How Will Health Reform Affect Employers?

David Levine, CEO of the American Sustainable Business Council: Measures taking effect in 2014 will create more competition among insurance companies, which will drive down prices. When the ACA is fully implemented, small businesses will no longer pay more than large corporations for their insurance. However, one element in the Court’s opinion could hurt small businesses. The Court said that states need not expand Medicaid to 133% of the federal poverty level, as required under the ACA. Small businesses would benefit from the expansion since it would reduce the number of employees needing to be covered by a company’s healthcare plan. AHIP: Employers will have more incentive to self-insure their health coverage — increasingly shifting the burden of the fees to smaller employers and individuals who must shoulder the cost of a statutorily fixed level of fees no matter the relative size of fully insured coverage markets. Edward Fensholt, JD, and Mark Holloway, JD — leaders of Lockton’s Compliance Services group: Employers will need to begin making significant decisions in the next several months. Regulations will be very complex, particularly on the employer mandate. We can expect a crush of complex guidance compressed into a very short time. The next stops on the health reform train include distribution of four-page plan summaries, W-2 reporting of health plan values, limits on health flexible spending accounts, new income, and capital gains taxes on executives. The Supreme Court opinion also adds a wrinkle to the expansion of Medicaid eligibility. The Court said the feds cannot hold a state’s Medicaid funding hostage if the state doesn’t play. That could mean that more people will seek subsidized coverage in an insurance exchange or-worse-that some won’t qualify for Medicaid or exchange-based subsidies. Julio Portalatin, president and CEO of Mercer: Any employer that has not conducted a health care reform check-up should make it their first order of business. Employers need to redouble their compliance efforts, especially for immediate requirements, such as providing summaries of benefits and coverage to employees. This court’s decision reinforces popular features, such as providing coverage of dependents up to 26 and eliminating exclusions for preexisting conditions. David Rahill, President of Mercer’s Health and Benefits business:Employers can expect a spike in plan enrollment for 2014 as a result of the individual mandate. But they may see enrollment level off once the state exchanges become operational. By 2014, health insurance exchanges will be operating in every state, offering community-rated insurance to certain small employers and individuals, with federal premium tax credits available to help some people buy that coverage. In the near term, employers must report the value of employer coverage on IRS Form W-2, cap dollar limits on health care flexible spending arrangements, and increase Medicare withholding for high earners (those earning more than $200,000 per year). They must also comply with the reforms already in effect, such as coverage of dependents up to age 26.

Here is a detailed analysis of today’s Supreme Court ruling from NAHU, courtesy of our retained counsel, Ernst & Young:

US Supreme Court Upholds Affordable Care Act

The US Supreme Court today (June 28, 2012) upheld the Affordable Care Act (ACA), ruling that the law’s individual mandate is a constitutional exercise of Congress’s power to impose taxes. With the Court’s decision, compliance efforts likely will move ahead at full speed with major provisions of the ACA becoming effective in 2013 and 2014.
In a 5-4 decision, Chief Justice Roberts, joined by Justices Ginsberg, Breyer, Sotomayor and Kagan, concluded, “The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax. Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.”
In the Court’s analysis of the ACA’s Medicaid provisions, it held that it would be unconstitutional for the federal government to withhold all Medicaid funding in order to force states to comply with the Medicaid expansion. Chief Justice Roberts wrote, “Nothing … precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding.”
The Court ruled that the Anti-Injunction Act, which limits lawsuits challenging a tax before it is assessed, does not apply because Congress specifically provided that the penalty payment enforcing the individual mandate would not be treated as a “tax.” Notwithstanding acceptance of Congress’s penalty label for purposes of application of the Anti-Injunction Act, the Court ruled that for purposes of determining whether the individual mandate is constitutional, the penalty payment falls within Congress’s general power to tax and, therefore, is upheld.
The decision arises from cases brought by the state of Florida (and joined by 25 other states), the National Federation of Independent Business, and several individuals challenging the constitutionality of the individual mandate and the Medicaid expansion. The cases were later consolidated.
In their dissent, Justices Kennedy, Scalia, Thomas and Alito wrote that the law should have been struck down in its entirety.
With the exception of the limitation on the federal government’s authority to withhold Medicaid funding, all provisions of the ACA stand and compliance efforts likely will move ahead at full speed. In preparation for the major coverage expansion to occur under the ACA in 2014, the Administration is expected to release a host of regulations dealing with the definition of minimum essential coverage, employer coverage and reporting requirements, and an array of new taxes and fees. Clients should be aware of provisions of the law set to take effect in 2013 and 2014, including those listed in the table below.
Provisions of the Affordable Care Act That Take Effect in 2012, 2013 and 2014
2012
• Medicare hospital value-based purchasing program
• Increase in physician quality reporting requirements in Medicare
• Additional Medicare pilot programs on alternative payment methodologies, e.g., accountable care organizations
• Increased requirements for hospitals to maintain not-for-profit status
• Fees from insured (including self-insured) plans transferred to the Patient-Centered Outcomes Research Trust Fund
2013
• Increase Medicare payroll tax by 0.9% on high-income earners
• Impose a 3.8% tax on net investment income of high-income individuals
• $500,000 cap on health insurers’ deduction for executive compensation  
• Eliminate employer deduction for Medicare Part D subsidy
• FSA limitations
• Excise tax on medical device manufacturers and importers
• Medical expense deduction floor increases to 10%  
• Nationwide bundled payment pilot begins in Medicare
• Increased Medicaid reimbursement for primary care
• Medicare physician comparison data available to the public
• Reductions in Medicare payments for select hospital readmissions
• Expanded coverage of preventive services by Medicaid
2014
• Employer mandate and individual mandate
• Employer and insurer reporting requirements
• New health insurance market reforms take effect
• State health insurance Exchanges established
• Premium tax credits and cost-sharing subsidies available to certain individuals in Exchange insurance products
• Medicaid expansion to new populations (100% federal match to states for newly-eligible populations through 2016)
• Annual fee on health insurers
• Medicare/Medicaid DSH payment cuts begin
• Independent Payment Advisory Board (IPAB) issues first report to Congress if Medicare spending exceeds growth target
Post-2014
• Excise tax on high-cost employer-sponsored coverage (2018) 
Political reactions
The Court’s ruling will not end the political debate over health care, which will remain a central issue in the 2012 elections and beyond. The law stands as the centerpiece of the domestic record  of President Obama, who today said, "Whatever the politics, today's decision was a victory for people all over this country whose lives will be more secure because of this law and the Supreme Court's decision to uphold it." The President added, "With today's announcement it is time for us to move forward to implement and, where necessary, to improve this law."
In comments in response to the ruling, presumed Republican presidential nominee Gov. Mitt Romney said, "What the Supreme Court did not do on its last day in session, I will do in my first day in office. I will act to repeal Obamacare."
Following the release of the decision, House Majority Leader Eric Cantor (R-VA) announced that the House on July 11 will hold a vote on legislation to repeal the ACA in its entirety. The measure likely will pass the Republican-controlled House, but it is unlikely to advance in the Democratic-controlled Senate.
Repeal of the ACA has been a primary focus of congressional Republicans and remains a central objective of many Republicans’ campaigns in the November elections. Efforts to repeal all or part of the law will remain difficult unless Republicans maintain control of the House, win the presidency, and win at least a majority in the Senate in the November 2012 elections.
Republicans to date have not coalesced around a proposal to replace the ACA. Further efforts to control rising health care costs, including reforms to federal health entitlement programs and health-related tax expenditures, will be at the center of budget and deficit-reduction debates that are expected to dominate Washington after the November elections.
Background on the law
The Affordable Care Act was enacted in March 2010; it comprises the Patient Protection and Affordable Care Act of 2010 (which President Obama signed on March 23, 2010) and the Health Care and Education Reconciliation Act of 2010 (which the President signed on March 30, 2010).
The primary goals of the ACA are to: (i) expand coverage to an estimated 32 million Americans without health insurance; (ii) reform the delivery system to improve quality and drive efficiency; and (iii) lower the overall costs of providing health care.
To accomplish the goal of expanding coverage, the ACA mandates that all Americans maintain a minimum level of health coverage (the so-called individual mandate) or face a tax penalty. The law expands Medicaid coverage and provides federal premium tax credits and cost-sharing subsidies to assist low and moderate income individuals without affordable employer-sponsored insurance in obtaining health insurance through state-based insurance Exchanges. The ACA mandates, for the first time, that employers with 50 or more full-time employees provide certain minimum benefits or pay penalty fees.
The law also implemented insurance market reforms, including a ban on exclusions for pre-existing conditions, premium rate restrictions, extension of dependent coverage through age 26, and mandatory coverage of preventive services.
A mix of Medicare and Medicaid reimbursement cuts; provisions to reduce fraud, waste, and abuse in those public programs; other delivery system reforms; and a series of tax increases on individuals, corporations and the health industry are used to offset the cost of the law.

