Yearly Archives: 2016

  • Regulations Regarding Short-Term Limited-Duration Insurance, Excepted Benefits, and Lifetime/Annual Limits | CA Benefit Advisors

    December 29, 2016

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    Recent­ly, the U.S. Depart­ment of the Trea­sury, Depart­ment of Labor (DOL), and Depart­ment of Health and Human Ser­vices (HHS) (col­lec­tive­ly the Depart­ments) issued final reg­u­la­tions regard­ing the def­i­n­i­tion of short-term, lim­it­ed-dura­tion insur­ance, stan­dards for trav­el insur­ance and sup­ple­men­tal health insur­ance cov­er­age to be con­sid­ered except­ed ben­e­fits, and an amend­ment relat­ing to the pro­hi­bi­tion on life­time and annu­al dol­lar limits.

    Effec­tive Date and Applic­a­bil­i­ty Date 

    These final reg­u­la­tions are effec­tive on Decem­ber 30, 2016. These final reg­u­la­tions apply begin­ning on the first day of the first plan or pol­i­cy year begin­ning on or after Jan­u­ary 1, 2017.

    Short-Term, Lim­it­ed-Dura­tion Insurance 

    Short-term, lim­it­ed-dura­tion insur­ance is a type of health insur­ance cov­er­age designed to fill tem­po­rary gaps in cov­er­age when an indi­vid­ual is tran­si­tion­ing from one plan or cov­er­age to anoth­er plan or cov­er­age. Although short-term, lim­it­ed-dura­tion insur­ance is not an except­ed ben­e­fit, it is exempt from Pub­lic Health Ser­vice Act (PHS Act) require­ments because it is not indi­vid­ual health insur­ance cov­er­age. The PHS Act pro­vides that the term ‘‘indi­vid­ual health insur­ance cov­er­age’’ means health insur­ance cov­er­age offered to indi­vid­u­als in the indi­vid­ual mar­ket, but does not include short-term, lim­it­ed-dura­tion insurance.

    On June 10, 2016, the Depart­ments pro­posed reg­u­la­tions to address the issue of short-term, lim­it­ed-dura­tion insur­ance being sold as a type of pri­ma­ry coverage.

    The Depart­ments have final­ized the pro­posed reg­u­la­tions with­out change. The final reg­u­la­tions define short-term, lim­it­ed-dura­tion insur­ance so that the cov­er­age must be less than three months in dura­tion, includ­ing any peri­od for which the pol­i­cy may be renewed. The per­mit­ted cov­er­age peri­od takes into account exten­sions made by the pol­i­cy­hold­er ‘‘with or with­out the issuer’s con­sent.’’ A notice must be promi­nent­ly dis­played in the con­tract and in any appli­ca­tion mate­ri­als pro­vid­ed in con­nec­tion with enroll­ment in such cov­er­age with the fol­low­ing language:

    THIS IS NOT QUALIFYING HEALTH COVERAGE (‘‘MINIMUM ESSENTIAL COVERAGE’’) THAT SATISFIES THE HEALTH COVERAGE REQUIREMENT OF THE AFFORDABLE CARE ACT. IF YOU DON’T HAVE MINIMUM ESSENTIAL COVERAGE, YOU MAY OWE AN ADDITIONAL PAYMENT WITH YOUR TAXES.

    The revised def­i­n­i­tion of short-term, lim­it­ed-dura­tion insur­ance applies for pol­i­cy years begin­ning on or after Jan­u­ary 1, 2017.

    Because state reg­u­la­tors may have approved short-term, lim­it­ed-dura­tion insur­ance prod­ucts for sale in 2017 that met the def­i­n­i­tion in effect pri­or to Jan­u­ary 1, 2017, HHS will not take enforce­ment action against an issuer with respect to the issuer’s sale of a short-term, lim­it­ed-dura­tion insur­ance prod­uct before April 1, 2017, on the ground that the cov­er­age peri­od is three months or more, pro­vid­ed that the cov­er­age ends on or before Decem­ber 31, 2017, and oth­er­wise com­plies with the def­i­n­i­tion of short-term, lim­it­ed-dura­tion insur­ance in effect under the reg­u­la­tions. States may also elect not to take enforce­ment actions against issuers with respect to such cov­er­age sold before April 1, 2017.

     

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

  • New Law Allows Small Employers to Pay Premiums for Individual Policies | California Employee Benefits

    December 26, 2016

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    This week, the U.S. Sen­ate passed the 21st Cen­tu­ry Cures Act which includes a pro­vi­sion allow­ing small busi­ness­es to offer a new type of health reim­burse­ment arrange­ment for their employ­ees’ health care expens­es, includ­ing indi­vid­ual insur­ance pre­mi­ums. The act was pre­vi­ous­ly passed by the House and Pres­i­dent Oba­ma is expect­ed to sign it short­ly. The pro­vi­sion for Qual­i­fied Small Employ­er Health Reim­burse­ment Arrange­ments (QSEHRAs), a new type of tax-free ben­e­fit, takes effect Jan­u­ary 1, 2017. Fur­ther, the act retroac­tive­ly relieves small employ­ers from the threat of excise tax­es under pri­or rules for plan years begin­ning before 2017.

    Background

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

    The pro­hi­bi­tion, imple­ment­ed under the Afford­able Care Act (ACA), was intend­ed to dis­cour­age employ­ers from can­cel­ing their group plans and push­ing work­ers into the indi­vid­ual insur­ance mar­ket. The rules have been par­tic­u­lar­ly dis­rup­tive for small busi­ness­es, how­ev­er, since pre­vi­ous­ly it had been com­mon prac­tice for many small employ­ers to sub­si­dize the cost of indi­vid­ual poli­cies instead of offer­ing group cov­er­age. The new law, passed this week with broad bipar­ti­san sup­port, responds to the con­cerns of small businesses.

    New Qualified Small Employer HRAs

    The new law does not repeal the ACA’s gen­er­al pro­hi­bi­tion against employ­er pay­ment of indi­vid­ual insur­ance pre­mi­ums. Rather, it pro­vides an excep­tion for a new type of arrange­ment — a Qual­i­fied Small Employ­er HRA or QSEHRA — pro­vid­ed that spe­cif­ic con­di­tions are met.

    First, the employ­er must meet two conditions:

    • Employs on aver­age no more than 50 full-time and full-time-equiv­a­lent employ­ees. In oth­er words, the employ­er can­not be an applic­a­ble large employ­er as defined under the ACA; and
    • Does not offer a group health plan to any of its employees.

    Next, the QSEHRA must meet all of the fol­low­ing conditions:

    • It is fund­ed sole­ly by the employ­er; employ­ee con­tri­bu­tions are not permitted;
    • It is offered to all full-time employ­ees, although the employ­er may choose to include sea­son­al or part-time employ­ees and/or may exclude employ­ees with less than 90 days of service;
    • For tax-free QSEHRA ben­e­fits, the employ­ee must have min­i­mum essen­tial cov­er­age (e.g., med­ical insur­ance under an indi­vid­ual policy);
    • It pays or reim­burs­es health­care expens­es (e.g., § 213(d) expens­es) and pre­mi­ums for indi­vid­ual policies;
    • It does not pay or reim­burse con­tri­bu­tions for any employ­er-spon­sored group coverage;
    • The same ben­e­fits and terms apply to all eli­gi­ble employ­ees, except the ben­e­fit amount may vary by: 
      • Sin­gle ver­sus fam­i­ly coverage;
      • Pro­rat­ed amounts for par­tial-year cov­er­age (e.g., new hires); and
      • For pre­mi­um reim­burse­ments, vari­a­tions con­sis­tent with the age- and fam­i­ly-size rat­ing struc­ture of a rep­re­sen­ta­tive indi­vid­ual pol­i­cy; and
    • Ben­e­fits do not exceed $4,950 if sin­gle cov­er­age (or $10,000 if fam­i­ly cov­er­age) per 12-month plan year. Amounts are pro­rat­ed if cov­ered for less than 12 months. Lim­its will be indexed for inflation.

    Coordination with Exchange Subsidies

    Cov­er­age under a QSEHRA will affect the employee’s eli­gi­bil­i­ty for a sub­si­dized indi­vid­ual pol­i­cy from an insur­ance Exchange (Mar­ket­place). Any sub­sidy for which the employ­ee would oth­er­wise qual­i­fy will be reduced dol­lar-for-dol­lar by the QSEHRA.

    Benefit Laws

    Group health plans are sub­ject to numer­ous fed­er­al laws, includ­ing SPD and oth­er notice require­ments under ERISA, cov­er­age con­tin­u­a­tion require­ments under COBRA, and ben­e­fit man­dates under the ACA. The new law spec­i­fies that QSEHRAs are not group health plans, so COBRA and oth­er require­ments will not apply.

    QSEHRA Notices

    Small employ­ers offer­ing QSEHRAs will be required to pro­vide a notice to each eli­gi­ble employ­ee that:

    • Informs the employ­ee of the QSEHRA ben­e­fit amount;
    • Instructs the employ­ee that he or she must give the QSEHRA infor­ma­tion to the Exchange if apply­ing for a sub­sidy for indi­vid­ual insur­ance; and
    • Explains the tax con­se­quences of fail­ing to main­tain min­i­mum essen­tial coverage.

    QSEHRA notices should be pro­vid­ed at least 90 days before the start of the plan year.

    Employ­ers also will be required to report the QSEHRA cov­er­age on Form W‑2, Box 12. The report­ing is infor­ma­tion­al only and has no tax con­se­quences. Although small employ­ers usu­al­ly are exempt from this type of W‑2 infor­ma­tion­al report­ing, appar­ent­ly it will be required for QSEHRAs start­ing with the 2017 tax year.

    More Information

    To learn more about QSEHRAs start­ing in 2017, or for details about the relief from excise tax­es for small employ­ers before 2017, see the 21st Cen­tu­ry Cures Act. The rel­e­vant pro­vi­sions are found in Sec­tion 18001 begin­ning on page 306.

    Employ­ers that are con­sid­er­ing QSEHRAs are encour­aged to work with legal coun­sel and tax advi­sors that offer exper­tise in this area. Start­ing in 2017, employ­er-fund­ed QSEHRAs can offer valu­able tax-free ben­e­fits to employ­ees as long as they are designed and admin­is­tered to meet all legal requirements.

     

    Orig­i­nal­ly pub­lished by ThinkHR — Read More

  • FAQs on Tobacco Cessation Coverage and Mental Health / Substance Use Disorder Parity | California Employee Benefits

    December 23, 2016

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    Recent­ly, the Depart­ment of the Trea­sury, Depart­ment of Labor (DOL), and Depart­ment of Health and Human Ser­vices (HHS) (col­lec­tive­ly, the Depart­ments) issued FAQs About Afford­able Care Act Imple­men­ta­tion Part 34 and Men­tal Health and Sub­stance Use Dis­or­der Par­i­ty Imple­men­ta­tion.

    The Depart­ments’ FAQs cov­er two pri­ma­ry top­ics: tobac­co ces­sa­tion cov­er­age and men­tal health / sub­stance use dis­or­der parity.

    Tobac­co Ces­sa­tion Coverage

    The Depart­ments seek pub­lic com­ment by Jan­u­ary 3, 2017, on tobac­co ces­sa­tion cov­er­age. The Depart­ments intend to clar­i­fy the items and ser­vices that must be pro­vid­ed with­out cost shar­ing to com­ply with the Unit­ed States Pre­ven­tive Ser­vices Task Force’s updat­ed tobac­co ces­sa­tion inter­ven­tions rec­om­men­da­tion applic­a­ble to plan years or pol­i­cy years begin­ning on or after Sep­tem­ber 22, 2016.

    Men­tal Health / Sub­stance Use Dis­or­der Parity

    Gen­er­al­ly, the Men­tal Health Par­i­ty and Addic­tion Equi­ty Act of 2008 (MHPAEA) requires that the finan­cial require­ments and treat­ment lim­i­ta­tions imposed on men­tal health and sub­stance use dis­or­der (MH/SUD) ben­e­fits can­not be more restric­tive than the pre­dom­i­nant finan­cial require­ments and treat­ment lim­i­ta­tions that apply to sub­stan­tial­ly all med­ical and sur­gi­cal benefits.

    A finan­cial require­ment (such as a copay­ment or coin­sur­ance) or quan­ti­ta­tive treat­ment lim­i­ta­tion (such as a day or vis­it lim­it) is con­sid­ered to apply to sub­stan­tial­ly all medical/surgical ben­e­fits in a clas­si­fi­ca­tion if it applies to at least two-thirds of all medical/surgical ben­e­fits in the classification.

    If it does not apply to at least two-thirds of medical/surgical ben­e­fits, it can­not be applied to MH/SUD ben­e­fits in that classification.

    If it does apply to at least two-thirds of medical/surgical ben­e­fits, the lev­el (such as 80 per­cent or 70 per­cent coin­sur­ance) of the quan­ti­ta­tive lim­it that may be applied to MH/SUD ben­e­fits in a clas­si­fi­ca­tion may not be more restric­tive than the pre­dom­i­nant lev­el that applies to medical/surgical ben­e­fits (defined as the lev­el that applies to more than one-half of medical/surgical ben­e­fits sub­ject to the lim­i­ta­tion in the classification).

    In per­form­ing these cal­cu­la­tions, the deter­mi­na­tion of the por­tion of medical/surgical ben­e­fits sub­ject to the quan­ti­ta­tive lim­it is based on the dol­lar amount of all plan pay­ments for medical/surgical ben­e­fits in the clas­si­fi­ca­tion expect­ed to be paid under the plan for the plan year. The MHPAEA reg­u­la­tions pro­vide that “any rea­son­able method” may be used to deter­mine the dol­lar amount of all plan pay­ments for the sub­stan­tial­ly all and pre­dom­i­nant analyses.

    MHPAEA’s pro­vi­sions and its reg­u­la­tions express­ly pro­vide that a plan or issuer must dis­close the cri­te­ria for med­ical neces­si­ty deter­mi­na­tions with respect to MH/SUD ben­e­fits to any cur­rent or poten­tial par­tic­i­pant, ben­e­fi­cia­ry, or con­tract­ing provider upon request and the rea­son for any denial of reim­burse­ment or pay­ment for ser­vices with respect to MH/SUD ben­e­fits to the par­tic­i­pant or beneficiary.

    How­ev­er, the Depart­ments rec­og­nize that addi­tion­al infor­ma­tion regard­ing medical/surgical ben­e­fits is nec­es­sary to per­form the required MHPAEA analy­ses. Accord­ing to the FAQs, the Depart­ment have con­tin­ued to receive ques­tions regard­ing dis­clo­sures relat­ed to the process­es, strate­gies, evi­den­tiary stan­dards, and oth­er fac­tors used to apply a non­quan­ti­ta­tive treat­ment lim­i­ta­tion (NQTL) with respect to medical/surgical ben­e­fits and MH/SUD ben­e­fits under a plan. Also, the Depart­ments have received requests to explore ways to encour­age uni­for­mi­ty among state reviews of issuers’ com­pli­ance with the NQTL stan­dards, includ­ing the use of mod­el forms to report NQTL information.

    To address these issues, the Depart­ments seek pub­lic com­ment by Jan­u­ary 3, 2017, on poten­tial mod­el forms that could be used by par­tic­i­pants and their rep­re­sen­ta­tives to request infor­ma­tion on var­i­ous NQTLs. The Depart­ments also seek pub­lic com­ment on the dis­clo­sure process for MH/SUD ben­e­fits and on steps that could improve state mar­ket con­duct exam­i­na­tions or fed­er­al over­sight of com­pli­ance by plans and issuers, or both.

     

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

  • Ask the Experts: Dealing With FSA Carryover Funds | California Benefit Advisors

    December 19, 2016

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    Ques­tion: If an employ­ee has a small health flex­i­ble spend­ing account (FSA) bal­ance with a car­ry­over to the next year, and the employ­ee choos­es not to par­tic­i­pate in the new FSA year, can the employ­er force the employ­ee to use those funds so as not to incur addi­tion­al admin­is­tra­tive fees in the next plan year?

    Answer: An employ­er can pre­vent “per­pet­u­al car­ry­overs” by care­ful­ly draft­ing the cafe­te­ria plan doc­u­ment with respect to car­ry­over amounts. IRS guid­ance allows car­ry­overs to be lim­it­ed to indi­vid­u­als who have elect­ed to par­tic­i­pate in the health FSA in the next plan year. Health FSAs may also require that car­ry­over amounts be for­feit­ed if not used with­in a spec­i­fied peri­od of time, such as one year. Note that this plan design requires addi­tion­al admin­is­tra­tion (to track the time lim­it for each car­ry­over dol­lar, for instance) as well as order­ing rules (e.g., will car­ry­overs be used first?), so you will need to care­ful­ly review the cafe­te­ria plan doc­u­ment. Under no cir­cum­stances are amounts returned to participants.

    Accord­ing to IRS guid­ance, a health FSA may lim­it the avail­abil­i­ty of the car­ry­over of unused amounts (sub­ject to the $500 lim­it) to indi­vid­u­als who have elect­ed to par­tic­i­pate in the health FSA in the next year, even if the abil­i­ty to par­tic­i­pate in that next year requires a min­i­mum salary reduc­tion elec­tion to the health FSA for that next year. For exam­ple, an employ­er spon­sors a cafe­te­ria plan offer­ing a health FSA that per­mits up to $500 of unused health FSA amounts to be car­ried over to the next year in com­pli­ance with Notice 2013–71, but only if the employ­ee par­tic­i­pates in the health FSA dur­ing that next year. To par­tic­i­pate in the health FSA, an employ­ee must con­tribute a min­i­mum of $60 ($5 per cal­en­dar month). As of Decem­ber 31, 2016, Employ­ee A and Employ­ee B each have $25 remain­ing in their health FSA. Employ­ee A elects to par­tic­i­pate in the health FSA for 2017, mak­ing a $600 salary reduc­tion elec­tion. Employ­ee B elects not to par­tic­i­pate in the health FSA for 2017. Employ­ee A has $25 car­ried over to the health FSA for 2017, result­ing in $625 avail­able in the health FSA. Employ­ee B for­feits the $25 as of Decem­ber 31, 2016 and has no funds avail­able in the health FSA there­after. This arrange­ment is a per­mis­si­ble health FSA car­ry­over fea­ture under Notice 2013171. The IRS also clar­i­fies that a health FSA may lim­it the abil­i­ty to car­ry over unused amounts to a max­i­mum peri­od (sub­ject to the $500 lim­it). For exam­ple, a health FSA can lim­it the abil­i­ty to car­ry over unused amounts to one year. Thus, if an indi­vid­ual car­ried over $30 and did not elect any addi­tion­al amounts for the next year, the health FSA may require for­fei­ture of any amount remain­ing at the end of that next year.

    Orig­i­nal­ly pub­lished by ThinkHR — Read More

  • Employer Exchange Subsidy Notices: Should You Appeal? | California Employee Benefits

    December 16, 2016

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    Under the Patient Pro­tec­tion and Afford­able Care Act (ACA), all pub­lic Exchanges are required to noti­fy employ­ers when an employ­ee is receiv­ing a sub­sidy (tax cred­its and cost-shar­ing reduc­tions) for indi­vid­ual health insur­ance pur­chased through an Exchange. Accord­ing to the final rules pub­lished in August 2013, employ­ers have the right, but are not required, to engage in an appeal process through the IRS if they feel an employ­ee should not be receiv­ing a sub­sidy because the employ­er offers min­i­mum val­ue, afford­able coverage.

    Some states began send­ing notices from pub­lic Exchanges indi­cat­ing that one or more employ­ees are cur­rent­ly receiv­ing a sub­sidy in 2015, but the U.S. Depart­ment of Health and Human Ser­vices (HHS) announced that all fed­er­al­ly-facil­i­tat­ed Exchanges will begin send­ing notices in 2016. Just because the employ­er receives a notice, it does not mean the employ­er will actu­al­ly owe a penal­ty pay­ment under Sec­tion 4980H.

    Dan Bond, Prin­ci­pal, Com­pli­ancedash­board, offers this impor­tant com­men­tary: “I think it’s impor­tant for employ­ers to remem­ber that just because they may receive one of these notices from the IRS telling them that one of their employ­ees is receiv­ing a sub­sidy on the exchange, it does not nec­es­sar­i­ly mean the employ­er has expo­sure to a penal­ty. There are var­i­ous rea­sons that some­one might have received a sub­sidy so the employ­er can use this notice to deter­mine exact­ly why and whether or not they have any expo­sure. In fact, small employ­ers will also receive these notices and they are not even sub­ject to the employ­er shared respon­si­bil­i­ty man­date so they will not be sub­ject to penal­ties, regardless.”

    subsidy appeal chart

    Appeal Form and Process
    So long as the require­ments in the final rules are met, each state Exchange is allowed to set up its own process and pro­ce­dures. Infor­ma­tion about how to file an appeal is usu­al­ly includ­ed in the notice, but it may be nec­es­sary to check with the applic­a­ble Exchange to find out exact­ly how to han­dle the appeals process, the par­tic­u­lars of which are man­aged by each Exchange separately.

    The form cur­rent­ly used by fed­er­al­ly-facil­i­tat­ed Exchanges, as well as by eight states, may be found on Healthcare.gov (approx­i­mate­ly half of the states are cur­rent­ly using this form and process). The forms and process­es for all oth­er states may be found by vis­it­ing a state’s Exchange site. The process gen­er­al­ly involves fil­ing a paper appeal, pro­vid­ing doc­u­men­ta­tion, and in some cas­es par­tic­i­pat­ing in a hearing.

    Con­clu­sion
    The employ­er does not have to appeal to avoid a penal­ty under Sec­tion 4980H, and penal­ties will not apply until after the employ­er report­ing (via Forms 1094‑C and 1095‑C) is rec­on­ciled. There is some spec­u­la­tion that it may be more ben­e­fi­cial to appeal with the Exchange rather than wait­ing to appeal lat­er with the IRS. This is a fair­ly new process, so the best approach for employ­ers may remain some­what unclear until the first year of employ­er report­ing is completed.

    Fil­ing an appeal as soon as pos­si­ble may help avoid has­sles with the IRS and pre­vent the indi­vid­ual from receiv­ing a sub­sidy for which they are inel­i­gi­ble. At the same time, although the appeals process does not appear to be a dif­fi­cult one, it is pos­si­ble that every­thing could be cleared up more quick­ly by sim­ply com­mu­ni­cat­ing direct­ly with the employ­ee that they may be receiv­ing the sub­sidy in error.

     

    By Vic­ki Ran­dall, Orig­i­nal­ly pub­lished by Unit­ed Ben­e­fit Advi­sors — Read More

  • The New HSA Under Trump’s Proposed Health Plan | California Benefit Advisors

    December 13, 2016

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    piggybankWith the elec­tion of a new Pres­i­dent, health care plans and the fate of the Afford­able Care Act are a hot top­ic of dis­cus­sion. As part of his 7‑tier health plan, Pres­i­dent-Elect Don­ald Trump has pro­posed a shift in the way health sav­ings accounts (HSAs) are offered to work­ing Amer­i­cans. Sim­ply put, an HSA is a sav­ings account for med­ical expens­es. They are tax advan­taged accounts an indi­vid­ual can open in addi­tion to their cur­rent health plan to pay out-of-pock­et expens­es rang­ing from co-pays to surgery deductibles. Typ­i­cal­ly, HSAs have been offered to indi­vid­u­als with high deductible health plans (HDH­Ps). How­ev­er, if the President-Elect’s new health plan strat­e­gy is enact­ed, an HDHP would no longer be an eli­gi­bil­i­ty require­ment, sig­nif­i­cant­ly impact­ing health­care options for mil­lions of Americans.

    HSA vs. FSA – Which one is right for you?

    When choos­ing a sav­ings account for med­ical expens­es there are two options: HSAs and FSAs. Each type of account is gen­er­al­ly non-tax­able for qual­i­fied med­ical expens­es, except under cer­tain cir­cum­stances in which a med­ical expense was incurred pri­or to open­ing an HSA, and each is accu­mu­lat­ed by con­tri­bu­tions from your pay­check. Some employ­ers offer HSA and FSA match­ing contributions.

    In the past, there have been some promi­nent dif­fer­ences between health sav­ings accounts and flex­i­ble spend­ing accounts (FSAs). Tra­di­tion­al­ly, FSAs have been the option for those who choose health plans with low deductibles. The mon­ey you con­tribute from your pay­check into your FSA account must be spent with­in the year, and can­not be rolled over. Con­verse­ly, you must have an HDHP to open an HSA, and funds accu­mu­lat­ed from pay­checks can be rolled over into the next year if left unused.

    Accu­mu­lat­ing tax advan­tages have made HSAs more pop­u­lar and ben­e­fi­cial in com­par­i­son to FSAs. When it comes to chang­ing jobs, HSAs typ­i­cal­ly are not affect­ed, while FSAs are impact­ed due to restric­tions in rollover of funds. How­ev­er, FSAs do not have eli­gi­bil­i­ty require­ments, which have made them more wide­ly avail­able to individuals.

    What’s Next? How HSAs would change under Trump’s health plan

    Trump’s new health plan would make HSAs read­i­ly avail­able to every­one by remov­ing the HDHP eli­gi­bil­i­ty require­ments that are cur­rent­ly in place. In addi­tion to this dras­tic bar­ri­er removal, Trump has said he will change pol­i­cy to allow fam­i­lies to share the accounts between one anoth­er. Any con­tri­bu­tion or inter­est-earned by an HSA is tax-deductible, and indi­vid­u­als with HSAs can with­draw­al mon­ey tax-free for cer­tain med­ical expens­es rang­ing from trans­plants to acupunc­ture. The com­bi­na­tion of these three tax-advan­tages cre­ates an unmatched sav­ings option for those who choose HSAs. While Trump has said he will change some fac­tors of HSAs, he plans to keep these tax advan­tages.

    Who will ben­e­fit from the new HSA model?

    In the past, HSAs have been more attrac­tive for retirees. Health care costs tend to rise in the retire­ment stage of life, which makes an HSA a more cost-effi­cient option for retirees. Since indi­vid­u­als are allowed to take out mon­ey for med­ical expens­es with­out being taxed, retirees have the poten­tial to save large amounts of mon­ey in the lat­er stages of their life. How­ev­er, under Trump’s pro­posed plan, HSAs will also become increas­ing­ly attrac­tive for younger peo­ple. Because indi­vid­u­als will con­tin­ue to be allowed to roll over mon­ey con­tributed to their HSA in a giv­en year into the next, young and healthy peo­ple will be able to save siz­able amounts for use lat­er in life.

    While much remains to be seen about which aspects of Pres­i­dent-Elect Trump’s health plan will be enact­ed when he takes office, take the time now to edu­cate your­self on how an HSA can work for you.

     

    By Nicole Fed­eri­co & Kate McGaugh­ey, eTekhnos

  • IRS Delay in 6055 and 6056 Reporting for 2017 | California Employee Benefits

    December 8, 2016

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    1208Under 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. Final instruc­tions for the 1094‑B and 1095‑B and the 1094‑C and 1095‑C forms were released in Sep­tem­ber 2016, as were the final forms for 1094‑B, 1095‑B, 1094‑C, and 1095‑C. The report­ing require­ments are in Sec­tions 6055 and 6056 of the ACA.

    Report­ing was first due in 2016, based on cov­er­age in 2015. Report­ing in 2017 will be based on cov­er­age in 2016. All report­ing will be for the cal­en­dar year, even for non-cal­en­dar year plans.

    On Novem­ber 18, 2016, the IRS issued Notice 2016–70, delay­ing the report­ing dead­lines in 2017 for the 1095‑B and 1095‑C forms to indi­vid­u­als. There is no delay for the 1094‑C and 1094‑B forms, or for forms due to the IRS.

    Orig­i­nal Deadlines Delayed Dead­lines
    DUE TO THE IRS
    The 1094‑C, 1095‑C, 1094‑B, and 1085‑B forms were orig­i­nal­ly due to the IRS by Feb­ru­ary 28, if fil­ing on paper, or March 31, if fil­ing electronically
    Dead­line to the IRS for all forms remains the same.
    DUE TO EMPLOYEES
    The 1095‑C form was due to employ­ees by Jan­u­ary 31 of the year fol­low­ing the year to which the Form 1095‑C relates.
    DUE TO EMPLOYEES
    The 1095‑C form is now due to employ­ees by March 2, 2017.
    DUE TO INDIVIDUALS AND EMPLOYEES
    The 1095‑B form was due to the indi­vid­ual iden­ti­fied as the “respon­si­ble indi­vid­ual” on the form by Jan­u­ary 31.
    DUE TO INDIVIDUALS AND EMPLOYEES
    The 1095‑B form is now due to the indi­vid­ual iden­ti­fied as the “respon­si­ble indi­vid­ual” on the form by March 2, 2017.

     

    For infor­ma­tion on the exten­sion process as well as the impact on indi­vid­ual tax­pay­ers, view UBA’s ACA Advi­sor, “IRS Delay in 6055 and 6056 Report­ing for 2017”.

     

    By Danielle Capil­la, Orig­i­nal­ly pub­lished by Unit­ed Ben­e­fit Advisors 

  • California Dreamin – new laws affecting employer employee relationship

    December 6, 2016

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    arrowlogoAB 2337 – employ­ers with 25 or more employ­ees must pro­vide writ­ten notice to employ­ees of their rights to take pro­tect­ed time off for domes­tic vio­lence, sex­u­al assault or stalk­ing.  This is an expan­sion of exist­ing law, now requir­ing that notice be pro­vid­ed.  Con­for­mi­ty with the law is required once the Labor Com­mis­sion­er devel­ops the prop­er notice.

    New Work­ers Com­pen­sa­tion rules – which will be issued as a pack­age from the Divi­sion of Work­ers Com­pen­sa­tion over the course of 2017.  Also, the WCIRB (Work­ers Com­pen­sa­tion Rat­ing Bureau) has rec­om­mend­ed a 4.3% drop in 2017 pre­mi­ums as part of pure premium.

    SB 1167 – OSHA must pro­vide, by Jan­u­ary 1, 2019, a heat ill­ness and injury pre­ven­tion stan­dard applic­a­ble to work­ers work­ing in indoor places of employment.

    SB 1234 – estab­lish­es the Secure Choice Retire­ment pro­gram for all cov­ered pri­vate sec­tor employ­ees.  Man­dates the cre­ation of sav­ings accounts for cov­ered work­ers whose employ­ers do not offer a retire­ment sav­ings option to be auto­mat­i­cal­ly enrolled.  The pro­gram will be phased in over a 36 month peri­od and over­seen by a new Secure Choice Retiremetn Sav­ings Invest­ment Board:

    • Groups of 100 or more employ­ees – must imple­ment with­in first 12 months
    • Groups of 50–99 employ­ees – must imple­ment with­in 24 months
    • Groups of 5 to 49 employ­ees – must imple­ment with­in 36 months

    Employ­ees do have the right to opt out of the pro­gram.  The Board to set the ini­tial employ­ee con­tri­bu­tion between 2 and 5% of their gross wages and employ­ers always retain the right to pro­vide their own employ­er spon­sored retire­ment plans in lieu of the new program.

  • The Shift Away from Health Risk Assessments | California Employee Benefits

    December 2, 2016

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    1129His­tor­i­cal­ly, employ­ers have uti­lized health risk assess­ments (HRAs) as one mea­sure­ment tool in well­ness pro­gram design. The main goals of an HRA are to assess indi­vid­ual health sta­tus and risk and pro­vide feed­back to par­tic­i­pants on how to man­age risk. Employ­ers have tra­di­tion­al­ly relied on this type of assess­ment to eval­u­ate the over­all health risk of their pop­u­la­tion in order to devel­op appro­pri­ate well­ness strategies.

    Recent­ly, there has been a shift away from the use of HRAs. Accord­ing to the 2016 UBA Health Plan Sur­vey, there has been a 4 per­cent decline in the per­cent­age of employ­er well­ness pro­grams using HRAs. In con­trast, the per­cent­age of well­ness pro­grams offer­ing bio­met­ric screens or phys­i­cal exams remains unchanged – 68 per­cent of plans where employ­ers pro­vide well­ness offer a phys­i­cal exam or bio­met­ric screening.

    One expla­na­tion for this shift away from HRAs is an increased focus on help­ing employ­ees improve or main­tain their health sta­tus through out­come-based well­ness pro­grams, which often require quan­tifi­able and objec­tive data. The main issue with an HRA is that it relies on self-report­ed data, which may not give an accu­rate pic­ture of indi­vid­ual or pop­u­la­tion health due to the fact that peo­ple tend to be more opti­mistic or biased when think­ing about their own health risk. A bio­met­ric screen­ing or phys­i­cal exam, on the oth­er hand, allows for the col­lec­tion of real-time, objec­tive data at both the indi­vid­ual and pop­u­la­tion level.

    Includ­ing a bio­met­ric screen­ing or phys­i­cal exam as part of a com­pre­hen­sive well­ness pro­gram can be ben­e­fi­cial for both the employ­er and employ­ees. Through a bio­met­ric screen­ing or phys­i­cal exam, key health indi­ca­tors relat­ed to chron­ic dis­ease can be mea­sured and tracked over time, includ­ing blood pres­sure, cho­les­terol lev­els, blood sug­ar, hemo­glo­bin, or body mass index (BMI). For employ­ees, this type of data can pro­vide real insight into cur­rent or poten­tial health risks and pro­vide moti­va­tion to engage in pro­grams or resources avail­able through the well­ness pro­gram. Beyond that, aggre­gate data col­lect­ed from these types of screen­ings can help employ­ers make informed deci­sions about the type of well­ness pro­grams that will pro­vide the great­est val­ue to their com­pa­ny, both from a pop­u­la­tion health and finan­cial perspective.

    One suc­cess sto­ry of includ­ing a phys­i­cal exam as part of a well­ness pro­gram comes from one of our small man­u­fac­tur­ing clients. From the ini­tial pop­u­la­tion health report, the com­pa­ny learned that there was a large per­cent­age of its pop­u­la­tion with lit­tle to no health data, result­ing in the inabil­i­ty to assign a risk score to those indi­vid­u­als. It is impor­tant to note that when a pop­u­la­tion is not uti­liz­ing health care, it can result in late-stage diag­noses, result­ing in greater costs and a bur­den for both the employ­ee and employ­er. In addi­tion, there was low phys­i­cal com­pli­ance and a high per­cent­age of adults with no pri­ma­ry care provider. In order to cap­ture more infor­ma­tion on its pop­u­la­tion and bet­ter under­stand the cur­rent health risks, the com­pa­ny shift­ed its well­ness plan to include annu­al phys­i­cals as a method for col­lect­ing bio­met­ric data for the 2016 ben­e­fit year. Employ­ees and spous­es cov­ered on the plan were required to com­plete an annu­al phys­i­cal and sub­mit bio­met­ric data in order to earn addi­tion­al incen­tive dollars.

    By includ­ing annu­al phys­i­cals in its well­ness pro­gram, pos­i­tive results were seen for employ­ees and spous­es and the com­pa­ny was able to make an informed deci­sion about next steps for its well­ness pro­gram. After the first phys­i­cal col­lec­tion peri­od, the per­cent­age of indi­vid­u­als with lit­tle to no infor­ma­tion was reduced from 31 per­cent to 16 per­cent (Fig­ure A). Annu­al phys­i­cal com­pli­ance increased from 36 per­cent in 2015 to over 80 per­cent in 2016 (Fig­ure B), which means more indi­vid­u­als were see­ing a pri­ma­ry care provider. As a result of increased bio­met­ric data col­lec­tion and one year of Vital Incite report­ing, the com­pa­ny was able to deter­mine next steps, which includ­ed address­ing chron­ic con­di­tion man­age­ment, specif­i­cal­ly hyper­ten­sion and dia­betes, with health coach­ing or a dis­ease man­age­ment nurse.

    Fig­ure A – RUB Dis­tri­b­u­tion 2014 — 2016

    RUB Distribution 2014-2016

    Fig­ure B – Pre­ven­tive Screen­ing Compliance

    Preventive Screening Compliance

    Employ­ers that are still inter­est­ed in col­lect­ing addi­tion­al infor­ma­tion from employ­ees may con­sid­er includ­ing alter­na­tives to the HRA, such as cul­ture or sat­is­fac­tion sur­veys. These tools can allow employ­ers the oppor­tu­ni­ty to eval­u­ate pro­gram engage­ment and fur­ther under­stand the needs and wants of their employ­ee population.

     

    Orig­i­nal­ly pub­lished by Unit­ed Ben­e­fit Advi­sors — Read More

  • BREAKING NEWS: Texas Court Issues Injunction Blocking New December 1st Overtime Regulations | California Benefit Advisors

    November 29, 2016

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    Ten o'clock on the white wall clocksOn Novem­ber 22, 2016, a fed­er­al dis­trict court in Texas grant­ed a pre­lim­i­nary injunc­tion that tem­porar­i­ly blocks the U.S. Depart­ment of Labor (DOL) from imple­ment­ing and enforc­ing its recent­ly revised reg­u­la­tions on the white col­lar exemp­tions to the Fair Labor Stan­dards Act (FLSA). The reg­u­la­tions, which were released in May and sched­uled to go into effect on Decem­ber 1, would more than dou­ble the min­i­mum salary require­ment cer­tain exec­u­tive, admin­is­tra­tive, and pro­fes­sion­al employ­ees must receive in order to be exempt from overtime.

    Employ­ers should note that this is only a tem­po­rary injunc­tion, not a per­ma­nent one. The injunc­tion applies nation­wide and sim­ply pre­vents the reg­u­la­tions from going into effect on Decem­ber 1. There will be a deci­sion issued at a lat­er date on the actu­al mer­its of the case, so changes in the FLSA salary thresh­old for exemp­tion may be back.

    Impact for Employers

    For many employ­ers, this is good news for the time being. As a result, employ­ers that have not made the nec­es­sary changes to their com­pen­sa­tion plans have more time to plan for the changes in the event the reg­u­la­tions are upheld. Employ­ers that have already made changes to their com­pen­sa­tion plans will need to deter­mine if they want to con­tin­ue with the changes, sus­pend the changes, or roll back those changes pend­ing any legal devel­op­ments. These deci­sions should be made in accor­dance with any applic­a­ble state or local laws. Employ­ers should con­sult their attor­neys to deter­mine what course of action is best for them.

     

    Orig­i­nal­ly pub­lished by ThinkHR — Read More

  • Why Technology Plays an Important Role as Workplace Demographics Shift | California Benefit Advisors

    November 25, 2016

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    resized-millennial-techAs an increas­ing num­ber of Baby Boomers retire and leave the work­force, mil­len­ni­als are posi­tioned to take on more lead­er­ship roles in the busi­ness world. Mil­len­ni­als bring with them a unique and evolv­ing knowl­edge of tech­nol­o­gy and inno­v­a­tive HR prac­tices that dif­fer great­ly from their Baby Boomer pre­de­ces­sors. As man­age­r­i­al roles are trans­ferred from the Baby Boomer gen­er­a­tion to mil­len­ni­als, for­ward-think­ing busi­ness­es will cre­ate plans that adapt to the inno­v­a­tive process­es and prac­tices mil­len­ni­als bring to the table. Worth­while risks and changes must be made to ensure com­pa­nies keep up with their rapid­ly evolv­ing com­peti­tors. To suc­cess­ful­ly tran­si­tion mil­len­ni­als into top man­age­ment posi­tions, here are a few fac­tors com­pa­nies should keep in mind.

    Mil­len­ni­als are technology-driven.

    75% of mil­len­ni­als believe that tech­nol­o­gy helps them oper­ate more effi­cient­ly in the work­place. Mil­len­ni­als are the first gen­er­a­tion to tru­ly incor­po­rate tech­nol­o­gy as an imper­a­tive tool for max­i­mum effi­cien­cy. Mil­len­ni­als look for effi­cien­cy, dig­i­tal com­mu­ni­ca­tion, and mobil­i­ty found­ed in tech­nol­o­gy in the work­place, and use of tech­nol­o­gy helps facil­i­tate inno­va­tion, engage­ment and clar­i­ty.  Baby Boomers in man­age­ment who are get­ting ready to hand over the reins to their younger coun­ter­parts can facil­i­tate a smooth oper­a­tional tran­si­tion by embrac­ing new sys­tems and process­es led by technology.

    Effi­cien­cy is key.

    Mil­len­ni­als have grown up in a fast-paced cul­ture where new tech­nolo­gies are con­stant­ly being devel­oped, and because of this they find it nat­ur­al to lean on tech­nol­o­gy to effi­cient­ly tack­le dai­ly work tasks. As opposed to pre­vi­ous gen­er­a­tions, mil­len­ni­als are used to instant grat­i­fi­ca­tion and desire work to be com­plet­ed in the most prac­ti­cal and time­ly man­ner. One exam­ple of state-of-the-art tech­nol­o­gy is auto­mat­ed task man­age­ment sys­tems which allow you to com­plete work ahead of time. For exam­ple, social media sched­ul­ing plat­forms like Hoot­suite allow you to sched­ule posts ahead of time and select when you want them to post auto­mat­i­cal­ly. The automa­tion process cre­ates a more effi­cient way to com­plete time-con­sum­ing, yet sim­ple tasks.  Anoth­er task man­age­ment tool is Asana. Asana pro­vides a sin­gle out­let for com­pa­nies to man­age projects, assign tasks and track progress, all through one sys­tem. Asana ensures a safe and orga­nized por­tal for your com­pa­ny to com­plete tasks in the most prac­ti­cal man­ner.  Invest time in research­ing tech­no­log­i­cal tools your mil­len­ni­al employ­ees find help­ful in their day-to-day work, and start imple­ment­ing them now.

    Dig­i­tal com­mu­ni­ca­tion is here to stay. 

    Com­mu­ni­ca­tion is vital to facil­i­tat­ing an engaged com­pa­ny cul­ture. Being able to com­mu­ni­cate well with not only clients, but with employ­ees, is cru­cial. Mil­len­ni­als have grown up uti­liz­ing tech­nol­o­gy as a main form of com­mu­ni­ca­tion, and they have mas­tered the art of mak­ing it work for them in the office as well. The mass amount of infor­ma­tion that must be learned when imple­ment­ing a new tech­nol­o­gy com­pa­ny-wide can be over­whelm­ing, and keep­ing track of rel­e­vant news with­in your com­pa­ny can be dif­fi­cult. To cre­ate an orga­nized and effec­tive inter­nal com­mu­ni­ca­tion strat­e­gy many com­pa­nies are turn­ing to social intranet soft­ware. This type of soft­ware cre­ates a por­tal that keeps all of the company’s inter­nal infor­ma­tion in one place mak­ing mass com­mu­ni­ca­tions eas­i­er to stream­line. Dig­i­tal com­mu­ni­ca­tion fos­ters more effi­cient and time­ly trans­fer of infor­ma­tion and prob­lem solv­ing. The impact of incor­po­rat­ing dig­i­tal tech­nol­o­gy reach­es beyond the office and can even help you pre­pare your employ­ees to be social media advo­cates for your brand in their off time.

    Mobil­i­ty is the new norm. 

    One of the most attrac­tive assets of tech­nol­o­gy is mobil­i­ty. Tech­nol­o­gy has com­plete­ly dis­rupt­ed the work­place by allow­ing employ­ees to work any­where at any time. Employ­ees no longer have to com­plete their typ­i­cal work­day in the office. Work­ing from home or remote loca­tions pro­vides room for great work/life bal­ance and cre­ative inspi­ra­tion. A prime exam­ple of an effec­tive tech­nol­o­gy when it comes to remote work and flex­i­ble hours is video con­fer­enc­ing through apps like Skype or Face­Time. By incor­po­rat­ing video con­fer­enc­ing, com­pa­nies can eas­i­ly expand their client base coun­try wide and even inter­na­tion­al­ly, at a much more cost effec­tive price.

    As mil­len­ni­als con­tin­ue to take over the work­force and we see more inno­va­tions and improve­ments made to cur­rent tech­nol­o­gy, be sure your com­pa­ny stays up to date on the lat­est trends. Ensur­ing your employ­ees are engaged with and flu­ent in tech­nolo­gies that are being glob­al­ly imple­ment­ed is vital to your company’s suc­cess in this dig­i­tal age.

     

    By Nicole Federico

  • Who decides on discrimination? The government believes it has discriminating tastes

    November 22, 2016

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    arrowlogoIn 2017 the fed­er­al gov­ern­ment will begin col­lect­ing pay data for all employ­ers with 100 or more employ­ees to help iden­ti­fy and address pay inequities – as part of the annu­al EEO‑1 process.
    We know the goal, but what are the poten­tial consequences?

