Tag: employee benefits california

  • Look Backward to Plan Forward | CA Employee Benefits Agency

    October 3, 2018

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    We have entered Open Enrollment season and that means you and everyone in your office are probably reading through enrollment guides and trying to decipher it all. As you begin your research into which plan to choose or even how much to contribute to your Health Savings Account (HSA), consider evaluating how you used your health plan last year. Looking backward can actually help you plan forward and make the most of your health care dollars for the coming year.

    Forbes magazine gives the advice, “Think of Open Enrollment as your time to revisit your benefits to make sure you are taking full advantage of them.” First, look at how often you used health care services this year. Did you go to the doctor a lot? Did you begin a new prescription drug regimen? What procedures did you have done and what are their likelihood of needing to be done again this year? As you evaluate how you used your dollars last year, you can predict how your dollars may be spent next year and choose a plan that accommodates your spending.

    Second, don’t assume your insurance coverage will be the same year after year. Your company may change providers or even what services they will cover with the same provider. You may also have better coverage on services and procedures that were previously not eligible for you. If you have choices on which plan to enroll in, make sure you are comparing each plan’s costs for premiums, deductibles, copays, and coinsurance for next year. Don’t make the mistake of choosing a plan based on how it was written in years prior.

    Third, make sure you are taking full advantage of your company’s services. For instance, their preventative health benefits. Do they offer discounted gym memberships? What about weight-loss counseling services or surgery? How frequently can you visit the dentist for cleanings or the optometrist? Make sure you know what is covered and that you are using the services provided for you. Check to see if your company gives discounts on health insurance premiums for completing health surveys or wellness programs—even for wearing fitness trackers! Don’t leave money on the table by not being educated on what is offered.

    Finally, look at your company’s policy choices for life insurance. Taking out a personal life insurance policy can be very costly but ones offered through your office are much more reasonable. Why? You reap the cost benefit of being a part of a group life policy. Again, look at how your family is expected to change this year—are you getting married or having a baby, or even going through a divorce? Consider changing your life insurance coverage to account for these life changes. Forbes says that “people entering or exiting your life is typically a good indicator that you may want to revisit your existing benefits.”

    As you make choices for yourself and/or your family this Open Enrollment season, be sure to look at ALL the options available to you. Do your research. Take the time to understand your options—your HR department may even have a tool available to help you estimate the best health care plan for you and your dependents. And remember, looking backward on your past habits and expenses can be an important tool to help you plan forward for next year.

  • Healthcare Tax Repeal | CA Employee Benefits Firm

    September 24, 2018

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    Recently, the President signed a bill repealing the Affordable Care Act’s Individual Mandate (the tax penalty imposed on individuals who are not enrolled in health insurance). While some are praising this action, there are others who are concerned with its aftermath. So how does this affect you and why should you pay attention to this change? Watch this short video to learn more!

  • DOL and IRS Release Additional Information on Association Health Plans | California Benefits Firm

    September 21, 2018

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    On August 20, 2018, the Department of Labor (DOL) posted the Association Health Plans ERISA Compliance Assistance fact sheet.

    On August 20, 2018, the IRS added a new Q&A 18 to its Questions and Answers on Employer Shared Responsibility Provisions Under the Affordable Care Act. Q&A 18 confirms that:

    • An employer that is not an applicable large employer (ALE) under the employer shared responsibility provisions does not become an ALE due to participation in an AHP.
    • An employer that is an ALE under the employer shared responsibility provisions continues to be an ALE subject to the employer shared responsibility provisions regardless of its participation in an AHP.
    • The only circumstance when multiple employers are treated as a single employer for determining whether the employer is an ALE is if the employers have a certain level of common or related ownership.

    Originally published by www.UBABenefits.com

    By Karen Hsu


  • Affordable Care Act Individual Mandate Update | CA Benefits Firm

    August 20, 2018

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    Recently, the President signed a bill repealing the Affordable Care Act’s Individual Mandate (the tax penalty imposed on individuals who are not enrolled in health insurance). While some are praising this action, there are others who are concerned with its aftermath. So how does this affect you and why should you pay attention to this change?

  • Leveraging Generational Factors for Overall Success | CA Employee Benefits Firm

    August 14, 2018

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    Millennials, commonly but not exclusively defined as people born between 1981 and 1996, occupy a complicated space in today’s workplace—predominantly because they’re the youngest generation in it. While many consider this group “ambitious” and “tech-savvy,” others understand it to be “whiney,” “distracted,” or “entitled.” As with any stereotype, this is a flat, un-nuanced version of a partial truth. The most important thing to remember, says Brad Karsh, CEO and founder of JBTraining Solutions, is that each generation in the workforce—from Boomers to Millennials—has been shaped by their upbringing.

    For example, says Karsh, many millennials grew up with working parents, the privileges of after-school activities and clubs, and constant individual mentoring. In a work environment, this translates to a desire to be told what to do, to be monitored while doing it, and then to receive praise for doing everything successfully. While not every work environment is able to supply such a structure, for any number of good reasons, it’s important to remember that the desire for it is rooted in generational factors, not necessarily selfishness or weakness.

    A solid compromise, offers Karsh, is to provide concrete explanations from the start, so that millennials always have a structure to return to when they desire it. At the same time, it is best practice to “ween them off structure,” for example, reminding them that a supervisor might not check in every day, and that this isn’t a bad sign. Often, he says, millennials respond well to direct communication. Of course, everyone is an individual no matter their generation, and over time, most new structures can be learned and put to effective use. Other best practices that have proved effective for millennials are future-focused credentials, real time conversations, and microlearning.

    Originally published by www.UBABenefits.com

    By Bill Olson

  • Wearable Technology | California Benefits Firm

    July 30, 2018

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    Don’t lie–we ALL love gadgets. From the obscure (but hilariously reviewed on Amazon) Hutzler 571 Banana Slicer to the latest iteration of the Apple empire. Gadgets and technology can make our lives easier, make processes faster, and even help us get healthier. Businesses are now using the popularity of wearable technology to encourage employee wellness and increase productivity and morale.

    According to a survey cited on Huffington Post, “82% of wearable technology users in American said it enhanced their lives in one way or another.” How so? Well, in the instance of health and wellness, tech wearers are much more aware of how much, or how little, they are moving throughout the day. We know that our sedentary lifestyles aren’t healthy and can lead to bigger health risks long term. Obesity, heart disease, high blood pressure, and Type 2 Diabetes are all side effects of this non-active lifestyle. But, these are all side effects that can be reversed with physically getting moving. Being aware of the cause of these problems helps us get motivated to work towards a solution.

    Fitbit, Apple Watch, Pebble, and Jawbone UP all have activity tracking devices.  Many companies are offering incentives for employees who work on staying fit and healthy by using this wearable technology. For example, BP Oil gave employees a free Fitbit in exchange for them tracking their annual steps. Those BP employees who logged 1 million steps in a year were given lower insurance premiums. These benefits for the employee are monetary but there are other pros to consider as well. The data collected with wearable technology is very accurate and can help the user when she goes to her physician for an ailment. The doctor can look at this data and it can help connect the dots with symptoms and then assist the provider with a diagnosis.

    So, what are the advantages to the company who creates wellness programs utilizing wearable technology?

    • Job seekers have said that employee wellness programs like this are very attractive to them when looking for a job.
    • Millennials are already wearing these devices and say that employers who invest in their well-being increases employee morale.
    • Employee healthcare costs are reduced.
    • Improved productivity including fewer disruptions from sick days.