Lack of Insurance Proves Fatal

Lack of health coverage lead to the premature death of 26,100 people in 2010, according to a study by Families USA. From 2005 to 2010, the number of people who died prematurely due to a lack of health coverage rose from 20,350 to 26,100 a year.
 States with the most premature deaths due to uninsurance in 2010 were
 California with 3,164 deaths, Texas with 2,955 deaths, Florida with 2,272 deaths, New York with 1,247 deaths, and Georgia with 1,161 deaths. The survey compared the uninsured to the insured:

• Uninsured adults are five times less likely to have a regular source of care than the insured (55% versus 11%).

• 51% of uninsured adults who tried to find a new primary care doctor in the past three years said it was somewhat difficult or very difficult, with 20% saying it was very difficult.

• 41% of the uninsured said that a doctor’s office or clinic would not accept them as a new patient.
• Uninsured adults are nearly four times as likely to delay or forgo a preventive care screening due to cost (36% versus 10%).
• Uninsured women over 50 are about half as likely to have gotten a mammogram in the past two years (42% versus 79%).
• Uninsured 50- to 64-year olds with incomes below 250% of the federal poverty level are five times less likely than insured people in the same age group to have gotten a colon cancer screening in the past five years (10% versus 50%.)
• Uninsured adults are more than six times as likely to go without needed care due to cost (26% versus 4%).
• Uninsured Cancer patients are more than five times as likely to delay or forgo cancer-related care because of medical costs (27% versus 5%).
• Uninsured adults are more likely to be diagnosed with a disease in an advanced stage. For example, uninsured women are substantially more likely to be diagnosed with advanced stage breast cancer than women with private insurance, as are uninsured people with colorectal cancer.
• Uninsured adults are at least 25% as likely to die prematurely.
• Uninsured patients can’t get the same discounts on hospital and doctor charges that the insurance companies get. As a result, uninsured patients are often charged more than 2.5 times what insured patients are charged for hospital services. Three out of five uninsured adults report having problems with medical bills or medical debt.

For more information, visit http://www.familiesusa.org/.

How to get discounts on your companies Workers Compensation!

Did you know that your Employers WC and Anthem BC can get up to 35% in credits??? That’s right! Not only will Employers give you 10% off of the premium for being on the Integrated Medicomp product but you can also receive an additional 25% in credits for having the following:

1.       Being members of the NFIB or CRA

2.       Industry experience

3.       Having a  formal work and safety program

4.       Employee Benefits (401k, IRA, vacation & sick policy, Employee Assistance Program, medical plan, dental plan, vision plan, life plan)

In addition Anthem BC will give you further discounts as this is an integrated product. Therefore,  you will get 6% off of the life, 6% off the dental (DentalBlue or DentalNet) and 1% off the medical but they may also be considered for an additional RAF reduction and they will get OVER 10% off of their workers comp premium on the Integrated Medicomp program!

NOTE: this is subject to being in a classification acceptable to Employers WC programs.

How Consumer Driven Health Care Plans Reduce Costs

Consumers who moved from a traditional health plan to consumer driven health plan (CDHP) were able to reduce their health care spending significantly. They also increased their use of preventive care, according to a study by Health Care Service Corp. (HCSC).  HCSC operates Blue Cross and Blue Shield Plans in Il, Texas, Okla. and N.M.