  • 2016 Election Results: The Potential Impact on Health and Welfare Benefits | California Employee Benefits

    November 18, 2016

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    1114Fol­low­ing the Novem­ber 2016 elec­tion, Don­ald Trump ® will be sworn in as the next Pres­i­dent of the Unit­ed States on Jan­u­ary 20, 2017. The Repub­li­cans will also have the major­i­ty in the Sen­ate (51 Repub­li­can, 47 Demo­c­rat) and in the House of Rep­re­sen­ta­tives (238 Repub­li­cans, 191 Demo­c­rat). As a result, the polit­i­cal atmos­phere is favor­able for the Trump Admin­is­tra­tion to begin imple­ment­ing its health­care pol­i­cy objec­tives. Rep­re­sen­ta­tive Paul Ryan (R‑Wis.) will like­ly remain the Speak­er of the House. Known as an indi­vid­ual who is expe­ri­enced in pol­i­cy, it is expect­ed that the Repub­li­can House will work to pass leg­is­la­tion that fol­lows the health care poli­cies in Speak­er Ryan’s “A Bet­ter Way” pro­pos­als. The suc­cess of any of these pro­pos­als remains to be seen.

    Employ­ers should be aware of the main tenets of Pres­i­dent-elect Trump’s pro­pos­als, as well as the poli­cies out­lined in Speak­er Ryan’s white paper. These pro­pos­als are like­ly to have an impact on employ­er spon­sored health and wel­fare ben­e­fits. Repeal of the Patient Pro­tec­tion and Afford­able Care Act (ACA) and cap­ping the employ­er-spon­sored insur­ance (ESI) exclu­sion for indi­vid­u­als would have a sig­nif­i­cant effect on employ­er spon­sored group health plans.

    Trump Pol­i­cy Proposals

    Pres­i­dent-elect Trump’s pol­i­cy ini­tia­tives have sev­en main components:

    • Repeal the ACA. Pres­i­dent-elect Trump has vowed to com­plete­ly repeal the ACA as his first order of Pres­i­den­tial business.
    • Allow health insur­ance to be pur­chased across state lines.
    • Allow indi­vid­u­als to ful­ly deduct health insur­ance pre­mi­um pay­ments from their tax returns.
    • Allow indi­vid­u­als to use health sav­ings accounts (HSAs) in a more robust way than reg­u­la­tion cur­rent­ly allows. Pres­i­dent-elect Trump’s pro­pos­al specif­i­cal­ly men­tions allow­ing HSAs to be part of an indi­vid­u­al’s estate and allow­ing HSA funds to be spent by any mem­ber of the account own­er’s family.
    • Require price trans­paren­cy from all health­care providers.
    • Block-grant Med­ic­aid to the states. This would remove fed­er­al pro­vi­sions on how Med­ic­aid dol­lars can and should be spent by the states.
    • Remove bar­ri­ers to entry into the free mar­ket for the phar­ma­ceu­ti­cal indus­try. This includes allow­ing Amer­i­can con­sumers access to import­ed drugs.

    Pres­i­dent-elect Trump’s pro­pos­al also notes that his immi­gra­tion reform pro­pos­als would assist in low­er­ing health­care costs, due to the cur­rent amount of spend­ing on health­care for ille­gal immi­grants. His pro­pos­al also states that the men­tal health pro­grams and insti­tu­tions in the Unit­ed States are in need of reform, and that by pro­vid­ing more jobs to Amer­i­cans we will reduce the reliance of Med­ic­aid and the Chil­dren’s Health Insur­ance Pro­gram (CHIP).

    Speak­er Ryan’s “A Bet­ter Way” Proposal

    In June 2016, Speak­er Ryan released a series of white papers on nation­al issues under the ban­ner “A Bet­ter Way.” With Repub­li­can con­trol of the House and Sen­ate, it would be plau­si­ble that elect­ed offi­cials will begin work­ing to imple­ment some, if not all, of the ideas pro­posed. The core ten­ants of Speak­er Ryan’s pro­pos­al are:

    • Repeal the ACA in full.
    • Expand con­sumer choice through con­sumer-direct­ed health care. Speak­er Ryan’s pro­pos­al includes spe­cif­ic means for this expan­sion, name­ly by allow­ing spous­es to make catch-up con­tri­bu­tions to HSA accounts, allow qual­i­fied med­ical expens­es incurred up to 60 days pri­or to the HSA-qual­i­fied cov­er­age began to be reim­bursed, set the max­i­mum con­tri­bu­tion of HSA accounts at the max­i­mum com­bined and allowed annu­al high deductible health plan (HDHP) deductible and out-of-pock­et expens­es lim­its, and expand HSA access for groups such as those with TRICARE cov­er­age. The pro­pos­al also rec­om­mends allow­ing indi­vid­u­als to use employ­er pro­vid­ed health reim­burse­ment account (HRA) funds to pur­chase indi­vid­ual coverage.
    • Sup­port portable cov­er­age. Speak­er Ryan sup­ports access to finan­cial sup­port for an insur­ance plan cho­sen by an indi­vid­ual through an advance­able, refund­able tax cred­it for indi­vid­u­als and fam­i­lies, avail­able at the begin­ning of every month and adjust­ed for age. The cred­it would be avail­able to those with­out job-based cov­er­age, Medicare, or Med­ic­aid. It would be large enough to pur­chase a pre-ACA insur­ance pol­i­cy. If the indi­vid­ual select­ed a plan that cost less than the finan­cial sup­port, the dif­fer­ence would be deposit­ed into an “HSA-like” account and used toward oth­er health care expenses.
    • Cap the employ­er-spon­sored insur­ance (ESI) exclu­sion for indi­vid­u­als. Speak­er Ryan’s pro­pos­al argues that the ESI exclu­sion rais­es pre­mi­ums for employ­er-based cov­er­age by 10 to 15 per­cent and holds down wages as work­ers sub­sti­tute tax-free ben­e­fits for tax­able income. Employ­ee con­tri­bu­tions to HSAs would not count toward the cost of cov­er­age on the ESI cap.
    • Allow health insur­ance to be pur­chased across state lines.
    • Allow small busi­ness­es to band togeth­er an offer “asso­ci­a­tion health plans” or AHPs. This would allow alum­ni orga­ni­za­tions, trade asso­ci­a­tions, and oth­er groups to pool togeth­er and improve bar­gain­ing power.
    • Pre­serve employ­er well­ness pro­grams. Speak­er Ryan’s pro­pos­al would lim­it the Equal Employ­ment Oppor­tu­ni­ty Com­mis­sion (EEOC) over­sight over well­ness pro­grams by find­ing that vol­un­tary well­ness pro­grams do not vio­late the Amer­i­cans with Dis­abil­i­ties Act of 1990 (ADA) and the col­lec­tion of infor­ma­tion would not vio­late the Genet­ic Infor­ma­tion Nondis­crim­i­na­tion Act of 2008 (GINA).
    • Ensure self-insured employ­er spon­sored group health cov­er­age has robust access to stop-loss cov­er­age by ensur­ing stop-loss cov­er­age is not clas­si­fied as group health insur­ance. This pro­vi­sion would also remove the ACA’s Cadil­lac tax.
    • Enact med­ical lia­bil­i­ty reform by imple­ment­ing caps on non-eco­nom­ic dam­ages in med­ical mal­prac­tice law­suits and lim­it­ing con­tin­gency fees charged by plain­tiff’s attorneys.
    • Address com­pe­ti­tion in insur­ance mar­kets by charg­ing the Gov­ern­ment Account­abil­i­ty Office (GAO) to study the advan­tages and dis­ad­van­tages of remov­ing the lim­it­ed McCar­ran-Fer­gu­son antitrust exemp­tion for health insur­ance car­ri­ers to increase com­pe­ti­tion and low­er prices. The exemp­tion allows insur­ers to pool his­toric loss infor­ma­tion so they can project future loss­es and joint­ly devel­op policy.
    • Pro­vide for patient pro­tec­tions by con­tin­u­ing pre-exist­ing con­di­tion pro­tec­tions, allow depen­dents to stay on their par­ents’ plans until age 26, con­tin­ue the pro­hi­bi­tions on rescis­sions of cov­er­age, allow cost lim­i­ta­tions on old­er Amer­i­cans’ plans to be based on a five to one ratio (cur­rent­ly the ratio is three to one under the ACA), pro­vide for state inno­va­tion grants, and ded­i­cate fund­ing to high risk pools.

    Speak­er Ryan’s white paper also address­es more robust pro­tec­tion of life by enforc­ing the Hyde Amend­ment (which pro­hibits fed­er­al tax­pay­er dol­lars from being used to pay for abor­tion or abor­tion cov­er­age) and improved con­science pro­tec­tions for health care providers by enact­ing and expand­ing the Wel­don Amend­ment.

    Speak­er Ryan also pro­pos­es oth­er ini­tia­tives includ­ing robust Med­ic­aid reforms, strength­en­ing Medicare Advan­tage, repeal­ing the Inde­pen­dent Pay­ment Advi­so­ry Board (IPAB) that was once referred to as “death pan­els,” com­bine Medicare Part A and Part B, repeal­ing the ban on physi­cian-owned hos­pi­tals, and repeal­ing the “Bay State Boon­dog­gle.”

    Process of Repeal

    Gen­er­al­ly speak­ing, the process of repeal­ing a law is the same as cre­at­ing a law. A repeal can be a sim­ple repeal, or leg­is­la­tors can try to pass leg­is­la­tion to repeal and replace. Bills can begin in the House of Rep­re­sen­ta­tives, and if passed by the House, they are referred to the Sen­ate. If it pass­es the Sen­ate, it is sent to the Pres­i­dent for sig­na­ture or veto. Bills that begin in the Sen­ate and pass the Sen­ate are sent to the House of Rep­re­sen­ta­tives, which can pass (and if they wish, amend) the bill. If the Sen­ate agrees with the bill as it is received from the House, or after con­fer­ence with the House regard­ing amend­ments, they enroll the bill and it is sent to the White House for sig­na­ture or veto.

    Although Repub­li­cans hold the major­i­ty in the Sen­ate, they do not have enough par­ty votes to allow them to over­come a poten­tial fil­i­buster. A fil­i­buster is when debate over a pro­posed piece of leg­is­la­tion is extend­ed, allow­ing a delay or com­plete­ly pre­vent­ing the leg­is­la­tion from com­ing to a vote. Fil­i­busters can con­tin­ue until “three-fifths of the Sen­a­tors duly cho­sen and sworn” close the debate by invok­ing clo­ture, or a par­lia­men­tary pro­ce­dure that brings a debate to an end. Three-fifths of the Sen­ate is 60 votes.

    There is poten­tial to dis­man­tle the ACA by using a bud­get tool known as rec­on­cil­i­a­tion, which can­not be fil­i­bus­tered. If Con­gress can draft a rec­on­cil­i­a­tion bill that meets the com­plex require­ments of our bud­get rules, it would only need a sim­ple major­i­ty of the Sen­ate (51 votes) to pass.

    Nei­ther Pres­i­dent-elect Trump nor Speak­er Ryan has giv­en any indi­ca­tion as to whether a full repeal, or a repeal and replace, would be their pre­ferred method of action.

    The via­bil­i­ty of any of these ini­tia­tives remains to be seen, but with a Repub­li­can Pres­i­dent and a Repub­li­can-con­trolled House and Sen­ate, if law­mak­ers are able to reach agree­able terms across the exec­u­tive and leg­isla­tive branch­es, some lev­el of change is to be expected.

     

    Orig­i­nal­ly pub­lished by Unit­ed Ben­e­fit Advi­sors — Read More

  • What Employers Can Expect from the Trump Administration | California Benefit Advisors

    November 15, 2016

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    1110

    The U.S. Pres­i­den­tial race win by Don­ald Trump will impact labor, employ­ment, and HR pro­fes­sion­als in the key issues of immi­gra­tion, paid leave, tax reform, and health care.

    Significant Shift in Immigration Policy

    Trump has been vocal about his stance on immi­gra­tion in regard to depor­ta­tion and ille­gal immi­gra­tion. He also seeks to strength­en U.S. jobs, wages, and secu­ri­ty through the nation­wide use of E‑Verify. Trump plans to work with Con­gress to strength­en and expand the use of E‑Verify as cur­rent­ly less than half the states require employ­ers to use E‑Verify; how­ev­er, more than 16.4 mil­lion cas­es were run through E‑Verify in fis­cal year 2016 by employ­ers in every indus­try, state, and U.S. ter­ri­to­ry. E‑Verify ensures a legal work­force, pro­tects jobs for autho­rized work­ers, deters doc­u­ment and iden­ti­ty fraud, and works seam­less­ly with Form I‑9. Employ­ers may also look to the changes in the Form I‑9 effec­tive Jan­u­ary 21, 2017 designed to make the form more user-friend­ly and alle­vi­ate mis­takes, although this was estab­lished pri­or to Trump’s presidency.

    Paid Leave for New Mothers

    Although the specifics are unclear right now, Trump has pro­posed six weeks of paid mater­ni­ty leave to new moth­ers. These pay­ments would come from recap­tur­ing fraud and improp­er pay­ments in the U.S. unem­ploy­ment insur­ance sys­tem. Trump has also dis­cussed allow­ing par­ents to enroll in tax-free depen­dent care sav­ings accounts for their chil­dren (read in-depth analy­sis of paid fam­i­ly leave from our own in-house expert Lau­ra Kerekes). Accord­ing to the Nation­al Part­ner­ship for Women and Fam­i­lies, employ­ers can expect paid leave to improve work­er reten­tion, reduce turnover costs with increased work­er pro­duc­tiv­i­ty, and increase employ­ee loyalty.

    Tax Reform

    Trump has advo­cat­ed for sig­nif­i­cant tax cuts “across the board” by increas­ing the stan­dard deduc­tion to $30,000 for joint fil­ers (from $12,600), and sim­pli­fy­ing the tax code. Trump plans to col­lapse the sev­en tax brack­ets to three with low-income Amer­i­cans at an income tax rate of 0 per­cent. Trump’s tax plan also seeks to low­er the busi­ness tax rate from 35 per­cent to 15 per­cent, and elim­i­nate the cor­po­rate alter­na­tive min­i­mum tax. Pro­po­nents of low­er­ing busi­ness tax­es assert that it cre­ates jobs in the Unit­ed States rather than over­seas, encour­ages invest­ment in our infra­struc­ture, and because the Unit­ed States has the high­est cor­po­rate income tax rates, busi­ness­es are at a sig­nif­i­cant dis­ad­van­tage. Trump intends to apply this low­er rate to all busi­ness, both small and large. Addi­tion­al­ly, accord­ing to Trump’s tax plan, busi­ness­es that pay a por­tion of an employee’s child­care expens­es would be per­mit­ted to exclude those con­tri­bu­tions from income. Employ­ees who are recip­i­ents of direct employ­er sub­si­dies would not be able to exclude those costs from the indi­vid­ual income tax and the costs of direct sub­si­dies to employ­ees could not be used as a cost eli­gi­ble for the credit.

    Repeal of the Affordable Care Act

    The Afford­able Care Act will be chal­lenged under Trump’s admin­is­tra­tion. Trump seeks to remove health­care exchanges and replace them with tax-free health sav­ings accounts for peo­ple with high-deductible insur­ance plans. Trump has also advo­cat­ed state-based high-risk pools for peo­ple with med­ical con­di­tions that make it hard to get cov­er­age on their own. He also seeks to allow com­pa­nies to sell insur­ance across state lines to boost com­pe­ti­tion and dri­ve down prices.

    What’s Next for Employers

    Inter­est­ing­ly, the largest impact of a Trump pres­i­den­cy may not be from his stance on these issues but may be seen when it comes time to nam­ing the next U.S. Supreme Court Jus­tices as he will like­ly appoint four jus­tices dur­ing his term in office. Experts pre­dict four because the aver­age age of retire­ment for a Supreme Court jus­tice has been approx­i­mate­ly 78.7 years old, and cur­rent­ly three of the eight jus­tices range in age from 78 – 83. The fourth open seat remains unoc­cu­pied since Jus­tice Antonin Scalia’s death in February.

    Under­stand­ably, there are oppos­ing views to these pre­sent­ed issues, and nei­ther can­di­date pro­vid­ed many details about how their plans for these issues would be financed or imple­ment­ed. ThinkHR will fol­low the changes in labor and employ­ment laws and will pro­vide infor­ma­tion and tools to help employ­ers make sense of the changes that impact Amer­i­can businesses.

     

    Orig­i­nal­ly pub­lished by ThinkHR — Read More

  • Employer FYI: Individual Mandate Requirements and Proposed Regulations | California Benefits Broker

    November 11, 2016

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    1109Though employ­ers are not required to edu­cate employ­ees about their indi­vid­ual respon­si­bil­i­ties under the Patient Pro­tec­tion and Afford­able Care Act (ACA), it is help­ful to know about the indi­vid­ual mandate.

    The indi­vid­ual respon­si­bil­i­ty require­ment (also known as the indi­vid­ual man­date) became effec­tive for most peo­ple as of Jan­u­ary 1, 2014. Under the indi­vid­ual man­date, most peo­ple resid­ing in the U.S. are required to have min­i­mum essen­tial cov­er­age or they must pay a penal­ty. Many indi­vid­u­als will be eli­gi­ble for finan­cial assis­tance through pre­mi­um tax cred­its (also known as pre­mi­um sub­si­dies) to help them pur­chase cov­er­age if they buy cov­er­age through the health insur­ance Mar­ket­place (also known as the Exchange).

    For 2014, the penal­ty for an adult was the greater of $95 or 1 per­cent of house­hold income above the tax fil­ing thresh­old. For 2015, the penal­ty was the greater of $325 or 2 per­cent of income above the tax fil­ing thresh­old. For 2016, the penal­ty is the greater of $695 or 2.5 per­cent of income above the tax fil­ing threshold.

    The penal­ty for a child under age 18 is 50 per­cent of the adult penal­ty. The max­i­mum penal­ty per fam­i­ly is three times the indi­vid­ual penal­ty. The penal­ty is cal­cu­lat­ed and paid as part of the employee’s fed­er­al income tax filing.

    A per­son must have “min­i­mum essen­tial cov­er­age” to avoid a penal­ty. Min­i­mum essen­tial cov­er­age is basic med­ical cov­er­age and may be pro­vid­ed through an employ­er, Medicare, Med­ic­aid, CHIP, TRICARE, some VA pro­grams, or an indi­vid­ual pol­i­cy (through or out­side the Mar­ket­place). Accept­able employ­er cov­er­age includes both insured and self-fund­ed PPO, HMO, HDHP and fee-for-ser­vice plans, as well as grand­fa­thered cov­er­age, COBRA, retiree med­ical, and health reim­burse­ment arrange­ments (HRAs). It does not mat­ter whether the cov­er­age is pro­vid­ed direct­ly by the employ­er or through anoth­er par­ty, such as a mul­ti­em­ploy­er plan, a col­lec­tive­ly bar­gained plan, a PEO, or a staffing agency.

    While most peo­ple must obtain cov­er­age or pay penal­ties, indi­vid­u­als will not be penal­ized if they do not obtain cov­er­age and:

    • They do not have access to afford­able cov­er­age (cost exceeds 8 per­cent of mod­i­fied adjust­ed gross house­hold income)
    • Their house­hold income is below the tax fil­ing threshold
    • They meet hard­ship cri­te­ria (such as recent bank­rupt­cy, home­less­ness, unre­im­bursed expens­es from nat­ur­al disasters)
    • Their peri­od with­out cov­er­age is less than three con­sec­u­tive months
    • They live out­side the U.S. long enough to qual­i­fy for the for­eign earned income exclusion
    • They reside in a U.S. ter­ri­to­ry for at least 183 days dur­ing the year
    • They are a mem­ber of a Native Amer­i­can Tribe
    • They belong to a reli­gious group that objects to hav­ing insur­ance, includ­ing Medicare and Social Secu­ri­ty, on reli­gious grounds (for exam­ple, the Amish)
    • They belong to a health shar­ing min­istry that has been in exis­tence since 1999
    • They are incar­cer­at­ed (unless await­ing tri­al or sentencing)
    • They are ille­gal aliens

    If the per­son has access to employ­er-pro­vid­ed cov­er­age as either the employ­ee or an eli­gi­ble depen­dent, afford­abil­i­ty of the employ­er-pro­vid­ed cov­er­age is the only fac­tor con­sid­ered for pur­pos­es of the indi­vid­ual mandate.

    • For the employ­ee, cov­er­age is unaf­ford­able (so no penal­ty applies for fail­ure to have cov­er­age) if the cost of sin­gle cov­er­age is more than 8 per­cent of house­hold income.
    • For a depen­dent, cov­er­age is unaf­ford­able (so no penal­ty applies for fail­ure to have cov­er­age) if the cost of the least expen­sive employ­er-pro­vid­ed depen­dent cov­er­age is more than 8 per­cent of house­hold income.
    • If the employ­ee and spouse both have access to cov­er­age through their own employ­er, the cost for each person’s cov­er­age is based on the cost of their own sin­gle cov­er­age, but the totals are then com­bined to see if the total cost exceeds 8 per­cent of house­hold income.

     

    Orig­i­nal­ly pub­lished Unit­ed Ben­e­fit Advi­sors — Read More

  • What implication will state changes have? The Supreme Court allows Michigan to proceed

    November 9, 2016

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    arrowThe state of Michi­gan levies a tax on health claims made under self fund­ed plans – 1% flat to those ren­dered in state to in state res­i­dents, along with record­keep­ing and report­ing oblig­a­tions.  The Supreme Court has vacat­ed its ear­li­er rul­ing and the Sixth Cir­cuit has con­clud­ed that ERISA does not pre­empt the tax.  Will oth­er states fol­low?  A great way to make mon­ey but not so great for self fund­ed plans try­ing to save it.

  • IRS Announces 2017 Retirement Plan Contribution Limits | California Benefit Advisors

    November 4, 2016

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    US Currency: Wads of US bills fastened with rubber bands, close-upOn Octo­ber 27, 2016, the Inter­nal Rev­enue Ser­vice (IRS) released Notice 2016–62 announc­ing cost-of-liv­ing adjust­ments affect­ing dol­lar lim­i­ta­tions for pen­sion plans and oth­er retire­ment-relat­ed items for tax year 2017. Many pen­sion plan lim­i­ta­tions will not change in 2017 because the increase in the cost-of-liv­ing index did not meet the statu­to­ry thresh­olds that trig­ger their adjust­ment. Some items, though, will see minor increas­es. The fol­low­ing is a sum­ma­ry of the lim­its for 2017.

    For 401(k), 403(b), and most 457 plans and the fed­er­al government’s Thrift Sav­ings Plans:

    • The elec­tive defer­ral (con­tri­bu­tion) lim­it remains unchanged at $18,000 for 2017.
    • The catch-up con­tri­bu­tion lim­it for employ­ees aged 50 and over who par­tic­i­pate in these plans remains at $6,000 for 2017.

    For indi­vid­ual retire­ment arrange­ments (IRAs):

    • The lim­it on annu­al con­tri­bu­tions remains unchanged at $5,500 for 2017.
    • The addi­tion­al catch-up con­tri­bu­tion lim­it for indi­vid­u­als aged 50 and over is not sub­ject to an annu­al cost-of-liv­ing adjust­ment and remains $1,000 for 2017.

    For sim­pli­fied employ­ee pen­sion (SEP) IRAs and individual/solo 401(k) plans:

    • Elec­tive defer­rals increase to $54,000 for 2017, based on an annu­al com­pen­sa­tion lim­it of $270,000 (up from the 2016 amounts of $53,000 and $265,000).
    • The min­i­mum com­pen­sa­tion that may be required for par­tic­i­pa­tion in a SEP remains unchanged at $600 for 2017.

    For sav­ings incen­tive match plan for employ­ees (SIMPLE) IRAs:

    • The con­tri­bu­tion lim­it on SIMPLE IRA retire­ment accounts remains unchanged at $12,500 for 2017.
    • The SIMPLE catch-up lim­it remains unchanged at $3,000 for 2017.

    For defined ben­e­fit plans:

    • The basic lim­i­ta­tion on the annu­al ben­e­fits under a defined ben­e­fit plan is increased to $215,000 for 2017 (from $210,000 for 2016).

    Oth­er changes:

    • High­ly com­pen­sat­ed and key employ­ee thresholds: 
      • The thresh­old for deter­min­ing “high­ly com­pen­sat­ed employ­ees” remains unchanged at $120,000 for 2017.
      • The thresh­old for offi­cers who are “key employ­ees” in a top-heavy plan increas­es to $175,000 for 2017 (from $170,000 for 2016).
    • Social Secu­ri­ty cost of liv­ing adjust­ment: In a sep­a­rate announce­ment, the Social Secu­ri­ty Admin­is­tra­tion stat­ed that the tax­able wage base will increase to $127,200 for 2017, an increase of $8,700 from the 2016 tax­able wage base of $118,500. Thus, the max­i­mum Social Secu­ri­ty tax lia­bil­i­ty will increase for both employ­ees and employers.

     

    Orig­i­nal­ly pub­lished by ThinkHR — Read More

  • 2016 Health Plan Survey: Topline Trends at a Glance | California Benefit Advisors

    November 2, 2016

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    1102The 2016 UBA Health Plan Sur­vey con­tains the val­i­dat­ed respons­es of 19,557 health plans and 11,524 employ­ers, who cumu­la­tive­ly employ over two and a half mil­lion employ­ees and insure more than five mil­lion total lives. Our data reflects the expe­ri­ences of 99% of U.S. busi­ness­es in rough pro­por­tion to their actu­al preva­lence, not just the largest employ­ers who are often the sole focus in oth­er sur­veys. As a result, our find­ings are exten­sive, so we’ve com­piled a topline list of the biggest trends below.

    Cost-shift­ing, plan changes and oth­er pro­tec­tions work to hold rates steady.

    • Increased preva­lence and enroll­ment in low­er-cost CDHP and HMO plans.
    • “Grand­moth­ered” employ­ers con­tin­ue to have the options they need to select cheap­er plans (ACA- com­pli­ant com­mu­ni­ty-rat­ed plans ver­sus pre-ACA com­pos­ite/health-rat­ed plans) depend­ing on the health sta­tus of their groups.
    • The Pro­tect­ing Afford­able Cov­er­age for Employ­ees (PACE) Act pro­tects employ­ers with 51 to 99 employ­ees from high­er-cost plans.
    • Increased out-of-net­work deductibles and out-of-pock­et max­i­mums, as well as pre­scrip­tion drug cost shift­ing, are among the plan design changes influ­enc­ing premiums.
    • UBA Part­ners lever­age their bar­gain­ing power.

    Over­all costs vary sig­nif­i­cant­ly by indus­try and geography.

    • Retail, con­struc­tion and hos­pi­tal­i­ty employ­ees cost the least to cov­er; gov­ern­ment employ­ees (the his­tor­i­cal cost leader) cost the most.
    • Plans in the North­east cost the most; plans in the Cen­tral U.S. cost the least.
    • Retail and con­struc­tion employ­ees pay the most toward their cov­er­age; gov­ern­ment employ­ees pay the least (bad news for taxpayers).

    Plan design changes strain employ­ees financially.

    PPOs, CDH­Ps have the biggest impact.

    • Pre­ferred provider orga­ni­za­tion (PPO) plans cost more than aver­age, but still dom­i­nate the market.
    • Con­sumer-direct­ed health plans (CDH­Ps) cost less than aver­age and enroll­ment is increasing.

    Over­all, well­ness pro­gram adop­tion holds steady, but pro­gram design is changing.

    • Health risk assess­ments con­tin­ue to decline, while chron­ic con­di­tion coach­ing is on the rise.

    Met­al lev­els dri­ve plan decisions.

    • Most plans are at the gold or plat­inum met­al lev­el. In the future, we expect this to change since it will be more dif­fi­cult to meet the ACA met­al lev­el require­ments and still keep rates in check.

    Key trends to watch in 2017:

    • Slow, but steady: increase in self-fund­ing for all group sizes, decrease in employ­ees elect­ing depen­dent cov­er­age, increase in plan options, and mail order phar­ma­ceu­ti­cal pro­grams more for con­ve­nience than cost savings.
    • Cau­tious trend: increased CDHP prevalence/enrollment.
    • Rapid­ly emerg­ing: increase of five-tier pre­scrip­tion drug plans, increased out-of-pock­et maximums.

     

    Orig­i­nal­ly pub­lished by Unit­ed Ben­e­fit Advi­sors — Read More

  • As goes San Francisco, and Oakland, and…now goes Berkeley with Paid Sick Leave Law

    November 1, 2016

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    arrowBerke­ley has offi­cial­ly amend­ed its min­i­mum wage law and cod­i­fied a new law con­cern­ing hos­pi­tal­i­ty ser­vice charges along with a Paid Sick Leave law that takes effect Octo­ber 1, 2017.

    1)    All employ­ers with a Berke­ley busi­ness license are sub­ject to the law
    2)    Dif­fer­ent stan­dards will apply to a small busi­ness with few­er than 25 employees
    3)    Applies to all employ­ees who work at least 2 hours a week with­in Berke­ley city limits
    4)    Col­lec­tive Bar­gain­ing Agree­ments may super­sede the sick pay rule
    5)    If employ­er already has a sim­i­lar law includ­ing accru­al they are not sub­ject to new law
    6)    Cov­ered employ­ees can use accrued leave 90 days after employ­ment begins
    7)    Each qual­i­fy­ing employ­ee is enti­tled to one sick leave hour for every 30 hours worked
    8)    Employ­ees are allowed to accu­mu­late 72 hours a year – small busi­ness­es only 48
    9)    Allowed for phys­i­cal or men­tal ill­ness or injury, obtain­ing diag­no­sis or treat­ment, get­ting a phys­i­cal exam, or to care for a sick fam­i­ly member

    Employ­ers must con­spic­u­ous­ly post at any work­place or job site a city cre­at­ed notice inform­ing employ­ees of their paid sick leave rights.  Employ­ers must keep employ­ee pay­roll records for a peri­od of four years that iden­ti­fy hours worked, wages paid and paid sick leave accrued.

    This law may be changed when Berke­ley vot­ers go to the polls, but…

  • 3 Life Insurance Myths That Could Hurt Young Families | California Benefit Advisors

    October 28, 2016

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    Portrait Of Family Group Tailgating In Stadium Car ParkWhen you’re just start­ing out, it often seems that a dol­lar nev­er stretch­es far enough. And with new com­mit­ments, such as buy­ing your first home or hav­ing chil­dren, comes the respon­si­bil­i­ty to make sure your loved ones will be pro­vid­ed for finan­cial­ly, no mat­ter what life may bring.

    If you were to die unex­pect­ed­ly, life insur­ance is there to make sure your loved ones can main­tain their stan­dard of liv­ing, stay in your home, send your kids to the same schools and keep their plans for the future on track. It also gives the griev­ing spouse or part­ner time to make deci­sions, or in some cas­es find work out­side the home, with­out wor­ry­ing about finances.

    But com­mon mis­con­cep­tions often pre­vent young fam­i­lies from pur­chas­ing the life insur­ance they need.

    Myth 1: I only need life insur­ance if I’m the pri­ma­ry bread­win­ner in my fam­i­ly. Whether you bring home the largest pay­check in your house­hold or a small­er one, your fam­i­ly relies on your income to main­tain its qual­i­ty of life, and it would be missed if some­thing were to hap­pen to you. Even if you don’t work out­side of the home, hav­ing life insur­ance is a smart choice. Stay-at-home par­ents per­form valu­able ser­vices such as child­care, cook­ing, house­clean­ing and house­hold man­age­ment, which can be cost­ly to replace for a sur­viv­ing spouse or partner.

    Stay-at-home par­ents per­form valu­able ser­vices such as child­care, cook­ing, house­clean­ing and house­hold man­age­ment, which can be cost­ly to replace for a sur­viv­ing spouse or partner.

    Myth 2: If I buy a term life insur­ance pol­i­cy and find that I still need pro­tec­tion when the term ends, I can always renew the pol­i­cy. Term poli­cies are quite pop­u­lar with many young fam­i­lies, and for good rea­son: They typ­i­cal­ly offer the great­est cov­er­age for the low­est cost. Term insur­ance pro­vides pro­tec­tion for a spe­cif­ic peri­od of time (the “term”), and can be ide­al for peo­ple who feel they have finan­cial needs to cov­er that will dis­ap­pear over time, such as a mort­gage or a child’s education.

    How­ev­er, many fam­i­lies real­ize that even after the kids are grown and the mort­gage is paid off, their need for insur­ance continues—to pro­vide income for a sur­viv­ing spouse, elim­i­nate debts, pay tax­es, etc. Because life insur­ance pre­mi­ums increase with age, renew­ing your pol­i­cy when the term expires can be very expen­sive. More­over, poor health may make renew­al impossible.

    Myth 3: I only need term life insur­ance. Term life insur­ance makes sense for many young fam­i­lies because their need for cov­er­age is great and their bud­gets are often lim­it­ed. But that doesn’t mean it’s the only type of insur­ance you should consider.

    Per­ma­nent life insur­ance poli­cies pro­vide a death ben­e­fit as well as oth­er unique fea­tures such as life­long pro­tec­tion and the abil­i­ty to accu­mu­late cash val­ues on a tax-deferred basis, sim­i­lar to assets in most retire­ment-sav­ings plans. You can access the cash val­ues for impor­tant uses like a child’s edu­ca­tion or a busi­ness oppor­tu­ni­ty. (Keep in mind, how­ev­er, that with­draw­ing or bor­row­ing funds from your pol­i­cy will reduce its cash val­ue and death ben­e­fit if not repaid.)

    If these fea­tures appeal to you, it might make sense to buy a large face amount term pol­i­cy, giv­ing you the death ben­e­fit pro­tec­tion you need, and com­bine it with a small­er per­ma­nent pol­i­cy. When your bud­get per­mits, you can grad­u­al­ly increase your per­ma­nent insur­ance coverage.

     

    Orig­i­nal­ly pub­lished by Life­Hap­pens — Read More

  • What to Expect in 2016 – Clarifying Some of the Confusion of the ACA | California Benefit Advisors

    October 27, 2016

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    1025One thing rings true when it comes to the Afford­able Care Act (ACA): “expect the unex­pect­ed.” I know this sounds cliché, but it was my best attempt to describe the expe­ri­ence HR pro­fes­sion­als encounter as they attempt to com­ply with this some­what murky piece of leg­is­la­tion. Last year on Decem­ber 28, we were alert­ed a month from the approach­ing dead­line that the forms and fil­ing require­ments had moved two and three months out to address chal­lenges. This was a fair­ly dras­tic move with­in a month of a sig­nif­i­cant com­pli­ance deadline.

    As a lead­ing provider of ACA solu­tions to hun­dreds of employ­ers, we are find­ing this con­cern about uncer­tain­ty spills into the 2016 tax sea­son. To pro­vide some use­ful guid­ance, I thought it would be help­ful to share with you a roll-up of com­mon ques­tions and key issues we are receiv­ing from our clients over the past sev­er­al months:

    1. Will the ACA be delayed again in 2016? We do not see the fil­ing require­ments delayed again in 2016. The delay for 2015 was a one-time delay, and the IRS has sig­naled this to be the case on their con­fer­ence calls.
    2. What changes do we need to be con­cerned with in the 1094‑C and 1095‑C forms? Over­all, the changes to these forms are minor in 2016. The 2015 Qual­i­fy­ing Offer, a form of tran­si­tion relief, was elim­i­nat­ed from the 1094 form. The biggest changes are with two con­tin­gent offer of cov­er­age codes 1J and 1K. The idea behind these new offer codes is that employ­er cov­er­age is con­tin­gent upon not hav­ing cov­er­age avail­able else­where. If this bet­ter describes how you offer cov­er­age, you may want to con­sid­er select­ing these codes over the tra­di­tion­al 1A or 1E.
    3. Will it be eas­i­er to work with name/TIN mis­match­es flagged through the cor­rec­tions process? In the first year it was dif­fi­cult to work with IRS request­ed cor­rec­tions because you often could not iden­ti­fy which cov­ered indi­vid­ual gen­er­at­ed the error (we didn’t know if it was the employ­ee, a depen­dent, or both). Sev­er­al IRS con­fer­ence calls have sig­naled they will be pro­vid­ing more detail on the cor­rec­tions this year. If your ACA solu­tion com­mu­ni­cates with the IRS Afford­able Care Act Infor­ma­tion Returns (AIR) sys­tem, you will like­ly be able to dis­play the detail of this error mes­sage and act on it. A side-note: remain­ing cor­rec­tions from 2015 do not have a spe­cif­ic due date, but should be addressed as soon as possible.
    4. Why do we still have tran­si­tion relief in 2016? The expec­ta­tions for many is that tran­si­tion relief was sim­ply a 2015 phe­nom­e­non. While non-cal­en­dar year and 2015 Qual­i­fy­ing Offer Tran­si­tion Relief have been elim­i­nat­ed, 4980H Tran­si­tion Relief has remained into 2016 for “non-cal­en­dar” plans that meet cer­tain cri­te­ria. This means that employ­ers who might be fac­ing shared respon­si­bil­i­ty penal­ties in 2016 can still take advan­tage of one of the two types of relief: 1) if you aver­age 50 to 99 FTEs you are shield­ed for the 2015 non-cal­en­dar year plan for the months that spill into 2016 (e.g., a July 1 plan will be shield­ed for the first six months of 2016), or 2) the same applies for 100+ clients in terms of being able to lever­age the 70 per­cent offer requirement.
    5. Will it be eas­i­er this year? This is a gen­er­al ques­tion that depends on the solu­tion you use. Over­all, we believe the answer is a resound­ing “YES!” With our solu­tion, a large num­ber of clients are able to take advan­tage of an auto­mat­ed renew­al process that tran­si­tions set­up from 2015 and trends exist­ing employ­ees from Decem­ber 31, 2015, into 2016. Ven­dors have learned how to make this process eas­i­er for their cus­tomers after all the pain they expe­ri­enced in 2015. Every­thing from data col­lec­tion, fil­ing and cor­rec­tions process should be more auto­mat­ed this year.

     

    Orig­i­nal­ly pub­lished by Unit­ed Ben­e­fit Advi­sors — Read More

  • How do we cut back on the increases? Reduce the size of provider networks

    October 25, 2016

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    arrowThe ACOs offered under the ACA were sup­posed to do this, and some have.  We also saw car­ri­ers forced to reduce the net­work sizes in response to the Exchanges imple­ment­ing for­mal guide­lines on rates and rate increas­es.  Now the car­ri­ers are think­ing about doing this as a gen­er­al practice…which is fun­ny, because that is what they were sup­posed to be doing when they start­ed HMO and PPO plans years ago.  By mak­ing the lists more “exclu­sive” they could extract greater dis­counts.  Then the lists expand­ed and costs con­tin­ued to climb.  So now we go back to the begin­ning and see what happens…and what com­plaints will fol­low.  The dif­fer­ence these days is that the dis­count comes with reduced avail­abil­i­ty as prac­tices begin to fill.  Then what?

  • Extension for Enforcement of OSHA Anti-Retaliation Provisions | California Employee Benefits

    October 20, 2016

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    1020On Octo­ber 18, 2016, in response to a request from a fed­er­al judge pre­sid­ing over a legal chal­lenge, the Occu­pa­tion­al Safe­ty and Health Admin­is­tra­tion (OSHA) agreed to extend the effec­tive date of the anti-retal­i­a­tion pro­vi­sions in its new final rule, Improve Track­ing of Work­place Injuries and Ill­ness­es, to Decem­ber 1, 2016. Fed­er­al Judge Sam Lind­say of the North­ern Dis­trict of Texas is con­sid­er­ing a com­plaint and motion for pre­lim­i­nary injunc­tion filed by sev­er­al indus­try groups chal­leng­ing the anti-retal­i­a­tion pro­vi­sions of the new rule to the extent that OSHA seeks to lim­it rou­tine post-acci­dent drug test­ing and inci­dent-based safe­ty incen­tive and recog­ni­tion plans. The case seeks to per­ma­nent­ly delay the effec­tive date of the rule until a deci­sion is reached.

    In its final rule, OSHA not only revised record­keep­ing require­ments but includ­ed anti-retal­i­a­tion pro­vi­sions intend­ed to pre­vent employ­ers from retal­i­at­ing against employ­ees for report­ing work-relat­ed injuries or ill­ness. Accord­ing to OSHA, the final rule would require employ­ers to inform employ­ees of their right to report work-relat­ed injuries and ill­ness­es free from retal­i­a­tion; would clar­i­fy the require­ment that an employer’s pro­ce­dure for report­ing work-relat­ed injuries and ill­ness­es must be rea­son­able and not deter or dis­cour­age employ­ees from report­ing; and would incor­po­rate the exist­ing statu­to­ry pro­hi­bi­tion on retal­i­at­ing against employ­ees for report­ing work-relat­ed injuries or illnesses.

    Of note, this is the sec­ond delay in enforce­ment as the OSHA pro­vi­sions were orig­i­nal­ly sched­uled to go into effect on August 10, 2016, then delayed to Novem­ber 1, 2016, and now employ­ers have until Decem­ber 1, 2016 to comply.

     

    Orig­i­nal­ly pub­lished by ThinkHR — Read More

  • HSA limits change again in 2017

    October 19, 2016

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    arrowFor an indi­vid­ual with self only cov­er­age the new max­i­mum allowance will be $3,400.

    For those cov­er­ing any depen­dents the new max­i­mum allowance will be $6,750.

    They’re seri­ous now…the penal­ties are get­ting real from the Depart­ment of Labor.

    They have not made any adjust­ments in some time, but that time has now ended.
    Effec­tive imme­di­ate­ly, and with future adjust­ments to be made every Jan­u­ary 15, the penal­ties for non com­pli­ance with var­i­ous parts of the DOL edicts are as follows:

    Fail­ure to file a 5500 form – raised from $1,100 per day to $2,063 per day – each day late
    Fail­ure to pro­vide a SBC to employ­ees is raised from $1,000 to $1,087 per failure
    Fail­ure to pro­vide a 401k pre­emp­tion notice when auto­mat­ic con­tri­bu­tion arrange­ments are in place is raised from $1,000 to $1,632 per day of noncompliance

    So yeah, get it done…

  • 4 Easy Ways to Step Up Your Employee Wellness Program | California Benefit Advisors

    October 17, 2016

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    Brooklyn BridgeEmploy­ee Well­ness Pro­grams are a key fac­tor in employ­ee engage­ment and over­all com­pa­ny suc­cess in today’s busi­ness world. Well­ness pro­grams are con­sis­tent­ly evolv­ing and chang­ing as employ­ee demands shift. Com­pa­nies are con­stant­ly look­ing for new ways to engage and encour­age their employ­ees, prefer­ably at a low­er cost. Below are some effec­tive and cost-effi­cient ways to enhance your employ­ee well­ness pro­grams, leav­ing your employ­ees hap­pi­er and more excit­ed about work!

    1. Walk and Talk Meetings

    Walk and Talk meet­ings are becom­ing a pop­u­lar new way that com­pa­nies can encour­age employ­ee fit­ness in the work­place. The aver­age Amer­i­can employ­ee spends the vast major­i­ty of the day sit­ting at the desk, and stud­ies show that 86% of them hate it. The walk and talk meet­ings pro­vide a way to get up and move around, while still being pro­duc­tive with the work that needs to be accom­plished. In addi­tion, walk­ing boosts cre­ativ­i­ty and new envi­ron­ments pro­duce fresh ideas. A Stan­ford study recent­ly found that, “walk­ing has a very spe­cif­ic ben­e­fit – the improve­ment of cre­ativ­i­ty.” So, next time you’re look­ing for a boost of cre­ativ­i­ty and activ­i­ty in your sched­ule, con­sid­er tak­ing your meet­ing for a walk.

    1. Fit Bit Challenges 

    Fit Bits are one of the most pop­u­lar fit­ness track­ers on the mar­ket. Sev­er­al employ­ees already have per­son­al Fit Bits so bring­ing them into the work­place is an easy tran­si­tion. For those that do not, many com­pa­nies are buy­ing them in large bun­dles for resale at dis­count­ed rates to their employ­ees. Com­pa­nies are find­ing inno­v­a­tive ways to incor­po­rate Fit Bits into their well­ness pro­grams to keep employ­ees active while also fos­ter­ing team­work. Accord­ing to Fit Bit, by hold­ing chal­lenges and com­pe­ti­tions using the Fit Bit, com­pa­nies cre­ate group health that is eas­i­ly track­able. More specif­i­cal­ly, “Fit Bit users with one or more friends are 27% more active.” The con­cept of using the Fit Bit with oth­er employ­ees builds bet­ter rela­tion­ships as well as holds them account­able for being active.

    The chal­lenges are a sim­ple and cost effi­cient way to improve over­all health and many com­pa­nies have had great suc­cess through using the Fit Bit. For exam­ple, The Cleve­land Cav­a­liers’ employ­ees did a Fit Bit walk­ing chal­lenge in which they logged their dai­ly activ­i­ties and food. In order to entice work­ers to take part, they held com­pe­ti­tions with prizes that spiked employ­ee par­tic­i­pa­tion and over­all health and hap­pi­ness. The result of the chal­lenge- “employ­ees reached their per­son­al fit­ness and weight loss goals, con­fer­ence room meet­ings became walk­ing meet­ings, and ele­va­tor trips were nixed in favor of the stairs. By the time their chal­lenge came to a close, par­tic­i­pants had record­ed a cumu­la­tive 76.6 mil­lion steps—more than 38,000 miles—and cre­at­ed new healthy habits to take into the future.” Your com­pa­ny could be the next to see amaz­ing Fit­Bit chal­lenge results!