    The overall health and fitness of the company can be the driving force behind introducing wearable technology in a business but the benefits are so much more than that. Morale and productivity are intangible benefits but very important ones to consider. All in all, wearable technology is a great incentive for adopting healthy lifestyles and that benefits everyone—employee AND employer.


  • Oral Health = Overall Health | Petaluma Benefits Advisors

    July 26, 2018

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    A healthy smile can lead to a healthier (and longer living) you! Check out how easy it is to have good oral health.


  • Additional Adjustments

    July 24, 2018

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    Employers need to see if their premiums are “affordable” for purposes of compliance with the Affordable Care Act for penalties.  Employees need to see the same to determine if they are eligible for a subsidy with the Exchanges.  New figures for 2019


    Household Income as                         New Percentage 2019

    Percentage of FPL


    Less than 133%                                              2.08%

    133 – 150%                                                     4.15

    150 – 200                                                        6.54

    200 – 250                                                        8.36

    250 – 300                                                        9.86

    300 – 400                                                        9.86


    Overall, then, if an employee pays a percentage of their annual income higher than these amounts, based on their Household Income, they have an “unaffordable” plan

  • Leadership, Now with More Humility | CA Benefits Consultants

    July 19, 2018

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    More and more, we are learning that scientists, marketers, programmers, and other kinds of knowledge workers lead office lives very similar to famous innovators like Watson, Crick, and Franklin, who discovered the structure of DNA. How so? All of these people live work lives structured around progress in meaningful work. And when this progress occurs, it boosts emotions, perceptions, and productivity.

    This could be an important key to supporting your employees at their desks, wherever those may be. While recognition, tangible incentives, and goals are important, leading managers must also consider nourishing progress through attention to inner work life, minor milestones, and appropriate modeling.

    When progress is effectively monitored and encouraged, it can lead to a self-sustaining progress loop, which often results in increased success and productivity, especially toward larger, group-based goals. In other words, when managers support inner work life and recognize minor progress, it leads to major accomplishments.

    Seeing employees as growing, positive individuals with a drive to experiment and learn, as opposed to mere means to an end goal, can make all the difference in an office, and over the yearsOne way to do this effectively is to incorporate humility into your leadership style. This doesn’t imply that you have low self-confidence or are yourself servile. Rather, it says you prioritize the autonomy of your office and support your employees to think responsibly for themselves. Ask them what their daily work lives are like, and how you can help them maximize effectiveness. Create low-risk opportunities for growth, and most importantly: follow through.

    Read More:
    “Leading through emotions”
    “Leading with emotional intelligence”


    By Bill Olson, VP, Marketing & Communications at United Benefit Advisors

    Originally posted on UBABenefits.com

  • California Employment Law Update – July 2018 | California Employee Benefits

    July 13, 2018

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    Milpitas Minimum Wage

    The city of Milpitas updated its official minimum wage notice to reflect an increase to $13.50 per hour effective July 1, 2018.

    See the poster

    Originally published by www.ThinkHR.com

  • Top 5 Social Media Tips | CA Benefits Firm

    June 27, 2018

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    The world is connected nowadays through our screens. Whether it be email, texting, websites, FaceTime, or social media; we all use technology to connect us to others. Check out this short video for more!

  • Does the President have a prescription for what ails drug prices? Depends on the dosage

    June 21, 2018

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    There is no doubt that prescription drug prices are a major driver in the overall cost of care.

    The question is what to do about it, and what repercussions would it have on other parts of the market and the manufacturers themselves?  The President has made partial good on his campaign promise, proposing a number of solutions to the problem, but will they work?  Some already say “no” because he is not using the purchasing power of Medicare to drive down prices, instead relying on legalistic prescriptions which will promote transparency and then…

    • Value based purchasing in federal programs
    • Using Medicare to pay different amounts for the same drug depending on the illness
    • Pressure other countries to raise their prices for prescription drugs (oh, sure)
    • Require drug ads to include the price (but if the carriers are paying, who cares?)
    • Ban gag clauses for pharmacists to they can recommend other, less expensive drugs
    • The patent system will change to reward innovation and not protect monopolies
    • Change the existing rebate system (but how, when no one understands how it works)

    That’s what it comes to in the analysis.  What was said in the long White Paper produced by the President and his team were the following goals:


    • Increasing competition – Accelerating FDA approval of generics, focus on FDA improving efficiency of generic development, clarify complex generics, closing loopholes allowing brand names to game the system, modernize Medicare Part D, put an inflation limit on Medicare Part B drugs, increasing the integrity of the Medicaid rebate program


    • Lowering list prices – transparency with Medicare, ACA rebate provisions, FDA evaluation on direct to consumer advertising


    • Reduce patient out of pocket spending – end gag clauses, require Part D providers to show lower cost alternatives on the Explanation of Benefits, evaluate options to alow high cost drugs to be priced differently based on indications



  • Hospitals cry foul over latest Anthem fare…definitions change and definitely cause harm

    June 15, 2018

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    Anthem has changed their policy regarding imaging performed in hospitals on an outpatient basis and will expand this into fourteen states.  Hospitals are not happy, nor amused and have filed suit.  Anthem stakes its claim on the idea of medical necessity, and hospitals are saying that doctors have the right to show necessity, not carriers.  And so the battle continues as carriers continue to try to dictate care but those who are responsible for care are not responsible for the payment.  No winners here…

    And as if that were not enough, Anthem has also begun pushing back on patients who visit the emergency room for ailments the carrier deems minor – called the “avoidable ER program” (as in avoiding payment).  While Anthem has lightened up on their procedures somewhat, they are refusing to pay some ER visits as non emergency (after the fact) which is not making patients and doctors particularly happy.  Stay tuned.

  • Independents may not be so depending on the interdependence of employment status

    June 11, 2018

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    The California State Supreme Court, in the case of a suit against Dynamex Operations West, said simply that “when a worker has not independently decided to engage in an independently established business but instead is simply designated an independent contractor – there is a substantial risk that the hiring business is attempt to evade the demands of an applicable wage order through misclassification.” In short, to be independent they must be, you know, independent.  Businesses must show that the worker is free from the control and direction of the employer, perform work that is outside the hirer’s core business and customarily engage in an independently established trade, occupation or business

    On April 30, 2018 the California Supreme Court determined that California employers must always start with the presumption that a worker is a common law employee.  They may classify them as independent ONLY IF ALL of these criteria are being met:

    Worker is free from control and direction in connection with the performance of the work

    The worker performs work that is outside the usual course of the hiring entity’s business

    Worker customarily engaged in independently established trade, occupation or business

    This gives common sense to what the Department of Labor has long used as their “twenty questions” to determine the independence of an independent contractor.  The only question remaining now is that, if the DOL finds an employer responsible for an “employee” who may have previously been misclassified, if all rights and benefits that apply will be made retroactively

  • Always ask the real price before you pay…prescription drugs need a prescription for action

    June 6, 2018

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    This should be apparent, but apparently it isn’t.  Sometimes prescription drugs, so often dispensed as generics, have a lower price than the copayment stated on the benefit card.  A new study, however, shows that consumers aren’t asking, thus not only paying a higher amount than necessary, but this amount is then “clawed back” by the Pharmacy Benefit Manager (no, the pharmacy does not keep the difference, nor does the insurance carrier) which acts as a middleman between the carrier and the consumer.  During a study period comprising the first half of 2013, a USC study found that overpayments totaled $135 million.  A good example – hydrocodone acetaminophen (that would normally be called “Vicodin”) was prescribed 120,000 times and there was an average overcharge of $6.94.  It is not just generics, moreover.  The brand name drugs of longer standing also often fall under the brand name co payment (Ambien was cited as the most egregious example)  So next time, don’t just reach for the card…

  • Opioids in America | CA Benefit Brokers

    June 5, 2018

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    Lately, there’s been a big focus on America’s opioid addiction in the news. Whether it’s news on the abuse of the drug or it’s information sharing on how the drug works, Americans are talking about this subject regularly. We want to help educate you on this hot topic.