The CDHP program, BlueEdge, is offered through the four Blue Cross and Blue Shield Plans and includes health savings account (HSA) and health reimbursement account (HRA) options. The study reveals the following about members who went from a traditional plan to a CDHP:

• They were 4% more likely to get preventive services.
• They reduced health care utilization more than 12%.
• They were 10% more likely to fill prescriptions with generics.
• They spent 24% less on in-patient hospital services and 8% less on out-patient services.
• They had a 12% decrease in emergency room visits.
• They reduced combined medical and pharmacy spending by 11%

Employers that offered only a CDHP saw even greater spending reductions up to 14.4% over the three years after moving from a traditional plan to a CDHP

Saving Tips for Young Adults

Today, younger adults face a variety of challenges in their pursuit of financial independence. Some of these challenges are similar to those faced by previous generations, while others are unique to the times. Here are five financial tips to help you manage your personal finances and prepare for your future:

1. Invest in your future. Rapidly changing technology used in various fields may require continuing education. You may wish to make ongoing education a priority to enhance your skills and increase your professional potential. The more varied and flexible your skills, the more you will have to offer to prospective employers.
   
2. Open an emergency savings account. The uncertainty of the workplace may mean that your professional life will be interrupted by career changes. If you need to return to school to change career paths, you may experience periods of time without steady income. Creating an emergency fund to cover at least six months' worth of living expenses can help you manage work-related transitions. This savings fund may also be used for other endeavors, such as starting your own business.
   
3. Save early and continuously for retirement. Saving for retirement is your responsibility. The more disciplined and diligent you are, the better off you may be. Social Security provides only a base level of income, and many employers no longer offer traditional pension plans. With employer-sponsored 401(k) plans, the responsibility of saving rests on your shoulders. Although you may be years away from retirement, the key is to make time and compound interest your allies.
   
4. Let retirement funds accumulate. If you change jobs early or often, consider rolling over your employer-sponsored retirement plan funds into an Individual Retirement Account (IRA) or new company retirement plan. It may be tempting to cash in the account, especially if you have accumulated only a small amount, but doing so would make it immediately taxable, and you may also incur an early withdrawal tax penalty. Perhaps a greater concern, however, is that you may be unable to make up for time already spent to accrue these savings.
   
5. Use credit wisely. Credit card companies frequently target young adults with the lure of "easy money." While credit cards offer convenience (it is virtually impossible to conduct some transactions, such as reserving airline tickets, without one), they also have the potential to create debt problems. Because payments can be extended far into the future, overspending on credit can create an illusion of wealth. Paying off the full balance each month is the best way to manage your use of credit.

Plan Now for the Future

Remember, the funds you accumulate during your working years may be your primary source of retirement income. Although inflation can erode your savings over time, a little discipline and common sense may help you better manage your current and future personal finances.

1. An Individual Disability Policy is a piece of valuable property.
It is a contract. Even though it is underwritten for the current occupation and income - it will cover you the insured in any job you may do through your career; for the benefit amount of the contract.

2. Retirement Savings Disability Income
What happens when your you go on disability? Usually cannot contribute to your retirement plan (IRA, 401(k), etc). This product will do that for you.  So - if they are disabled through age 65/67 they will actually have a 'retirement' fund to use.

3. LTC - Calendar or Service Day Elimination? This is a huge difference at claim time.
When your client's doctor says they need care - on a Calendar Day contract - that starts the elimination period and each day counts. The Service Day contract says that only the days on which the client gets service counts toward the elimination period. This is important because in the beginning - they may only get service 3 times a week or so.

4. MET - Catastrophic Rider - this is different from other carriers!!!
Standard, Principal and Ameritas all use the '2 of 6 ADL's' in conjunction with their CAT rider. If a client's disability is such - they pay the CAT rider benefit in addition to the base benefit. MET - their definition of Catastrophic is the loss of both hands, feet, speech etc!

About Social Security / Get The Biggest Check

Patience Pays Off.

waiting, that larger first check becomes the basis for future cost-of-living adjustments. 

reaches his retirement age, he can ‘file and suspend’, meaning she can collect her share while he waits to collect until later.

The longer you wait, the bigger the check. You can start collecting at age 62. ByMarriage Has Its Perks. Say she’s ready to start collecting benefits but he is not ready to retire. The solution: Once he

Collect If You Decouple.

Bide Your Time. If you wait until age 70 you can collect even more, thanks to the delayed-retirement credit. With life expectancies at an all-time high, chances are good you’ll be around to enjoy the higher benefits.

 

Ask For A Do-Over.

 

Have a Financial Advisor review the best options for you.

If you started collecting Social Security and wish you had waited in order to get a higher benefit, you can press the ‘reset button’. You’ll need to pay back what you’ve received and request a tax refund.

You may be able to collect on your former spouse’s benefits, as long as you were married for at least ten years and are 62 or older.

Don't get stuck with high medical bills

Health Insurance

May 31, 2012 8:15 AM

You probably already realize that a gallbladder operation or knee replacement, or a simple blood test, for that matter, doesn't come with a price tag attached. But do you have any idea how difficult it really is for consumers to figure out how much health care costs? Consider these three facts:
1. The price of the identical service, in the identical city, can vary by five-fold or even more. Proof is right there in our report, out today, entitled "That CT scan costs how much?" In one Midwestern city, insurers pay anywhere from $840 to $4,481 for a simple colonoscopy, according to figures compiled for Consumer Reports by Healthcare Blue Book, a service that provides consumers information on local "fair" prices for a range of medical services.
2. Your PPO may not pay as much as you think it will for the out-of-network coverage it brags about. Just ask the woman who got a bill of $480,000 for her share of an out-of-network back surgery. Our report explains exactly how such a thing can happen, and how to keep it from happening to you.
3. Even if you faithfully go to hospitals and doctors in your health plan's network, you can still be hit with, and have to pay, whopping out-of-network balance bills. That's because a lot of doctors who work inside hospitals don't participate in the same networks the hospital does. And no one has to warn you about this, either.
Get more details, along with advice on how to protect yourself, in our full report. And see our health insurance buying guide, too.

