for­nia Exec­u­tive Direc­tor Peter Lee. The new no bid con­tracts rep­re­sent 20% of the amount of mon­ey Cov­ered Cal­i­for­nia has award­ed to out­side agen­cies. Accord­ing to Peter Lee, he need­ed to move fast and “need­ed expe­ri­enced indi­vid­u­als who could go toe to toe with health plans and bring to our con­sumers the best pos­si­ble insur­ance val­ue” So he couldn’t bid it? He has had four years…

• Speaking of affordability, what happened to that part of the “Affordable” Care Act?

  December 1, 2014

  A new poll from the AP and NORC Cen­ter for Pub­lic Affairs Research shows that 1 in 4 pri­vate­ly insured adults say they doubt they could pay for a major unex­pect­ed ill­ness or injury. The biggest wor­ry, of course, is the high deductible they chose to keep pre­mi­ums down.

• Group Health Plans That Do Not Cover Inpatient Hospital or Physician Services | Petaluma Employee Benefits

  November 28, 2014

  Tags: 2015, Group health plans, Hospital, In-Patient, Physician

  Post­ed by Lin­da Rowings

  Begin­ning in 2015, large employ­ers must offer afford­able, min­i­mum val­ue cov­er­age to their full-time employ­ees or poten­tial­ly pay a penal­ty. Some com­pa­nies have been mar­ket­ing a plan that they state sat­is­fies the min­i­mum val­ue require­ment (an actu­ar­i­al val­ue of 60%), based upon a cal­cu­la­tor pro­vid­ed by the Depart­ment of Health and Human Ser­vices (HHS), even though the plan does not cov­er inpa­tient hos­pi­tal charges. In Notice 2014–69, HHS and the IRS state that plans that do not pro­vide sub­stan­tial cov­er­age for physi­cian and inpa­tient hos­pi­tal ser­vices will not be con­sid­ered min­i­mum val­ue plans, and that the result obtained through the HHS cal­cu­la­tor should not be con­sid­ered valid since that cal­cu­la­tor was built on the assump­tion that a tra­di­tion­al plan design would be used. The agen­cies do rec­og­nize that some employ­ers have already imple­ment­ed these plans based on the cal­cu­la­tor results, and the Notice states that a lim­it­ed excep­tion will be avail­able to those employ­ers. To be able to use the exception:

  1. The employ­er must have had a bind­ing writ­ten com­mit­ment (such as a signed agree­ment) in place before Novem­ber 4, 2014, to adopt this type of a plan, or it must have begun to enroll employ­ees in this type of a plan before that date.
  2. The plan must have a plan year (gen­er­al­ly, an effec­tive date) that begins on or before March 1, 2015.
  3. The employ­er must not state or imply in any employ­ee com­mu­ni­ca­tions that avail­abil­i­ty of the plan that does not pro­vide cov­er­age for inpa­tient hos­pi­tal stays or physi­cian ser­vices will pre­vent the employ­ee from receiv­ing a pre­mi­um tax cred­it, and it must cor­rect any pre­vi­ous com­mu­ni­ca­tions to that effect (note that this may mean that a Sum­ma­ry of Ben­e­fits and Cov­er­age may need to be reissued).

  Employ­ees who are offered cov­er­age under one of these “non-hos­pi­tal/non-physi­cian ser­vices plans” will be eli­gi­ble to receive a pre­mi­um tax cred­it, as long as the oth­er cri­te­ria to receive a tax cred­it are met. How­ev­er, employ­ers that can meet the lim­it­ed excep­tion will be con­sid­ered to have offered min­i­mum val­ue cov­er­age for the 2015 plan year and will not owe a penal­ty for the 2015 plan year even if the employ­ee receives a pre­mi­um tax cred­it. Begin­ning in 2016 non-hos­pi­tal/non-physi­cian ser­vices plans will not be con­sid­ered min­i­mum val­ue for any employ­ers, so employ­ers that qual­i­fy for the lim­it­ed excep­tion will be sub­ject to penal­ties on employ­ees who receive a pre­mi­um tax cred­it unless they offer more com­plete coverage.

  This notice only applies to plans that claim to offer min­i­mum val­ue cov­er­age even though they do not pro­vide sig­nif­i­cant cov­er­age for inpa­tient hos­pi­tal and physi­cian ser­vices. Although some have report­ed that “skin­ny” and “MEC” plans are no longer allowed, that is not cor­rect. Plans that lim­it cov­er­age to pre­ven­tive care (often referred to as “skin­ny” or “MEC” plans) are per­mit­ted and appear to meet the cri­te­ria to be con­sid­ered “min­i­mum essen­tial cov­er­age.” Employ­ers may con­tin­ue to offer a non-hos­pi­tal/non-physi­cian ser­vices plan, and that plan like­ly will meet the require­ment to offer min­i­mum essen­tial cov­er­age, but it will not meet a require­ment to offer min­i­mum val­ue coverage.

  To get the lat­est infor­ma­tion on oth­er plan designs being disallowed—such as employ­er reim­burse­ment of pre­mi­ums for indi­vid­ual cov­er­age, incen­tiviz­ing employ­ees in poor health to enroll in the mar­ket­place, and more—download UBA’s PPACA Advi­sor, “Agen­cies Dis­al­low Sev­er­al Plan Designs; Oth­er Fed­er­al Developments”.

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• What is Affordable just got less so – IRS issues new limits on “affordability”

  November 26, 2014

  The def­i­n­i­tion has been 9.5%. The new def­i­n­i­tion is 9.56%. What does it mean?

  For pur­pos­es of “pay or play” it means that the con­tri­bu­tion made by an employ­ee for the “employ­ee only” share of the pre­mi­um can­not exceed 9.56% of their annu­al wages.

  For pur­pos­es of qual­i­fy­ing for a sub­sidy on the state exchange (Cov­ered Cal­i­for­nia), an employ­ee must have paid more than 9.56% of their annu­al wages for their share of the “employ­ee only” share of the premium

• The ACA will save money…unless you live in Minnesota (which may be trending)

  November 25, 2014

  The top sell­ing med­ical plan on the MN Sure Exchange is Pre­ferred One. Ear­li­er this month the Min­neso­ta Depart­ment of Com­merce announced that Min­neso­ta would con­tin­ue to have among the “low­est health insur­ance rates in the coun­try” with an increase of only 4.5% — but Pre­ferred One has announced new rates that will see an aver­age increase of 63% due to “high claims costs” (which more than a few were pre­dict­ing would be the result of the ACA rules on issu­ing cov­er­age with­out med­ical review and with­out lim­i­ta­tions on pre exist­ing med­ical conditions)

• Transitional Reinsurance Fee Filing Date Extended to December 5 | CA Benefits Broker

  November 24, 2014

  Tags: Centers for Medicare and Medicaid Services, CMS, December 5, extended, Transitional Reinsurance Fee, TRF

  Post­ed by Lin­da Rowings

  The Cen­ters for Medicare and Med­ic­aid Ser­vices (CMS) extend­ed the dead­line for group health plans to pro­vide their 2014 tran­si­tion­al rein­sur­ance fee (TRF) sub­mis­sion. Fil­ing is now due by 11:59 p.m. on Decem­ber 5, 2014. The Jan­u­ary 15, 2015, and Novem­ber 15, 2015, dead­lines to pay the fee remain the same. For more infor­ma­tion on the TRF, see our recent blog. For the answers to near­ly 30 ques­tions about fil­ing, due dates, cal­cu­la­tion meth­ods, pay­ment, sub­mis­sion and more, CLICK HERE to Request UBA’s “Fre­quent­ly Asked Ques­tions about the Tran­si­tion­al Rein­sur­ance Fee (TRF)”.

  Read More ..

• What’s in a number? Senate Budget Committee updates Senator Dirksen’s maxim on ACA

  November 24, 2014

  Sen­a­tor Everett Dirk­sen said in the Six­ties “a bil­lion here, a bil­lion there, pret­ty soon you’re talk­ing about real mon­ey” Such has been the con­found­ing and con­flict­ing analy­ses sur­round­ing the Afford­able Care Act. The last review by the Con­gres­sion­al Bud­get Office pre­dict­ed that the ACA would reduce the fed­er­al deficit by $100 bil­lion. Now the Sen­ate Bud­get Com­mit­tee has pro­ject­ed that the ACA will increase the fed­er­al deficit by $130 bil­lion. Of course, that was accord­ing to the Repub­li­can mem­bers of that committee…

• We Knew it and the Carriers Knew it – did anyone else know it? Sicker people have enrolled in ACA plans

  November 21, 2014

  So when you offer new, afford­able cov­er­age on a guar­an­teed basis is it pos­si­ble that those who have been wait­ing for the oppor­tu­ni­ty to get such cov­er­age and use it will actu­al­ly enroll? As sus­pect­ed, the answer is yes. The New York Times reports that two new stud­ies using pre­scrip­tion drug data found that exchange poli­cies cov­er old­er peo­ple with more chron­ic ill­ness­es than employ­er poli­cies. As Prime Ther­a­peu­tics Chief Mar­ket­ing Offi­cer Michael Showal­ter said “We orig­i­nal­ly sug­gest­ed this may be a sick­er pop­u­la­tion. What I can tell you offi­cial­ly today is that this real­ly is a sick­er population”

• Independent Contractor vs Employee | CA Benefits Broker

  November 20, 2014

  Tags: contractor, employee, independent, IRS

  By K. Michael Ward
  The Wil­son Agency
  A UBA Part­ner Firm

  As a busi­ness pro­fes­sion­al who is try­ing to clas­si­fy a work­er, it is impor­tant to remain com­pli­ant with the IRS reg­u­la­tions that deter­mine whether an indi­vid­ual pro­vid­ing ser­vices to your orga­ni­za­tion should be clas­si­fied as an inde­pen­dent con­trac­tor or an employee.

  Fur­ther­more, the “employ­er man­date” sec­tion of the Patient Pro­tec­tion and Afford­able Care Act (PPACA) requires com­pa­nies with 50 or more employ­ees to either pro­vide ade­quate and afford­able cov­er­age to their work­ers or pay tax penal­ties. Unit­ed Ben­e­fit Advi­sors (UBA) has devel­oped a guide to help employ­ers deter­mine how many employ­ees they have for sev­er­al pur­pos­es under PPACA. Those who think they are exempt need to make sure they are count­ing employ­ees cor­rect­ly so they’re not sur­prised with penalties.

  The guide pro­vides the def­i­n­i­tions of full-time employ­ees, how to count part-time employ­ees on a pro-rata basis, how to treat sea­son­al employ­ees, who the law con­sid­ers an “employ­ee,” count­ing hours cor­rect­ly, deter­min­ing aver­age hours worked, penal­ties that result if a “large employ­er” does­n’t offer cov­er­age, apply­ing the require­ment to offer cov­er­age, pay­ing the penal­ty, and eli­gi­bil­i­ty for the Small Busi­ness Health Options Pro­gram (SHOP).

  Your UBA Part­ner Firm can help you find the com­pli­ance solu­tions spe­cif­ic to the issues your com­pa­ny is fac­ing. Vis­it the UBA web­site to learn more.

  Why does it matter?

  Not cor­rect­ly clas­si­fy­ing an indi­vid­ual as an employ­ee can lead to an employ­er being required to pay tax­es, such as unem­ploy­ment tax, that would have been required of the employ­er if the indi­vid­ual had been cor­rect­ly clas­si­fied. The orga­ni­za­tion may also be held liable for over­time pay, result­ing in a cost­ly expense for the orga­ni­za­tion. In cer­tain sit­u­a­tions, the issue can esca­late lead­ing to civ­il law­suits against the employer.

  How do I know how to clas­si­fy individuals?

  Gen­er­al­ly, an indi­vid­ual is an inde­pen­dent con­trac­tor if the employ­er con­trols only the final result of the work and not when, where and how it will be done. There­fore, employ­ers can­not demand that inde­pen­dent con­trac­tors work a “9–5” sched­ule in their office. If the per­son is an inde­pen­dent con­trac­tor, they are free to per­form the work on a beach at 4 a.m., as long as they pro­duce the ser­vices for which they were hired.

  An indi­vid­ual may also be clas­si­fied as an employ­ee if the com­pa­ny pro­vides the major­i­ty of the equip­ment used to per­form the ser­vices. Inde­pen­dent con­trac­tors will gen­er­al­ly work with their own equip­ment and are unlike­ly to be reim­bursed for any equip­ment pur­chas­es required to per­form the job.

  Some oth­ers fac­tors to take into con­sid­er­a­tion are the time peri­od of hire and whether the indi­vid­ual pro­vides ser­vices that are inte­gral to the busi­ness. If an indi­vid­ual has been hired on an indef­i­nite basis, ver­sus for a spe­cif­ic project or time peri­od, and/or pro­vides key ser­vices, then the employ­ee may be clas­si­fied as an employee.

  There are a vari­ety of oth­er nuances that can deter­mine whether an indi­vid­ual is an inde­pen­dent con­trac­tor or an employ­ee. There­fore, it is advised that you speak with a pro­fes­sion­al before tak­ing action that could have an adverse effect on your business.

  Read More …

• Save at Wal Mart! They’re cutting prices by cutting benefits!

  November 19, 2014

  While say­ing that the cut rep­re­sents only 2% of their employ­ee pop­u­la­tion, have you seen how many peo­ple that involves? Yes 30,000 employ­ees work­ing less than 30 hours per week at Wal Mart will see their ben­e­fits elim­i­nat­ed effec­tive Jan­u­ary 1. This fol­lows moves made by Home Depot, Walgreen’s, Trad­er Joe’s and Tar­get. Wal Mart had pre­vi­ous­ly cut back its pro­gram in 2011 to elim­i­nate cov­er­age of asso­ciates work­ing few­er than 24 hours per week. Of course, these peo­ple will need some­where to go…so look for more sub­si­dies on the exchanges.

• Can Employers Assist Employees with Premiums for Individual Plans? | CA Employee Benefits

  November 18, 2014

  Tags: DOL, employees, employers, FAQ, HHS, individual plans, premiums

  Post­ed by Car­ol Taylor

  On Novem­ber 6, 2014, the col­lec­tive Depart­ments of Health and Human Ser­vices (HHS), Labor (DOL) and the Trea­sury released three Fre­quent­ly Asked Ques­tions (FAQs) direct­ed at employ­er pay­ment plans for the pur­chase of indi­vid­ual insur­ance. While the depart­ments had pre­vi­ous­ly released sev­er­al oth­er pieces of guid­ance about these arrange­ments, this lat­est round exclaimed an emphat­ic no!

  The oth­er releas­es on the top­ic start­ed well over a year ago. How­ev­er, there are still agents and admin­is­tra­tors that have insist­ed either Sec­tion 125 (Cafe­te­ria Plans) or Sec­tion 105 (Reim­burse­ment Arrange­ments) of the IRS code allowed employ­ers to deduct pre­mi­ums in a pre­tax man­ner or reim­burse for indi­vid­ual pre­mi­ums. Sev­er­al of the admin­is­tra­tors tout­ing these plans even went as far as claim­ing they were so con­fi­dent in their inter­pre­ta­tion of the reg­u­la­tions, that they would pay any fines incurred because of their advice that these plans were com­pli­ant. This lat­est round of clar­i­fi­ca­tion was a resound­ing com­ply or pay fines.

  Any employ­er pay­ment that pro­vides cash reim­burse­ment for the pur­chase of an indi­vid­ual mar­ket pol­i­cy is not com­pli­ant with the Patient Pro­tec­tion and Afford­able Care Act (PPACA), whether the employ­er treats the mon­ey as pre­tax or post-tax to the employ­ee. It is inter­est­ing to note that the lat­ter pro­vi­sion has not been present in oth­er reg­u­la­to­ry releas­es, but is new with this round. While it is not clear at the moment how that would apply, a post-tax amount would put the insured in a pre­car­i­ous posi­tion, sub­ject to fines and pay­back of sub­si­dies on their own, since the addi­tion­al income could low­er the sub­sidy that they would oth­er­wise qual­i­fy for, with­out the assis­tance from the employer.

  Like­wise, if a Sec­tion 105 reim­burse­ment plan is set up for the pur­chase of indi­vid­ual poli­cies, these plans are deemed non­com­pli­ant. The basis for this deter­mi­na­tion is the employer’s involve­ment of the plan, even though they may not have assist­ed the indi­vid­ual with their plan selec­tion, they are still tak­ing part by con­tribut­ing cash for the pol­i­cy purchase.

  Anoth­er ques­tion delves into com­pen­sat­ing employ­ees that have a high claims risk to enroll in a Mar­ket­place plan ver­sus join­ing the group health plan offered by the employ­er. This sce­nario involves oth­er fac­tors that are pro­hib­it­ed, such as dis­crim­i­nat­ing due to a health fac­tor and eli­gi­bil­i­ty rule dis­crim­i­na­tion. These plans also fail due to the employ­er-pro­vid­ed pay­ment for pur­chase of an indi­vid­ual plan.

  In all of these sce­nar­ios, since they would be deemed a group health plan, they would be sub­ject to the mar­ket reforms such as unlim­it­ed life­time max­i­mum ben­e­fits, pre­ven­tive care cov­er­age at no cost share and oth­er aspects of the law. This could also open the door for law­suits against the employ­er if the indi­vid­ual pol­i­cy failed to pay a claim for the insured.

  The FAQs ref­er­ence the fines that would apply in these instances under Sec­tion 4980D. In the May 2014 release from the IRS, they spelled out the excise fines as $100 per day, per employ­ee or $36,500 annu­al­ly. How­ev­er, these fines are an excise tax in the amount of $100 per day with respect to each indi­vid­ual to whom such fail­ure relates. So, if the employ­er were to con­tribute to depen­dents’ cov­er­age, the fines would also be incurred for each depen­dent per day, in addi­tion to the employee.

  It is always best to get a plan into com­pli­ance as quick­ly as pos­si­ble. With many of these hav­ing been put into place ear­li­er this year, there is still time to cor­rect at least part, but not all, of the issues. Speak with your tax coun­sel as quick­ly as pos­si­ble to get your plans into com­pli­ance. Your local Unit­ed Ben­e­fit Advi­sors office, with their vast com­pli­ance resources, can also assist you with these issues.

  Read More …

• California has conceived a new law – no cost contraception

  November 18, 2014

  Gov­er­nor Brown signed into law SB 1053 which ensures access to no cost con­tra­cep­tion ser­vices for both men and women. The Afford­able Care Act already requires insur­ers to cov­er FDA approved con­tra­cep­tion with­out co pay­ments. Now the new law will require no cost cov­er­age for vasec­tomies and oth­er male con­tra­cep­tive devices.

• On the other hand, look at how much money they saved…

  November 17, 2014

  The ACA is expect­ed to low­er uncom­pen­sat­ed hos­pi­tal care by $5.7 bil­lion this year. The Wash­ing­ton Post said this comes as a direct result of the fact that more peo­ple have health insur­ance cov­er­age to pay for care.