    Opioids are made from the opium poppy plant.  Opium has been around since 3,400 BC and it was first referenced as being cultivated in Southwest Asia. The drug traveled the Silk Road from the Mediterranean to Asia to China. Since then, the drug has gained popularity for pain relief but it also has gained notoriety as an abused drug. Morphine, Codeine, and Heroin are all derived from the opium poppy and are all highly addictive drugs that are abused all around the world. As the demand for these drugs has increased, so has the production.  From 2016 to 2017, the area under opium poppy cultivation in Afghanistan increased by 63 percent. In 2016, it killed some 64,000 Americans, more than double the number in 2005.

    We can see that the danger from this drug is growing rapidly. What can we do to recognize potential abuse problems and to get help? Here are some facts about opioid addiction:

    • How do they work? Opioids attach to pain receptors in your brain, spinal cord, and other areas that recognize pain signals. As they attach to the receptors, it reduces the sending of pain messages to the brain and therefore reduces the feelings of pain in your body.
    • Short-acting opiates are typically prescribed for injuries and only for a few days. They take 15-30 minutes for pain relief to begin and this relief lasts for 3-4 hours. Long-acting opiates are prescribed for moderate to severe pain and are used over a long period of time. Relief typically lasts for 8-12 hours and can be used alongside a short-acting drug for breakthrough pain.
    • Dependence is common with long-term use of an opiate. This means that the patient needs to take more of and higher doses of the medicine to get the same pain relieving effect. This does not necessarily mean the patient is addicted. Addiction is the abuse of the drug by taking it in an unprescribed way—like crushing tablets or using intravenously.
    • Americans account for less than 5% of the world’s population, but take 80% of the world’s opioid About 5% of the people who take opiates become addicted to the drug.
    • Help is available through many channels from private recovery centers to insurance providers. The Substance Abuse and Mental Health Services Administration helpline is 1-800-662-HELP. This line is confidential, free, and available 24-hours a day and 7 days a week. Family and friends may also call this number for resources for help. Additional resources can be found at drugabuse.com.

    Make sure you are educated about the dangers of opioid abuse. But, don’t be discouraged and think that the abuse is incurable! There are many resources that can be used to break the addiction cycle and can make real change in the lives of its victims. Ask for help and offer help.


  • Are retirees given any guarantees? The issue keeps going back and forth

    June 4, 2018

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    The Supreme Court has once again found that retiree benefits are not vested.  So the employer can promise but…     Actually, the Court simply clarified the need for clarity.  In the absence of specific language that vests retiree health benefits, the retirees may no longer assume that silence or ambiguity allows a lifetime contract.  Instead, the contract itself must state the case.  Seems simple, but this has been kicking around, even though the Supreme Court said the same thing in 2015.  Now it will show the unions that what they want needs to be negotiated and then put in writing (we will call this the “common sense” doctrine)

  • The new normal – see our White Paper – everyone is buying everyone – can we buy their act?

    May 31, 2018

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    Walmart is in preliminary talks to buy and partner with Humana

    CIGNA is buying Express Scripts

    CVS bought Aetna

    And the list goes on…

  • Notifying Participants of a Plan Change | California Employee Benefit Firm

    May 15, 2018

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    Curious about when you should notify a participant about a change to their health care plan?

    The answer is that it depends!

    Notification must happen within one of three time frames: 60 days prior to the change, no later than 60 days after the change, or within 210 days after the end of the plan year.

    For modifications to the summary plan description (SPD) that constitute a material reduction in covered services or benefits, notice is required within 60 days prior to or after the adoption of the material reduction in group health plan services or benefits. (For example, a decrease in employer contribution is a material reduction in covered services or benefits. So is a material modification in any plan terms affecting the content of the most recent summary of benefits and coverage (SBC).) While the rule here is flexible, the definite best practice is to give advance notice. For collective practical purposes, employees should be told prior to the first increased withholding.

    However, if the change is part of open enrollment, and communicated during open enrollment, this is considered acceptable notice regardless of whether the SBC, SPD, or both are changing. Essentially, open enrollment is a safe harbor for all 60-day prior/60-day post notice requirements.

    Finally, changes that do not affect the SBC and are not a material reduction in benefits must be communicated and summarized within 210 days after the end of the plan year.

    By Danielle Capilla

    Originally published by www.UBABenefits.com


  • The Questions to Ask When Looking for Napa Benefit Brokers

    May 10, 2018

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    When working with Napa benefit brokers, it’s important that you find a company that is on your side and ready to help guide you in choosing the ideal coverage options. Without experience in the process it can be difficult to make progress, and so within this latest post, we’ll look at the questions you must ask in finding qualified Napa benefit brokers. Read More >>

  • Top 5 Social Media Tips That Can Benefit Every Agency | CA Benefit Consultants

    May 7, 2018

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    The world is connected nowadays through our screens. Whether it be email, texting, websites, FaceTime, or social media; we all use technology to connect us to others. According to Hubspot, an online marketing and sales software provider, consumers are on social networks more than ever before. They wrote:

    In our survey of 1,091 global internet users, we’ve found people have dramatically increased content consumption on the three most popular social networks in the last two years: Facebook (+57% increase), Twitter (25% increase), and LinkedIn (21% increase). These networks have notably doubled down on content in the past few years to capture and retain the attention of their users — and it appears the playbook is working.The Future of Content Marketing: How People Are Changing the Way They Read, Interact, and Engage With Content

    So, how do you harness this tech to strengthen your connectivity to your audience? Here’s the top 5 tips for using social media that every agency can benefit from using.

    1. Consistent Content Posting

    Your followers want to know when they can expect new info to be posted on your website and social media. If you post once a week for 3 weeks and then not post again for another month, your audience will quit paying attention. Consistency is the key! Make a point to post at the same general time on the same days and you will see more interaction from your followers.

    1. Images & Videos

    62% of users thoroughly consume the social media post if it includes video as compared to only 25% consumption of traditional long content posts. That’s a HUGE difference! Grab your audience’s attention when they are scrolling through their social media by posting pictures and videos. They are telling us that they will stop and watch or read more than skimming because of the images they see.

    1. Keep Up with Social Media Trends

    Pay attention to what you are most engaged with on social media. Do you like to watch Facebook Live videos? Do you stop and scroll through pictures from companies when they post what they are doing in the community? Do you prefer to chat with a customer service representative online versus an email? If you are seeing your preferences change, there is a good chance your audience’s preferences are changing. Post pictures of your teams serving their community. Use videos to educate your clients on relevant issues in your field. Social media is constantly evolving so stay up on trends and use them on your pages!

    1. Facebook is Still King

    Consumers are using Facebook for more than just connecting to their high school friends—they are using it to read content from their favorite businesses and groups. This means you MUST keep your Facebook page updated and have new content posted regularly. According to a new Hubspot survey, 48% of consumers use their Facebook feed to catch up on news, business, and lifestyle stories. This ties back to Tip #1 and reiterates that consistent posting is the sweet spot for engaging customers.

    1. Engage Your Audience

    How are you talking to the people who use your business? Are you responding to inquiries on Facebook? When you post pictures on LinkedIn are you responding to the people who are looking and commenting on them? When you engage with your followers, they are more likely to have a stronger relationship with you. Entrepreneur Magazine says, “They are more likely to have a better evaluation of the brands, stay loyal to the brands and recommend the brands to others.”