    1. Healthy Vend­ing Machines 

    In order to achieve a healthy lifestyle, the com­bi­na­tion of exer­cise and healthy eat­ing is essen­tial. For busy employ­ees, grab­bing a quick snack is a typ­i­cal dai­ly rou­tine, how­ev­er these quick grabs are often unhealthy. Keep­ing healthy vend­ing machines, or stock­ing the fridge with fruits and veg­eta­bles allows work­ers to snag a healthy snack that will aid over­all health and also sat­is­fy mid-day hunger crav­ings. In addi­tion, eat­ing healthy has many cog­ni­tive ben­e­fits that can trans­fer into employ­ees’ work. For exam­ple, typ­i­cal ben­e­fits that arise from healthy eat­ing are an increase in con­cen­tra­tion and alert­ness, gen­er­at­ing bet­ter work from each of your employ­ees.

    1. Competitions

    Com­pe­ti­tions can eas­i­ly be tai­lored to fit your company’s cul­ture! One of the most pop­u­lar work­place com­pe­ti­tions is the Biggest Los­er chal­lenge. In this type of chal­lenge, the employ­ee or team of employ­ees sets a weight loss goal. The group that los­es the most weight by the end of the allot­ted com­pe­ti­tion time wins! Anoth­er pop­u­lar chal­lenge is sign­ing up for local 5Ks or half marathons and run­ning the race with your co-work­ers. You can encour­age employ­ees to par­take in fit­ness chal­lenges by hav­ing prizes or mon­e­tary rewards. Aside from the obvi­ous health results, chal­lenges like these encour­age team­work and healthy com­pe­ti­tion inside the work­place. Above all else, it’s impor­tant to get cre­ative with whichev­er com­pe­ti­tion you choose!

    The key to a suc­cess­ful well­ness pro­gram is to make it per­son­al to what your employ­ees enjoy and will want to par­tic­i­pate in. These are just a few ways that you can find suc­cess in employ­ee well­ness through­out your com­pa­ny. So, boost your over­all employ­ee morale and effi­cien­cy by imple­ment­ing these sim­ple yet cost effi­cient well­ness ideas in your dai­ly routines!

     

    Con­tributed by Nicole Federico

  • Nondiscrimination Rules for Cafeteria Plans | California Benefit Brokers

    October 14, 2016

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    1013A cafe­te­ria plan is an employ­er-pro­vid­ed writ­ten plan that offers employ­ees the oppor­tu­ni­ty to choose between at least one per­mit­ted tax­able ben­e­fit and at least one qual­i­fied employ­ee ben­e­fit. There is no fed­er­al law that requires employ­ers to estab­lish cafe­te­ria plans; how­ev­er, some states require employ­ers to have cafe­te­ria plans for employ­ees to pay for health insur­ance on a pre-tax basis.

    To com­ply with Inter­nal Rev­enue Code Sec­tion 125, a cafe­te­ria plan must sat­is­fy a set of struc­tur­al require­ments and a set of nondis­crim­i­na­tion rules. Vio­la­tions of the struc­tur­al require­ments will dis­qual­i­fy the entire plan so that no employ­ee obtains the favor­able tax ben­e­fits under Sec­tion 125, even if the plan meets the nondis­crim­i­na­tion rules. Vio­la­tions of the nondis­crim­i­na­tion rules have adverse con­se­quences only on the group of employ­ees in whose favor dis­crim­i­na­tion is prohibited.

    A cafe­te­ria plan must pass an eli­gi­bil­i­ty test, a con­tri­bu­tions and ben­e­fits test, and a con­cen­tra­tion test for high­ly com­pen­sat­ed indi­vid­u­als to receive the tax ben­e­fits of Sec­tion 125. Fail­ure to meet these nondis­crim­i­na­tion require­ments has no effect on non-high­ly com­pen­sat­ed cafe­te­ria plan participants.

    The IRS issued pro­posed cafe­te­ria plan reg­u­la­tions on August 6, 2007. Final reg­u­la­tions have not been issued. Accord­ing to the pro­posed reg­u­la­tions, tax­pay­ers may rely on the pro­posed reg­u­la­tions for guid­ance pend­ing the issuance of final regulations.

    The pro­posed cafe­te­ria plan reg­u­la­tions make it clear that the plan must meet the nondis­crim­i­na­tion tests. Also, the plan must not dis­crim­i­nate in favor of high­ly com­pen­sat­ed par­tic­i­pants in its oper­a­tion. For exam­ple, a plan might be con­sid­ered dis­crim­i­na­to­ry if adop­tion assis­tance is added to the plan when the CEO is in the process of adopt­ing a child and adop­tion assis­tance is dropped when the adop­tion is final.

    Be aware that Sec­tion 125 nondis­crim­i­na­tion rules are sep­a­rate from and unre­lat­ed to Sec­tion 105(h) nondis­crim­i­na­tion rules. Fur­ther, Sec­tion 125 nondis­crim­i­na­tion rules apply to all cafe­te­ria plans regard­less of their sta­tus as ful­ly insured, self-fund­ed, church plan, or gov­ern­men­tal plan.

    As a prac­ti­cal mat­ter, these nondis­crim­i­na­tion rules pro­hib­it exec­u­tive health plans offered through a cafe­te­ria plan.

    Nondis­crim­i­na­tion test­ing can help employ­ers avoid rule vio­la­tions. But there are a num­ber of def­i­n­i­tions of key terms used in the tests that must be under­stood pri­or to com­plet­ing the tests:

    High­ly Com­pen­sat­ed Indi­vid­u­als. High­ly com­pen­sat­ed indi­vid­u­als are defined as:

    • Offi­cers
    • Five per­cent shareholders
    • High­ly com­pen­sat­ed employ­ees (HCEs)
    • Spous­es or depen­dents of any of the pre­ced­ing individuals

    High­ly Com­pen­sat­ed Par­tic­i­pant. A high­ly com­pen­sat­ed par­tic­i­pant is a high­ly com­pen­sat­ed indi­vid­ual who is eli­gi­ble to par­tic­i­pate in the cafe­te­ria plan.

    Offi­cers. Offi­cers include any indi­vid­ual who was an offi­cer of the com­pa­ny for the pri­or plan year (or cur­rent plan year in the case of the first year of employment).

    Five Per­cent Share­hold­ers. Five per­cent share­hold­ers include any indi­vid­ual who – in either the pre­ced­ing plan year or cur­rent plan year – owns more than five per­cent of the vot­ing pow­er or val­ue of all class­es of stock of the employ­er, deter­mined with­out attribution.

    High­ly Com­pen­sat­ed. High­ly com­pen­sat­ed means any indi­vid­ual or par­tic­i­pant who – for the pri­or plan year or the cur­rent plan year in the case of the first year of employ­ment – had annu­al com­pen­sa­tion from the employ­er in excess of the com­pen­sa­tion amount spec­i­fied in the Inter­nal Rev­enue Code and, if elect­ed by the employ­er, was also in the top-paid group of employ­ees for the year. For 2016, the applic­a­ble com­pen­sa­tion amount is $120,000.

    Key Employ­ee. A key employ­ee is a par­tic­i­pant who, at any time dur­ing the plan year, is one of the following:

    • An offi­cer with annu­al com­pen­sa­tion greater than an indexed amount ($170,000 for 2016)
    • A five per­cent own­er of the employer
    • A one per­cent own­er hav­ing com­pen­sa­tion in excess of $150,000

     

    Orig­i­nal­ly pub­lished by Unit­ed Ben­e­fit Advi­sors — Read More

  • Health plan opt out options are being considered – new IRS regulations forthcoming

    October 12, 2016

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    arrowSome orga­ni­za­tions let employ­ees opt out of their med­ical plan elec­tion, in return for which they are giv­en some tax­able com­pen­sa­tion.  The prob­lem is that if employ­ees are not par­tic­i­pat­ing in the plan, there may be a penal­ty for non-com­pli­ance with the ACA.  Now the gov­ern­ment has made it sim­ple – or at least clar­i­fied appro­pri­ate opt outs.  If it is CONDITIONAL – which means an employ­ee may only opt out and receive cash if the employ­er makes the pay­ment con­di­tion­al upon proof of hav­ing oth­er group cov­er­age (with annu­al update) then it will pass muster.  IF, how­ev­er, it does not have any con­di­tions placed upon it…you have a problem.

  • Reporting Minimum Essential Coverage | CA Benefits Broker

    October 7, 2016

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    Min­i­mum essen­tial cov­er­age (MEC) is the type of cov­er­age that an indi­vid­ual must have under the Patient Pro­tec­tion and Afford­able Care Act (ACA). Employ­ers that are sub­ject to the ACA’s shared respon­si­bil­i­ty pro­vi­sions (often called “play or pay”) must offer MEC cov­er­age that is afford­able and pro­vides min­i­mum value.

    In the fall of 2015 the IRS issued Notice 2015–68 stat­ing it was plan­ning to pro­pose reg­u­la­tions on report­ing MEC that would, among oth­er things, require health insur­ance issuers to report cov­er­age in cat­a­stroph­ic health insur­ance plans, as described in sec­tion 1302(e) of the ACA, pro­vid­ed through an Afford­able Insur­ance Exchange (an Exchange, also known as a Health Insur­ance Mar­ket­place). The notice also cov­ered report­ing of “sup­ple­men­tal cov­er­age” such as a health reim­burse­ment arrange­ment (HRA) in addi­tion to a group health plan.

    Recent­ly, the IRS released the antic­i­pat­ed pro­posed reg­u­la­tions, incor­po­rat­ing the guid­ance giv­en in Notice 2015–68. These reg­u­la­tions are gen­er­al­ly pro­posed to apply for tax­able years end­ing after Decem­ber 31, 2015, and may be relied on for cal­en­dar years end­ing after Decem­ber 31, 2013.

    The pro­posed reg­u­la­tions pro­vide that:

    1. Report­ing is required for only one MEC plan or pro­gram if an indi­vid­ual is cov­ered by mul­ti­ple plans or pro­grams pro­vid­ed by the same provider.
    2. Report­ing gen­er­al­ly is not required for an individual’s eli­gi­ble MEC only if the indi­vid­ual is cov­ered by oth­er MEC for which sec­tion 6055 report­ing is required.

    These rules would apply month by month and indi­vid­ual by indi­vid­ual. Once final­ized, the reg­u­la­tions would adopt the same infor­ma­tion pro­vid­ed in the final instruc­tions for report­ing under sec­tions 6055 and 6056 of the ACA.

    For exam­ples under the first rule and more detail on the sec­ond rule, as well as how to avoid penal­ties, view UBA’s ACA Advi­sor, “Report­ing Min­i­mum Essen­tial Cov­er­age”.

    Orig­i­nal­ly pub­lished by www.ubabenefits.com

  • HIPAA Phase 2 Audits | California Employee Benefits

    October 6, 2016

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    1006The U.S. Depart­ment of Health and Human Ser­vices’ (HHS) Office for Civ­il Rights (OCR) began a pilot pro­gram in 2012 to assess the pro­ce­dures imple­ment­ed by cov­ered enti­ties to ensure com­pli­ance with the Health Insur­ance Porta­bil­i­ty and Account­abil­i­ty Act (HIPAA). OCR eval­u­at­ed the effec­tive­ness of the pilot pro­gram and then announced Phase 2 of the pro­gram on March 21, 2016. Phase 2 Audits focus on the poli­cies and pro­ce­dures adopt­ed by both cov­ered enti­ties and busi­ness asso­ciates to ensure they meet select­ed stan­dards and imple­men­ta­tion spec­i­fi­ca­tions of the Pri­va­cy, Secu­ri­ty, and Breach Noti­fi­ca­tion Rules. Cov­ered enti­ties include health plans, health care clear­ing­hous­es, and health care providers; where­as, busi­ness asso­ciates include any­one han­dling health infor­ma­tion on behalf of a cov­ered entity.

    Phase 2 Audits of busi­ness asso­ciates focus on risk analy­sis, risk man­age­ment, and report­ing of HIPAA breach­es to cov­ered enti­ties. OCR empha­sizes the impor­tance of audits as a com­pli­ance improve­ment activ­i­ty in order to iden­ti­fy best prac­tices and proac­tive­ly uncov­er and address risks and vul­ner­a­bil­i­ties to pro­tect health infor­ma­tion (PHI).

    OCR chose enti­ties to audit through ran­dom sam­pling of the audit pool. Com­mu­ni­ca­tions from OCR were sent via email, so it is impor­tant to check spam fil­ters and junk emails for com­mu­ni­ca­tions from [email protected] OCR emailed a notice to ver­i­fy con­tact infor­ma­tion. Once the con­tact infor­ma­tion was ver­i­fied, OCR emailed a pre-audit ques­tion­naire to gath­er data about size, type, and oper­a­tions of the enti­ty. This data was used with oth­er infor­ma­tion to devel­op pools of poten­tial cov­ered enti­ties for mak­ing audit selections.

    Phase 2 Audits con­sist of three sets of audits. The first set of audits will be desk audits of cov­ered enti­ties and the sec­ond set of audits will be desk audits of busi­ness asso­ciates. These audits will exam­ine com­pli­ance with spe­cif­ic require­ments of the Pri­va­cy, Secu­ri­ty, or Breach Noti­fi­ca­tion Rules and cov­ered enti­ties will be noti­fied of their audit in a doc­u­ment request let­ter. All desk audits in this phase will be com­plet­ed by the end of Decem­ber 2016. OCR will select enti­ties and request they elec­tron­i­cal­ly sub­mit doc­u­men­ta­tion with­in 10 days. The third set of audits will be onsite and exam­ine a broad­er scope of require­ments from HIPAA Rules.

    On July 11, 2016, 167 cov­ered enti­ties were noti­fied that they were select­ed for a desk audit. Desk audits of busi­ness asso­ciates will begin this fall. Down­load the com­plete Com­pli­ance Advi­sor, “HIPPA Phase 2 Audits” for best prac­tices for cov­ered enti­ties fac­ing desk or field audits.

    Orig­i­nal­ly pub­lished by Unit­ed Ben­e­fit Advi­sors — Read More

  • Finally, a New I‑9 | California Benefit Consultants

    September 29, 2016

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    0928Since the cur­rent ver­sion of the Form I‑9, Employ­ment Eli­gi­bil­i­ty Ver­i­fi­ca­tion, expired on March 31, 2016, employ­ers have been await­ing a new, updat­ed form. On August 25, 2016, the fed­er­al Office of Man­age­ment and Bud­get (OMB) approved a revised Form I‑9. Con­se­quent­ly, the U.S. Cit­i­zen­ship and Immi­gra­tion Ser­vices (USCIS) has 90 days to update the form and must pub­lish a revised form by Novem­ber 22, 2016. Accord­ing to the OMB Notice of Action, this new Form I‑9 will expire on August 31, 2019 — a three-year val­i­da­tion peri­od sim­i­lar to pre­vi­ous val­i­da­tion peri­ods. In the mean­time, employ­ers may con­tin­ue using the cur­rent ver­sion of Form I‑9 (with a revi­sion date of 03/08/2013 N) until Jan­u­ary 21, 2017. After Jan­u­ary 21, 2017, all pre­vi­ous ver­sions of Form I‑9 will be invalid.

    Changes to the Form

    Many of the Form I‑9 changes were designed to help with com­plet­ing the form and assist in reduc­ing tech­ni­cal errors. For instance, new smart error-check­ing fea­tures have been added when the form is com­plet­ed using an Adobe PDF view­er or appli­ca­tion. Some oth­er new fea­tures include:

    • Addi­tion of a sup­ple­ment where more than one pre­par­er or trans­la­tor is used to com­plete Sec­tion 1 (trans­la­tor cer­ti­fi­ca­tion where an employ­ee must check that he or she did or did not use a pre­par­er or trans­la­tor in com­plet­ing the form).
    • Con­trols with­in the form for users to elec­tron­i­cal­ly access the instruc­tions, print the form, and clear the form.
    • Drop-down cal­en­dars and lists.
    • Embed­ded instruc­tions for com­plet­ing each field.
    • Pro­vi­sion of addi­tion­al spaces to enter mul­ti­ple pre­par­ers and translators.
    • Quick-response matrix bar­code (QR code) that gen­er­ates once the form is print­ed and may be used to stream­line audit processes.
    • Rather than all oth­er names used, only requir­ing employ­ees to pro­vide oth­er last names used in Sec­tion 1.
    • Remov­ing the require­ment that aliens autho­rized to work pro­vide both for­eign pass­port infor­ma­tion and Form I‑94 in Sec­tion 1 after attes­ta­tion of such status.
    • Sep­a­rat­ing instruc­tions from the form.
    • Spe­cif­ic area to enter addi­tion­al infor­ma­tion that employ­ers are cur­rent­ly required to notate in the form’s margins.
    • Val­i­da­tions on cer­tain fields to ensure infor­ma­tion is entered correctly.

    The new Form I‑9 instruc­tions also pro­vide revised abbre­vi­a­tions for use on the form. Employ­ers should use these abbre­vi­a­tions although longer, com­mon­ly used abbre­vi­a­tions may still be accept­able. For exam­ple, “Per­ma­nent Res­i­dent Card” is now “Perm. Res­i­dent Card (Form I‑551).”

    Related Rulemaking

    Also impor­tant, the fed­er­al Office of Spe­cial Coun­sel (OSC) has pro­posed to revise reg­u­la­tions imple­ment­ing a sec­tion of the Immi­gra­tion and Nation­al­i­ty Act con­cern­ing unfair immi­gra­tion-relat­ed employ­ment prac­tices. In these revised reg­u­la­tions, the OSC pro­pos­es a new def­i­n­i­tion of dis­crim­i­na­tion along with a revi­sion to the lan­guage relat­ed to unfair doc­u­men­tary prac­tices. The pro­posed def­i­n­i­tion clar­i­fies that dis­crim­i­na­tion is the act of inten­tion­al­ly treat­ing an indi­vid­ual dif­fer­ent­ly, regard­less of the expla­na­tion for the dis­crim­i­na­tion, and regard­less of whether it is because of ani­mus or hos­til­i­ty, to include the process relat­ed to com­plet­ing the Form I‑9.

    There is also a pro­posed unfair doc­u­men­tary prac­tices por­tion to pro­hib­it unfair immi­gra­tion-relat­ed employ­ment prac­tices. It would replace the cur­rent doc­u­ment abuse pro­vi­sion, which pro­hibits requir­ing more or dif­fer­ent doc­u­ments than pre­sent­ed if the employ­ee pre­sent­ed doc­u­ments from the list of accept­able doc­u­ments. This also goes to an employer’s rejec­tion of employ­ee-com­plet­ed Sec­tion 1 — which may be con­sid­ered a dis­crim­i­na­to­ry employ­ment practice.

    Cur­rent­ly, the USCIS pro­vides this guid­ance in the pre­ven­tion of dis­crim­i­na­tion in the Form I‑9 process.

    What to Do

    As a response to the many pend­ing changes to the Form I‑9 and relat­ed laws, the next step for employ­ers is to review cur­rent poli­cies and pro­ce­dures. For instance, employ­ers will still be per­mit­ted to print and com­plete the new Form I‑9 by hand, but that may not be a per­ma­nent option. In fact, employ­ers and employ­ees may elect to fill out any or all sec­tions of the form by com­put­er, by hand (print­ed), or a com­bi­na­tion of both.

    Orig­i­nal­ly pub­lished by ThinkHR — Read More

  • Yes, there are complaints, yes there are problems, so what’s the deal with the ACA?

    September 28, 2016

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    arrowFirst, we don’t know, because the elec­tion will decide a few things.  Mr. Trump pro­pos­es to dis­man­tle the ACA but doesn’t say what will take its place (the Repub­li­cans have some ideas, but will he fol­low the par­ty, and are their ideas ful­ly worked out? (no would be the answer))
    If Mrs. Clin­ton takes the seat, she can, will and should resume the con­ver­sa­tions she was hav­ing when Mr. Clin­ton first arrived in office, which will include con­sid­er­a­tion of the “pub­lic (read – nuclear) option” which means replace­ment of the ACA with a gov­ern­ment run system
    for health care delivery.

    The weird thing is that the gov­ern­ment is deny­ing that there are any med­ical “infla­tion” prob­lems because the sub­si­dies, which con­tin­ue to be paid, off­set these increas­es con­sid­er­ably.  So how long will the sub­si­dies continue…especially in a Trump White House?

    Mean­while, the insur­ance com­pa­nies have lost hun­dreds of mil­lions of dol­lars and three of the largest – Unit­ed, Humana and Aet­na – have decid­ed to drop out of most of the Exchanges in which they cur­rent­ly par­tic­i­pate.  They are still very much in the game for group cov­er­age, where they have long adapt­ed to rules that affect how plans are deliv­ered, but the indi­vid­ual plans con­tin­ue to present a prob­lem – a prob­lem that every­one saw com­ing.  It’s a clas­sic case – the car­ri­ers low­ered their rates to be attrac­tive, the gov­ern­ment forced the issue by hav­ing nego­ti­a­tions with car­ri­ers that com­pelled them to be com­pet­i­tive, and then when old­er, sick­er enrollees got on the plan, costs went up (no kid­ding).  And so here we are, fac­ing the pre­dict­ed “death spi­ral” which will only get worse as costs go up, those who need the cov­er­age will con­tin­ue while those that don’t won’t (and the cost of cov­er­age remains con­sid­er­ably above the penal­ties imposed for fail­ure to have cov­er­age), more car­ri­ers will pull out (now some states only have one left, and what if they lose mon­ey?) which reduces com­pe­ti­tion, lead­ing to even high­er rate increas­es to go along with the dete­ri­o­rat­ing pool – and then either the ACA fails and the gov­ern­ment aban­dons the issue…or the gov­ern­ment dou­bles down and does it all.

    A sam­pling:

    Aet­na pulls out of 11 of its 14 mar­kets, and Unit­ed out of 31 of its 34 markets
    Enroll­ment in the ACA Exchanges are now said to be half of the orig­i­nal forecasts
    Some states will now be down to one car­ri­er of “choice”
    Geor­gia reg­u­la­tors have approved dou­ble dig­it rate hikes for ACA plans
    Con­necti­cut increas­es sup­posed to be 25%
    Flori­da should see increas­es of 19%
    Nebras­ka increas­es will be an aver­age of 35%
    Thou­sands of West Vir­gini­ans are unable to qual­i­fy for sub­si­dies due to high incomes

    And the list goes on (or the beat goes on, or some­thing like that).

  • Why Care About Diabetes and What You Can Do as an Employer | California Benefit Consultants

    September 27, 2016

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    0927Dia­betes is an expen­sive dis­ease: $322 bil­lon in Amer­i­ca! Costs are com­pound­ed because dia­betes is the lead­ing cause of heart dis­ease, stroke, kid­ney dis­ease, low­er limb ampu­ta­tion, and blind­ness, and also has con­nec­tions with some can­cers, arthri­tis, gum dis­ease and Alzheimer’s dis­ease. To add some per­spec­tive, con­sid­er these facts: Today, 3,835 Amer­i­cans will be diag­nosed with dia­betes. Today, dia­betes will cause 200 Amer­i­cans to under­go an ampu­ta­tion, 136 to enter end-stage kid­ney dis­ease treat­ment, and 1,795 to devel­op severe retinopa­thy that can lead to vision loss and blindness.

    Near­ly 30 mil­lion Amer­i­cans have dia­betes and 86 mil­lion have pre-dia­betes. While Type 1 dia­betes presents sud­den­ly, Type 2 dia­betes is known as a silent killer. One can have it for years before dis­play­ing symp­toms but, dur­ing that time, dam­age is occur­ring through­out the body.  For that rea­son, pre­ven­tion or ear­ly diag­no­sis of dia­betes is imper­a­tive. In Vital Incite’s bench­mark data of just under 12,000 indi­vid­u­als with A1c val­ues who have not been diag­nosed with dia­betes, 8 per­cent of those indi­vid­u­als had A1c val­ues greater than 7 per­cent. Those val­ues indi­cate uncon­trolled dia­betes, but these indi­vid­u­als were not yet diag­nosed. In order to reduce risk, and reduce dis­ease bur­den, the goal is to con­trol dia­betes in its ear­ly stages so it does not progress. Yet, in exam­in­ing the con­trol of A1c val­ues, we find that more than 39 per­cent of dia­bet­ics have A1c val­ues that are not controlled.

    ID with Diabetes and A1c Value

    Using the appro­pri­ate resources to con­trol dia­betes is crit­i­cal because, as risk increas­es, cost also jumps. More impor­tant­ly, these indi­vid­u­als expe­ri­ence a sig­nif­i­cant reduc­tion in their qual­i­ty of life.

    Diabetes costs increase with risk

    Accord­ing to Car­ol Dixon, Region­al Direc­tor for Com­mu­ni­ty Health Strate­gies at the Amer­i­can Dia­betes Asso­ci­a­tion Indi­ana, the Amer­i­can Dia­betes Asso­ci­a­tion offers many free resources to sup­port you.

    Well­ness Lives Here℠ (wellnessliveshere.org): With year-round oppor­tu­ni­ties, Well­ness Lives Here will help your orga­ni­za­tion edu­cate and moti­vate employ­ees to adopt health­ful habits. For some, it means few­er sick days and high­er pro­duc­tiv­i­ty. For oth­ers, it means look­ing and feel­ing bet­ter. For every­one, the result is empowerment—Americans who are bet­ter able to con­trol or pre­vent dia­betes and relat­ed health problems.

    Well­ness Lives Here resources include:

    • Engage­ment with the local Amer­i­can Dia­betes Asso­ci­a­tion office for lunch and learns and health fairs
    • Stop Dia­betes @Work – Hand­outs on many health top­ics that can be co-brand­ed, month­ly newslet­ter arti­cles to com­mu­ni­cate healthy lifestyle mes­sages, and a mul­ti­tude of resources to inte­grate health into the cor­po­rate culture
    • Mis­sion Engage­ment Days – Spe­cial­ly designed, easy to use toolk­its are pro­vid­ed, includ­ing Get Fit, Don’t Sit Day (May), and Healthy Lunch Day (Novem­ber)
    • Health Cham­pi­on Des­ig­na­tion – This spe­cial recog­ni­tion goes to orga­ni­za­tions that inspire and encour­age a cul­ture of wellness.
    • The CEO Lead­er­ship Cir­cle brings togeth­er invit­ed exec­u­tives for the oppor­tu­ni­ty to work joint­ly with the local Asso­ci­a­tion office toward spe­cif­ic health goals and objec­tives for their company.

    For more infor­ma­tion on how the Amer­i­can Dia­betes Asso­ci­a­tion can sup­port your well­ness pro­gram, con­tact your local chap­ter or vis­it their web­site at diabetes.org. Read our recent blog on oth­er cost-effec­tive well­ness strate­gies, par­tic­u­lar­ly for small employ­ers.

    Orig­i­nal­ly pub­lished by Unit­ed Ben­e­fit Advi­sors — Read More

  • Top Wellness Program Components | California Benefits Broker

    September 23, 2016

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    0922-2While well­ness pro­grams and offer­ings con­tin­ue to evolve among new trends and reg­u­la­tions, there are sev­en key com­po­nents that tend to dri­ve the most suc­cess­ful and effec­tive pro­grams we have seen with our clients.

    Bio­met­ric Data Collection

    Whether in the form of a bio­met­ric screen­ing event or annu­al phys­i­cal exam with a pri­ma­ry care provider, col­lect­ing bio­met­ric data (such as height, weight, blood pres­sure, blood sug­ar, hemo­glo­bin and cho­les­terol lev­els) is a key piece to any well­ness pro­gram. Iden­ti­fi­ca­tion of high risk bio­met­rics and poten­tial­ly undi­ag­nosed chron­ic dis­eases are crit­i­cal to get employ­ees engaged with prop­er care and treat­ment, but to also show progress and risk migra­tion over time.

    Dis­ease Man­age­ment and Case Management

    While many well­ness pro­grams have engaged health coach­es, we have found sig­nif­i­cant mer­it with spe­cif­ic dis­ease man­age­ment or case man­age­ment pro­grams to address the spe­cif­ic needs of the mem­ber pop­u­la­tion. Using col­lect­ed bio­met­rics to iden­ti­fy uncon­trolled chron­ic con­di­tions and get­ting employ­ees engaged with a dis­ease man­age­ment nurse that can assist with con­di­tion and med­ica­tion man­age­ment can have a greater impact on over­all dis­ease con­trol and pro­gres­sion. Sim­i­lar­ly, with case man­age­ment, the goal to engage par­tic­i­pants pri­or to major events such as hos­pi­tal­iza­tion, to bet­ter man­age risk and over­all spend. Tele­phon­ic coach­ing for high-risk indi­vid­u­als is on the rise, accord­ing to the UBA Health Plan Sur­vey. For the lat­est sta­tis­tics exam­in­ing well­ness pro­gram design among 19,557 health plans and 11,524 employ­ers, pre-order UBA’s 2016 Health Plan Sur­vey Exec­u­tive Sum­ma­ry which will be avail­able to the pub­lic in late September.

    Health Action Campaigns

    While in recent years employ­ers have start­ed look­ing for more ways to show hard dol­lar sav­ings with well­ness pro­grams, we have begun see­ing a return to includ­ing com­po­nents of the “soft­er” side of well­ness, such as lunch and learns, phys­i­cal activ­i­ty chal­lenges, or gen­er­al edu­ca­tion top­ics. Although it may be more dif­fi­cult to show the impact and sav­ings asso­ci­at­ed with these pro­grams, the fact remains that employ­ees gen­er­al­ly enjoy and appre­ci­ate these types of pro­grams. Health action cam­paigns can pro­vide an easy entry into well­ness pro­grams for employ­ees that oth­er­wise may be hes­i­tant to join, and it meets the need of pro­vid­ing infor­ma­tion and options for those healthy and low­er risk mem­bers not involved with dis­ease or case management.

    Com­mu­ni­ca­tion Portal

    A clear com­mu­ni­ca­tion plan, includ­ing con­sis­tent mes­sag­ing and brand­ing and a main source of infor­ma­tion, is a key com­po­nent to keep­ing the well­ness pro­gram mov­ing through­out the year. A well­ness por­tal is often use­ful for this task, as well as hous­ing key par­tic­i­pant infor­ma­tion includ­ing incen­tive track­ing. There are numer­ous options for por­tal ven­dors, and employ­ers have had suc­cess with build­ing a well­ness page as part of an exist­ing Intranet page. Estab­lish­ing a well­ness com­mit­tee or well­ness cham­pi­ons is help­ful for relay­ing com­mu­ni­ca­tion and gen­er­at­ing engage­ment from var­i­ous depart­ments with­in an organization.

    Incen­tive Structure

    While the goal of every employ­er would be to have its employ­ees intrin­si­cal­ly moti­vat­ed to improve their own heath, employ­ees often need some extrin­sic moti­va­tion to get them start­ed. Whether in the form of health sav­ings account (HSA) con­tri­bu­tions, pre­mi­um reduc­tions or var­i­ous oth­er incen­tives, sim­plic­i­ty is essen­tial. Adding com­plex details, mul­ti­ple dates, and rules com­pli­cates the pro­gram and often dri­ves employ­ees to only seek the details to qual­i­fy for the rewards, instead of mak­ing changes and being invest­ed in their own health. For both par­tic­i­pa­tion-based and out­come-based pro­grams, an easy-to-under­stand and inter­pret incen­tive struc­ture will help to engage employ­ees in the over­all pro­gram. To under­stand legal require­ments for well­ness pro­grams, par­tic­u­lar­ly as it relates to incen­tive struc­ture, request UBA’s ACA Advi­sor, “Under­stand­ing Well­ness Pro­grams and Their Legal Require­ments,” which reviews the five most crit­i­cal ques­tions that well­ness pro­gram spon­sors should ask and work through to deter­mine the oblig­a­tions of their well­ness pro­gram under the ACA, HIPAA, ADA, GINA, and ERISA, as well as con­sid­er­a­tions for well­ness pro­grams that involve tobac­co use in any way.

    Senior Lead­er­ship Support

    The one key com­po­nent to any pro­gram that you can’t buy – but that could ulti­mate­ly be most crit­i­cal to the suc­cess of the pro­gram – is the sup­port from senior lead­er­ship. This could take the form of com­mu­ni­ca­tion of their com­mit­ment to employ­ee well-being, engage­ment in the pro­grams, and task­ing man­agers to sup­port the pro­gram are all crit­i­cal items to the long-term suc­cess of any pro­gram. With­out clear sup­port and engage­ment, par­tic­i­pa­tion is like­ly to remain with those already com­mit­ted to well­ness and lessen the impact on those who could ben­e­fit most from the programs.

    Data Ana­lyt­ics and Pro­gram Evaluation

    Every pro­gram should start and end with data ana­lyt­ics. Using data to first iden­ti­fy the risks with­in the pop­u­la­tion and med­ical spend waste with­in the plan sup­ports the devel­op­ment and imple­men­ta­tion of a care­ful­ly thought out strat­e­gy. Clear met­rics and goals for all ven­dor part­ners can be estab­lished and data analy­sis on a quar­ter­ly or annu­al basis allows us to see the progress and suc­cess (or lack there­of) of inter­ven­tions and pro­grams with­in the population.

     

    Orig­i­nal­ly post­ed by Unit­ed Ben­e­fit Advi­sors — Read More

  • The FLSA Overtime Changes and Their Impact on Employee Benefits | CA Employee Benefits

    September 22, 2016

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    0915Most employ­ers should be review­ing pay­roll bud­gets and job descrip­tions to ensure that changes to salaries and job clas­si­fi­ca­tions are all in order by the Decem­ber 1 dead­line based on the new over­time exempt salary thresh­old and oth­er final rule changes to the Fair Labor Stan­dards Act (FLSA). Anoth­er area that will be impact­ed by these changes and needs review now is employ­ee benefits.

    Review Now

    This is the best oppor­tu­ni­ty to review your company’s eli­gi­bil­i­ty require­ments for cer­tain ben­e­fits and ben­e­fit lev­els. Some ben­e­fit plans may include eli­gi­bil­i­ty require­ments based on exempt ver­sus nonex­empt sta­tus or salary ver­sus hourly sta­tus. With the FLSA changes soon approach­ing, and many com­pa­nies prepar­ing for their annu­al open enroll­ment peri­ods, you may want to use these next few months to review your eli­gi­bil­i­ty require­ments and make any nec­es­sary changes. These clas­si­fi­ca­tion changes may unin­ten­tion­al­ly cause a reduc­tion or loss of cer­tain ben­e­fits for some of your employees.

    Retirement Plans

    Often, com­pa­ny con­tri­bu­tions to retire­ment sav­ings plans are based on an employee’s salary lev­el. These con­tri­bu­tions will increase as you raise salaries or incur addi­tion­al over­time costs. The costs of short-term dis­abil­i­ty, long-term dis­abil­i­ty, and group life insur­ance plans are fre­quent­ly based on an employee’s annu­al earn­ings; there­fore, there may be an increase in these ben­e­fits costs as well. Review the eli­gi­bil­i­ty require­ments for health and wel­fare ben­e­fits and oth­er fringe ben­e­fits offered by your com­pa­ny. Deter­mine if any employ­ees may be impact­ed and con­sid­er whether you will make any changes to those ben­e­fit plans.

    Affordable Care Act

    With regard to the Afford­able Care Act (ACA), high­er pay may increase the employ­ee thresh­old for afford­abil­i­ty if your com­pa­ny is using the rate of pay or W‑2 safe har­bor meth­ods to deter­mine health care afford­abil­i­ty. Addi­tion­al­ly, high­er pay may reduce any gov­ern­ment-pro­vid­ed health care sub­si­dies that employ­ees may cur­rent­ly be able to receive.

    Tracking

    Your company’s track­ing method for record­ing hours of ser­vice when review­ing your employ­ees’ mea­sure­ment and sta­bil­i­ty peri­ods should also be reviewed. Some employ­ers may use dif­fer­ent meth­ods for dif­fer­ent class­es of employ­ees. A change in class for cer­tain employ­ees may impact their mea­sure­ment and sta­bil­i­ty peri­od for health care ben­e­fit eligibility.

    Time Off

    Paid time off accru­als, paid sick leave accru­als, and work­place flex­i­bil­i­ty will all need to be addressed as you work through these changes. It is extreme­ly impor­tant for you to be able to explain the changes to your employ­ees and rein­force the fact that the new over­time law does not negate their impor­tance to the company.

    Communicating Changes

    Man­agers should already be talk­ing to employ­ees about these changes and allow­ing employ­ees to ask ques­tions. Com­pa­nies need to think about new ways of main­tain­ing the same lev­el of flex­i­bil­i­ty and auton­o­my that many of their exempt employ­ees have enjoyed in the past. This may mean think­ing of new and dif­fer­ent ways of get­ting the work done that will pro­vide a sense of empow­er­ment and auton­o­my to the employ­ees. Cross train­ing, work shar­ing, and fine-tun­ing process­es will allow bet­ter effi­cien­cies enabling employ­ees to accom­plish more with­out the need for exces­sive work hours.

    Employ­ee engage­ment and morale issues are crit­i­cal con­cerns as many cur­rent­ly exempt employ­ees, par­tic­u­lar­ly man­agers, will feel that they have lost their sta­tus and pres­tige. HR pro­fes­sion­als and oth­er senior lead­ers in the orga­ni­za­tion should be avail­able to have open dis­cus­sions with these employ­ees to explain the new law and rein­force that this has noth­ing to do with their over­all job per­for­mance or lev­el of respon­si­bil­i­ty. For most, this does not mean a change in job duties; it mere­ly means a change in the record­ing of hours and method of pay­ment. When man­aged cor­rect­ly, employ­ees should not see a reduc­tion in their wages. They should earn approx­i­mate­ly the same as or more than their cur­rent salary, based on a wage increase, over­time earn­ings, or adjust­ment to a com­pa­ra­ble hourly wage.

    There is no argu­ment that these changes will be sig­nif­i­cant for many employ­ees. The con­tin­ued FLSA min­i­mum salary adjust­ments sched­uled to occur every three years will cre­ate a new par­a­digm shift in how exempt and nonex­empt employ­ees are viewed. No longer can it be said that all man­agers are exempt employ­ees, as many will con­tin­ue to man­age employ­ees and also be eli­gi­ble for over­time. Remem­ber that you can pay your nonex­empt employ­ees a salary, but you also must have a method to record their hours worked and you must com­pen­sate them for overtime.

    These changes are esti­mat­ed to impact 4.2 mil­lion employ­ees across the Unit­ed States. How you com­mu­ni­cate these changes to your employ­ees will help tremen­dous­ly in pre­serv­ing a pos­i­tive morale in your workplace.

    Orig­i­nal­ly pub­lished by ThinkHR — Read More

  • Striving for a Culture Change in Your Wellness Program (Part 2) | CA Benefit Advisors

    September 17, 2016

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    0914wellnessMany well­ness pro­grams start off with good inten­tions, offer some edu­ca­tion and fun, but even after sev­er­al years, have failed to meet their orig­i­nal goals or pro­duce real cul­ture change. We recent­ly reviewed the first three steps to a suc­cess­ful, sus­tain­able work­place pro­gram. Here we con­clude with steps four through six for set­ting up a suc­cess­ful program.

    4.  Find inter­nal well­ness cham­pi­ons; devel­op and embrace an orga­ni­za­tion­al vision for wellbeing.

    Now that the stars are begin­ning to align, man­age­ment is invest­ed in the pro­gram, the part­ners, tools, and resources need­ed have been estab­lished, you can now begin to look inter­nal­ly at where to go next. Most well­ness ven­dors, and con­sul­tants like me, rec­om­mend set­ting up a com­mit­tee to cham­pi­on the pro­gram. Small­er orga­ni­za­tions might have one or two peo­ple, while a larg­er orga­ni­za­tion may have a larg­er group. To obtain a well-round­ed per­spec­tive, the com­mit­tee should rep­re­sent the office as a whole, not just cer­tain pieces. Dif­fer­ent divi­sions, remote employ­ees, var­i­ous depart­ments, or oth­er orga­ni­za­tion­al demo­graph­ics should all be rep­re­sent­ed. A suc­cess­ful pro­gram needs a group of peo­ple who are in charge of equal parts of the orga­ni­za­tion and who are active­ly engaged in effec­tive change. These cham­pi­ons are the ones the employ­ees come to rely on for infor­ma­tion; they are the well­ness cheer­lead­ers of your orga­ni­za­tions, walk­ing the talk! Mem­bers can be appoint­ed or vol­un­teer, but I high­ly rec­om­mend set­ting guide­lines and expec­ta­tions for com­mit­tee mem­bers up front.

    Cre­ate a vision with­in the com­mit­tee or team and gain insight on what the employ­ees want in a pro­gram. What is the goal and pur­pose of hav­ing a health and well­ness pro­gram? This might seem basic, but it is a nec­es­sary ques­tion. What do you want to accom­plish? Is your orga­ni­za­tion look­ing to dri­ve down the cost of claims? Although cost con­tain­ment may be rea­son to look at well­ness, it should not be your only goal. Suc­cess­ful groups imple­ment pro­grams to improve the lives of employ­ees and their fam­i­lies. Your vision does not have to be for­mal, but the pur­pose of the pro­gram and why it is being put in place should be com­mu­ni­cat­ed. As the employ­er, sit down and ask the employ­ees what they want in a well­ness pro­gram. You would be sur­prised at the num­ber of employ­ers I have worked with that have not asked their employ­ees any­thing. Engage­ment with employ­ees is vital to the suc­cess of the pro­gram; build your vision and plan with their help.

    5.  Set health goals and tai­lor pro­gram ele­ments and incen­tives to meet them.

    With the aggre­gate data in hand, it is time to define a pro­gram out­line and set goals. It is easy to get ahead of your­self when begin­ning this pro­gram by cre­at­ing unre­al­is­tic goals that are too demand­ing of employ­ees. You will not have 100 per­cent par­tic­i­pa­tion in your first year. Strate­gize and estab­lish mea­sur­able goals with your com­mit­tee, well­ness ven­dor, and ben­e­fits con­sul­tant. Set­ting real­is­tic expec­ta­tions is cru­cial for pro­gram success.

    Find the bal­ance between offer­ing enough activ­i­ties to keep employ­ees engaged, but not over­whelm­ing them with so many activ­i­ties that it becomes tax­ing. Do not be afraid to want to see your pro­gram suc­ceed! Look ahead and cre­ate a six- to 12-month pro­gram. I pre­fer to cre­ate a 10-month pro­gram with some type of month­ly healthy activ­i­ty. Select pro­grams and top­ics that relate direct­ly back to the aggre­gate data you col­lect­ed. For exam­ple, if you have data that says less than five per­cent of your pop­u­la­tion uses tobac­co, then you do not need to imple­ment a 12-week tobac­co ces­sa­tion pro­gram. Instead, assist that five per­cent by pro­vid­ing some free edu­ca­tion and resources for sup­port, then focus on where your orga­ni­za­tion might need more attention.

    Find pro­grams that sup­port employ­ees on their over­all health jour­ney. Ask ques­tions to iden­ti­fy pro­grams that will encour­age and influ­ence behav­ior changes. For most orga­ni­za­tions, it is com­mon to offer pro­gram­ming geared to employ­ees that are pre-hyper­ten­sive or hyper­ten­sive, over­weight, obese, have high cho­les­terol, or employ­ees expe­ri­enc­ing high stress and anx­i­ety. Rely on your ben­e­fits con­sul­tant or well­ness ven­dor to make the best prac­tice rec­om­men­da­tions for cre­at­ing behav­ior changes relat­ed to these risk areas. You may be able to use your exist­ing Employ­ee Assis­tance Pro­gram (EAP) and mar­ket it more heav­i­ly. In more extreme cas­es, you may need to uti­lize health coach­es avail­able with your well­ness ven­dor or through your dis­ease man­age­ment program.

    Think of set­ting goals in terms of the per­cent­age of par­tic­i­pa­tion would you like to see in the first, sec­ond, third, and future years. For exam­ple, you may want to see uti­liza­tion of med­ical pre­ven­tive care ben­e­fits increase from 57 to 75 per­cent, or see employ­ee engage­ment increase from one activ­i­ty to the next. Set­ting two to five mea­sur­able goals ear­ly on, then eval­u­at­ing those goals month­ly, pro­vides valu­able insight into the program’s suc­cess. Make goals and pro­gram­ming obtain­able; cre­ate an atmos­phere of suc­cess for your employees.

    Do not for­get to use incen­tives. What will get your pop­u­la­tion “mov­ing?” The dis­cus­sion of whether intrin­sic or extrin­sic incen­tives are more effec­tive is a lengthy one and of much debate these days.

    From inter­nal case stud­ies, it is my expert opin­ion that employ­ers will­ing to link their well­ness pro­gram incen­tives to their ben­e­fit plan design in the form of reduced med­ical pre­mi­ums, or mak­ing con­tri­bu­tions to an employee’s health sav­ings account or flex­i­ble spend­ing account, see the great­est lev­el of par­tic­i­pa­tion and over­all behav­ior change in their employ­ees. Of course, this does not occur overnight, but rather over time in coor­di­na­tion with your ben­e­fits con­sul­tant. This becomes a way of cre­at­ing a cost-effec­tive and con­sumer-dri­ven health­care plan that uses incen­tives to encour­age your employ­ees to make high-val­ue deci­sions. A tes­ti­mo­ni­al from one of our client’s employ­ees says it all when it comes to intrin­sic vs. extrin­sic incentives.