—Nancy Metcalf

Inflation Adjusted Amounts for HSAs in 2013

On April 27, 2012, the IRS released Rev. Proc. 2012-26 that provides the 2013 inflation adjusted amounts for health savings accounts (HSAs) as determined under Internal Revenue Code Section 223. Amounts effective for the 2013 calendar year are summarized below.

2013 Inflation Adjusted Items
Calendar Year	2013	2012	2011
Maximum Annual Contribution Limit (Self-only)	$3,250*	$3,100*	$3,050*
Maximum Annual Contribution Limit (Family)	$6,450*	$6,250*	$6,150*
Catch-up Contribution Limit	$1,000	$1,000	$1,000
Minimum Annual Deductible (Self-only)	$1,250	$1,200	$1,200
Minimum Annual Deductible (Family)	$2,500	$2,400	$2,400
Maximum Out-of-pocket (Self-only)	$6,250	$6,050	$5,950
Maximum Out-of-pocket (Family)	$12,500	$12,100	$11,900
*An employee is treated as being eligible for the entire calendar year as long as he or she is eligible during the last month of the calendar year. However, failure to maintain eligibility during the "testing period" will result in adverse tax consequences (including an additional excise tax). The testing period begins in December of the year in which the employee becomes eligible and ends the last day of December of the following year.

The full revenue procedure text is available on the IRS website.

Best Practices for Health and Fitness Month

May is Global Employee Health and Fitness Month. So Healthyroads is offering employers nine best practice tips to encourage organizations to build a culture of wellness at their worksites:

1. Understand Your Goals – Study claims data, absenteeism, and other issues to understand the causes of increasing health costs. Then develop a wellness program that addresses those issues.  For example, does the employer have a lot of smokers?  Smoking-related health issues may be increasing health care costs. Are work-related back injuries increasing medical utilization?

2. Know what motivates employees – Set achievable goals and create incentives to motivate healthy changes.

3. Get senior management to support health improvement initiatives – Encourage company leaders to set an example for healthier lifestyles. A manager who is ready to quit smoking, lose weight, or get fit can encourage employees. Conversely, if senior managers smoke, employees will have a hard time believing the company’s commitment to go smoke-free.

4. Build a champions network – This network should include representatives of the entire company who support company-wide health improvement initiatives.

5. Provide consistent communications throughout the year – It may take sending many messages to get through to people. Use various ways of communicating with posters, emails, meetings, contests, bulletin boards, word of mouth, and onsite health activities. Different approaches work for different people.

6. Offer onsite health activities throughout the year – This will generate awareness and enthusiasm, especially when you sponsor competitions.

7. Promote a culture of wellness – Encourage healthy alternatives at luncheons; offer healthy foods in vending machines; organize lunchtime run/walk clubs; invited community health and wellness professionals to provide lunch and learn seminars; and sponsor things like health fairs, onsite massage therapy, and gym membership discounts.

9. Initiate and integrate – Wellness programs should be included in the employee benefit plans (medical, prescription drug, disease management, EAP, etc.) to provide a seamless program design that streamlines communication and education. For more information, visit Healthyroads.com.

GETTING A REVERSE MORTGAGE

A reverse mortgage is a loan for senior homeowners that uses a portion of the home’s equity as collateral.
The loan generally does not have to be repaid until the last surviving homeowner permanently moves out of the property or passes away.

Eligibility for a reverse mortgage – For eligibility ... the FHA requires that all homeowners be at least 62.
Reverse mortgage vs. home equity loan – A home equity loan has strict requirements for income and credit
worthiness. A reverse mortgage has no nincome or credit score requirements.  Outliving the reverse mortgage – It cannot be outlived.  As long as at least one homeowner lives in the home as their primary residence and maintains the home in accordance with FHA.  Estate inheritance – In the event of death or that the home ceases to be the primary residence … the homeowner’s estate can choose to repay the reverse mortgage or put the home up for sale.  Loan limit – The amount available depends on four factors:
age, current interest rate, appraised value of home and imposed lending limits.  Proceeds – Proceeds can be received as: 1) a lump sum of cash, 2) equal monthly payments, 3) payments for a fi xed number of years, 4) a draw on a line of credit, or 5) any combination of above.  Contact a reverse mortgage specialist to explore options.

Source: Reverse Mortgage GuideAMS Senior Newsletter

Five Effective Ways to Control Benefit Costs

Focusing on five cost-saving measures could significantly lower benefit costs while minimizing the affect on employees, according to a white paper by Colonial Life. Colonial used in-house and industry-wide research as well as case studies to show the effectiveness of strategies to contain employee health benefit costs. The white paper finds the following strategies to be effective in controlling costs:
• Offering Wellness initiatives — Wellness initiatives were among the top cost-control strategies implemented by employers in a recent survey of government financial officers. Nearly 80% added wellness initiatives to their benefit programs and 90% of those would recommend them to others, according to a survey by the Government Finance Officers Association. A Society for Human Resource Management report reveals that 75% of employers offer wellness resources and information.
• Pre-taxing benefits/Section 125 participation – Seventy-seven percent of employers in the government financial officers survey offer pre-tax benefit plans and 86% of them recommend this option. It was the most enthusiastically endorsed strategy of the survey options.
• Providing Benefit communications and education — In the government financial officers survey, only 31% of employers were using an external service provider for benefit enrollment and 52% shifted benefit education and communication expense to suppliers. However, 78% of those who outsourced enrollment would recommend it and 84% recommended using a benefit carrier to handle benefit education and communication.
• Voluntary benefits — Only about a third of employers in the government financial officers study have moved non-core benefits to employee-paid voluntary coverage. However, 87% of employers that did so recommended this strategy.
• Dependent verification — Health plan audits can reveal a significant number of ineligible participants, including dependents who are over age or who aren’t a blood relative or a spouse, or former employees who haven’t been removed from the plan. The potential cost savings offered by dependent verification can be considerable and the service is sometimes available at no cost to the employer. Government employers who implemented these kinds of strategies report significant savings in their employee healthcare benefits. Fifty-five percent of participants in the government financial officers study saved at least 6% while 40% of them saved more than 10%. Other studies show an employer return on investment for wellness initiatives ranging from $3 to $6 for every dollar spent. The complete white paper is available in Colonial Life’s online newsroom at ColonialLife.com.

