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Friday, June 28, 2013

Individual Penalty Transition Relief for Those Eligible to Enroll in Employer-Sponsored Coverage with a Plan Year That Begins in 2013 and ends in 2014

 

Because many employer-sponsored plans have non-calendar plan years, brokers have questions regarding how to advise clients with employees and/or dependents who waived employer-sponsored coverage but would need to have minimum essential coverage beginning January 1, 2014 in order to avoid the Individual Shared Responsibility Payment (i.e. individual penalty).   IRS Notice 2013-42, issued Wednesday 6/26/2013, addresses these questions and provides an employee, or an individual with a relationship to the employee, who is eligible to enroll in a non-calendar year employer-sponsored plan with a plan year beginning in 2013 and ending in 2014 will not be liable for the individual penalty until the end of the 2013-2014 plan year. Thus, employees and dependents that choose to wait until the 2014-2015 plan year to enroll in coverage will not be subject to the individual penalty for the months in 2014 that are part of the 2013-2014 plan year.
For your easy access, we posted IRS Notice 2013-42 in the Health Reform Updates & News section of our Health Reform Resource Center; where you also will find an abundance of helpful resources like our ACA Calculators http://ca.wordandbrown.com/HRRC/ACANews.aspx.

Tuesday, June 25, 2013

Employer notice to employees on Health Insurance Market Place


EMPLOYER EXCHANGE NOTICE- Federal regulators have moved back the date in which ALL EMPLOYERS must provide a written notice about the health insurance exchanges , known in CA as “COVERED CALIFORNIA”.  A copy my be obtained from the Department of Labor for Employers WITH and WITHOUT plans and in English and Spainish.  See below for the information contained in the letter.

Form Approved
OMB No.

New Health Insurance Marketplace Coverage
Options and Your Health Coverage
PART A: General Information

When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance
: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace.
What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.


Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income.


Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.
1
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.


How Can I Get More Information?

The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.


1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.

Thursday, June 20, 2013

Retail Clinics Expand Health Care Services


 
In a move that caught the attention of the American Academy of Family Physicians (AAFP), Walgreens' Take Care ClinicsSM have begun offering assessment, treatment and management for chronic conditions such as hypertension, diabetes, high cholesterol, asthma, and more ... READ MORE

Self–compliance Tools for Health Benefits Laws

Self–compliance Tools for Health Benefits Laws
 
There’s no denying it — numerous provisions of Health Insurance Portability and Accountability Act (HIPAA) and Affordable Care Act (ACA) are complicated and confusing. To help with this confusion, the Department of Labor (DOL) now provides two tools on its website that group health plans, plan sponsors, plan administrators, and health insurance issuers can use to test their compliance. These tools, or checklists, deal specifically with group health plan requirements (Part 7) of ERISA.
The first checklist focuses on HIPAA portability and other law provisions, such as pre–existing conditions exclusions, certificates of creditable coverage, special enrollment rights, wellness programs, and more. The questions and explanations of applicable statutes and other regulatory/administrative interpretation materials assist those involved in operating a group health plan in understanding the laws and their related responsibilities.
The second checklist focuses on ACA provisions, including a plan’s status as a "grandfathered" plan exempt from some ACA requirements, and such ACA requirements as limitations on rescission and annual and lifetime limits, and more. The various sets of questions and answers allow users to assess their plan's compliance with the ACA provisions that have already taken place, or will take place in the near future

Wednesday, June 12, 2013

Do you no someone who needs help with buying Health Insurance, let them know that in starting in October they will be to look for help to begin Jan1, 2014!

Two types of financial assistance will available through the Marketplace for individuals: one reduces your monthly insurance premium, and the other helps with out-of-pocket expenses for care. Applicants may qualify for one or both depending on household income. If you qualify, the federal government will pay any financial assistance to Kaiser Permanente on your behalf. Learn more about federal financial help.

Watch a short video from the U.S. Department of Health and Human Services that explains the Marketplaces.