    By following these tips, your social media pages can grow into healthy sites and you can be more effective as you engage with your audience.  Start using them today!


  • Will wellness make you sick? Well, no, but it won’t cure you either, say studies

    April 20, 2018

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    The first problem in proving the value of wellness programs, of course, is that the data, while considerable, is also anecdotal.  Further, the use of wellness does not necessarily correlate to some of the results claimed. Finally, though this is one good reason to do it anyway, is that you can’t quantify the results based on what diseases or injuries you would have prevented.  A recent study in Health Affairs, which is the leading journal for health care theory and practice, said care coordination and management initiatives have not been drivers of savings in Medicare, and an earlier study shows that even if 90% of consumers utilized preventive services (much higher than the current takeup rate) the total effect on health care spending would be just under 0.2% – a lot of money overall, but not much money as part of the system.  Cynics also point out that if we let people live longer, they will consume more health care services.  This is, of course, a good societal thing, but if you want to look purely at how to save money and how to improve care, there is always contention with the “law of unintended consequences’  Overall, the argument should be about improving quality and not saving costs. Oh, well.

  • Don’t worry…we’re going to fix it now

    April 20, 2018

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    Well, now the concerns are over.  Jamie Dimon JP Morgan, Jeff Bezos from Amazon and Warren Buffet from Berkshire Hathaway have all teamed up to solve our nation’s health care problems.  There are no details at this point, of course, but they say they plan to hold down costs by bringing “their scale and complementary expertise to this long term effort”  They will create an independent company “free from profit making incentives and constraints” to focus on technology solutions”  This is great, except for the fact that technology is only one part of the problem (but definitely worth fixing) and that the scale these companies bring will really only benefit a narrow slice of consumers – their companies.  By the way, Steve Case of AOL tried this years ago and failed miserably, but who remembers Steve Case any more?

  • A DOL Audit Can Happen to You | Petaluma Benefit Consultants

    April 19, 2018

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    Summary plan descriptions (SPDs) are required for all retirement, health, and welfare plans subject to the Employee Retirement Income Security Act of 1974 (ERISA). However, misconceptions about this requirement are widespread. ERISA attorney Stacy H. Barrow, partner with Marathas Barrow Weatherhead Lent LLP, had a chat with ThinkHR about the importance of having proper ERISA documentation and the consequences of failing to do so.

    THR: What types of employers need to have an SPD?

    SHB: We tell all employers — of any size — who offer plans subject to ERISA that they need to have an SPD. This is the first item in every Department of Labor (DOL) audit. If you don’t have one and you get audited or a participant asks for plan documents, you will be scrambling to put documents together and you can’t do them fast enough to avoid an issue. In addition, cafeteria plans can only be adopted prospectively, so if you don’t have a written cafeteria plan in place, you may be jeopardizing the tax qualified status of your plan.

    THR: Won’t my broker or carrier take care of these documents?

    SHB: Employers may think that brokers or carriers take care of all required benefits documentation, but at the end of the day, it’s the employer who is responsible for complying with ERISA’s SPD requirement. Your broker may help you, but they might not be aware of every benefit you offer or your eligibility guidelines. The carrier’s documentation often is missing some of the required language, which is why you use a wrap. You don’t specifically have to use a wrap to develop your SPD, but the carrier document won’t get you there and an wrap is often the best way to comply. If the plan documents aren’t compliant, that’s not the carrier’s or broker’s responsibility, it’s the employer’s.

    THR: Do I really need to be concerned about a DOL audit?

    SHB: Employers can get complacent about documentation, thinking that only large employers get audited, or it won’t happen to them. It’s not only the large corporations that get audited. It can happen to employers of any size or type. It’s important to make sure you have good benefits documentation, because if you don’t, and you do get audited, it might cause the DOL to dig deeper and look for other problems, such as looking into your 401(k) plan.

    Plan documentation is a huge part of every DOL audit. I can’t stress strongly enough that they will want to see the summary plan description and plan documents. If you can get good, compliant documents to the DOL, it increases the chances of a speedy resolution. If you can provide them quickly, it sends a message that you are ready and in compliance.

    THR: What are the consequences of being out of compliance?

    SHB: Not having the proper documents may be an issue if you get audited or there is litigation over a denied claim. You need to be prepared for this possibility. If the DOL audits and imposes penalties, it may not be because the employer didn’t have a wrap document, but rather because the document wasn’t updated, wasn’t compliant, or wasn’t distributed to employees. And the DOL may impose penalties of up to $152 per day for failure to provide an SPD upon request. Also, failure to inform participants of plan changes may invalidate those changes.

    By Rachel Sobel

    Originally published by WWW.ThinkHR.com

  • Non-profits now may have to show a profit on something from which employees profit

    April 11, 2018

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    Under the new Tax Act, and effective January 1, 2018, non profit employers must pay a corporate tax (defined as 21% under Section 13703 of amended section 512(A) of the Tax Code) for the following benefits made available to employees on a cost free basis:

    • Qualified transportation plan
    • Parking facilities used in connection with qualified parking
    • On premises athletic facilities

  • Disability Insurance and why you need it! | CA Benefit Consultants

    April 9, 2018

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    “Your most valued asset isn’t your house, car, or retirement account. It’s the ability to make a living.”

    No one foresees needing disability benefits.  But, should a problem arise, the educated and informed employee can plan for the future by purchasing disability insurance to help cover expenses when needed.

    When you ask people what is the number one reason disability insurance is needed, most will answer that it is for workplace related injuries. However, the leading causes of long-term absences are back injuries, cancer, and heart disease and most of them are NOT work related.   In addition, the average duration of absences due to disability is 34 months.  So how do you prepare for an unplanned absence from work as a result of an injury or illness? Disability insurance is a great option.

    Disability insurance is categorized into two main types.

    • Short Term Disability covers 40-60% of the employee’s base salary and can last for a few weeks to a few months to a year. There is typically a short waiting period before benefits begin after the report of disability. This plan is generally sponsored by the employer.
    • Long Term Disability covers 50-70% of the employee’s base salary and the benefits end when the disability ends or after a pre-set length of time depending on the policy. The wait period for benefits is longer—typically 90 days from onset of disability. This plan kicks in after the short-term coverage is exhausted. The individual purchases this plan to prevent a loss of coverage after short-term disability benefits are exhausted.

    While the benefits of these disability plans are not a total replacement of salary, they are designed for the employee to maintain their current standard of living while recovering from the injury or illness. This also allows the individual to pay regular expenses during this time.

    There are many ways to enroll in a disability insurance plan. Often times your employer will offer long-term and short-term coverage as part of a benefits package. Supplemental coverage can also be purchased.  Talk with your company’s HR department for more information on how to enroll in these plans.  Individuals who are interested in purchasing supplemental coverage can also contact outside insurance brokers or even check with any professional organizations to which they belong (such as the American Medical Association for medical professionals) as many times they offer insurance coverage to members.

    As you begin planning for your future, make sure you research the types of coverage available and different avenues through which to purchase this coverage. For more information on disability and the workplace, check out:




  • The New Tax Act has some gifts for employers who have employees on leave

    April 3, 2018

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    To encourage employers to provide eligible employees with paid leave under the FMLA, the new tax law provides them with a new business credit equal to 12.5% of the amount of wages paid to “qualifying employees” during any period in which such employees are on family and medical leave as long as the rate of payment under the program is at least 50% of the employee’s normal wages.

  • Price Shop Healthcare | CA Benefit Advisors

    April 3, 2018

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    As the costs of health care soar, many consumers are looking for ways to control their medical spending. Also, with the rise of enrollment in high deductible health plans, consumers are paying for more health care out-of-pocket. From medical savings accounts to discount plans for prescriptions, patients are growing increasingly conscious of prices for their healthcare needs. Price shopping procedures and providers allows you to compare prices so that you are getting the best value for your care.