Health Care Reform Employer Compliance Obligations 2012

Following are compliance obligations under the Patient Protection and Affordable Care Act (" Health Care Reform Act") forthcoming in 2012.

Summary of Benefits and Coverage
Employer health plans (and insurers for insured plans) are required to prepare and distribute a document called a Summary of Benefits and Coverage ("SBC"). The purpose is to assist individuals in understanding and comparing their health coverage options. The SBC is in addition to, and not in lieu of, the Summary Plan Description (SPD) that employers must already provide to participants.

SBCs are subject to content and formatting rules and must be provided in a culturally and linguistically appropriate manner. Regulations recently issued by the governing federal agencies include SBC templates (along with instructions, sample language and uniform glossary).

The requirement to provide an SBC applies for disclosures to participants and beneficiaries who enroll or re-enroll in group health coverage through an open enrollment period beginning on the first day of the first open enrollment period that begins on or after September 23, 2012. For disclosures to participants and beneficiaries who enroll in group health plan coverage other than through an open enrollment period (including individuals who are newly eligible for coverage and special enrollees), the requirement applies beginning on the first day of the first plan year that begins on or after September 23, 2012.

Self-insured employers should consult with their third party administrators to determine whether they will be preparing, or will assist in preparation of, SBCs for the plans.

Comparative Effectiveness Fees
These are fees imposed on health insurance issuers and self-insured health plans to fund research. The purpose of the research is to determine the effectiveness of medical treatments, services and items. Some plans such as certain dental, vision and health flexible spending accounts are exempt.

Fees will begin to be imposed for policy and plan years "ending after" September 30, 2012. The fee is not imposed for policy or plan years "ending after" September 30, 2019. For calendar year plans, this means the fee will apply for years 2012 through 2018. The fees will be treated as a tax and are imposed on the insurer for insured plans and the plan sponsor for self-insured plans. The fee imposed is equal to $2 ($1 in the case of plan years ending before October 1, 2013) times the average number of lives covered under the plan or policy for the year.

The IRS asked for public comments and plans to publish guidance on methods for determining the average number of lives covered by a plan or policy and other logistics. We will update you as further guidance is issued.

W-2 Reporting of Health Coverage Value
Required W-2 reporting of the value of certain health benefits begins with the W-2s for tax year 2012 (due in 2013). The IRS issued guidance on this requirement. Until further guidance is issued, an employer is not subject to the reporting requirement for any calendar year if the employer was required to file fewer than 250 W-2 Forms for the preceding calendar year. Special rules apply in determining whether fewer than 250 W-2s have to be filed.

Cap on Health Flexible Spending Account Salary Reductions
Effective January 1, 2013, the annual limit on salary reductions to a health flexible spending account program is $2,500 per year. The limit is inflation adjusted annually. Employers will need to amend their plans and employee communication materials this year to accommodate this change.

New Tax Rules Seek to Help Employers Provide Retirement Plans with Lifetime Income Options

"Although not all of the provisions have been finalized, employers may wish to begin exploring potential plan design changes, as well as examining the administrative, economic, and fiduciary implications of offering lifetime income distribution options, to accommodate the trend toward providing these options in defined contribution plans."

Ask us about your retirement plans and how we can assit you with our 401K palns?

Consumers Make Better Healthcare Choices with the Right Information

When asked to choose a healthcare provider based only on cost, consumers choose the more expensive option, according to a study funded by HHS’ Agency for Healthcare Research and Quality. Consumers worry that lower cost means lower quality care.

However, when consumers are shown the right mix of cost and quality information, they are more likely to choose providers that deliver high-quality care at a lower cost. The study appears in the March issue of Health Affairs. For more information about public reporting, visit

How to get the most from outside consultants

Getting the Most from Outside Consultants

At various points in its development, your business may benefit from the expertise and insight that only an external consultant can provide. But without the right selection process and procedures in place, bringing in an outside consultant can be a waste of time and money.

Here are some tips for selecting and effectively utilizing outside consultants: read more here:

Trading Pay For Benefits

Workers Would Trade Pay for BenefitsAn increasing number of U.S. workers are willing to trade some of their pay for more generous retirement and healthcare benefits, according to a survey by Towers Watson.

Fifty-five percent of respondents are willing to pay more from each paycheck to ensure a guaranteed retirement. That compares with 46% two years ago. Fifty-percent of respondents would trade a portion of their pay to have healthcare benefits if they retire before they are eligible for Medicare, versus 40% in 2009.

“Since the economic crisis, employees have been paying much closer attention to their retirement readiness and many are willing to look at new ways to balance their mix of pay and benefits,” said Kevin Wagner, a senior retirement consultant at Towers.

Retirement security has become especially important to older employees who may be facing declines in their retirement accounts and their home values. But, the growing interest in retirement security is not limited to older workers. In fact, some of the most dramatic changes in attitudes have been among younger employees and those with a defined benefit plan. Seventy percent of defined-benefit plan participants who are younger than 40 are willing to pay for a guaranteed retirement benefit compared to 66% in 2011 and 39% in 2009.

Forty-four percent of workers are worried about reductions to their retirement benefits over the next two years. Younger defined benefit plan participants are particularly concerned (63%).

Employees are even more concerned about healthcare costs. Seventy-three percent are concerned about higher out-of-pocket health costs and co-pays over the next two years, compared to 67% in 2007.

The rise in healthcare costs is the most important reason employees are concerned about retirement security, cited by 64% of respondents. Fifty-six percent cited concerns over Social Security or Medicare benefits and higher prices for necessities.

Older employees, women, lower-paid workers, and those with health issues are most willing to relinquish control over their retirement investments in exchange for more long-term stability in their retirement benefits.

For more information, visit http://www.towerswatson.com/newsletters/insider/6411.

Key Features of the Law; Affordable Health Care Act

The health care law offers clear choices for consumers and provides new ways to hold insurance companies accountable. The most important parts of the law are broken into groups below. We’ll highlight new features of the law here as they roll out between now and 2014.

