Today, the Obama administration announced that the employer mandate aspect of the Patient Protection and Affordable Care Act (PPACA) will be delayed by one year.
This mandate requires businesses with 50 or more workers to provide health insurance coverage to employees. As a result, the administration will start enforcing the mandate in 2015, rather than January 1, 2014, in an effort to give businesses more time to prepare. This change has come about due to the input they have received from businesses.
There will be additional changes tied to this delay, and the administration has stated that they will provide formal guidance within the next week.
We will do our best to keep you up-to-date and informed of the changes associated with the PPACA.
See the official release here:
http://www.treasury.gov/connect/blog/Pages/Continuing-to-Implement-the-ACA-in-a-Careful-Thoughtful-Manner-.aspx
Tuesday, July 2, 2013
Friday, March 8, 2013
Tax Considerations For 2014
Once you’ve completed your taxes this year, take a look at your income and see if you’ll qualify for a federal health insurance subsidy in 2014. If your adjusted gross income was less than 400% of the federal poverty level (that’s about $45,000 for a single person or $92,000 for a family of four, in 2012), you may qualify for a government subsidy in 2014. Click here to calculate your subsidy. Failure to obtain health insurance in 2014 could result in a tax penalty. The penalty starts at $95 or 1% of income (whichever is greater) per person in 2014. It gradually rises until it hits 2.5% or $695 (whichever is greater) per person by 2016.
Another change: starting this year, you may notice a new dollar figure in Box 12 of your W-2. If you have employer-based health insurance, the cost of your coverage may be reported to the IRS here. Even though the value of your plan is reported on your W-2, it’s not taxable. So you don’t need to report it as income on your tax return. This reporting is for the so-called “Cadillac” plans (with aggregate values of over $10,200 for individual coverage or $27,500 for families) which may be subject to an excise tax starting in 2018.
Tuesday, February 26, 2013
Enrollment Suspending for High Risk Health Pool
The following information is from the government website for Pre-Existing Condition Insurance Plan http://1.usa.gov/YWVY9i
Beginning February 16, 2013, the federally-run Pre-Existing Condition Insurance Plan (PCIP) is suspending acceptance of new enrollment applications until further notice. State-based PCIPs may continue accepting enrollment applications through March 2, and will then suspend acceptance of new enrollment applications until further notice. PCIP will continue providing coverage to more than 100,000 people currently enrolled nationwide. We encourage you to visithttp://finder.healthcare.gov 
to explore your other health care options.
to explore your other health care options.
Note: If you lost PCIP coverage during the past 6 months because you moved out of state, you may be eligible to re-enroll in PCIP in your new state of residence. Please call 1-866-717-5826 (TTY: 1-866-561-1604), Monday – Friday, 8 a.m. to 11 p.m. EST, if you believe you are eligible.
Why is PCIP enrollment being suspended?
PCIP is a temporary program for those locked out of the current insurance marketplace. The program has a limited amount of funding from Congress.
Based on program experience and trends since the start of the program, PCIP enrollees have serious and expensive illnesses with significant and immediate health care needs. More information can be found in the Annual Report on the Implementation and Operation of the PCIP Program available here.
This suspension will help ensure that funds are available through 2013 to continuously cover people currently enrolled in PCIP.
The Health Insurance Marketplace
Starting next year, the Affordable Care Act guarantees that all Americans – regardless of their health status or pre-existing conditions – will finally have access to quality, affordable coverage. People will be able to apply for affordable health insurance coverage choices in Health Insurance Marketplaces when open enrollment begins on October 1. The Health Insurance Marketplace will offer a choice of quality, affordable health plans. Coverage begins on January 1, 2014. Visit www.healthcare.gov to learn more about the Marketplace.
Monday, December 3, 2012
PCORI Fees on Medical Mutual Bills
Healthcare Reform: PCORI Fees Appearing on Invoices in Early 2013
The federal government began assessing health plan sponsors
a Patient Centered Outcomes Research Institute fee, or PCORI fee, this fall based on federal regulations in
the Affordable Care Act. To cover this fee we will begin to include it on most fully insured group (all market
segments) and most individual account invoices in 2013.
Beginning with the earliest possible invoice in 2013,*
Medical Mutual will assess a $0.16 per member per month fee. The assessment will capture every contract holder and
dependent in the calculation. Applicable group and individual invoices will include a line item for this fee
that reflects the per-member-per-month charge. Areas of business not impacted by PCORI at this time include:
- High Risk Pool
- Medicare Supplement
- Individual Short Term
- Dental, Vision and Life
We are sending a letter to impacted 1-99 fully insured
groups and to impacted individual policy holders, as well as our 100+ and self-funded groups.
*As a courtesy to our customers, we are not assessing any
fees to our fully insured group customers or individual customers for the first three months the PCORI fee was in
place (October, November and December 2012). We will absorb this initial amount, which is about $150,000
Friday, September 28, 2012
Summary of Benefits and Coverage
The Summary of Benefits and Coverage (SBC) is a new plan document required by the Affordable Care Act. The purpose of the SBC is to give members information about health insurance benefits in an easy to understand format. All employers and insurance companies are required to use the same document format outlined by the final regulations.
The new SBC has required outlines which include:
- Basic benefits and coverage
- Cost sharing requirements
- Exclusion and limitations of the plan
- Examples of how the plan would cover:
- Normal delivery of a baby
- Type 2 Diabetes
- Information on how to access a uniform glossary that provides definitions of health coverage & medical terminology used in the SBC.