    Why do you need to look beyond your nearby and familiar providers and locations for healthcare? Here’s a hypothetical example: Chris is a 45-year old male in good physical health. During his last check-up he mentions to his doctor that he’s had some recent shortness of breath and has been more tired as of late. His doctor orders an EKG to rule out any problems. If Chris went to his local hospital for this procedure, it would cost $1150. He instead looks online and shops around to find other providers in his area and finds he can get the same procedure for $450 at a nearby imaging center. His potential savings is $700 simply by researching locations.

    So where do you start when shopping around for your health care?  A good place to begin is by researching your health plan online. Insurance companies will post cost estimates based on facility, physician, and type of procedure. Keep in mind that these are just estimates and may vary based on what coverage you are enrolled in. Another way to shop is by checking out websites that have compiled thousands of claims information for various procedures and locations to give an estimate of costs. However, deciphering whether a site is reporting estimates based on the “medical sticker price” of charges or rates for private insurance plans or Medicare is difficult.  There are huge differences in prices at different providers for the exact same procedure. This is because contracts between insurance agencies and providers vary based on negotiated amounts. This makes it hard to get consistent pricing information.

    Check out these sites that do a great job comparing apples to apples for providers:

    • Healthcare Blue Book
      • What Kelly Blue Book is to cars, Healthcare Blue Book is to medical pricing
    • New Choice Health
      • Reports on pricing of medical procedures, providers, quality of facilities, and customer feedback for healthcare in all 50 states
    • The Leapfrog Group
      • Publishes data on hospitals so patients can compare facilities and costs for treatments and procedures

    After compiling all the information on prices and procedures, you can still call and negotiate costs with the location of your care. Fair Health Consumer has tips on how to negotiate with providers and plan for your healthcare needs.

    Knowledge is POWER and when you spend time researching and comparing healthcare costs, you are empowering yourself!  Exercising due diligence to plan for you and your family’s medical needs will save you money and give you confidence in your decisions for care.



  • Federal Employment Law Update – March 2018 | California Employee Benefit Brokers

    March 28, 2018

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    FLSA Amendments to Tip Sharing Provisions

    On March 23, 2018, President Trump signed legislation (H.R. 1625) amending the federal Fair Labor Standards Act (FLSA) by prohibiting employers from keeping tips received by employees for any purpose. This includes prohibiting managers or supervisors from keeping any portion of employees’ tips, regardless of whether the employer takes a tip credit. Employers in violation of these protections are liable to the affected employee(s) for the sum of any tip credit taken, and all tips unlawfully kept, in addition to an equal amount as liquidated damages. Regarding willful violations of the employment of minors provisions (at 29 U.S.C. § 216(c)), any person in violation of the law will be subject to a civil penalty of up to $1,100 for each violation and will be liable to the affected employee(s) for all tips unlawfully kept and an additional equal amount as liquidated damages.

    The law is currently effective.

    Read US H.R. 1625

    Postponement of E-Verify Temporary Unavailability

    On March 15, 2018, the U.S. Citizenship and Immigration Services (USCIS) announced via fact sheet that E-Verify and E-Verify Services would be temporarily unavailable from 12 a.m. March 23 to 8 a.m. March 26 Eastern Time for system enhancements. However, on March 22 the USCIS released an email stating that the enhancements were “still in the works,” and the modernization launch was postponed. Subsequently, E-Verify will remain available, and all regular employment eligibility verification timelines continue to apply.

    Read about the planned enhancements

    IRS Adjusts 2018 Inflation Amounts for Health Savings Accounts

    On March 5, 2018, the federal Internal Revenue Service (IRS) announced 2018 annual limits on deductions for individuals covered under a high deductible health plan (HDHP) in Rev. Proc. 2018-18. The deduction limit is $3,450 for an individual with self-only coverage and $6,850 for an individual with family coverage.

    Additionally, for calendar year 2018, an HDHP is defined as a health plan with an annual deductible that is not less than $1,350 for self-only coverage or $2,700 for family coverage, and the annual out-of-pocket expenses (deductibles, co-payments, and other amounts, excluding premiums) do not exceed $6,650 for self-only coverage or $13,300 for family coverage.

    Read Rev. Proc. 2018-18

    EEO-1 Reporting and Employees Who Regularly Report to Client Sites

    The portal for 2017 EEO-1 reporting is open and reports must be submitted and certified by March 31, 2018 at the latest.

    The federal Equal Employment Opportunity Commission (EEOC) has addressed the issue that there may be some confusion as to how employers are to report employees working at client sites (a workplace the employer does not own but where the employee reports for work). According to the EEOC’s 2017 EEO-1 User Guide (see page 132), employers must still submit an EEO-1 report under the address of the client site for those employees, as opposed to the employer’s own address.

    See How to File an EEO-1 Report

    IRS Updates Withholding Calculator and Releases New Form W-4

    On February 28, 2018, the federal Internal Revenue Service (IRS) released an updated Withholding Calculator and a new version of Form W-4 following passage of the Tax Cuts and Jobs Act in December.

    The Tax Cuts and Jobs Act made changes to the tax law, including increasing the standard deduction, removing personal exemptions, increasing the child tax credit, limiting or discontinuing certain deductions, and changing the tax rates and brackets.

    If changes to withholding should be made, the Withholding Calculator gives employees the information they need to fill out a new Form W-4, Employee’s Withholding Allowance Certificate.

    More information is available at the IRS page, Withholding Calculator Frequently Asked Questions.

    Read the press release

    NLRB Vacates Hy-Brand and Browning-Ferris Joint Employment Standard Reinstated

    On February 26, 2018, the National Labor Relations Board (NLRB) announced that it vacated its December 14, 2017 decision in Hy-Brand Industrial Contractors regarding the joint employment standard. As a result, the Obama-era, employee-friendly joint employment standard established by Browning-Ferris Industries was reinstated. Under the reinstated Browning-Ferris standard, a company can be found to be a joint employer based on the potential of its ability to exercise control over terms and conditions of employment, regardless of whether the actual authority is exercised. This is an “indirect control” standard and is considered the main factor in determining whether a joint employer relationship exists, and thus liability, under the National Labor Relations Act (NLRA).

    According to the NLRB, Hy-Brand was vacated due a determination by the board’s designated agency ethics official that member William Emanuel is, and should have been, disqualified from participating in the Hy-Brand proceeding. In a memorandum issued on February 9, 2018, the U.S. Inspector General found that Emmanuel’s former law firm was involved in the original Browning-Ferris decision, and subsequently, he should have recused himself from the Hy-Brand decision.

    Because the Board’s Decision and Order in Hy-Brand has been vacated, the overruling of the Board’s decision in Browning-Ferris Industries, 362 NLRB No. 186 (2015), is of no force or effect.

    Read the press release and order

  • The ACA still makes its way but maybe in the wrong direction

    March 26, 2018

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    Enrollment has dropped nearly 4% in those areas covered by the Federal Exchange, but remained about the same in states that ran their own (e.g. California).  Meanwhile, a“Treasury watchdog” reported that the IRS overpaid the ACA tax credits by $3.5 billion in 2017.  The good news is that the total was actually $5.8 billion but they were able to get recovery on the amounts that can be recovered – but the rest seems to be lost.  Oops.

  • Learn all about Medical Savings Accounts! | CA Benefit Brokers

    March 23, 2018

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    Take control of your health care expenses and save money in 2018!