Rights and Protections
If you have insurance, these consumer protections can help you get the most out of your plan.

Insurance Choices
If you need insurance coverage or have been rejected due to a health condition or disability, you may be eligible for coverage through one of these programs.

Insurance Costs
How does your health insurance policy affect your wallet? Find out how the law helps you get the most value for your premium dollar.

65 or Older
The health care law strengthens Medicare and provides access to preventive services and prescription drug discounts for seniors.

Employers
Tax credits and new programs are available to small businesses to help make care more affordable for employers, employees, and early retirees.



If you need help dealing with your insurance, finding insurance, or getting answers to questions about how the health care system works, visit the Get Help Using Insurance section. Use our interactive FAQ tool at answers.healthcare.gov to find answers to your questions about health care and insurance.

Good News for Employess_Payroll Tax Holiday Extended

On February 17, 2012, Congress passed the Middle Class Tax Relief and Job Creation Act of 2012 (H.R. 3630). President Obama signed the bill February 22, 2012.

In addition to a number of other provisions, H.R. 3630 extended the payroll tax reduction which had previously been scheduled to expire at the end of February. Under the new law, for all of 2012, employees will pay the Old-Age, Survivors, and Disability Insurance (OASDI) portion of the payroll tax at a 4.2% rate (compared with 6.2%), on the first $110,100 in wages. Similarly, self-employed individuals will pay OASDI at a rate of 10.4% (rather than 12.4%) on the first $110,100 in self-employment income. The 2.0% reduction in OASDI does not apply to employers; an employer’s share of OASDI remains at 6.2%

The Medicare Hospital Insurance (HI) tax remains at 1.45% each for employers and employees, and at 2.90% for self-employed individuals, on all wages and earnings.

Amsinsure.com - Torrance, CA - Insurance Agent in Torrance, California

Amsinsure.com - Torrance, CA - Insurance Agent in Torrance, California

Target Date Funds Inspire Confidence

WORKPLACE RETIREMENT PLANS

Employees who participate in workplace retirement plans and use target-date funds are more confident about reaching their retirement goals and managing their portfolios, according to a study by ING. “Like many of the latest 401(k) features, target date funds …make saving for retirement easier and more automatic for the average plan investor. These funds are being designed into the newest breed of guaranteed income solutions,” said Rick Mason, president of Corporate Markets, ING U.S. Retirement.

Target date funds offer automatic asset allocation, over time, through a single age- and risk-appropriate investment. This simplified approach to investing is becoming increasingly popular among employers and employees. Target date assets have grown from $15 billion in 2002 to $363 billion in 2011, According to Morningstar and Financial Research Corporation.

Workplace investors have a strong preference for funds that are managed by multiple investment managers and provide a guaranteed income stream at retirement. Ninety-three percent of those who use target date funds say they would want a target date fund with stronger protection against market losses in the years leading up to and including retirement. Additionally, 80% prefer less market risk at that stage of the investment cycle.

“These findings suggest that diversified, age-adjusted target date funds may work better than traditional offerings in bridging the gap between investor knowledge and long-term retirement objectives,” said Paul Zemsky, Chief Investment Officer of Multi-Asset Strategies for ING Investment Management.

Other key findings of the study include the following:

• 88% of target date investors want a target date fund that offers guaranteed income at retirement.

• 61% of target date investors prefer multi-manager strategies and 14% prefer a single-manager.
To view a report, visit the ING Retirement Research Institute.

AMS Benefit Consultants has avocated these plans and all of our plans include them. Our expierence has been that employees contribute more to plans which they have confidence in performance with lower risk.

More Businesses Will Qualify for the Healthcare Tax Credit

President Obama is expanding the Small Business Healthcare Tax Credit tax credit so that more businesses can qualify. The Fiscal Year 2013 budget proposal increases the maximum size of eligible companies from 25 employees to 50; proposes more generous phase-out provisions; and simplifies the credit, making it easier to claim. The White House says that the proposed changes would benefit about half a million employers who provide healthcare to 4 million workers in 2012 alone. Over the next decade, this proposal would provide an additional $14 billion in tax credits to small employers across the country. For more information, visit www.healthcare.gov.

Manta confirms AMS philosophy on client services with thier tip of the day?

Respond Promptly to Requests for Information

When customers request information about your company via email, a website form, over the phone or through some other means, they expect a quick response. When a company fails to respond--due to poor organization, incorrect contacts or a busy schedule--customers are left feeling abandoned and likely won't do business with you now or in the future.

Learn More about HSA plans from AMS

HSA FAQ
What is a Health Savings Account (“HSA”)?
A Health Savings Account is a special type of savings account like an Individual Retirement Account (IRA) that offers a different way for consumers to pay for their health care. HSAs enable you to pay for current health expenses and/or save for future qualified medical and retiree health expenses on a tax-free basis.You must be covered by a High Deductible Health Plan (HDHP) to be able to take advantage of HSAs. An HDHP generally costs less than what traditional health care coverage costs, so the money that you save on insurance can therefore be put into the Health Savings Account.

You own and you control the money in your HSA. Decisions on how to spend the money are made by you without interference from a third party or a health insurer. You also decide what types of investments to make with the money in the account in order to make it grow.

What Is a “High Deductible Health Plan” (HDHP)?
You must be covered by an HDHP if you want to open an HSA. Sometimes referred to as a “catastrophic” health insurance plan, an HDHP is an inexpensive health insurance plan that generally doesn’t pay for the first several thousand dollars of health care expenses (i.e., your “deductible”) but will generally cover you after that. Of course, your HSA is available to help you pay for the expenses your plan does not cover.

For 2012, an HDHP must have a deductible no lower than $1,200 for individuals with self-only coverage or $2,400 for family coverage. In addition, the HDHP must limit your out-of-pocket expenses to no more than $6,050 (self) or $12,100 (family). HDHPs can have first dollar coverage (no deductible) for preventive care and higher out-of-pocket (copays & coinsurance) for services received outside the plan’s provider network.

for more information click here:

Why Use an Online Payroll Service?