• Arrow Benefits Group on the Cover of North Bay Business Journal

  November 13, 2014

  

• Healthcare.gov disaster was also expensive — $2.1 billion and counting

  November 13, 2014

  Accord­ing to a Bloomberg Gov­ern­ment analy­sis, the cost is $2.1 bil­lion, which exceeds the most recent­ly pro­vid­ed gov­ern­ment esti­mate, which was $834 mil­lion. Wasn’t it Sen­a­tor Dirk­sen who said, “a bil­lion here and a bil­lion there and pret­ty soon you’re talk­ing about real money”

• Reference-Based Pricing and Cost-Sharing Limits | California Benefits Broker

  November 12, 2014

  Tags: Cost-Sharing, Department of Health and Human Services, Department of Labor, DOL, HHS, IRS, Limits, Pricing, Reference-Based

  Post­ed by Lin­da Rowings

  The Depart­ment of Labor (DOL), the IRS, and the Depart­ment of Health and Human Ser­vices (HHS) have joint­ly issued a FAQ that address­es how “ref­er­ence-based pric­ing” works with the Patient Pro­tec­tion and Afford­able Care Act’s (PPACA) restric­tions on out-of-pock­et max­i­mums. PPACA lim­its the out-of-pock­et max­i­mum a non-grand­fa­thered plan may impose, and gen­er­al­ly requires that co-pays, coin­sur­ance, and deductibles be count­ed toward this lim­it. How­ev­er, pre­mi­ums, bal­ance billed amounts for non-net­work providers, and non-cov­ered ser­vices do not need to be applied to the out-of-pock­et lim­it. (For 2015, the lim­its are $6,600 per indi­vid­ual or $13,200 per fam­i­ly.) The new FAQ explains how the out-of-pock­et lim­it applies to plans that use ref­er­ence-based pricing–i.e., a design under which the plan pays a fixed amount for a par­tic­u­lar pro­ce­dure (such as a knee replace­ment), which cer­tain providers have agreed to accept as full payment.

  The FAQ states that the agen­cies will per­mit the ref­er­ence price to be treat­ed as the in-net­work price, as long as the plan uses a rea­son­able method to pro­vide ade­quate access to qual­i­ty providers who are will­ing to accept the ref­er­ence price. The agen­cies will deter­mine whether a plan that uses ref­er­ence-based pric­ing (or a sim­i­lar net­work design) is using a rea­son­able method to ensure ade­quate access to qual­i­ty providers based on:

  • The Type of Ser­vice. Plans may treat providers that accept the ref­er­ence price as the sole net­work providers only for those ser­vices for which con­sumers have enough time to make an informed choice of provider. For exam­ple, this design is not appro­pri­ate for emer­gency services.
  • Rea­son­able Access. Plans should ensure the avail­abil­i­ty of an ade­quate num­ber of providers that accept the ref­er­ence price. Con­sid­er­a­tions include net­work ade­qua­cy approach­es devel­oped by the states, geo­graph­ic dis­tance mea­sures, and patient wait times.
  • Qual­i­ty Stan­dards. Plans should ensure that an ade­quate num­ber of providers accept­ing the ref­er­ence price meet rea­son­able qual­i­ty standards.
  • Excep­tions Process. Plans should offer an eas­i­ly acces­si­ble excep­tions process when access to a provider that accepts the ref­er­ence price is unavail­able or would com­pro­mise the qual­i­ty of ser­vices for a par­tic­u­lar indi­vid­ual because, for exam­ple, of the patien­t’s oth­er med­ical issues.

  Dis­clo­sure. Plans should pro­vide, auto­mat­i­cal­ly and free of charge, infor­ma­tion about the pric­ing struc­ture, includ­ing the ser­vices to which it applies and the excep­tions process. In addi­tion, the plan should pro­vide spec­i­fied infor­ma­tion, such as provider lists, upon request.

  For more infor­ma­tion to help you bench­mark your health plan’s out of pock­et lim­its with oth­er employ­ers of sim­i­lar size, indus­try and geog­ra­phy, pre-order the 2014 UBA Health Plan Sur­vey Exec­u­tive Sum­ma­ry which will soon be avail­able with the lat­est data from near­ly 17,000 plans.

  Read More …

• Don’t have an I‑Phone? Well Apple has other needs handled with their new Health Kit

  November 12, 2014

  Apple is launch­ing a mobile health track­ing sys­tem that will enable peo­ple to gath­er infor­ma­tion on their health via their iPhone or the new Apple Watch. Tired of the Fit Bit? Now you can get to the core of the prob­lem. Not only will they track, but you can send the infor­ma­tion to an online health record accessed by your pri­ma­ry care physi­cian imme­di­ate­ly. So will this be an addi­tion­al means of mov­ing from an employ­er based health insur­ance sys­tem to consumer?

• Can the IRS really police all the penalties? Not without funding…though they disagree

  November 11, 2014

  The IRS Com­mis­sion­er John Kosk­i­nen said the IRS is not get­ting the fund­ing they need to deal with the new fil­ing require­ments regard­ing com­pli­ance with the indi­vid­ual man­date. They have asked for $430 mil­lion which includes $300 mil­lion to build out need­ed sys­tems. Regard­less, they will plow ahead (giv­en that they have no choice)

• Requirement to Obtain a Health Plan Identifier (HPID) Delayed | California Employee Benefits

  November 10, 2014

  Tags: delay, Health Plan Identifier, HPID

  By Lin­da Rowings

  On Fri­day, Octo­ber 31, 2014, the Depart­ment of Health and Human Ser­vices (HHS) qui­et­ly updat­ed its Health Plan Iden­ti­fi­er infor­ma­tion page to delay the require­ment that insur­ance car­ri­ers and self-fund­ed health plans obtain a health plan iden­ti­fi­er (HPID). The delay is in effect until fur­ther notice.

  Plans that have already obtained their HPID do not need to take any action. Those that do not yet have the num­ber do not need to com­plete the process.

  This delay does not affect the Tran­si­tion­al Rein­sur­ance Fee (TRF) fil­ing — that sub­mis­sion remains due Novem­ber 15, 2014. For the answers to near­ly 30 ques­tions about TRF fil­ing, due dates, cal­cu­la­tion meth­ods, pay­ment, sub­mis­sion and more, CLICK HERE to Request UBA’s “Fre­quent­ly Asked Ques­tions about the Tran­si­tion­al Rein­sur­ance Fee (TRF)”.

  Read More …

• Now you see it – Now you don’t – what about my subsidy? Many to lose them

  November 10, 2014

  It is esti­mat­ed by CMS (which runs Medicare and Med­iCal) that near­ly half a mil­lion peo­ple could lose sub­si­dies or health insur­ance cov­er­age they obtained through the ACA. Of this round num­ber, 363,000 could lose the sub­sidy due to an inabil­i­ty to ver­i­fy qual­i­fy­ing income and 115,000 could have their poli­cies can­celled because they could not prove immi­gra­tion status

• California Nonexempt Employee Meal Breaks | Arrow Benefits Group

  November 7, 2014

  Tags: california, employee meals, rest periods

  Ques­tion:

  Can Cal­i­for­nia nonex­empt employ­ees waive lunch breaks? What are the require­ments for the two rest breaks for an 8‑hour shift?

  Answer:

  In Cal­i­for­nia, if employ­ees work more than 6 hours in a work­day, they may not waive their meal peri­od. Accord­ing to the Cal­i­for­nia Labor Code, an employ­er may not employ an employ­ee for a work peri­od of more than 5 hours per day with­out pro­vid­ing the employ­ee with a meal peri­od of no less than 30 minutes.

  How­ev­er, if the total work peri­od per day of the employ­ee is no more than 6 hours, the meal peri­od may be waived by mutu­al con­sent of both the employ­er and employ­ee. An employ­er may not employ an employ­ee for a work peri­od of more than 10 hours per day with­out pro­vid­ing the employ­ee with a sec­ond meal peri­od of no less than 30 min­utes. How­ev­er, if the total hours worked is no more than 12 hours, the sec­ond meal peri­od may be waived by mutu­al con­sent of the employ­er and the employ­ee only if the first meal peri­od was not waived.

  In Cal­i­for­nia, employ­ees are enti­tled to a 10-minute paid rest peri­od for every 4 hours worked. Each rest peri­od is sup­posed to take place as close to the mid­dle of each 4‑hour work peri­od as possible.

  Exam­ple of Meal and Rest Peri­ods in an 8‑Hour Shift

  John Doe is sched­uled to work 8 a.m. to 4:30 p.m. He is allowed two 10-minute paid rest peri­ods and one 30-minute unpaid meal peri­od dur­ing his 8‑hour shift. John Doe takes his rest and meal peri­ods as fol­lows, in com­pli­ance with Cal­i­for­nia meal and rest peri­od requirements:

  10:15 a.m.: 10-minute rest period
  12:30 p.m. to 1 p.m.: 30-minute unpaid meal period
  3:30 p.m.: 10-minute rest period

  John Doe received his meal peri­od before the end of the 5th work­ing hour and both his rest peri­ods in the mid­dle of each 4 hours worked.

  Sources:

  www.dir.ca.gov/dlse/faq_mealperiods.htm
  www.dir.ca.gov/dlse/faq_restperiods.htm

  Read More …

• Hospitals want to do a Wallet ectomy – new rules on paying bills up front

  November 7, 2014

  As peo­ple that have insur­ance are respon­si­ble for a big­ger por­tion of their med­ical bills, hos­pi­tals are more con­cerned about col­lect­ing. Now 41% of Amer­i­cans have deductibles of $1,000 or more, which is up from 10% in 2006. Add to those cov­ered by their employ­ers with the new­ly cov­ered 7 mil­lion or so, almost all of whom chose high deductible health plans. Hos­pi­tals total cost of uncom­pen­sat­ed care reached $46 bil­lion in 2012, which is equal to 6% of their expens­es. So now many hos­pi­tals try to get patients to pay up front 30 to 50% of what they will owe and some offer dis­counts for pay­ing early.

• Marketplace Notice is not an Annual Notice – but must be provided

  November 6, 2014

  When the Exchange plans (now called Mar­ket­place plans) were begun, the gov­ern­ment required that all employ­ers let employ­ees know of its exis­tence and some details. There was some con­fu­sion, as employ­ers assumed (and the gov­ern­ment did not make it clear either way) that the notice had to be pro­vid­ed annu­al­ly. Actu­al­ly, it does not – it only needs to be giv­en to employ­ees when they become eli­gi­ble for ben­e­fits offered by the employer.

• New Rules – Cafeteria Plan Mid Year Changes

  November 5, 2014

  IRS Notice 2014–55 per­mits a cafe­te­ria plan to allow an employ­ee to revoke their elec­tion under the cafe­te­ria plan regard­ing med­ical insur­ance cov­er­age at such time as they are eli­gi­ble for and elect to enroll in a Mar­ket­place (Exchange) plan

  What they did not say in their notice is that some­one should care­ful­ly con­sid­er whether they are get­ting a bet­ter deal by buy­ing cov­er­age with after tax dol­lars vs. pre tax dol­lars, and also what the val­ue of any sub­sidy they may receive would be to off­set the dif­fer­ence. Note that the sub­sidy is NOT avail­able to those that have cov­er­age avail­able through their employer

• New Limits

  November 4, 2014

  HSA for 2015: the annu­al con­tri­bu­tion lim­its are raised to $3,350 for self only and $6,650 family

  The min­i­mum annu­al required deductible is raised from $1,250 to $1,300

  PCORI Tax: raised from charge for 10/1/14 to 10/1/15 from $2 per mem­ber per year to $2.08

  Medicare Part B pre­mi­ums will remain unchanged

• Breast cancer awareness month events | Petaluma Benefits Broker

  October 14, 2014

  Tags: breast cancer, petaluma, pink ribbon, women's health

  Dur­ing the month of Octo­ber, many busi­ness­es and indi­vid­u­als are doing their part to increase aware­ness on treat­ing and pre­vent­ing breast can­cer, and to raise funds in the fight against the dis­ease. Here are a few fun events you can attend to help the cause.

  Thurs­day, Oct. 16

  Get­ting Things Off My Chest: After sur­viv­ing breast can­cer, Melanie Young wrote her first book, “Get­ting Things Off My Chest: A Survivor’s Guide to Stay­ing Fear­less & Fab­u­lous in the Face of Breast Can­cer,” a wit­ty and prac­ti­cal guide to help new­ly diag­nosed women remain focused and able to make smarter choic­es through­out their recov­ery. On Thurs­day, Oct. 16, Young will be the guest speak­er at the North Bay Can­cer Alliance event at the Flamin­go Resort in San­ta Rosa. Reg­is­tra­tion begins at 6 p.m for the 6:30 p.m event. Sug­gest­ed dona­tion is $15. Par­tial pro­ceeds from book sales will ben­e­fit the Alliance. For more infor­ma­tion, call Pat Nees at 528‑0282, or vis­it northbaycancer.org.

  Sat­ur­day, Oct. 18

  Sis­ters 5K Walk/Run: This event kicks off at Sis­ters Bou­tique in Yountville with a high-heel dash at 8:30 a.m., fol­lowed at 9 a.m. by a 5K run/walk and a post-5K cel­e­bra­tion. The event will include food and wine, shop­ping oppor­tu­ni­ties, swag bags and a silent auc­tion. Tick­ets are $35 for the 5K, $20 for the cel­e­bra­tion, ben­e­fit­ing Car­ing­Bridge, Breast Can­cer Emer­gency Fund and Pink Heals Napa Val­ley. Details at sisterscrushbreastcancer.org.

  Sat­ur­day, Oct. 18

  Gra­ton Ridge Cel­lars Pink Par­ty: In its 6th year of cel­e­brat­ing Breast Can­cer Aware­ness Month, Gra­ton Ridge Cel­lars will be bring­ing out the pink boas for every­one who pur­chas­es wine at the event. A por­tion of wine sales will be donat­ed to Sut­ter North Bay Women’s Health Cen­ter in San­ta Rosa. Whether you can attend or not, the win­ery is encour­ag­ing every­one to send in the name and pho­to of loved ones affect­ed by breast can­cer so they can add it to their “Pret­ty in Pink” Wall of Fame. Admis­sion is $10 per per­son, and the event starts at 11 a.m. Vis­it gratonridge.com for more information.

  Fri­day, Oct. 24

  Healthy Habits for Healthy Breasts: As part of its Women’s Night Out series, Kaiser Per­ma­nente San­ta Rosa hosts a free pre­sen­ta­tion about reduc­ing risk for breast can­cer. It will cov­er fac­tors that could affect breast can­cer risk and the impact of lifestyle. Keynote speak­ers are Loie Sauer, M.D. and Paula Kelle­her, NP. Check-in begins at 6 p.m. in con­fer­ence rooms E‑3, E‑4, and E‑5, Med­ical Build­ing East at 401 Bicen­ten­ni­al Way, with pre­sen­ta­tion 6:30–8:30 p.m. Reg­is­ter at surveymonkey.com/s/H5DS98C. More infor­ma­tion: bit.ly/KaiserOctNightOut.

• HR/Benefits Industry Leader Announces New Company Name — Arrow Benefits Group

  October 7, 2014

  UBA Partner Continues Legacy of Elevating Industry Standards

  Petaluma, CA—For over 30 years, the names and rep­u­ta­tions of Jor­dan Shields and Kei­th McNeil have been syn­ony­mous with lead­ing the path for change and improv­ing the Ben­e­fits indus­try. Now called Arrow Ben­e­fits Group (for­mer­ly The SSM Group), their team remains the 3^rd largest ben­e­fits com­pa­ny in the North Bay. “We human­ize Human Resources,” says Shields, “This is an excit­ing time of change in our indus­try and peo­ple need the right team of spe­cial­ists to guide them.” Ben­e­fits are about people’s lives, hopes, and dreams. Arrow Ben­e­fits Group takes these ideals seri­ous­ly — pro­tect­ing over 900 clients. Shields and McNeil, along with two gen­er­a­tions of fam­i­ly and a team of indus­try experts, con­tin­ue their mis­sion to build solu­tions unique­ly tai­lored to match their clients’ needs. They have re-brand­ed the com­pa­ny to bet­ter tell their sto­ry includ­ing the addi­tion of sev­er­al new divi­sions. Watch Our New Com­pa­ny Video & Tes­ti­mo­ni­als Here & Con­tact us with Any Questions!

  Arrow Ben­e­fits Group “is not tied to any oth­er cor­po­rate orga­ni­za­tion,” explains McNeil, “we own the company—we own the work and rep­re­sent the bot­tom line for clients.” To take good care of peo­ple, you need this kind of account­abil­i­ty and flex­i­bil­i­ty. Every­thing at Arrow is done in-house with­out mid­dle­men, and each team mem­ber is ful­ly empow­ered to craft any solu­tion need­ed in a spe­cif­ic “Blue­print” for each client. Arrow pro­vides a diverse array of employ­er ser­vices relat­ed to employ­ee ben­e­fits man­age­ment and com­pli­ance includ­ing: a new HR divi­sion with 10 expe­ri­enced human resource con­sul­tants, Third Par­ty Admin­is­tra­tor (TPA) doing COBRA, Flex, self-fund­ed dental/vision, and an “Umbrel­la” pro­gram incor­po­rat­ing the prac­tices and expe­ri­ence of a diverse range of expert health insur­ance agents, which com­ple­ments their large bro­ker­age team.

  HR advo­cates through­out their careers, Shields and McNeil have shaped many indus­try advance­ments prac­ticed today. McNeil was one of the founders and devel­op­ers of Enwisen, which is the pre­mier ben­e­fits com­mu­ni­ca­tion plat­form now used by For­tune 500 sized com­pa­nies such as 20^th Cen­tu­ry Fox, ConA­gra and Unisys. He has served on mul­ti­ple indus­try boards and co-found­ed the “Task Force on Low­er­ing Health Insur­ance Costs,” a resource for large employ­ers and bro­kers. Shields is the for­mer Chair­man and long-time board mem­ber of Unit­ed Ben­e­fit Advi­sors (UBA) one of the largest ben­e­fits con­sult­ing and bro­ker­age firms in the coun­try. He has also served on numer­ous pres­ti­gious indus­try boards. High­ly active with­in the com­mu­ni­ty and youth based orga­ni­za­tions, Shields has authored sev­er­al arti­cles and books about the ben­e­fits industry.

  We’ve worked with Arrow Ben­e­fits Group for so long because of the out­stand­ing ser­vice lev­el they pro­vide. They real­ly under­stand what we’re try­ing to do, and they help us meet the needs of our employ­ees. I’ve been very pleased with their tech­ni­cal exper­tise, espe­cial­ly how they ensure we’re in compliance.

  —Bob Gotel­li, Direc­tor of Human Resources, Bank of Marin

  See all our lat­est videos and tes­ti­mo­ni­als on our new­ly updat­ed web­site! Please feel free to con­tact us with any questions—we’re here to speak with you any­time you need us.

  ---

   

  About Arrow Ben­e­fits Group

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

  We work very per­son­al­ly as advi­sors deter­min­ing spe­cif­ic needs, pri­or­i­tiz­ing goals, and pro­vid­ing tech­nol­o­gy tools that will stream­line costs and improve over­all ben­e­fits pack­ages. The Arrow Ben­e­fits Group employs a for­mal and sophis­ti­cat­ed process, sup­port­ed by data and HR ana­lyt­ics that save time and mon­ey while build­ing a blue­print and liv­ing ben­e­fit mod­el, con­tin­u­al­ly adapt­able to chang­ing needs.

  ###

• How Do Insurance Companies Test for Nicotine? | California Employee Benefits

  September 26, 2014

  By Chris Sherwood

  

  Intro­duc­tion

  When apply­ing for life insur­ance, and in some cas­es health insur­ance, cer­tain lifestyle habits may end up cost­ing you more each months in pre­mi­ums. One of these habits is smok­ing or oth­er nico­tine use. Employ­ers who pro­vide health insur­ance as part of their ben­e­fits pack­age may also charge more in pre­mi­ums for smok­ers. Even if you mark non-smok­er on your appli­ca­tion form, many insur­ance com­pa­nies require a med­ical exam before offer­ing cov­er­age. Lying about smok­ing habits on your insur­ance appli­ca­tion can cause an imme­di­ate denial of coverage.

