Yearly Archives: 2015

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

    December 30, 2015

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

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

    December 29, 2015

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    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

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 At that time all of the pri­or inter­im rules will be superseded.

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

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

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

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

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

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

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

    Read More …

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

    December 24, 2015

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    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

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

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

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

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

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

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

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

    Read More …

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

    December 23, 2015

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

  • Use These Effective Time Management Strategies | Petaluma Benefits Broker

    December 21, 2015

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    by: Mer­rie C. Weeks

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

    First thing to do is Pri­or­i­tize your work.

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

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

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

    Third Be Flexible.

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

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

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

    Fifth is to Delegate.

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

    Com­pro­mise when necessary.

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

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

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

    Read More …

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

    December 17, 2015

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

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

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

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

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

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

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

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

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

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

    It becomes a sticky mess, indeed!

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

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

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

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

    Read More …

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

    December 16, 2015

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

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

    December 14, 2015

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

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

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

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

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

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

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

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

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

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

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

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

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

    Read More …

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

    December 11, 2015

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

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

    December 10, 2015

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    www.newsusa.com

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

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

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

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

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

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

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

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

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

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

    Read More …

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

    December 9, 2015

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

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

    December 7, 2015

    Tags: , ,

    By Bill Olson
    Chief Mar­ket­ing Offi­cer at Unit­ed Ben­e­fit Advisors

    AnnualLimits

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

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

    2016BenefitLimits

    Read More …

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

    December 4, 2015

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

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

    December 3, 2015

    Tags: , , , , ,

    By Bill Olson
    Chief Mar­ket­ing Offi­cer at Unit­ed Ben­e­fit Advisors

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

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

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

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

    Read More …

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

    December 1, 2015

    Tags: , , ,

    By Bill Olson
    Chief Mar­ket­ing Offi­cer at Unit­ed Ben­e­fit Advisors

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

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

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

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

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

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

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

    Read More …

  • How to Reduce Fullness | Petaluma Employee Benefits

    November 27, 2015

    By Ser­e­na Styles
    www.livestrong.com

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

    Step 1

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

    Step 2

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

    Step 3

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

    Step 4

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

    Step 5

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

    Step 6

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

    Tips

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

    Read More …

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

    November 24, 2015

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

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

    November 19, 2015

    Tags: , , , ,

    blueface

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

    SurveyImage1

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

    SurveyImage2

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

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

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

    Read More …

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

    November 18, 2015

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

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

    November 17, 2015

    Tags: , , ,

    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

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

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

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

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

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

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

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

    Read More …

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

    November 12, 2015

    Tags: , , , , , ,

    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

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

    Lac­ta­tion Counseling

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

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

    Obe­si­ty Screen­ing and Interventions

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

    Colono­scopies

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

    Con­tra­cep­tion Cov­er­age Accom­mo­da­tions for Self-Fund­ed Plans

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

    BRCA Test­ing

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

    Well­ness Programs

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

    Men­tal Health Parity

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

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

    Read More …

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

    November 11, 2015

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

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

    November 5, 2015

    Tags: , , , , ,

    By Danielle Capilla

    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

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

    Gen­er­al­ly, ERISA applies to:

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

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

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

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

    Read More …

  • Happy Halloween …! | Petaluma Benefits Broker

    November 2, 2015

    …or is it????

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

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

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

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

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

    October 28, 2015

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

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

    October 22, 2015

    Tags: , , ,

    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

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

    Only cer­tain ben­e­fits can be offered through a cafe­te­ria plan:

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

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

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

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

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

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

    Read More …

  • Exchange Success – More people are needed

    October 21, 2015

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

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

    October 20, 2015

    Tags: , , , , , , ,

    www.newsusa.com

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

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

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

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

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

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

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

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

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

    Read More …

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

    October 14, 2015

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

     

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

  • Zen Battles – whose ego is involved in this

    October 7, 2015

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

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

    October 5, 2015

    www.newsusa.com

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

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

    Rats

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

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

    Bats

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

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

    Spi­ders

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

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

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

    Read More …

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

    October 2, 2015

    Tags: , ,

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

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

    Are employ­ees real­ly look­ing for­ward to this?