Payroll. The Hollywood image of an unobtrusive character in the back room poring over figures may come to mind but that’s so last century. Today, businesses don’t have the luxury of dedicating large chunks of time and other resources to getting employees paid accurately and on time and to complying with the myriad regulations associated with payroll. Indeed, payroll, though an essential element in operating any business, must proceed transparently freeing owners, managers and other employees to get on with the business of business.

Below are some of the best reasons to consider using an online payroll service:

Save Time and Money - In business, time is money and running payroll can’t be a full time job. It’s an overhead expense that doesn’t directly add to the business’ bottom line and it is one of the most commonly outsourced functions. While employing an accounting firm or more traditional payroll outsourcer may be beyond the reach of many small businesses, online payroll services provide a critical array of services at rather nominal prices.

Ease of Use - Processing payroll is regarded as a rather arduous task by most business operators but inputting data into an online payroll service is intuitive, quick and easy. The initial setup is critical because future calculations are based on it, but online payroll service providers have made the process about as simple as one could imagine. What’s more, they generally provide support to assist in getting things set up right initially as well as resolving any problems that may arise.

Avoid Costly Errors - Getting it right the first time is a major advantage that online payroll services provide. In addition to making data entry simple, they generally present a completed payroll for review before live submission. The services also use their expertise and systemization to make certain that all payroll tax reporting and payments are made accurately and on time thus avoiding costly penalties.

Stay Current - A major complaint of business operators is always that there’s too much government regulation and that they are often not aware of changes as they occur. Keeping up to date on applicable regulations from the multiple levels of taxing authorities is at the heart of an online payroll services business so that their clients are liberated from the need to be payroll experts and can concentrate on running their businesses.

Online Payroll Services: What to Look For

Pricing
We don’t want to place any more emphasis on the price of an online payroll service than is absolutely necessary, but the reality is that the cost of the service is one of the most significant distinguishing factors. The reporting and deposit requirements that an online payroll service must meet are, for the most part, statutory in nature and the features that are offered from one service to the next don’t vary greatly. These facts result in price being an important factor in choosing a provider. When comparing prices of the various providers, don’t forget to consider those features that some companies include in their overall service while others impose additional fees.

Ease of Use
Of course you should consider ease of use. But online software and services are now almost universally conforming to best practices when it comes to user interfaces. So unless you encounter a design that happens to annoy you, ease of use is not the most important feature to examine.

Features
If you have less than 150 employees, you might prefer the ability to print checks locally. Some online payroll services let you print checks and paystubs locally, but some offer centrally printed checks only. Direct deposit is a standard feature, but some vendors include it in the monthly fee and others charge more for the feature.

Pay Options
These days, most employees receive their pay via direct deposit to a bank account but some still find the option of getting a paper check preferable. Payroll cards are becoming more popular, particularly for employees who don’t have a bank account. These are essentially debit cards that can be used to make purchases as well as to make cash withdrawals.

Tax Compliance Features
When thinking of payroll processing, the first thing that comes to mind is likely to be getting employees paid. But for employers, the biggest problems associated with payroll involve compliance with a multitude of tax regulations. An online payroll service can file the quarterly and annual returns that are required by the various levels of taxing authorities and make the mandatory periodic deposits. Most offer the option of doing the filings on behalf of the client or of providing ready for signature documents that the customer then files.

Help & Support
In a competitive industry in which everybody provides services that strongly resemble one another, customer service is deciding factor. Payroll issues are usually time sensitive and missed deadlines are costly. While many online payroll service providers guarantee timeliness and accuracy, the business operator always deserves and should insist upon superb customer support.

Software Integration
The data entered into an online payroll service can generally be exported to other accounting software. Some services allow for integration with multiple software packages, while others only support the use of one or two. The important point is that the data should be compatible with the accounting software used by your business. An online payroll service should make running a business easier and more productive rather than requiring duplicate data entry or a complete changeover of accounting software.

We’ve taken care to evaluate online payroll services with the needs of small businesses in mind. As you compare services on our side-by-side matrix, take note of those characteristics that are best for a small business.

Our affiliate offers substantial discounts to our clients.

info@amsinsure.com

2013 Reporting W-2 employee benefits.

For employers that issue less than 250 w-2's not employees a year there is currently no requirement to report under this part of Health Care Reform. For employers that issue more than 250 w-2's a year they will have to report the value of health care benefits.

AMS is avialable to discuss the importance of this issue and also clinets or prospects should be discussing with there CPA, Payroll Vendor, or others who would provide services for internal payroll departments.

Employee Morale Shapes Business Success

The start of a new year represents an excellent time to contemplate employee morale within the organization. One success formula for an employer is to place and retain the right employees in the right jobs. Although monetary incentives are one way to help employees cope with economic downturns and challenges, the quality of work/life issues is a vital element that impacts the morale and the successful contributions of your employees.
The first step is to take time to assess how employees feel about their current roles and what the company can do to ensure they are positioning themselves as an attractive employer. Remember to recognize exceptional workers within the organization. Having employees who are valued, recognized and appreciated for their efforts will generally boost the overall morale of the organization. Such employees may also provide critical business and employee referrals to further contribute to the company’s success.
Management immediately can do a great deal to help increase employee morale. Consider the following three tips:
• Analyze the Business Situation. Question where improvements need to be made or enhancements should take place for employees to effectively and efficiently carry out their work duties.
• Communicate with Your Employees. Inform employees about changes within staff, budgeting, etc. and take feedback into consideration.
• Increase Workplace Incentives. Provide an environment with growth opportunities, monetary and non-monetary rewards, and a positive business culture. One simple example that can be easily overlooked is to thank your employees periodically for their efforts in email communications or staff meetings.
In this new year, resolve to make employee morale a priority. A business can prosper with the right mind-set, tools, and the greatest asset – its employees. When employees feel respected, appreciated, and recognized, the increased success of a business will generally follow.