  Sam­ples

  All nico­tine tests are done using a bod­i­ly sam­ple. Although nico­tine can be test­ed through sali­va and hair, most com­mon­ly nico­tine is test­ed in urine or blood sam­ples. This is because, in most cas­es, a blood or urine sam­ple is a reg­u­lar part of a phys­i­cal exam­i­na­tion for insurance.

  Results

  Most nico­tine tests are done using com­pet­i­tive immunoas­say. In this test­ing process, test­ing strips are coat­ed with a sub­stance that acts as a coti­nine anti­gen. The urine is mixed with a gold anti­body, which will col­or the anti­gen line once the two come in con­tact with each oth­er. Once the test­ing strip is placed in con­tact with the urine and anti­body mix­ture, the mix­ture will absorb into the strip. If coti­nine is present in the urine, the coti­nine will pre­vent the anti­body from col­or­ing the anti­gen line, result­ing in a pos­i­tive test result. If no coti­nine is present in the urine, the anti­body will freely col­or the anti­gen line, result­ing in a neg­a­tive result.

  Length of Time

  Although nico­tine can only be test­ed in the blood for a few hours after using, due to its fast metab­o­lism by the liv­er, the result­ing metabo­lite coti­nine can remain much longer in your urine and blood. In fact, accord­ing to the Foun­da­tion for Blood Research, coti­nine can be test­ed in your sys­tem for up to 10 days before drop­ping back to the lev­el of a non-smok­er. For those who have smoked for many years, it may take even longer to drop to normal.

  Rea­son­ing

  Insur­ance com­pa­nies base their pre­mi­ums off of health risks. The high­er chance you will need to access your cov­er­age (such as through health­care costs or death), the more mon­ey they will even­tu­al­ly have to pay out to cov­er those costs. Accord­ing to the Amer­i­can Heart Asso­ci­a­tion, more than 444,000 deaths in the Unit­ed States alone can be attrib­uted to nico­tine use through cig­a­rette smok­ing. Nico­tine use also increas­es rates for heart dis­ease, and even some forms of can­cer, both of which are expen­sive to treat. To make up for the increased finan­cial risk of using nico­tine, insur­ance com­pa­nies charge more to these indi­vid­u­als for insurance.

  Read More …

• Did you really think they wouldn’t figure a way out – insurers trick the sick

  September 26, 2014

  They’re not stu­pid, you know. They have found ways to avoid risk and make prof­its for a long time. Still can, appar­ent­ly. Car­ri­er crit­ics are now up in arms (belat­ed­ly) about the new prac­tices that are bur­den­ing those who are try­ing to take advan­tage of what Pres­i­dent Oba­ma promised. Over 300 patient advo­ca­cy groups recent­ly wrote the new HHS Sec­re­tary with their con­cerns say­ing that the insur­er prac­tices “are high­ly dis­crim­i­na­to­ry against patients with chron­ic health con­di­tions and may…violate the (law’s) nondis­crim­i­na­tion pro­vi­sions” Well, not exact­ly. Cre­ate a large bill and expect a lot of space with­in which to find loop­holes, of which they took advan­tage. Among their con­cerns are dif­fi­cul­ties con­sumers face in try­ing to get a full pic­ture of the plans avail­able on the exchange (true in part, but they dis­count the val­ue of agents in help­ing peo­ple find what they need), nar­row­ing of net­works (also required because of the demands of states such as Cal­i­for­nia to con­trol costs), and cut­backs in what are con­sid­ered to be pre­ferred drugs which must be list­ed to be cov­ered (no pro­hi­bi­tion against that, so car­ri­ers “took a shot”) as well as con­vert­ing some to co-insur­ance rather than using co-payments.

• Mid-Year Qualifying Events and Tag-Along Rule | California Benefits Broker

  September 22, 2014

  

  Ques­tion:
  If an employ­ee is adding a new baby to his health­care plan, can this employ­ee also add his spouse at the same time?

  Answer:
  Please review your plan doc­u­ments to deter­mine whether your Sec­tion 125 cafe­te­ria plan allows for mid-year elec­tion changes. If so, an employ­ee would gen­er­al­ly be allowed to add his or her spouse to the plan if the employ­ee has a mid-plan year qual­i­fy­ing event such as the birth of a child. This is called the “tag along” rule.

  Read More …

• California Paid Sick Leave | Arrow Benefits Group

  September 19, 2014

  On Sep­tem­ber 10, 2014, Cal­i­for­nia Gov­er­nor Jer­ry Brown signed into law the Healthy Work­places, Healthy Fam­i­lies Act of 2014 (A.B. 1522). The law requires Cal­i­for­nia employ­ers to pro­vide employ­ees at least three paid sick days (24 hours) per year. With the sign­ing, Cal­i­for­nia joins Con­necti­cut as one of only two states that require employ­ers to pro­vide paid sick leave. The law goes into effect on July 1, 2015.

  Who is cov­ered by the law?

  California’s paid sick leave law gen­er­al­ly applies to all employ­ers and employ­ees; how­ev­er, the law does not apply to indi­vid­u­als who pro­vide in-home sup­port­ive ser­vices (as defined by the state Wel­fare and Insti­tu­tions Code), cer­tain air car­ri­er employ­ees such as flight deck or cab­in crew mem­bers sub­ject to the fed­er­al Rail­way Labor Act (45 U.S.C. 181 et seq.), or employ­ees cov­ered by a valid col­lec­tive bar­gain­ing agree­ment that express­ly pro­vides for paid sick days.

  Employ­ee eligibility

  Eli­gi­ble employ­ees must work in Cal­i­for­nia for 30 or more days with­in a year from the com­mence­ment of employ­ment. There­fore, an employ­ee who was employed pri­or to July 1, 2015 (the effec­tive date of the law), will start to accrue paid sick leave on July 31, 2015, assum­ing the employ­ee worked every day in July.

  Leave accru­al

  Employ­ees accrue one hour of paid sick leave for every 30 hours worked. Employ­ees who are exempt from over­time require­ments (admin­is­tra­tive, exec­u­tive, or pro­fes­sion­al employ­ees under a wage order) are deemed to work 40 hours per work­week, unless the employee’s nor­mal work­week is less than 40 hours, in which case the employ­ee will accrue paid sick leave based upon the nor­mal work­week. Employ­ers may lim­it accru­al to 24 hours of paid sick leave per year.

  Employ­ers must allow employ­ees to car­ry over all unused accrued paid sick leave to the fol­low­ing year;   how­ev­er, employ­ers are not required to allow employ­ees to accrue more than 48 hours of paid sick leave.

  Employ­ers’ cur­rent leave policies

  Employ­ers with exist­ing paid leave or paid time off poli­cies are not required to pro­vide addi­tion­al leave to their employ­ees if their policies:

  1. Sat­is­fy the law’s accru­al, usage, and car­ry over require­ments; and
  2. Pro­vide no less than 24 hours of paid sick leave annually.

  Cash out

  Employ­ees are not enti­tled to be paid for accrued unused sick leave upon ter­mi­na­tion, res­ig­na­tion, retire­ment, or oth­er sep­a­ra­tion from employ­ment. How­ev­er, if an employ­ee sep­a­rates from an employ­er and is rehired by the employ­er with­in one year from the date of sep­a­ra­tion, pre­vi­ous­ly accrued and unused paid sick days must be rein­stat­ed. The employ­ee is enti­tled to use those pre­vi­ous­ly accrued and unused paid sick days and to accrue addi­tion­al paid sick days upon rehiring.

  Request for leave

  Employ­ees may request leave ver­bal­ly or in writ­ing. If the need for paid sick leave is fore­see­able, the employ­ee must pro­vide rea­son­able advance noti­fi­ca­tion. If the need for paid sick leave is unfore­see­able, the employ­ee must pro­vide notice of the need for the leave as soon as practicable.

  Use of leave

  Employ­ees may use accrued paid sick days begin­ning on the 90th day of employ­ment, after which day the employ­ee may use paid sick days as they are accrued. An employ­er may lend paid sick leave to an employ­ee in advance of accru­al at the employer’s discretion.

  An employ­ee may use paid sick leave for the diag­no­sis, care, or treat­ment of an exist­ing health con­di­tion of, or pre­ven­tive care for, the employ­ee or the employee’s fam­i­ly mem­ber. In addi­tion, an employ­ee who is a vic­tim of domes­tic vio­lence, sex­u­al assault, or stalk­ing may use paid sick leave for any of the following:

  • To seek med­ical atten­tion for injuries caused by domes­tic vio­lence, sex­u­al assault, or stalking.
  • To obtain ser­vices from a domes­tic vio­lence shel­ter, pro­gram, or rape cri­sis cen­ter as a result of domes­tic vio­lence, sex­u­al assault, or stalking.
  • To obtain psy­cho­log­i­cal coun­sel­ing relat­ed to an expe­ri­ence of domes­tic vio­lence, sex­u­al assault, or stalking.
  • To par­tic­i­pate in safe­ty plan­ning and take oth­er actions to increase safe­ty from future domes­tic vio­lence, sex­u­al assault, or stalk­ing, includ­ing tem­po­rary or per­ma­nent relocation.

  Employ­ers may not require as a con­di­tion of using paid sick time that the employ­ee search for or find a replace­ment work­er to cov­er the days dur­ing which the employ­ee uses paid sick days.

  Employ­ers may set a rea­son­able min­i­mum incre­ment of paid sick leave, not to exceed two hours, for the use of paid sick leave.

  Pro­hib­it­ed conduct

  Pur­suant to the law, employ­ers may not:

  • Deny an employ­ee the right to use accrued sick leave; or
  • Dis­charge, threat­en to dis­charge, demote, sus­pend, or in any man­ner dis­crim­i­nate against any employ­ee for: 
    • Using accrued sick leave.
    • Attempt­ing to exer­cise the right to use accrued sick leave.
    • Fil­ing a com­plaint or alleg­ing a vio­la­tion of the law.
    • Coop­er­at­ing in an inves­ti­ga­tion or pros­e­cu­tion of an alleged violation.
    • Oppos­ing any pol­i­cy or prac­tice that is pro­hib­it­ed under the law.

  The law estab­lish­es a rebut­table pre­sump­tion of unlaw­ful retal­i­a­tion for any adverse employ­ment action occur­ring with­in 30 days of an employ­ee engag­ing in the pro­tect­ed activ­i­ty just described.

  Notice

  At the time of hir­ing, new employ­ees must be pro­vid­ed a notice (as part of the Wage Theft Pre­ven­tion Act notice), inform­ing them of their rights to paid sick leave and their right to file a com­plaint with the Labor Com­mis­sion­er in the event of a vio­la­tion of the law.

  Employ­ers must also pro­vide employ­ees with writ­ten notice of their avail­able amount of paid sick leave, or paid time off an employ­er pro­vides in lieu of sick leave, on either the employee’s item­ized wage state­ment or in a sep­a­rate writ­ing pro­vid­ed on the des­ig­nat­ed pay date with the employee’s pay­ment of wages.

  Post­ing requirement

  Employ­ers are required to dis­play a poster, cre­at­ed by the Labor Com­mis­sion­er, in each work­place that sum­ma­rizes the require­ments of the law. Employ­ers that vio­late the post­ing require­ment may be sub­ject to a civ­il penal­ty of up to $100 per offense.

  Record­keep­ing

  Employ­ers must keep records doc­u­ment­ing the hours worked and the paid sick leave accrued and used by an employ­ee for three years. These records must be made avail­able to employ­ees for inspec­tion with­in 21 days of a ver­bal or writ­ten request.

  If an employ­er fails to main­tain ade­quate records, it will be pre­sumed that the employ­ee is enti­tled to the max­i­mum num­ber of hours accru­able under the law, unless the employ­er can prove oth­er­wise by clear and con­vinc­ing evidence.

  Enforce­ment and penalties

  The Labor Com­mis­sion­er is respon­si­ble for enforc­ing the paid sick leave law. If after an inves­ti­ga­tion the Labor Com­mis­sion­er finds that a vio­la­tion of the law has occurred, the com­mis­sion­er may order appro­pri­ate relief (includ­ing rein­state­ment, back­pay, pay­ment of sick days unlaw­ful­ly with­held, and admin­is­tra­tive penal­ties) for vio­la­tions. If paid sick days were unlaw­ful­ly with­held, the employ­ee may recov­er the dol­lar val­ue of the paid sick days with­held, or $250 mul­ti­plied by three — whichev­er is greater — up to an aggre­gate penal­ty of $4,000. If a paid sick leave-relat­ed vio­la­tion results in oth­er harm to the employ­ee or per­son (such as dis­charge from employ­ment), the admin­is­tra­tive penal­ty will include $50 for each day that the vio­la­tion occurred or con­tin­ued, up to $4,000.

  The Labor Com­mis­sion­er or the Attor­ney Gen­er­al may also bring a civ­il action on behalf of an aggriev­ed employ­ee against any­one who vio­lates the law. In such case the employ­ee may be award­ed relief sim­i­lar to that dis­cussed above.

  Steps to take now

  While the law does not go into effect until July 1, 2015, employ­ers should:

  • Review and, if nec­es­sary, update their cur­rent paid sick leave and/or paid time off poli­cies to ensure com­pli­ance with the law.
  • Review and, if nec­es­sary, update their record­keep­ing pro­to­cols to ensure com­pli­ance with the law.
  • Mon­i­tor the Labor Commissioner’s web­site for devel­op­ments in the law (reg­u­la­to­ry releas­es, required posters, mod­el notices, guid­ance doc­u­ments, FAQs, etc.).
  • Train super­vi­so­ry, man­age­r­i­al, human resources, and pay­roll per­son­nel on the law’s requirements.

  Read More …

• EEOC Files Suit Over Wellness Program | Petaluma Employee Benefits

  September 15, 2014

  Post­ed by Lin­da Rowings

  

  The Equal Employ­ment Oppor­tu­ni­ty Com­mis­sion (EEOC) has sued an employ­er because the penal­ty it applied for not par­tic­i­pat­ing in its well­ness pro­gram was, in the eyes of the EEOC, so high that par­tic­i­pa­tion was not, as a prac­ti­cal mat­ter, “vol­un­tary.” Under EEOC rules, an employ­er may con­duct med­ical exam­i­na­tions, which includes obtain­ing med­ical his­to­ries and blood draws, only in lim­it­ed sit­u­a­tions. One of those per­mit­ted sit­u­a­tions is a vol­un­tary well­ness pro­gram. Because the pro­gram did not qual­i­fy as “vol­un­tary,” the ques­tions employ­ees were asked about their health on a health risk assess­ment, a blood draw, and a range of motion assess­ment vio­lat­ed the Amer­i­cans with Dis­abil­i­ties Act (ADA), accord­ing to the EEOC’s Complaint.

  This is the first law­suit brought by the EEOC chal­leng­ing the incen­tives of an employer’s well­ness pro­gram. The sit­u­a­tion that cre­at­ed the com­plaint is a bit unusu­al, because the employ­ee was ter­mi­nat­ed short­ly after com­plain­ing about the well­ness pro­gram. How­ev­er, the EEOC also seems dis­turbed by the terms of the pro­gram itself. The pro­gram was designed so that the com­pa­ny paid 100% of the health insur­ance pre­mi­um for employ­ees who par­tic­i­pat­ed in the well­ness pro­gram and paid noth­ing toward the pre­mi­um of any employ­ee who did not par­tic­i­pate. The EEOC has described this penal­ty as “steep” and “enor­mous.” It remains to be seen whether the court will agree with the EEOC that the penal­ty vio­lates the ADA rules, but employ­ers con­sid­er­ing sig­nif­i­cant penal­ties for non-com­pli­ance with, or incen­tives for par­tic­i­pat­ing in, a well­ness pro­gram should under­stand that their design could lead to an EEOC charge or lawsuit.

  As a reminder, in addi­tion to the ADA require­ments, well­ness pro­grams need to com­ply with PPACA’s rules for these pro­grams. Under the 2014 rules, well­ness pro­grams are either “par­tic­i­pa­to­ry” or “health-con­tin­gent.” A par­tic­i­pa­to­ry pro­gram is one that either has no reward or penal­ty (such as pro­vid­ing free flu shots) or sim­ply rewards par­tic­i­pa­tion (such as a pro­gram that reim­burs­es the cost of a mem­ber­ship to a fit­ness facil­i­ty or the cost of a sem­i­nar on nutri­tion). As long as a par­tic­i­pa­to­ry pro­gram is equal­ly offered to all sim­i­lar employ­ees, no spe­cial require­ments will apply to the program.

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

  • Be rea­son­ably designed to pro­mote health or pre­vent disease
  • Give employ­ees a chance to qual­i­fy for the incen­tive at least once a year
  • Cap the incen­tive at 30% of the cost of cov­er­age if the incen­tive does not relate to non-use of tobac­co and to 50% of the cost of cov­er­age if the incen­tive relates to non-use of tobacco
  • Pro­vide a rea­son­able alter­na­tive way to qual­i­fy for the incentive
  • Describe the avail­abil­i­ty of the alter­na­tive method of qual­i­fy­ing for the incen­tive in writ­ten pro­gram materials

  The case was filed in Wis­con­sin against Ori­on Ener­gy Systems

• How to Add a Grandchild to Insurance | Petaluma Benefits Broker

  September 12, 2014

  By Bri­an Connolly

  Grand­par­ents act­ing as pri­ma­ry care­givers for their grand­chil­dren has become a grow­ing trend. Accord­ing to “The Exam­in­er,” each health insur­ance com­pa­ny gen­er­al­ly has its own set of rules regard­ing the inclu­sion of grand­chil­dren to a health insur­ance plan. While some com­pa­nies may offer the ser­vice for any grand­par­ent over the age of 55, oth­ers may require you to be the legal guardian of the child before allow­ing you to add them to your insur­ance pol­i­cy. With per­sis­tence, tenac­i­ty and a will­ing­ness to do the research, prac­ti­cal­ly any grand­par­ent can find out if their grand­child is eli­gi­ble to join their health insur­ance plan.

  Step 1

  Call the num­ber list­ed on your month­ly health insur­ance billing state­ment to speak with a live rep­re­sen­ta­tive of your health insur­ance provider. Ask to speak with a pol­i­cy man­ag­er or oth­er spe­cial­ized employ­ee who can answer spe­cif­ic ques­tions on pol­i­cy matters.

  Step 2

  Ask if you can add your grand­child to your cur­rent health insur­ance pol­i­cy and under what con­di­tions or terms the ser­vice will be avail­able. You may be asked to vis­it a local office of your insur­ance provider to fill out the nec­es­sary forms.

  Step 3

  Fill out the insur­ance pol­i­cy mod­i­fi­ca­tion form and include the details and infor­ma­tion of your grand­child. Include their full name, age, eth­nic­i­ty, social secu­ri­ty num­ber and any oth­er required data asked about your grand­child. If required, bring in your grand­child for any nec­es­sary blood or urine test that may be nec­es­sary to com­plete the application.

  Step 4

  Receive your con­fir­ma­tion insur­ance pack­et in the mail and store your child’s health insur­ance card next to yours in your wal­let, purse or oth­er secure loca­tion. If desired, guide your grand­child through the spe­cif­ic ben­e­fits and terms of their health insur­ance policy.