    “In short, I came for the sav­ings, I stayed for my health. The first year I only par­tic­i­pat­ed for cost sav­ings think­ing, ‘Who would real­ly like this?’ The fol­low­ing year I signed up for a health coach. Now I’m liv­ing health­i­er, eat­ing bet­ter, exer­cis­ing more, and more impor­tant­ly, feel­ing bet­ter. Now I think, ‘Who would­n’t real­ly like this’?”

    6. Kick it off, com­mu­ni­cate and evaluate.

    Roll out your pro­gram! Hold a kick-off par­ty for the employ­ees in the office, and con­duct a webi­nar for the employ­ees who work off-site. Pro­vide employ­ees with an overview of the pro­gram so they under­stand why your orga­ni­za­tion has cre­at­ed a well­ness pro­gram, what employ­ees should expect from their pro­gram, and the vision of the program.

    Make sure to com­mu­ni­cate about the pro­gram week­ly, and use all forms of com­mu­ni­ca­tion. Ask your employ­ees what fre­quen­cy of emails they pre­fer. Many of our clients, includ­ing my own com­pa­ny, like to have two emails a week to remind them of what is going on. Use social media, pro­vide videos, webi­na­rs, etc. The more buzz that can be cre­at­ed around the pro­gram the bet­ter. Keep employ­ees engaged and excit­ed when it comes to your pro­gram, but do not over­whelm them with com­mu­ni­ca­tion. Send emails about the chal­lenges keep­ing employ­ees engaged and involved, on who is win­ning, and suc­cess of activ­i­ties. Cre­ate an envi­ron­ment of suc­cess using these com­mu­ni­ca­tion methods.

    Last, eval­u­ate the pro­gram real­is­ti­cal­ly. What went well? What needs improve­ment mov­ing for­ward? Get real-time report­ing from the ven­dor for par­tic­i­pa­tion. Review the pro­gram through­out the year and adjust as need­ed – no pro­gram is ever sta­t­ic. If you are not mak­ing changes each year, you are not being real­is­tic. Improve­ments can always be made. Sur­vey employ­ees about things they learned, what they liked, and what they would do dif­fer­ent­ly. You can use your ven­dor or ben­e­fits con­sul­tant to assist here. Make sure that the feed­back from the employ­ee sur­veys is tak­en into con­sid­er­a­tion when mov­ing for­ward with the pro­gram. The more employ­ees engage in the well­ness pro­gram in its entire­ty, the more suc­cess you will have mov­ing forward.

    Orig­i­nal­ly pub­lished by Unit­ed Ben­e­fit Advi­sors — Read More

  • Striving for a Culture Change in Your Wellness Program (Part 1) | CA Benefit Advisors

    September 9, 2016

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    0909klbgblMany of us have seen or heard about the var­i­ous well­ness pro­grams referred to as “participation–based” pro­grams. These par­tic­i­pa­tion-only pro­grams con­tin­ue to be the start­ing point for many orga­ni­za­tions when they enter the world of work­place well­ness. Par­tic­i­pa­to­ry pro­grams typ­i­cal­ly include a few indi­vid­ual and team-based activ­i­ties, offer a lev­el of elec­tron­ic or onsite sem­i­nar edu­ca­tion, and offer employ­ees bio­met­ric screen­ing and per­son­al health risk assess­ments. Orga­ni­za­tions may even award prizes, hold draw­ings, or offer giveaways.

    These pro­grams are typ­i­cal­ly cre­at­ed with the goals of pro­mot­ing and encour­ag­ing health­i­er lifestyles for their employ­ees and their fam­i­lies, reduc­ing health­care costs of the orga­ni­za­tion, or sim­ply because own­er­ship feels it is the right thing to do.

    Fast for­ward a few years, and the same pro­gram is being offered. In most cas­es, employ­ees have received some edu­ca­tion and had fun, but the orga­ni­za­tion has yet to meet its orig­i­nal goals or expe­ri­ence a real cul­ture change. Employ­ees still seem to be lead­ing unhealthy lifestyles, pro­duc­tiv­i­ty and morale seem low­er than ever, and health­care claims con­tin­ue to sky­rock­et. So why do you even have this well­ness program?

    In my eight years work­ing as Well­ness Pro­gram Man­ag­er for a mid-sized ben­e­fits con­sult­ing firm, I have been a part of and have seen the good, the bad, and the ugly of the pro­grams. I have learned from mis­takes made ear­ly on, and I val­ue shar­ing those expe­ri­ences with those I have the oppor­tu­ni­ty to con­sult with. I share first­hand exam­ples from my own company’s pro­gram, as well as the expe­ri­ences of my clients and oth­er busi­ness part­ners. A pro­gram set up suc­cess­ful­ly – with the right sup­port, tools, part­ners, and ini­tial incen­tives – will absolute­ly reap the reward, and your orga­ni­za­tion should rec­og­nize a true cul­tur­al change.

    These are the key fac­tors that I believe con­tribute most to the suc­cess of a well­ness program.

    1. Secure senior man­age­ment com­mit­ment and participation.

    It is easy for busi­ness own­ers to say they want a well­ness pro­gram, but it is a dif­fer­ent sto­ry when they actu­al­ly embrace the con­cept, sup­port the process, and engage in the pro­gram them­selves. Own­ers of orga­ni­za­tions have come to me for help in imple­ment­ing a well­ness pro­gram. They assign one per­son to be in charge of the pro­gram, typ­i­cal­ly some­one whose time is already lim­it­ed, and for one rea­son or anoth­er the pro­gram stalls. If the top lead­er­ship of the orga­ni­za­tion is not sup­port­ive or engaged, it could take any­where from six months to five years try­ing to get a sus­tain­able well­ness pro­gram off the ground. The pro­gram may not even take off at all.

    I have seen these pro­grams fiz­zle for many rea­sons, includ­ing a shift in busi­ness objec­tives, lack of estab­lished goals, or lack of par­tic­i­pa­tion or role-mod­el­ing from man­age­ment or own­er­ship. It can be rec­og­nized ear­ly whether a pro­gram is going to suc­ceed by the sup­port it has from its lead­ers. Think of a suc­cess­ful pro­gram much like the game “fol­low the leader.” Good lead­ers and own­ers should not only spon­sor the pro­gram, but should also be active­ly engaged and sup­port­ing it, lead­ing by exam­ple. When employ­ees see own­ers and employ­ers par­tic­i­pat­ing and sup­port­ing the pro­gram, they too will “fol­low the leader.” Once you have back­ing from the peo­ple who invoke change with­in your orga­ni­za­tion, lay­ing the ground­work for the pro­gram will become a smoother process.

    2.  Sur­vey the orga­ni­za­tion and gath­er aggre­gate data to estab­lish need and risk areas.

    Once you have built the foun­da­tion, it is a good time to col­lect and gath­er data to deter­mine need and eval­u­ate aggre­gate risks in the orga­ni­za­tion. Of those orga­ni­za­tions that cre­at­ed the par­tic­i­pa­to­ry pro­grams we dis­cussed ear­li­er, how many of them do you think actu­al­ly asked their employ­ees first what they want­ed or need­ed in order to change unhealthy behav­iors or lead a healthy lifestyle? What lifestyle-relat­ed claims is the orga­ni­za­tion expe­ri­enc­ing that might be able to be con­trolled with inter­ven­tions? What health risks exist with­in the orga­ni­za­tion? Orga­ni­za­tions typ­i­cal­ly roll out the pro­gram before they gath­er the data, and then look back and won­der why their par­tic­i­pa­tion in their pro­gram was so low. Log­i­cal­ly, it is because the employ­ees didn’t want or need it or see the value.

    When work­ing with a ben­e­fits con­sult­ing firm, orga­ni­za­tions ask for employ­ees to be sur­veyed annu­al­ly on their likes and dis­likes in med­ical and den­tal cov­er­age. It only makes sense that employ­ees also be sur­veyed about their needs in a well­ness pro­gram. The employ­ee well­ness sur­vey may include ques­tions about areas where they may want help, pro­grams they would be will­ing to par­tic­i­pate in, what would moti­vate them to engage in the pro­gram, and whether or not they are even look­ing to make any changes. Do not wor­ry or be dis­cour­aged, as there is always five to ten per­cent of a pop­u­la­tion that is resis­tant to any­thing and will nev­er par­tic­i­pate regard­less of what you provide.

    Addi­tion­al data is then obtained by ana­lyz­ing your organization’s aggre­gate claims, if data is avail­able. Along with claims data, orga­ni­za­tions may also com­pile aggre­gate data through health screen­ings, bio­met­rics, health and fit­ness diag­nos­tics and assess­ments, blood work, and more.

    3.  Uti­lize exist­ing tools and resources, estab­lish part­ner­ships and seek guidance.

    Many orga­ni­za­tions may not be aware of the vari­ety of well­ness pro­gram tools and resources avail­able to them. First, look to your ben­e­fits insur­ance con­sul­tant. Qual­i­fied, rep­utable ben­e­fit con­sult­ing firms now have cre­den­tialed well­ness pro­gram man­agers or coor­di­na­tors on staff to work along­side you and your team. Con­sul­tants can help nav­i­gate what is avail­able to you from your insur­ance car­ri­er or third par­ty admin­is­tra­tor and are like­ly tapped into local and nation­al resources, well­ness ven­dors, and oth­er work­place well­ness tools. One of the best parts of my role as a Well­ness Pro­gram Man­ag­er is to share my pas­sion for well­ness with our clients and help them design a sus­tain­able pro­gram. If you have a ben­e­fits con­sul­tant that is not pro­vid­ing this lev­el of sup­port or staff, it is worth inquiring.

    Estab­lish a part­ner­ship with a well­ness ven­dor. This is one resource that is often over­looked because orga­ni­za­tions try to do it them­selves. Sus­tain­able pro­grams have ven­dors that can design pro­grams based on need and risk, man­age day-to-day pro­gram tasks, pro­vide ongo­ing report­ing, and rec­om­mend best prac­tices for goal achievement.

    Over the last few years, hun­dreds of new well­ness ven­dors have entered the mar­ket­place. I have worked with great ven­dors and ven­dors that I will not work with again. Employ­ers should not set­tle for a “cook­ie cut­ter” pro­gram. Look for a part­ner that shares a sim­i­lar view on well­ness, one who will cus­tomize a pro­gram to sat­is­fy your organization’s objec­tives. Ensure that you part­ner with a ven­dor that offers actu­al guid­ance and man­age­ment of your pro­gram. CAUTION: Many ven­dors pro­mote account man­age­ment as a top ser­vice they pro­vide, but few deliv­er. A great way to find the right ven­dor is through the part­ner­ships your employ­ee ben­e­fits con­sul­tant has estab­lished or from oth­er busi­ness refer­rals and tes­ti­mo­ni­als. When I place a client with a ven­dor, the most impor­tant thing I look for is the type of ser­vice my client will receive. Accept noth­ing but high qual­i­ty and service.

    Sub­scribe to the UBA blog for part 2 in this series, which will cov­er the final steps to suc­cess­ful­ly set up a pro­gram with the right sup­port, tools, part­ners, and ini­tial incentives.

    For addi­tion­al trends among well­ness pro­grams, down­load In UBA’s new whitepa­per: “Well­ness Pro­grams — Good for You & Good for Your Orga­ni­za­tion”.

    To under­stand legal require­ments for well­ness pro­grams, request UBA’s ACA Advi­sor, “Under­stand­ing Well­ness Pro­grams and Their Legal Require­ments,” which reviews the five most crit­i­cal ques­tions that well­ness pro­gram spon­sors should ask and work through to deter­mine the oblig­a­tions of their well­ness pro­gram under the ACA, HIPAA, ADA, GINA, and ERISA, as well as con­sid­er­a­tions for well­ness pro­grams that involve tobac­co use in any way. With over 20 pages of com­pre­hen­sive guid­ance, exam­ples and fre­quent­ly asked ques­tions, this is an invalu­able employ­er resource.

    For the lat­est sta­tis­tics from the UBA sur­vey exam­in­ing well­ness pro­gram design among 19,557 health plans and 11,524 employ­ers, pre-order UBA’s 2016 Health Plan Sur­vey Exec­u­tive Sum­ma­ry which will be avail­able to the pub­lic in late September.

    Orig­i­nal­ly pub­lished by Unit­ed Ben­e­fit Advi­sors — Read More

  • Employer Medicare Part D Notices Are Due Before October 15 | Petaluma Employee Benefits

    September 8, 2016

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    Deadline text on the calendar (or desk planner) underlined with red markerAre you an employ­er that offers or pro­vides group health cov­er­age to your work­ers? Does your health plan cov­er out­pa­tient pre­scrip­tion drugs — either as a med­ical claim or through a card sys­tem? If so, be sure to dis­trib­ute your plan’s Medicare Part D notice before Octo­ber 15.

    Purpose

    Medicare began offer­ing “Part D” plans — option­al pre­scrip­tion drug ben­e­fit plans sold by pri­vate insur­ance com­pa­nies and HMOs — to Medicare ben­e­fi­cia­ries many years ago. Per­sons may enroll in a Part D plan when they first become eli­gi­ble for Medicare. If they wait too long, a “late enroll­ment” penal­ty amount is per­ma­nent­ly added to the Part D plan pre­mi­um cost when they do enroll. There is an excep­tion, though, for indi­vid­u­als who are cov­ered under an employer’s group health plan that pro­vides “cred­itable” cov­er­age. (“Cred­itable” means that group plan’s drug ben­e­fits are actu­ar­i­al­ly equiv­a­lent or bet­ter than the ben­e­fits required in a Part D plan.) In that case, the indi­vid­ual can delay enrolling for a Part D plan while he or she remains cov­ered under the employer’s cred­itable plan. Medicare will waive the late enroll­ment pre­mi­um penal­ty for indi­vid­u­als who enroll in a Part D plan after their ini­tial eli­gi­bil­i­ty date if they were cov­ered by an employer’s cred­itable plan. To avoid the late enroll­ment penal­ty, there can­not be a gap longer than 62 days between the group plan and the Part D plan.

    To help Medicare-eli­gi­ble per­sons make informed deci­sions about whether and when to enroll in a Part D drug plan, they need to know if their employer’s group health plan pro­vides cred­itable or non­cred­itable pre­scrip­tion drug cov­er­age. That is the pur­pose of the fed­er­al require­ment for employ­ers to pro­vide an annu­al notice (Employer’s Medicare Part D Notice) to all Medicare-eli­gi­ble employ­ees and spouses.

    Employer Requirements

    Fed­er­al law requires all employ­ers that offer group health cov­er­age includ­ing any out­pa­tient pre­scrip­tion drug ben­e­fits to pro­vide an annu­al notice to plan par­tic­i­pants. This notice require­ment applies regard­less of the employer’s size or whether the group plan is insured or self-funded.

    • Deter­mine whether your group health plan’s pre­scrip­tion drug cov­er­age is “cred­itable” or “non­cred­itable” for the upcom­ing year (2017). If your plan is insured, the carrier/HMO will con­firm “cred­itable” or “non­cred­itable” sta­tus. Keep a copy of the writ­ten con­fir­ma­tion for your records. For self-fund­ed plans, the plan actu­ary will deter­mine the plan’s sta­tus using guid­ance pro­vid­ed by the Cen­ters for Medicare and Med­ic­aid Ser­vices (CMS).
    • Dis­trib­ute a Notice of Cred­itable Cov­er­age or a Notice of Non­cred­itable Cov­er­age, as applic­a­ble, to all group health plan par­tic­i­pants who are or may become eli­gi­ble for Medicare in the next year. “Par­tic­i­pants” include cov­ered employ­ees and retirees (and spous­es) and COBRA enrollees. Employ­ers often do not know whether a par­tic­u­lar par­tic­i­pant may be eli­gi­ble for Medicare due to age or dis­abil­i­ty. For con­ve­nience, many employ­ers decide to dis­trib­ute their notice to all par­tic­i­pants regard­less of Medicare status.
    • Notices must be dis­trib­uted at least annu­al­ly before Octo­ber 15. Medicare holds its Part D enroll­ment peri­od each year from Octo­ber 15 to Decem­ber 7, which is why it is impor­tant for group health plan par­tic­i­pants to receive their employer’s notice before Octo­ber 15.
    • Notices also may be required after Octo­ber 15 for new enrollees and/or if the plan’s cred­itable ver­sus non­cred­itable sta­tus changes.

    Preparing the Notice(s)

    Mod­el notices are avail­able on the CMS web­site. Start with the mod­el notice and then fill in the blanks and vari­able items as need­ed for each group health plan. There are two ver­sions: Notice of Cred­itable Cov­er­age or Notice of Non­cred­itable Cov­er­age and each is avail­able in Eng­lish and Spanish:

    Employ­ers that offer mul­ti­ple group health plans options, such as PPOs, HDH­Ps, and HMOs, may use one notice if all options are cred­itable (or all are non­cred­itable). In this case, it is advis­able to list the names of the var­i­ous plan options so it is clear for the read­er. Con­verse­ly, employ­ers that offer a cred­itable plan and a non­cred­itable plan, such as a cred­itable HMO and a non­cred­itable HDHP, will need to pre­pare sep­a­rate notices for the dif­fer­ent plan participants.

    Distributing the Notice(s)

    You may dis­trib­ute the notice by first-class mail to the employee’s home or work address. A sep­a­rate notice for the employee’s spouse or fam­i­ly mem­bers is not required unless the employ­er has infor­ma­tion that they live at dif­fer­ent addresses.

    The notice is intend­ed to be a stand-alone doc­u­ment. It may be dis­trib­uted at the same time as oth­er plan mate­ri­als, but it should be a sep­a­rate doc­u­ment. If the notice is incor­po­rat­ed with oth­er mate­r­i­al (such as sta­pled items or in a book­let for­mat), the notice must appear in 14-point font, be bold­ed, off­set, or boxed, and placed on the first page. Alter­na­tive­ly, in this case, you can put a ref­er­ence (in 14-point font, either bold­ed, off­set, or boxed) on the first page telling the read­er where to find the notice with­in the mate­r­i­al. Here is sug­gest­ed text from the CMS for the first page:

    “If you (and/or your depen­dents) have Medicare or will become eli­gi­ble for Medicare in the next 12 months, a Fed­er­al law gives you more choic­es about your pre­scrip­tion drug cov­er­age. Please see page XX for more details.”

    Email dis­tri­b­u­tion is allowed but only for employ­ees who have reg­u­lar access to email as an inte­gral part of their job duties. Employ­ees also must have access to a print­er, be noti­fied that a hard copy of the notice is avail­able at no cost upon request, and be informed that they are respon­si­ble for shar­ing the notice with any Medicare-eli­gi­ble fam­i­ly mem­bers who are enrolled in the employer’s group plan.

    CMS Disclosure Requirement

    Sep­a­rate from the par­tic­i­pant notice require­ment, employ­ers also must dis­close to the CMS whether their group health plan pro­vides cred­itable or non­cred­itable cov­er­age. The plan spon­sor (employ­er) must sub­mit its annu­al dis­clo­sure to CMS with­in 60 days of the start of the plan year. For instance, for cal­en­dar-year group health plans, the employ­er must com­ply with this dis­clo­sure require­ment by March 1.

    Dis­clo­sure to CMS also is required with­in 30 days of ter­mi­na­tion of the pre­scrip­tion drug cov­er­age or with­in 30 days of a change in the plan’s sta­tus as cred­itable cov­er­age or non­cred­itable coverage.

    The CMS online tool is the only method allowed for com­plet­ing the required dis­clo­sure. From this link, fol­low the prompts to respond to a series of ques­tions regard­ing the plan. The link is the same regard­less of whether the employer’s plan pro­vides cred­itable or non­cred­itable cov­er­age. The entire process usu­al­ly takes only 5 or 10 min­utes to complete.

    Orig­i­nal­ly pub­lished by ThinkHR — Read More

  • Speaking of Hits…what will happen with the remaining exchanges?

    September 7, 2016

    arrowThe good news is that they had three years on the pub­lic dole to final­ize start­up expens­es and get things rolling. The bad news is that may not have been enough time. The Con­gres­sion­al Quar­ter­ly said the exchanges “sur­vived start­up prob­lems with botched tech­nol­o­gy and polit­i­cal threats but con­tin­ue to grap­ple with a fun­da­men­tal chal­lenge – finan­cial sus­tain­abil­i­ty” So look for rates to increase just because they do, fur­ther drop off from the exchanges and some des­per­ate polit­i­cal lob­by­ing, par­tic­u­lar­ly in Cal­i­for­nia, to stave off bank­rupt­cy. Should be fun.

  • The Hits Keep Coming at Zenefits…reorganization means downsizing

    September 6, 2016

    arrowIn Feb­ru­ary they had 250 lay­offs. In mid June they had 106 lay­offs. In late June 110 employ­ees took vol­un­tary buy­outs after the CEO declared that only com­mit­ted work­ers should stay. Now they are down to 950…and in free fall?

  • How to Realize the Full Potential of a Private Exchange | California Benefits Broker

    September 1, 2016

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

    0901In Part 1 of this series, I took a few shots at some of the hype around pri­vate exchanges, but I still come down firm­ly on the “pro” side of the conversation.

    Giv­en the right cir­cum­stances, and by tak­ing the right approach, a pri­vate exchange can deliv­er a tremen­dous amount of val­ue while solv­ing many of the chal­lenges fac­ing employ­ers who wish to offer a sus­tain­able and effec­tive employ­ee ben­e­fits program.

    For many large employ­ers, those with thou­sands of employ­ees, this is not news. By deploy­ing pri­vate exchanges, they’ve been able to achieve excep­tion­al cost and per­for­mance out­comes while gain­ing a strate­gic advan­tage over their competitors.

    For small to mid-sized employ­ers, this is big news!

    Solu­tions that were once avail­able only to the largest employ­ers are now avail­able to employ­ers of prac­ti­cal­ly any size. And, if you use your pri­vate exchange wise­ly, you too can enjoy a key strate­gic advan­tage over your competitors.

    So, let’s begin by look­ing at the cir­cum­stances indi­cat­ing that par­tic­i­pa­tion in a pri­vate exchange may be a wise move for a small to mid-sized employer.

    The Ben­e­fit Val­ue Grid

    For near­ly 100 years, the pri­ma­ry method for peo­ple to access health­care in the U.S. has been through employ­er-spon­sored ben­e­fit plans. Now, we’ve reached a point where strate­gic think­ing has large­ly been replaced by an annu­al train wreck of tac­ti­cal reac­tion to an ever-increas­ing cost burden.

    Understanding health care inflation

    Look­ing back, increas­es in annu­al med­ical spend­ing tracked almost per­fect­ly with the Con­sumer Price Index (CPI) until 1965. Every year since then, the increase in health­care cost has exceed­ed CPI, some­times by two to three times. What hap­pened in 1965? That’s the year Medicare was intro­duced. We’ve been try­ing to tame the beast ever since.

    Most of the sub­tleties and oppor­tu­ni­ties have been lost because offer­ing ben­e­fits has been turned into a polit­i­cal talk­ing point. No one ever asks if you should be offer­ing ben­e­fits. We’re sim­ply being told, “You must offer benefits.”

    So, let’s begin at the begin­ning by ask­ing, “Does offer­ing ben­e­fits make sense for your business?”

    Despite the hype, ben­e­fits are sim­ply a tool – one of many tools you can use – for recruit­ing and retain­ing employ­ees. Which means the use of ben­e­fits has to align with your busi­ness strat­e­gy. Two fac­tors are key here: Are you com­pet­ing for employ­ees with oth­er employ­ers and how much work are you will­ing to do to design, imple­ment and sus­tain an effec­tive ben­e­fits program?

    Using these fac­tors and a cou­ple of oth­ers, I’ve plot­ted a num­ber of ben­e­fit solu­tions on The Ben­e­fit Val­ue Grid. Your first task is to decide where your com­pa­ny lands on the grid.

    Benefit Program Value Grid

    What’s right for your com­pa­ny is sim­ply right for your company

    By that I mean, your strat­e­gy should dic­tate your approach. Start­ing with tac­tics first (switch­ing car­ri­ers or plans to reduce ben­e­fits cost or increas­ing cost shar­ing or any of a num­ber of tac­tics used to try to bend the cost curve) is the wrong approach. Don’t let any­one tell you otherwise.

    So, for the sake of argu­ment (and to make the rest of this blog rel­e­vant!), let’s assume you fall in the upper right quad­rant: ben­e­fits are impor­tant to your suc­cess, you’re will­ing to do the work, and you have clear out­comes you wish to achieve.

    While learn­ing to con­nect wis­dom to tech­nol­o­gy, I have observed what does and does­n’t work when it comes to design­ing and main­tain­ing a suc­cess­ful pri­vate exchange. From this, I have devel­oped a very basic “how to” mod­el for you to use if you are con­sid­er­ing mov­ing to an exchange or want to get more out of the one you cur­rent­ly use.

    Your first step is to get expert advice

    You’re look­ing for some­one with the expe­ri­ence and knowl­edge nec­es­sary to help you choose and active­ly man­age the best tech­nol­o­gy avail­able. As I said in Part 1 of this blog, the devel­op­ers of suc­cess­ful exchanges now know that open, flaw­less, and ful­ly mobile tech­nol­o­gy is the cost of entry into the pri­vate exchange game. A good advi­sor can help you find a provider who meets this new min­i­mum standard.

    And, here’s a key dis­tinc­tion: you’re look­ing for some­one who takes respon­si­bil­i­ty for being much more than a bro­ker. You’re look­ing for an advi­sor. This is an impor­tant devel­op­ment in the ben­e­fits indus­try. In the tra­di­tion­al world of the ben­e­fit drum­beat­ers, where ben­e­fits are seen as a com­mod­i­ty and one car­ri­er is con­sid­ered to be much the same as anoth­er, the bro­ker has an arms-length rela­tion­ship with ven­dors. Their job is to solic­it bids on your behalf, present the bids to you, and let you decide which fits your needs… or, in far too many instances, which is the less­er of sev­er­al evils.

    It’s much dif­fer­ent with an “open archi­tec­ture” exchange mod­el; the more inti­mate the rela­tion­ship between your advi­sor and the exchange provider, the greater the oppor­tu­ni­ty to inno­vate and improve. The capa­bil­i­ty to com­plete­ly cus­tomize a solu­tion does not just depend on tech­nol­o­gy; it also requires a col­lab­o­ra­tive part­ner­ship between you, your advi­sor, and the exchange provider.

    A good exam­ple of this type of capa­bil­i­ty – one that goes even far­ther and lever­ages the col­lec­tive wis­dom of many advi­sors and the pooled pur­chas­ing pow­er of many employ­ers – is the pri­vate exchange cre­at­ed by Unit­ed Ben­e­fit Advi­sors (UBA) called Ben­e­fits Passport.

    You then devel­op a plan that fits your strategy 

    If you are mak­ing the switch from a ful­ly insured to a self-fund­ed plan host­ed on a pri­vate exchange, the good news is your basic plan design is most like­ly going to look very sim­i­lar to what you’ve done in the past. That’s because offer­ing ben­e­fits that fit your strate­gic needs makes sense regard­less of the fund­ing method or tech­nol­o­gy used (or not used).

    Even bet­ter news is that, with an open archi­tec­ture pri­vate exchange, you can weave your strat­e­gy into every ele­ment of the employ­ee expe­ri­ence. You can pur­pose­ful­ly cus­tomize each inter­ac­tion your employ­ees have with the exchange and its asso­ci­at­ed technology.

    Sound like a lot of work? There’s no deny­ing it does take time, effort, and strate­gic think­ing. But, if you think about the tra­di­tion­al, annu­al rehash of frus­trat­ing cost con­trol tac­tics that slow­ly gut the val­ue and effec­tive­ness of your plan with­out actu­al­ly con­trol­ling costs, then per­haps there is san­i­ty in tak­ing a longer view and doing the work.

    If you do take this on, the big promise you real­ize is that next year, instead of going back to the draw­ing board to find new ways to scrimp and save, you can actu­al­ly use the data and infor­ma­tion the exchange pro­vides to build on the foun­da­tion your plan has cre­at­ed. The “lath­er, rinse, repeat” mad­ness of a tra­di­tion­al renew­al becomes a thing of the past. The mon­ster that annu­al­ly emerged from the clos­et is per­ma­nent­ly locked away.

    And there is so much more you can do 

    For exam­ple, dur­ing and after enroll­ment you can con­tin­u­ous­ly rein­force your company’s com­mit­ment to its employ­ees. The oppor­tu­ni­ty to brand your ben­e­fits to achieve greater loy­al­ty and engage­ment – not to men­tion greater appeal to would-be employ­ees – can be real­ized by includ­ing edu­ca­tion about the why behind your ben­e­fits plan. Telling your employ­ees why you think ben­e­fits are cru­cial to their (and their fam­i­lies’) well-being and suc­cess, and why you want them to have the best pos­si­ble plan, can be eas­i­ly facil­i­tat­ed on an open archi­tec­ture pri­vate exchange platform.

    Dur­ing enroll­ment, the best employ­ers pro­vide edu­ca­tion, infor­ma­tion, and sup­port to empow­er employ­ees to make the best choic­es for them and their fam­i­ly. In Part 1 of this blog, I pro­posed new break­throughs occur when employ­ers and their advi­sors adopt an open atti­tude toward the way they and the employ­ees can put the tech­nol­o­gy to use. A sub­tle but impor­tant con­cept here is to be open to the idea that the tech­nol­o­gy, no mat­ter how func­tion­al, may be a poor replace­ment for real, live human interaction.

    Tra­di­tion­al­ly, after enroll­ment, employ­ees con­tact insur­ance car­ri­ers direct­ly when they use their ben­e­fits. With a strate­gic, pur­pose­ful­ly designed plan, one includ­ing ongo­ing employ­ee engage­ment, you can help employ­ees not only bet­ter man­age car­ri­er inter­ac­tions, but also help them become aware of and more dis­cern­ing in choos­ing cost-effec­tive care options. You also have a con­tin­u­ous oppor­tu­ni­ty to nur­ture and rein­force an over­all health­i­er approach to life. Which, of course, is a won­der­ful way to reduce plan cost: few­er claims = low­er cost!

    A caveat: there is a nat­ur­al sequence to engag­ing employ­ees and cre­at­ing a cul­ture of health and well-being account­abil­i­ty. You must first edu­cate and moti­vate employ­ees to become active par­tic­i­pants in ben­e­fit uti­liza­tion before you can engage them in becom­ing more active in their own health management.

    There are two addi­tion­al items to con­sid­er while design­ing your plan.

    First, exchange providers have the oppor­tu­ni­ty to have bet­ter, more aligned rela­tion­ships with pre­ferred car­ri­ers. Sim­i­lar to the new, more col­lab­o­ra­tive rela­tion­ship advi­sors have with a pre­ferred exchange provider, with car­ri­ers, it can lead to pref­er­en­tial prod­ucts and ser­vices being made avail­able on the exchange. Guid­ing employ­ees to these pref­er­en­tial options helps you con­trol cost while enhanc­ing the per­ceived and real val­ue of your ben­e­fits program.

    Sec­ond, pri­vate exchange tech­nol­o­gy can make it a lot eas­i­er for you to meet reg­u­la­to­ry and report­ing require­ments. Dur­ing plan devel­op­ment, be sure to take advan­tage of as much com­pli­ance automa­tion as possible.

    An Open Atti­tude: Two examples

    Cit­ed ear­li­er, UBA’s pri­vate exchange, Ben­e­fits Pass­port, pro­vides two exam­ples of how an open atti­tude impacts tech­nol­o­gy utilization.

    First, UBA’s pri­vate exchange gives employ­ees access to live human advice, assis­tance, coach­ing, and advo­ca­cy where it is most needed.

    Sec­ond, “open­ly” acknowl­edg­ing where their exper­tise begins and ends moti­vat­ed the Ben­e­fits Pass­port team to form a strate­gic part­ner­ship with a tech­nol­o­gy-based employ­ee edu­ca­tion firm called Touch­points. The inte­grat­ed plat­forms enable employ­ers and their advi­sors to ful­ly cus­tomize the com­mu­ni­ca­tion com­po­nent of every inter­ac­tion employ­ees have with the exchange and with their benefits.

    It’s your data… use it!

    Final­ly, mod­ern pri­vate exchange tech­nol­o­gy gives you the infor­ma­tion you need to accu­rate­ly mea­sure the effec­tive­ness, expense, and impact of your plan design and deliv­ery. Instead of being clubbed each year by trend, the car­ri­ers’ favorite cud­gel, and instead of mak­ing deci­sions based on some­one else’s infor­ma­tion and opin­ion, you now have the oppor­tu­ni­ty to make sound deci­sions based on facts.

    To do so, you must insist on com­plete trans­paren­cy wher­ev­er pos­si­ble. And, per­haps more impor­tant, you must be will­ing to take an open – there’s that word again – and hon­est approach to accept­ing what the data is telling you.

    The last word… until Part 3!

    It is impor­tant to repeat that this is a long-term strate­gic process that begins with cre­at­ing the best pos­si­ble plat­form for progress and then work­ing with your advi­sor and all oth­er key part­ners to learn as you go. I believe the future of health­care deliv­ery lies beyond exchanges, but we must walk before we can run.

    Turn­ing the promise of mod­ern, tech­nol­o­gy-empow­ered employ­ee ben­e­fits pro­grams into real­i­ty, now and in the future, requires adopt­ing a mod­ern, three-pronged approach.

    1. Adopt an open atti­tude to the role tech­nol­o­gy and expert advi­sors can play
    2. Step up to the plate when it comes to access­ing and uti­liz­ing your data
    3. Con­tin­u­ous­ly build on the foun­da­tion you cre­ate to expand your strat­e­gy for ben­e­fits deliv­ery and employ­ee engage­ment (remem­ber, this is not a “set it and for­get it” proposition)

    Com­ing soon

    Part 3: A look at the future of pri­vate exchanges

    Orig­i­nal­ly pub­lished by Unit­ed Ben­e­fit Advi­sors — Read More

  • Do You Know Who Your Primary Care Physician Is? Well, You Should. | California Employee Benefits

    August 30, 2016

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

    0830The Afford­able Care Act (ACA) has brought about many changes to the health insur­ance indus­try. As we are now in the sixth year of imple­men­ta­tion of the Act, we are see­ing more changes com­ing just around the corner.

    Gen­er­al­ly speak­ing, most health plans can be clas­si­fied into two cat­e­gories: HMO and PPO. With an HMO plan, you choose your physi­cian group where you will seek ser­vices, and you choose a pri­ma­ry care physi­cian that you will see for all of your needs, who will refer you to a spe­cial­ist or oth­er ser­vice facil­i­ty, if need­ed. The HMO mod­el is designed to be as cost-effec­tive as pos­si­ble, only pro­vid­ing ser­vices when the physi­cian deems it nec­es­sary, or sole­ly for the ben­e­fit of the patient.

    Due to the ACA, with an HMO plan, a woman is no longer required to get a refer­ral from her pri­ma­ry care physi­cian to an OB-GYN, and a par­ent is not required to get a refer­ral to a pedi­a­tri­cian for his or her chil­dren even though nei­ther are clas­si­fied as pri­ma­ry care physicians.

    In con­trast, a PPO plan has more flex­i­bil­i­ty for the patient. With a PPO plan you are encour­aged to see physi­cians and providers that are par­tic­i­pat­ing in your plan’s net­work, but are not required to do so. You can, in fact, see any doc­tor or provider that you wish, when you wish to see them, and with­out a refer­ral from your pri­ma­ry care physician.

    How­ev­er, times they are a‑changin’. Begin­ning Jan­u­ary 1, 2017, Cov­ered Cal­i­for­nia, California’s state insur­ance exchange, will require both HMO and PPO enrollees to spec­i­fy their pri­ma­ry care physi­cian dur­ing the enroll­ment process. If one is not select­ed, the plan will select one for the plan par­tic­i­pant. A plan par­tic­i­pant is allowed to change their pri­ma­ry care physi­cian at any time. Right now, this is only being imple­ment­ed for indi­vid­ual plan subscribers.

    It is expect­ed that this change will be imple­ment­ed for group PPO plan sub­scribers in 2018.

    Begin­ning in 2012, the ACA imple­ment­ed the Patient-Cen­tered Out­comes Research Insti­tute (PCORI) fee. This is a charge of $1 to $2 per enrollee, per year in a plan. If the plan is ful­ly insured, the fee is paid to the gov­ern­ment direct­ly by the insur­ance car­ri­er. If the plan is self-fund­ed it is paid by the plan spon­sor using IRS Form 720 and is due by July 31 for the pre­vi­ous plan year.

    The pur­pose of the PCORI is to help ana­lyze the over­all costs of health care and iden­ti­fy trends to find ways to best reduce the over­all cost of health care.

    HMOs like Kaiser Per­ma­nente have ful­ly inte­grat­ed infor­ma­tion sys­tems that allow them to track each patient elec­tron­i­cal­ly so that they can see every­thing about the patient in one place. By track­ing each patient, notes from the nurs­es and physi­cians, treat­ments, and med­ica­tions, they can track costs and trends eas­i­ly by min­ing the data from the system.

    Most PPO plans do not track this data, in part because patients in the past have not had to choose a pri­ma­ry care physi­cian or provider group. When they can see whomev­er they choose, it makes track­ing of this data very dif­fi­cult across mul­ti­ple providers. In addi­tion, par­tic­i­pants in a small group, ful­ly-insured plan are pooled with oth­er small groups where claim data is not shared with the plan spon­sor, and there is no need to track it close­ly as the infor­ma­tion at the patient lev­el is not rel­e­vant to the actu­ar­ies that cal­cu­late plan costs and premiums.

    How­ev­er, that is going to change. In order to study the over­all cost of med­ical care, iden­ti­fy trends, and dis­cov­er ways to curb inflat­ing costs, data is need­ed, and select­ing a pri­ma­ry care physi­cian for plan par­tic­i­pants is the first step.

    Cigna, which pro­vides both HMO and PPO plans, has imple­ment­ed a Col­lab­o­ra­tive Care Pro­gram with more than 120 physi­cian groups in 29 states, includ­ing provider group Palo Alto Med­ical Foun­da­tion (PAMF) in the San Fran­cis­co Bay area. By track­ing client claims data and patient out­reach pro­grams to help patients to remem­ber to take their med­ica­tions as pre­scribed and con­tin­ue with fol­low up treat­ments, PAMF has been able to reduce its infla­tion trend by 5 per­cent com­pared to oth­er providers in the San Fran­cis­co Bay Area. The goal is to dupli­cate and build on the suc­cess that Cigna has already shown through its pro­gram and con­trol and reduce the cost of health care.

    So when you or your employ­ees are apply­ing for health insur­ance, make sure that pri­ma­ry care physi­cian infor­ma­tion is handy, because it is going to be needed.

    Orig­i­nal­ly pub­lished by Unit­ed Ben­e­fit Advi­sors — Read More

  • COOPS leaving the coop…fewer and fewer hurt the ACA promise

    August 30, 2016

    arrowThere were 23 in 2014. Now there are sev­en. Soon there will be four. Even those remain­ing are chang­ing things with a cou­ple diver­si­fy­ing to serve large employ­ers and one no longer lim­it­ing them­selves to ACA man­dat­ed plans. Sur­vival is the issue of the day. Yet they were the promise to change the bad old ways of the insur­ance com­pa­nies and a bea­con of hope. Now the bea­con is slow­ly being extinguished….

  • Salary Considerations under the New DOL Standards | CA Benefit Advisors

    August 19, 2016

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

    0818On Decem­ber 1, 2016, the Depart­ment of Labor (DOL) will imple­ment changes rais­ing the min­i­mum com­pen­sa­tion for exempt employ­ees to $47,476 annu­al­ly. While salary is just half of a two-part equa­tion that includes a duties test of essen­tial job func­tions, scruti­ny is under way to ana­lyze com­pen­sa­tion and find solu­tions to avoid con­flict with the new rule. Many employ­ers are ask­ing: Why not just have all employ­ees work 40 hours and get approval for overtime?

    The statu­to­ry def­i­n­i­tion of “employ” is “to suf­fer or per­mit to work.” The phrase “suf­fer or per­mit” to work does not mean “approve.” Hence, any time a nonex­empt employ­ee works, the employ­ee must be com­pen­sat­ed. A nonex­empt employ­ee can­not vol­un­teer to work off the clock, so activ­i­ties as innocu­ous as an employ­ee arriv­ing ear­ly and just start­ing their day become prob­lem­at­ic. Com­mon advice is to issue pro­gres­sive dis­ci­pline for employ­ees who work unap­proved over­time, but writ­ing up a good employ­ee for what they rea­son­ably per­ceive to be ini­tia­tive can open a new can of worms.

    Employ­ers fur­ther bear the bur­den of cap­tur­ing and record­ing all time worked. Doc­u­ment­ing com­pens­able time is com­pli­cat­ed when review­ing the vari­a­tions of what con­sti­tutes work time. The non-exhaus­tive list includes:

    • Wait­ing or on-call time when it is on the employer’s premis­es (for exam­ple, wait­ing for a shift replace­ment to arrive)
    • Work-relat­ed train­ing activ­i­ties (includ­ing trav­el time if they are off-site
    • Eat­ing meals while check­ing emails or answer­ing phones
    • Work trav­el out­side of the employee’s nor­mal commute
    • Answer­ing work emails or com­plet­ing reports after work hours
    • Atten­dance at required com­pa­ny func­tions, includ­ing vol­un­teer activ­i­ties and social events

    Even with a sophis­ti­cat­ed time-keep­ing sys­tem, cap­tur­ing all hours is a chal­lenge. So what are some solu­tions? View the lat­est UBA Com­pli­ance Advi­sor, “Salary Con­sid­er­a­tions under the New DOL Stan­dards,” which reviews work­able solu­tions using salary increas­es, bonus­es or incentives—as well as impor­tant con­sid­er­a­tions when pay­ing nonex­empt staff on a salary basis.

    Orig­i­nal­ly pub­lished by Unit­ed Ben­e­fit Advi­sors — Read More

  • CPR & AED Training

    August 18, 2016

    Be a Community Hero!

    Arrow Ben­e­fits Group, is spon­sor­ing CPR & AED train­ing to help you safe­guard lives at work and in your community.

    • Approx­i­mate­ly 220,000 sud­den car­diac arrests occur annually.
    • Wait­ing for emer­gency med­ical sys­tem per­son­nel results in only 5–7% sur­vival rate.
    • Pro­vid­ing imme­di­ate CPR and AED (Auto­mat­ed exter­nal defib­ril­la­tors) with­in 3–5 min­utes of col­lapse increas­es sur­vival rates by as much as 70%; sur­vival rates with CPR alone are about 7%.

    CPR & AED Training
    Sep­tem­ber 24, 2016
    9:00 a.m. — 12:30 p.m.
    Petaluma Val­ley Hospital

    To reserve your seat:
    Andrew McNeil 707.992.3789
    (remem­ber to men­tion that you are a TPP client)

    Details on the training
    Details on OSHA’s car­diac arrest statistics

    Arrow Com­mu­ni­ty Well­ness Ini­tia­tive offers train­ing pro­grams aimed at increas­ing com­mu­ni­ty health and wellness.

    Petaluma Health Care Dis­tric­t’s Heart­Safe Com­mu­ni­ty works to increase com­mu­ni­ty pre­pared­ness in respond­ing to car­diac emergencies.

  • 2016 VETS-4212 Filing Period Is Open | CA Employee Benefits

    August 16, 2016

    Tags: , , , , , , , , ,

    0727ssgReminder: the VETS-4212 report­ing cycle for 2016 is now open, and the fil­ing dead­line is Sep­tem­ber 30. Fil­ing infor­ma­tion is avail­able on the Depart­ment of Labor’s Vet­er­ans’ Employ­ment and Train­ing Ser­vice (VETS) web­site.

    The Viet­nam Era Vet­er­ans’ Read­just­ment Assis­tance Act of 1974 (VEVRAA) (locat­ed at 38 U.S.C. § 4212(d)), requires fed­er­al con­trac­tors and sub­con­trac­tors sub­ject to the act’s affir­ma­tive action pro­vi­sions in § 4212(a) to track and report annu­al­ly to the Sec­re­tary of Labor the num­ber of employ­ees and new hires that are cov­ered vet­er­ans, by job cat­e­go­ry and hir­ing loca­tion, who belong to the spec­i­fied cat­e­gories of vet­er­ans pro­tect­ed under the statute. Under the most recent amend­ments to the statute, those cat­e­gories are:

    • Dis­abled veterans;
    • Vet­er­ans who served on active duty in the Armed Forces dur­ing a war or in a cam­paign or expe­di­tion for which a cam­paign badge has been authorized;
    • Vet­er­ans who, while serv­ing on active duty in the Armed Forces, par­tic­i­pat­ed in a Unit­ed States mil­i­tary oper­a­tion for which an Armed Forces ser­vice medal was award­ed pur­suant to Exec­u­tive Order 12985 (61 FR 1209); and
    • Recent­ly sep­a­rat­ed vet­er­ans (vet­er­ans with­in 36 months from dis­charge or release from active duty). The report­ing form for this require­ment is admin­is­tered by VETS; gen­er­al­ly the report­ing cycle begins annu­al­ly on or around August 1 and ends Sep­tem­ber 30.