Tool of the Month:
Essential Job Functions Worksheet
Essential job functions are the fundamental duties of a job position – the duties an employee with that job absolutely must be able to perform. In the event a charge is filed (e.g. under the Americans with Disabilities Act), a crucial and basic component of the charge will be the employer’s definition of and justification for the essential functions of the employee’s job in question. Therefore, carefully assess and document the essential functions for each job in your company.
The Essentials Job Functions Worksheet will help you with the following:
• Identify key characteristics of an essential function,
• Determine which functions are essential or non-essential to a specific job,
• Develop documentation of employer good faiths efforts to establish essential job functions.

Request more information:

HR TIPS

Clearing the Smoke on Smoking in the Workplace
Is it a smart move for an employer to discriminate against an individual who uses tobacco? This month’s HRCast will explore the benefits and the pitfalls surrounding this question.
On February 15th, be sure to visit the HR Support Center and listen to this month’s HRCast to learn more about this topic.


Manage Workplace Stress
Workplace stress results from multiple internal and external factors. Internal factors can be attributed to budgets, employee performance issues, sales and profit outlooks, and overall employee relationships within the business. External factors can result from economic uncertainty, competitors, and market value prices. To help reduce and control workplace stress for your employees, consider applying certain coping mechanisms. One stress-reducing technique is to provide workers with opportunities to participate in decisions that affect their jobs (e.g. work scheduling and advancement opportunities).


34%
According to a December 2011 survey, more than one-third (34%) of employers have terminated an employee for being late to work. (Source: Harris Interactive)


"Unless commitment is made, there are only promises and hopes…but no plans."
- Peter Drucker

Medicare Advantage Plans Improve Diabetic Care

Medicare Advantage Chronic Special Needs Plans are effective in managing care for some of Medicare’s most vulnerable beneficiaries with diabetes, according to a study published in the January issue of Health Affairs.

The study compared 36,000 Care Improvement Plus members with diabetes to a similar population enrolled in traditional Medicare. Members of special needs plans members had more primary care. They had reduced rates of hospitalization and hospital readmissions. The study indicates that offering additional services to people with chronic diseases could result in lower Medicare spending and may improve the quality of life for beneficiaries with diabetes.

The plans were able to reduce hospital readmission rates, by as much as 40%, by offering services such as in-home preventive health visits. these include services such as foot exams, social needs assessments, and medication reviews. The plans were able to reduce hospitalizations and readmissions for non-Caucasian members at rates greater than their Caucasian counterparts, suggesting that the plan’s model is effective in addressing ethnic and racial disparities in healthcare.

What Will Healthcare Look Like in 2025?

By 2025, patient-doctor relationships and healthcare delivery will look radically different, according to a forecast by the Institute for Alternative Futures. Working with more than 50 national healthcare leaders, the Institute created four scenarios to show what primary care might look like in 2025. The scenarios take into consideration the nation’s economic challenges, political polarization, and opportunities afforded by technological advances and new delivery systems. Clem Bezold, Institute for Alternative Futures chair and senior futurist said, “In all four scenarios, we forecast that electronic records will become ubiquitous. Community health centers will give high-quality care to low-income people, and a small persistent group of affluent will receive great fee-for-service concierge healthcare. You will see more virtual care, personal health avatars and doctors operating remotely.”

Wellness Programs Get Results

Forty-one percent of workers agree that having a wellness program encourages them to work harder and perform better at work, according to the latest Principal Financial Well-Being Index. The index surveys American workers at growing businesses with 10 to 1,000 workers and is conducted by Harris Interactive. Fifty-two percent of workers (up from 37% last year) say they have more energy to be more productive at work because they participated in a wellness program. Another 35% (up from 28% a year ago) and say they missed fewer days of work. Forty-five percent of workers chose better overall physical health as the top benefit to participating in a wellness program. Other top mentions included receiving a meaningful incentive from their employer for participation (30%) and reduced personal healthcare costs, greater chance of living a longer, healthier life and reduced stress (29% each). Fifty-five percent of workers rated wellness activities offered by an employer as very successful or somewhat successful in improving health and reducing health risks. The top four wellness benefits workers would most like to see their employer offer are fitness center discounts (25%), on-site preventive screenings (22%), access to wellness experts such as nutritionists (21%), and onsite fitness facilities (19%). However, the top four wellness benefits offered by employers are online wellness information (19%), educational tools or resources (18%), fitness center discounts (17%), and printed wellness information (17%). Interestingly, access to wellness experts was only available to 11% of those surveyed.

Berkley Wellness Newsletter

This is one of the best places to stay informed on health topics and receive great emails with current state of the art information.

* Special Offer From Berkeley Wellness Alerts *


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It's one of the most common chronic disorders that we face.

Health Insurnace

Health insurance is a necessity for a family. However, with the price of health insurance rising, more families are looking for affordable options. With a little bit of time and effort, affordable health insurance can be found for the right price.

Health insurance through an employer utilizes a group plan, so the premiums are less expensive. Some employers will also pay a percentage of the premium for each employee. Dependents such as a spouse or children can be enrolled in your employer's health plan in order for the whole family to have insurance coverage.

If you are self-employed or if your job does not offer health insurance benefits, you can obtain private health insurance for yourself and your family. Private insurance tends to be more expensive than insurance through an employer, but there are ways to make it more affordable. When shopping for private health insurance, seek the assistance of an experienced health insurance broker. An insurance broker does not work for just one insurance company; they can sell policies from many different companies, and this allows them to compare different policies to find the best rates. A way to save money is to choose an HMO plan; these offer good coverage and tend to be less expensive than a PPO insurance plan. You will also pay less in premiums if you choose to have a higher deductible. The higher the deductible, the lower the monthly premium.

If money is tight, you may want to purchase a "catastrophe" health insurance plan for yourself and your family. These plans are very affordable, but the deductible can be between $5,000 and $10,000. With a catastrophe health insurance plan, you are responsible for the first $5,000 or $10,000 of medical bills and the insurance company pays the rest. This plan is very useful in case of serious illness or injury that requires an expensive stay in the hospital. If there is no way you can afford to pay for any type of health insurance coverage right now, look into your state's programs. Most states will offer health coverage for children for very little or no cost.

Health insurance can be very expensive, but not having health insurance can be even costlier. There are ways to save money on health insurance; look at all of your options and find the plan that is the best fit for you and your family.