  Tips

  If your insur­ance com­pa­ny denies your request to add your grand­child to the pol­i­cy, con­tact your local Med­ic­aid office to see if he is eli­gi­ble to join the gov­ern­ment-enrolled health program.

  Read More …

• PTO as a Partial No – How do Employers Apply the Rules? New California Appellate Decision

  September 12, 2014

  In Thea v. Gen­er­al Atom­ics the Cal­i­for­nia appel­late court reaf­firmed and clar­i­fied the vaca­tion rule.  In this case, the com­pa­ny offered exempt employ­ees accrued PTO, and requires them to use their PTO hours when they are absent from work for par­tial or full days.  Deduc­tions are made from accrued PTO for par­tial day absences of any length.  They con­tin­ue to accrue PTO and their full salary dur­ing this “leave” They are not required to use PTO if their work week exceeds 40 hours, however.

  The plain­tiff said the rule for par­tial day deduc­tions was unlaw­ful, vio­lat­ing the law pro­hibit­ing for­fei­ture of wages (includ­ing accrued vaca­tion or annu­al leave).  The tri­al court dis­agreed with the plain­tiff and upheld the rule for the employ­er.  On appeal the Cal­i­for­nia court agreed.

• California Employment Law Update – August 2014 | CA Benefits Broker

  September 9, 2014

  Unfair Immi­gra­tion-Relat­ed Practices

  On June 28, 2014, Cal­i­for­nia Gov­er­nor Jer­ry Brown signed leg­is­la­tion (A.B. 2751) amend­ing recent­ly enact­ed Cal­i­for­nia law that pro­hibits employ­ers from retal­i­at­ing against undoc­u­ment­ed work­ers who engage in pro­tect­ed activity.

  Among oth­er things, the law:

  Expands the def­i­n­i­tion of “unfair immi­gra­tion-relat­ed prac­tice” to include threat­en­ing to file or fil­ing of a false report or com­plaint with any state or fed­er­al agency.
  Pro­hibits an employ­er from dis­charg­ing or in any man­ner dis­crim­i­nat­ing, retal­i­at­ing, or tak­ing any adverse action against an employ­ee because the employ­ee updates or attempts to update per­son­al infor­ma­tion based on a law­ful change of name, Social Secu­ri­ty num­ber, or fed­er­al employ­ment autho­riza­tion document.

  The law goes into effect on Jan­u­ary 1, 2015.

  Read 2014 CA A.B. 2751

  Read More …

• New Guidelines on Pregnancy Discrimination – Because They Have not Outlined this Enough

  September 9, 2014

  It’s exact­ly what you expect­ed.  Don’t do it – in trip­li­cate.  Any evi­dence that an employ­er knew of a preg­nan­cy (office gos­sip and what­ev­er) and then made an employ­ment deci­sion based on it, or in advance made a deci­sion based on stereo­types about appli­cants is pro­hib­it­ed.  And don’t even think about con­sid­er­ing an appli­cant or employee’s past preg­nan­cy or someone’s capac­i­ty to become preg­nant.  No kidding…but they found the EEOC found a need to repeat it.

  No leave poli­cies with gen­der based dis­tinc­tions, no accom­mo­da­tions dif­fer­ent for one employ­ee tem­porar­i­ly unable to per­form a job than anoth­er, and all ben­e­fits and infer­til­i­ty insur­ance cov­er­age must be the same for every­one.  You knew this already, right?

• Filing for California SDI | CA Employee Benefits

  September 5, 2014

  Ques­tion:

  How does an employ­ee file for Cal­i­for­nia state dis­abil­i­ty ben­e­fits (SDI) when going on leave in California?

  Answer:

  The process for fil­ing for Cal­i­for­nia State Dis­abil­i­ty is real­ly up to the employ­ee and the employee’s physi­cian. The employ­er can pro­vide resource infor­ma­tion, but should refrain from tak­ing actu­al action on behalf of the employ­ee. Infor­ma­tion about the process and enroll­ment instruc­tions may be found on the Cal­i­for­nia Employ­ment Devel­op­ment Depart­ment (EDD) web­site at http://www.edd.ca.gov/disability/di_how_to_file_a_claim.htm.

  Read More …

• Buy the Insurance…Or Else…Unless We Change the Rules and Make it Easier to Avoid

  September 5, 2014

  The penal­ty is the greater of 1% of fam­i­ly income or $95 per year (but they reduced that to $47.50 for chil­dren)  if you do not have health insur­ance this year.  But now, fed­er­al offi­cials have decid­ed to cap the poten­tial lia­bil­i­ty to $2,448 per per­son, based on the nation­al aver­age annu­al pre­mi­um for a bronze lev­el health plan.  So you’re in trou­ble if you do not buy…just not as much trou­ble as you may have feared.

   

• Pay and WARN Notice | California Benefits Broker

  August 9, 2014

  Ques­tion: May an employ­er who is clos­ing a plant pay out employ­ees in lieu of a 60-day Work­er Adjust­ment and Retrain­ing Noti­fi­ca­tion Act (WARN) notice?

  Answer: The Work­er Adjust­ment and Retrain­ing Noti­fi­ca­tion Act (WARN) requires a 60-day writ­ten notice and does not con­tain a pro­vi­sion for an alter­nate option. Best prac­tice is to pro­vide the 60-day notice. While we would not rec­om­mend tak­ing the approach of pay­ment in lieu of notice, the Depart­ment of Labor does dis­cuss this sit­u­a­tion on their web­site and a link to this infor­ma­tion is con­tained as a source. Please con­sult with a labor attor­ney for the best advice to man­age this par­tic­u­lar situation.

  The dam­ages for vio­lat­ing WARN are back pay and ben­e­fits up to 60 days. Accord­ing to the Depart­ment of Labor, if an employ­er paid these amounts but did not pro­vide 60-day notice, while they have tech­ni­cal­ly vio­lat­ed WARN they have also already paid the WARN dam­ages. Keep in mind that employ­ers should be aware that WARN allows for vol­un­tary pay­ments of wages and ben­e­fits to be off­set against dam­ages award­ed for vio­la­tions of the act. How­ev­er, if these pay­ments were required by anoth­er law, con­tract, or com­pa­ny pol­i­cy or prac­tice, the employ­er can­not use them to off­set WARN damages.

  Read More …

• Another Measure of Success or Failure – The Hits Keep Coming for the ACA

  August 6, 2014

  In April, the Pres­i­dent told the nation­al that Exchange enroll­ment was at 8 mil­lion, exceed­ing expec­ta­tions and at low­er costs than antic­i­pat­ed.  Those sta­tis­tics were selective.

  As of April, 20% of those enrolled in the Exchange had still not paid their premium.

  A Kaiser Foun­da­tion study shows that only 57% of the num­ber are real­ly insured and they con­sid­ered those who once had cov­er­age to be pre­vi­ous­ly insured even though there were not at the time of the Exchange enroll­ment.  The prob­lem here is that the poll was only of 742 indi­vid­u­als and even then there was antic­i­pat­ed devi­a­tion of +/- 4 points.

  Using the Kaiser sta­tis­tics com­bined with the pay­ment notes, this would drop the actu­al new enroll­ment to about 3.9 mil­lion.  By this time, the CBO esti­mat­ed that the enroll­ment should be at 19 mil­lion and CMS esti­mat­ed 26 mil­lion. So…

• Drafting Opposition for Obamacare Due to Drafting Error in Legislation

  August 5, 2014

  So one court said “no” and the oth­er said “yes” and in the end it will be up to the Supreme Court…again.  Remem­ber when the Pres­i­dent could do what he wished?  Well, that was back in the days of Wash­ing­ton and Adams…when things were hec­tic (which explains why we are still going through this four years lat­er) Con­gress wrote the ACA to say that sub­si­dies would be pro­vid­ed through “an exchange estab­lished by the State” – so when the Feds moved in, the oppo­si­tion was also on the move.  The prob­lem, of course, is that the law was draft­ed to give the states incen­tives to set up the exchanges (mon­ey!), but when 36 did not take them up on the offer some­thing had to be done.  They did the right thing…but with­out permission.

• FMLA Leave Designation and Notice | Petaluma Benefits Broker

  August 5, 2014

  Ques­tion: Is an employ­er still required to issue a Fam­i­ly and Med­ical Leave Act (FMLA) notice to an employ­ee if the employ­er decides to con­tin­ue pay­ing the employ­ee while on leave?

  Answer: Even if the com­pa­ny has a pol­i­cy that exceeds the rights and ben­e­fits of the Fam­i­ly and Med­ical Leave Act (FMLA), we rec­om­mend des­ig­nat­ing the leave as FMLA, con­cur­rent with your inter­nal pol­i­cy, assum­ing the rea­son for leave qual­i­fies under the FMLA. If you do not do this, you may find your­self in a sit­u­a­tion where an employ­ee takes leave under your inter­nal pol­i­cy and then asks for an addi­tion­al 12 weeks under the FMLA. FMLA is a pro­tec­tion leave pro­vid­ing job and ben­e­fit secu­ri­ty for a spe­cif­ic peri­od of time, so what­ev­er wage replace­ment an employ­er choos­es to pay employ­ees while on leave is sep­a­rate from FMLA.

  Addi­tion­al­ly, not pro­vid­ing the notice if you have knowl­edge that the rea­son would qual­i­fy for FMLA might con­sti­tute an inter­fer­ence with an employee’s FMLA rights. Employ­ers must pro­vide an employ­ee notice of their rights with­in five busi­ness days of learn­ing of the need for leave. We also cau­tion that if a prac­tice is imple­ment­ed to pay one employ­ee while on leave, it should be repli­cat­ed for every employ­ee on leave.

  Read More …

• Benefits Continuation While on Leave | Petaluma Employee Benefits

  August 1, 2014

  Ques­tion: We pay half of our employ­ees’ ben­e­fits. If the employ­ee is out on Fam­i­ly and Med­ical Leave Act (FMLA) leave, does the employ­er still have to pay their half, or can we require the employ­ee to pay 100 percent?

  Answer: The employ­er must con­tin­ue to pay their por­tion of the premium.

  The reg­u­la­tion requires employ­ers to main­tain health ben­e­fits at the same lev­el for the dura­tion of the leave as the employ­ee was at pri­or to going on leave. Addi­tion­al­ly, this also means if the employ­ee was pre­vi­ous­ly pay­ing for a por­tion of their pre­mi­um, they should con­tin­ue to do so while on leave.

  If the leave is exhaust­ed and the employ­er extends addi­tion­al time to the employ­ee based on an inter­nal pol­i­cy, health ben­e­fits are not required to be con­tin­ued at that point unless the employ­er has a pol­i­cy or prac­tice of doing so for oth­er employ­ees, in which case it would then be best prac­tice to doc­u­ment that prac­tice as a policy.

  Read More ..

• State Base Loses Face but is Courted Well with New Decisions

  August 1, 2014

  First, many state based exchanges are hav­ing dif­fi­cul­ty surviving

  Sec­ond, a fed­er­al appeals court just ruled that the fed­er­al exchange can­not offer subsidies

  Cov­er Ore­gon is near­ly broke but tak­ing pris­on­ers, “claim­ing that it actu­al­ly did suc­ceed in build­ing a func­tion­ing web­site – but the state’s Demo­c­ra­t­ic gov­er­nor killed it for polit­i­cal reasons”

  In Mass­a­chu­setts, a local dai­ly slammed Gov­er­nor Patrick for ‘again decid­ing to reward the incom­pe­tence of the ven­dor that was sup­posed to set up the state’s new Health Con­nec­tor web­site (CGI) but this time to the tune of $35 million

  And Mass­a­chu­setts was sup­posed to be the mod­el for the nation…

  The US Court of Appeals for the Dis­trict of Colum­bia, mean­while, said the IRS went too far in extend­ing sub­si­dies to those buy­ing insur­ance from the fed­er­al exchange.  Sub­si­dies are there­fore no longer allowed to be pro­vid­ed through these exchanges (for the record, Cal­i­for­nia would be exempt here, as we have a state based exchange).  The case is Hal­big v. Bur­well but in it, the court said “we reach this con­clu­sion, frankly, with reluc­tance.  At least until states that wish to can set up Exchanges (note – there aren’t any now) our rul­ing will like­ly have sig­nif­i­cant con­se­quences both for the mil­lions of indi­vid­u­als receiv­ing tax cred­its through fed­er­al Exchanges and for health insur­ance mar­kets more broad­ly”  In the dis­sent, it was stat­ed that “this case is about Appel­lants’ not so veiled attempt to gut the Patient Pro­tec­tion and Afford­able Care Act (ACA)”  (duh)  The White House demurs (of course) say­ing that ‘while this rul­ing is inter­est­ing to legal the­o­rists, it has no prac­ti­cal impact” on indi­vid­u­als’ abil­i­ty to cur­rent­ly receive tax cred­its for their health care.  The Press Sec­re­tary said “you don’t need a fan­cy legal degree to under­stand Con­gress intend­ed” for qual­i­fied indi­vid­u­als to receive tax cred­its regard­less of who was admin­is­ter­ing the exchange.

  Fam­i­ly Med­ical Leave Act rede­fines Fam­i­ly to include Gen­der Neu­tral Marriages

  The Depart­ment has pro­posed to move from a “state of res­i­dence” require­ment to rec­og­nize same sex mar­riages to “place of cel­e­bra­tion” which makes things quite a bit sim­pler, and easier

  The pro­posed def­i­n­i­tion­al change means that eli­gi­ble employ­ees will be able to:

  1. Take FMLA leave to care for their same sex spouse with a seri­ous health condition
  2. Take qual­i­fy­ing exi­gency leave due to their same sex spouse’s cov­ered mil­i­tary service
  3. Take mil­i­tary care­giv­er leave for their same sex spouse

• San Francisco Update – you’re not going to like it

  July 28, 2014

  Also note that increas­es in the amount you must pay per employ­ee increas­es in 2015.  For larg­er employ­ers (100 or more employ­ees) the amount is $2.48 per hour and for small­er employ­ers (20–99 employ­ees) will be $1.65 per hour.

  What is the Wait­ing Peri­od Exact­ly?  Dif­fer­ent Inter­pre­ta­tions and Now a Final Fed­er­al Rule

  The max­i­mum wait­ing peri­od allowed before offer­ing cov­er­age to a full time employ­ee was estab­lished as 90 days by the fed­er­al Afford­able Care Act.  Then Cal­i­for­nia said it was 60 days, but the restric­tion was imposed on car­ri­ers and not employ­ers.  Some car­ri­ers have said it does not apply, cer­ti­fy­ing that fed­er­al law over­rides the Cal­i­for­nia statute, and are not enforc­ing this law.  Oth­er car­ri­ers took it seri­ous­ly but said their sys­tems couldn’t han­dle it, so they gave their employ­er groups the option of “first of the month fol­low­ing date of hire” or “first of the month fol­low­ing 30 days”  And now the fed­er­al gov­ern­ment has come up with final reg­u­la­tions con­cern­ing their orig­i­nal 90 day wait­ing peri­od, allow­ing a “one month ori­en­ta­tion peri­od” before the 90 day count begins.  Of course, the caveat is that the gov­ern­ment knows these peri­ods are com­mon­place but would not be used to “vio­late the spir­it” of the 90 day wait­ing peri­od.  The start date for the new fed­er­al rules is Jan­u­ary 1, 2015.

  Just to con­fuse mat­ters fur­ther (which has now become a hall­mark of the ACA), the “pay or play” rules have a dif­fer­ent for­mu­la­tion for con­sid­er­a­tion of a cov­er­age offer, say­ing that an employ­er MUST offer cov­er­age to eli­gi­ble employ­ees no lat­er than the first day of the fourth full cal­en­dar month of employment.

• Hobby Lobby Ruling Cooling ACA Ardor Contra to Initial Perception but Congressional Reception is Cooler Still | California Employee Benefits

  July 25, 2014

  The case was Bur­well vs Hob­by Lob­by.  To put it sim­ply, the Supreme Court ruled that “close­ly held (sor­ry Gen­er­al Motors) for prof­it com­pa­nies can, on reli­gious grounds, opt out of a fed­er­al require­ment to pro­vide cer­tain con­tra­cep­tion cov­er­age.  Of course, they did not exact­ly define what “close­ly held” meant (but as Jus­tice Pot­ter Stew­art once said “I’ll know it when I see it”).  Pub­licly trad­ed com­pa­nies, of course, are not.

  With a lit­tle more ambi­gu­i­ty, the Supreme Court gave tem­po­rary relief to Wheaton Col­lege, rul­ing “it does not for now have to com­ply with the Oba­ma administration’s require­ment that it fill out a form to reg­is­ter reli­gious objec­tions to pro­vid­ing some types of con­tra­cep­tive cov­er­age man­dat­ed by the Afford­able Care Act”  What is odd about this is that the male jus­tices tried to sneak it through, but the female jus­tices were furi­ous, claim­ing that, while they were a part of the Hob­by Lob­by deci­sion, this did not mean that they were open­ing the door for oth­er exemp­tions, espe­cial­ly those that had not been ful­ly heard.

  Con­se­quences?  Well oth­er than chang­ing employ­ee hand­books, try­ing to explain moral and reli­gious con­vic­tions to employ­ees, the poten­tial ero­sion of ACA cred­i­bil­i­ty and the open­ing of fur­ther “reli­gious grounds” chal­lenges for oth­er fed­er­al laws, not much.  There are also at least four dozen sim­i­lar faith based law­suits now under con­sid­er­a­tion.  But in this case…

  No soon­er was the Supreme Court rul­ing issued that Democ­rats released a bill to over­turn it.  They devel­oped this to “ensure that women have access to cov­er­age for birth con­trol even if they work for busi­ness­es that have reli­gious objec­tions”. In oth­er words, they want the ACA to do what it said it would (mean­ing cov­er­ing con­tra­cep­tion) and they won’t lis­ten to the Supreme Court say oth­er­wise.  The bill failed.

  One legal firm, com­ment­ing on the rul­ing, said “the Court indi­cat­ed it may not pro­vide the Admin­is­tra­tion much lee­way in its imple­men­ta­tion of the ACA where such imple­men­ta­tion impacts and is led by oth­er Fed­er­al rights”

  Note that the rul­ing does not apply to state laws, which means that ful­ly insured plans are essen­tial­ly exempt from the Court rul­ing because they are sub­ject to state and not fed­er­al reg­u­la­tions (for the most part)

  Over­all, the gen­er­al impli­ca­tions, or lack of same, are:

  1. The deci­sion is lim­it­ed to cov­er­age of con­tra­cep­tion with­out cost shar­ing under the ACA pre­ven­tive care mandate
  2. The Supreme Court did not address the appli­ca­tion of the deci­sion to pub­licly trad­ed companies
  3. Employ­ees may still be able to access all FDA approved forms of con­tra­cep­tion with­out cost shar­ing, but not with­out addi­tion­al reg­u­la­to­ry action
  4. Plan fund­ing may lim­it an employ­er with sin­cere reli­gious objec­tions from “carv­ing out” cer­tain types of contraception

• Length of Maternity Leave in California | California Benefits Broker

  July 24, 2014

  Ques­tion: How long is mater­ni­ty leave in Cal­i­for­nia? How long do we have to hold a posi­tion for an employ­ee on mater­ni­ty leave?

  Answer: It is pos­si­ble for a preg­nant Cal­i­for­nia employ­ee to be out on qual­i­fy­ing leave for up to sev­en months.

