Categorized as: Blog

Health Care Exchanges: Just Five Months Away

Companies Get Aggressive on Wellness: Given that the potential benefits of wellness programs include reigning in runaway health care costs, decreasing turnover and improving productivity, it’s no surprise that companies are eager to increase employee participation. The most popular way of raising participation rates is through incentives. This is primarily done through rewards and prizes, but increasingly companies are using penalties as a way of spurring employees to take part in wellness programs. Penalties, however, don’t come without risk, including negative reactions from employees. To minimize potential dissatisfaction, companies must communicate clearly and regularly about their wellness programs and goals, ensuring…

Exchange Availability Notices

Employers Must Provide Notices Regarding Availability of Exchange Coverage A provision of the 2010 health care reform law requires employers to provide notices, by March 1, 2013, to all employees regarding the availability of health coverage options through the state-based exchanges created pursuant to that law. In January, the Department of Labor had announced delayed enforcement of the exchange coverage notice provision (which added Section 18B to the Fair Labor Standards Act) in light of the reality that, by March 1st, it was unlikely that enough information regarding the exchanges would be available, employers had no way of ascertaining some…

IRS Issues 2014 HSA Limits

                       IRS ISSUES 2014 HSA LIMITS The IRS has issued the 2014 limits for health savings accounts.  PPACA requires that this out-of-pocket limit be the maximum out-of-pocket for all health plans in 2014.  The minimum deductible only applies to high deductible health plans integrated with an HSA. The limits are: Limit 2014 2013 Maximum Out-of-Pocket $6,350 single/$12,700 family $6,250 single/$12,500 family Minimum Deductible $1,250 single/$2,500 family (unchanged) $1,250 single/$2,500 family Maximum Contribution $3,300 single/$6,550 family $3,250 single/$6,450 family Maximum catch-up contribution  – for individuals age 55 or older $1,000 (unchanged) $1,000   The out-of-pocket includes the deductible, coinsurance and co-pays,…

Wellness Incentives, Updated SBCs, and Annual Limits Waivers

The Departments of Labor, Health and Human Services and the Treasury have issued several updates that affect employer-sponsored group health plans. Wellness Incentives, HRAs, Minimum Value and Affordability The IRS has released proposed regulations that address how wellness incentives or penalties are applied to premium affordability (for purposes of the employer shared responsibility/play or pay requirements) and to minimum value. The proposed regulations provide that when deciding if the employee’s share of the premium is affordable (less than 9.5% of the employee’s safe harbor income), the employer may not consider wellness incentives or surcharges except for a non-smoking incentive.  In…

Who are my Employees? The Answer may surprise you!

Below are the topics discussed in our first quarterly newsletter in 2013. Please read the topics you feel are most important to your company. You find the link to the full newsletter below. PPACA 90 Day Waiting Period Requirements: New Proposed Regulations: The Patient Protection and Affordable Care Act (“PPACA”) prohibits group health plans from requiring a waiting period of longer than 90 days following the date that the plan’s eligibility requirements are met. Who are my Employees? Under the Affordable Care Act, the Answer May Surprise You: For a business, the first step to compliance under the Affordable Care Act…

Experts See Future Filled with High Deductibles

As federal agencies continue to release more guidance on the Patient Protection and Affordable Care Act (PPACA), everyone from employees to companies to benefit advisors are taking notice. A new poll by Prudential finds that almost half (46%) of employees expect PPACA to drive up overall health insurance costs. In addition, 31% of workers said they think it is likely that fewer companies will offer health insurance benefits in the future because of the law. To alleviate these worries, employers are turning to skilled benefit advisors to help them grapple with these new challenges created by PPACA. In turn, advisors are working…

Important Transition Relief for Non-Calendar Year Plans

The January 1, 2014 effective date of the Pay-or-Play requirements under health care reform presents special issues for employers with non-calendar year plans.  Prior to the release of the proposed regulations under the shared responsibility rules, employers with non-calendar year plans would either need to comply with the Pay-or-Play requirements at the beginning of the 2013 plan year or change the terms and conditions of the plan mid-year in order to comply.  Recognizing that compliance as of January 1, 2014 caused a special hardship for non-calendar year plans, the proposed regulations, provide special transition relief.  Employers with non-calendar year plans…

Essential Health Benefits, Minimum Essential Coverage, Minimum Value Coverage – What’s the Difference?

The Patient Protection and Affordable Care Act (PPACA) uses terms that sound alike for three very different things. Here’s a closer look at these terms, and when they’re used. Essential Health Benefits Significantly affects individuals and small employers with a fully insured plan. Has a limited impact on self-funded and large insured plans. Beginning in 2014, policies in the individual and small group markets* will be required to provide coverage for each of the 10 “essential health benefits” regardless whether the policy is purchased through or outside the exchange. Self-funded plans (regardless of size), large group plans, and grandfathered plans…

New PPACA Details: Eligibility Waiting Periods, Employee Notices, & Claims Appeals

The Department of Health and Human Services (HHS), the Department of Labor (DOL) and the Internal Revenue Service (IRS) continue to issue details on the Patient Protection and Affordable Care Act (PPACA).  The past 10 days has brought several changes of interest to employers: Eligibility Waiting Periods Affects all plans, whether fully insured, self-funded or grandfathered.  Applies to all sizes of employers, as of the start of the 2014 plan year The agencies have issued proposed regulations that state that an eligibility waiting period cannot be more than 90 days.  This literally is 90 calendar days — a plan that…