Nearly 7M Might Enroll Outside HIX Open Enrollment

Despite open enrollment for Affordable Care Act plans not starting until November 15, a new report estimates that nearly 7 million adults may be able to enroll through special enrollment periods. READ MORE » AMS ENROLLMENT AND PLANS

Medicare Open Enrollment starts November 15th

Looking for or to reconsider your Medicare Insurance options or if you’re satisfied with your current coverage, you needn’t do anything—your coverage will renew automatically. If not, Contact us for a Medicare Supplement Plan.

Now, before open enrollment begins November 15, is the time to learn more about your options.

Your Medicare Options

Medicare-eligible individuals have two options for obtaining health insurance: original Medicare or a Medicare Advantage plan.
Original Medicare, the government insurance program geared primarily for seniors, has three parts:

• Part A, hospitalization insurance. Medicare Part A helps cover inpatient care in hospitals and skilled nursing facilities. It also helps cover hospice care and some home health care. It does not cover custodial or long-term care. U.S. citizens and lawfully admitted aliens who have lived in the U.S. for a five-year period when they turn 65 automatically qualify for Part A coverage. Individuals who develop end-stage renal disease or certain other disabilities may also qualify. Most people do not pay a premium.
• Part B, medical insurance. Medicare Part B helps pay for doctors’ services and outpatient care. It covers some other medical services. These include physical and occupational therapist services and some home health care when medically necessary. For most people, the federal government pays about 75 percent of the cost of Part B coverage; enrollees pays the rest. Higher-income people (about 5 percent of beneficiaries) will pay higher premiums.
• Medicare Part D, prescription drug insurance. The Part D monthly premium varies by plan and your income—higher-income consumers may pay more. The Centers for Medicare & Medicaid Services (CMS) estimated average 2014 premiums for basic Medicare Part D plans at $31 per month. As with Part B, higher-income people will pay more.
• Medicare supplement (“Medigap”) plans. Unlike Medicare Parts A, B and D, private insurers underwrite Medigap policies. They must adhere to specific plan designs that cover a specific set of benefits. In most states, policies are identified by letters. Not all plans are available in all states.
  As the name suggests, Medicare supplement plans supplement the coverage under traditional Medicare. These policies can help pay some of the out-of-pocket costs you’ll have with original Medicare, such as copayments, coinsurance and deductibles. Some Medigap policies also cover services that original Medicare excludes, such as medical care when you travel outside the U.S. If you have original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.

Get a quote today:  ONE STOP QUOTE

Private Exchanges:

The New Business Model for Insurers and Employers

Private Exchanges: The New Business Model for Insurers and Employers examines the details of how private exchanges work, which models are most successful at gaining members, and the pros and cons for insurers of taking part in nonproprietary exchanges versus building their own. This report is filled with valuable, practical intelligence from several national private exchange experts, on topics such as:

• The business model for private exchanges and how insurers expect to prosper by operating their own proprietary exchanges or selling coverage on other marketplaces.
• How defined contribution is playing into employer decision making and the ramifications of shifting health benefits to private exchanges.
• The differences between private exchanges and traditional "slice" business.
• The opportunities and threats that private exchanges present for insurers.
• The membership tradeoff for insurers — membership gain from previously closed relationships (such as an employer with another carrier) vs. potential loss of membership in exclusive employer relationships.
• How much revenue insurers can generate with the potential move of employers from self-insured to fully insured benefit plans.

Contact to learn more on how a PRIVATE EXCHANE will enhance you benefit package.

info@amsinsure.com

This week's health care reform news:

Enrollment verifications expected to reduce Exchange numbers

The administration is sending letters to more than 300,000 people warning that health coverage purchased through an exchange could be cut off unless eligibility issues, such as immigration status, are resolved. Similar eligibility follow‐ups are expected soon for reported income.

Preparing employers for 2015 health plan enrollment growth.

By Kathleen Koster

August 8, 2014

Open enrollment rates for employer-sponsored health plans in 2014 remained flat, but advisers and their employer clients are already putting strategies in place to prepare for expected growth in 2015 enrollments. 

Despite the Affordable Care Act’s requirement that individuals seek health insurance coverage in 2014 and the fact that employers are already preparing for the health reform law’s employer shared responsibility provision, open enrollment levels for employer-sponsored health plans remained mostly unchanged from 2013, new research from Mercer shows. On average, 69.3% of employees enrolled in employer-sponsored health plans in 2014, up only slightly from 69.1% in 2013.
In 2015, researchers expect there will be at least some growth; especially since the individual mandate penalty for obtaining coverage will be higher and more employers will open their plans to newly eligible employees under the ACA shared responsibility rules.
Benefit advisers have already begun to work with employers to put strategies in place to diminish the burden of increased health care costs an enrollment surge could bring.


Managing growth in eligibility
To manage a potential uptick in employees eligible for health coverage in 2015, 10% of employers will decrease the number of employees working 30+ hours per week by next year, the Mercer survey found. Another 14% are making additional adjustments to their workforce strategies.
The survey found retail and hospitality industries, which have a higher proportion of low-wage, part-time workers, are most concerned about higher enrollment in plans. These groups are followed by the higher education sector, in which adjunct professors make up a significant portion of the faculty, yet typically are not eligible for health benefits.
What’s more, employers are concerned about becoming “dependent magnets” and attracting additional dependents and spouses, as more employees become eligible for coverage and the individual mandate penalty stiffens. About 20% of employers said they would raise the employee contribution for dependent coverage in 2014.
To further curb the number of dependents on their plans in 2015, employers are considering special provisions for employees’ spouses who have other coverage available. Currently only one-fifth of employers have such a provision in place —12% require a surcharge and 8% exclude spouses with other coverage entirely. However, this practice may gain in popularity as many employers are considering it —16% considering a surcharge and 12% considering a spousal exclusion, the survey found.