  Exam­ple:

  An employ­ee goes out on Preg­nan­cy Dis­abil­i­ty Leave (PDL) for the max­i­mum term of four months (or 17–1/3 weeks), and her leave under the Fam­i­ly and Med­ical Leave Act (FMLA) runs concurrently.
  Once the PDL ends, she is still eli­gi­ble for up to 12 weeks of leave under California’s Fam­i­ly Rights Act (CFRA), which could result in up to sev­en months total away from her job.

  If an employ­ee has not yet been employed for at least 12 months, the employ­ee is not eli­gi­ble for FMLA or CFRA; how­ev­er, the employ­ee is eli­gi­ble for the full PDL allo­ca­tion as of her date of hire.

  If an employ­ee is out on PDL, FMLA, or CFRA, an employ­er is required to rein­state the employ­ee to her orig­i­nal posi­tion (or a com­pa­ra­ble one) once the leave is com­plete (assum­ing the employ­ee has not exceed the allow­able leave time). While an employ­er may tem­porar­i­ly fill the posi­tion while an employ­ee is on leave, once the leave ends, the employ­ee should be placed into the same posi­tion or one with equiv­a­lent pay, ben­e­fits, senior­i­ty, etc. Gen­er­al­ly, there are very few excep­tions to the rein­state­ment requirement.

  If exist­ing employ­ees are fill­ing in while she is out, or if a tem­po­rary employ­ee is hired, it should be made clear to that employ­ee that this is a tem­po­rary sit­u­a­tion and that once the employ­ee returns, there should be no expec­ta­tion that the tem­po­rary arrange­ment continue.

  Read More …

• Glitches leave safety net in stitches – can we subsidize people federally? | California Employee Benefits

  July 24, 2014

  A pend­ing court rul­ing may say that the sub­si­dies being pro­vid­ed to those who qual­i­fy for them due to their income sta­tus are ille­gal.  The Afford­able Care Act orig­i­nal­ly intend­ed to have the “exchanges” (now known as “mar­ket­places”) pro­vid­ing sub­si­dized indi­vid­ual med­ical cov­er­age run by the states, and said so in their law (“exchange estab­lished by the state”)  When 36 states decid­ed they couldn’t, or wouldn’t, do it, the fed­er­al gov­ern­ment set up their own exchange (which did not go too well, if mem­o­ry serves).  Now it may turn out that they weren’t sup­posed to do that…and if that is the case, whith­er goes the ACA?  Well, we’re not sure, but in Cal­i­for­nia the Exchange (Cov­ered Cal­i­for­nia) con­tin­ues to go strong.

• Changing from Hourly to Salaried in California | Petaluma Benefits Broker

  July 22, 2014

  Ques­tion:
  Can we change our hourly employ­ees to salaried? If so, what is the min­i­mum pay for salaried employ­ees in California?

  Answer:
  An employ­er may pay employ­ees who were pre­vi­ous­ly paid an hourly wage a fixed salary and retain the nonex­empt clas­si­fi­ca­tion, but should be aware of laws sur­round­ing over­time and meal/break require­ments ensur­ing they are not in vio­la­tion of the Fair Labor Stan­dards Act (FLSA). It is pos­si­ble to pay nonex­empt (hourly) employ­ees on a salary basis and some employ­ers choose to do so for ease of pay­roll admin­is­tra­tion. How­ev­er, this does not release the employ­er from an oblig­a­tion to pay one and one-half times the equiv­a­lent hourly wage for any hours over eight in one work­day (in Cal­i­for­nia) or over 40 hours in one work­week. Even if you pay nonex­empt employ­ees a salary you must still pay them over­time for any qual­i­fy­ing hours.

  Read More …

  Sources:

  http://thinkhrcomply.com/ClassificationTools/OvertimeEligible

  http://www.dol.gov/elaws/overtime.htm

  https://www.dir.ca.gov/iwc/wageorderindustries.htm

• What is the Waiting Period Exactly? Different Interpretations and Now a Final Federal Rule | California Benefits Broker

  July 18, 2014

  The max­i­mum wait­ing peri­od allowed before offer­ing cov­er­age to a full time employ­ee was estab­lished as 90 days by the fed­er­al Afford­able Care Act.  Then Cal­i­for­nia said it was 60 days, but the restric­tion was imposed on car­ri­ers and not employ­ers.  Some car­ri­ers have said it does not apply, cer­ti­fy­ing that fed­er­al law over­rides the Cal­i­for­nia statute, and are not enforc­ing this law.  Oth­er car­ri­ers took it seri­ous­ly but said their sys­tems couldn’t han­dle it, so they gave their employ­er groups the option of “first of the month fol­low­ing date of hire” or “first of the month fol­low­ing 30 days”  And now the fed­er­al gov­ern­ment has come up with final reg­u­la­tions con­cern­ing their orig­i­nal 90 day wait­ing peri­od, allow­ing a “one month ori­en­ta­tion peri­od” before the 90 day count begins.  Of course, the caveat is that the gov­ern­ment knows these peri­ods are com­mon­place but would not be used to “vio­late the spir­it” of the 90 day wait­ing peri­od.  The start date for the new fed­er­al rules is Jan­u­ary 1, 2015.

   

  Just to con­fuse mat­ters fur­ther (which has now become a hall­mark of the ACA), the “pay or play” rules have a dif­fer­ent for­mu­la­tion for con­sid­er­a­tion of a cov­er­age offer, say­ing that an employ­er MUST offer cov­er­age to eli­gi­ble employ­ees no lat­er than the first day of the fourth full cal­en­dar month of employ­ment.   Got all that?

• San Francisco Update – you’re not going to like it | California Employee Benefits

  July 17, 2014

  Also note that increas­es in the amount you must pay per employ­ee increas­es in 2015.  For larg­er employ­ers (100 or more employ­ees) the amount is $2.48 per hour and for small­er employ­ers (20–99 employ­ees) will be $1.65 per hour.

• Hobby Lobby Ruling Cooling ACA Ardor Contra to Initial Perception but Congressional Reception is Cooler Still

  July 16, 2014

  The case was Bur­well vs Hob­by Lob­by.  To put it sim­ply, the Supreme Court ruled that “close­ly held (sor­ry Gen­er­al Motors) for prof­it com­pa­nies can, on reli­gious grounds, opt out of a fed­er­al require­ment to pro­vide cer­tain con­tra­cep­tion cov­er­age.  Of course, they did not exact­ly define what “close­ly held” meant (but as Jus­tice Pot­ter Stew­art once said “I’ll know it when I see it”)

  Pub­licly trad­ed com­pa­nies, of course, are not.

   

  With a lit­tle more ambi­gu­i­ty, the Supreme Court gave tem­po­rary relief to Wheaton Col­lege, rul­ing “it does not for now have to com­ply with the Oba­ma administration’s require­ment that it fill out a form to reg­is­ter reli­gious objec­tions to pro­vid­ing some types of con­tra­cep­tive cov­er­age man­dat­ed by the Afford­able Care Act”  What is odd about this is that the male jus­tices tried to sneak it through, but the female jus­tices were furi­ous, claim­ing that, while they were a part of the Hob­by Lob­by deci­sion, this did not mean that they were open­ing the door for oth­er exemp­tions, espe­cial­ly those that had not been ful­ly heard.

   

  Con­se­quences?  Well oth­er than chang­ing employ­ee hand­books, try­ing to explain moral and reli­gious con­vic­tions to employ­ees, the poten­tial ero­sion of ACA cred­i­bil­i­ty and the open­ing of fur­ther “reli­gious grounds” chal­lenges for oth­er fed­er­al laws, not much.  There are also at least four dozen sim­i­lar faith based law­suits now under con­sid­er­a­tion.  But in this case…

  
  No soon­er was the Supreme Court rul­ing then Democ­rats said they have devel­oped leg­is­la­tion to over­ride it, to “ensure that women have access to cov­er­age for birth con­trol even if they work for busi­ness­es that have reli­gious objec­tions”  In oth­er words, they want the ACA to do what it said it would (mean­ing cov­er­ing con­tra­cep­tion) and they won’t lis­ten to the Supreme Court say otherwise.

• Glitches leave safety net in stitches – can we subsidize people federally? | California Employee Benefits

  July 15, 2014

  A pend­ing court rul­ing may say that the sub­si­dies being pro­vid­ed to those who qual­i­fy for them due to their income sta­tus are ille­gal.  The Afford­able Care Act orig­i­nal­ly intend­ed to have the “exchanges” (now known as “mar­ket­places”) pro­vid­ing sub­si­dized indi­vid­ual med­ical cov­er­age run by the states, and said so in their law (“exchange estab­lished by the state”)  When 36 states decid­ed they couldn’t, or wouldn’t, do it, the fed­er­al gov­ern­ment set up their own exchange (which did not go too well, if mem­o­ry serves).  Now it may turn out that they weren’t sup­posed to do that…and if that is the case, whith­er goes the ACA?  Well, we’re not sure, but in Cal­i­for­nia the Exchange (Cov­ered Cal­i­for­nia) con­tin­ues to go strong.

• What part of “Affordable” don’t these people understand? Struggling to pay premiums… | California Employee Benefits

  June 27, 2014

  In a recent poll con­duct­ed by the Kaiser Fam­i­ly Foun­da­tion, it was found that 57% of those who pur­chased a plan through the new exchanges (and that doesn’t count new enrollees in the pri­vate mar­ket, which also had gains) were not pre­vi­ous­ly insured.  Despite the avail­abil­i­ty of sub­si­dies, how­ev­er, 40% of those who bought the plan and qual­i­fy for sub­si­dies are still strug­gling to pay the month­ly pre­mi­um.  Inter­est­ing find­ings include the sta­tis­tic that 39% report­ed that the pre­mi­ums for their new plans were high­er than before, and also that 46% said there were not con­fi­dent that they would be able to cov­er the expens­es required under the plan design they chose.

• Changes in the Exchange – More Diversity to allay Perversity in Enrollment | California Benefits Broker

  June 26, 2014

  A new Assem­bly bill passed 68–2 to encour­age the state to make changes to the Cov­ered Cal­i­for­nia board.  Blam­ing the non-diverse board pop­u­la­tion con­sist­ing sole­ly of health care and insur­ance admin­is­tra­tors for some of the fail­ures of the first Cov­ered Cal­i­for­nia roll­out, there is now a call for more diver­si­ty, in the hopes that peo­ple from dif­fer­ent indus­tries and cul­tures will be more sen­si­tive to the needs of prospec­tive enrollees.  The ques­tion is whether the enroll­ment fail­ure was a lack of suf­fi­cient edu­ca­tion which would have been bet­ter han­dled by more cul­tur­al­ly sen­si­tive board mem­bers, or whether it was a mat­ter of too much, too soon, in too over­whelm­ing a con­text, with car­ri­ers, con­sumers and con­sul­tants sim­ply ill pre­pared to han­dle it all (and what makes any­one think they will han­dle it any bet­ter next time?)

• Major Risk goes way of minor tragedies – California quietly ends protection for uninsured | Petaluma Employee Benefits

  June 25, 2014

  With the orig­i­nal rules, those who applied for indi­vid­ual cov­er­age could be denied.  As a back­stop, they could apply for the Major Risk Med­ical Insur­ance Plan which, though afford­able, only cov­ered up to $75,000 of claims in a giv­en year, and had a wait­ing list, as there was a max­i­mum allowed for enroll­ment due to fund­ing lim­its (set by receipts from the tobac­co fund).  Now the state of Cal­i­for­nia has decid­ed that MR MIP is no longer need­ed, with the advent of guar­an­tees under the Afford­able Care Act.  So the only ques­tion now is…has the tobac­co mon­ey gone up in smoke or do they have some oth­er health needs it may fund in this state?

• CBO can’t make it a go and now throw in the towel on scoring Obamacare

  June 24, 2014

  There has always been a lot of cre­dence (and a lot of press) devot­ed to the true val­ue, or true cost of the Afford­able Care Act.  Now, the objec­tive CBO, the one on which many rely to give the “facts” about the cost of var­i­ous pieces of leg­is­la­tion, has said that “scor­ing” Oba­macare has become impos­si­ble.  “The pro­vi­sions that expand insur­ance cov­er­age estab­lished entire­ly new pro­grams or com­po­nents of pro­grams that can be iso­lat­ed and reassessed.  In con­trast, oth­er pro­vi­sions of the ACA sig­nif­i­cant­ly mod­i­fied exist­ing fed­er­al pro­grams and made changes to the Inter­nal Rev­enue Code”  This came in a foot­note at the end of the CBO April report.

• Exchanges allow the exchange of company responsibility for that of the employees

  June 5, 2014

  There is an employ­er mandate…except when there isn’t. Retirees are not pro­tect­ed under the ACA man­date per­tain­ing to employ­ers. Mean­while, the man­date for employ­ees con­tin­ues. But there is help for them – they can always go to the exchange when they are dumped by their plan. In Detroit, Emer­gency Man­ag­er Kevyn Orr fought to send retirees to the exchanges for health insur­ance as part of the city’s plan to exit bank­rupt­cy. Of course, they gave them some mon­ey, and some of them qual­i­fy for Medicare. The city said they would give $125 to $300 per month to retirees over age 65 who do not qual­i­fy for Medicare, $125 to spous­es who aren’t eli­gi­ble for Medicare with a house­hold income below $75,000, and $175 for retirees under 65. Not enough to cov­er the cost, but hey, you’re retired!

  In Chica­go, a ten year agree­ment requir­ing the city to share health care costs with retirees has end­ed. May­or Rahm Emmanuel is mov­ing for­ward on a three year phased in plan to cut the retiree health care sub­sidy for retirees from 55% to 0. Those who retired pri­or to 8/23/89 will keep their sub­si­dies for a lifetime.

  In She­boy­gan Coun­ty, Wis­con­sin, the Board of Com­mis­sion­ers sim­ply vot­ed to stop cov­er­ing retiree health care and send them to the exchange effec­tive Jan­u­ary 1, 2014

• Two sides of the story…will rates go up or down in 2015 – theories abound (here’s a summary)

  June 5, 2014

  Pre­mi­ums will increase because –

  1) First round pre­mi­um set­ting was over­ly aggressive
  2) Mar­kets with lim­it­ed com­pe­ti­tion could see larg­er increas­es because they can
  3) Some car­ri­ers with insuf­fi­cient mar­ket share could leave the mar­ket, reduc­ing competition
  4) Pres­sure to expand provider networks
  5) Insur­ers will react to reduced fund­ing lev­els for rein­sur­ance in 2015

  Then again, maybe they won’t be so bad after all –

  1) Growth in health care costs slow through 2012 (though picked up in 2013)
  2) Enroll­ment in Exchange plans should be high­er in 2015 than in 2014
  3) Cost shar­ing in the sil­ver tier (most often select­ed) is high enough to cut utilization
  4) Increas­ing size and attrac­tive­ness of non group mar­kets could inten­si­fy with competition

• There are the subsidies, and there is the sub testing that was not sub-posed to miss anything

  June 5, 2014

  The Wash­ing­ton Post report­ed that inter­nal doc­u­ments show that the gov­ern­ment may be pay­ing incor­rect sub­si­dies to more than 1 mil­lion Amer­i­cans for their health plans in the new fed­er­al insur­ance mar­ket­place. Oops…

• What is a risk corridor and why do we care? It makes you want to run down the hall and hide

  June 5, 2014

  The Afford­able Care Act con­tains a “risk cor­ri­dor” pro­vi­sion which is designed to lim­it the loss­es of insur­ance com­pa­nies who end up tak­ing an inor­di­nate amount of “risk” due to the ACA (in Cal­i­for­nia, that would main­ly be Anthem Blue Cross). This year, the Oba­ma admin­is­tra­tion has, accord­ing to the Los Ange­les Times “qui­et­ly adjust­ed” the cor­ri­dor “to poten­tial­ly make bil­lions of addi­tion­al tax­pay­er dol­lars avail­able to the insur­ance industry”

• The “affordable” part seems unlikely given the “out of pocket” maximum – and now is higher

  June 5, 2014

  This and oth­er sur­pris­es in store where “more” is the word of the day:

  1) A high­er out of pock­et max­i­mum – from $6,350 per year to $6,600
  2) A high­er penal­ty for fail­ure to com­ply with Pay or Play – from $3,000 to $3,120 per person
  3) A high­er penal­ty for fail­ing to offer cov­er­age at all (groups of 50+) from $2,000 to $2,080
  4) That’s for 2015 – the fines will be high­er still in 2016, as will the out of pock­et limit

• HSA, FSA get carried away over amounts carried over – new IRS guidance | California Insurance Broker

  June 5, 2014

  The IRS issued new rules allow­ing FSA par­tic­i­pants to car­ry over (with the per­mis­sion of the employ­er) unused amounts up to $500 each plan year. There are con­sid­er­a­tions with regard to simul­ta­ne­ous HSA par­tic­i­pa­tion, how­ev­er, and the IRS has clar­i­fied those rules as well. Now the IRS has made some clarifications:

  An indi­vid­ual who is cov­ered by a gen­er­al pur­pose med­ical FSA is inel­i­gi­ble to contribute
  to an HSA, even if the individual’s med­ical FSA bal­ance con­sists sole­ly of unused amounts
  car­ried over from the pri­or plan year (even if they are exhaust­ed dur­ing the year, the
  indi­vid­ual is inel­i­gi­ble to make any HSA con­tri­bu­tion for the year

  The indi­vid­ual may con­tribute to a gen­er­al pur­pose FSA if they have an unused bal­ance IF

  1) The indi­vid­ual waives or declines a car­ry­over of unused amounts from a gen­er­al purpose
  FSA to the sub­se­quent plan year; or

  2) The cafe­te­ria plan offers an HSA com­pat­i­ble FSA (lim­it­ed ben­e­fits) and the individual
  elects to car­ry over unused amounts to the HSA com­pat­i­ble FSA for the subsequent
  plan year; or

  3) The cafe­te­ria plan is designed to auto­mat­i­cal­ly enroll those who elect a high
  deductible health plan cov­er­age for the fol­low­ing plan year in an HSA compatible
  FSA (includ­ing car­ry­over amounts)

• If you build it, they will come…unless they are there already

  June 5, 2014

  A McK­in­sey study has shown that a large major­i­ty of peo­ple sign­ing up are already pay­ing for their cov­er­age – and that num­ber is 78%. Yes, only 22% of Oba­macare signups are paid, pre­vi­ous­ly unin­sured enrollees. Not all of them have yet paid, either. So it helps a lot of peo­ple (that is the “afford­able” part) but not every­one has sought “care”

• Some came running…but they should have walked first…four state exchanges will bite the dust

  June 5, 2014

  So far four states have spent $474 mil­lion on state health­care exchanges that are con­sid­ered to be in sham­bles and so the final price tag for sav­ing them may go even high­er. The fed­er­al gov­ern­ment must now decide whether to throw more mon­ey at them or let them fail. These exchanges are in Mass­a­chu­setts, Ore­gon, Neva­da and Mary­land. That leaves 9, but Wash­ing­ton has many iden­ti­fied flaws and the head of the Hawaii exchange is call­ing on the state to shut it down. So we are at a 50% poten­tial fail­ure rate? Accord­ing to the Los Ange­les Times, fed­er­al pros­e­cu­tors in Ore­gon have “issued sub­poe­nas to Oregon’s health insur­ance exchange as part of a grand jury inves­ti­ga­tion into the spec­tac­u­lar fail­ure of the state’s sys­tem, which was nev­er able to enroll con­sumers online even though it spent more than $248 mil­lion in tax­pay­er mon­ey on the operation”