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

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

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

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

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

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

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

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

    Read More …

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

    September 30, 2015

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

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

    September 29, 2015

    Tags: , , , , , ,

    Post­ed by Danielle Capilla

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

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

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

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

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

    Read More …

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

    September 24, 2015

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    By Bill Olson
    Chief Mar­ket­ing Offi­cer at Unit­ed Ben­e­fit Advisors

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

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

    2015SurveyResults

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

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

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

    Employ­er Coverage

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

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

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

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

    Read More …

  • Cadillac Tax | California Benefits Broker

    September 21, 2015

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

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

    YouTube

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

  • Affordable Care Act Information Returns | California Employee Benefits

    September 17, 2015

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    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

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

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

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

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

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

    Read More …

  • Arrow Wins Best Places to Work 2015!

    September 17, 2015

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

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

    September 15, 2015

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    Sept2015_CvrFINALFINAL

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

    Read entire arti­cle here…

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

    September 14, 2015

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    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

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

    Draft 2015 Instructions

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

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

    Who Must File

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

    Exten­sions and Waivers

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

    Cor­rec­tions to Forms 1094‑C and 1095‑C

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

    Exten­sions to Fur­nish State­ments to Employees

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

    Penal­ties

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

    98 Per­cent Offer Method

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

    Plan Start Month Box

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

    Mul­ti­em­ploy­er (Union) Plan Relief

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

    COBRA Cov­er­age

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

    Line 15 Calculations

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

    Break in Service

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

    Read More …

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

    September 10, 2015

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    By Bill Olson
    Chief Mar­ket­ing Offi­cer at Unit­ed Ben­e­fit Advisors

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

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

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

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

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

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

    Read More …

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

    September 8, 2015

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    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

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

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

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

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

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

    Read More …

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

    September 4, 2015

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

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

    September 3, 2015

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

    www.newsusa.com

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

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

    Eat Wise­ly and Well

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

    Be Smart About Supplements

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

    Build Your Sup­port System

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

    Get Mov­ing

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

    Read More …

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

    September 2, 2015

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

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

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

    August 31, 2015

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

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

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

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

     

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

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

    August 28, 2015

    thebusinessjournal

     

    BUSINESS JOURNAL STAFF REPORT

    http://www.northbaybusinessjournal.com

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

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

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

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

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

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

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

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

    The win­ners are, list­ed alphabetically:

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

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

    August 28, 2015

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

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

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

  • Medicare Costs Explained | California Benefits Broker

    August 27, 2015

    Tags: , , , , ,

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

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

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

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

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

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

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

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

    UBA resource

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

    Read More …

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

    August 25, 2015

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

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

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

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

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

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

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

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

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

    August 24, 2015

    Tags: , , , ,

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

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

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

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

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

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

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

    Per­son­al­iza­tion

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

    Com­mu­ni­ca­tion

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

    Peer pres­sure

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

    Spread incen­tives out over time

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

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

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

    Read More …

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

    August 21, 2015

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

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

    August 18, 2015

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

     

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

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

    August 17, 2015

    Tags: , , ,

    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

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

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

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

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

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

    Read More …

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

    August 17, 2015

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

  • They Paid the Penalty…so who lost?

    August 14, 2015

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

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

    August 12, 2015

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

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

    August 3, 2015

    Tags: , , , ,

    www.newsusa.com

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

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

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

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

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

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

    Read More …

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

    July 29, 2015

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

  • Health Spending is Growing Faster Again…Just Like Before

    July 27, 2015

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

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

    July 24, 2015

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

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

  • Unexpected E‑xchange fallout for E‑companies

    July 20, 2015

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

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

    July 20, 2015

    Tags: , , , ,

    By Danielle Capilla, Chief Compliance Officer at United Benefit Advisors 

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

    Draft 2015 Forms

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

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

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

    Draft 1094‑C (Transmittal/cover sheet)

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

    Draft 1094‑B (Transmittal/cover sheet)

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

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

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

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

    Read More …

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

    July 15, 2015

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

  • Blue Hawaii…another state exchange is leid waste

    July 8, 2015

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

  • Preparation is Key for Department of Labor Audit

    July 6, 2015

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

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

    July 1, 2015

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

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

    June 30, 2015

    Tags: , , , , , ,

    www.newsusa.com

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

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

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

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

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

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

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

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

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

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

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

    Read More …

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

    June 25, 2015

    Tags: , , , ,

    By Bill Olson
    Chief Mar­ket­ing Offi­cer at Unit­ed Ben­e­fit Advisors

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

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

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

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

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

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

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

    Read More …

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

    June 24, 2015

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

  • Employers Procrastinating? | CA Benefits Broker

    June 22, 2015

    Tags: , , , ,

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

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

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

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

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

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

    Read More …

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

    June 17, 2015

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

  • CPR & AED Training and certification | Arrow Benefits Group

    June 15, 2015

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    petalumahealth

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

    Training saves lives

    Are You Prepared?