    Note that the thresh­old for VETS-4212 report­ing was increased from $100,000 to $150,000 on Octo­ber 1, 2015. Accord­ing­ly, for the 2016 fil­ing year begin­ning on August 1, the fil­ing thresh­old for con­tracts entered into pri­or to Octo­ber 1, 2015, is still $100,000; for con­tracts entered into on or after Octo­ber 1, 2015, the fil­ing thresh­old will be $150,000. The fil­ing thresh­old for con­trac­tors con­tin­u­ing to file their VETS-4212 reports for 2015 is still $100,000.

     Orig­i­nal­ly pub­lished by ThinkHR — Read More

  • It’s not that simple! | CA Employee Benefits

    August 9, 2016

    Tags: , ,

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

    EmployeeAttentionExit or remain, wel­come refugees or build a wall to keep them out, guns or no guns, black or white, include all or be exclu­sive… the list of extreme posi­tions that peo­ple are tak­ing goes on and on. What is dri­ving this sud­den increase in polar­ized think­ing in the world? The world was get­ting small­er, tech­nol­o­gy was sup­posed to ”lev­el the play­ing field,” and peo­ple were sup­posed to become more con­nect­ed. What hap­pened to the ”it’s a small world after all” think­ing we hoped to grow up to realize?

    There is a sur­feit of com­plex­i­ty in the world, and we are under more and more pres­sure from this com­plex­i­ty. We can­not live in our sim­ple silos of think­ing any more. There is more trav­el, more migra­tion, more inter­ac­tion between peo­ple who come from dif­fer­ent life sit­u­a­tions and his­to­ry. As these com­plex sys­tems col­lide, it cre­ates even more com­plex prob­lems to which there are no sim­ple solutions.

    Yet we search for sim­ple solu­tions. We come to real­ize that there is a lim­it to the com­plex­i­ty that can be tol­er­at­ed by a nor­mal human mind. The reduc­tion of com­plex domes­tic and for­eign pol­i­cy strate­gies into text that scores at a fourth-grade read­ing lev­el, and the nave sound bites that seem to make the world sim­ple and ring with truth, have filled our world pol­i­tics for over a decade. We search for sim­plic­i­ty, and when we find it, are will­ing to pay an addi­tion­al price for it. We pay more for a phone with just one but­ton. We can see that less is more.

    How­ev­er, this desire for sim­plic­i­ty can lead to some com­plex prob­lems. The Brex­it vote is an exam­ple of what appeared to be a sim­ple ref­er­en­dum where peo­ple were asked to vote for Britain to exit or remain in the Euro­pean Union. In real­i­ty, it required that sim­ple peo­ple with a lim­it­ed appre­ci­a­tion of the com­plex­i­ty and impli­ca­tions of the sit­u­a­tion make a world-chang­ing deci­sion. Could Britain have found a con­sen­sus-build­ing process that allowed the com­plex issues to sur­face and address the desire for exit? Could it have found a way to work with the rest of the EU and make nec­es­sary adjust­ments to the hard line posi­tion? That sort of com­plex analy­sis and con­sen­sus can­not be done by the aver­age per­son. We rely on and trust elect­ed rep­re­sen­ta­tives and oth­er sub­ject-mat­ter experts to bet­ter engage with the com­plex ques­tions to arrive at the best avail­able option. That is the demo­c­ra­t­ic sys­tem – that uses the will of the peo­ple as a guide, while giv­ing itself the abil­i­ty not to be over­whelmed by it.

    What does all this mean to the employ­ee ben­e­fits busi­ness? The issues are too impor­tant for employ­ers and employ­ees to make choic­es about ben­e­fits with­out prop­er study and assess­ment, but the over­whelm­ing com­plex­i­ty of cov­er­age options and reg­u­la­tions make this dif­fi­cult. For this we need experts who can be trust­ed to under­stand all dimen­sions of com­plex­i­ty and present the non-experts with easy-to-under­stand solu­tions. There will be trade-offs and few­er options, but the options would take into account the com­plex under­ly­ing issues.

    The rec­om­men­da­tion engine that helps employ­ees choose an appro­pri­ate health plan is an exam­ple. Instead of the employ­ee doing the what-if analy­sis on dif­fer­ent plans for their spe­cif­ic fam­i­ly sta­tus and need for health ser­vices, a bet­ter start­ing point is a tool that looks at their cur­rent plan uti­liza­tion and presents the option that would best suit them if all things stayed the same.

    Sim­i­lar­ly, employ­ers have so many options to choose from – ful­ly-insured, self-fund­ed, lev­el fund­ing, unbun­dled stop-loss, cap­tive, dif­fer­ent meth­ods of stop-loss gain shar­ing arrange­ments, so on and on. Short of a sys­tem with arti­fi­cial intel­li­gence capa­bil­i­ties, there is no way to have a sim­ple inter­face to this prob­lem-solv­ing method. Except—if you get help from an advi­sor you can trust, an advi­sor who has the wis­dom, insight and expe­ri­ence to under­stand your sit­u­a­tion, your risk tol­er­ance, busi­ness mod­el, and employ­ee demo­graph­ics and their risk tol­er­ance, and can rec­om­mend the best options for you from among the pletho­ra of those avail­able. Good ben­e­fits advi­sors will embrace this chal­lenge to make com­plex things sim­ple for their clients with­out los­ing integri­ty. It is not easy. Employ­ers should seek out advi­sors who can adapt to the new com­plex­i­ty of this world and rise to the chal­lenge of sim­pli­fy­ing it for their clients.

    How do you iden­ti­fy the right advi­sor? You have to avoid being mes­mer­ized by the exag­ger­at­ed­ly sim­ple solu­tion that dis­re­gards under­ly­ing com­plex­i­ty, and look for those who make the com­plex sim­ple for your ben­e­fit, with­out sub­ject­ing you to the com­plex­i­ty that hides the sim­ple solu­tion. A quote attrib­uted to Ein­stein, who grap­pled with the most com­plex of con­cepts, goes “Every­thing should be made as sim­ple as pos­si­ble, but not sim­pler.” Eval­u­at­ing employ­ee ben­e­fits options is tough work, but the right employ­ee ben­e­fits advi­sor can make it seem sim­ple. The duck swim­ming across a pond seems to glide across the water effort­less­ly. Under the water, how­ev­er, its feet are pad­dling like mad!

    Unit­ed Ben­e­fit Advi­sors is full of such ”ducks” – pad­dling tire­less­ly to make the com­plex world of employ­ee ben­e­fits sim­ple for our employ­er clients and their employees.

    Read more here …

  • What the federal government giveth…someone sues to recover

    July 6, 2016

    At the incep­tion of the Afford­able Care Act, the fed­er­al gov­ern­ment guar­an­teed car­ri­ers a sub­sidy to help them off­set antic­i­pat­ed loss­es from the new “guar­an­teed issue” enroll­ment rules. With no under­writ­ing per­mit­ted, health car­ri­ers antic­i­pat­ed (cor­rect­ly) greater loss­es on their book of busi­ness, and the gov­ern­ment was will­ing to give them a break, except that now they are going broke (well, not broke exact­ly, but they are limp­ing) In the end, insur­ers received pay­ment under the “risk cor­ri­dor” allowance on only 12.6% of the amount claimed. As a result, High­mark, which is the fourth largest “Blues” com­pa­ny, has filed suit to recov­er their loss­es, claim­ing they were down $222 mil­lion in the ACA mar­ket in 2014 and $590 mil­lion in 2015.
    And since every­one likes a good pile on, oth­er car­ri­ers are expect­ed to join the suit. OK…

  • Qualifying Life Event’s | Benefit Specialist California

    July 5, 2016

    Tags: , , , , , ,

    Abridged from www.healthcare.gov

    WeddingRingsA change in your sit­u­a­tion – like get­ting mar­ried, hav­ing a baby, or los­ing health cov­er­age – that can make you eli­gi­ble for a Spe­cial Enroll­ment Peri­od, allow­ing you to enroll in health insur­ance out­side the year­ly Open Enroll­ment Period.

    There are 4 basic types of qual­i­fy­ing life events. (The fol­low­ing are exam­ples, and is not a full list)

    Loss of health coverage

    • Los­ing exist­ing health cov­er­age, includ­ing job-based, indi­vid­ual, and stu­dent plans
    • Los­ing eli­gi­bil­i­ty for Medicare, Med­ic­aid, or CHIP
    • Turn­ing 26 and los­ing cov­er­age through a parent’s plan

    Changes in household

    • Get­ting mar­ried or divorced
    • Hav­ing a baby or adopt­ing a child
    • Death in the family

    Changes in residence

    • Mov­ing to a dif­fer­ent ZIP code or county
    • A stu­dent mov­ing to or from the place they attend school
    • A sea­son­al work­er mov­ing to or from the place they both live and work
    • Mov­ing to or from a shel­ter or oth­er tran­si­tion­al housing

    Oth­er qual­i­fy­ing events

    • Changes in your income that affect the cov­er­age you qual­i­fy for
    • Gain­ing mem­ber­ship in a fed­er­al­ly rec­og­nized tribe or sta­tus as an Alas­ka Native Claims Set­tle­ment Act (ANCSA)
    • Cor­po­ra­tion shareholder
    • Becom­ing a U.S. citizen
    • Leav­ing incar­cer­a­tion (jail or prison)
    • Ameri­Corps mem­bers start­ing or end­ing their service

    For more infor­ma­tion and advice regard­ing this or any oth­er health insur­ance top­ics, please con­tact our office today to speak to one of our ded­i­cat­ed professionals.

    Read more here …

  • And the winner is…Oscar is going to have to raise their rates

    July 1, 2016

    They’ve only been in New York and New Jer­sey, but that was tough enough for an out of town try­out. Last year, New York author­i­ties only allowed Oscar to raise their med­ical rates 4.5%. This year, antic­i­pat­ed increas­es are rang­ing between 8 and 30% — and the New York author­i­ties have not yet weighed in on what they will allow. At first, Oscar had low rates to entice new enrollees – then they ran into state require­ments over the size of their increase (did they not see that com­ing?). Now they are try­ing to save mon­ey by reduc­ing the size of their net­works (a very unpop­u­lar move as we have wit­nessed with “the Blues” singing them in Cal­i­for­nia) For­tu­nate­ly? They have also expand­ed into Texas and Cal­i­for­nia. Oh, great.

  • Exempt from exemptions – major new FLSA thresholds for determination of overtime

    June 28, 2016

    Effec­tive Decem­ber 1, 2016 there will be new FLSA stan­dards which affect the abil­i­ty of orga­ni­za­tions to have an employ­ee be clas­si­fied as exempt from over­time rules. Cal­i­for­nia rules were already stricter but now the salary lim­its have been exceed­ed. The new thresh­old for con­sid­er­a­tion of poten­tial exemp­tion is now $47,476 per year, which com­pares to the pre­vi­ous Fed­er­al thresh­old of $23,660 and the cur­rent Cal­i­for­nia thresh­old of $41,600. A new pro­vi­sion allows up to 10% of the min­i­mum salary to be met by non dis­cre­tionary bonus­es, incen­tive pay or com­mis­sions, if made at least on a quar­ter­ly basis. Cal­i­for­nia rules still apply to duties, where at least 50% of an exempt employee’s work must be spent on exempt duties.

    What does this mean? Employ­ers must now iden­ti­fy those posi­tions they con­sid­er to be exempt with salaries below $47,476 – and real­ize that they are no longer exempt.

  • Make it on your own or don’t make it at all – Covered California’s new challenge

    June 24, 2016

    Enroll­ment is drag­ging, but rates are still up, which may lead to more of a drag, as rate hikes should aver­age 8% vs. the 4% con­sumers were used to in the last two years. It doesn’t help that the churn rate on the exchange is 47%, and enroll­ment should be drop­ping over­all. Add to that the biggest chal­lenge – the exchange has to be ful­ly self sus­tain­ing in the fis­cal year
    2016–17, as fed­er­al sub­si­dies are sched­uled to end. That’s not just a lit­tle num­ber – in its first fis­cal year the sub­sidy was 87% of total rev­enue ($324.5 mil­lion) and 47% in the sec­ond year ($157.2 mil­lion). That’s a big drop, not just a drop in the bucket.

  • We’ve all been wondering what she’d say, if she were in a position to get her way

    June 22, 2016

    It’s been a long time since she was tasked with reform­ing health care and the reim­burse­ment asso­ci­at­ed with it, and a long time since she was blamed for the fail­ure to enact such reform. Many have spec­u­lat­ed, and been con­cerned, with what Hillary Clin­ton would pro­pose as part of her Pres­i­den­tial plat­form. Now we know – she would expand Medicare by low­er­ing the eli­gi­bil­i­ty age to either 50 or 55. This stirs a few thoughts (of course):

    1) Some have tried to raise the Medicare age, since the actu­ar­i­al expec­ta­tions first derived in 1965 have gone, well, miss­ing, giv­en that the aver­age life expectan­cy has increased so much since that time. As a result, Medicare keeps rais­ing its fees, but still los­es mon­ey. Not only are peo­ple liv­ing longer, but the cost of care and treat­ment for them once they hit a cer­tain age has risen astronomically.

    2) Many cost sav­ing mech­a­nisms have been insti­tut­ed to reduce the con­tin­ued and expand­ing loss­es attrib­uted to Medicare, and still Medicare los­es mon­ey and its end is pred­i­cat­ed annu­al­ly (they should form a bet­ting pool on the date of its sup­posed demise)
    The cur­rent pro­jec­tion is bank­rupt­cy of Medicare by 2030.

    3) Mrs. Clin­ton has sug­gest­ed that younger retirees would have to buy in to the pro­gram to some extent (yes, more fees), they “would be buy­ing into such a big pro­gram that the costs would be more even­ly dis­trib­uted” This is and should not be true. Insur­ance car­ri­ers have huge pools of par­tic­i­pants, but at some point there are dimin­ish­ing returns. A pool can only grow so much before its size is of no real con­se­quence. In the mean­time, Medicare would be adding an addi­tion­al cohort of old­er Amer­i­cans who will need to use its ser­vices. When you have a big­ger pool of less desir­able risks, what you have is even more trouble.

    4) This is recy­cled Clin­ton rhetoric – under Pres­i­dent Bill Clin­ton a pro­pos­al was made to allow those age 55 or above who had retired to buy in to Medicare with a cost of $400 per month (and that was then – what would they charge now?). Con­gress didn’t like it then, so how much more will they like it now (espe­cial­ly with Repub­li­cans in con­trol) That detail, of how much the gov­ern­ment, and the new­ly Medicare eli­gi­ble would pay, is still miss­ing from the proposal

    5) Expand­ing Medicare to younger retirees could lead to more provider cost shift­ing to those cov­ered by employ­er plans

    6) There is dis­cus­sion of how the cost of this would be off­set – using Health Reim­burse­ment Accounts to pay for the pre­mi­ums – but HRAs are them­selves being changed and restricted

    7) This wouldn’t be pan­der­ing to anoth­er class of vot­ers, would it?

  • CMS Data Match – not words you want to hear – but proceed with what you see

    June 21, 2016

    CMS is the Cen­ter for Medicare and Med­ic­aid Ser­vices – essen­tial­ly, the gov­ern­ment arm that runs Medicare. While they have been doing audits for some time, this has recent­ly inten­si­fied and you are advised to respond when they come calling.

    Essen­tial­ly, they are look­ing for those who are in vio­la­tion of the 1984 ADEA rule which made group cov­er­age pri­ma­ry for employ­ees who are 65 and old­er. Some employ­ers have giv­en employ­ees incen­tives to drop off the group plan and thus make Medicare pri­ma­ry. This is pos­i­tive­ly prohibited…and they are now look­ing to catch those who are guilty of this “crime”

    Sim­ple solu­tion – give us a call if it hap­pens to you and we will walk you through the process

  • They still want the ACA to go away…a judge judges one key provision to be against the law

    June 15, 2016

    Only Con­gress can allo­cate funds to sup­port a fed­er­al ini­tia­tive. The Afford­able Care Act autho­rizes sub­si­dies to make cov­er­age more afford­able, autho­riz­ing the Trea­sury Depart­ment to make funds avail­able. Accord­ing to Fed­er­al Dis­trict Court Judge Rose­mary Col­ly­er, how­ev­er, the Health and Human Ser­vices Depart­ment, which car­ried out the ACA, “does not have the author­i­ty to spend bil­lions of dol­lars on a key pro­gram under the ACA” Since Con­gress did not explic­it­ly allow for such fund­ing, “such an appro­pri­ate can­not be inferred”

    Of course, her deci­sion will be appealed, and then we will have moved on to a new Pres­i­den­tal admin­is­tra­tion and…and…

  • How Much Life Insurance Do You Really Need? | CA Benefits Broker Services

    June 13, 2016

    Tags: , , , , , , ,

    Mar­vin H. Feldman
    www.lifehappens.org

    apple and tapeSome peo­ple equate life insur­ance with tragedy and death. In truth, life insur­ance is for the liv­ing. With­out it, the sud­den demise of a key bread­win­ner could leave a fam­i­ly strand­ed with­out the resources to main­tain their lifestyle—or even retain their home.

    Not so long ago, pro­fes­sion­als rec­om­mend­ed that fam­i­lies car­ry a life insur­ance pol­i­cy with a death ben­e­fit of 10 times their annu­al house­hold income. Today, how­ev­er, in light of ris­ing house prices in many parts of the coun­try, spi­ral­ing col­lege costs and low inter­est rates most advi­sors now rec­om­mend up to 20 times your house­hold income.

    Unfor­tu­nate­ly, most Amer­i­can fam­i­lies are under­in­sured. The gap between what house­holds have and what they need is near­ly $320,000, accord­ing to LIMRA’s study Clos­ing the Life Insur­ance Gap, 2015.

    If you’d like to get a work­ing idea of how much life insur­ance you may need (or how much more you may need), you can use our quick Life Insur­ance Needs Calculator.

    A Cor­ner­stone of Your Finan­cial Plan
    Life insur­ance is a cor­ner­stone of your finan­cial plan, for these reasons.

    1. It pro­vides income replace­ment. For most peo­ple, their most valu­able eco­nom­ic asset is their abil­i­ty to earn a liv­ing. If you have depen­dents, then you need to con­sid­er what would hap­pen to them if they could no longer rely on your income. A life insur­ance pol­i­cy can also help sup­ple­ment retire­ment income, which can be espe­cial­ly use­ful if the ben­e­fits of your sur­viv­ing spouse or domes­tic part­ner will be reduced after your death.

    2. It cov­ers out­stand­ing debts and long-term oblig­a­tions. With­out life insur­ance, your loved ones must shoul­der bur­ial costs, cred­it card debts, and med­ical expens­es not cov­ered by health insur­ance using out-of-pock­et funds. The policy’s death ben­e­fit might also be used to pay off a mort­gage, sup­ple­ment retire­ment sav­ings, or fund col­lege tuition.

    3. It can be used for estate plan­ning. The pro­ceeds of a life insur­ance pol­i­cy can be ear­marked to pay estate tax­es so that your heirs will not have to liq­ui­date oth­er assets to do so.

    4. You can use it to sup­port a char­i­ty of your choice. If you have a favorite char­i­ty, you can des­ig­nate some or all of the pro­ceeds from your life insur­ance to go to this organization.

    Read more here …

  • What they should have learned in medical school…errors now the third leading cause of death

    June 10, 2016

    The CBS Evening News report­ed that “med­ical errors are now the third largest cause of death behind heart dis­ease and can­cer” Any­thing we say here may be a mistake…

  • CPR & AED Training | Arrow Benefits Group

    June 9, 2016

    Tags: , , , , ,

    CPR

    Date:

    June 25, 2016, Saturday

    Time:

    9am — Noon

    Place:

    Petaluma Val­ley Hospital
    400 N McDow­ell Blvd — Burns Hall
    Petaluma, CA 94954

    Cost:

    $0 — Spon­sored by Arrow Ben­e­fits Group

    Please call Andrew McNeil at 707.992.3789 to reserve your seat.  Space is limited.

    arrowCPR1

  • Some news is just odd…but the Exchange is trying to increase their odds of success

    June 7, 2016

    Cal­i­for­nia law­mak­ers are now tak­ing steps to allow undoc­u­ment­ed immi­grants to pur­chase health insur­ance through the Cov­ered Cal­i­for­nia Exchange. Kaiser Health News says the pro­pos­al “could engen­der a com­bustible reac­tion” par­tic­u­lar­ly in an elec­tion year. Well, yeah.
    What is inter­est­ing is that this can be con­sid­ered a play by the Exchange to increase enroll­ment and thus bol­ster their fail­ing for­tunes. It is also a polit­i­cal­ly “cor­rect” move – or not – by the gov­ern­ment. Who is try­ing to impress whom…and how does this inter­act with fed­er­al law?

  • Marketplace Notices Are Coming | Petaluma Employee Benefits Specialist

    June 2, 2016

    Tags: , , , , , , ,

    www.thinkhr.com

    HealthMarketplaceUnder the Afford­able Care Act (ACA), each Health Insur­ance Exchange (Mar­ket­place) must noti­fy employ­ers when they have an employ­ee who has received a gov­ern­ment sub­sidy to enroll in a health plan through the Mar­ket­place. These notices will begin being sent to employ­ers in the com­ing weeks and months, either indi­vid­u­al­ly or in batch­es. Because the notice pro­ce­dure is being phased in, you may or may not receive notices, even if you have employ­ees who received sub­si­dies through a Mar­ket­place. Here’s what you need to know.

    Reason for Notice

    These notices, also called 1411 Cer­ti­fi­ca­tions in ref­er­ence to the per­ti­nent sec­tion of the ACA, will be sent to employ­ers as part of the government’s ver­i­fi­ca­tion efforts regard­ing per­sons who received Mar­ket­place sub­si­dies for indi­vid­ual health insur­ance. Mar­ket­places want to con­firm whether the indi­vid­ual was eli­gi­ble for, or enrolled in, an employer’s health plan since those facts can affect someone’s eli­gi­bil­i­ty for subsidies.

    You may receive a notice (sim­i­lar to the sam­ple found here) for each employ­ee that received a sub­sidy to enroll in insur­ance through a Mar­ket­place. The notice only informs you that the employ­ee was grant­ed a sub­sidy — it is not a noti­fi­ca­tion that you have been assessed any penal­ty. Under the ACA’s play or pay rules, penal­ties may be assessed lat­er by the Inter­nal Rev­enue Ser­vice to applic­a­ble large employ­ers for fail­ing to offer full-time employ­ees afford­able min­i­mum val­ue cov­er­age; how­ev­er, play or pay penal­ties, and notice of them, are a sep­a­rate process entirely.

    What You Should Do

    • Even if you do not believe that any of your employ­ees obtained indi­vid­ual cov­er­age through a Mar­ket­place, be on the look­out for these notices because you have 90 days from the date of the notice to file an appeal, if nec­es­sary. Notices may go to a sub­sidiary instead of the par­ent com­pa­ny or to a par­tic­u­lar work­site instead of the employer’s main office, depend­ing on the infor­ma­tion the employ­ee pro­vid­ed to the Mar­ket­place. Alert all depart­ments and work­sites to watch for mail in envelops from a gov­ern­ment agency or insur­ance Marketplace.
    • Important:Keep these notices con­fi­den­tial because employ­ers are pro­hib­it­ed by law from dis­crim­i­nat­ing or retal­i­at­ing against employ­ees who may receive sub­si­dies. Con­sid­er seg­re­gat­ing func­tions so staff involved in review­ing notices is sep­a­rate from staff involved in employ­ment or ben­e­fit plan decisions.
    • Estab­lish your audit process for review­ing any notices you may receive and for fil­ing appeals when appro­pri­ate. Con­firm that the infor­ma­tion is cor­rect based on your employ­ment and pay­roll records. If you are an applic­a­ble large employ­er sub­ject to the ACA’s play or pay rules, you also should check if the employ­ee was a full-time employ­ee and, if so, whether you had offered afford­able min­i­mum val­ue cov­er­age to the employ­ee. Read more about the notice and appeal process here.
    • File an appeal with­in 90 days of receipt of the notice if any of the infor­ma­tion is incor­rect. To do this, be sure to retain the notice and fol­low the direc­tions for appeal. Remem­ber that these notices will not advise you of any penal­ties on large employ­ers, so appeals at this stage are to cor­rect any mis­takes in employ­ment infor­ma­tion. In addition: 
      • If you are a small employ­er and not sub­ject to the ACA play or pay rules, you are not impact­ed direct­ly but your appeal may alert the Mar­ket­place that the indi­vid­ual was enrolled in your group health plan and not eli­gi­ble for subsidies.
      • If you are an applic­a­ble large employ­er who is sub­ject to the ACA’s play or pay rules, you should be proac­tive in appeal­ing the Marketplace’s sub­sidy deter­mi­na­tion if any infor­ma­tion is incor­rect. (An applic­a­ble large employ­er gen­er­al­ly is one that employed an aver­age of 50 or more full-time and full-time-equiv­a­lent employ­ees in the pri­or cal­en­dar year. Relat­ed employ­ers in a con­trolled group are count­ed togeth­er.) Although Mar­ket­places can­not access play or pay penal­ties, your appeal may help estab­lish the facts and head off lat­er penal­ty action by the IRS.

    Read more here…

  • Some subsidies end, and thus there is no end in sight to medical premium increases

    June 1, 2016

    The good news is that this applies to indi­vid­ual plans only. The bad news is that it is going to hap­pen. Health insur­ers are expect­ed to sig­nif­i­cant­ly increase pre­mi­ums for ACA plans due to mas­sive loss­es. These loss­es have been off­set by a gov­ern­ment rein­sur­ance sub­sidy, which ends this year. With­out the sub­sidy, the loss­es are direct…and direct­ly com­ing back to affect pol­i­cy­hold­ers. Evi­dence is based on ini­tial rate fil­ings, but these are only pre­lim­i­nary. The gov­ern­ment, of course, down­plays their significance…we shall see.

  • Digital Eye Strain and Vision Benefits | Employee Benefits California

    May 30, 2016

    Tags: , , ,

    By Geoff Mukhtar
    Com­mu­ni­ca­tions Man­ag­er at Unit­ed Ben­e­fit Advisors

    GlassesEyeChartEighty-one per­cent of employ­ees have elect­ed vision ben­e­fits in 2016, up from 78 per­cent last year, accord­ing to Tran­si­tions. This increase moved vision into a tie with den­tal as the sec­ond most pop­u­lar ben­e­fit elec­tion behind medical.

    Dig­i­tal eye strain, which is detailed by a report from The Vision Coun­cil, could be a con­tribut­ing fac­tor to the trend. Some of the Coun­cil’s find­ings include:

    • 65 per­cent of Amer­i­cans report expe­ri­enc­ing symp­toms of dig­i­tal eye strain, includ­ing 70 per­cent of women.
    • Near­ly 90 per­cent of Amer­i­cans use dig­i­tal devices for two or more hours dai­ly and near­ly 60 per­cent do so for five or more daily.
    • 77 per­cent of those who suf­fer from dig­i­tal eye strain use two or more devices simul­ta­ne­ous­ly, with women more like­ly to do so than men. In com­par­i­son, only 53 per­cent of those who use only one device at a time suf­fer from dig­i­tal eye strain.

    The symp­toms of dig­i­tal eye strain include neck/back/shoulder pain, headache, blurred ver­sion and dry eyes. In addi­tion to the health con­cerns they bring, these symp­toms can also neg­a­tive­ly impact employ­ee productivity.

    An arti­cle in Employ­ee Ben­e­fit News by Dr. Lin­da Chous, Unit­ed­Health­care’s chief eye care offi­cer, titled “Dig­i­tal Eye Strain Among Work­ers Caus­ing Employ­ers to Rethink Vision Ben­e­fits,” has sev­er­al pre­ven­tion tips for reduc­ing dig­i­tal eye strain in your employees:

    1. Employ­ees should keep com­put­er screens about 30 inch­es away from their eyes.
    2. Employ­ees should rest their eyes every 15 minutes.
    3. Employ­ees should blink fre­quent­ly, which reduces dry eye and helps main­tain eye health.

    Chous also advo­cates for reg­u­lar eye exams, for rea­sons beyond dig­i­tal eye strain. She writes, “The eyes are also a win­dow to over­all health. Reg­u­lar eye exams play an impor­tant role in iden­ti­fy­ing and man­ag­ing seri­ous, chron­ic con­di­tions, includ­ing dia­betes, high cho­les­terol, hyper­ten­sion, mul­ti­ple scle­ro­sis and some tumors.”

    She goes on to note how some employ­ers are now “embrac­ing an inte­grat­ed approach to vision and med­ical ben­e­fits that sup­port patients and health care pro­fes­sion­als with infor­ma­tion, deci­sions and out­comes.” These pro­grams have a vari­ety of fea­tures, such as:

    • Eye care prac­ti­tion­ers can be encour­aged to code claims with chron­ic con­di­tion cat­e­gories, and patients with those diag­noses can be auto­mat­i­cal­ly referred to dis­ease man­age­ment programs.
    • Eye care prac­ti­tion­ers can be noti­fied of patients with at-risk con­di­tions dur­ing the exam autho­riza­tion process.
    • Patients with cer­tain con­di­tions (such as dia­betes and hyper­ten­sion) can be noti­fied with a phone call about the impor­tance of their annu­al eye exam.
    • For patients who may have chron­ic con­di­tions, eye care prac­ti­tion­ers can use spe­cial­ly designed online forms to refer them to pri­ma­ry care providers or specialists.

    As an employ­er, you have the abil­i­ty to help pro­tect your employ­ees’ eye health–which, in turn, influ­ences their over­all health and pro­duc­tiv­i­ty. And, with adults under 30 expe­ri­enc­ing the high­est rates of dig­i­tal eye strain (73 per­cent) of all age groups, tak­ing actions and pro­vid­ing ben­e­fits that pro­tect employ­ees’ eye health is like­ly to become even more important.

    Read more here …

  • Moving toward millennial status – how to engage them on benefits (so says the survey)

    May 27, 2016

    Con­sumer Health Mind­set Study 2016 says 56% of mil­len­ni­als think employ­ers should direct par­tic­i­pants to facil­i­ties or providers for the most appro­pri­ate care or cost, com­pared to 40% for all oth­er gen­er­a­tions.  Near­ly a third of mil­len­ni­als who respond­ed say they sup­port employ­ers impos­ing con­se­quences for less than healthy con­di­tions com­pared to 21% of Gen Xers and 14% of baby boomers

  • Same-Sex Marriages and Group Health Benefits | Benefits Broker Petaluma

    May 26, 2016

    Tags: , , ,

    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

    WeddingRingsFrom 2013 to 2015, a series of Supreme Court cas­es and gov­ern­ment updates have changed the land­scape of the way employ­ers must con­sid­er same-sex spous­es in rela­tion to employ­ee benefits.

    Most recent­ly, in June 2015, the Supreme Court ruled in Oberge­fell v. Hodges, that the 14th Amend­ment requires a state to license a mar­riage between two peo­ple of the same sex, and to rec­og­nize a mar­riage between two peo­ple of the same sex when their mar­riage was law­ful­ly licensed and per­formed out of state. Pri­or to the Supreme Court’s deci­sion in Oberge­fell v. Hodges, approx­i­mate­ly two-thirds of states rec­og­nized same-sex mar­riage (whether per­formed with­in the state or anoth­er state or coun­try that rec­og­nizes same-sex marriage).

    In Feb­ru­ary 2015, the Depart­ment of Labor (DOL) issued an updat­ed def­i­n­i­tion of “spouse” under the Fam­i­ly and Med­ical Leave Act (FMLA) to make com­pli­ance eas­i­er, and defined “spouse” as a hus­band or wife, which refers to a per­son “with whom an indi­vid­ual entered into mar­riage as defined or rec­og­nized by state law.” The gov­ern­ing state law is that of the cel­e­bra­tion state, or where the mar­riage took place. This def­i­n­i­tion was set to go into effect across the Unit­ed States on March 27, 2015, but lit­i­ga­tion in Texas, Arkansas, Louisiana, and Nebras­ka pre­vent­ed the new rule from going into effect in those states imme­di­ate­ly. After the rul­ing in Oberge­fell, which severe­ly under­mined the argu­ments of the object­ing states, the injunc­tion was dissolved.

    In June 2013, the Supreme Court ruled that the Defense of Mar­riage Act (DOMA), which pro­vid­ed that, for fed­er­al law pur­pos­es, mar­riage could only be between a man and a woman, was unconstitutional.

    Impli­ca­tion for Employers

    For indi­vid­u­als with a same-sex spouse (valid­ly mar­ried in a state allow­ing same-sex mar­riage) who reside in a state that did not pre­vi­ous­ly rec­og­nize same-sex-mar­riage, the rul­ing in Oberge­fell like­ly trig­gered a change in sta­tus event for Sec­tion 125 plans. That is because, as of June 26, 2015, the indi­vid­ual was con­sid­ered mar­ried under state law, where­as they were not the day before.

    As a result of these changes, employ­ers need to review the eli­gi­bil­i­ty require­ments in their group life and health plans, Sec­tion 125 plans, and health reim­burse­ment arrange­ments. The Employ­ee Retire­ment Income and Secu­ri­ty Act (ERISA) requires employ­ers to admin­is­ter their plans accord­ing to the terms of the plan, which means that the plan’s def­i­n­i­tion of a cov­ered spouse is key. A plan that cov­ers “spous­es” or “law­ful spous­es” must offer cov­er­age to same-sex spouses.

    While most prac­ti­tion­ers agree that ful­ly insured plans are required to cov­er same-sex spous­es, employ­ers should con­tact their car­ri­er to ver­i­fy this approach.

    Down­load UBA’s Com­pli­ance Advi­sor, “Same-Sex Mar­riages and Group Health Ben­e­fits” for com­pre­hen­sive infor­ma­tion on tax treat­ment of same-sex spous­es, FMLA admin­is­tra­tion, and whether self-fund­ed plans may exclude same-sex spouses.

    The IRS has issued Fre­quent­ly Asked Ques­tions that employ­ers and employ­ees may also find help­ful. The ques­tions and answers that relate to ben­e­fits begin with Ques­tion 10.

    Read more here …

  • They agree to disagree but they do keep disagreeing

    May 24, 2016

    The Con­gres­sion­al Bud­get Office has new num­bers and they are dis­may­ing, but Health and Human Ser­vices is point­ing to the suc­cess of the Afford­able Care Act, stat­ing that ACA pre­mi­ums have increased less than antic­i­pat­ed last year with 8% on aver­age. When the tax cred­its for indi­vid­u­als are fac­tored in, the net increase is only 4% — but wait, isn’t that our money?

  • Dental Insurance and Preexisting Conditions | CA Benefits Broker

    May 23, 2016

    Tags: , , , , , , ,

    By Barb Nefer
    www.livestrong.com

    toothInsur­ance is designed to off­set major expens­es in var­i­ous life areas. For exam­ple, a home­own­er’s pol­i­cy cov­ers dam­age to your house, while car insur­ance pays for repairs after an auto acci­dent. Med­ical poli­cies do not cov­er den­tal work, but you can get ded­i­cat­ed den­tal insur­ance. Den­tal poli­cies vary, and many lim­it or exclude cov­er­age for pre-exist­ing conditions.

    Def­i­n­i­tion

    Den­tal insur­ance is a type of insur­ance that pays for den­tal care. It cov­ers pre­ven­ta­tive pro­ce­dures like clean­ings, and the Den­tal Insur­ance Helper infor­ma­tion site states it often cov­ers prob­lems like cav­i­ties or chipped teeth and restora­tive work like crowns and bridges. Cov­er­age lev­els may vary depend­ing on the type of pro­ce­dure. For exam­ple, a plan might pay 100 per­cent of clean­ings, 80 per­cent of fill­ings and 50 per­cent for restora­tions. You may get den­tal insur­ance through your employ­er or pur­chase it on your own.

    Lim­i­ta­tions

    Den­tal insur­ance often has lim­i­ta­tions on cov­er­age for pre-exist­ing con­di­tions, accord­ing to the Ani­mat­ed Teeth den­tal infor­ma­tion site. The term “pre-exist­ing con­di­tion” usu­al­ly refers to major work rather than minor prob­lems like cav­i­ties or deep fill­ings that even­tu­al­ly need to be crowned. For exam­ple, replace­ment of a miss­ing tooth would be con­sid­ered a pre-exist­ing con­di­tion if it was lost or removed before you joined the insur­ance plan. The insur­ance might also exclude replace­ment of crowns, bridges and den­tures unless they are old­er than a cer­tain num­ber of years.

    Con­sid­er­a­tions

    Cer­tain con­di­tions have a wait­ing peri­od for cov­er­age. The insur­ance plan will pay for them once that peri­od has passed. Ani­mat­ed Teeth explains this com­mon­ly applies to pro­ce­dures like fill­ings, root canals or crowns. Ini­tial­ly your den­tal insur­ance might pay only for clean­ings, X‑rays and oth­er pre­ven­ta­tive treat­ments. It will pay for the oth­er work after a pre­de­ter­mined peri­od, which typ­i­cal­ly runs between six months and a year. Some­times there will be imme­di­ate cov­er­age, but the pay­ment lev­el will be low­er until the des­ig­nat­ed time peri­od passes.

    Time­frame

    Your den­tal insur­ance ben­e­fits are often capped at an annu­al lim­it. You may pass the six-month wait­ing peri­od for cov­er­age of expen­sive pro­ce­dures or root canals, but they may not be cov­ered ful­ly because of the cap. For exam­ple, your plan may only pay $2,000 per year for restora­tions. You are liable for $2,000 if you get two crowns that cost $3,000 each. You may be able to avoid this restric­tion by delay­ing some work until the next annu­al peri­od begins.

    Alter­na­tives

    You may have some pay­ment alter­na­tives for pre-exist­ing con­di­tions if your den­tal insur­ance does not cov­er them. Many den­tal offices work with finance com­pa­nies spe­cial­iz­ing in den­tal care loans. You can bor­row funds to cov­er the treat­ment if your cred­it is rea­son­ably good. You also can pur­chase a den­tal dis­count plan. This is dif­fer­ent than insur­ance because it does not pay direct­ly for treat­ment. It pre-nego­ti­ates dis­counts on var­i­ous pro­ce­dures. Mem­bers who use par­tic­i­pat­ing den­tists pay the low­er rates. The Den­tal Plans infor­ma­tion site explains most plans do not have caps or pre-exist­ing con­di­tion exclu­sions. Dis­count plans have an annu­al fee, so you do not have to renew the plan once your work is completed.

    Read more here …

  • Clarification of reimbursement for spouse’s medical insurance

    May 20, 2016

    A recent Chief Coun­sel Advice memo explains when an employ­er can reim­burse employ­ees on a tax free basis when the cov­er­age is pro­vid­ed by the spouse’s employ­er. It fol­lows com­mon sense – you can only have one tax free event. Thus, if a spouse has cov­er­age with anoth­er employ­er and pays the pre­mi­um on an after tax basis, then the employee’s employ­er may reim­burse the employ­ee for the spouse’s cov­er­age on a tax free basis. There was some doubt about whether a reim­burse­ment was pos­si­ble at all, but this allows it – ONLY where there is a tax­able event on one side, erased by the tax free event on the oth­er. This is also meant to apply to sit­u­a­tions where a Health Reim­burse­ment Account pays for premiums.

  • Mileage update by IRS

    May 18, 2016

    Your accoun­tant has been a lit­tle busy, so here’s an update on employ­er vehi­cles used by employ­ees. For 2016, the max­i­mum val­ues for which the cents per mile rule may be used are $15,900 for pas­sen­ger auto­mo­biles and $17,700 for tucks or vans

    The stan­dard mileage for use of an auto­mo­bile to obtain med­ical care will be 19 cents for 2016, a drop of 4 cents from 2015

  • Will individual rates continue to increase? Oh, yes, for clear and obvious reasons

    May 16, 2016

    Car­ri­ers sell­ing indi­vid­ual plans now have a prob­lem due to the expi­ra­tion of two key pro­vi­sions of the Afford­able Care Act which are due to expire in 2016. These are col­lec­tive­ly called “The Three R’s” – risk adjust­ment, rein­sur­ance and risk cor­ri­dors. With­out these addi­tion­al pro­tec­tions, car­ri­ers will be forced to look direct­ly at their loss­es on this book of busi­ness and adjust their rates accordingly.

  • Even the Blues are singing of trouble in health care costs

    May 10, 2016

    The nation­al Blue Cross Blue Shield Asso­ci­a­tion, which rep­re­sents 36 of the plans cov­er­ing 105 mil­lion peo­ple, released a study stat­ing the following:

    1) New­ly enrolled mem­bers in indi­vid­ual health plans have high­er rates of many major or poten­tial­ly expen­sive dis­eases (e.g. hyper­ten­sion, dia­betes, depres­sion and others)

    2) New­ly enrolled mem­bers received sig­nif­i­cant­ly more med­ical care in 2014 and 2015 on aver­age than those who had been on the Blues plans pri­or to 2014

    3) New enrollees used more med­ical ser­vices across all sites of care

    4) Med­ical costs of care for the new indi­vid­ual mar­ket mem­bers were on aver­age 19% high­er than employ­er based group mem­bers in 2014 and 22% high­er than in 2015

    They won’t be singing the Blues of course – they will sim­ply raise their rates

  • The hits keep on coming and jury is still out…mixed metaphors abound in judging Obamacare

    May 4, 2016

    The Con­gres­sion­al Bud­get Office can’t seem to make up its non par­ti­san mind.  In its lat­est report they have shown sev­er­al mea­sures by which nation­al health care reform is failing:

     

    • The enroll­ment goals for the exchanges have been reduced from 22 mil­lion to 18 million
    • The aver­age sub­sidy was pro­ject­ed to be $4,040 but it is not $4,240
    • Sub­si­dies are expect­ed to aver­age $4,550 next year, most­ly due to pre­mi­um increases
    • More peo­ple may go on the rolls as employ­er pro­vid­ed cov­er­age has dis­placed near­ly 9 mil­lion when the orig­i­nal pro­jec­tion was 3 million
    • Med­ic­aid expan­sion has forced the Med­ic­aid cost pro­jec­tion to increase $146 bil­lion due to enroll­ment ris­ing by 2 to 4 mil­lion more than orig­i­nal­ly projected
    • The num­ber of unin­sured was sup­posed to drop 32 mil­lion, but is revised to 24 million
    • The employ­er man­date will raise $12 bil­lion less than they said last year, the indi­vid­ual man­date penal­ty $6 bil­lion less and the Cadil­lac tax $28 bil­lion less

     

    So what of the promise not to add any­thing to the deficit?  Seems unlike­ly now.

  • 6 Reasons Single People May Need Life Insurance | Employee Benefits Petaluma

    April 25, 2016

    Tags: , , , , , , , , ,

    By Mag­gie Leyes
    www.lifehappens.org

    moneybankMany peo­ple make the assump­tion that life insur­ance is for mar­ried cou­ples and those with kids. While it is true that not all sin­gle peo­ple need life insur­ance, there are a num­ber of rea­sons when it can make (real­ly) good sense.

    1. You have stu­dent loan debt. Many peo­ple assume that your debt dies with you, but that’s not always the case. While the loans through the fed­er­al gov­ern­ment are dis­charged (aka for­giv­en) if you were to die, per­son­al loans that have a cosign­er are gen­er­al­ly not. That means if your par­ents, for exam­ple, co-signed your stu­dent loan through a bank, they would be respon­si­ble for pay­ing the rest of the loan if some­thing hap­pened to you. There are instances when the bank has called for the loan to be paid in full imme­di­ate­ly fol­low­ing a death. You don’t want to leave your par­ents deal­ing with grief and loan payments.

    2. You’re liv­ing with your sig­nif­i­cant oth­er. When you’re liv­ing togeth­er, a lot becomes shared finan­cial respon­si­bil­i­ty. Con­sid­er this exam­ple: You need both your incomes to meet the mort­gage or rent where you’re liv­ing. Have you thought about what hap­pens if one of you dies pre­ma­ture­ly? Would the oth­er part­ner have to sell up? Find a new place to live imme­di­ate­ly? And this is just one exam­ple of many shared finan­cial respon­si­bil­i­ties cou­ple have. Ade­quate life insur­ance is an easy answer to those questions.

    3. You plan on hav­ing kids … some­day. It may not be now, but when kids do come, so do the expens­es and bills. Accord­ing the USDA, it costs $245,340 to raise a child to age 18, and that’s with­out fac­tor­ing in the cost of col­lege. Get­ting life insur­ance in place now means you have cov­er­age in place for when you do have a child. Plus, you pro­tect your insur­a­bil­i­ty for the future. … and that leads us to the next reason.

    4. You’re young and healthy. Age and health are two major dri­vers of how much you’ll be pay­ing for life insur­ance. Why not lock in a low price if you have both of those work­ing for you? Did you know that a health 30-year-old can get a 20-year $250,000 term life insur­ance pol­i­cy for about $13 a month? Doable, right? Don’t wait until a health issue or age puts life insur­ance out of your reach.