• Shared Responsibility has Pared Reliability as Hardships are Exempted

  June 5, 2014

  While med­ical cov­er­age is man­dat­ed, it doesn’t mean that every­one can afford it. Sub­si­dies are pro­vid­ed, Medi-Cal might be avail­able, but there are still those in the mid­dle, even those get­ting sub­si­dies, where the pay­ment offered is not enough. There are now a num­ber of cat­e­gories in which sub­scribers may fall and be allowed to reduce or avoid pay­ment while still being cov­ered. Some make sense (home­less or evict­ed, received util­i­ty shut­off, filed for bank­rupt­cy, had med­ical expens­es you couldn’t pay, car­ing for an aging or ill fam­i­ly mem­ber). The odd ones, how­ev­er, are these: 

  “You received a notice say­ing that your cur­rent health insur­ance plan is being can­celled and
  you con­sid­er the oth­er plans avail­able unaf­ford­able”; and 

  “you expe­ri­enced anoth­er hard­ship in obtain­ing health insurance”

  Noth­ing like leav­ing things open ended…

• But who will be paying? Costs increase in the industry but not all have paid their premiums

  June 5, 2014

  Grant­ed, these are fig­ures com­ing from Repub­li­cans, and grant­ed, it is too soon to tell exact­ly who will pay for what they bought, but ear­ly fig­ures show that just two thirds of those who signed up for cov­er­age under the ACA had paid their pre­mi­ums by April 15

• When the Costs Come Rolling In…What the ACA Costs is now becoming clear

  June 5, 2014

  In 1965, after pas­sage of the nation­al Medicare Act, health care expens­es increased dra­mat­i­cal­ly, as pent up demand among seniors was slaked and they began to use ser­vices that were pre­vi­ous­ly denied them due to inabil­i­ty to afford. The same was antic­i­pat­ed to hap­pen with the Afford­able Care Act. Despite the increase in the “insured pool” the prob­lem was that those join­ing the pool were those who had delayed med­ical care. Ear­ly reports show this is the case, as sev­er­al sources have report­ed sky­rock­et­ing costs in the health care indus­try. The good news is that this helps the economy…but at what cost, as these charges will come back to the car­ri­ers that spon­sor cov­er­age, and thus to the com­pa­nies and con­sumers who pay pre­mi­ums. The Wash­ing­ton Exam­in­er expressed its alarm by say­ing the accel­er­a­tion comes after years of “Oba­ma and his allies…crediting a show­down in the rate of growth for health care to pay­ment reforms imposed by the law” Yes that was true in the begin­ning, but now we are see­ing the true expansion…and the true costs. As report­ed in the Huff­in­g­ton Post (admit­ted­ly not the most unbi­ased of reportage) “Who could have pre­dict­ed that a recov­er­ing econ­o­my, high­er incomes and a rise in the num­ber of peo­ple with health cov­er­age brought about by Oba­macare would increase how much Amer­i­cans are spend­ing on med­ical care? Well, pret­ty much anyone”

• New HSA Limits for 2015 | California Healthcare Reform

  May 5, 2014

  The annu­al lim­i­ta­tion for indi­vid­u­als will be raised to $3,350 and for fam­i­lies $6,650.  The def­i­n­i­tion of a high deductible plan moves to $1,300 deductible for self only cov­er­age and $2,600 for fam­i­ly cov­er­age, with “out of pock­et” expens­es not to exceed $6,450 and $12,900.

• So Speaking of Costs…How Badly will the ACA Affect the Medical Insurance Market?

  May 5, 2014

  An analy­sis of the first two months of claims data from the fed­er­al and state mar­ket­places show that new enrollees are more like­ly to use expen­sive spe­cial­ty drugs to treat con­di­tions such as HIV/AIDS and hepati­tis C than those with job based insur­ance. It’s only two months, but…and the experts are naysay­ers and sup­port­ers agree with them and so on…but it should be watched

• When will the cost projections be final? CBO updates again…after just two months

  May 5, 2014

  The Con­gres­sion­al Bud­get Office has changed their mind…again…and says that the ten year cost pro­jec­tion for the Afford­able Care Act will be $100 bil­lion less than they thought recent­ly The White House took cred­it (of course) say­ing “this report demon­strates the Afford­able Care Act is work­ing. It shows that mar­ket­place health care costs have gone down because pre­mi­um esti­mates have gone down. Addi­tion­al­ly, the effort to con­strain health care costs more broad­ly is show­ing con­tin­ued momen­tum, as evi­denced by the fur­ther deduc­tion in pro­ject­ed Medicare spend­ing” Of course, the cost is still enor­mous — $1.383 tril­lion over the next decade

• Let Begin the Liberal Woes – against their usual predatory foes (yes, the insurance companies)

  May 5, 2014

  Accord­ing to Con­sumer Watch­dog, the major insur­ance car­ri­ers and the asso­ci­a­tion that rep­re­sents them (Cal­i­for­nia Asso­ci­a­tion of Health Plans) have col­lec­tive­ly giv­en $25 mil­lion of pol­i­cy­hold­er mon­ey to a cam­paign against the upcom­ing bal­lot ini­tia­tive to lim­it the amount car­ri­ers may raise their rates. The “Jus­ti­fy Rates” bal­lot mea­sure requires car­ri­ers to get per­mis­sion from the state before rais­ing rates like auto and home insur­ance companies

  Actu­al­ly, and inter­est­ing­ly, it’s not the rate increas­es so much, but the fact that car­ri­ers con­tin­ue to raise their rates while they have exces­sive reserves. Con­sumer Watch­dog cit­ed Blue Shield, a non prof­it which has $3.68 bil­lion in reserves now, which is 1,667% more than required. Then again there is all the adver­tis­ing, such as Kaiser’s “Thrive” cam­paign at a cost of $40–50 mil­lion per year. Also not­ed are “exces­sive” exec­u­tive pay (a com­mon com­plaint) and the fines that car­ri­ers have paid due to inap­pro­pri­ate claims actions – and we all get to pay.

• There is Enrollment…but then there is payment and more numbers behind the numbers

  May 5, 2014

  Due to the late surge, enroll­ment in Cov­ered Cal­i­for­nia, the pub­lic exchange in this state, has hit 1.4 mil­lion, which exceed­ed expec­ta­tions. So far about 85% of them have paid, and 88% of those enrolled qual­i­fied for sub­si­dies. Anoth­er 1.5 mil­lion enrolled under Medi-Cal.

  Of those enrolled, tar­get pop­u­la­tions of those 18–34 and Lati­nos, both of which had slow starts, have increased con­sid­er­ably and are at 29% and 28% of the over­all enrollment.

• It’s not just medical coverage…the ACA affects other things (of course)

  May 5, 2014

  Accord­ing to the RAND research orga­ni­za­tion, the costs of auto insur­ance (which has a med­ical pay­ment com­po­nent), Work­ers Com­pen­sa­tion and gen­er­al lia­bil­i­ty insur­ance will all go down slight­ly because, as more become enrolled on med­ical plans, the pres­sure on those oth­er cov­er­ages drops, and thus their prices. RAND esti­mates a price reduc­tion of up to 5% — but then imme­di­ate­ly hedges and says there is a lot of uncer­tain­ty about these num­bers. It then turned around and said that, with over 8 mil­lion new cov­ered peo­ple, mal­prac­tice costs could soar. As goes enclo­sure, so goes exposure.

• What went wrong in other places…State Exchanges look to recoup losses

  May 5, 2014

  Cal­i­for­nia is seen as the shin­ing star among the 13 exchanges, but that may be damn­ing with faint praise, giv­en the sham­bles some of the states made of the entire Afford­able Care roll­out. In Ore­gon, they are decid­ing whether to give up and go fed­er­al or hir­ing a new con­trac­tor to fix the tech­nol­o­gy. In Mass­a­chu­setts, they admit there is a lot of work to be done for the next roll­out this fall and the gov­er­nor is busi­ly tem­per­ing expec­ta­tions. Cal­i­for­nia still comes under scruti­ny, not because of the sys­tem, but because they have found it nec­es­sary to nar­row the provider net­works. They have extend­ed dead­lines for enroll­ment in Wash­ing­ton, and Ver­mont may get an over­haul. As for Mary­land, call an MD.

• It was only a matter of time…before the scapegoats go…Kathleen Sebelius resigns

  May 5, 2014

  No it wasn’t her fault, but some­one has to take the blame, so HHS Sec­re­tary Kath­leen Sebe­lius chose the day after the close of the indi­vid­ual open enroll­ment peri­od to make way for a replace­ment. What’s iron­ic is that she is leav­ing on a high note, since it appears, at least for now, that the final roll­out of the Afford­able Care Act is at least a mod­er­ate suc­cess, with pos­si­ble enroll­ment exceed­ing 7.5 mil­lion (yet all the major net­works, in announc­ing the res­ig­na­tion, all char­ac­ter­ized the begin­ning of the roll­out to be “rocky”) Her suc­ces­sor will be a long estab­lished Wash­ing­ton play­er, cur­rent OMB Direc­tor Sylvia Math­ews Bur­well. David Yepsen of the Paul Simon Pub­lic Pol­i­cy Insti­tute, said, how­ev­er “If the Oba­ma peo­ple thought this was going to calm the waters, I think they mis­read it. I think it’s just going to embold­en Repub­li­cans” The lat­est Kaiser Fam­i­ly Foun­da­tion poll says that 46% still have an unfa­vor­able view of the law and 38% have a favor­able view. Sen­ate Major­i­ty Leader Mitch McConnell said “Sec­re­tary Sebe­lius may be gone, but the prob­lems with this law and the impact it’s hav­ing on our con­stituents aren’t. Oba­macare has to go, too”

• Making it easier to get there, at taxpayer expense – another San Francisco mandate

  May 5, 2014

  So there was a rule about bicy­cle com­mut­ing, and there was a rule say­ing that groups of 20 had to offer some form of com­muter ease…but now San Fran­cis­co is mak­ing manda­to­ry for groups of 50 or more employ­ees some­thing they should have found easy to do already – pro­vide tax free com­muter reim­burse­ment to their employ­ees. For those who work 20 hours or more per week, employ­ers must pro­vide the fol­low­ing options:

  1. Pre tax ben­e­fit: employ­er allows employ­ees to exclude their tran­sit or van­pool costs from tax­able income (which fed­er­al law has allowed for many years)
  2. Employ­er pro­vid­ed sub­sidy for tran­sit or van­pools, up to $75 per month
  3. Employ­er pro­vid­ed transit
  4. Alter­nate com­muter ben­e­fit pro­vid­ed by employers

• It’s a Success! But at what cost? The Affordable Care Act in the final days

  May 5, 2014

  There was a huge push, and in the end the final enroll­ment exceed­ed pro­jec­tions in both Cal­i­for­nia and nation­al­ly, but the nation­al toll polled well for our state. But…we still don’t know how many “new enrollees” were found, and what they found. Many of the new­ly enfran­chised enrolled in Med­ic­aid, which will cost us. Many enrolled in the indi­vid­ual exchanges, at a cost of $10 bil­lion in tax cred­its, an aver­age of $2,890 for each of the 3.5 mil­lion peo­ple who qual­i­fied for a sub­sidy as of March 1 So the final results are still to be count­ed, and more sub­si­dies may be com­ing our way. How long will they be sus­tained, and what of the new­ly enfranchised?

• One more change…one more time – a change in the ACA dealing with deductibles

  May 5, 2014

  Just when we’re all set and the mid terms seem ready to go…they have made one more change. Pres­i­dent Oba­ma signed the “Pro­tect­ing Access to Medicare Act of 2014” which imme­di­ate­ly repeals the deductible lim­its imposed under the ACA for non grand­fa­thered plans pur­chased in the small group insur­ance mar­ket (and what does this have to do with Medicare?) Thus small employ­ers can pur­chase high­er deductibles than the lim­its which had been allowed of $2,000 – the fun­ny thing, of course, is that car­ri­ers have already done this, cit­ing the actu­ar­i­al stud­ies that “val­ue” plans in terms of the over­all lia­bil­i­ty lim­it and not the deductible

• Inflation debate among inflated claims freighted with doubt about who’s in and who’s out

  May 5, 2014

  The rates are a guess­ing game. Just do a com­par­i­son between what exists and what is being tout­ed now as part of the Afford­able Care Act and you can see the gaps are too large. So it is no sur­prise that Well­point, par­ent of Anthem Blue Cross of Cal­i­for­nia, is threat­en­ing dou­ble dig­it rate increas­es in 2015. The Con­sumer Watch­dog Cam­paign has said that Well­point has done bet­ter than any oth­er car­ri­er in terms of new enroll­ment, and thus should not be talk­ing about rate increas­es. So…we have the Insur­ance Rate Pub­lic Jus­ti­fi­ca­tion and Account­abil­i­ty Act on the Novem­ber bal­lot in Cal­i­for­nia. Great…so increas­ing mys­tery will be shroud­ed in greater bureau­crat­ic mis­ery and enig­mas mul­ti­ply as every­one seeks to jus­ti­fy their position.

• Special legal training…where the Obama Affordable Care Act could still derail

  May 5, 2014

  The last legal chal­lenge remain­ing to the Afford­able Care Act is a miss­ing clause in the statute, which means, to some, that the sub­si­dies now made avail­able to make indi­vid­ual health insur­ance more afford­able actu­al­ly ille­gal. This issue has been kick­ing around for some time, but now the case has been brought to the US Court of Appeals in Wash­ing­ton, DC. Accord­ing to Michael Can­non, direc­tor of health pol­i­cy stud­ies at the Cato Insti­tute, “they miscalculated…everyone assumed that all states would estab­lish exchanges” and “this was a draft­ing error that was made nine times. That tells you, no, this wasn’t an error. It was done deliberately.”

• It’s complicated…the government giveth and taketh away on FSA and HSA

  May 5, 2014

  Yeah, it should be sim­ple. First we had the FSA. Then we had the HSA. Then we had the IRS say that an FSA had to be lim­it­ed to den­tal and vision while the HSA could cov­er med­ical, den­tal and vision all togeth­er. Then the gov­ern­ment said we could have grace peri­ods of up to ten weeks for the FSA. That wasn’t too hard, but there were some unan­swered ques­tions. Then the gov­ern­ment decid­ed that a grace peri­od wasn’t enough, and now employ­ers have the option of rolling over $500 of unused funds to the next plan year. Final­ly the IRS decid­ed they had had enough…and had to step in and pro­vide a slew of rules (oh boy):

  1. Indi­vid­ual cov­ered by gen­er­al health FSA (bureau speak for reg­u­lar old FSA) may not make con­tri­bu­tions to an HSA (yes, we already knew that). This includes, how­ev­er, some­one who has cov­er­age in an FSA sole­ly as the result of a car­ry­over of unused amounts in a health FSA from the pri­or year
  2. Indi­vid­ual cov­ered by gen­er­al health FSA sole­ly as the result of a car­ry­over of unused amounts in the FSA from the pre­vi­ous year may not con­tribute to an HSA even for months in the plan year after the health FSA no longer has any amounts avail­able to pay or reim­burse med­ical expenses
  3. Indi­vid­ual who par­tic­i­pates in gen­er­al health FSA and elects, for the fol­low­ing year, to par­tic­i­pate in an HSA com­pat­i­ble lim­it­ed pur­pose FSA (mean­ing den­tal and vision only) may choose to have any unused amounts from the gen­er­al health FSA car­ried over to the HSA com­pat­i­ble lim­it­ed pur­pose health FSA. There is no require­ment that the unused amounts in the gen­er­al health FSA only be car­ried over to a gen­er­al health FSA
  4.  Indi­vid­ual who par­tic­i­pates in gen­er­al health FSA and elects, for the fol­low­ing year, to par­tic­i­pate in an HSA com­pat­i­ble lim­it­ed pur­pose FSA and have any unused amounts from the gen­er­al pur­pose health FSA car­ried over to the HSA com­pat­i­ble health FSA is eli­gi­ble to con­tribute to an HSA dur­ing the fol­low­ing year if the indi­vid­ual is oth­er­wise HSA eligible
  5.  A cafe­te­ria plan that offers both a gen­er­al health FSA and an HSA com­pat­i­ble lim­it­ed pur­pose health FSA may be draft­ed or amend­ed to auto­mat­i­cal­ly treat an indi­vid­ual who elects cov­er­age in a High Deductible Health Plan for the fol­low­ing year as enrolled in the HSA com­pat­i­ble lim­it­ed pur­pose health FSA and car­ry over any unused amounts from a gen­er­al health FSA to the HSA com­pat­i­ble lim­it­ed pur­pose health FSA for the fol­low­ing year
  6. A cafe­te­ria plan may be draft­ed or amend­ed to pro­vide that if an indi­vid­ual par­tic­i­pates in a gen­er­al health FSA that pro­vides for a car­ry­over of unused amounts, the indi­vid­ual may elect pri­or to the begin­ning of the fol­low­ing year to decline or waive the FSA car­ry­over for the fol­low­ing year. In that case, the indi­vid­ual who declines the FSA car­ry­over under the terms of the Cafe­te­ria Plan may con­tribute to an HSA dur­ing the fol­low­ing year if the indi­vid­ual is oth­er­wise HSA eligible

  Got it? Yes, it’s com­pli­cat­ed. We are ready to help you as soon as we deci­pher it.

• What are we waiting for? And what is the waiting period anyway? New rules…

  May 5, 2014

  The Afford­able Care Act pro­vid­ed a max­i­mum 90 day wait­ing peri­od for cov­er­age of employ­ees (Cal­i­for­nia has updat­ed this and made it 60 days, both as of the anniver­sary date of exist­ing group cov­er­age). What’s in a word, or expres­sion, or name? Some high­lights, which are left open to inter­pre­ta­tion as to how this should all be insti­tut­ed (26 CFR Part 54)

  1. A group health plan or health insur­ance issuer offer­ing group health insur­ance cov­er­age shall not apply any wait­ing peri­od that exceeds 90 (60) days
  2. Applies to both grand­fa­thered and non grand­fa­thered plans
  3. Eli­gi­bil­i­ty con­di­tions that are based sole­ly on the lapse of a time peri­od would be per­mis­si­ble for no more than 90 days
  4. The eli­gi­bil­i­ty con­di­tion is not con­sid­ered to be designed to avoid com­pli­ance with the 90 day wait­ing peri­od lim­i­ta­tion if the cumu­la­tive hours of ser­vice require­ment does not exceed 1,200 hours
  5. Wait­ing peri­od still defined as that which must pass before cov­er­age for an indi­vid­ual who is oth­er­wise eli­gi­ble to enroll under the terms of a group health plan can become effective
  6. Wait­ing peri­od lim­i­ta­tion gen­er­al­ly doesn’t require the plan spon­sor to offer cov­er­age to any par­tic­u­lar indi­vid­ual or class of indi­vid­u­als. Instead the final reg­u­la­tions pro­hib­it requir­ing oth­er­wise eli­gi­ble indi­vid­u­als to wait more than 90 days before cov­er­age becomes effective
  7. Oth­er con­di­tions are gen­er­al­ly per­mis­si­ble under these reg­u­la­tions unless the con­di­tion is designed to avoid com­pli­ance with the 90 day wait­ing peri­od limitation

• And then there’s the other stuff (and when does this end?)…

  May 5, 2014

  Car­ri­ers will be able to more eas­i­ly qual­i­fy for the rein­sur­ance pool that was intend­ed to pay back the insur­ers for “loss­es” they expe­ri­ence by work­ing with the Afford­able Care Act

  Not only will it be eas­i­er, but the new bud­get asks for anoth­er $5.5 bil­lion in spend­ing to reim­burse the car­ri­ers, which Repub­li­cans are nat­u­ral­ly call­ing a bailout for insur­ers. A hand­ful of Repub­li­can law­mak­ers have intro­duced leg­is­la­tion to repeal the so called risk corridors

  Unions, uni­ver­si­ties and some oth­er self fund­ed employ­ers will not have to pay the $63 fee required to cov­er the rein­sur­ance fund

  We final­ly have rules that define how employ­ers with more than 50 employ­ees must report their infor­ma­tion (more on that lat­er) to the gov­ern­ment with respect to coor­di­na­tion with the “pay or play” initiative

• The Democrats are in the House…just not as many – the supermajority is lost in CA

  May 5, 2014

  A pair of high pro­file cor­rup­tion cas­es have cost Democ­rats their super­ma­jor­i­ty in the state Sen­ate after lit­tle more than a year “in charge” – Sen­a­tor Calderon has tak­en a paid leave of absence fight­ing fed­er­al cor­rup­tion charges (we pay him while he is fight­ing scan­dal?) and Sen­a­tor Wright is in the wrong (or is he?)