  • IRS Releases New Form W-4 and Updates Withholding Calculator | California Benefit Consultants

    March 16, 2018

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    Our February 1, 2018 blog post reported on the late February release of the Form W-4 and guidance on the income withholding rules that changed under the Tax Cuts and Jobs Act. On February 28, 2018, the federal Internal Revenue Service (IRS) released the new 2018 Form W-4 and an updated withholding calculator.

    Why a Withholding Calculator?

    The IRS encourages the use of the withholding calculator for a quick paycheck checkup in light of the changes to the tax law for 2018. According to the IRS, employees may be encouraged to use the calculator to ensure the correct tax amount is being withheld from their paychecks. For example, reviewing withholding may help protect employees against having too little tax withheld and facing an unexpected tax bill or penalty during next year’s tax season. Alternatively, with the average refund being $2,800, the IRS anticipates that some employees may have less tax withheld up front and instead receive more in their paychecks. If an employee needs to make changes to his or her withholding, the calculator provides the necessary information to fill out a new W-4.

    Next Steps

    Make sure your employees know about the availability of the calculator. Only employees changing their withholding need to complete a new W-4, and they may use results from the calculator to complete the new form. Encourage those employees to submit updated W-4s as soon as possible to ensure their withholdings are accurate.

    The IRS also suggests that if employees follow the calculator’s recommendations and change their 2018 withholding, they should recheck their withholding at the beginning of 2019 to protect against having too little withheld. This is important where an employee reduces his or her withholding sometime during 2018 because a mid-year withholding change in 2018 may have a different full-year impact in 2019.

    Get it All

    More information is available at the IRS page, Withholding Calculator Frequently Asked Questions.

    Learn more about the Tax Cuts and Jobs Act.

    By Samantha Yurman

    Originally published by www.ThinkHR.com

  • California Employment Law Update – March 2018 | CA Benefit Advisors

    March 14, 2018

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    California Supreme Court Rules on Overtime Calculations with Retroactive Application

    On March 5, 2018, the California Supreme Court ruled in Alvarado v. Dart Container Corporation of California (Alvarado) that when calculating overtime in pay periods when an employee earns a flat rate bonus, employers must divide the total compensation earned in a pay period by only the non-overtime hours worked. This means, according to the Alvarado decision, the correct calculation of overtime associated with a flat sum bonus is the amount of the bonus divided by the regular hours worked by the employee, multiplied by 1.5 (not a 0.5 multiplier, which the employer used in the case):

    (Overtime Hours x Regular Rate x 1.5) + (Bonus/Regular Hours Worked x Overtime Hours Worked x 1.5) = Total Overtime Compensation in California

    This decision applies retroactively; thus all California employers who pay flat rate bonuses must ensure immediate compliance with these calculations or risk incurring penalties and liability.

    Read Alvarado

    Originally published by www.ThinkHR.com

  • 6 Ways to Keep the Flu from Sidelining Your Workplace | CA Employee Benefit Brokers

    March 2, 2018

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    This year’s flu season is a rough one. Although the predominant strains of this year’s influenza viruses were represented in the vaccine, they mutated, which decreased the effectiveness of the immunization. The flu then spread widely and quickly, and in addition, the symptoms were severe and deadly. The U.S. Centers for Disease Control and Prevention (CDC) reported that the 2017 – 2018 flu season established new records for the percentage of outpatient visits related to flu symptoms and number of flu hospitalizations.

    Younger, healthy adults were hit harder than is typical, which had impacts on the workplace. In fact, Challenger, Gray & Christmas, Inc. recently revised its estimates on the impact of this flu season on employers, raising the cost of lost productivity to over $21 billion, with roughly 25 million workers falling ill.

    Fortunately, the CDC is reporting that it looks like this season is starting to peak, and while rates of infection are still high in most of the country, they are no longer rising and should start to drop. What can you do as an employer to keep your business running smoothly for the rest of this flu season and throughout the next one?

    1. Help sick employees stay home. Consider that sick employees worried about their pay, unfinished projects and deadlines, or compliance with the company attendance policy may feel they need to come to work even if they are sick. Do what you can to be compassionate and encourage them to stay home so they can get better as well as protect their co-workers from infection. In addition, make sure your sick leave policies are compliant with all local and state laws, and communicate them to your employees. Be clear with the expectation that sick employees not to report to work. For employees who feel well enough to work but may still be contagious, encourage them to work remotely if their job duties will allow. Be consistent in your application of your attendance and remote work rules.
    2. Know the law. Although the flu is generally not serious enough to require leaves of absence beyond what sick leave or PTO allow for, in a severe season, employees may need additional time off. Consider how the federal Family and Medical Leave Act (FMLA), state leave laws, and the Americans with Disabilities Act (ADA) may come into play for employees who have severe cases of the flu, complications, or family members who need care.
    3. Be flexible. During acute flu outbreaks, schools or daycare facilities may close, leaving parents without childcare. Employees may also need to be away from the workplace to provide care to sick children, partners, or parents. Examine your policies to see where you can provide flexibility. Look for opportunities to cross-train employees on each other’s essential duties so their work can continue while they are out.
    4. Keep it clean. Direct cleaning crews to thoroughly disinfect high-touch areas such as doorknobs, kitchen areas, and bathrooms nightly. Provide hand sanitizer in common areas and encourage frequent handwashing. Keep disinfecting wipes handy for staff to clean their personal work areas with.
    5. Limit exposure. Avoid non-essential in-person meetings and travel that can expose employees to the flu virus. Rely on technology such as video conferencing, Slack, Skype, or other platforms to bring people together virtually. Consider staggering work shifts if possible to limit the number of people in the workplace at one time.
    6. Focus on wellness. Offer free or low-cost flu shots in the workplace. If your company provides snacks or meals for employees, offer healthier options packed with nutrients.

    Get it all

    AGENCY RESOURCES: Get the latest weekly flu stats from the CDC. Learn more about how the FMLA and ADA may be used during pandemic flu from the U.S. Department of Labor.

    By Rachel Sobel

    Originally posted by www.ThinkHR.com

  • California Employment Law Update – February 2018 | Petaluma Benefit Consultants

    February 28, 2018

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    Employer Response to Immigration Inspection Notice

    In January 2018, the California Department of Labor Standards and Enforcement (DLSE) released its pre-inspection notice, Notice to Employee Labor Code section 90.2.

    Effective January 1, 2018, and except as otherwise required by federal law, California employers must provide notice to current employees of any inspection of I-9 Employment Eligibility Verification forms or other employment records conducted by an immigration agency. This notice is completed by posting the DLSE’s Notice to Employee Labor Code section 90.2 in the language the employer normally uses to communicate employment-related information to the employee within 72 hours of receiving notice of the inspection.

    A copy of the Notice of Inspection of I-9 Employment Eligibility Verification forms, and any accompanying documents, must be posted or given to employees with the DLSE notice.

    See the notice

    Originally posted by www.ThinkHR.com

  • Benefits of an Annual Exam | California Benefit Advisors

    February 22, 2018

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    Have you ever heard the proverb “Knowledge is power?” It means that knowledge is more powerful than just physical strength and with knowledge people can produce powerful results. This applies to your annual medical physical as well! The #1 goal of your annual exam is to GAIN KNOWLEDGE. Annual exams offer you and your doctor a baseline for your health as well as being key to detecting early signs of diseases and conditions.


    The #1 goal of your annual exam is to  GAIN KNOWLEDGE


    According to Malcom Thalor, MD, “A good general exam should include a comprehensive medical history, family history, lifestyle review, problem-focused physical exam, appropriate screening and diagnostic tests and vaccinations, with time for discussion, assessment and education. And a good health care provider will always focus first and foremost on your health goals.”