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

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

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

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

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

    For more infor­ma­tion or to reserve seats, please call Andrew McNeil at 707–992-3789 or email Andrew at [email protected].

  • Economic Trends and Human Resources | Petaluma Employee Benefits

    June 11, 2015

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    By Robin J. Anderson
    Senior Econ­o­mist, Prin­ci­pal Glob­al Investors

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

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

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

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

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

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

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

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

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

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

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

    Read More …

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

    June 10, 2015

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

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

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

    June 9, 2015

    Tags: , ,

    By Bill Olson, Chief Marketing Officer at United Benefit Advisors

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

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

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

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

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

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

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

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

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

    Read More …

  • Preventive Service Requirement FAQ | CA Employee Benefits

    June 5, 2015

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    By: Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

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

    BRCA Test­ing

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

    Con­tra­cep­tion

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

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

    Sex-Spe­cif­ic Rec­om­mend­ed Pre­ven­tive Services

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

    Well-Woman Pre­ven­tive Care for Dependents

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

    Colono­scopies and Anes­the­sia Charges

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

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

    Read More …

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

    June 3, 2015

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

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

    June 1, 2015

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    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

    PPACA_QuestionQues­tion:

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

    Answer:

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

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

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

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

    Read More …

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

    May 29, 2015

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

  • Stop-loss Contract Periods Explained | Petaluma Benefits Broker

    May 29, 2015

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

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

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

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

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

    Read More …

  • EAP and COBRA explained | Petaluma Employee Benefits

    May 26, 2015

    Tags: , , ,

    www.thinkhr.com

    Information

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

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

    Read More …

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

    May 20, 2015

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

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

    May 19, 2015

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

    Health Insur­ance Providers Fee

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

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

    Cadil­lac Tax

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

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

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

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

    Read More …

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

    May 14, 2015

    Tags: , , , , , ,

    By Danielle Capil­la,
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

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

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

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

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

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

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

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

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

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

    Read More …

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

    May 13, 2015

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

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

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

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

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

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

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

    May 12, 2015

    Tags: , , , , , ,

    By Bill Olson
    Chief Mar­ket­ing Offi­cer at Unit­ed Ben­e­fit Advisors

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

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

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

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

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

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

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

    Read More …

  • Integrated Community Services | Arrow Benefits Group

    May 7, 2015

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    ICS

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

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

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

    May 4, 2015

    Tags: , , ,

    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

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

    Q1. Who is affect­ed by Medicare Sec­ondary Pay­er rules?

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

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

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

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

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

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

    A4. No, this is prohibited.

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

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

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

    Read More …

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

    April 27, 2015

    Tags: , , , , ,

    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

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

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

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

    Read More …

  • Industry Differences Among Health Savings Accounts | CA Benefits Broker

    April 24, 2015

    Tags: , , , ,

    By Bill Olson
    Chief Mar­ket­ing Offi­cer at Unit­ed Ben­e­fit Advisors

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

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

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

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

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

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

    HSAFunding

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

    Read More …

  • Health Checklist for Men Over 40 | California Employee Benefits

    April 21, 2015

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    By Stacey Anderson
    www.livestrong.com

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

    Vac­ci­na­tions

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

    Abdom­i­nal Aor­tic Aneurysm

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

    Heart Health

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

    Colon Can­cer Screening

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

    Prostate Exam

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

    Dia­betes

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

    Oth­er Screen­ing Tests

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

    Eye Health

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

    Read More …

  • Arrow Benefits Group Wellness Series Makes the News

    April 17, 2015

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

     

     

     

     

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

    April 9, 2015

    Tags: , , , ,

    By Jennifer Kupper

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

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

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

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

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

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

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

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

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

    Read More …

  • Keith McNeil Quoted in Business Journal

    April 6, 2015

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

    “…

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

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

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

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

    …”

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

    April 6, 2015

    Tags: , ,

    By Danielle Capilla, Chief Compliance Officer at United Benefit Advisors

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

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

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

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

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

    Read More …

  • We’re in the Top 500!