• The Republicans are getting Koched up…speeding down denial river

  May 5, 2014

  Ads against the Afford­able Care Act, many spon­sored by the Koch-fueled Amer­i­cans for Pros­per­i­ty group, have been labeled untrue by Sen­ate Major­i­ty Leader Har­ry Reid – “despite all the good news, there’s plen­ty of hor­ror sto­ries being told. All of them are untrue, but they’re being told all over Amer­i­ca. Those tales turned out to be just that – tales, sto­ries, made up from whole cloth”

• Show me the money – is it a bailout, a fallout or a sellout? Money to carriers for support

  May 5, 2014

  Humana and Well­point (Anthem Blue Cross) each stand to gain $5.5 bil­lion next year to cov­er loss­es from Oba­macare due to the risk cor­ri­dors they have “sup­port­ed” by tak­ing on more risk than oth­ers in an effort to “bal­ance the bud­get” when it comes to pro­vid­ing cov­er­age under the new ACA rules. Yes, they com­plained about the new law…but why? Sen­a­tor Mar­co Rubio, who has made a one man cam­paign (besides his own for Pres­i­dent) against the Afford­able Care Act said “the risk of a bailout has always been high…as many of us pre­dict­ed, these exchanges have not attract­ed enough young and healthy peo­ple to sign up”

• Florida casts ACA sunshine – will it continue to play – can Florida decide another election?

  May 5, 2014

  Flori­da had a spe­cial elec­tion for Con­gress in the 13^th Dis­trict. Repub­li­can David Jol­ly was pret­ty hap­py to win over Demo­c­rat Alex Sink, whose can­di­da­cy, you know, sunk. The New York Times said this is “an expen­sive tri­umph in the GOP fight against Pres­i­dent Obama’s health care plan (and it) will embold­en Repub­li­cans as they head into the midterm elec­tion and bol­ster their mes­sage that the nation dis­ap­proves of the Afford­able Care Act and Pres­i­dent Obama’s lead­er­ship” The Brook­ings Insti­tute said of this con­test “The Flori­da elec­tion is a test case of the pow­er of Obamacare…Democrats put a lot of effort into win­ning this race, and the loss sug­gests this will be a tough fall for the nation­al par­ty” The New York Times said the win is “dev­as­tat­ing at a time when Democ­rats are des­per­ate to change the pre­vail­ing sto­ry line that 2014 could cost them the Sen­ate, with the House already out of reach” Of course, it may be too much to con­sid­er as Politi­co reports “Democ­rats can’t even agree whether Oba­macare was the rea­son for their crush­ing loss” The Wall Street Jour­nal sug­gests that the ACA is like­ly to hurt Democ­rats in com­pet­i­tive races this fall, but for the GOPO to fur­ther cap­i­tal­ize on the issue, Repub­li­cans should draw up leg­is­la­tion that both high­lights and reme­dies per­ceived flaws in the law…so the GOP should craft legislation

• The Exchange will work no matter the cost…so if you spend it they will come?

  May 5, 2014

  The pro­posed bud­get asks for anoth­er $600 mil­lion to help run the fed­er­al mar­ket­place, call cen­ters and oth­er out­reach efforts. The Health and Human Ser­vices Depart­ment is not con­cerned about bud­get pas­sage, however…if they don’t get the mon­ey they have already said they have the author­i­ty to trans­fer funds from exist­ing accounts or tap the agency’s non recur­ring expense fund, which allows the agency to take mon­ey from expired accounts and use it for infor­ma­tion tech­nol­o­gy and oth­er cap­i­tal invest­ments. Of course, it is impor­tant that they spend mon­ey on the marketplace…since the bud­get also con­tains a reduc­tion of $402 bil­lion for Medicare, Med­ic­aid and oth­er fed­er­al health pro­grams. The bud­get already requests $77.1 billion

• Then we get the details…and denials

  May 5, 2014

  Kath­leen Sebe­lius, Sec­re­tary of HHS, held the line on the man­date despite the Pres­i­dent not hold­ing the line on the man­date say­ing that the date is not dat­ed and unabat­ed and thus every­one must enroll by March 31…or else.

• No date on the mandate or womandate or whatever date you want – another ACA amendment

  May 5, 2014

  Mil­lions of peo­ple may be exempt from the indi­vid­ual man­date – the CMS issued guid­ance on Decem­ber 19, 2013 “indi­cat­ing that indi­vid­u­als whose poli­cies are can­celed because the cov­er­age is not com­pli­ant with the Afford­able Care Act qual­i­fy for a hard­ship exemp­tion if they find oth­er options to be more expen­sive, and are able to pur­chase cat­a­stroph­ic cov­er­age. This hard­ship exemp­tion will con­tin­ue to be avail­able until Octo­ber 1, 2016 to those indi­vid­u­als whose non com­pli­ant cov­er­age is can­celed and who meet the require­ments spec­i­fied in the guid­ance” – in oth­er words, the Act is sup­posed to be “afford­able” but if it is not because the pol­i­cy was changed, even though the change was sup­posed to be about qual­i­ty, we are OK to over­look it, because we were kid­ding about forc­ing qual­i­ty on peo­ple despite its poten­tial unaf­ford­abil­i­ty? OK…and in pub­lic testimony

• More ACA Delays…but the train may have left the station

  May 5, 2014

  Now that the states and the car­ri­ers have made all the changes required under the Afford­able Care Act, the Pres­i­dent has respond­ed to pub­lic pres­sure and said that qual­i­ty is no longer a pri­or­i­ty and he did not mean what he said about can­celling the indi­vid­ual poli­cies. First he extend­ed the dead­line for changes to indi­vid­ual plans to March 31, but now he will extend it anoth­er three years. That avoids both mid term elec­tion fall­out and goes into the next Pres­i­den­tial elec­tion as well. That’s nice…but the changes have already been made. Who is going to fol­low this man­date when the car­ri­ers have already announced and made the changes? Under the pro­posed rule, con­sumers may con­tin­ue to pur­chase the pre­vi­ous­ly dis­al­lowed “skimpy plans” until Octo­ber 2016 and can keep them until Sep­tem­ber 2017 Rep­re­sen­ta­tive Fred Upton said “the admin­is­tra­tion can­not run fast enough away from its bro­ken promis­es” and House Over­sight Chair­man Dar­rell Issa said “this move is a cyn­i­cal ploy that delays thou­sands of insur­ance pol­i­cy can­cel­la­tions under after the elections”

• No we really mean it…wait, there’s another delay…will we ever agree on this law?

  May 5, 2014

  Just in time for the mid term elec­tions, Pres­i­dent Oba­ma has seen his way clear to allow­ing an exten­sion of those plans that did not meet the stan­dards of his sig­na­ture health insur­ance law for anoth­er two years. The main idea was to ensure that plans meet cer­tain min­i­mum stan­dards and include “essen­tial health ben­e­fits” That was a good idea…but the plans that did not meet those stan­dards cost less than those that do…and there was a major media fall­out regard­ing the dif­fer­ence between qual­i­ty of cov­er­age and quan­ti­ty of mon­ey. So the Pres­i­dent caved…in response to polit­i­cal pres­sures. So now there is a two year exten­sion to the can­cel­la­tion of those poli­cies. The prob­lem is that the bus may have left the sta­tion (sure­ly there is a bet­ter metaphor here) and the car­ri­ers, at least in Cal­i­for­nia, that have already dropped those poli­cies and replaced them with new­er ones at the Administration’s behest are prob­a­bly loathe to go back…especially since the open enroll­ment dead­line for new plans, coin­ci­dent with the expiry of the old plans, is only March 31.

• The list is smaller, but they can’t seem to manage it – more Exchange problems

  April 4, 2014

  For the sec­ond time since the launch, Cov­ered Cal­i­for­nia has tak­en down its physi­cian direc­to­ries because they are full of errors, unre­li­able, not up to date, and even the doc­tors them­selves don’t know which list they’re on…in addi­tion to show­ing doc­tors as flu­ent in lan­guages they do not speak, doc­tors being mis­la­beled, etc.  Oh, and they aren’t doing any bet­ter on the nation­al web­site either…and some­how they have noticed that there are not enough doc­tors to fill the onslaught of new demand (hey, didn’t we say that four years ago?)

  The prob­lem, of course, is exac­er­bat­ed by the nar­row­ing of net­works in Cal­i­for­nia.  Insur­ance Com­mis­sion­er David Jones said “it’s a lit­tle ear­ly for any­one to know how wide­spread and deep this prob­lem is.  There are a lot of eco­nom­ic incen­tives for health insur­ers to nar­row their net­works (Mr. Jones, what eco­nom­ic incen­tives?  Cov­ered Cal­i­for­nia asked for this in an attempt to bring rates down), but if they go too far, peo­ple won’t have access to care.  Net­work ade­qua­cy will be a big issue in 2014”  One doc­tor called it a “phan­tom net­work”  Lar­ry Levitt, of the Kaiser Fam­i­ly Foun­da­tion, said “insur­ers have made the judg­ment that peo­ple pre­fer low­er pre­mi­ums to broad­er networks”

• You’ll Never Get Away with it – the Republicans saw this one coming

  April 4, 2014

  Employ­ers who thought they would be able to cut their finan­cial expo­sure by reduc­ing the num­ber of hours below the required 30 hour min­i­mum may be sur­prised by the fact that the House is not sur­prised by this maneu­ver.  House Major­i­ty Leader Eric Can­tor said the House will soon con­sid­er leg­is­la­tion aimed at low­er­ing the minimum.

• Calls for Malls within Prison Walls…Health Insurance Marketplace Pro’s for Cons

  April 4, 2014

  In Ore­gon, it is esti­mat­ed that $6.5 bil­lion per year would be saved if pris­on­ers in state and coun­ty jails were enrolled in state med­ical exchanges.  Pro­po­nents of this change say “they’ll like­ly get treat­ment for men­tal ill­ness, sub­stance abuse and oth­er con­di­tions that lead them to a life of crime” says the Pro­fes­sion­al Insur­ance Agents Asso­ci­a­tion.  So pris­on­ers are not required to enroll in cov­er­age (the new man­date) but now the pris­ons will take advan­tage of what has been created…and so we shift the respon­si­bil­i­ty from one part of the gov­ern­ment to the other.

• You’re Covered – but there may be no one there to treat you

  April 4, 2014

  The LA Times print­ed a sto­ry say­ing that new enrollees are get­ting faulty infor­ma­tion about which providers are cov­ered, get­ting lit­tle help from swamped insur­ers to answer ques­tions, and even what they can find shows that the num­bers of par­tic­i­pat­ing doc­tors has been cut dramatically…perhaps too much so.  Dave Jones, Insur­ance Com­mis­sion­er, said with sim­ple under­state­ment “It’s a lit­tle ear­ly for any­one to know how wide­spread and deep this prob­lem is”

  Yeah…and we knew that was com­ing.  Why didn’t the car­ri­ers or the politicians?

• Another Delay in Pay or Play – when will they stop tinkering – after four years

  April 4, 2014

  Employ­ers with 50 to 99 employ­ees will NOT have to com­ply with Pay or Play in 2015, a delay of an addi­tion­al year on top of the orig­i­nal delay for all groups that put off com­pli­ance until Jan­u­ary 1, 2015.  While these groups will be required to report on those who are cov­ered, they do not have to com­ply with the rules until 2016. In addi­tion, groups of over 100 employ­ees are being giv­en a grad­u­at­ed sched­ule for com­pli­ance – employ­ers will need to offer cov­er­age to 70% of full time employ­ees in 2015 and 95% in 2016 and lat­er years or they will, as is always threat­ened, be sub­ject to penal­ties.  There are, of course, conditions:

  1)    The employ­er has on aver­age at least 50 full time employ­ee equiv­a­lents but few­er than 100 on busi­ness days dur­ing 2014

  2)    From Feb­ru­ary 9 to Decem­ber 31, the employ­er does not reduce the size of its work­force or over­all hours of ser­vice in order to avoid com­ply­ing with the Pay or Play man­date in 2015

  3)    Any health care ben­e­fits offered by the employ­er on Feb­ru­ary 9 must not be elim­i­nat­ed or mate­ri­al­ly reduced.  The employ­er must con­tin­ue to offer cov­er­age dur­ing this cov­er­age main­te­nance peri­od at near­ly the same cost shar­ing lev­els through the last day of the plan year begin­ning on or after Jan­u­ary 1, 2015

  4)    Employ­ers who are eli­gi­ble for the one year delay will need to com­plete a form cer­ti­fy­ing that they meet the tran­si­tion­al relief require­ments.  This form will be includ­ed with IRC Sec­tion 6056 health insur­ance report­ing once they are published

  John Boehn­er respond­ed, of course – “Once again, the pres­i­dent is giv­ing a break to cor­po­ra­tions while indi­vid­u­als and fam­i­lies are still stuck under the man­dates of his health care law.  And, once again, the pres­i­dent is rewrit­ing law on a whim”  “Anoth­er day, anoth­er law­less exemp­tion” said the Wall Street Jour­nal.  J. Mark Iwry, deputy assis­tant Trea­sury sec­re­tary for health pol­i­cy (now there’s a title), defend­ed the admin­is­tra­tion and said they have broad author­i­ty to grant tran­si­tion relief under a sec­tion of the Inter­nal Rev­enue Code that directs the Trea­sury Sec­re­tary to pre­scribe all need­ful rules and reg­u­la­tions for the enforce­ment of tax obligations…which has often been used to post­pone the appli­ca­tion of new laws that would cause unrea­son­able admin­is­tra­tive bur­dens or costs to tax­pay­ers (oh)

• The SHOP Flop – what if they wrote a group plan and nobody cared?

  April 4, 2014

  Incen­tives are low, some of the states only have one car­ri­er, rates are not nec­es­sar­i­ly all that low, net­works are being cut, and the small group tax incen­tive is sel­dom used – much as it has been sel­dom used since it was first allowed in 2010 with the pas­sage of the ACA.  “even if the process was auto­mat­ed on the web­site, it still wouldn’t be appeal­ing because of the port­fo­lio” says a spokesper­son from the Nation­al Asso­ci­a­tion of Health Underwriters

• It’s the Spin that I’m in…what does the CBO know?

  April 4, 2014

  The Con­gres­sion­al Bud­get Office has released a report pre­dict­ing that the sub­si­dies now allowed for indi­vid­ual health poli­cies will cre­ate a “dis­in­cen­tive for peo­ple to work” because the sub­si­dies taper off as they earn more.  So while some have decried the incip­i­ent prac­tice of employ­ers cut­ting their employ­ees to below 30 hours to avoid the man­date, the CBO is say­ing many employ­ees will will­ing­ly cut back because it is in their eco­nom­ic inter­est to do so.  Paul Ryan, the Bud­get Com­mit­tee Chair, said he is trou­bled because “to begin work­ing, get­ting the dig­ni­ty of work, get­ting more oppor­tu­ni­ties, rais­ing their income, join­ing the mid­dle class – this means few­er peo­ple will do that”  He also not­ed that with Baby Boomers retir­ing in large num­bers this dis­in­cen­tive to work will have “jaw drop­ping impli­ca­tions for the econ­o­my and debt reduc­tion”  The CBO Direc­tor said the Afford­able Care Act “will reduce the total num­ber of hours worked in the econ­o­my by between one and a half and two per­cent from 2017 to 2024”

  In response the White House said such reduc­tions were not real­ly a prob­lem.  Chair­man of the Coun­cil of Eco­nom­ic Advi­sors Jason Fur­man said Oba­maCare allows greater choice for work­ers to scale back their hours to spend more time with their chil­dren, or to leave their jobs to launch a small busi­ness or start­up  “This is not busi­ness­es cut­ting back on jobs.  This is peo­ple hav­ing new choices”

• It’s a matter of perspective – are they raising rates because they must or because they must do it now before it’s too late – Blue Cross decision

  April 4, 2014

  Anthem and its par­ent com­pa­ny Well­point have giv­en $12.9 mil­lion to defeat a Cal­i­for­nia bal­lot ini­tia­tive that would require car­ri­ers to get approval for rate hikes – while they have pro­posed a 25% increase in the rates of indi­vid­ual poli­cies held by over 300,000 mem­bers in California.

• Was the law ill conceived? The Supremes weigh in to stop in the name of love – contraception

  April 4, 2014

  On Jan­u­ary 31 the US Supreme Court tem­porar­i­ly exempt­ed a reli­gious non prof­it orga­ni­za­tion from the fed­er­al health care law’s man­date that insur­ance plans include free cov­er­age of con­tra­cep­tives.  This is not the end of the Court’s involve­ment in such issues, as they hear two cas­es in March involv­ing non prof­it cor­po­ra­tions whose own­ers oppose abortion.

• Here have some more…but can you pay it back? More funding for Covered California

  April 4, 2014

  Now they are real­ly covered…with $1.1 bil­lion in fed­er­al funds alone.  Let’s not for­get the mon­ey they got from foun­da­tions and oth­er sources.  So it keeps pil­ing in and they keep pil­ing on, but can they pay it back by tack­ing on an admin­is­tra­tion fee?  Start­ing in 2016?  With enroll­ment below the num­bers they need?  Do we sound skeptical?

• They’re in control…but not quite, or at least not enough. Is that a good thing?

  December 31, 2014

  With some upset vic­to­ries, Cal­i­for­nia Democ­rats knew what it felt like in Con­gress as they lost their super majori­ties in both Cal­i­for­nia hous­es.  When a series of spe­cial elec­tions fin­ish­es next year they will be one vote short in the Sen­ate and two in the Assembly.

• OSHA’s New Reporting and Recordkeeping Rule Goes into Effect on January 1, 2015 | California Employee Benefits

  December 29, 2014

  Tags: OSHA, Recordkeeping, reporting

  www.thinkhr.com

  On Sep­tem­ber 11, 2014, the U.S. Depart­ment of Labor’s Occu­pa­tion­al Safe­ty and Health Admin­is­tra­tion (OSHA) announced a final rule which updates the report­ing and record-keep­ing require­ments for injuries and ill­ness­es, found at 29 C.F.R. 1904. The rule goes into effect on Jan­u­ary 1, 2015.

  Changes to record-keep­ing requirements

  Under OSHA’s record-keep­ing reg­u­la­tion, cer­tain cov­ered employ­ers are required to pre­pare and main­tain records of seri­ous occu­pa­tion­al injuries and ill­ness­es using the OSHA 300 Log. How­ev­er, there are two class­es of employ­ers that are par­tial­ly exempt from rou­tine­ly keep­ing injury and ill­ness records:

  • Employ­ers with 10 or few­er employ­ees at all times dur­ing the pre­vi­ous cal­en­dar year; and
  • Estab­lish­ments in cer­tain low-haz­ard industries.