The Facts about the Marketplaces

  • Marketplaces are federal or state-run marketplaces where consumers can compare and buy health insurance plans.
  • The individual Marketplaces will open on October 1, 2013, with coverage available beginning January 1, 2014.*
  • All plans available through the Marketplaces will provide comprehensive benefits – from visits to the doctor or hospital, to prescriptions, to screenings for cancer and other conditions.
  • To help consumers compare plans from different insurance companies, several standard levels of coverage will be offered. These include Bronze, Silver, and Gold plans. Platinum plans and high cost share/low premium plans will also be available in some states for some people.
  • The Marketplaces will also help determine if consumers are eligible for a reduced premium, lower cost-sharing, or for Medicaid or other publicly subsidized health benefits coverage.

Tuesday, June 11, 2013

Question: Next year, based on the new Health Care Reform regulations, may our company still require a 90-day waiting period (60 days in California) before new employees become eligible to enroll in the health plan?



Answer: Yes, your company may still impose a waiting period of up to 90 days for new employees entering your group health plan. However, it is important to note that beginning with an employer’s first plan year starting on or after January 1, 2014, an organization may not use a waiting period that exceeds 90 days (60 days in California). This restriction applies to all employers, regardless of size, that sponsor a group health plan, as well as to both grandfathered and non-grandfathered plans. The proposed guidance does not permit the employer to wait to offer benefits until the first of the month following 90 days of employment. (However, many employer advocacy groups have submitted comments asking for the allowance of a “first of the month following 90 days” waiting period, so it is still possible that the federal government may institute a safe harbor to allow this calculation method in its final guidance.) As the proposed regulations currently read, the employer must count all calendar days when calculating the 90-day waiting period (60 days in California), including weekends and holidays. If the 91st day (61st day in California) is a weekend or holiday, the organization may set a policy permitting coverage to be effective earlier than the 91st day of employment, but it may not make the effective date of coverage later than the 91st day (61st day in California). If your current health insurance plan utilizes a longer waiting period, it may need to be adjusted in 2014 in order to comply with the new regulations. These adjustments may include the authorization of mid-month enrollments if your organization opts to use a 90-day waiting period (60 days in California). There are some exceptions to this rule when the employer is unable to determine if a new employee’s average hours will be sufficient to qualify for health plan participation. When this occurs, the plan may take a reasonable period of time to determine whether the employee meets the plan's eligibility requirements, which may include a measurement look-back period of up to 12 months.

Monday, June 10, 2013

Employers that offer Health Coverage need to send a letter regarding the exchanges.

http://www.dol.gov/ebsa/pdf/FLSAwithplans.pdf

New Health Insurance Marketplace Coverage
Options and Your Health Coverage

PART A: General Information
When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment­based health coverage offered by your employer.

What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income.Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer doesnot offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household
income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.1

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an aftertax basis.

How Can I Get More Information?

For more information about your coverage offered by your employer, please check your summary plan description or contact . The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.

Form Approved
OMB No.

Notice to employers that do not provide health coverage

http://www.dol.gov/ebsa/pdf/FLSAwithoutplans.pdf

New Health Insurance Marketplace Coverage
Options and Your Health Coverage


PART A: General Information

When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace.

What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income.

Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards.

 If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.1 Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an aftertax basis.

How Can I Get More Information?

The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.  1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.

Form Approved
OMB No.

Friday, June 07, 2013

How does the individual subsidy for the purchase of Health Insurnance work and who qualifies.

Subsidies: Who is eligible and how do they work?

June 5, 2013
Starting January 1, 2014, some of your individual clients may be able to get subsidies or tax credits when they buy health coverage. So who can get these subsidies or tax credits, and how do they work? We’ll break it down for you.
Subsidies for individuals
In 2014, people who qualify may be able to get a tax credit from the government to help them buy health coverage and pay their premiums. Or they may qualify for subsidies from the government to help them pay for their out-of-pocket health care costs. And they don’t have to wait until tax time to get it. The tax credit can be used for any individual plan sold on the exchange, or health care marketplace.
Who qualifies
  • Tax credit:
    • People who are U.S. citizens or legally live in the U.S.
    • People earning between 100% and 400% of the federal poverty level if they are not eligible for other sources of minimum essential coverage, including government-sponsored programs such as Medicare and Medicaid or Medi-Cal in California.
    • Single people with household modified adjusted gross incomes from 100% to 400% of the federal poverty level would earn from $11,490 to $45,960 each year.
    • A family of four with household modified adjusted gross income from 100% to 400% of the federal poverty level would earn from $23,550 to $94,200 each year.
  • Subsidy:
    • People with incomes up to 250% of the federal poverty level may also get an extra subsidy when they buy a silver level plan. These subsidies are lower cost shares for services covered by the silver plan. The federal government subsidizes the higher benefits provided by the insurer.
Who doesn’t qualify
  • People who can get Medicare or Medicaid (Medi-Cal in California)
  • People who can get a plan of a minimum value at work with premiums that cost less than 9.5% of their earnings