    April 2, 2015

    NorthBayBiz2015-1

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

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

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

    April 1, 2015

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

    Jor­dan Shields

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

    March 24, 2015

    Tags: , , , ,

    By Elizabeth Kay, Compliance & Retention Analyst, AEIS Advisors

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

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

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

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

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

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

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

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

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

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

     

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

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

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

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

     

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

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

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

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

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

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

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

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

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

    Read More …

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

    March 13, 2015

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

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

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

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

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

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

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

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

    March 11, 2015

    For Imme­di­ate Release
    Con­tact: Jen­ny Kaplan, JKC
    [email protected]
    707–578-1336

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

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

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

    About St. Joseph Health

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

    About Arrow Ben­e­fits Group

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

    ###

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

    March 11, 2015

    Tags: , , , , , , , , , , , ,

    By Bill Olson, Chief Mar­ket­ing Offi­cer at Unit­ed Ben­e­fit Advisors

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

    030515BlogPost

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

    Read More …

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

    March 9, 2015

    Tags: , , , , , , , , , , , ,

    By Bill Olson, Chief Mar­ket­ing Offi­cer at Unit­ed Ben­e­fit Advisors

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

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

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

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

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

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

    Read More …

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

    March 3, 2015

    Tags: , , , ,

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

    ADA/ADAAA

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

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

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

    GINA

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

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

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

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

    HIPAA and PPACA

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

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

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

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

    HIPAA Nondis­crim­i­na­tion Pro­vi­sions and the Well­ness Pro­gram Exception

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

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

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

    This is not the end…

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

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

    Read More …

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

    February 26, 2015

    Tags: , ,

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

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

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

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

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

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

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

    Read More …

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

    February 23, 2015

    Tags: , , , , ,

    By Lin­da Rowings

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

    Lim­its of par­tic­u­lar inter­est to employ­ers include the following.Money

    For health and Sec­tion 125 plans:

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

     For qual­i­fied plans:

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

     Social Security/Medicare Withholding:

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

    Read More …

  • Petaluma a healthy role model | Arrow Benefits Group

    February 19, 2015

    Tags: , , ,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    In oth­er efforts PHCD is:

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

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

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

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

    Read More …

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

    February 17, 2015

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

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

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

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

    February 16, 2015

    Tags: , , , ,

    FREE Sem­i­nar!

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

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

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

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

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

    Date:
    Tues­day, Feb­ru­ary 24, 2015

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

    Park­ing:
    Free sur­face lot adja­cent to building

    Work­shop Co-Hosts:
    Sono­ma Coun­ty Eco­nom­ic Devel­op­ment Board

    Petaluma Cham­ber of Commerce

    Read More …

  • Benefit Survey Results – How do you Compare?

    February 13, 2015

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

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

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

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

    February 12, 2015

    Tags: , ,

    By Eliz­a­beth Kay, Com­pli­ance & Reten­tion Analyst
    AEIS Advisors

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Read More …

  • PCORI fee increase – annual update

    February 10, 2015

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

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

    February 9, 2015

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

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

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

  • Weight Loss Retreats in Northern California | Arrow Benefits Group

    February 9, 2015

    Tags: , ,

    By Erin Harty

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

    Food

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

    Fit­ness

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

    Over­all Health

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

    Per­son­al­ized Programs

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

    Boot Camp

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

    Read More …

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

    February 6, 2015

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

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

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

    February 5, 2015

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    By Bill Olson

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

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

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

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

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

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

    Read More …

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

    February 3, 2015

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

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

    February 2, 2015

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

    1. How much is the tax?

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

    2. What is the threshold?

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

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

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

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

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

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

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

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

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

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

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

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

    Read More …

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

    January 31, 2015

    Tags:

    For Imme­di­ate Release
    Con­tact: Jen­ny Kaplan, JKC
    [email protected]
    415–342-2209

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

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

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

    About Petaluma Health Care District

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

    About Heart­Safe Com­mu­ni­ty Program

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

    About Arrow Ben­e­fits Group

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

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

    ###

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

    January 29, 2015

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    By Lin­da Rowings

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

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

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

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

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

    Read More …

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

    January 26, 2015

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    By Jean­nine Mancini

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

    How it Works

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

    Self-Paid Plans

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

    Employ­er-Paid Plans

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

    With­hold­ing and Reporting

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

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

    January 20, 2015

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    (New­sUSA)

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

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

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

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

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

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

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

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

    Read More …

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

    January 14, 2015

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

  • Committee On The Shelterless | Arrow Benefits Group

    January 12, 2015

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    COTS

     

     

     

     

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

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

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

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

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

    Read More …

  • Top 2014 UBA Publications for Employers | Petaluma Employee Benefits

    January 9, 2015

    Tags: , , ,

    Post­ed by Bill Olson 

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

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

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

    2.  2014 Health Plan Sur­vey Exec­u­tive Summary.