You do not need a SBC for:
- Stand alone dental
- Stand alone vision
- The bank account of a Health Savings Account Health
- FSAs if funded solely with employee pre‐tax salary reductions
To whom must the SBCs be provided?
- Covered EEs
- Their covered dependents
- Anyone who is eligible to enroll
Timelines and Triggers for Distributing the Summary of Benefits and Coverage
Employer Sponsored Plans
- Renewal – No later than 30 calendar days before policy’s effective date
- New business – within 7 days of receipt of application
- Active enrollment periods – SBC must be provided with enrollment materials
- Automatic enrollments – in which members do not have to take any action to sign up, the SBC must be provided no later than 30 days before the effective date.
- Open Enrollment –No later than first day of the open enrollment period
- New hires – SBC needs to be provided with enrollment or application materials. If enrollment materials are not distributed, then no later than the first day of enrollment.
- Special enrollee – any member that gets married, has a child, or loses other coverage and enrolls outside of open enrollment - 90 calendar days from enrollment.
- Upon request – within 7 days
- Material Modification* – No later than 60 days before the effective date of the coverage change. Send a notice of the Material Modification or a revised SBC.
*A material modification, as defined by ERISA is generally described as any modification to the benefits that either enhances or decreases the benefits to subscribers or that changes the content of the SBC.
Individual plans:
- Renewal– No later than 30 days before the first day the new policy’s effective date.
- New Application – within 7 days.
- Upon Request – within 7 days.
Distribution of the Summary of Benefits and Coverage
The SBC may be delivered either in paper form or electronically. If you choose to send the SBC electronically there are certain guidelines that need to be followed to avoid a penalty.
Employees that are already enrolled and have access to the company’s computer system is an integral part of their job.
- The email must protect any private information.
- Include the significance of the SBC
- Notify employee that a free paper copy is also available upon request.
- Maintain the style, content and format requirements of the SBC.
Employees that are already enrolled whose jobs do NOT have access to the company’s computer system as an integral part of their job. Prior consent must be obtained from the employee to receive the SBC electronically.
- The consent can be a paper notification or email and must include the following:
- Types of documents being sent
- How to access the SBC electronically
- Rights to withdraw from consent at any time
- Procedure for withdrawing consent
For anyone who is eligible for coverage but not yet enrolled:
- Paper notification or an email on how to access the electronic SBC.
- Ensure the SBC is readily accessible.
The employer is responsible for the distribution of the SBC to employees. The insurance companies will not be distributing the SBCs directly to your employees. This is important to note since there is a financial penalty attached to these new requirements.
Penalty Information
Included in the new SBC requirements are financial penalties for noncompliance. Employers offering group health insurance coverage that willfully fail to provide the SBC will be subject to a maximum fine of $1,000 daily for each employee plus a daily $100 penalty per employee in excise taxes.
For example if you have 50 employees and fail their SBC for 30 days:
Daily penalty 50 x $1000 = $50,000
30 days x $5000 = $1,500,000
Excise tax 50 x $ 100 = $5000
30 days x $500 = $150,000
TOTAL PENALTY: $1,650,000
However, during the first year of implementation the penalties will not be enforced as long as employers and insurance companies are working diligently and a good faith effort is being made to communicate the SBC to all parties.
If you are a current client of Creekstone Benefits and have any questions regarding the Summary Benefits and Coverage please contact us 740.967.0210.
For more detailed information and examples of the Summary of Benefits and Coverage please click on the links below:
Thursday, September 6, 2012
Republican Platform for Medicare Changes
Amidst the fiery speeches and political pageantry, Republicans at the party’s national convention in Tampa last week adopted a party platform that attracted much media attention for its shifts on issues such as Medicare. The platform calls for significant changes to Medicare and Medicaid largely in keeping with proposals outlined by U.S. Rep. Paul Ryan (R-WI), the party’s nominee for vice president. The platform calls for partially privatizing Medicare by allowing seniors to choose between existing Medicare coverage and a subsidy to help buy private insurance. The platform also calls for converting Medicaid into a state block-grant program, giving states the power to control the number of people eligible for Medicaid and the benefits they receive. The proposals represent a change from previous Republican platforms but have the endorsement of both Ryan and the Republican presidential nominee, Mitt Romney. The Republicans also continue to call for repeal of the Affordable Care Act (ACA).
From Aetna, "Health Care Reform updates for the week of September 3"
From Aetna, "Health Care Reform updates for the week of September 3"
Friday, July 6, 2012
Women's Preventive Healthcare Benefits – Effective 8/1/2012
As you may know, the federal health care reform legislation, known as the Patient Protection & Affordable Care Act (PPACA), includes changes that are being phased in over a number of years. The latest set of changes now includes coverage for Women’s Preventive Health Benefits.
As of August 1, 2012, all of the following women’s health services are considered preventive and therefore generally covered at no cost share,when provided in-network:
• Well-woman visits (annual routine physical, annual routine GYN exam and prenatal visits)
• Screening for gestational diabetes
• Human Papillomavirus (HPV) DNA testing
• Counseling for sexually transmitted infections
• Counseling and screening for human immunodeficiency virus (HIV)
• Screening and counseling for interpersonal and domestic violence
• Breastfeeding support, supplies and counseling
• Contraceptive methods and counseling
To have these benefits you must be on a Non-Grandfathered plan, or one that has most likely changed since the PPACA was signed into law. If you are unsure if you have these benefits and Creekstone Benefits is you broker please don't hesitate to contact us 740-924-0210. If we are not your broker please contact your HR department or your current insurance broker.
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