  The new rule main­tains the exemp­tion for employ­ers with few­er than 10 employ­ees. How­ev­er, the new rule has an updat­ed list of indus­tries that will be par­tial­ly exempt from keep­ing OSHA records. The pre­vi­ous list of par­tial­ly exempt indus­tries was based on the old Stan­dard Indus­tri­al Clas­si­fi­ca­tion (SIC) sys­tem and injury and ill­ness data from the Bureau of Labor Sta­tis­tics (BLS) from 1996, 1997, and 1998. The new list of par­tial­ly exempt indus­tries in the updat­ed rule is based on the North Amer­i­can Indus­try Clas­si­fi­ca­tion Sys­tem (NAICS) and injury and ill­ness data from the Bureau of Labor Sta­tis­tics (BLS) from 2007, 2008, and 2009. As a result, many employ­ers who were once exempt­ed from OSHA’s record­keep­ing require­ments are now required to keep records. A list of new­ly cov­ered indus­tries can be found at www.osha.gov/recordkeeping2014/reporting_industries.html.

  Changes to the report­ing requirements

  In addi­tion to revis­ing the record-keep­ing require­ments, the new rule expands the list of severe injuries and ill­ness­es that employ­ers must report to OSHA. Under the pre­vi­ous rule, employ­ers were required to report the fol­low­ing events to OSHA:

  • All work-relat­ed fatalities.
  • All work-relat­ed hos­pi­tal­iza­tions of three or more employees.

  Under the new rule, employ­ers must report the fol­low­ing events to OSHA:

  • All work-relat­ed fatalities.
  • All work-relat­ed in-patient hos­pi­tal­iza­tions of one or more employees.
  • All work-relat­ed amputations.
  • All work-relat­ed loss­es of an eye.

  For any fatal­i­ty that occurs with­in 30 days of a work-relat­ed inci­dent, employ­ers must report the event with­in eight hours of find­ing out about it.

  For any in-patient hos­pi­tal­iza­tion, ampu­ta­tion, or eye loss that occurs with­in 24 hours of a work-relat­ed inci­dent, employ­ers must report the event with­in 24 hours of learn­ing about it.

  Employ­ers do not have to report an event if the event:

  • Result­ed from a motor vehi­cle acci­dent on a pub­lic street or high­way, except in a con­struc­tion work zone; employ­ers must report the event if it hap­pened in a con­struc­tion work zone.
  • Occurred on a com­mer­cial or pub­lic trans­porta­tion sys­tem (air­plane, sub­way, bus, fer­ry, street car, light rail, train).
  • Occurred more than 30 days after the work-relat­ed inci­dent in the case of a fatal­i­ty or more than 24 hours after the work-relat­ed inci­dent in the case of an in-patient hos­pi­tal­iza­tion, ampu­ta­tion, or loss of an eye.

  Employ­ers do not have to report an in-patient hos­pi­tal­iza­tion if it was for diag­nos­tic test­ing or obser­va­tion only. An in-patient hos­pi­tal­iza­tion is a for­mal admis­sion to the in-patient ser­vice of a hos­pi­tal or clin­ic for care or treatment.

  Employ­ers do have to report an in-patient hos­pi­tal­iza­tion due to a heart attack, if the heart attack result­ed from a work-relat­ed incident.

  What to report

  Employ­ers report­ing a fatal­i­ty, inpa­tient hos­pi­tal­iza­tion, ampu­ta­tion, or loss of an eye to OSHA must report all of the fol­low­ing information:

  • The name of the establishment.
  • The loca­tion of the work-relat­ed incident.
  • The time of the work-relat­ed incident.
  • The type of reportable event (i.e., fatal­i­ty, inpa­tient hos­pi­tal­iza­tion, ampu­ta­tion, or loss of an eye).
  • The num­ber of employ­ees who suf­fered the event.
  • The names of the employ­ees who suf­fered the event.
  • The con­tact per­son and his or her phone number.
  • A brief descrip­tion of the work-relat­ed incident.

  How to report

  Employ­ers can use the fol­low­ing three options to report an event:

  • Call the near­est OSHA Area Office dur­ing nor­mal busi­ness hours.
  • Call the 24-hour OSHA hot­line (800–321-OSHA or 800–321-6742).
  • Report an inci­dent elec­tron­i­cal­ly (OSHA is devel­op­ing a new means of report­ing events elec­tron­i­cal­ly, which will be released soon and will be acces­si­ble on OSHA’s website).

  Con­clu­sion

  It is rec­om­mend­ed that employ­ers famil­iar­ize them­selves with the final rule and train per­son­nel accord­ing­ly. All employ­ers under OSHA juris­dic­tion, even those who are exempt from main­tain­ing injury and ill­ness records, are required to com­ply with the new severe injury and ill­ness report­ing requirements.

  Read More …

• When is a medical plan not a medical plan? When it is a dental plan…Exchange counts off

  December 29, 2014

  The Depart­ment of Health and Human Ser­vices has admit­ted that it made a mis­take in count­ing the total enroll­ment under the Afford­able Care Act by 380,000…because it count­ed den­tal plans as med­ical plans.  This allowed them to hit the “mag­ic num­ber” extolled by the admin­is­tra­tion of 7 mil­lion enrollees, thus hit­ting their tar­get and claim­ing enroll­ment a suc­cess.  Sec­re­tary Bur­well apol­o­gized, say­ing “this mis­take was unac­cept­able (but) the fact that we have quick­ly cor­rect­ed the num­bers should give peo­ple confidence”

• Proposed 2016 Benefit and Payment Parameters | California Benefits Broker

  December 26, 2014

  Tags: 2016, Benefit, HHS, Parameters, Payment, UBA PPACA Advisor

  Post­ed by Lin­da Rowings

  The Depart­ment of Health and Human Ser­vices (HHS) has issued its pro­posed Ben­e­fit and Pay­ment Para­me­ters for 2016. While these amounts and dates are not yet final, they may be of help for plan­ning pur­pos­es. At this time, HHS expects:

  • Open enroll­ment for cov­er­age through the Mar­ket­place in 2016 will be from Octo­ber 1 through Decem­ber 15, 2015 (with cov­er­age effec­tive as of Jan­u­ary 1, 2016).
  • The tran­si­tion­al rein­sur­ance fee for 2016 is like­ly to be $27 per cov­ered life. Fil­ing for 2016 would be due Novem­ber 15, 2016, with $21.60 per cov­ered life due Jan­u­ary 15, 2017, and $5.40 per cov­ered life due Novem­ber 15, 2017.
  • The out-of-pock­et lim­its for health plans that are not high deductible plans relat­ed to HSAs would be $6,850 for sin­gle cov­er­age and $13,700 for fam­i­ly cov­er­age (with a max­i­mum out-of-pock­et for any fam­i­ly mem­ber of $6,850).
  • The fed­er­al­ly facil­i­tat­ed exchange fee would remain at 3.5% of premium.
  • A spe­cial enroll­ment peri­od would be avail­able at renew­al for indi­vid­u­als enrolled in non-cal­en­dar year plans.
  • Retirees and COBRA par­tic­i­pants could be cov­ered through a Small Busi­ness Health Options Pro­gram (SHOP) plan.
  • The cur­rent bench­mark plans for essen­tial health ben­e­fits would remain in effect for 2016, with new bench­mark plans based on 2014 ben­e­fits and enroll­ment in effect for 2017.

  A draft of an updat­ed AV cal­cu­la­tor and method­ol­o­gy for 2016 also are avail­able. While this will help you stay for­ward-think­ing, don’t for­get about tak­ing steps to ensure you are pre­pared to meet the Patient Pro­tec­tion and Afford­able Care Act (PPACA) require­ments that begin in 2015 and those which must be com­plet­ed in 2014. For a com­plete check­list, down­load UBA’s PPACA Advi­sor, “Prepar­ing for 2015 — Key PPACA Requirements”.

  Read More …

• It was not well suited to their needs – so they are filing suit against it – GOP vs. Obama

  December 23, 2014

  They didn’t like the bill, now they don’t like the fact that it is not hap­pen­ing fast enough.  Accus­ing Pres­i­dent Oba­ma of “mak­ing up his own laws” (John Boehn­er) by delay­ing the employ­er man­date, the Repub­li­cans are also con­sid­er­ing fil­ing a suit over the recent deci­sion to pro­vide depor­ta­tion relief.  They’re not relat­ed, except inso­far as it con­cerns the Chief Exec­u­tive.  House Minor­i­ty Leader Nan­cy Pelosi was a bit upset : “the fact is, this law­suit is a bald faced attempt to achieve what Repub­li­cans have been unable to achieve through the polit­i­cal process.  The leg­isla­tive branch can­not sue sim­ply because they dis­agree with the way a law passed by a dif­fer­ent Con­gress has been implemented…the law­suit is an embar­rass­ing loser.”

• Hand Washing Helps Defeat the Flu | Petaluma Benefits Broker

  December 22, 2014

  Tags: CDC, flu, influenza, wellness

  www.thinkhr.com

  H3N2 influen­za virus­es led to record num­bers of deaths in the 2004, 2008, and 2013 flu sea­sons. Doc­tors are con­cerned because this type of virus appears to be dom­i­nat­ing the 2015 flu sea­son. Employ­ers should stress opti­mal health and hand-wash­ing behav­iors in their work­places to avoid the threat of flu and keep their work­places healthy and germ-free.

  The Unit­ed States Cen­ters for Dis­ease Con­trol (CDC) reports a major­i­ty of cas­es so far this flu sea­son are H3N2 virus­es. When these types of virus­es are the most preva­lent in a flu sea­son, the result is often more severe ill­ness with greater instances of hos­pi­tal­iza­tion and death. This year the CDC is find­ing that the flu vaccine’s abil­i­ty to pro­tect against H3N2 virus­es is not as strong as was hoped when the vac­cine was being for­mu­lat­ed. This reduced pro­tec­tion is the result of muta­tion in about half of the H3N2 virus­es since the sea­son began. The CDC still rec­om­mends the vac­cine as vac­ci­nat­ed peo­ple will like­ly have a more mild ill­ness if they do become ill. This warn­ing will help employ­ers to see the need to aug­ment vac­ci­na­tion with oth­er pre­ven­tive health measures.

  Effec­tive hand wash­ing is essen­tial to pre­vent the spread of infec­tious dis­ease. The bac­te­ria, virus­es, and oth­er microbes that spread infec­tion usu­al­ly are not vis­i­ble to the naked eye. Every­one should care about the spread of harm­ful organ­isms because every­one has the poten­tial to unknow­ing­ly spread them to a per­son with a com­pro­mised immune sys­tem. Exam­ples of those with com­pro­mised immune sys­tems include fam­i­ly mem­bers, par­tic­u­lar­ly chil­dren and the elder­ly, or co-work­ers cop­ing with ill­ness­es like can­cer, heart dis­ease, or diabetes.

  Hands should be washed fre­quent­ly. You may be sur­prised to dis­cov­er how many times you inad­ver­tent­ly touch your face in the course of a day, which is often the method that intro­duces con­t­a­m­i­nates to our bod­ies through our eyes, nose, or mouth. At a min­i­mum, wash your hands sev­er­al times per day to lessen the risk of inad­ver­tent­ly spread­ing harm­ful organisms.

  Wash hands both before, dur­ing, and after food prepa­ra­tion as well as before eat­ing, treat­ing a wound, or adjust­ing con­tact lens­es. Hands may need to be washed mul­ti­ple times dur­ing food prepa­ra­tion. For exam­ple, Sal­mo­nel­la is a bac­te­ria that can be found on raw meats and veg­eta­bles, and is a seri­ous con­cern in the Unit­ed States. Accord­ing to the CDC, each year over one mil­lion peo­ple acquire the ill­ness, lead­ing to 19,000 hos­pi­tal­iza­tions and 380 deaths. In addi­tion to cook­ing food prop­er­ly and clean­ing work sur­faces, Sal­mo­nel­la  abate­ment requires hands to be cleaned before han­dling cooked meat or oth­er ingre­di­ents to pre­vent the trans­fer of organ­isms from raw items.

  To min­i­mize the spread of res­pi­ra­to­ry infec­tions and diar­rheal ill­ness, wash hands after using the toi­let, cough­ing, blow­ing your nose, chang­ing a dia­per, or touch­ing garbage, soiled laun­dry, shoes, an ani­mal, or any­thing touched by an ani­mal. This pre­ven­tive step lessens the amount of germs trans­ferred to key boards, handrails, door knobs, or toys.

  Soap and Water

  Soap and clean run­ning water are two ele­ments of opti­mal hand wash­ing. The sur­fac­tants in soap lift soil and microor­gan­isms from the hands, enabling the run­ning water to car­ry the unde­sir­able ele­ments away with­out pos­ing the risk of recon­t­a­m­i­na­tion caused by stand­ing water. Water of cool or warm tem­per­a­ture works equal­ly well in remov­ing unde­sir­able organ­isms. Anoth­er help­ful part of the process is the mechan­i­cal action cre­at­ed when hands are scrubbed or rubbed togeth­er continuously.

  Best prac­tice for hand wash­ing requires wet­ting the hands, turn­ing the water off to pre­vent waste, apply­ing soap, and spread­ing the soap across all sur­faces of your hands for 20 sec­onds, being sure to include fin­ger­nails, back of hands, and wrists. Impor­tant­ly, don’t rush the hand-wash­ing process. Often par­ents will teach chil­dren to wash hands to the time it takes to sing the A‑B-C song or anoth­er jin­gle that reli­ably takes 20 sec­onds. After scrub­bing for 20 sec­onds, rinse hands thor­ough­ly under run­ning water. If the faucet is not oper­at­ed by a sen­sor, use a tow­el or your elbow to turn it off in a man­ner avoid­ing hand recon­t­a­m­i­na­tion. Final­ly, dry hands with a clean cloth, new dis­pos­able tow­el, or air blower.

  Alco­hol as an Alternative

  An alco­hol-based san­i­tiz­er can be an effec­tive alter­na­tive to soap and water where a sink or clean water is unavail­able. Exam­ples of loca­tions where san­i­tiz­er may be prac­ti­cal include con­fer­ence rooms, break rooms, recep­tion areas, or just out­side of restroom doors.

  Accord­ing to the CDC, effec­tive use of water­less hand san­i­tiz­er requires an alco­hol-based solu­tion con­tain­ing at least 60 per­cent alco­hol. For hand san­i­tiz­ers to be effec­tive, it’s impor­tant that enough solu­tion is used, that it stays on the skin and is not wiped or washed off pre­ma­ture­ly, and that the solu­tion is allowed to thor­ough­ly dry on the skin.

  Sim­i­lar to the use of soap and water, mechan­i­cal action or fric­tion caused by scrub­bing or rub­bing hands togeth­er is essen­tial for water­less hand san­i­tiz­er to stop the spread of microor­gan­isms. Addi­tion­al­ly, the hands must be free of organ­ic mat­ter pri­or to apply­ing hand san­i­tiz­er. Using the appro­pri­ate amount of san­i­tiz­er requires plac­ing enough san­i­tiz­er to cov­er a dime in the palm of one hand. Hands must then be rubbed togeth­er in a man­ner that cov­ers all sur­faces, includ­ing the back of the hands, until they are dry.

  Read More …

• Gruber stake is Uber mistake…Obamacare architect shares too much

  December 22, 2014

  A series of videos have been released of var­i­ous con­fer­ences and con­ver­sa­tions involv­ing Jonathan Gru­ber, who was one of the writ­ers of the orig­i­nal ACA leg­is­la­tion, and they are not flattering…to any­one involved.  A sampling:

  “Lack of trans­paren­cy is a huge polit­i­cal advan­tage.  Basi­cal­ly, call it the stu­pid­i­ty of the Amer­i­can vot­er of what­ev­er, but basi­cal­ly that was real­ly, real­ly crit­i­cal to get­ting things to pass”

  “This bill was writ­ten in a tor­tured way to make sure the Con­gres­sion­al Bud­get Office did not score the man­date as tax­es (because) if CBO scored the man­date as tax­es, the bill dies” (even though Pres­i­dent Oba­ma kept insist­ing the man­date was not a tax)

  “If you had a law which…made explic­it that healthy peo­ple pay in and sick peo­ple get mon­ey, it would not have passed”

  “If you’re a state and you don’t set up an exchange, that means your cit­i­zens don’t get tax cred­its” (which is enlight­en­ing giv­en that the Supreme Court is hear­ing on this issue right now, while the Oba­ma admin­is­tra­tion is insist­ing that the Fed­er­al Exchange can offer subsidies)

  “It turns out polit­i­cal­ly (the employ­er sub­sidy) is real­ly hard to get rid of…and the only way we could get rid of it was first by mis­la­bel­ing it, call­ing it a tax on insur­ance plans (refer­ring to the nascent Cadil­lac tax) rather than a tax on peo­ple when we all know it’s a tax on peo­ple who hold those insur­ance plans”  “What that means is the tax that starts out hit­ting only 8% of the insur­ance plans essen­tial­ly amounts over the next 20 years essen­tial­ly get­ting rid of the exclu­sion for employ­er spon­sored plans…this was the only polit­i­cal way we were ever going to take on one of the worst pub­lic poli­cies in America”

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

  December 18, 2014

  Tags: 2015, Adjustments, Cost-of-Living, IRS, Social Security Administration

  Post­ed by Lin­da Rowing

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

  Lim­its of par­tic­u­lar inter­est to employ­ers include the following.

  For health and Sec­tion 125 plans:

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

  For qual­i­fied plans:

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

  Social Security/Medicare Withholding:

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

  Request a quick ref­er­ence chart from your local UBA Part­ner Firm.

  Read More …

• SHOP until you drop…it…sales are not what were expected on Exchange group plan

  December 18, 2014

  The atten­tion was all paid to the indi­vid­ual plans that sud­den­ly made health care “afford­able” – if you received a sub­sidy (from which the fed­er­al gov­ern­ment is backpedal­ing furi­ous­ly).  But along­side the indi­vid­ual plans the gov­ern­ment decid­ed that doing group insur­ance was a necessity…and it is the only vehi­cle that allows for the receipt of the small group health insur­ance tax cred­it.  This was sup­posed to help sales, even though the first two years of the pro­gram qual­i­fi­ca­tion was open for any plan, and bare­ly tak­en (espe­cial­ly in Cal­i­for­nia).  So now there is no sur­prise to find that the sale of the SHOP plan has not met expec­ta­tions.  Dif­fi­cul­ty in ser­vice, the lack of flex­i­bil­i­ty in choice, nar­row net­works and oth­er prob­lems do not make it palat­able in the mar­ket, and thus less than 12,000 busi­ness­es signed up in the first 8 months.

• Identify yourself…unless of course you can’t figure out how to do it – HIPD suspended

  December 17, 2014

  It seemed like a good idea at the time…have all plans of a cer­tain size set up a Health Plan Iden­ti­fi­ca­tion Num­ber.  But then, the day before it was to go into effect, the fed­er­al gov­ern­ment sus­pend­ed action.  It appears even the sharpest busi­ness peo­ple who tried to sim­ply reg­is­ter a num­ber had too much dif­fi­cul­ty in doing so.  A report was made to the DOL say­ing that it should be set up for addi­tion­al con­sid­er­a­tion.  More ACA delays…