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

    3.  A Busi­ness Case for Ben­e­fits Communications.

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

    4.  Count­ing Employ­ees Under PPACA.

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

    5.  Cus­tom UBA Health Plan Bench­mark­ing Report.

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

    Read More …

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

    January 5, 2015

    Tags: , , , ,

    www.thinkhr.com

    gardenQues­tion:

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

    Answer:

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

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

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

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

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

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

    Read More …

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

    January 2, 2015

    Tags: , , , , ,

    Post­ed by Jen­nifer Kupper

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

    ADA/ADAAA

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

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

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

    GINA

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

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

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

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

    HIPAA and PPACA

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

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

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

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

    HIPAA Nondis­crim­i­na­tion Pro­vi­sions and the Well­ness Pro­gram Exception

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

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

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

    This is not the end…

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

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

    Read More …

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

    December 30, 2015

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

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

    December 29, 2015

    Tags: , ,

    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

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

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

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

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

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

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

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

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

    Read More …

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

    December 24, 2015

    Tags: , , , , , , ,

    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

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

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

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

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

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

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

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

    Read More …

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

    December 23, 2015

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

  • Use These Effective Time Management Strategies | Petaluma Benefits Broker

    December 21, 2015

    Tags: , , , ,

    by: Mer­rie C. Weeks

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

    First thing to do is Pri­or­i­tize your work.

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

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

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

    Third Be Flexible.

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

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

    Whether you work from home or out of the home there are things that can dis­tract us and waste time. Lim­it small talk with co-work­ers, fam­i­ly, friends, etc. while you are work­ing. Respect your deci­sion to make a plan and stick to it. Oth­ers will need to under­stand that if it isn’t some­thing that needs to be tak­en care of right this minute then it can wait.

    Fifth is to Delegate.

    Remem­ber that you prob­a­bly can’t do every­thing your­self so if there is a task that you might not be very good at or like doing and there is some­one that can do the task then by all means pass it on. In this way the task will get done and you won’t waste time putting it off because you can’t accom­plish it yourself.

    Com­pro­mise when necessary.

    As your day pro­gress­es the urgency of a task may also change. There may be times when your tasks will need to be re-pri­or­i­tized, resched­uled, post­poned or dropped alto­geth­er, mak­ing adjust­ments if things come up that needs your atten­tion is important.

    Every­one has lim­i­ta­tions and if you real­ize what those are then you will know what you can work on lat­er to improve those skills or know in advance what tasks you will need help with.

    Learn­ing to man­age your time is not to stress your day so remem­ber to relax and learn as you go. The more you prac­tice man­ag­ing your time, the bet­ter you will get at it. Time man­age­ment is so that you will take con­trol of your days and see how much you real­ly can accom­plish each day and then enjoy some time with fam­i­ly and friends. This is your only viable option no mat­ter where you are work­ing, this is the only way to accom­plish any­thing worthwhile.

    Read More …

  • Negotiating over COBRA Coverage – Use EXTREME CAUTION! | California Benefits Broker

    December 17, 2015

    Tags: , , , ,

    By Eliz­a­beth Kay, Com­pli­ance & Reten­tion Analyst
    AEIS Advisors
    A UBA Part­ner Firm

    CautionHave you ever over­heard the new employ­ee in the break room, brag­ging about how good their health insur­ance was with their pre­vi­ous employ­er, and how much less expen­sive it was than the cov­er­age they are cur­rent­ly being offered?

    You may think ”If it was so good, then why give it up?” There are always a num­ber of fac­tors that can lead to some­one mak­ing a job change, but what hap­pens when COBRA becomes a part of the nego­ti­at­ing process when they are work­ing out the terms of employ­ment with the new company?

    We know that, as of Novem­ber 2014, the Depart­ment of Labor (DOL) made it very clear that an employ­er can­not pay the pre­mi­um for an indi­vid­ual plan of an employ­ee or an employee’s depen­dents, peri­od. If they do, the employ­er could pay an excise tax of $100 per day they are out of com­pli­ance per employ­ee affect­ed. That could be up to $36,500 for ONE employ­ee, for ONE year!