    Early detection of chronic diseases can save both your personal pocketbook as well as your life! By scheduling AND attending your annual physical, you are able to cut down on medical costs of undiagnosed conditions. Catching a disease early means you are able to attack it early. If you wait until you are exhibiting symptoms or have been symptomatic for a long while, then the disease may be to a stage that is costly to treat. Early detection gives you a jump start on treatments and can reduce your out of pocket expenses.

    When you are prepared to speak with your Primary Care Physician (PCP), you can set the agenda for your appointment so that you get all your questions answered as well as your PCP’s questions. Here are some tips for a successful annual physical exam:

    • Bring a list of medications you are currently taking—You may even take pictures of the bottles so they can see the strength and how many.
    • Have a list of any symptoms you are having ready to discuss.
    • Bring the results of any relevant surgeries, tests, and medical procedures
    • Share a list of the names and numbers of your other doctors that you see on a regular basis.
    • If you have an implanted device (insulin pump, spinal cord stimulator, etc) bring the device card with you.
    • Bring a list of questions! Doctors want well informed patients leaving their office. Here are some sample questions you may want to ask:
      • What vaccines do I need?
      • What health screenings do I need?
      • What lifestyle changes do I need to make?
      • Am I on the right medications?

    Becoming a well-informed patient who follows through on going to their annual exam as well as follows the advice given to them from their physician after asking good questions, will not only save your budget, but it can save your life!




  • Federal Employment Law Update – February 2018 | Petaluma Benefit Brokers

    February 16, 2018

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    IRS Releases Publication 15 and W-4 Withholding Guidance for 2018

    On January 31, 2018, the federal Internal Revenue Service (IRS) released Publication 15 — Introductory Material, which includes the following:

    • 2018 federal income tax withholding tables.
    • Exempt Form W-4.
    • New information on:
      • Withholding allowance.
      • Withholding on supplemental wages.
      • Backup withholding.
      • Moving expense reimbursement.
      • Social Security and Medicare tax for 2018.
      • Disaster tax relief.

    Read Publication 15 and further details here.

    EEOC Penalty Increases for Failure to Post Required Notices

    On January 18, 2018, the U.S. Equal Employment Opportunity Commission (EEOC) released a final rule increasing the penalty amount from $534 to $545 for violations of Title VII of the Civil Rights Act (Title VII), the Americans with Disabilities Act (ADA), and the Genetic Information Nondiscrimination Act (GINA) notice posting requirements.

    The final rule is effective February 20, 2018.

    Read the rule

    Originally published by www.ThinkHR.com

  • 2018 W-4 Forms Won’t Be Released Until Late February | CA Employee Benefit Brokers

    February 14, 2018

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    If you’ve been getting questions from your employees about completing new 2018 W-4 forms to take advantage of the tax reform rules, we’ve finally received some answers. You can continue to rely on the current W-4 forms for now until the new 2018 form is released in late February.

    The January 29th Internal Revenue Service (IRS) Notice 2018-14 provides additional guidance on the income withholding rules that were changed under the recently passed Tax Cuts and Jobs Act. The guidance:

    • Extends the effective period of Forms W-4 furnished to claim exemption from withholding for 2017 until February 28, 2018.
    • Permits employees to claim exemption from withholding for 2018 by temporarily using the 2017 Form W-4. This procedure will expire 30 days after the 2018 Form W-4 is released.
    • States that employees experiencing a change in status that causes a reduction in the number of withholding exemptions are not required to furnish employers with new withholding certificates until 30 days after the 2018 Form W-4 is released.
    • Provides that employees who have a reduction in the number of withholding allowances solely due to changes made by the Tax Cuts and Jobs Act are not required to furnish employers with new withholding certificates during 2018. However, employees may choose to update their withholding at any time in response to the act. Employees who choose to update their withholding may use the 2017 Form W-4 instead of the 2018 Form W-4 to report changes in withholding allowances until 30 days after the 2018 Form W-4 is released.
    • Confirms that the optional withholding rate on supplemental wage payments is 22 percent for 2018 through 2025.
    • Specifies that, for 2018, withholding under IRC 3405(a)(4) on periodic payments when no withholding certificate is in effect will be based on treating the payee as a married individual claiming three withholding allowances.

    In addition to the guidance, the IRS also released a new Publication 15, (Circular E), Employer Tax Guide, for 2018. Publication 15 includes the 2018 withholding tables and explains an employer’s tax responsibilities, such as withholding, depositing, reporting, paying, and correcting employment taxes.

    ThinkHR will continue to follow developments in this area and report on the availability of the new 2018 W-4 Form and other IRS guidance as it becomes available.

    By Rick Montgomery

    Originally published by www.ThinkHR.com

  • Benefits Easy: Intro to Self-Funding | Petaluma Benefit Advisors

    February 9, 2018

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    As the first month of 2018 wraps up, companies have already begun the arduous task of submitting budgets and finding ways to cut costs for the new year. One of the most effective ways to combat increasing health care costs for companies is to move to a Self-Funded insurance plan. By paying for claims out-of-pocket instead of paying a premium to an insurance carrier, companies can save around 20% in administration costs and state taxes. That’s quite a cost savings!

    The topic of Self-Funding is huge and so we want to break it down into smaller bites for you to digest. This month we want to tackle a basic introduction to Self-Funding and in the coming months, we will cover the benefits, risks, and the stop-loss associated with this type of plan.


    • When the employer assumes the financial risk for providing health care benefits to its employees, this is called Self-Funding.
    • Self-Funded plans allow the employer to tailor the benefits plan design to best suit their employees. Employers can look at the demographics of their workforce and decide which benefits would be most utilized as well as cut benefits that are forecasted to be underutilized.
    • While previously most used by large companies, small and mid-sized companies, even with as few as 25 employees, are seeing cost benefits to moving to Self-Funded insurance plans.
    • Companies pay no state premium taxes on self-funded expenditures. This savings is around 1.5% – 3.5% depending on in which state the company operates.
    • Since employers are paying for claims, they have access to claims data. While keeping within HIPAA privacy guidelines, the employer can identify and reach out to employees with certain at-risk conditions (diabetes, heart disease, stroke) and offer assistance with combating these health concerns. This also allows greater population-wide health intervention like weight loss programs and smoking cessation assistance.
    • Companies typically hire third-party administrators (TPA) to help design and administer the insurance plans. This allows greater control of the plan benefits and claims payments for the company.

    As you can see, Self-Funding has many facets. It’s important to gather as much information as you can and weigh the benefits and risks of moving from a Fully-Funded plan for your company to a Self-Funded one. Doing your research and making the move to a Self-Funded plan could help you gain greater control over your healthcare costs and allow you to design an original plan that best fits your employees.



  • Court Modifies Order Regarding EEOC Wellness Rules | CA Benefit Advisors

    February 2, 2018

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    In August 2017, the United States District Court for the District of Columbia held that the U.S. Equal Employment Opportunity Commission (EEOC) failed to provide a reasoned explanation for its decision to adopt 30 percent incentive levels for employer-sponsored wellness programs under both the Americans with Disabilities Act (ADA) rules and Genetic Information Nondiscrimination Act (GINA) rules.

    At that time, the court declined to vacate the EEOC’s rules because of the significant disruptive effect it would have. However, the court remanded the rules to the EEOC for reconsideration.

    In September 2017, the EEOC filed a status report indicating its schedule to comply with the court order, including issuing a proposed rule by August 2018 and a final rule by October 2019. It stated that it did not expect to require employers to comply with a new rule before 2021.