Thursday, June 06, 2013

What Small Business with 2 to 50 employees have to know about Health Care Reform?

How is employer size defined?

A large employer is defined as having 50 or more full-time equivalent employees during a testing period that can be from six to 12 months. Full time is defined by the government as 30 hours per week.

The term equivalent is used to account for those who work less than 30 hours per week. For example, if an employer has 30 full-time employees working 30 hours each week and three part-time employees working 20 hours each week, it has 32 full-time equivalent employees. The part-time hours per month are added, then divided by 130 to determine additional full-time equivalent employees.

There is some relief for seasonal workers.

How does PPACA apply to small employers?

The employer penalties are just one piece. All employers are subject to certain rules if providing a health insurance plan, such as:
  • Waiting periods for eligibility cannot exceed 90 days, beginning in 2014.
  • Continuing to cover dependents of employees until age 26, in most cases.
  • Providing a Summary of Benefits and Coverage to each employee at specific events, such as open enrollment.
  • Supplying 60-day notification for any plan changes, except at renewal.
What are some other considerations?

If a plan is not grandfathered — hasn’t changed since the law went into effect in 2010 — then it must continue to waive all cost sharing for preventive care services, which includes women’s preventive care for plans renewing on or after Aug. 1, 2012.

Employers also must offer employees information on the public insurance exchange whether providing health coverage or not. The law requires this notice be distributed each March; however, it has been delayed in 2013, pending Department of Labor guidance.

In 2014, all non-grandfathered small group plans will have limits on the deductibles charged in-network. The maximum deductible will be $2,000 per individual and $4,000 per family. There also will be out-of-pocket limits that apply to all non-grandfathered plans. These limits are the same as those for high deductible health plans, which this year is $6,250 for an individual and $12,500 for a family.

How will the pricing methodology change?

The biggest change for small employers will be the pricing methodology applied to group insurance plans. Insurance companies will be unable to use gender, industry, group size or medical history, and therefore are limited to family size, geography, tobacco use and age. The companies can charge the oldest ages no more than three times what they charge the youngest ages. Many insurance companies use a ratio of 7:1 or higher, so this should result in higher rates for younger, healthier groups and better rates for older, less healthy groups. In addition, there will be new taxes and fees passed through to the employer in 2014.

Where do small employers have flexibility?

A small employer, with fewer than 50 full-time employees, has more flexibility in determining how many hours an employee must work to be benefits-eligible. For example, a small employer can establish 37.5 hours as the minimum to be eligible for the company health plan, so employees regularly working less than 37.5 hours aren’t eligible. Those employees most likely are eligible for a subsidy to purchase coverage in the public insurance exchange. But, as a small employer not subject to the employer penalties, there are no financial consequences.

Because of the complexities, employers are encouraged to review their employee count and other pending health care reform legislation with a qualified advisor.

 

 

Tuesday, June 04, 2013

The high cost of U.S. health care


The cost of hip replacement surgery in the U.S. is up to four times higher than what's paid in Switzerland or France, while charges for cesarean section births were more triple the cost of the same procedure in New Zealand or Britain, according to a Commonwealth Fund report. Meanwhile, colonoscopies alone contribute more than $10 billion in annual costs. This report explores the drivers behind high costs in the U.S. using the colonoscopy example as a case study for understanding why 18% of U.S. gross domestic product goes to spending on health care. The New York Times (tiered subscription model)