    But what if a prospec­tive employ­ee were com­ing to work for you, and the plan with their cur­rent employ­er had sim­i­lar cov­er­age but low­er pre­mi­ums because the employ­er was a larg­er com­pa­ny, the employ­ees were in very good health over­all and the employ­er had nego­ti­at­ed very low rates with its car­ri­er as a result, or the employ­er was based in a dif­fer­ent state where health care costs were low­er? What if that prospec­tive employ­ee tells you that you could pay their COBRA pre­mi­ums and pay less pre­mi­um for them than if they enroll in your plan? Many employ­ers would love to save $500 a month for one employ­ee. But the deal is not near­ly as sweet as it sounds, and here’s why.

    While it is not ille­gal for an employ­er to pay for COBRA pre­mi­ums, if it is for a group plan and not an indi­vid­ual plan, it can cre­ate oth­er prob­lems with regard to ERISA and COBRA compliance.

    As soon as an employ­er pays the pre­mi­um on a pre-tax basis on behalf of an employ­ee for its com­pa­ny pol­i­cy or anoth­er pol­i­cy, an employ­er-spon­sored plan is cre­at­ed, and is there­fore sub­ject to both ERISA and COBRA regulations.

    ERISA requires that the plan spon­sor dis­trib­ute noti­fi­ca­tions to enrollees of the plan, includ­ing a Sum­ma­ry Plan Descrip­tion, and oth­er doc­u­ments that con­tain spe­cif­ic plan details. If the employee’s plan ben­e­fits were under anoth­er employer’s plan, it may be dif­fi­cult to get that infor­ma­tion and dis­trib­ute it to your employee.

    Fed­er­al COBRA reg­u­la­tion requires that the employ­ee have access to the same cov­er­age for up to 18 months after he or she los­es eli­gi­bil­i­ty for the plan due to ter­mi­na­tion of employ­ment, for exam­ple. What hap­pens if the COBRA plan ter­mi­nates because that pre­vi­ous com­pa­ny goes out of busi­ness and its group plan dis­solves? Now the cur­rent employ­er is oblig­at­ed to con­tin­ue the employee’s cov­er­age, per­haps with­out a means to do so.

    Or, what if this employ­ee ter­mi­nates from your com­pa­ny after 12 months? It now becomes your respon­si­bil­i­ty to pro­vide the employ­ee with 18 months of COBRA cov­er­age, except the employ­ee has already used a por­tion of his or her COBRA eli­gi­bil­i­ty while under your employ­ment. Since COBRA is an employ­er oblig­a­tion, you could be respon­si­ble for pro­vid­ing COBRA cov­er­age to an employ­ee who was nev­er enrolled in your company’s group pol­i­cy in the first place.

    It becomes a sticky mess, indeed!

    On the flip side, what about nego­ti­at­ing an employee’s sev­er­ance pack­age? If an employ­ee is leav­ing your com­pa­ny and you are putting togeth­er a sev­er­ance pack­age, be care­ful when includ­ing pay­ing for the employee’s COBRA con­tin­u­a­tion cov­er­age. Many employ­ers will offer to pay for three, six or 12 months of COBRA pre­mi­ums on behalf of the ter­mi­nat­ed employee.

    While this can be done, be care­ful how you word it in the sev­er­ance agree­ment. Most employ­er spon­sored plans are on a 12 month con­tract. If you make a very gen­er­al state­ment say­ing you will pay to con­tin­ue the employee’s COBRA cov­er­age at your expense for 12 months, and your pre­mi­ums sky­rock­et at renew­al, or if you change car­ri­ers, and the ter­mi­nat­ed employ­ee choos­es a more expen­sive plan with rich­er ben­e­fits, you could be on the hook for the increase in premiums.

    If you are clear in the sev­er­ance agree­ment about the amount you will com­mit to pay on the employee’s behalf, or clear about the lev­el of cov­er­age to be pro­vid­ed (plat­inum, gold, sil­ver, or bronze lev­el plan, for exam­ple), then you will be bet­ter protected.

    If you are pay­ing COBRA pre­mi­ums on a tax-exempt basis for a cur­rent employ­ee, or you are con­cerned about a sev­er­ance agree­ment that you made with a ter­mi­nat­ed employ­ee, please seek advice from your ERISA or employ­ment law attorney.