    In December 2017, the court found the EEOC’s process of not generating applicable rules until 2021 to be unacceptable. Instead, the court determined that one year was ample time for employers to adjust to new EEOC rules. The court vacated the EEOC rules under the ADA and GINA effective January 1, 2019, and ordered the EEOC to promulgate any new proposed rules by August 31, 2018.

    In January 2018, the EEOC asked the court to reconsider the portion of the court’s order that required the EEOC to promulgate new proposed rules by August 31, 2018. The court vacated that portion of its order. The court’s order to vacate the portions of the EEOC’s wellness rules under the ADA and GINA as of January 1, 2019, remains.

    Current and Upcoming Impact on Employer Wellness Plans

    • Employers are still subject to the EEOC’s wellness rules, including the incentive limits, through 2018.
    • If the EEOC does not promulgate new rules by the end of 2018, then the EEOC’s incentive limit rules will not apply to employers’ wellness programs starting on January 1, 2019. Employers would only be subject to HIPAA’s more lenient incentive limits.

    Originally published by www.UBABenefits.com

  • New Tax Breaks for Health Plans | Petaluma Benefits Broker

    January 26, 2018

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    Last week’s drama that shut down the federal government, then un-shut it three days later, was settled when agreement was reached on a Continuing Resolution. Included in the resolution are three tax breaks of particular interest to employers that offer group health coverage to their workers.

    Cadillac Tax: Delayed until 2022

    The Affordable Care Act (ACA) imposes a 40 percent excise tax on the value of employer-provided health coverage exceeding certain thresholds. This so-called Cadillac tax was scheduled to take effect in 2020 but now is delayed until 2022.

    Efforts to repeal the Cadillac tax are expected to continue. It originally had been scheduled to take effect in 2018, then was delayed to 2020. This additional two-year delay, to 2022, provides further relief to employers while giving Congress time to consider permanent action.

    Health Insurance Providers (HIP) Fee: Suspended for 2019

    Starting in 2014, the ACA has imposed an annual fee on certain health insurers that generally is passed on to their policyholders. It affects insured plans, including medical, dental, and vision insurance, but does not apply to self-funded plans. Most advisors estimate the current fee impacts health insurance costs by 3 to 4 percent.

    The HIP fee was suspended for 2017, then resumed for 2018. Last week’s resolution will provide another one-year moratorium: the fee is suspended for 2019.

    Medical Device Tax: Suspended for 2018 and 2019

    The ACA added a 2.3 percent excise tax on the sale of medical device products, starting in 2013. It was suspended for 2016 and 2017, then scheduled to resume for 2018. Analysts cite the tax as one factor in increased health care expenses that are passed on to health insurers and employers.

    The new resolution suspends the medical device tax retroactively for 2018 and 2019.

    ThinkHR continually monitors legislative and regulatory changes that affect employers and their benefit offerings.

    Originally published by www.ThinkHR.com

  • California Employment Law Update – January 2018 | CA Benefit Advisors

    January 24, 2018

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    Workplace Discrimination Poster Updated

    In November 2017, the California Division of Labor and Employment updated its workplace discrimination poster, California Law Prohibits Workplace Discrimination and Harassment, to include the new supervisor training requirements to prevent sexual harassment and a revision date of November 2017. All employers must conspicuously post this document in hiring offices, on employee bulletin boards, in employment agency waiting rooms, union halls, and other places employees gather. Any employer whose workforce at any facility or establishment consists of more than 10 percent of non-English speaking persons must also post this notice in the appropriate language or languages.

    Download the poster

    Oakland Minimum Wage Poster Updated

    The City of Oakland updated its official notice for the city’s minimum wage. Beginning January 1, 2018, employees who perform at least two hours of work per workweek and within the geographic limits of the city must be paid a minimum wage of at least $13.23 per hour.

    Download the poster

    Originally published by www.ThinkHR.com

  • Oral Health = Overall Health | California Benefit Advisors

    January 12, 2018

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    Have you heard the saying “the eyes are the window to your soul”? Well, did you know that your mouth is the window into what is going on with the rest of your body? Poor dental health contributes to major systemic health problems. Conversely, good dental hygiene can help improve your overall health.  As a bonus, maintaining good oral health can even REDUCE your healthcare costs!

    Researchers have shown us that there is a close-knit relationship between oral health and overall wellness. With over 500 types of bacteria in your mouth, it’s no surprise that when even one of those types of bacteria enter your bloodstream that a problem can arise in your body. Oral bacteria can contribute to:

    1. Endocarditis—This infection of the inner lining of the heart can be caused by bacteria that started in your mouth.
    2. Cardiovascular Disease—Heart disease as well as clogged arteries and even stroke can be traced back to oral bacteria.
    3. Low birth weight—Poor oral health has been linked to premature birth and low birth weight of newborns.

    The healthcare costs for the diseases and conditions, like the ones listed above, can be in the tens of thousands of dollars. Untreated oral diseases can result in the need for costly emergency room visits, hospital stays, and medications, not to mention loss of work time. The pain and discomfort from infected teeth and gums can lead to poor productivity in the workplace, and even loss of income. Children with poor oral health miss school, are more prone to illness, and may require a parent to stay home from work to care for them and take them to costly dental appointments.

    So, how do you prevent this nightmare of pain, disease, and increased healthcare costs? It’s simple! By following through with your routine yearly dental check ups and daily preventative care you will give your body a big boost in its general health. Check out these tips for a healthy mouth:

    • Maintain a regular brushing/flossing routine—Brush and floss teeth twice daily to remove food and plaque from your teeth, and in between your teeth where bacteria thrive.
    • Use the right toothbrush—When your bristles are mashed and bent, you aren’t using the best instrument for cleaning your teeth. Make sure to buy a new toothbrush every three months. If you have braces, get a toothbrush that can easily clean around the brackets on your teeth.
    • Visit your dentist—Depending on your healthcare plan, visit your dentist for a check-up at least once a year. He/she will be able to look into that window to your body and keep your mouth clear of bacteria. Your dentist will also be able to alert you to problems they see as a possible warning sign to other health issues, like diabetes, that have a major impact on your overall health and healthcare costs.
    • Eat a healthy diet—Staying away from sugary foods and drinks will prevent cavities and tooth decay from the acids produced when bacteria in your mouth comes in contact with sugar. Starches have a similar effect. Eating healthy will reduce your out of pocket costs of fillings, having decayed teeth pulled, and will keep you from the increased health costs of diabetes, obesity-related diseases, and other chronic conditions.

    There’s truth in the saying “take care of your teeth and they will take care of you”.  By instilling some of the these tips for a healthier mouth, not only will your gums and teeth be thanking you, but you may just be adding years to your life.

  • Ask the Experts: Employee Claims to Not Receive Message of Office Closure | CA Benefit Advisor

    January 9, 2018

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    Question: We are a California employer. If we notify a nonexempt employee of a disaster-related closure via voice mail, text, or email, and they show up saying they never got the message, do we still owe them the half-day pay?

    Answer: The answer depends upon how the company manages its notification process. If the company has communicated to all employees the method that will be used for notifying employees of workplace closures, reinforces that policy prior to or during weather events, and can verify that the message was sent and received by the employee, then the employer would not be liable for the show-up pay.

    As a best practice, we recommend asking employees to respond to the voicemail, text, or email acknowledging that they have received the message. Otherwise, especially with weather emergencies where power, internet, or phone service may be interrupted, the employee’s claims of not getting the message may in fact be true. Consult with counsel prior to denying show-up pay if you cannot prove that the message was received. Paying the employee a few hours of pay costs far less than responding to a state agency if a wage complaint is filed.

    Originally published by www.ThinkHR.com

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