    5. You know you’ll be tak­ing care of fam­i­ly mem­bers in the future. This may mean aging par­ents or per­haps you have a spe­cial-needs sib­ling that you help care for and sup­port finan­cial­ly. What would hap­pen to them if some­thing hap­pened to you and your sup­port dis­ap­peared? Life insur­ance can ensure that there is mon­ey in place to fund those needs into the future. This is where it might be wise to con­sid­er a per­ma­nent life insur­ance pol­i­cy (one that’s there for your life­time, as long as you pay your premiums).

    6. It will pay for your funer­al. No one likes to think about such things, but the truth is if you die, some­one will have to pay for your funer­al. You wouldn’t want to leave your par­ents, part­ner or oth­er fam­i­ly mem­bers strug­gling with grief as well as pay­ing for a funer­al and bur­ial, which can cost an aver­age of $7,100.

    Read more here …

  • Seven Common Mistakes That Could Trigger a DOL Audit | Benefits Broker Petaluma

    April 21, 2016

    Tags: , , , ,

    By Bill Olson
    Chief Mar­ket­ing Offi­cer at Unit­ed Ben­e­fit Advisors

    DOL-CTA-BLOGNot many things incite more fear than receiv­ing a notice that you’re about to have an audit, espe­cial­ly from the Depart­ment of Labor (DOL). The DOL is a cab­i­net-lev­el depart­ment of the U.S. fed­er­al gov­ern­ment respon­si­ble for occu­pa­tion­al safe­ty, wage and hour stan­dards, unem­ploy­ment insur­ance ben­e­fits, re-employ­ment ser­vices, and some eco­nom­ic sta­tis­tics. It is head­ed by the U.S. Sec­re­tary of Labor.

    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. While a DOL audit may or may not be trig­gered by the fol­low­ing, there are cer­tain ways in which employ­ers expose them­selves to unnec­es­sary risks:

    1. Not sub­mit­ting Form 5500 reports on time if they have 100 or more participants
    2. Not hav­ing Sum­ma­ry Plan Descrip­tions (SPDs) for each Employ­ee Retire­ment Income Secu­ri­ty Act (ERISA) cov­ered ben­e­fit or not using an SPD wrap doc­u­ment. Read more on the per­ils of neglect­ing writ­ten poli­cies and pro­ce­dures.
    3. Not com­plet­ing all the var­i­ous annu­al employ­ee noti­fi­ca­tions such as Medicare Part D, Children’s Health Insur­ance Pro­gram (CHIP), Men­tal Health Par­i­ty Act (MHPA), New­borns’ and Moth­ers’ Health Pro­tec­tion Act (NMHPA), Women’s Health and Can­cer Rights Act (WHCRA), Patient Pro­tec­tion and Afford­able Care Act (ACA), Health Insur­ance Porta­bil­i­ty and Account­abil­i­ty Act (HIPAA), Health Exchange, etc.
    4. Not gen­er­at­ing Sum­ma­ry of Mate­r­i­al Mod­i­fi­ca­tion (SMM) when­ev­er there are mate­r­i­al changes to ben­e­fits and then not sav­ing these SMMs for future reference
    5. Not keep­ing Sec­tion 125 Pre­mi­um Only Plan (POP) and flex­i­ble spend­ing account (FSA) doc­u­ments cur­rent and accurate
    6. Not fil­ing Form 1095/1094 reports in a time­ly fash­ion, or if hav­ing con­flict­ing infor­ma­tion on these reports
    7. Not prop­er­ly fol­low­ing the con­trolled group rules for own­ers of mul­ti­ple organizations

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

    Read more here…

  • Should Failed Co-ops be responsible for paying back what they borrowed when they’re broke?

    April 20, 2016

    The gov­ern­ment lent them $1.2 bil­lion. They went broke – 12 of them. The mon­ey was spent and can­not be returned. Con­gress­man Rob Port­man said “these failed CO OPs were a cost­ly exper­i­ment gone wrong, and real peo­ple got hurt – includ­ing the more than 700,000 Amer­i­cans who lost their health plans” while CMS Act­ing Admin­is­tra­tor Andy Slavitt said the CO OPs “chal­lenges should be viewed as a small busi­ness start­up prob­lem” rather than a prob­lem of the pro­gram itself (of course not – only 12 of the 23 went broke, spend­ing half the total gov­ern­ment loan) Sen­ate Repub­li­cans have now gone on record say­ing they want the CO-Ops to pay back the mon­ey – with what?

  • Group Healthcare Premiums by State: How does your plan stack up? | California Employee Benefits

    April 19, 2016

    Tags: , , , ,

    By Bill Olson
    Chief Mar­ket­ing Offi­cer at Unit­ed Ben­e­fit Advisors

    We recent­ly high­light­ed the top five best and worst states for group health plan costs. See below for your state’s aver­age month­ly pre­mi­ums and read our break­ing news release with the cost find­ings by indus­try.

    2015HealthcarePremiumByState

    To quick­ly bench­mark your plan by indus­try, region, or employ­er size, down­load our Quick Check Bench­mark­ing Tool.

    UBA’s Health Plan Sur­vey ana­lyzes a wide range of health care costs trends. To com­pre­hen­sive­ly bench­mark your exact plan to your peers, con­tact a UBA Part­ner near you to run a cus­tom bench­mark­ing report.

    For detailed find­ings from our Health Plan Sur­vey, view the Exec­u­tive Sum­ma­ry, or down­load our free high­lights.

    For more infor­ma­tion, please click here…

  • What doesn’t control – what does Medicare require and not?

    April 15, 2016

    An employ­ee was on a med­ical leave and con­sid­ered able to return to active employment.
    She had been receiv­ing ben­e­fits under her employer’s med­ical plan rather than Medicare.
    In this instance, she did not receive ben­e­fits from the plan, which stat­ed that Medicare was to be the pri­ma­ry car­ri­er, con­traindi­cat­ed by pre­vi­ous claims pay­ment. The court, how­ev­er, held that while some­one in “cur­rent employ­ment sta­tus” would nor­mal­ly have the plan be the pri­ma­ry pay­or, they also said that such sta­tus does not extend beyond six months, and there­fore the plan was cor­rect in deny­ing the claim.

  • What controls – SPD or plan document – court decision says it is the plan document

    April 12, 2016

    In Apol­lo Edu­ca­tion Group Inc. vs. Hen­ry (Ari­zona) the com­pa­ny sought to recov­er dam­ages from a third par­ty pay­ing due to an acci­dent. The plan par­tic­i­pant assert­ed that the plan had no right to reim­burse­ment because the for­mal plan doc­u­ment did not con­tain any reim­burse­ment pro­vi­sions. The plan con­tend­ed these rights were con­tained in the Sum­ma­ry Plan Description.
    The court said the plan doc­u­ment was the con­trol­ling piece here. “The court reject­ed the plan’s argu­ment that the doc­u­ments were effec­tive­ly one and the same due to the incor­po­ra­tion by ref­er­ence, point­ing to an SPD pro­vi­sion spec­i­fy­ing that the for­mal plan doc­u­ment would gov­ern any con­flict as evi­dence that the doc­u­ments were distinct

  • Changes, more changes – to the ACA – premiums may steady, but not the total cost

    April 8, 2016

    The max­i­mum out of pock­et cost allowed to be charged by the health plans under the ACA will be adjust­ed to $7,150 for an indi­vid­ual and $14,300 for a fam­i­ly. The cur­rent lev­els run a bit amok, tend­ing from $6,200 to $6,500. The increase is sub­stan­tial – will rates go down? (don’t hold your breath)

  • North Bay employers learn new language of Affordable Care Act compliance | Arrow Benefits Group

    April 7, 2016

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    BusinessJournalhttp://www.northbaybusinessjournal.com

    North Bay employ­ers learn new lan­guage of Afford­able Care Act compliance
    Inter­view with Andrew McNeil

     

    “We are still get­ting new clients, peo­ple we should have been talk­ing to about this a cou­ple of months ago,” said Andrew McNeil, prin­ci­pal, Arrow Benefits.

    McNeil’s advice to employ­ers is to track employ­ees on a month­ly basis. “Then their records will be in bet­ter shape,” he said.

    Penal­ties for non-com­pli­ance with the man­date are $2,000 per employ­ee. As long as employ­ers make a good faith effort to file, how­ev­er, the IRS has said they would be lenient and not issue a fine.

     

    Read the entire arti­cle here

    North Bay Busi­ness Jour­nal – April 2016

  • Inflation adjustments…the ACA continues to change

    April 1, 2016

    The $2,000 excise tax is adjust­ed to $2,160 for the year 2016
    The $3,000 excise tax is adjust­ed to $3,240 for the year 2016
    The def­i­n­i­tion of afford­abil­i­ty is raised to 9.66% of annu­al wages

  • They’ve taxed our resources so we must tax them which will be a trying and taxing task

    April 1, 2016

    For years, the four major Cal­i­for­nia health car­ri­ers – Health Net, Kaiser, Blue Shield and Anthem Blue Cross – have either part­ly or com­plete­ly avoid­ed the manda­to­ry 2.35% state pre­mi­um tax on col­lect­ed pre­mi­ums. The com­pa­nies claim to be “health ser­vice plans” because doc­tors are required to assume finan­cial risk and that they are noth­ing like CIGNA or Aet­na. Uh huh…needless to say health care and con­sumer advo­cates dis­agree (if it walks like a duck, etc)
    There is now a court case to bring the car­ri­ers to task…with the suit just being heard at the end of Jan­u­ary. Gov­er­nor Brown’s admin­is­tra­tion, how­ev­er, has sided with the plans in this case, despite his pledge to con­tin­ue bal­anc­ing the budget.

  • They can have it but you can’t – third party subrogation is not available to plan administrator

    March 30, 2016

    The Unit­ed States Supreme Court decid­ed in Mon­tainile v. Board of Trustees of the Nation­al Ele­va­tor Indus­try Health Ben­e­fit Plan that a plan admin­is­tra­tor may not bring a sub­ro­ga­tion claim against a par­tic­i­pant whose third par­ty set­tle­ment is dis­persed into non-trace­able items.
    The deci­sion is actu­al­ly not that clear cut. The plain­tiff had filed a neg­li­gence claim for unin­sured motorist’s insur­ance, obtained a set­tle­ment of $500,000, but the trustees of the plan did not file their claim with­in the time lim­it set by the plaintiff’s attorney…and thus were denied reim­burse­ment. The court upheld orig­i­nal deci­sions to deny the pay­ment, main­ly because of the tim­ing issue.

  • California Employment Law Update – March 2016 | Employee Benefits Petaluma

    March 28, 2016

    Tags: , , , , , ,

    www.thinkhr.com

    Amend­ed FEHA Regulations

    californiaCal­i­for­nia has amend­ed its Fair Employ­ment and Hous­ing Act (FEHA) reg­u­la­tions. The FEHA pro­hibits harass­ment and dis­crim­i­na­tion in employ­ment because of race, col­or, reli­gion, sex, gen­der, gen­der iden­ti­ty, gen­der expres­sion, sex­u­al ori­en­ta­tion, mar­i­tal sta­tus, nation­al ori­gin, ances­try, men­tal and phys­i­cal dis­abil­i­ty, med­ical con­di­tion, age, preg­nan­cy, denial of med­ical and fam­i­ly care leave, or preg­nan­cy dis­abil­i­ty leave.

    Among the more notable changes in the amend­ed reg­u­la­tions is the require­ment that employ­ers with five or more employ­ees have a writ­ten pol­i­cy against unlaw­ful harass­ment, dis­crim­i­na­tion, and retal­i­a­tion in the work­place that:

    • Is in writing.
    • Lists all cur­rent pro­tect­ed cat­e­gories cov­ered under the FEHA.
    • Indi­cates that the FEHA pro­hibits co-work­ers and third par­ties, as well as super­vi­sors and man­agers with whom the employ­ee comes into con­tact, from engag­ing in con­duct pro­hib­it­ed by the FEHA. 
      • Cre­ates a com­plaint process to ensure that com­plaints receive:
      • An employer’s des­ig­na­tion of con­fi­den­tial­i­ty, to the extent possible;
      • A time­ly response;
      • Impar­tial and time­ly inves­ti­ga­tions by qual­i­fied personnel;
      • Doc­u­men­ta­tion and track­ing for rea­son­able progress;
      • Appro­pri­ate options for reme­di­al actions and res­o­lu­tions; and
      • Time­ly closures.
    • Pro­vides a com­plaint mech­a­nism that does not require an employ­ee to com­plain direct­ly to his or her imme­di­ate super­vi­sor, includ­ing, but not lim­it­ed to, the following: 
      • Direct com­mu­ni­ca­tion, either oral­ly or in writ­ing, with a des­ig­nat­ed com­pa­ny rep­re­sen­ta­tive, such as a human resources man­ag­er, EEO offi­cer, or oth­er super­vi­sor; and/or
      • A com­plaint hot­line; and/or
      • Access to an ombudsper­son; and/or
      • Iden­ti­fi­ca­tion of the Depart­ment of Fair Employ­ment and Hous­ing and the U.S. Equal Employ­ment Oppor­tu­ni­ty Com­mis­sion (EEOC) as addi­tion­al avenues for employ­ees to lodge complaints.
    • Instructs super­vi­sors to report any com­plaints of mis­con­duct to a des­ig­nat­ed com­pa­ny rep­re­sen­ta­tive, such as a human resources man­ag­er, so the com­pa­ny can try to resolve the claim inter­nal­ly. Employ­ers with 50 or more employ­ees are required to include this as a top­ic in man­dat­ed sex­u­al harass­ment pre­ven­tion train­ing, pur­suant to § 11024 of the regulations.
    • Indi­cates that when an employ­er receives alle­ga­tions of mis­con­duct, it will con­duct a fair, time­ly, and thor­ough inves­ti­ga­tion that pro­vides all par­ties appro­pri­ate due process and reach­es rea­son­able con­clu­sions based on the evi­dence collected.
    • States that con­fi­den­tial­i­ty will be kept by the employ­er to the extent pos­si­ble, but does not indi­cate that the inves­ti­ga­tion will be com­plete­ly confidential.
    • Indi­cates that if at the end of the inves­ti­ga­tion mis­con­duct is found, appro­pri­ate reme­di­al mea­sures will be taken.
    • Makes clear that employ­ees will not be exposed to retal­i­a­tion as a result of lodg­ing a com­plaint or par­tic­i­pat­ing in any work­place investigation.

    Employ­ers must dis­sem­i­nate their poli­cies by one or more of the fol­low­ing methods:

    • Print­ing and pro­vid­ing a copy to all employ­ees with an acknowl­edg­ment form for the employ­ee to sign and return;
    • Send­ing the pol­i­cy via email with an acknowl­edg­ment return form;
    • Post­ing cur­rent ver­sions of the poli­cies on a com­pa­ny intranet with a track­ing sys­tem ensur­ing all employ­ees have read and acknowl­edged receipt of the policies;
    • Dis­cussing poli­cies upon hire and/or dur­ing a new hire ori­en­ta­tion ses­sion; and/or
      Any oth­er way that ensures employ­ees receive and under­stand the policies.

    Any employ­er whose work­force at any facil­i­ty or estab­lish­ment con­tains 10 per­cent or more of per­sons who speak a lan­guage oth­er than Eng­lish as their spo­ken lan­guage must trans­late the pol­i­cy into every lan­guage that is spo­ken by at least 10 per­cent of the workforce.

    The amend­ed reg­u­la­tions go into effect on April 1, 2016.

    View the Amend­ed Regulations

    Read more here …

  • 2017 Benefit and Payment Parameters Rule and HIP FAQ | Health Insurance CA

    March 24, 2016

    Tags: , , , , ,

    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

    2017FeeThe 2017 Ben­e­fit and Pay­ment Para­me­ters (BPP) rule, an annu­al rule that sets poli­cies relat­ing to the Patient Pro­tec­tion and Afford­able Care Act (ACA), has been released by the Cen­ters for Medicare and Med­ic­aid Ser­vices (CMS). The 2017 rule con­tains numer­ous updates, includ­ing the annu­al open enroll­ment peri­ods for the indi­vid­ual mar­ket, rat­ing areas for small group health plans, guar­an­teed avail­abil­i­ty and renewa­bil­i­ty, bro­ker and agent reg­is­tra­tion to assist con­sumers with apply­ing for Exchange cov­er­age, the employ­er notice sys­tem when its employ­ees are deter­mined to be eli­gi­ble for a tax cred­it, and exemp­tions to the indi­vid­ual man­date. The rule also set cost shar­ing lim­its for 2017.

    In con­junc­tion with the rule, the Depart­ment of Health and Human Ser­vices (HHS) released an FAQ on the imple­men­ta­tion of the 2017 mora­to­ri­um on the Health Insur­ance Provider (HIP) fee. The FAQ states that insur­ers will not be charged the HIP fee for the 2017 fee year, based on 2016 infor­ma­tion. Insur­ers should adjust pre­mi­ums down­ward as a result.

    Final­ly, HHS also released a bul­letin that extends tran­si­tion­al plans from expir­ing on Octo­ber 1, 2017, to the end of 2017 to allow indi­vid­u­als to enroll in an ACA-com­pli­ant plan begin­ning in cal­en­dar year 2018, rather than hav­ing to account for Octo­ber through Decem­ber 2017 pri­or to the new cal­en­dar year.

    Cost Shar­ing Limits

    The rule set the 2017 max­i­mum annu­al lim­i­ta­tion on cost shar­ing at $7,150 for self-only cov­er­age and $14,300 for oth­er than self-only coverage.

    Open Enroll­ment – Exchange

    Open enroll­ment for 2017 and 2018 will be from Novem­ber 1 until Jan­u­ary 31. No new spe­cial enroll­ment peri­ods are being added, and no cur­rent spe­cial enroll­ment peri­ods are being eliminated.

    Employ­er Notice

    Employ­ers will be noti­fied when an employ­ee actu­al­ly enrolls in a qual­i­fied health plan through the Exchange. Cur­rent­ly employ­ers are noti­fied when an employ­ee is deter­mined to be eli­gi­ble for fed­er­al finan­cial assis­tance. The Exchange can either noti­fy employ­ers on an employ­ee-by-employ­ee basis or for groups of employ­ees who enroll with finan­cial assis­tance. The notice employ­ers receive will indi­cate that the law pro­hibits retal­i­a­tion against employ­ees who receive finan­cial assis­tance on the Exchange.
    For more infor­ma­tion on stan­dard­ized plans, small employ­er def­i­n­i­tion, rein­sur­ance fees, rat­ing areas, guar­an­teed avail­abil­i­ty, and exemp­tions, down­load UBA’s ACA Advi­sor, “Ben­e­fit and Pay­ment Para­me­ters Rule and HIP FAQ”.

    Read more here …

  • The coverage is mandatory but what if they don’t want it – rules on opt out arrangements

    March 23, 2016

    Many orga­ni­za­tions pro­vide employ­ees the oppor­tu­ni­ty to waive their right to the offered med­ical cov­er­age and receive tax­able reim­burse­ment in return. But how does that get report­ed on the new­ly required 1095‑C form? IRS Notice 2015–87 has now stat­ed that all such arrange­ments in place pri­or to Decem­ber 17, 2015 need not do any report­ing of this option. The notice does pro­vide that such pay­ments will be added to the employee’s cost of cov­er­age for pur­pos­es of deter­min­ing the employee’s eli­gi­bil­i­ty for a sub­sidy on the Exchange and whether the employ­ee might be exempt from a penal­ty under the indi­vid­ual man­date. The cal­cu­la­tion for afford­abil­i­ty will, how­ev­er, be the amount the employ­ee receives for the opt-out plus the amount the employ­ee would have had to pay in the absence of the opt-out provision.

    All this is true…of course…until the final reg­u­la­tions are issued, so…

  • Top Talent Prefers Being Recruited Via Their Mobile Device | Petaluma Benefits Broker

    March 22, 2016

    Tags: , , ,

    By Bill Olson
    Chief Mar­ket­ing Offi­cer at Unit­ed Ben­e­fit Advisors

    TopTalentIf you haven’t noticed, news­pa­pers are shrink­ing in size. Few­er peo­ple, espe­cial­ly the younger demo­graph­ic of 18- to 40-year-olds, read them and this espe­cial­ly applies to when they’re search­ing for jobs. Employ­ers who con­tin­ue to use only the old­er meth­ods of recruit­ment – clas­si­fied ads and job boards – may not attract the most cov­et­ed appli­cants due to them not see­ing the post­ing, or worse, feel­ing that the com­pa­ny look­ing to fill the posi­tion is old-fash­ioned and not tech­no­log­i­cal­ly up to date.

    Accord­ing to an arti­cle on the web­site of Soci­ety For Human Resource Man­age­ment titled, “The Most Sought-After Tal­ent Pre­fer Mobile Recruit­ment,” almost 70% of appli­cants labeled as “high-poten­tials” were attract­ed more to com­pa­nies with mobile recruit­ing options ver­sus just over 50% of oth­er appli­cants. Anoth­er com­par­i­son of high-poten­tials shows that about 75% use mobile devices when search­ing for jobs while only 40% of oth­er poten­tial employ­ees do.

    Because most peo­ple tend to do every­thing on their tablets or smart­phones, it makes sense that search­ing for a job would just be anoth­er addi­tion to that list. The arti­cle bears that out, not­ing that con­ve­nience is one of the pri­ma­ry rea­sons that high-poten­tials do this. Besides con­ve­nience, anoth­er ben­e­fit not­ed is that infor­ma­tion can be obtained quick­ly via mobile device and high-poten­tials can respond faster to job postings.

    The arti­cle states that every­one, at some point, will use a mobile device when job hunt­ing, but those who are high-poten­tials take it to the next lev­el. Every­thing from research­ing com­pa­nies, receiv­ing job alerts, fill­ing out job appli­ca­tions, and even tak­ing assess­ments was more like­ly to be done by a high-poten­tial can­di­date on a mobile device. Fur­ther­more, high-poten­tials were near­ly two times as like­ly to pre­fer text mes­sages and com­mu­ni­ca­tion through social media (e.g., LinkedIn).

    So, what’s the mes­sage to employ­ers? If you want to attract top tal­ent, then you must uti­lize mobile recruit­ing. Employ­ers can build such a pro­gram by inte­grat­ing all their job search func­tions, such as list­ings, appli­ca­tions, assess­ment tests, etc. on a mobile plat­form. They also need to make it sim­ple and stream­lined. As the arti­cle states, you don’t want a can­di­date who’s a high-poten­tial to skip through your job recruit­ing process due to frustration.

    Read more here …

  • Case Study: Using Data to Identify Healthcare Savings for a Mid-size Manufacturer | California Employee Health Insurance

    March 16, 2016

    Tags: , ,

    His­tor­i­cal­ly, com­pa­nies have strug­gled with the best way to pack­age and deliv­er ben­e­fits to attract tal­ent and retain staff. Today, com­pa­nies under­stand that they need to lever­age a vari­ety of solu­tions to pro­vide mean­ing­ful health­care cov­er­age, pro­mote well­be­ing and mit­i­gate cost. UBA Part­ners offer inno­v­a­tive prod­uct and ser­vice solu­tions to iden­ti­fy med­ical spend waste and improve effi­cient spend, allow­ing employ­ers to rein­vest in the cor­rect resources that will improve employ­ee health. For one mid-sized man­u­fac­tur­er, UBA Part­ner LHD Ben­e­fit Advi­sors used Vital Incite risk scor­ing tools to coor­di­nate efforts between the employ­er HR and C‑suite, the advi­sor and the pop­u­la­tion health consultant.

    Key infor­ma­tion unique to this employer:

    • Japan­ese owned and mul­ti­ple nation­al­i­ties employed with lit­tle knowl­edge of the Amer­i­can health care sys­tem oth­er than in the HR team
    • Man­u­fac­tur­ing com­pa­ny with pre­dom­i­nate­ly male employees
    • Onsite clin­ic opened April 2014 with ini­tial ser­vices includ­ing pri­ma­ry care, phys­i­cal ther­a­py, mas­sage ther­a­py, lab, nurse health coaching
    • Increase in med­ical plan par­tic­i­pa­tion due to grow­ing work­force and rich med­ical plan offered at a low cost to employees.

    Val­ue of what was delivered:

    • Improved risk migra­tion of high/very high risk mem­bers (total pop­u­la­tion and same cohort)
    • Improved effi­cien­cy of med­ical plan uti­liza­tion and improved unit cost
    • Improved care coor­di­na­tion (decreased ER vis­its, decrease in mul­ti­ple med­ica­tions, increase in num­ber of mem­bers with a pri­ma­ry care physician)
    • Tar­get­ed out­reach from onsite clin­ic to improve over­all health of members

    Prob­lem 1: Increase in med­ical plan spend

    Pri­or to the clin­ic open­ing, the med­ical plan saw uti­liza­tion of ER vis­its and imag­ing ser­vices along with asso­ci­at­ed costs above bench­mark. The num­ber of cov­ered lives (employ­ees and spous­es) was also increas­ing as well as the aver­age employ­er paid amount per mem­ber due to high cost uti­liza­tion of an unman­aged work­force. Cur­rent med­ical plans were two low deductible, PPO plans with lit­tle con­sumerism and offered at low cost to employees.

    Prob­lem 2: Low onsite clin­ic utilization

    The first six months the clin­ic was open showed low uti­liza­tion for sev­er­al ser­vices result­ing in the employ­er reduc­ing ser­vices effec­tive Jan­u­ary 1, 2015, through March 31, 2015, to help reduce costs. The sus­pend­ed ser­vices includ­ed patient advo­ca­cy, evening clin­ic hours, reduced health coach­ing hours and phys­i­cal ther­a­py. In order to ful­ly rec­og­nize the ben­e­fit of an onsite clin­ic, employ­ees need­ed eas­i­er access to the clin­ic dur­ing work­ing hours, a bet­ter under­stand­ing of ser­vices pro­vid­ed (i.e. labs, med­ica­tions and nurse coach­ing) and tar­get­ed out­reach to key members.

    Prob­lem 3: Increase in risk migra­tion of mem­ber population

    Data revealed employ­ees car­ried the major­i­ty of the high/very high risk, and risk migra­tion from 2013 to 2014 showed a neu­tral to slight increase (Fig­ure 1). Fur­ther analy­sis showed a high­er than aver­age per­cent­age of untreat­ed chron­ic con­di­tions, includ­ing dia­betes, high cho­les­terol and high blood pres­sure. Cost infor­ma­tion from a dis­ease per­spec­tive showed the poten­tial impact spe­cif­ic dis­ease pro­grams with­in the clin­ic could have on employ­ee health and med­ical cost.

    Risk Distribution - high to very high riskRisk distribution bar chart

    Analy­sis of Avoid­ed Costs

    The data report­ed from the pop­u­la­tion health team was instru­men­tal in devel­op­ing a strat­e­gy to have an impact on the mem­ber pop­u­la­tion and a suc­cess­ful onsite clin­ic. Once there was an under­stand­ing of the prospec­tive risk and impact of chron­ic dis­ease man­age­ment by the employ­er C‑suite, the HR team gained sup­port for the ini­tia­tives devel­oped by the pop­u­la­tion health and HR teams. A key illus­tra­tion (Fig­ure 2) to this point was show­ing a cost avoid­ance cal­cu­la­tion for key ser­vices pro­vid­ed by the onsite clinic.

    Avoided cost calculation

    To learn about the rec­om­mend­ed solu­tions, the imple­men­ta­tion strate­gies, and how data was used to mea­sure results, down­load the full case study.

    Read More…

  • What happens to benefits eligibility during an unpaid leave of absence? | Petaluma Employee Benefits

    March 14, 2016

    Tags: , ,

    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

    Question mark at the computer key

    Ques­tion mark at the com­put­er key

    Ques­tion: If an employ­ee of an applic­a­ble large employ­er takes an unpaid leave of absence (not Fam­i­ly and Med­ical Leave Act), what hap­pens to their ben­e­fit eli­gi­bil­i­ty dur­ing that time?

    Answer: The answer depends on whether the employ­er is using the mea­sure­ment and look­back method of track­ing employ­ees or the month­ly method.

    Mea­sure­ment and look­back: If the employ­ee is on an unpaid leave of absence and in a sta­bil­i­ty peri­od, the employ­ee must be offered cov­er­age through the sta­bil­i­ty peri­od. When the employ­ee’s hours are cal­cu­lat­ed dur­ing the con­tem­po­ra­ne­ous mea­sure­ment peri­od, the leave of absence will count as zero hours of ser­vice. If an employ­ee declined cov­er­age for a sta­bil­i­ty peri­od, and then has a leave of absence that is less than 13 weeks, upon return the employ­er is not oblig­at­ed to make a new offer of cov­er­age to the employee.

    Month­ly: The employ­ee would not be cred­it­ed with hours of ser­vice. Once the employ­ee drops below 30 hours per week for the month, the employ­er does not need to offer coverage.

    Employ­ers should note that unpaid FMLA is han­dled dif­fer­ent­ly and spe­cial rules apply for edu­ca­tion­al institutions.

    Leaves of absence can make it dif­fi­cult for an employ­er to deter­mine if or how an employ­ee counts toward the applic­a­ble large employ­er (ALE) thresh­old of 100, as well as deter­min­ing if an employ­ee is con­sid­ered full time and must be offered cov­er­age. Request UBA’s ACA Advi­sor, “Per­fect Atten­dance! How to Han­dle Leaves of Absence under the ACA” which defines ser­vice hours, excep­tions, meth­ods for count­ing hours, FMLA, USERRA, and jury duty, unpaid leave, lay­offs, dis­abil­i­ty, con­vey­ing poli­cies, deter­min­ing ALE sta­tus, and cred­it­ing hours to employees.

    Read more here …

  • The Debates Continue – and on health care it is getting nasty

    March 11, 2016

    We stay out of the over­all debate – who wins, who los­es is less a con­cern than what works on a prac­ti­cal basis and how it will get through Con­gress, then the admin­is­tra­tors and the mar­ket, etc. It is a lit­tle weird, though…as Don­ald Trump is say­ing the same thing as Bernie Sanders where it con­cerns health care (Sin­gle Pay­er is our prayer, or some­thing like that). Hillary Clin­ton has tak­en aim at Sanders (so is it also a swipe at Trump?), telling sup­port­ers at a ral­ly that he would replace their health insur­ance with some­thing more expen­sive. “He wants to have a new sys­tem that would be quite chal­leng­ing because you would have to give up the insur­ance you have now, and it would cost a lot of money”

  • Life Insurance & Sports | CA Employee Benefits

    March 10, 2016

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    www.lifehappens.org

    BOOTSQues­tion: “Will my sport cause me prob­lems in pur­chas­ing new life insurance?”
    Answer: in most cas­es no, but there are some hob­bies that may be a prob­lem for the under­writ­ers in the insur­ance company.

    Here is a list of sev­en high-risk sports that are prob­lem­at­ic when it comes to get­ting life insurance.

    1. Ice climb­ing. Unlike their moun­tain-climb­ing coun­ter­parts, ice climbers are in con­stant dan­ger of caus­ing a self-inflict­ed stab wound from one of their razor-sharp cram­pons, which is their No. 1 source of injury. Not to men­tion the pos­si­bil­i­ty that the ice they are climb­ing may crack and take them down with it.

    2. Free run­ning. Free run­ning is jump­ing from roof to roof at max­i­mum speed. No ropes, no para­chute, no insur­ance. Free run­ning is prac­ticed in urban areas that fea­ture lots of rail­ings and con­crete walls for par­tic­i­pants to jump, flip and tum­ble over in an acro­bat­ic fash­ion. I call it run, jump, bleed.

    3. Base jump­ing. Talk about insane! I don’t like look­ing down from a tall build­ing, and I cer­tain­ly have no desire to jump into the unknown from any height. Yes, I can remem­ber when I was a kid and want­ed to fly like super­man, but a base jumper? No way. By the way, base-jump­ing is ille­gal in the U.S., unless it’s being per­formed by a pro­fes­sion­al at an event, so not only will you not get insur­ance, but you may end up in jail.

    4. Heli-ski­ing. A ski­er is dropped from a heli­copter onto fresh white pow­der in a remote sec­tion of the moun­tains, a place where there is no oth­er way to get there. There’s a pos­si­bil­i­ty of start­ing an avalanche or falling through an ice patch, and if you do, it may be near impos­si­ble to get rescued.

    5. Street luge. Loose­ly described, this is the equiv­a­lent of lying on your skate­board and hav­ing your friend push you down Lom­bard Street in San Fran­cis­co. Rid­ers on street luge boards can reach 70 mph.

    6. Big-wave surf­ing. Surfers dream of rid­ing the “big” wave and are will­ing to trav­el around the world to catch one, and by big I mean the 50-foot mon­ster. What are the risks? Bro­ken bones, drown­ing, shark attacks. No thanks. I will watch this on TV.

    7. Cliff div­ing. Have you thought about jump­ing off a 90-foot cliff? Into water that will feel like con­crete when you hit it? The biggest issue is not hit­ting the water, because you may hit the side of the cliff on the way down; or slam against the rocks in the ocean below you. You could also break a hip or incur a spinal cord injury by land­ing feet first in the water. If it was me, I would die of a heart attack on the way down.

    So yes, there are sports for which only the very brave or fool­ish should par­tic­i­pate in, but if you do, don’t expect to buy pre­ferred-rat­ed life insur­ance or per­haps any life insurance.

    Read more here …

  • Hacking of health care records coughs up a lot more detail – an 11,000% increase

    March 8, 2016

    I can’t count that high but NBC News announced that “experts say health care record hack­ing is sky­rock­et­ing” and this means that “rough­ly one out of every three Amer­i­cans” have had their health­care records com­pro­mised, which are then sold on the dark web, where com­plete health care records can go for $60 each. I’m sure I bring the aver­age down, but…

  • Best and Worst Health Savings Accounts for Singles, Families | Benefits Broker Petaluma

    March 7, 2016

    Tags: , , , ,

    By Bill Olson
    Chief Mar­ket­ing Offi­cer at Unit­ed Ben­e­fit Advisors

    We’ve just released the lat­est find­ings from the UBA Health Plan Sur­vey relat­ed to how health reim­burse­ment arrange­ments (HRAs) and health sav­ings accounts (HSAs) are being used among employ­ers. (Spoil­er alert: Cal­i­for­nia employ­ers lead the way with the most gen­er­ous account-based plans.)

    So which is far­ing bet­ter in the indus­try, HRAs or HSAs? The answer very much depends on where you are in the coun­try, what indus­try you’re in, and how many employ­ees you have. See our free spe­cial report for all the detailed find­ings.

    At a glance, here are the win­ners and losers when it comes to HSA plans:

    HSAPLANS

    A health reim­burse­ment arrange­ment (HRA) and a health sav­ings account (HSA) have many things in com­mon, but also sev­er­al key dif­fer­ences that define their pur­pose and ben­e­fits. For a clos­er look at the dif­fer­ences and sim­i­lar­i­ties, see the UBA doc­u­ment HRAs, HSAs, and Health FSAs – What’s the Difference?

    Read more here

  • They finally did it – only to be rebuffed (and not surprisingly) Obamacare redux redux redux

    March 4, 2016

    There have been so many attempts they have almost lost count – but it is over 60. Over 60 times the Repub­li­cans have pro­posed leg­is­la­tion to repeal the Afford­able Care Act. In Jan­u­ary they final­ly got enough votes from both the House and the Sen­ate to pass repeal leg­is­la­tion. It went to the President’s desk, which was prompt­ly vetoed. Surprise…but Pres­i­dent Oba­ma said “rather than refight­ing old polit­i­cal bat­tles by once again vot­ing to repeal basic pro­tec­tions that pro­vide secu­ri­ty for the mid­dle class. Mem­bers of Con­gress should be work­ing togeth­er to grow the econ­o­my, strength­en mid­dle class fam­i­lies, and cre­ate new jobs” Well, yeah, but…

  • But there are also new rules on what makes premiums affordable – the rules expand

    March 2, 2016

    Employ­er flex con­tri­bu­tions will reduce the amount of an employee’s pre­mi­um con­tri­bu­tion only if the amount may not be tak­en as cash, is used to pur­chase min­i­mum essen­tial cov­er­age and may only be used for med­ical care (as per IRC Code Sec­tion 213)

    Cash in lieu of ben­e­fits does not apply to the afford­abil­i­ty analysis

    Employ­er con­tri­bu­tions to Health Reim­burse­ment Arrange­ments (HRA) may reduce the employee’s required con­tri­bu­tion for afford­abil­i­ty for the employ­er man­date – thus the amount that an employ­er has agreed to con­tribute to an HRA reduces the amount the employ­ee is deemed to “owe” for their health insur­ance (e.g. $1,200 HRA tech­ni­cal­ly reduces the count­ed pre­mi­um for the employ­ee by $100 per month, even though it does not sup­port the premium)

  • The Team That Eats Together Performs Better | Petaluma Employee Benefits

    February 29, 2016

    Tags: , , , ,

    By Bill Olson
    Chief Mar­ket­ing Offi­cer at Unit­ed Ben­e­fit Advisors

    burgerDo your employ­ees often eat alone? If so, you may be miss­ing an oppor­tu­ni­ty, accord­ing to an arti­cle on the Soci­ety For Human Resource Man­age­men­t’s web­site titled, “Break­ing Bread At Work Boosts Bot­tom Line, Study Claims.

    This goes beyond the sim­ple ques­tion of whether there’s food in the break room. The arti­cle sug­gests that com­mu­nal eat­ing has a marked improve­ment on per­for­mance. Researchers from Cor­nell stud­ied fire depart­ments in a large city and found that those with kitchens where fire­fight­ers ate togeth­er earned high­er marks for their team per­for­mances ver­sus ones who did not.

    Unlike fire depart­ments, most com­pa­nies in the U.S. don’t pro­vide the perk of food at the work­place, whether it’s free or not. A few, such as Apple and Google, do pro­vide food on-site with the goal of offer­ing health­i­er food options as well as reduc­ing dis­trac­tions at work. A side ben­e­fit of this is that eat­ing with cowork­ers pro­motes col­lab­o­ra­tion and the swap­ping of ideas.

    The arti­cle says that while eat­ing at work may seem ordi­nary or even dull, it’s a pow­er­ful activ­i­ty that fos­ters busi­ness objec­tives like improv­ing com­mu­ni­ca­tion among co-work­ers who might not oth­er­wise talk with each oth­er, increas­ing pro­duc­tiv­i­ty due to employ­ees not hav­ing to trav­el off-site for lunch, and even poten­tial­ly low­er­ing health insur­ance costs from the health­i­er choic­es offered at an on-site cafeteria.

    Essen­tial­ly, every­one needs to eat and peo­ple at work have to choose where they eat and whether it’s alone or with cowork­ers. Com­pa­nies can encour­age com­mu­nal eat­ing and forge ahead with new and improved ways of doing business.

    Read More …

  • HRAs, HSAs, and Health FSAs – What’s the Difference? | Employee Benefits CA

    February 25, 2016

    Tags: , , , , , , , , ,

    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

    HSA

    Health reim­burse­ment arrange­ments (HRAs), health sav­ings accounts (HSAs) and health care flex­i­ble spend­ing accounts (HFSAs) are gen­er­al­ly referred to as account-based plans. That is because each par­tic­i­pant has their own account, at least for book­keep­ing pur­pos­es. Under the tax rules, amounts may be con­tributed to these accounts (with cer­tain restric­tions) and used for health care on a tax-favored basis.

    The Patient Pro­tec­tion and Afford­able Care Act (PPACA) has added new require­ments that affect HRAs and HFSAs. Most HFSAs and HRAs will need to be amend­ed to meet the new PPACA require­ments. HSAs gen­er­al­ly are not affect­ed by PPACA.

    The chart below describes the main char­ac­ter­is­tics of these types of accounts.

    hsa2

    To help deter­mine the best option for your par­tic­u­lar sit­u­a­tion, request the UBA PPACA Advi­sor, “HRAs, HSAs, and Health FSAs — What’s the Dif­fer­ence?” for a com­pre­hen­sive chart com­par­ing eli­gi­bil­i­ty cri­te­ria, con­tri­bu­tion rules, reim­burse­ment rules, report­ing require­ments, pri­va­cy require­ments, applic­a­ble fees, non-dis­crim­i­na­tion rules and oth­er char­ac­ter­is­tics of these types of accounts.

    UBA’s Health Plan Sur­vey ana­lyzes a wide range of health care costs trends. To read the full press release announc­ing the lat­est find­ings relat­ed to HSA fund­ing, click here. For all 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 …

  • New penalty amounts – just when you thought it was safe

    February 24, 2016

    So not only does afford­abil­i­ty bare­ly increase while rates are ris­ing, the penal­ties for fail­ure to com­ply have also increased, just as we get start­ed. For cal­en­dar year 2016, Penal­ty A (fail­ure to pro­vide cov­er­age at all) is $180 per month ($2,160 per year) mul­ti­plied by the num­ber of full time employ­ees less 30. For Penal­ty B, which con­cerns offer­ing cov­er­age that does not meet min­i­mum stan­dards or is unaf­ford­able, the penal­ty is $270 per month ($3,240 per year).

  • Webinar Series | Arrow Benefits Group

    February 18, 2016

    Tags: ,

    ubaMore com­plex com­pli­ance reg­u­la­tions and rapid­ly shift­ing ben­e­fits pro­grams pose an increas­ing chal­lenge to employers.

    We, as part of the Unit­ed Ben­e­fit Advi­sors, (UBA) are com­mit­ted to deliv­er­ing knowl­edge that will help sim­pli­fy those com­pli­cat­ed choic­es and improve the effec­tive­ness and suc­cess of your pro­grams. In order to pro­vide edu­ca­tion­al oppor­tu­ni­ties for a broad audi­ence of human resource and ben­e­fits pro­fes­sion­als, we have designed webi­na­r’s to help you with the cur­rent issues affect­ing the ben­e­fits world.

    Each webi­nar is 60 — 90 min­utes and is an excep­tion­al val­ue for only $149. Com­pli­men­ta­ry reg­is­tra­tion is avail­able exclu­sive­ly though us, a UBA affil­i­at­ed Firm.

     

    Tues­day, March 8, 2:00 p.m. ET

    Plan Doc­u­ments 101: Who Needs What and Best Practices

    Video Record­ing from Tues­day, Jan­u­ary 19

    The Fam­i­ly and Med­ical Leave Act: Legal Con­sid­er­a­tions for Employers

     

    Most of our webi­na­rs have been sent for approval by the Human Resource Cer­ti­fi­ca­tion Insti­tute to qual­i­fy for re-cer­ti­fi­ca­tion cred­it hours.

    Con­tact us today to find out more and to register:

    [email protected]

  • New safe harbors – the law is barely in place and the ACA amounts have changed

    February 17, 2016

    The def­i­n­i­tion of “afford­abil­i­ty” for a health plan is one where the amount an employ­ee pays for just their por­tion of the cov­er­age at a lev­el not to exceed 9.5%. This was increased last year and is now increas­ing again to 9.66% So employ­ers get a break…sort of…as med­ical rate increas­es are at least 6% for the year and in two years the IRS has increased the thresh­old by a whop­ping 0.16% Thanks….

  • Top 10 Questions about the Minimum Value Penalty | California Employee Benefits

    February 16, 2016

    Tags: , , , ,

    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

    10QuestionsAn employ­er that offers min­i­mum essen­tial cov­er­age to sub­stan­tial­ly all of its full-time employ­ees may still owe penal­ties if the cov­er­age it offers is inad­e­quate because it is not “afford­able” or it does not pro­vide “min­i­mum val­ue.” It also may owe penal­ties on the employ­ees it does not offer cov­er­age to who receive a pre­mi­um subsidy.

    Here we answer the top 10 ques­tions relat­ed to min­i­mum val­ue penal­ties based on the IRS’s final reg­u­la­tion. More on min­i­mum val­ue can be found in our blogs on ACA Penal­ties, Tax­es and Fees and on Min­i­mum Val­ue. Com­pre­hen­sive answers to 120 ques­tions relat­ed to the play-or-pay penal­ty and count­ing employ­ees under ACA can be found in our ACA Advi­sor on Play or Pay and Count­ing Employ­ees.

    Q1: What is “min­i­mum val­ue” coverage?
    A1: Cov­er­age is “min­i­mum val­ue” if the cov­er­age is expect­ed to pay at least 60 per­cent of cov­ered claims costs. It must pro­vide sub­stan­tial cov­er­age for inpa­tient hos­pi­tal and physi­cians’ services.

    Ful­ly insured plans pro­vid­ed to small groups must pro­vide cov­er­age at bronze lev­el, or bet­ter. Bronze lev­el is an actu­ar­i­al val­ue of approx­i­mate­ly 60 per­cent, and those plans are auto­mat­i­cal­ly con­sid­ered to pro­vide min­i­mum value.

    The gov­ern­ment has pro­vid­ed a cal­cu­la­tor and sev­er­al safe har­bor plan designs to assist large insured plans and self-fund­ed plans with their min­i­mum val­ue determinations.