    Read More …

  • They keep amending it, but they cannot kill it…another change in the Affordable Care Act

    December 16, 2015

    Repub­li­cans con­tin­ue to beat their breasts, but there are cer­tain aspects that remain pests, and these keep fail­ing to meet the tests…of creduli­ty and prac­ti­ca­bil­i­ty. In the recent Bipar­ti­san Bud­get Act of 2015, Pres­i­dent Oba­ma qui­et­ly erased the “auto enroll­ment” fea­ture that was sup­posed to help employ­ers, who didn’t want the help. Anoth­er one bites the dust…but there are plen­ty of pro­vi­sions left

  • Cadillac Tax – Should employers be making changes now? | California Employee Benefits

    December 14, 2015

    Tags: , , , , ,

    By Eliz­a­beth Kay, Com­pli­ance & Reten­tion Analyst
    AEIS Advisors
    A UBA Part­ner Firm

    ChangeAheadThe Afford­able Care Act (ACA) has brought about many changes in employ­ee ben­e­fits. Plans have been elim­i­nat­ed, ben­e­fits added, rules changed, and rules have been delayed.

    The ACA has always been a heav­i­ly debat­ed top­ic between the Repub­li­cans and Democ­rats, and now that we are com­ing up to anoth­er pres­i­den­tial elec­tion we know that we can expect it to be talked about quite a lot.

    Some spec­u­late that the Repub­li­cans will attempt to repeal the law, again, but the truth of the mat­ter is that the ACA is bring­ing in too much rev­enue for a repeal to be suc­cess­ful. The Con­gres­sion­al Bud­get Office (CBO) pro­jec­tions there will be $353 bil­lion dol­lars in rev­enue from the ACA over the next 10 years.

    This means that in order for the Repub­li­cans to be suc­cess­ful in repeal­ing any part of the law that gen­er­ates rev­enue, they will need to find a way to replace that lost revenue.

    Look­ing at the pro­ject­ed cost increas­es based on its annu­al Health Plan Sur­vey of over 18,000 health, plans offered by near­ly 11,000 employ­ers nation­wide, UBA esti­mates that near­ly three out of four U.S. employ­ers will be hit with the Cadil­lac tax by 2022. With alarm bells sound­ing, many employ­ers are plan­ning ben­e­fit cuts to avoid the tax and, as a result, the CBO actu­al­ly expects the ACA’s Cadil­lac tax (and Med­ical Device Tax) won’t gen­er­ate the most rev­enue. Instead they are count­ing heav­i­ly on the sec­ond largest source of expect­ed rev­enue from the ACA: $209 bil­lion dol­lars from ”oth­er sources.”

    What are ”oth­er sources?” The CBO believes that there will be an increase in income tax­es due to employ­ers that reduce employ­ee health plans in order to avoid hav­ing to pay the Cadil­lac tax, and in turn raise their employ­ees’ wages to compensate.

    If this sce­nario were real­is­tic (although reduc­ing ben­e­fits due to the ris­ing cost of pre­mi­ums with­out any increase in wages seems to be more real­is­tic), we should see employ­ers begin to mod­i­fy their plans in antic­i­pa­tion of the Cadil­lac tax in 2018, and then a sig­nif­i­cant increase in salaries. But will employ­ers act soon­er? If the Cadil­lac tax were to be repealed by Con­gress, it would most like­ly hap­pen in 2017 after the pres­i­den­tial elec­tion. The ques­tion then becomes when should employ­ers make these changes? Do they make them now, live with the poten­tial for the Cadil­lac tax to be elim­i­nat­ed, and their pay­roll will just remain high­er? Or do they wait to make those changes until 2017, the year before the tax goes into effect?

    As if anoth­er tax were not bad enough, the 2015 UBA Ben­e­fits Sur­vey shows that, if some employ­ers were to reduce ben­e­fits to avoid the Cadil­lac tax, they would no longer be able to offer a plan that meets the ACA min­i­mum val­ue require­ment. It seems hard to believe that a plan could have pre­mi­ums that are more than $10,200 annu­al­ly for one per­son yet have an actu­ar­i­al val­ue of only 60 per­cent. And with the ever-increas­ing cost of health care, pre­mi­ums will only con­tin­ue to rise over the next three years. More and more employ­ers will have to make dif­fi­cult deci­sions about their ben­e­fit plans.