    Q2: May an employ­er use well­ness incen­tives when deter­min­ing min­i­mum value?
    A2: The employ­er may use non-smok­ing incen­tives when deter­min­ing min­i­mum val­ue if non-smok­ing incen­tives are used to reduce cost-shar­ing (deductibles, coin­sur­ance, copays, or the out-of-pock­et max­i­mum). If non-smok­ing incen­tives are avail­able to reduce cost-shar­ing, essen­tial­ly the employ­er may assume that all employ­ees qual­i­fy for the non-smok­er incen­tive. All oth­er well­ness incen­tives must be disregarded.

    Q3: May an employ­er use HRA con­tri­bu­tions when deter­min­ing min­i­mum value?
    A3: When deter­min­ing min­i­mum val­ue, an employ­er may apply HRA con­tri­bu­tions for the cur­rent year if those con­tri­bu­tions may only be used by employ­ees for cost-shar­ing. (Cost-shar­ing gen­er­al­ly means deductibles, coin­sur­ance, or copays.)

    Q4: May an employ­er use HSA con­tri­bu­tions when deter­min­ing min­i­mum value?
    A4: When deter­min­ing whether cov­er­age is afford­able, an employ­er’s con­tri­bu­tions to an HSA may be con­sid­ered as a first-dol­lar benefit.

    Q5: What is the penal­ty for not offer­ing afford­able, min­i­mum val­ue coverage?
    A5: The penal­ty is $250 per month ($3,000 per year, indexed) for each full-time employ­ee who:

    • Is not offered cov­er­age that is both min­i­mum val­ue and afford­able cov­er­age, and
    • Pur­chas­es cov­er­age through a gov­ern­ment Mar­ket­place, and
    • Is eli­gi­ble for a pre­mi­um tax credit/subsidy (so his house­hold income must be below 400 per­cent of fed­er­al pover­ty level).

    Exam­ple: Jones, Inc. has 55 full-time employ­ees and eight part-time employ­ees. Jones offers cov­er­age that is min­i­mum val­ue for all employ­ees, but which is not afford­able for 10 of the full-time employ­ees (nine of whom buy cov­er­age through the Mar­ket­place) and all of the part-time employ­ees (all eight buy through the Mar­ket­place). Sev­en of the nine full-time employ­ees and six of the eight part-time employ­ees who buy through the Mar­ket­place qual­i­fy for a pre­mi­um tax credit.

    Jones owes a penal­ty on each full-time employ­ee who enrolls in a Mar­ket­place plan and receives a pre­mi­um tax cred­it, so Jones owes $21,000 ($250 per month for each of the sev­en full-time employ­ees who receive a pre­mi­um cred­it; the part-time employ­ees are not counted).

    Note that the first 30 (or 80) employ­ees do count under this “inad­e­quate cov­er­age” penal­ty. Also, if the “no offer” penal­ty would be less expen­sive than the “inad­e­quate cov­er­age” penal­ty, the employ­er would pay the “no offer” penalty.

    Q6: Does the employ­er owe a penal­ty if the employ­ee declines afford­able, min­i­mum val­ue cov­er­age offered by the employ­er and buys cov­er­age through the Mar­ket­place instead?
    A6: No. The employ­er sim­ply has to offer afford­able, min­i­mum val­ue cov­er­age. (Specif­i­cal­ly, the least expen­sive plan that pro­vides min­i­mum val­ue cov­er­age must be afford­able based on the cost of self-only cov­er­age.) If the employ­ee choos­es to obtain cov­er­age through the Mar­ket­place, he or she can, but the employ­ee will not be eli­gi­ble for a pre­mi­um tax credit/subsidy and there­fore the employ­er will not owe a penalty.

    Q7: Does the employ­er owe a penal­ty if the employ­er offers min­i­mum essen­tial cov­er­age that is not afford­able and min­i­mum val­ue cov­er­age to an employ­ee who would be eli­gi­ble for a pre­mi­um tax credit/subsidy, but the employ­ee choos­es to enroll in the employ­er’s plan?
    A7: No. If the employ­ee choos­es to obtain cov­er­age through his or her employ­er instead of through the Mar­ket­place, the employ­ee can, but he or she will usu­al­ly not be eli­gi­ble for a pre­mi­um tax credit/subsidy and there­fore the employ­er will not owe a penalty.

    Q8: Is it pos­si­ble for an employ­ee to qual­i­fy for a pre­mi­um tax credit/subsidy even though his or her employ­er offers afford­able coverage?
    A8: Yes. If the cost of self-only cov­er­age through the Mar­ket­place is more than 9.5 per­cent (indexed to 9.56 per­cent in 2015, and 9.66 per­cent in 2016) of an employ­ee’s actu­al house­hold income, an employ­ee could be eli­gi­ble for the sub­sidy even though the cov­er­age offered by his or her employ­er is afford­able under one of the three safe har­bors. This will be a fair­ly unusu­al occur­rence, but could hap­pen because cer­tain deduc­tions are allowed when deter­min­ing house­hold income.

    Q9: Must all plan options pro­vide afford­able, min­i­mum val­ue coverage?
    A9: No. Only the low­est cost option that pro­vides min­i­mum val­ue cov­er­age needs to be afford­able to avoid the penal­ty. An employ­er is free to offer oth­er options that do not meet affordability.

    Q10: Are there spe­cial rules for mul­ti­em­ploy­er plans?
    A10: Yes. If the employ­er is required to make a con­tri­bu­tion to a mul­ti­em­ploy­er plan with respect to some or all of its employ­ees under a col­lec­tive bar­gain­ing agree­ment or relat­ed par­tic­i­pa­tion agree­ment and the mul­ti­em­ploy­er plan offers afford­able, min­i­mum val­ue cov­er­age to eli­gi­ble employ­ees, the employ­er will be con­sid­ered to have offered afford­able, min­i­mum val­ue cov­er­age. In addi­tion to the three afford­abil­i­ty safe har­bors, cov­er­age under a mul­ti­em­ploy­er plan is con­sid­ered afford­able if the employ­ee’s con­tri­bu­tion toward self-only cov­er­age does not exceed 9.5 per­cent (indexed to 9.56 per­cent in 2015, and 9.66 per­cent in 2016) of the wages report­ed to the mul­ti­em­ploy­er plan, based on either actu­al wages or an hourly wage rate under the bar­gain­ing agreement.

    Deter­min­ing how many employ­ees you have under ACA is crit­i­cal to avoid­ing penal­ties. Request UBA’s com­pre­hen­sive ACA Advi­sor that answers over 120 ques­tions relat­ed to the play or pay penal­ty and count­ing employ­ees under ACA, including:

    • The def­i­n­i­tions of full time employees
    • How to count part-time employ­ees on a pro-rata basis
    • How to treat sea­son­al employees
    • Who the law con­sid­ers an “employ­ee”
    • Count­ing hours correctly
    • Deter­min­ing aver­age hours worked
    • Penal­ties that result if a “large employ­er” does­n’t offer coverage

    Read More …

  • Minimum Value: HRA Contributions and Flex Credits | California Benefits Broker

    February 11, 2016

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    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

    HRAContributionsThe Inter­nal Rev­enue Ser­vice (IRS) recent­ly issued a final rule that clar­i­fies var­i­ous top­ics relat­ing to the Patient Pro­tec­tion and Afford­able Care Act (ACA) and pre­mi­um tax cred­it eli­gi­bil­i­ty pro­vi­sions. Mir­ror­ing guid­ance from IRS Notice 2015–87, the final rule clar­i­fies that health reim­burse­ment arrange­ment (HRA) con­tri­bu­tions by an employ­er that may be used to pay pre­mi­ums for an eli­gi­ble employ­er spon­sored plan are count­ed toward the employ­ee’s required con­tri­bu­tion, sub­se­quent­ly reduc­ing the amount required for their contribution.

    Sim­i­lar­ly, an employ­er’s flex con­tri­bu­tions to a cafe­te­ria plan can reduce the amount of the employ­ee por­tion of the pre­mi­um so long as the employ­ee may not opt to receive the amount as a tax­able ben­e­fit, the flex cred­it may be used to pay for the min­i­mum essen­tial cov­er­age (MEC), and the employ­ee may use the amount only to pay for med­ical care. If the flex con­tri­bu­tion can be used to pay for non-health care ben­e­fits (such as depen­dent care), it could not be used to reduce the amount of the employ­ee pre­mi­um for afford­abil­i­ty pur­pos­es. Fur­ther­more, if an employ­ee is pro­vid­ed with a flex con­tri­bu­tion that may be used for health expens­es, but may be used for non-health ben­e­fits, and is designed so an employ­ee who elects the employ­er health plan must forego any of the flex plan’s non-health ben­e­fits, those flex ben­e­fits may not be used to reduce the employ­ee’s pre­mi­um for afford­abil­i­ty purposes.

    Down­load UBA’s ACA Advi­sor for an expla­na­tion of min­i­mum val­ue rules relat­ed to child income, well­ness incen­tives, con­tin­u­a­tion cov­er­age, and mid-month enrollment.

    Read More …

  • Obamacare will save money…no wait…its elimination will save money – huh?

    February 10, 2016

    The Con­gres­sion­al Bud­get Office is an objec­tive means for Con­gress to deter­mine the cost effect of var­i­ous pieces of leg­is­la­tion. Unfor­tu­nate­ly, it has weighed in too often and with even con­tra­dic­to­ry assess­ments of the poten­tial cost of the Afford­able Care Act. Now on the cusp of Con­gres­sion­al action to dra­mat­i­cal­ly change or even elim­i­nate the ACA, the CBO has now said that the GOP led effort for change would cost $42 bil­lion less than pre­vi­ous­ly expect­ed and save more than half a tril­lion (yes tril­lion) over ten years. Of course, that is what they said about the pas­sage of the ACA in the first place, so…

  • IRS Updates FAQs Related to 6055/6056 Reporting | Petaluma Employee Benefits

    February 8, 2016

    Tags: , , , , , , ,

    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

    IRSUpdatesThe long-stand­ing IRS FAQs relat­ed to report­ing under sec­tions 6055 and 6056 on require­ments pro­vid­ed by the Patient Pro­tec­tion and Afford­able Care Act (ACA) have been updat­ed to reflect new infor­ma­tion. Final instruc­tions for both the 1094‑B and 1095‑B and the 1094‑C and 1095‑C were released in Sep­tem­ber 2015, as were the final forms for 1094‑B, 1095‑B, 1094‑C, and 1095‑C. On Decem­ber 28, 2015, in Notice 2016-04, the IRS extend­ed the infor­ma­tion report­ing due dates for insur­ers, self-insur­ing employ­ers, oth­er health cov­er­age providers and applic­a­ble large employ­ers. The updat­ed FAQs take the infor­ma­tion from Notice 2016-04 into account.

    The 6056 FAQ, which dis­cuss­es infor­ma­tion report­ing for applic­a­ble large employ­ers (ALEs), and the 6055 FAQ, which dis­cuss­es report­ing on min­i­mum essen­tial cov­er­age (MEC), clar­i­fy that the dead­lines for fix­ing mis­takes on forms has been extend­ed due to the over­all exten­sion for infor­ma­tion report­ing. For state­ments fur­nished to indi­vid­u­als under sec­tions 6055 and 6056, any fail­ures that report­ing enti­ties cor­rect by April 30 and Octo­ber 1, 2016, respec­tive­ly, will be sub­ject to reduced penalties.

    The 6056 FAQ also clar­i­fied that an employ­er may only issue one 1095‑C per full-time employee.

    UBA offers key resources to help employ­ers under­stand the report­ing pro­vi­sions con­tained in the IRS FAQs and notices:

    Final Forms and Instruc­tions for Employ­er and Indi­vid­ual Shared Respon­si­bil­i­ty Report­ing Forms: Employ­ers with 50 or more full-time or full-time equiv­a­lent employ­ees and insur­ers are now required to report on the health cov­er­age they offer. This ACA Advi­sor has com­pre­hen­sive infor­ma­tion on what forms to use for employ­ees, fil­ing dates, respon­si­ble par­ties and forms to be sent to the IRS, includ­ing sam­ple situations.

    Tem­plate Let­ter to Employ­ees about IRS Forms 1095‑B and 1095‑C: UBA has cre­at­ed a tem­plate let­ter that employ­ers may use to draft writ­ten com­mu­ni­ca­tion to employ­ees regard­ing what to expect in rela­tion to IRS Forms 1095‑B and 1095‑C, and what employ­ees should do with a form or forms they receive. The tem­plate is meant to be adjustable so employ­ers can add per­ti­nent addi­tion­al information.

    IRS Pro­vides Major Delay in 6055 and 6056 Report­ing: This ACA Advi­sor explains the recent due date exten­sions, the exten­sion process and the impact on employees.

    Read Mpre …

  • Employee Benefit Compliance Checkup | Arrow Benefits Group

    January 19, 2016

    More and more orga­ni­za­tions are pres­sured to have their employ­ee ben­e­fit plans ful­ly com­pli­ant with all employ­ee ben­e­fit laws (Afford­able Care Act (ACA), ERISA, COBRA, HIPAA, etc.) or face fines, penal­ties, and loss of tax favor­able sta­tus or even crim­i­nal charges. The Employ­ee Ben­e­fits Secu­ri­ty Admin­is­tra­tion (EBSA), a divi­sion of the Depart­ment of Labor (DOL), has been con­duct­ing exten­sive ERISA audits on pen­sion and wel­fare ben­e­fit plans and show no signs of let­ting up.

    In this arti­cle, we cov­er crit­i­cal areas of con­sid­er­a­tion in keep­ing your health and wel­fare ben­e­fit plans ful­ly com­pli­ant. We do not cov­er com­pli­ance for retirement/pension plans or required ben­e­fit plans such as social secu­ri­ty tax­es, unem­ploy­ment, work­ers com­pen­sa­tion or disability.

    Plan Admin­is­tra­tors
    All plan admin­is­tra­tors and indi­vid­u­als man­ag­ing ben­e­fits must fol­low judi­cia­ry require­ments, look­ing out for the best inter­ests of par­tic­i­pants while man­ag­ing plans to com­ply with all require­ments and must fol­low these fidu­cia­ry requirements:
    • Mak­ing sure par­tic­i­pants receive promised benefits;
    • Estab­lish and main­tain plans in a fair and finan­cial­ly sound manner;
    • Man­age plans for the exclu­sive ben­e­fit of par­tic­i­pants and beneficiaries;
    • Car­ry out their duties in a pru­dent man­ner and refrain from con­flict of interest;
    • Fund ben­e­fits in accor­dance with the law and plan rules;
    • Report and dis­close infor­ma­tion on the oper­a­tions and finan­cial con­di­tion of plans to the gov­ern­ment and par­tic­i­pants; and
    • Pro­vide doc­u­ments required in the con­duct of inves­ti­ga­tions to ensure com­pli­ance with the law.

    Fidu­cia­ry Bond
    If the plan administrator’s duty or activ­i­ty cre­ates a risk in which funds or prop­er­ty could be lost due to fraud, they may be required to main­tain a fidu­cia­ry bond. If they have phys­i­cal con­tact with cash or checks, includ­ing access to a safe deposit box, pow­er of cus­tody or pow­er to trans­fer prop­er­ty, they may need a fidu­cia­ry bond.

    Employ­ers with insured plans usu­al­ly are not sub­ject to the bond­ing require­ments for those plans. No bond­ing is required when pre­mi­ums or oth­er pay­ments made to pur­chase ben­e­fits, includ­ing health ben­e­fits, are paid direct­ly from the employer’s gen­er­al assets to an insur­ance carrier.

    Dis­clo­sure and Noti­fi­ca­tion Requirements
    There are numer­ous noti­fi­ca­tions that are required, based on ben­e­fits offered and the num­ber of employ­ees. Below is a sum­ma­ry of the var­i­ous noti­fi­ca­tion requirements.

    Sum­ma­ry of Ben­e­fits & Cov­er­age (SBC)
    Plan admin­is­tra­tor or issuer must pro­vide a uni­form sum­ma­ry of ben­e­fits and cov­er­age to par­tic­i­pants and ben­e­fi­cia­ries in med­ical insur­ance upon appli­ca­tion for cov­er­age and at renew­al. Plan admin­is­tra­tors and issuers must also pro­vide a 60-day advance notice of mate­r­i­al changes to the sum­ma­ry that take place mid-plan year. Plans and issuers must begin pro­vid­ing the sum­ma­ry to par­tic­i­pants and ben­e­fi­cia­ries who enroll or re-enroll in plans. The SBC is typ­i­cal­ly cre­at­ed by insur­ance providers or third par­ty admin­is­tra­tors and dis­trib­uted by the employer.

    Notice of Patent Pro­tec­tions and Selec­tion of Providers. (All who offer med­ical insurance)
    Plan admin­is­tra­tors or issuers must pro­vide a notice of patient pro­tec­tions and selec­tion of providers when­ev­er the sum­ma­ry plan descrip­tion (SPD) or sim­i­lar descrip­tion of ben­e­fits is pro­vid­ed to a par­tic­i­pant. These pro­vi­sions relate to the choice of a health care pro­fes­sion­al and ben­e­fits for emer­gency services.

    Grand­fa­thered Plan Disclosure/Notice (Only grand­fa­thered plans)
    Orga­ni­za­tions who offer a grand­fa­thered plan are required to pro­vide par­tic­i­pants with a spe­cial grand­fa­ther notice peri­od­i­cal­ly with mate­ri­als describ­ing plan ben­e­fits. These types of plans seem to be phas­ing out, with few­er and few­er employ­ers offer­ing grand­fa­thered plans.

    Men­tal Health Par­i­ty and Addic­tion Equi­ty Act (MHPAEA) Notice (50+ employees)
    The MHPAEA applies to group health plans offer­ing men­tal health and sub­stance use dis­or­der ben­e­fits who have 50 or more employ­ees. The MHPAEA impos­es par­i­ty require­ments on group health plans that pro­vide ben­e­fits for men­tal health or sub­stance use dis­or­der ben­e­fits. For exam­ple, plans must offer the same access to care and patient costs for men­tal health and sub­stance use dis­or­der ben­e­fits as those that apply to gen­er­al med­ical or sur­gi­cal benefits.

    Health Care Reform – Employ­ee Notice of Exchange (All employers)
    The Employ­ee Notice of Exchange require­ment applies to all employ­ers who are sub­ject to the Fair Labor Stan­dards Act (FLSA). Employ­ers are required to pro­vide all new hires and cur­rent employ­ees with a writ­ten notice about the health care reform law’s health insur­ance exchanges (Exchanges). This notice is designed to inform employ­ees about the exis­tence of the Exchange and give a descrip­tion of the ser­vices pro­vid­ed by the Exchange. It explains how employ­ees may be eli­gi­ble for a pre­mi­um tax cred­it or a cost-shar­ing reduc­tion if the employ­er’s plan does not meet cer­tain require­ments. It informs employ­ees that if they pur­chase cov­er­age through the Exchange, they may lose any employ­er con­tri­bu­tion toward the cost of employ­er-pro­vid­ed cov­er­age, and that all or a por­tion of this employ­er con­tri­bu­tion may be exclud­able for fed­er­al income tax pur­pos­es. Final­ly, the notice includes con­tact infor­ma­tion for the Exchange and an expla­na­tion of appeal rights. Pro­vide this notice to all employ­ees regard­less of whether or not they are on the med­ical insur­ance plan at least one time.

    COBRA Notices (20+ employees)
    Under the Con­sol­i­dat­ed Omnibus Bud­get Rec­on­cil­i­a­tion Act (COBRA), group health plans spon­sored by an employ­er with at least 20 employ­ees must pro­vide var­i­ous notices to par­tic­i­pants. Orga­ni­za­tions must pro­vide each cov­ered employ­ee and cov­ered spouse and depen­dents (if any) with writ­ten notice of their indi­vid­ual COBRA con­tin­u­a­tion cov­er­age rights under the plan. These notices must be pro­vid­ed with­in 90-days of begin­ning cov­er­age and writ­ten in plain lan­guage so that the aver­age par­tic­i­pant can understand.

    Send an Ini­tial COBRA notice inform­ing par­tic­i­pants of COBRA rights and the need for them to noti­fy the employ­er any­time a spe­cial a qual­i­fy­ing event occurs for which you may not know oth­er­wise such as divorce, or child turn­ing 26 year’s old.

    Send a COBRA Elec­tion Notice or Qual­i­fy­ing Event Notice with­in 14-days of a qual­i­fy­ing event such as ter­mi­na­tion of employment.

    Oth­er COBRA notices may apply if par­tic­i­pants are no longer eli­gi­ble, are late on a pay­ment or the employ­er is ter­mi­nat­ing the med­ical plan.

    Note: Employ­ers with less than 20 employ­ees may be sub­ject to state con­tin­u­a­tion require­ments. Con­tact your state insur­ance com­mis­sion or state labor depart­ment for more information.

    Qual­i­fied Med­ical Child Sup­port Order Receipt and Deter­mi­na­tion Letters
    (All who offer med­ical coverage)
    Group health plans are required to estab­lish writ­ten pro­ce­dures for deter­min­ing the qual­i­fi­ca­tion of a Med­ical Child Sup­port Order. The employ­er respond to an order is required with­in 20 busi­ness days of the date of the Notice.

    HIPAA Cer­tifi­cate of Cred­itable Coverage
    (Any employ­er offer­ing med­ical coverage)
    A par­tic­i­pant or ben­e­fi­cia­ry is enti­tled to demon­strate pri­or cred­itable cov­er­age under an ear­li­er plan, to reduce the amount of time for which a cur­rent health plan can impose exclu­sions based on a pre­ex­ist­ing con­di­tion. The par­tic­i­pant or ben­e­fi­cia­ry may obtain a cer­tifi­cate of cred­itable cov­er­age from the plan spon­sor or insur­er that pro­vid­ed ben­e­fits previously.

    HIPAA Pri­va­cy Poli­cies and Practices
    (Any plan with pro­tect­ed health infor­ma­tion (PHI))
    Health Plans are required to estab­lish writ­ten pri­va­cy poli­cies and pro­ce­dures regard­ing pro­tect­ed health infor­ma­tion (PHI). Poli­cies should include: 1) Per­mit­ted uses and dis­clo­sures, 2) Autho­riza­tion require­ment for oth­er uses and dis­clo­sures, 3) Des­ig­na­tion of pri­va­cy offi­cial, and pri­va­cy con­tact, 4) Sanc­tions for vio­la­tions, 5) Pri­va­cy safe­guards, 6) Com­plaints pro­ce­dure, 7) Pro­hi­bi­tion of retal­i­a­tion and waiv­er of rights, 8) Doc­u­men­ta­tion and record reten­tion, and 9) Busi­ness Asso­ciates agree­ments. HIPAA notice must be pro­vid­ed to par­tic­i­pants at time of enroll­ment and with­in 60-days of a mate­r­i­al change.

    HIPAA Secu­ri­ty Poli­cies and Practices
    Plans that store, receive or trans­mit PHI are required to estab­lish writ­ten poli­cies and pro­ce­dures regard­ing the main­tain­ing and trans­mis­sion of PHI. Busi­ness Asso­ciates agree­ments may need to be amend­ed. Ful­ly insured plans are excluded.

    Notice of Spe­cial Enroll­ment Rights (All med­ical plans)
    Admin­is­tra­tors are to noti­fy eli­gi­ble par­tic­i­pants of spe­cial enroll­ment rights when offered the oppor­tu­ni­ty to enroll in group health insur­ance, includ­ing a descrip­tion of spe­cial enroll­ment events and enroll­ment pro­ce­dures (e.g. birth, adop­tion, mar­riage, etc.).

    Medicare Part D Notice of Cred­itable Cov­er­age (All who offer plans with pre­scrip­tion drugs)
    The Medicare Part D require­ments apply to group health plan spon­sors that pro­vide pre­scrip­tion drug cov­er­age to indi­vid­u­als who are eli­gi­ble for Medicare Part D cov­er­age. Medicare Part D requires a dis­clo­sure notice must be pro­vid­ed to Medicare Part D eli­gi­ble indi­vid­u­als who are cov­ered by, or apply for, pre­scrip­tion drug cov­er­age under the employer’s health plan. It must be pro­vid­ed at cer­tain times, includ­ing before the Medicare Part D Annu­al Coor­di­nat­ed Elec­tion Peri­od (Octo­ber 15 through Decem­ber 7 of each year). Because of the dif­fi­cul­ty in know­ing if an employ­ee or their depen­dents qual­i­ty, it is rec­om­mend­ed to pro­vide this notice to the employ­ee and depen­dents annually.

    Employ­ers must dis­close to the Cen­ters for Medicare and Med­ic­aid Ser­vices (CMS) whether the plan’s cov­er­age is cred­itable on an annu­al basis (with­in 60-days after the begin­ning of the plan year) and upon any change that affects the plan’s cred­itable cov­er­age status.

    Women’s Health Act Notice (All offer­ing these benefits)
    Plans that pro­vide med­ical and sur­gi­cal mas­tec­to­my ben­e­fits are required to noti­fy par­tic­i­pants that such ben­e­fits are avail­able. This notice must be pro­vid­ed to par­tic­i­pants upon enroll­ment and annually.

    New­borns’ and Moth­ers’ Health Pro­tec­tion Act (All who offer maternity)
    If the plan pro­vides mater­ni­ty or new­born infant cov­er­age, a state­ment that a stay for a nor­mal deliv­ery must be no less than 48 hours and 96 hours for a cesare­an sec­tion should be pro­vid­ed annually.

    Children’s Health Insur­ance Pro­gram (CHIP) Reau­tho­riza­tion Act Notice (All who offer med­ical insur­ance in a state where CHIP is offered)
    The CHIPRA require­ments applies to employ­ers that main­tain group health plans in states that pro­vide pre­mi­um assis­tance sub­si­dies under a Med­ic­aid plan or CHIP. This noti­fies employ­ees of poten­tial oppor­tu­ni­ties cur­rent­ly avail­able in the state in which the employ­ee resides for pre­mi­um assis­tance under Med­ic­aid and CHIP for health cov­er­age of the employ­ee or the employee’s depen­dents. Employ­ers that main­tain a group health plan in a state that pro­vides med­ical assis­tance under a state Med­ic­aid plan or CHIP must dis­trib­ute the notice to par­tic­i­pants upon enroll­ment and annually.

    Sum­ma­ry Plan Descrip­tion (SPD) or SPD Wrap (All who offer ERISA cov­ered plans)
    The SPD informs par­tic­i­pants and ben­e­fi­cia­ries of their rights and oblig­a­tions under the plan. It must be writ­ten in a man­ner under­stand­able to the aver­age par­tic­i­pant. This is gen­er­al­ly more than is pro­vid­ed by the insur­ance com­pa­ny and must be pro­vid­ed for all ERISA cov­ered ben­e­fits (i.e. med­ical, den­tal, vision, life, dis­abil­i­ty, HRA, FSA, POP, etc.). Gen­er­al­ly, ben­e­fits where the employ­ers share in the cost, endorse the plan or allow the plan to run through a 125 Plan pay­ing for pre­mi­ums on a pre-tax basis would be con­sid­ered cov­ered by ERISA and would require an SPD. Orga­ni­za­tions exclud­ed from this require­ment include gov­ern­ment plans, pub­lic schools and churches.

    An SPD must include the fol­low­ing: plan name; employer/sponsor name; EIN; type of plan; type of admin­is­tra­tion; plan administrator’s name, address, tele­phone num­ber; name of per­son des­ig­nat­ed as agent for ser­vice of legal process; plan year; plan eli­gi­bil­i­ty require­ments; descrip­tion of ben­e­fits; infor­ma­tion regard­ing plan con­tri­bu­tions and fund­ing; infor­ma­tion regard­ing claims and pro­ce­dures; and a state­ment of ERISA rights.

    A com­mon approach is to use an SPD Wrap that cre­ates one over­all SPD wrap­ping in all cov­ered ben­e­fit plans, pulling in the miss­ing insur­ance com­pa­ny infor­ma­tion. SPD Wraps may include the plan doc­u­ment and the SPD in the same doc­u­ment or they can be separate.

    Sum­ma­ry of Mate­r­i­al Reduc­tion Notice
    (All ERISA ben­e­fit plans)
    Any mod­i­fi­ca­tion in the terms of the plan that is a “mate­r­i­al reduc­tion” in cov­ered ser­vices or ben­e­fits must be fur­nished to par­tic­i­pants no lat­er than 60-days after the date of adop­tion of the reduc­tion. A reduc­tion in cov­ered ser­vices or ben­e­fits gen­er­al­ly will include any plan mod­i­fi­ca­tion or change that:
    • Elim­i­nates ben­e­fits payable under the plan;
    • Reduces ben­e­fits payable under the plan;
    • Increas­es pre­mi­ums, deductibles, coin­sur­ance, copay­ments or oth­er amounts to be paid by a par­tic­i­pant or beneficiary;
    • Reduces the ser­vice area cov­ered by a health main­te­nance orga­ni­za­tion; or
    • Estab­lish­es new con­di­tions or require­ments (e.g., preau­tho­riza­tion require­ments) to obtain­ing ser­vices or ben­e­fits under the plan.

    Sum­ma­ry of Mate­r­i­al Modification
    (All ERISA ben­e­fit plans)
    Any mod­i­fi­ca­tion in the terms of the plan that is “mate­r­i­al” and any change in the infor­ma­tion required to be in the SPD, must be report­ed to plan par­tic­i­pants with­in 210 days after the end of the plan year in which a mod­i­fi­ca­tion or change is adopted.

    Oth­er ben­e­fit laws

    Genet­ic Infor­ma­tion Nondis­crim­i­na­tion Act (GINA) (All employers)
    GINA pro­hibits health plans and health insur­ance issuers from dis­crim­i­nat­ing based on genet­ic infor­ma­tion. GINA gen­er­al­ly pro­hibits group health plans and health insur­ance issuers from: (1) adjust­ing group pre­mi­um or con­tri­bu­tion amounts on the basis of genet­ic infor­ma­tion; (2) request­ing or requir­ing an indi­vid­ual or an indi­vid­u­al’s fam­i­ly mem­bers to under­go a genet­ic test; and (3) col­lect­ing genet­ic infor­ma­tion, either for under­writ­ing pur­pos­es or pri­or to or in con­nec­tion with enrollment.

    Fam­i­ly and Med­ical Leave Act (FMLA) (50+ size groups)
    The FMLA pro­vides eli­gi­ble employ­ees with job-pro­tect­ed leave for cer­tain fam­i­ly and med­ical rea­sons or mil­i­tary exi­gency sit­u­a­tions. An employ­er must main­tain group health cov­er­age dur­ing the FMLA leave at the lev­el and under the con­di­tions that cov­er­age would have been pro­vid­ed if the employ­ee had not tak­en leave.

    The FMLA requires employ­ers to pro­vide the fol­low­ing notices/disclosures:
    1. Gen­er­al Notice – Cov­ered employ­ers must promi­nent­ly post a gen­er­al FMLA notice where it can be read­i­ly seen by employ­ees and appli­cants for employ­ment. If the employ­er has any FMLA-eli­gi­ble employ­ees, it must also include the gen­er­al notice in the employ­ee hand­book or oth­er writ­ten employ­ee guid­ance or dis­trib­ute a copy of the notice to each employ­ee upon hiring.
    2. Eligibility/Rights and Respon­si­bil­i­ties Notice – Writ­ten guid­ance must be pro­vid­ed to an employ­ee when he or she noti­fies the employ­er of the need for FMLA leave. The employ­er must detail the spe­cif­ic expec­ta­tions and oblig­a­tions of the employ­ee, and explain the con­se­quences for fail­ing to meet these obligations.
    3. Des­ig­na­tion Notice – After the employ­er has suf­fi­cient infor­ma­tion, it must pro­vide a des­ig­na­tion notice inform­ing the employ­ee whether the leave is des­ig­nat­ed as FMLA leave. Mod­el forms from the DOL are avail­able at: dol.gov/whd/fmla/index.htm

    Report­ing Requirements

    Form 5500 (100+ participants)
    Plan admin­is­tra­tors must report spec­i­fied plan infor­ma­tion to the Depart­ment of Labor each year. Fringe ben­e­fit plans and wel­fare plans with less than 100 par­tic­i­pants at the begin­ning of the plan year that are unfund­ed, ful­ly insured or a com­bi­na­tion of both are not required to file the form. Form 5500 must be sub­mit­ted to the Employ­ee Ben­e­fits Secu­ri­ty Admin­is­tra­tion (EBSA) by the last day of the 7th month fol­low­ing the end of the plan year. Applic­a­ble sched­ules (i.e., Sched­ule A, C, H or I) may need to be attached. Employ­ers using an SPD Wrap doc­u­ment would sub­mit one 5500 report for the SPD Wrap, instead of sub­mit­ting one for each ben­e­fit plan.

    Sum­ma­ry Annu­al Report (SAR) (If filed 5500 report)
    The SAR sum­ma­rizes the form 5500 finan­cial infor­ma­tion as a nar­ra­tive sum­ma­ry of the Form 5500, and includes a state­ment of the right to receive a copy of the plan’s annu­al report. The SAR must gen­er­al­ly be pro­vid­ed with­in nine months after the end of the plan year to par­tic­i­pants and beneficiaries.

    Health Care Reform – W‑2 Report­ing (250 Employ­ee Size Groups)
    The Form W‑2 report­ing oblig­a­tion applies to employ­ers spon­sor­ing group health plans who have 250 or more W‑2 forms the pri­or year.

    Employ­ers must dis­close the aggre­gate cost of employ­er-spon­sored cov­er­age pro­vid­ed to employ­ees on the employ­ees’ W‑2 Forms. The pur­pose of the report­ing require­ment is to pro­vide infor­ma­tion to employ­ees regard­ing how much their health cov­er­age costs. The report­ing does not mean that the cost of the cov­er­age is tax­able to employees.

    ACA Report­ing (50 + FTE or self-fund­ed plans)
    Orga­ni­za­tions who are Applic­a­ble Large Employ­ers (ALEs), mean­ing they had 50 or more full-time (FT) or full-time equiv­a­lent (FTE) employ­ees dur­ing the pre­vi­ous year, are required to pro­vide any­one who was full-time for one month or more with Form 1095‑C by Jan­u­ary 31st (extend­ed to March 31, 2016 for 2015 report­ing year). ALEs are then required to sub­mit trans­mit­tal doc­u­ment 1094‑C to the IRS, along with copies of the 1095-Cs giv­en to full-time employ­ees by Feb­ru­ary 28th (extend­ed May 31, if sub­mit­ted man­u­al­ly or to June 31 if fil­ing elec­tron­i­cal­ly for 2015 report­ing year).

    Orga­ni­za­tions who offer self-fund­ed plans, who have less than 50 FT or FTE are required to pro­vide FT employ­ees with Form 1095‑B, then sub­mit trans­mit­tal Form 1094‑B to the IRS on the same dates shown above for ALEs.

    BENEFIT ADMINISTRATION
    There are a num­ber of rec­om­mend­ed ben­e­fit admin­is­tra­tion prac­tices that help you com­ply with the var­i­ous laws, while max­i­miz­ing ben­e­fits received by participants.

    Plan Year and Open Enrollment
    Orga­ni­za­tions should define a plan year, then hold open enroll­ments pri­or to each plan year, review­ing cov­er­age and provider options. Par­tic­i­pants are allowed an oppor­tu­ni­ty to enroll or make changes to their plans dur­ing open enroll­ments. Though not rec­om­mend­ed, orga­ni­za­tions can have more than one open enroll­ment date for dif­fer­ent ben­e­fits. Do not allow mid-year changes to select­ed ben­e­fit plans unless they expe­ri­ence a qual­i­fy­ing event or you risk vio­lat­ing sec­tion 125 plans (Pre­mi­um Only or Flex­i­ble Spend­ing Account) tax-favor­able sta­tus of your plans, if applic­a­ble, and may vio­late agree­ments with insur­ance providers.

    ALE Med­ical Insur­ance Cov­er­age Offers
    Most ALEs will elect to offer cov­er­age to at least 95% of eli­gi­ble employ­ees that meets Min­i­mum Essen­tial Cov­er­age (MEC), Min­i­mum Val­ue (MV) at afford­able rates to avoid penal­ties. A plan meets MV if it cov­ers at least 60% of the total allowed cost of ben­e­fits that are expect­ed to be incurred under the plan. It is afford­able if the med­ical insur­ance rates charged for the employ­ee-only, MV cov­er­age does not exceed 9.56% of the employee’s W‑2 wages, fed­er­al pover­ty lev­el or rate of pay safe harbors.

    It is a good prac­tice to col­lect either an appli­ca­tion or waiv­er of cov­er­age from all employ­ees offered cov­er­age. Keep these on file demon­strat­ing they were offered coverage.

    Eli­gi­bil­i­ty & Wait­ing Periods
    Employ­ers are to set up prac­tices that com­ply with required Afford­able Care Act (ACA) require­ments relat­ed to wait­ing peri­ods and eli­gi­bil­i­ty. The wait­ing peri­od must allow par­tic­i­pants to join a med­ical plan with­in 90-days of their date of hire. Employ­ers may elect a 30-day ori­en­ta­tion peri­od that occurs before the nor­mal wait­ing peri­od. The most com­mon wait­ing peri­ods are the first of the month fol­low­ing 30 or 60-days of employment.

    Clas­si­fy employ­ees as full-time if you antic­i­pate they will on aver­age work 30-hours or more per week, and make them eli­gi­ble to join your med­ical insur­ance plan, if applic­a­ble. It is a good prac­tice to also clear­ly define job clas­si­fi­ca­tions of part-time, full-time, tem­po­rary and sea­son­al to iden­ti­fy vari­able hour employ­ees, help­ing you man­age ben­e­fit eli­gi­bil­i­ty. Mon­i­tor work hours for all employ­ees to effec­tive­ly man­age eli­gi­bil­i­ty over defined mea­sure­ment peri­ods. In addi­tion to actu­al hours per­formed, work hours include vaca­tion, sick leave, paid-time off, hol­i­day pay or time out on an injury.

    Mea­sure­ment Periods
    Estab­lish a set mea­sure­ment peri­od where you will mon­i­tor work hours for new vari­able hour employ­ees (part-time, tem­po­rary and sea­son­al) of 30 days to 12 months or you may elect to use the month­ly mea­sure­ment method. Those who aver­age 30-hours or more dur­ing the mea­sure­ment peri­od would be eli­gi­ble to par­tic­i­pate in the med­ical plan. Have all mea­sure­ment peri­ods begin as of the first of the month fol­low­ing dates of hire, mak­ing it so you only have to review eli­gi­bil­i­ty twelve times per year. If desired, you can have a sep­a­rate mea­sure­ment peri­od for on-going employ­ees, those who are past one stan­dard mea­sure­ment period.
    Admin­is­tra­tive Periods
    Define an admin­is­tra­tive peri­od of 30 to 90-days, which is your allowed time between the mea­sure­ment peri­od and the insur­ance effec­tive date to cal­cu­late eli­gi­bil­i­ty, pro­vide enroll­ment mate­ri­als to eli­gi­ble employ­ees and per­form oth­er admin­is­tra­tive func­tions. The com­bi­na­tion of your select­ed mea­sure­ment peri­od for new­ly hired employ­ees and admin­is­tra­tive peri­od may not exceed 13 months.

    Sta­bil­i­ty Periods
    Indi­vid­u­als who qual­i­fy for med­ical insur­ance cov­er­age after com­plet­ing the mea­sure­ment peri­od are eli­gi­ble to remain on med­ical cov­er­age, regard­less of changes to their aver­age work hours, for a peri­od of time equal to your defined mea­sure­ment peri­od or 6 months, whichev­er is greater.

    ACA Report­ing Data
    Because of the need to meet ACA report­ing require­ments, ALE’s need to estab­lish track­ing sys­tems to mon­i­tor the fol­low­ing data used to com­plete doc­u­ments 1095‑C and 1094‑C:
    • Employ­ee names
    • Employ­ee SS#
    • Employ­ee address
    • Employ­ee tele­phone number
    • The month cov­er­age was offered to each employ­ee and each month there­after for which the employ­ee was eli­gi­ble for coverage
    • Num­ber of employ­ees (full-time and full-time equivalent)
    • Employee’s cost of the low­est cost month­ly pre­mi­um for self-only
    • Name, SS# OR DOB if no SS# is attain­able for spouse and depen­dents for ALL self-fund­ed plans (ALE and small employers)

    125 Pre­mi­um Only Plans (POP) or Flex­i­ble Spend­ing Accounts (FSA)
    Many orga­ni­za­tions offer a POP, help­ing par­tic­i­pants pay for pre­mi­ums on a pre-tax basis, and/or an FSA, to set aside funds to cov­er antic­i­pat­ed uncov­ered med­ical costs (e.g. deductibles, co-pays, etc.) or to pay for work relat­ed depen­dent care, if applicable.

    It is impor­tant to main­tain up-to-date POP or FSA doc­u­ments and to com­mu­ni­cate these ser­vices along with oth­er ben­e­fits through dis­tri­b­u­tion of Sum­ma­ry Plan Descrip­tions (SPDs) or SPD Wrap doc­u­ments. There were recent updates to def­i­n­i­tion of spouse, new qual­i­fy­ing events for mar­ket­place enroll­ment for POP doc­u­ments, new health FSA max­i­mums, and $500 rollovers for FSA that must be updat­ed in these plan documents.

    If offer­ing these plans, make sure to con­duct annu­al dis­crim­i­na­tion test­ing of eli­gi­bil­i­ty to par­tic­i­pate, ben­e­fits and con­tri­bu­tions, and key-employ­ee-con­cen­tra­tion to ensure plans do not vio­late dis­crim­i­na­tion test­ing requirements.

    COBRA
    As pre­vi­ous­ly dis­cussed, make sure to have pro­ce­dures in place to pro­vide required COBRA notices, man­age COBRA pay­ments and prop­er­ly man­age cov­er­age for these par­tic­i­pants. It is good to pro­vide them with the same com­mu­ni­ca­tion and rights as employ­ee par­tic­i­pants. Even if you out­source this admin­is­tra­tion, you still want good prac­tices to ensure all par­tic­i­pant rights are allowed and you are adding and tak­ing some­one on and off cov­er­age in accor­dance with these laws. There are huge risks and penal­ties that can result for mis­han­dling COBRA.

    In con­clu­sion, there are many laws you need to know, many com­mu­ni­ca­tion and notices to dis­trib­ute to par­tic­i­pants, and the need for clear, effec­tive ben­e­fit admin­is­tra­tive prac­tices to help you offer effec­tive ben­e­fits for employ­ees. It is essen­tial to have a knowl­edge­able insur­ance bro­ker to help you man­age your ben­e­fit sys­tems and nav­i­gate the many ben­e­fit laws.

    By Ken Spencer, Pres­i­dent & CEO, HR Ser­vice, Inc. & ERISA Solu­tions, www.HRServiceInc.com

  • IRS Provides Major Delay in 6055 and 6056 Reporting | Petaluma Benefits Specialist

    January 14, 2016

    Tags: , , , , , ,

    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

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

    Report­ing will first be due in 2016, based on cov­er­age in 2015. All report­ing will be for the cal­en­dar year, even for non-cal­en­dar year plans. On Decem­ber 28, 2015, the IRS issued Notice 2016–4, delay­ing the report­ing deadlines.

    The report­ing require­ments are in Sec­tions 6055 and 6056 of the ACA. The 1094‑C, 1095‑C, 1094‑B, and 1095‑B were orig­i­nal­ly due to the IRS by Feb­ru­ary 28 if fil­ing on paper (Feb­ru­ary 29, in 2016, because Feb­ru­ary 28 falls on the week­end), or March 31 if fil­ing elec­tron­i­cal­ly. The 1095‑C form was due to employ­ees by Jan­u­ary 31 of the year fol­low­ing the year to which the Form 1095‑C relates (Feb­ru­ary 1, in 2016, because Jan­u­ary 31 falls on a week­end). The 1095‑B was due to the indi­vid­ual iden­ti­fied as the “respon­si­ble indi­vid­ual” on the form by Jan­u­ary 31 (Feb­ru­ary 1, in 2016, because Jan­u­ary 31 falls on a weekend).

    The tran­si­tion relief pro­vid­ed by Notice 2016–4 extend­ed the due date for fur­nish­ing Form 1095‑B and 1095‑C to indi­vid­u­als to March 31, 2016. The due date for fil­ing all forms (1094‑C, 1095‑C, 1094‑B, and 1095‑B) to the IRS is moved from Feb­ru­ary 29, 2016, to May 31, 2016, if fil­ing by paper. If fil­ing elec­tron­i­cal­ly, the date is moved to June 30, 2016.

    Employ­ers that have dif­fi­cul­ty meet­ing the extend­ed report­ing dead­lines are encour­aged to file late, as the IRS will take late fil­ing into con­sid­er­a­tion when deter­min­ing whether to reduce penal­ties for rea­son­able caus­es. The IRS will also take into account if an employ­er made rea­son­able efforts to pre­pare for report­ing, such as gath­er­ing or trans­mit­ting nec­es­sary infor­ma­tion to a report­ing service.