    There is hope that leg­is­la­tors will add an actu­ar­i­al val­ue safe har­bor into the Cadil­lac tax pro­vi­sion so that employ­ers who are offer­ing a plan that meets an actu­ar­i­al val­ue of less than 90 per­cent will be exempt from the Cadil­lac tax. Oth­er­wise, an applic­a­ble large employ­er that is sub­ject to the ACA’s “play or pay” rules may have to pay the Cadil­lac tax, and will also be fined for not offer­ing a plan that meets the min­i­mum val­ue requirements.

    Read UBA’s lat­est press release for the per­cent­ages of employ­ers like­ly to be sub­ject to the Cadil­lac tax bro­ken down by actu­ar­i­al value.

    Down­load the free 2015 Health Plan Sur­vey Exec­u­tive Sum­ma­ry for addi­tion­al infor­ma­tion on health plan cost trends across the U.S., includ­ing employ­er con­tri­bu­tions and costs for employees.

    To bench­mark your plan against oth­ers in your region, indus­try or size brack­et, con­tact a UBA Part­ner near you to run a cus­tom bench­mark­ing report.

    Read More …

  • More CO OPS fly the coop…continuing failure of an ACA experiment

    December 11, 2015

    Then Ari­zona and then Michi­gan, which became the 12th co op fail­ure of the year, which now makes it half of all of these non prof­its who have failed to pro­vide ade­quate cov­er­age for a rea­son­able length of time…at con­sid­er­able tax­pay­er cost. As of the end of the third quar­ter this year, the remain­ing sur­viv­ing 11 co ops have lost $200 mil­lion, which is triple the loss­es they report­ed at the end of June.

  • Holiday Health Check-List: Use It or Lose It | Petaluma Employee Benefits

    December 10, 2015

    Tags: , , ,

    www.newsusa.com

    fsa2016As the end of the year nears, many of us are pre­oc­cu­pied with hol­i­day par­ties, search­ing for the per­fect gift for loved ones or mak­ing lists of things to accom­plish before the new year begins. Dur­ing this busy time, one impor­tant task is often for­got­ten on the to-do list: Make sure to use flex­i­ble spend­ing account (FSA) funds before it’s too late.

    Some employ­ers will allow you to roll over $500 of your FSA funds into the next year. How­ev­er, for those who are not per­mit­ted a car­ry­over, these funds must be used by the end of the ben­e­fits year, which for most peo­ple is Dec.31. Oth­er­wise the funds will be for­feit­ed back to your employ­er. In fact, each year more than $400 mil­lion in tax-free income is wast­ed when FSA hold­ers don’t spend these funds or fail to sub­mit expens­es to be reimbursed.

    That said, it’s not too late to cre­ate a health care check­list to keep you and your fam­i­ly on a healthy track dur­ing these last few weeks of the year. Here are five ways to ensure you get the most out of your ben­e­fits dollars:

    1. Sched­ule annu­al check-ups with ALL physi­cians. Vis­it impor­tant spe­cial­ists, such as an optometrist, den­tist, der­ma­tol­o­gist or gyne­col­o­gist, along with your pri­ma­ry care physician.

    2. Don’t for­get about eye care/medical aids. Con­sid­er whether you need an addi­tion­al pair of eye­glass­es, con­tact lens­es or even orthot­ic shoe inserts to help uti­lize FSA funds.

    3. Con­sid­er pur­chas­ing low-cost health care items. Stock up on items for year-round and emer­gency use, such as first-aid kits, con­tact solu­tion, ther­mome­ters, neck/wrist/joint braces, aspirin and oth­er pain relievers.

    4. Ask employ­ers about unique FSA offer­ings. Find out whether Lasik eye surgery, mas­sages, acupunc­ture treat­ments, and oth­er unique pro­ce­dures or treat­ments are includ­ed in your FSA plans.

    5. Sub­mit receipts. If spend­ing your entire FSA funds still seems unre­al­is­tic after any last-minute check­ups and first-aid pur­chas­es, dou­ble-check to make sure you’ve sub­mit­ted past receipts for eli­gi­ble out-of-pock­et health care pur­chas­es so you can be reimbursed.

    “It’s impor­tant to review your out-of-pock­et expens­es from the past year and con­sid­er any changes that may occur to gain a bet­ter idea of how much to con­tribute to an FSA in the com­ing year,” says Matthew Owen­by, senior vice pres­i­dent and chief human resources offi­cer at Aflac.

    By cre­at­ing a list, and check­ing it twice, you can ensure that you don’t leave mon­ey on the table as you pre­pare for a new year.

    Read More …

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