    For addi­tion­al infor­ma­tion on how the exten­sion may impact your employ­ees, as well as the exten­sion process, down­load the UBA ACA Advi­sor, “IRS Pro­vides Major Delay in 6055 and 6056 Report­ing”.

    Read More …

  • Arrow Just Published…

    January 12, 2016

    Read our just pub­lished arti­cle by Prin­ci­pal Mari­ah Shields on the pow­er of philanthropy….

    MariahShields

    I real­ize run­ning a suc­cess­ful busi­ness means your plate is piled-high with dai­ly pri­or­i­ties but there’s one often-over­looked busi­ness act that can ful­fill, enrich and reward you if you make time for it: phil­an­thropy. Giv­ing back to your com­mu­ni­ty can serve your busi­ness goals while tak­ing care of the world around you. When you give to oth­ers, you’ll find you’re actu­al­ly tak­ing care of yourself—and your business. 

     

    READ FULL ARTICLE HERE 

  • COBRA and the Affordable Care Act | California Employee Benefits

    January 11, 2016

    By Danielle Capilla
    Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

    The Con­sol­i­dat­ed Omnibus Bud­get Rec­on­cil­i­a­tion Act (COBRA) requires employ­ers to offer cov­ered employ­ees who lose their health ben­e­fits due to a qual­i­fy­ing event to con­tin­ue group health ben­e­fits for a lim­it­ed time at the employ­ee’s own cost. COBRA pro­vi­sions are found in the Employ­ee Retire­ment Income Secu­ri­ty Act (ERISA), the Inter­nal Rev­enue Code (Code), and the Pub­lic Health Ser­vice Act (PHSA). Employ­ers with 20 or more employ­ees and group health plans are sub­ject to COBRA pro­vi­sions. Most gov­ern­men­tal plans, church plans, and cer­tain plans of Indi­an trib­al gov­ern­ments are exempt from COBRA. Employ­ers should always con­sult with coun­sel about state con­tin­u­a­tion laws that are sim­i­lar to COBRA and apply to small employers.

    Only sev­en events can trig­ger COBRA oblig­a­tions and offers of cov­er­age. They are:

    • Ter­mi­na­tion of employment
    • Reduc­tion of hours
    • Divorce or legal separation
    • Death of the cov­ered employee
    • A depen­dent child ceas­ing to be a depen­dent under the plan
    • Enti­tle­ment to Medicare
    • Bank­rupt­cy

    These events must lead to an indi­vid­u­al’s loss of cov­er­age. For exam­ple, if a reduc­tion of hours or enti­tle­ment to Medicare did not result in an employ­ee’s loss of ben­e­fit eli­gi­bil­i­ty, there would be no oblig­a­tion to offer COBRA cov­er­age. Con­verse­ly, employ­ees might expe­ri­ence a loss of cov­er­age that does not trig­ger COBRA; for exam­ple if they fail to pay their por­tion of the pre­mi­um or their employ­er stops offer­ing cov­er­age to spouses.

    Afford­able Care Act Impact on COBRA

    The Patient Pro­tec­tion and Afford­able Care Act (ACA) did not direct­ly impact or change COBRA oblig­a­tions for employ­ers, but oth­er changes in relat­ed reg­u­la­tions will deter­mine how and when employ­ers offer COBRA cov­er­age to employees.

    Begin­ning in 2015, to com­ply with the ACA large employ­ers must offer their full-time employ­ees health cov­er­age, or pay one of two employ­er shared respon­si­bil­i­ty (play or pay) penal­ties. An employ­er is con­sid­ered large, or an applic­a­ble large employ­er (ALE), if it has 50 or more full-time or full-time equiv­a­lent employ­ees. Full-time employ­ees are employ­ees that aver­age 30 hours a week or more. There are two meth­ods that an ALE can use to deter­mine which employ­ees must be offered cov­er­age to avoid penal­ties: the month­ly method, and the mea­sure­ment and look-back method. ALEs are also required to report on cov­er­age that they did or did not provide.

    For an in-depth review of the mea­sure­ment and look-back meth­ods and options, as the report­ing oblig­a­tions and FSA car­ry­overs, request UBA’s ACA Advi­sor, “Cobra and the Afford­able Care Act”.

    Read More …

  • Health care costs are on the rise, the exchange isn’t saving…but, wait, what of Blue Shield?

    January 8, 2016

    No pro­tec­tion here. Blue Shield has report­ed that, while Unit­ed may be reel­ing and the oth­er car­ri­ers feel­ing less than san­guine about their chances for suc­cess, they have made $107 mil­lion in “excess prof­its” It was fur­ther report­ed that Blue Shield of Cal­i­for­nia account­ed for near­ly 30% of the excess prof­its nation­al­ly from all exchanges. A Blue Shield spokesper­son said “when pric­ing for 2014, like oth­er insur­ers, we were doing it in the dark. We hap­pened to get a health­i­er pop­u­la­tion. That was pure­ly by chance” Uh, huh. So why are they increas­ing rates again in 2016? Must be pure­ly by chance.

  • Temporary relief on Part B premiums – but we will have to see

    January 5, 2016

    The Medicare Part B pre­mi­ums were sup­posed to increase sub­stan­tial­ly – as in 52% — in 2016 Now with the pas­sage of the recent bud­get, there has been a reprieve, with an increase of “only” 15% — along with a flat $3 charge per month to help pay down a loan the gov­ern­ment gave to Medicare to off­set lost rev­enue (huh?)

  • How to Give Your 2016 Resolutions Staying Power | Arrow Benefits Group

    January 4, 2016

    Tags: , , , , , ,

    www.newsusa.com

    resolutionWith any new year comes a clean slate and a chance to take on new goals. For many, res­o­lu­tions revolve around healthy changes, but experts cau­tion that resolve begins to waver at the end of Jan­u­ary — which is why set­ting spe­cif­ic, real­is­tic goals is proven to be more effective.

    “When it comes to fit­ness res­o­lu­tions, the focus should be on small steps,” said Tom Hol­land, exer­cise phys­i­ol­o­gist and Bowflex Fit­ness Advi­sor. “While hav­ing a big goal to work toward can be moti­vat­ing, it’s impor­tant to have small, man­age­able goals that allow you to cel­e­brate the mile­stones along your fit­ness journey.”

    Here are three exam­ples of lofty fit­ness res­o­lu­tions — and how to break them down into achiev­able goals:

    * “I want to run a marathon.” Train­ing for a race takes months of com­mit­ment. Start with a 5K and work your way up to a 10K or half marathon, before decid­ing if you’re ready to com­plete the full 26.2 miles. To build endurance before you hit the pave­ment, con­sid­er start­ing your train­ing on a run­ning machine.

    * “I want to look like a body­builder.” This route takes seri­ous patience. Begin with small­er goals, such as gain­ing one pound of mus­cle per month. You can accom­plish this by increas­ing the amount of weight and reps with each workout.

    * “I want to go on a cross-coun­try bike trip.” Like a marathon, months of train­ing go into prepar­ing for this long-dis­tance jour­ney. Experts sug­gest build­ing up your sta­mi­na over time to avoid injury.

    Read More …

  • Regulations Regarding Short-Term Limited-Duration Insurance, Excepted Benefits, and Lifetime/Annual Limits | CA Benefit Advisors

    December 29, 2016

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    Recent­ly, the U.S. Depart­ment of the Trea­sury, Depart­ment of Labor (DOL), and Depart­ment of Health and Human Ser­vices (HHS) (col­lec­tive­ly the Depart­ments) issued final reg­u­la­tions regard­ing the def­i­n­i­tion of short-term, lim­it­ed-dura­tion insur­ance, stan­dards for trav­el insur­ance and sup­ple­men­tal health insur­ance cov­er­age to be con­sid­ered except­ed ben­e­fits, and an amend­ment relat­ing to the pro­hi­bi­tion on life­time and annu­al dol­lar limits.

    Effec­tive Date and Applic­a­bil­i­ty Date 

    These final reg­u­la­tions are effec­tive on Decem­ber 30, 2016. These final reg­u­la­tions apply begin­ning on the first day of the first plan or pol­i­cy year begin­ning on or after Jan­u­ary 1, 2017.

    Short-Term, Lim­it­ed-Dura­tion Insurance 

    Short-term, lim­it­ed-dura­tion insur­ance is a type of health insur­ance cov­er­age designed to fill tem­po­rary gaps in cov­er­age when an indi­vid­ual is tran­si­tion­ing from one plan or cov­er­age to anoth­er plan or cov­er­age. Although short-term, lim­it­ed-dura­tion insur­ance is not an except­ed ben­e­fit, it is exempt from Pub­lic Health Ser­vice Act (PHS Act) require­ments because it is not indi­vid­ual health insur­ance cov­er­age. The PHS Act pro­vides that the term ‘‘indi­vid­ual health insur­ance cov­er­age’’ means health insur­ance cov­er­age offered to indi­vid­u­als in the indi­vid­ual mar­ket, but does not include short-term, lim­it­ed-dura­tion insurance.

    On June 10, 2016, the Depart­ments pro­posed reg­u­la­tions to address the issue of short-term, lim­it­ed-dura­tion insur­ance being sold as a type of pri­ma­ry coverage.

    The Depart­ments have final­ized the pro­posed reg­u­la­tions with­out change. The final reg­u­la­tions define short-term, lim­it­ed-dura­tion insur­ance so that the cov­er­age must be less than three months in dura­tion, includ­ing any peri­od for which the pol­i­cy may be renewed. The per­mit­ted cov­er­age peri­od takes into account exten­sions made by the pol­i­cy­hold­er ‘‘with or with­out the issuer’s con­sent.’’ A notice must be promi­nent­ly dis­played in the con­tract and in any appli­ca­tion mate­ri­als pro­vid­ed in con­nec­tion with enroll­ment in such cov­er­age with the fol­low­ing language:

    THIS IS NOT QUALIFYING HEALTH COVERAGE (‘‘MINIMUM ESSENTIAL COVERAGE’’) THAT SATISFIES THE HEALTH COVERAGE REQUIREMENT OF THE AFFORDABLE CARE ACT. IF YOU DON’T HAVE MINIMUM ESSENTIAL COVERAGE, YOU MAY OWE AN ADDITIONAL PAYMENT WITH YOUR TAXES.

    The revised def­i­n­i­tion of short-term, lim­it­ed-dura­tion insur­ance applies for pol­i­cy years begin­ning on or after Jan­u­ary 1, 2017.

    Because state reg­u­la­tors may have approved short-term, lim­it­ed-dura­tion insur­ance prod­ucts for sale in 2017 that met the def­i­n­i­tion in effect pri­or to Jan­u­ary 1, 2017, HHS will not take enforce­ment action against an issuer with respect to the issuer’s sale of a short-term, lim­it­ed-dura­tion insur­ance prod­uct before April 1, 2017, on the ground that the cov­er­age peri­od is three months or more, pro­vid­ed that the cov­er­age ends on or before Decem­ber 31, 2017, and oth­er­wise com­plies with the def­i­n­i­tion of short-term, lim­it­ed-dura­tion insur­ance in effect under the reg­u­la­tions. States may also elect not to take enforce­ment actions against issuers with respect to such cov­er­age sold before April 1, 2017.

     

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

  • New Law Allows Small Employers to Pay Premiums for Individual Policies | California Employee Benefits

    December 26, 2016

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    This week, the U.S. Sen­ate passed the 21st Cen­tu­ry Cures Act which includes a pro­vi­sion allow­ing small busi­ness­es to offer a new type of health reim­burse­ment arrange­ment for their employ­ees’ health care expens­es, includ­ing indi­vid­ual insur­ance pre­mi­ums. The act was pre­vi­ous­ly passed by the House and Pres­i­dent Oba­ma is expect­ed to sign it short­ly. The pro­vi­sion for Qual­i­fied Small Employ­er Health Reim­burse­ment Arrange­ments (QSEHRAs), a new type of tax-free ben­e­fit, takes effect Jan­u­ary 1, 2017. Fur­ther, the act retroac­tive­ly relieves small employ­ers from the threat of excise tax­es under pri­or rules for plan years begin­ning before 2017.

    Background

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

    The pro­hi­bi­tion, imple­ment­ed under the Afford­able Care Act (ACA), was intend­ed to dis­cour­age employ­ers from can­cel­ing their group plans and push­ing work­ers into the indi­vid­ual insur­ance mar­ket. The rules have been par­tic­u­lar­ly dis­rup­tive for small busi­ness­es, how­ev­er, since pre­vi­ous­ly it had been com­mon prac­tice for many small employ­ers to sub­si­dize the cost of indi­vid­ual poli­cies instead of offer­ing group cov­er­age. The new law, passed this week with broad bipar­ti­san sup­port, responds to the con­cerns of small businesses.

    New Qualified Small Employer HRAs

    The new law does not repeal the ACA’s gen­er­al pro­hi­bi­tion against employ­er pay­ment of indi­vid­ual insur­ance pre­mi­ums. Rather, it pro­vides an excep­tion for a new type of arrange­ment — a Qual­i­fied Small Employ­er HRA or QSEHRA — pro­vid­ed that spe­cif­ic con­di­tions are met.

    First, the employ­er must meet two conditions:

    • Employs on aver­age no more than 50 full-time and full-time-equiv­a­lent employ­ees. In oth­er words, the employ­er can­not be an applic­a­ble large employ­er as defined under the ACA; and
    • Does not offer a group health plan to any of its employees.

    Next, the QSEHRA must meet all of the fol­low­ing conditions:

    • It is fund­ed sole­ly by the employ­er; employ­ee con­tri­bu­tions are not permitted;
    • It is offered to all full-time employ­ees, although the employ­er may choose to include sea­son­al or part-time employ­ees and/or may exclude employ­ees with less than 90 days of service;
    • For tax-free QSEHRA ben­e­fits, the employ­ee must have min­i­mum essen­tial cov­er­age (e.g., med­ical insur­ance under an indi­vid­ual policy);
    • It pays or reim­burs­es health­care expens­es (e.g., § 213(d) expens­es) and pre­mi­ums for indi­vid­ual policies;
    • It does not pay or reim­burse con­tri­bu­tions for any employ­er-spon­sored group coverage;
    • The same ben­e­fits and terms apply to all eli­gi­ble employ­ees, except the ben­e­fit amount may vary by: 
      • Sin­gle ver­sus fam­i­ly coverage;
      • Pro­rat­ed amounts for par­tial-year cov­er­age (e.g., new hires); and
      • For pre­mi­um reim­burse­ments, vari­a­tions con­sis­tent with the age- and fam­i­ly-size rat­ing struc­ture of a rep­re­sen­ta­tive indi­vid­ual pol­i­cy; and
    • Ben­e­fits do not exceed $4,950 if sin­gle cov­er­age (or $10,000 if fam­i­ly cov­er­age) per 12-month plan year. Amounts are pro­rat­ed if cov­ered for less than 12 months. Lim­its will be indexed for inflation.

    Coordination with Exchange Subsidies

    Cov­er­age under a QSEHRA will affect the employee’s eli­gi­bil­i­ty for a sub­si­dized indi­vid­ual pol­i­cy from an insur­ance Exchange (Mar­ket­place). Any sub­sidy for which the employ­ee would oth­er­wise qual­i­fy will be reduced dol­lar-for-dol­lar by the QSEHRA.

    Benefit Laws

    Group health plans are sub­ject to numer­ous fed­er­al laws, includ­ing SPD and oth­er notice require­ments under ERISA, cov­er­age con­tin­u­a­tion require­ments under COBRA, and ben­e­fit man­dates under the ACA. The new law spec­i­fies that QSEHRAs are not group health plans, so COBRA and oth­er require­ments will not apply.

    QSEHRA Notices

    Small employ­ers offer­ing QSEHRAs will be required to pro­vide a notice to each eli­gi­ble employ­ee that:

    • Informs the employ­ee of the QSEHRA ben­e­fit amount;
    • Instructs the employ­ee that he or she must give the QSEHRA infor­ma­tion to the Exchange if apply­ing for a sub­sidy for indi­vid­ual insur­ance; and
    • Explains the tax con­se­quences of fail­ing to main­tain min­i­mum essen­tial coverage.

    QSEHRA notices should be pro­vid­ed at least 90 days before the start of the plan year.

    Employ­ers also will be required to report the QSEHRA cov­er­age on Form W‑2, Box 12. The report­ing is infor­ma­tion­al only and has no tax con­se­quences. Although small employ­ers usu­al­ly are exempt from this type of W‑2 infor­ma­tion­al report­ing, appar­ent­ly it will be required for QSEHRAs start­ing with the 2017 tax year.

    More Information

    To learn more about QSEHRAs start­ing in 2017, or for details about the relief from excise tax­es for small employ­ers before 2017, see the 21st Cen­tu­ry Cures Act. The rel­e­vant pro­vi­sions are found in Sec­tion 18001 begin­ning on page 306.

    Employ­ers that are con­sid­er­ing QSEHRAs are encour­aged to work with legal coun­sel and tax advi­sors that offer exper­tise in this area. Start­ing in 2017, employ­er-fund­ed QSEHRAs can offer valu­able tax-free ben­e­fits to employ­ees as long as they are designed and admin­is­tered to meet all legal requirements.

     

    Orig­i­nal­ly pub­lished by ThinkHR — Read More

  • FAQs on Tobacco Cessation Coverage and Mental Health / Substance Use Disorder Parity | California Employee Benefits

    December 23, 2016

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    Recent­ly, the Depart­ment of the Trea­sury, Depart­ment of Labor (DOL), and Depart­ment of Health and Human Ser­vices (HHS) (col­lec­tive­ly, the Depart­ments) issued FAQs About Afford­able Care Act Imple­men­ta­tion Part 34 and Men­tal Health and Sub­stance Use Dis­or­der Par­i­ty Imple­men­ta­tion.

    The Depart­ments’ FAQs cov­er two pri­ma­ry top­ics: tobac­co ces­sa­tion cov­er­age and men­tal health / sub­stance use dis­or­der parity.

    Tobac­co Ces­sa­tion Coverage

    The Depart­ments seek pub­lic com­ment by Jan­u­ary 3, 2017, on tobac­co ces­sa­tion cov­er­age. The Depart­ments intend to clar­i­fy the items and ser­vices that must be pro­vid­ed with­out cost shar­ing to com­ply with the Unit­ed States Pre­ven­tive Ser­vices Task Force’s updat­ed tobac­co ces­sa­tion inter­ven­tions rec­om­men­da­tion applic­a­ble to plan years or pol­i­cy years begin­ning on or after Sep­tem­ber 22, 2016.

    Men­tal Health / Sub­stance Use Dis­or­der Parity

    Gen­er­al­ly, the Men­tal Health Par­i­ty and Addic­tion Equi­ty Act of 2008 (MHPAEA) requires that the finan­cial require­ments and treat­ment lim­i­ta­tions imposed on men­tal health and sub­stance use dis­or­der (MH/SUD) ben­e­fits can­not be more restric­tive than the pre­dom­i­nant finan­cial require­ments and treat­ment lim­i­ta­tions that apply to sub­stan­tial­ly all med­ical and sur­gi­cal benefits.

    A finan­cial require­ment (such as a copay­ment or coin­sur­ance) or quan­ti­ta­tive treat­ment lim­i­ta­tion (such as a day or vis­it lim­it) is con­sid­ered to apply to sub­stan­tial­ly all medical/surgical ben­e­fits in a clas­si­fi­ca­tion if it applies to at least two-thirds of all medical/surgical ben­e­fits in the classification.

    If it does not apply to at least two-thirds of medical/surgical ben­e­fits, it can­not be applied to MH/SUD ben­e­fits in that classification.

    If it does apply to at least two-thirds of medical/surgical ben­e­fits, the lev­el (such as 80 per­cent or 70 per­cent coin­sur­ance) of the quan­ti­ta­tive lim­it that may be applied to MH/SUD ben­e­fits in a clas­si­fi­ca­tion may not be more restric­tive than the pre­dom­i­nant lev­el that applies to medical/surgical ben­e­fits (defined as the lev­el that applies to more than one-half of medical/surgical ben­e­fits sub­ject to the lim­i­ta­tion in the classification).

    In per­form­ing these cal­cu­la­tions, the deter­mi­na­tion of the por­tion of medical/surgical ben­e­fits sub­ject to the quan­ti­ta­tive lim­it is based on the dol­lar amount of all plan pay­ments for medical/surgical ben­e­fits in the clas­si­fi­ca­tion expect­ed to be paid under the plan for the plan year. The MHPAEA reg­u­la­tions pro­vide that “any rea­son­able method” may be used to deter­mine the dol­lar amount of all plan pay­ments for the sub­stan­tial­ly all and pre­dom­i­nant analyses.

    MHPAEA’s pro­vi­sions and its reg­u­la­tions express­ly pro­vide that a plan or issuer must dis­close the cri­te­ria for med­ical neces­si­ty deter­mi­na­tions with respect to MH/SUD ben­e­fits to any cur­rent or poten­tial par­tic­i­pant, ben­e­fi­cia­ry, or con­tract­ing provider upon request and the rea­son for any denial of reim­burse­ment or pay­ment for ser­vices with respect to MH/SUD ben­e­fits to the par­tic­i­pant or beneficiary.

    How­ev­er, the Depart­ments rec­og­nize that addi­tion­al infor­ma­tion regard­ing medical/surgical ben­e­fits is nec­es­sary to per­form the required MHPAEA analy­ses. Accord­ing to the FAQs, the Depart­ment have con­tin­ued to receive ques­tions regard­ing dis­clo­sures relat­ed to the process­es, strate­gies, evi­den­tiary stan­dards, and oth­er fac­tors used to apply a non­quan­ti­ta­tive treat­ment lim­i­ta­tion (NQTL) with respect to medical/surgical ben­e­fits and MH/SUD ben­e­fits under a plan. Also, the Depart­ments have received requests to explore ways to encour­age uni­for­mi­ty among state reviews of issuers’ com­pli­ance with the NQTL stan­dards, includ­ing the use of mod­el forms to report NQTL information.

    To address these issues, the Depart­ments seek pub­lic com­ment by Jan­u­ary 3, 2017, on poten­tial mod­el forms that could be used by par­tic­i­pants and their rep­re­sen­ta­tives to request infor­ma­tion on var­i­ous NQTLs. The Depart­ments also seek pub­lic com­ment on the dis­clo­sure process for MH/SUD ben­e­fits and on steps that could improve state mar­ket con­duct exam­i­na­tions or fed­er­al over­sight of com­pli­ance by plans and issuers, or both.

     

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

  • Ask the Experts: Dealing With FSA Carryover Funds | California Benefit Advisors

    December 19, 2016

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    Ques­tion: If an employ­ee has a small health flex­i­ble spend­ing account (FSA) bal­ance with a car­ry­over to the next year, and the employ­ee choos­es not to par­tic­i­pate in the new FSA year, can the employ­er force the employ­ee to use those funds so as not to incur addi­tion­al admin­is­tra­tive fees in the next plan year?

    Answer: An employ­er can pre­vent “per­pet­u­al car­ry­overs” by care­ful­ly draft­ing the cafe­te­ria plan doc­u­ment with respect to car­ry­over amounts. IRS guid­ance allows car­ry­overs to be lim­it­ed to indi­vid­u­als who have elect­ed to par­tic­i­pate in the health FSA in the next plan year. Health FSAs may also require that car­ry­over amounts be for­feit­ed if not used with­in a spec­i­fied peri­od of time, such as one year. Note that this plan design requires addi­tion­al admin­is­tra­tion (to track the time lim­it for each car­ry­over dol­lar, for instance) as well as order­ing rules (e.g., will car­ry­overs be used first?), so you will need to care­ful­ly review the cafe­te­ria plan doc­u­ment. Under no cir­cum­stances are amounts returned to participants.

    Accord­ing to IRS guid­ance, a health FSA may lim­it the avail­abil­i­ty of the car­ry­over of unused amounts (sub­ject to the $500 lim­it) to indi­vid­u­als who have elect­ed to par­tic­i­pate in the health FSA in the next year, even if the abil­i­ty to par­tic­i­pate in that next year requires a min­i­mum salary reduc­tion elec­tion to the health FSA for that next year. For exam­ple, an employ­er spon­sors a cafe­te­ria plan offer­ing a health FSA that per­mits up to $500 of unused health FSA amounts to be car­ried over to the next year in com­pli­ance with Notice 2013–71, but only if the employ­ee par­tic­i­pates in the health FSA dur­ing that next year. To par­tic­i­pate in the health FSA, an employ­ee must con­tribute a min­i­mum of $60 ($5 per cal­en­dar month). As of Decem­ber 31, 2016, Employ­ee A and Employ­ee B each have $25 remain­ing in their health FSA. Employ­ee A elects to par­tic­i­pate in the health FSA for 2017, mak­ing a $600 salary reduc­tion elec­tion. Employ­ee B elects not to par­tic­i­pate in the health FSA for 2017. Employ­ee A has $25 car­ried over to the health FSA for 2017, result­ing in $625 avail­able in the health FSA. Employ­ee B for­feits the $25 as of Decem­ber 31, 2016 and has no funds avail­able in the health FSA there­after. This arrange­ment is a per­mis­si­ble health FSA car­ry­over fea­ture under Notice 2013171. The IRS also clar­i­fies that a health FSA may lim­it the abil­i­ty to car­ry over unused amounts to a max­i­mum peri­od (sub­ject to the $500 lim­it). For exam­ple, a health FSA can lim­it the abil­i­ty to car­ry over unused amounts to one year. Thus, if an indi­vid­ual car­ried over $30 and did not elect any addi­tion­al amounts for the next year, the health FSA may require for­fei­ture of any amount remain­ing at the end of that next year.

    Orig­i­nal­ly pub­lished by ThinkHR — Read More

  • Employer Exchange Subsidy Notices: Should You Appeal? | California Employee Benefits

    December 16, 2016

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    Under the Patient Pro­tec­tion and Afford­able Care Act (ACA), all pub­lic Exchanges are required to noti­fy employ­ers when an employ­ee is receiv­ing a sub­sidy (tax cred­its and cost-shar­ing reduc­tions) for indi­vid­ual health insur­ance pur­chased through an Exchange. Accord­ing to the final rules pub­lished in August 2013, employ­ers have the right, but are not required, to engage in an appeal process through the IRS if they feel an employ­ee should not be receiv­ing a sub­sidy because the employ­er offers min­i­mum val­ue, afford­able coverage.

    Some states began send­ing notices from pub­lic Exchanges indi­cat­ing that one or more employ­ees are cur­rent­ly receiv­ing a sub­sidy in 2015, but the U.S. Depart­ment of Health and Human Ser­vices (HHS) announced that all fed­er­al­ly-facil­i­tat­ed Exchanges will begin send­ing notices in 2016. Just because the employ­er receives a notice, it does not mean the employ­er will actu­al­ly owe a penal­ty pay­ment under Sec­tion 4980H.

    Dan Bond, Prin­ci­pal, Com­pli­ancedash­board, offers this impor­tant com­men­tary: “I think it’s impor­tant for employ­ers to remem­ber that just because they may receive one of these notices from the IRS telling them that one of their employ­ees is receiv­ing a sub­sidy on the exchange, it does not nec­es­sar­i­ly mean the employ­er has expo­sure to a penal­ty. There are var­i­ous rea­sons that some­one might have received a sub­sidy so the employ­er can use this notice to deter­mine exact­ly why and whether or not they have any expo­sure. In fact, small employ­ers will also receive these notices and they are not even sub­ject to the employ­er shared respon­si­bil­i­ty man­date so they will not be sub­ject to penal­ties, regardless.”

    subsidy appeal chart

    Appeal Form and Process
    So long as the require­ments in the final rules are met, each state Exchange is allowed to set up its own process and pro­ce­dures. Infor­ma­tion about how to file an appeal is usu­al­ly includ­ed in the notice, but it may be nec­es­sary to check with the applic­a­ble Exchange to find out exact­ly how to han­dle the appeals process, the par­tic­u­lars of which are man­aged by each Exchange separately.

    The form cur­rent­ly used by fed­er­al­ly-facil­i­tat­ed Exchanges, as well as by eight states, may be found on Healthcare.gov (approx­i­mate­ly half of the states are cur­rent­ly using this form and process). The forms and process­es for all oth­er states may be found by vis­it­ing a state’s Exchange site. The process gen­er­al­ly involves fil­ing a paper appeal, pro­vid­ing doc­u­men­ta­tion, and in some cas­es par­tic­i­pat­ing in a hearing.

    Con­clu­sion
    The employ­er does not have to appeal to avoid a penal­ty under Sec­tion 4980H, and penal­ties will not apply until after the employ­er report­ing (via Forms 1094‑C and 1095‑C) is rec­on­ciled. There is some spec­u­la­tion that it may be more ben­e­fi­cial to appeal with the Exchange rather than wait­ing to appeal lat­er with the IRS. This is a fair­ly new process, so the best approach for employ­ers may remain some­what unclear until the first year of employ­er report­ing is completed.

    Fil­ing an appeal as soon as pos­si­ble may help avoid has­sles with the IRS and pre­vent the indi­vid­ual from receiv­ing a sub­sidy for which they are inel­i­gi­ble. At the same time, although the appeals process does not appear to be a dif­fi­cult one, it is pos­si­ble that every­thing could be cleared up more quick­ly by sim­ply com­mu­ni­cat­ing direct­ly with the employ­ee that they may be receiv­ing the sub­sidy in error.

     

    By Vic­ki Ran­dall, Orig­i­nal­ly pub­lished by Unit­ed Ben­e­fit Advi­sors — Read More

  • The New HSA Under Trump’s Proposed Health Plan | California Benefit Advisors

    December 13, 2016

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    piggybankWith the elec­tion of a new Pres­i­dent, health care plans and the fate of the Afford­able Care Act are a hot top­ic of dis­cus­sion. As part of his 7‑tier health plan, Pres­i­dent-Elect Don­ald Trump has pro­posed a shift in the way health sav­ings accounts (HSAs) are offered to work­ing Amer­i­cans. Sim­ply put, an HSA is a sav­ings account for med­ical expens­es. They are tax advan­taged accounts an indi­vid­ual can open in addi­tion to their cur­rent health plan to pay out-of-pock­et expens­es rang­ing from co-pays to surgery deductibles. Typ­i­cal­ly, HSAs have been offered to indi­vid­u­als with high deductible health plans (HDH­Ps). How­ev­er, if the President-Elect’s new health plan strat­e­gy is enact­ed, an HDHP would no longer be an eli­gi­bil­i­ty require­ment, sig­nif­i­cant­ly impact­ing health­care options for mil­lions of Americans.

    HSA vs. FSA – Which one is right for you?

    When choos­ing a sav­ings account for med­ical expens­es there are two options: HSAs and FSAs. Each type of account is gen­er­al­ly non-tax­able for qual­i­fied med­ical expens­es, except under cer­tain cir­cum­stances in which a med­ical expense was incurred pri­or to open­ing an HSA, and each is accu­mu­lat­ed by con­tri­bu­tions from your pay­check. Some employ­ers offer HSA and FSA match­ing contributions.

    In the past, there have been some promi­nent dif­fer­ences between health sav­ings accounts and flex­i­ble spend­ing accounts (FSAs). Tra­di­tion­al­ly, FSAs have been the option for those who choose health plans with low deductibles. The mon­ey you con­tribute from your pay­check into your FSA account must be spent with­in the year, and can­not be rolled over. Con­verse­ly, you must have an HDHP to open an HSA, and funds accu­mu­lat­ed from pay­checks can be rolled over into the next year if left unused.

    Accu­mu­lat­ing tax advan­tages have made HSAs more pop­u­lar and ben­e­fi­cial in com­par­i­son to FSAs. When it comes to chang­ing jobs, HSAs typ­i­cal­ly are not affect­ed, while FSAs are impact­ed due to restric­tions in rollover of funds. How­ev­er, FSAs do not have eli­gi­bil­i­ty require­ments, which have made them more wide­ly avail­able to individuals.

    What’s Next? How HSAs would change under Trump’s health plan

    Trump’s new health plan would make HSAs read­i­ly avail­able to every­one by remov­ing the HDHP eli­gi­bil­i­ty require­ments that are cur­rent­ly in place. In addi­tion to this dras­tic bar­ri­er removal, Trump has said he will change pol­i­cy to allow fam­i­lies to share the accounts between one anoth­er. Any con­tri­bu­tion or inter­est-earned by an HSA is tax-deductible, and indi­vid­u­als with HSAs can with­draw­al mon­ey tax-free for cer­tain med­ical expens­es rang­ing from trans­plants to acupunc­ture. The com­bi­na­tion of these three tax-advan­tages cre­ates an unmatched sav­ings option for those who choose HSAs. While Trump has said he will change some fac­tors of HSAs, he plans to keep these tax advan­tages.

    Who will ben­e­fit from the new HSA model?

    In the past, HSAs have been more attrac­tive for retirees. Health care costs tend to rise in the retire­ment stage of life, which makes an HSA a more cost-effi­cient option for retirees. Since indi­vid­u­als are allowed to take out mon­ey for med­ical expens­es with­out being taxed, retirees have the poten­tial to save large amounts of mon­ey in the lat­er stages of their life. How­ev­er, under Trump’s pro­posed plan, HSAs will also become increas­ing­ly attrac­tive for younger peo­ple. Because indi­vid­u­als will con­tin­ue to be allowed to roll over mon­ey con­tributed to their HSA in a giv­en year into the next, young and healthy peo­ple will be able to save siz­able amounts for use lat­er in life.

    While much remains to be seen about which aspects of Pres­i­dent-Elect Trump’s health plan will be enact­ed when he takes office, take the time now to edu­cate your­self on how an HSA can work for you.

     

    By Nicole Fed­eri­co & Kate McGaugh­ey, eTekhnos

  • IRS Delay in 6055 and 6056 Reporting for 2017 | California Employee Benefits

    December 8, 2016

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    1208Under 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. Final instruc­tions for the 1094‑B and 1095‑B and the 1094‑C and 1095‑C forms were released in Sep­tem­ber 2016, as were the final forms for 1094‑B, 1095‑B, 1094‑C, and 1095‑C. The report­ing require­ments are in Sec­tions 6055 and 6056 of the ACA.

    Report­ing was first due in 2016, based on cov­er­age in 2015. Report­ing in 2017 will be based on cov­er­age in 2016. All report­ing will be for the cal­en­dar year, even for non-cal­en­dar year plans.

    On Novem­ber 18, 2016, the IRS issued Notice 2016–70, delay­ing the report­ing dead­lines in 2017 for the 1095‑B and 1095‑C forms to indi­vid­u­als. There is no delay for the 1094‑C and 1094‑B forms, or for forms due to the IRS.

    Orig­i­nal Deadlines Delayed Dead­lines
    DUE TO THE IRS
    The 1094‑C, 1095‑C, 1094‑B, and 1085‑B forms were orig­i­nal­ly due to the IRS by Feb­ru­ary 28, if fil­ing on paper, or March 31, if fil­ing electronically
    Dead­line to the IRS for all forms remains the same.
    DUE TO EMPLOYEES
    The 1095‑C form was due to employ­ees by Jan­u­ary 31 of the year fol­low­ing the year to which the Form 1095‑C relates.
    DUE TO EMPLOYEES
    The 1095‑C form is now due to employ­ees by March 2, 2017.
    DUE TO INDIVIDUALS AND EMPLOYEES
    The 1095‑B form was due to the indi­vid­ual iden­ti­fied as the “respon­si­ble indi­vid­ual” on the form by Jan­u­ary 31.
    DUE TO INDIVIDUALS AND EMPLOYEES
    The 1095‑B form is now due to the indi­vid­ual iden­ti­fied as the “respon­si­ble indi­vid­ual” on the form by March 2, 2017.

     

    For infor­ma­tion on the exten­sion process as well as the impact on indi­vid­ual tax­pay­ers, view UBA’s ACA Advi­sor, “IRS Delay in 6055 and 6056 Report­ing for 2017”.

     

    By Danielle Capil­la, Orig­i­nal­ly pub­lished by Unit­ed Ben­e­fit Advisors 

  • California Dreamin – new laws affecting employer employee relationship

    December 6, 2016

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    arrowlogoAB 2337 – employ­ers with 25 or more employ­ees must pro­vide writ­ten notice to employ­ees of their rights to take pro­tect­ed time off for domes­tic vio­lence, sex­u­al assault or stalk­ing.  This is an expan­sion of exist­ing law, now requir­ing that notice be pro­vid­ed.  Con­for­mi­ty with the law is required once the Labor Com­mis­sion­er devel­ops the prop­er notice.

    New Work­ers Com­pen­sa­tion rules – which will be issued as a pack­age from the Divi­sion of Work­ers Com­pen­sa­tion over the course of 2017.  Also, the WCIRB (Work­ers Com­pen­sa­tion Rat­ing Bureau) has rec­om­mend­ed a 4.3% drop in 2017 pre­mi­ums as part of pure premium.

    SB 1167 – OSHA must pro­vide, by Jan­u­ary 1, 2019, a heat ill­ness and injury pre­ven­tion stan­dard applic­a­ble to work­ers work­ing in indoor places of employment.

    SB 1234 – estab­lish­es the Secure Choice Retire­ment pro­gram for all cov­ered pri­vate sec­tor employ­ees.  Man­dates the cre­ation of sav­ings accounts for cov­ered work­ers whose employ­ers do not offer a retire­ment sav­ings option to be auto­mat­i­cal­ly enrolled.  The pro­gram will be phased in over a 36 month peri­od and over­seen by a new Secure Choice Retiremetn Sav­ings Invest­ment Board:

    • Groups of 100 or more employ­ees – must imple­ment with­in first 12 months
    • Groups of 50–99 employ­ees – must imple­ment with­in 24 months
    • Groups of 5 to 49 employ­ees – must imple­ment with­in 36 months

    Employ­ees do have the right to opt out of the pro­gram.  The Board to set the ini­tial employ­ee con­tri­bu­tion between 2 and 5% of their gross wages and employ­ers always retain the right to pro­vide their own employ­er spon­sored retire­ment plans in lieu of the new program.

  • The Shift Away from Health Risk Assessments | California Employee Benefits

    December 2, 2016

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    1129His­tor­i­cal­ly, employ­ers have uti­lized health risk assess­ments (HRAs) as one mea­sure­ment tool in well­ness pro­gram design. The main goals of an HRA are to assess indi­vid­ual health sta­tus and risk and pro­vide feed­back to par­tic­i­pants on how to man­age risk. Employ­ers have tra­di­tion­al­ly relied on this type of assess­ment to eval­u­ate the over­all health risk of their pop­u­la­tion in order to devel­op appro­pri­ate well­ness strategies.

    Recent­ly, there has been a shift away from the use of HRAs. Accord­ing to the 2016 UBA Health Plan Sur­vey, there has been a 4 per­cent decline in the per­cent­age of employ­er well­ness pro­grams using HRAs. In con­trast, the per­cent­age of well­ness pro­grams offer­ing bio­met­ric screens or phys­i­cal exams remains unchanged – 68 per­cent of plans where employ­ers pro­vide well­ness offer a phys­i­cal exam or bio­met­ric screening.

    One expla­na­tion for this shift away from HRAs is an increased focus on help­ing employ­ees improve or main­tain their health sta­tus through out­come-based well­ness pro­grams, which often require quan­tifi­able and objec­tive data. The main issue with an HRA is that it relies on self-report­ed data, which may not give an accu­rate pic­ture of indi­vid­ual or pop­u­la­tion health due to the fact that peo­ple tend to be more opti­mistic or biased when think­ing about their own health risk. A bio­met­ric screen­ing or phys­i­cal exam, on the oth­er hand, allows for the col­lec­tion of real-time, objec­tive data at both the indi­vid­ual and pop­u­la­tion level.

    Includ­ing a bio­met­ric screen­ing or phys­i­cal exam as part of a com­pre­hen­sive well­ness pro­gram can be ben­e­fi­cial for both the employ­er and employ­ees. Through a bio­met­ric screen­ing or phys­i­cal exam, key health indi­ca­tors relat­ed to chron­ic dis­ease can be mea­sured and tracked over time, includ­ing blood pres­sure, cho­les­terol lev­els, blood sug­ar, hemo­glo­bin, or body mass index (BMI). For employ­ees, this type of data can pro­vide real insight into cur­rent or poten­tial health risks and pro­vide moti­va­tion to engage in pro­grams or resources avail­able through the well­ness pro­gram. Beyond that, aggre­gate data col­lect­ed from these types of screen­ings can help employ­ers make informed deci­sions about the type of well­ness pro­grams that will pro­vide the great­est val­ue to their com­pa­ny, both from a pop­u­la­tion health and finan­cial perspective.

    One suc­cess sto­ry of includ­ing a phys­i­cal exam as part of a well­ness pro­gram comes from one of our small man­u­fac­tur­ing clients. From the ini­tial pop­u­la­tion health report, the com­pa­ny learned that there was a large per­cent­age of its pop­u­la­tion with lit­tle to no health data, result­ing in the inabil­i­ty to assign a risk score to those indi­vid­u­als. It is impor­tant to note that when a pop­u­la­tion is not uti­liz­ing health care, it can result in late-stage diag­noses, result­ing in greater costs and a bur­den for both the employ­ee and employ­er. In addi­tion, there was low phys­i­cal com­pli­ance and a high per­cent­age of adults with no pri­ma­ry care provider. In order to cap­ture more infor­ma­tion on its pop­u­la­tion and bet­ter under­stand the cur­rent health risks, the com­pa­ny shift­ed its well­ness plan to include annu­al phys­i­cals as a method for col­lect­ing bio­met­ric data for the 2016 ben­e­fit year. Employ­ees and spous­es cov­ered on the plan were required to com­plete an annu­al phys­i­cal and sub­mit bio­met­ric data in order to earn addi­tion­al incen­tive dollars.

    By includ­ing annu­al phys­i­cals in its well­ness pro­gram, pos­i­tive results were seen for employ­ees and spous­es and the com­pa­ny was able to make an informed deci­sion about next steps for its well­ness pro­gram. After the first phys­i­cal col­lec­tion peri­od, the per­cent­age of indi­vid­u­als with lit­tle to no infor­ma­tion was reduced from 31 per­cent to 16 per­cent (Fig­ure A). Annu­al phys­i­cal com­pli­ance increased from 36 per­cent in 2015 to over 80 per­cent in 2016 (Fig­ure B), which means more indi­vid­u­als were see­ing a pri­ma­ry care provider. As a result of increased bio­met­ric data col­lec­tion and one year of Vital Incite report­ing, the com­pa­ny was able to deter­mine next steps, which includ­ed address­ing chron­ic con­di­tion man­age­ment, specif­i­cal­ly hyper­ten­sion and dia­betes, with health coach­ing or a dis­ease man­age­ment nurse.

    Fig­ure A – RUB Dis­tri­b­u­tion 2014 — 2016

    RUB Distribution 2014-2016

    Fig­ure B – Pre­ven­tive Screen­ing Compliance

    Preventive Screening Compliance

    Employ­ers that are still inter­est­ed in col­lect­ing addi­tion­al infor­ma­tion from employ­ees may con­sid­er includ­ing alter­na­tives to the HRA, such as cul­ture or sat­is­fac­tion sur­veys. These tools can allow employ­ers the oppor­tu­ni­ty to eval­u­ate pro­gram engage­ment and fur­ther under­stand the needs and wants of their employ­ee population.

     

    Orig­i­nal­ly pub­lished by Unit­ed Ben­e­fit Advi­sors — Read More

  • BREAKING NEWS: Texas Court Issues Injunction Blocking New December 1st Overtime Regulations | California Benefit Advisors

    November 29, 2016

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    Ten o'clock on the white wall clocksOn Novem­ber 22, 2016, a fed­er­al dis­trict court in Texas grant­ed a pre­lim­i­nary injunc­tion that tem­porar­i­ly blocks the U.S. Depart­ment of Labor (DOL) from imple­ment­ing and enforc­ing its recent­ly revised reg­u­la­tions on the white col­lar exemp­tions to the Fair Labor Stan­dards Act (FLSA). The reg­u­la­tions, which were released in May and sched­uled to go into effect on Decem­ber 1, would more than dou­ble the min­i­mum salary require­ment cer­tain exec­u­tive, admin­is­tra­tive, and pro­fes­sion­al employ­ees must receive in order to be exempt from overtime.

    Employ­ers should note that this is only a tem­po­rary injunc­tion, not a per­ma­nent one. The injunc­tion applies nation­wide and sim­ply pre­vents the reg­u­la­tions from going into effect on Decem­ber 1. There will be a deci­sion issued at a lat­er date on the actu­al mer­its of the case, so changes in the FLSA salary thresh­old for exemp­tion may be back.

    Impact for Employers

    For many employ­ers, this is good news for the time being. As a result, employ­ers that have not made the nec­es­sary changes to their com­pen­sa­tion plans have more time to plan for the changes in the event the reg­u­la­tions are upheld. Employ­ers that have already made changes to their com­pen­sa­tion plans will need to deter­mine if they want to con­tin­ue with the changes, sus­pend the changes, or roll back those changes pend­ing any legal devel­op­ments. These deci­sions should be made in accor­dance with any applic­a­ble state or local laws. Employ­ers should con­sult their attor­neys to deter­mine what course of action is best for them.

     

    Orig­i­nal­ly pub­lished by ThinkHR — Read More

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