Health care reform: Know the rules and penalties of the individual mandate

May 29, 2013
The individual mandate starts in January 2014 and is an important part of the Affordable Care Act. The individual mandate requires people legally living in the U.S. to buy a minimum amount of health coverage unless they are exempt. In general, people who don’t have to file taxes due to low income are exempt from the individual mandate.
But how does it work? And what are the penalties for people who don't get coverage?
How the individual mandate works
When your clients file their 2014 taxes in 2015, they’ll need to report whether or not they had health coverage in 2014. If they did have coverage, they will need to report if they qualified for a tax credit or subsidy. Health coverage includes a group plan, an individual plan, Medicare or Medicaid. If they don’t have health coverage, they could face a tax penalty. Each year, the penalty increases.
What are the tax penalties?
If a person doesn’t have a health plan, he or she will pay a tax penalty as follows:.

• 2014: Penalty is the larger amount - $95 or 1% of taxable earnings
• 2015: Penalty is the larger amount - $325 or 2% of taxable earnings
• 2016: Penalty is the larger amount - $695 or 2.5% of taxable earnings
 

What happens if your clients can’t pay for a plan?
Your clients may qualify for a tax credit through the exchange based on their incomes. People earning between 100% and 400% of the federal poverty level can qualify if they are not eligible for other sources of minimum essential coverage, including government-sponsored programs such as Medicare and Medicaid.
This includes:

• Individuals with modified adjusted gross incomes of $11,490 to $45,960 a year
• Families of four with modified adjusted gross incomes of $23,550 to $ 94,200 a year.

Your clients may qualify for cost-sharing subsidies based on their income. This includes:

• Individuals with modified adjusted gross incomes of $11,490 to $28,725 a year.
• Families of four with modified adjusted gross incomes of $23,500 to $58,875 a year.

HR Tip of the Month

HR Tip of the Month

Family Medical Leave Act (FMLA) allows employers to require employees to substitute vacation, sick or other paid leave for all or part of the 12 weeks of unpaid FMLA leave.

Employers Consider Expanding Voluntary Benefits

Critical illness insurance, identity theft coverage and financial counseling services are among the voluntary benefits companies are considering offering to employees, a recent survey found. Critical illness and accident insurance are increasingly seen as complementary to consumer-driven health plans and have driven voluntary sales over the past year, research shows. Employee Benefit News (8/4) read more

Study Shows Members Enrolled in CDHPs Experience Lower Health Care Costs

Today, the operator of Blue Cross and Blue Shield of Texas (BCBSTX) released the results of its annual Consumer Directed Health Plan (CDHP) study. The study shows that individuals enrolled in CDHPs continue to experience lower health care costs and take advantage of more preventive health measures, long after switching from their traditional insurance plans.

In fact, the study found that after switching from a traditional plan to a CDHP, members saw a three-year average reduction in:

• Medical expenses — decreased by 11.8 percent
• Overall spending, combined medical and pharmacy costs — decreased by 10.5 percent
• Inpatient care costs — decreased by 23.5 percent
• Outpatient care costs — decreased by 5.1 percent
• Professional services costs — decreased by 14 percent

IRS Publishes Form Drafts for New ACA Employer Reporting Requirement

Please note; check with your payroll or HR provider for information.

On Thursday, July 24, 2014, the IRS published highly anticipated drafts of the forms large employers with 50 or more full-time equivalent employees will be required to use for the Code 6056 reporting requirement.  Code 6056 requires applicable large employers to file a transmittal with the IRS (Form 1094-C) and provide a new return to employees (Form 1095-C) in January 2016 for the 2015 calendar year.  This reporting requirement has a triple purpose, as it is designed to allow the IRS to enforce the employer mandate, enforce the individual mandate, and confirm eligibility for premium tax credits for coverage purchased through an Exchange.

This reporting and disclosure requirement is new for employers and may catch some employers off-guard.  For example, the reporting requires collection and disclosure of information including, but not limited to, the following:

• Social Security numbers of employees, spouses and dependents;
• Names and EINs of other employers within the employer’s controlled group of corporations for each month of the calendar year;
• Number of full-time employees for each calendar month;
• Total number of employees (full-time equivalents) for each calendar month;
• Section 4980H transition relief indicators for each calendar month;
• Employee’s share of the lowest-cost monthly premium for self-only, minimum value coverage for each calendar month; and
• Applicable Section 4980H safe harbor for each calendar month.

Please note these forms are in draft form only and are subject to change. The IRS has not yet released instructions for the forms, which should provide the detail necessary to complete some of the more ambiguous cells in the forms. The first transmittal and returns will not be filed until January 2016, but much of the information must be reported for each calendar month of 2015. Ensuring internal time and attendance systems, record management, and payroll systems are capable of producing the required information is critical. Although there is much information left to be released by the IRS concerning the Code 6056 reporting requirement, employers subject to this requirement should begin preparing now.

More Patients Are Visiting Retail Clinics

Retail clinics are playing a growing role in health care delivery, according to a study from Walgreens. Patients are relying more on nurse practitioners at retail clinics to provide chronic and preventive health services. The study also reveals marked increases in the number of patients who are making return visits to clinics. Visits to healthcare clinics for preventive services, screening, and chronic care increased from 4% in 2007 to 17% in 2013. The annual percentage of return patient visits to Healthcare Clinic climbed from 15% in 2007 to more than 50% in 2012 and 2013. For patients age 17 and under, visits for preventive services and vaccinations increased 180% For patients ages 18 to 64, visits for health testing increased 90% while preventive health service visits increased 66%. Acute visits increased 84% for patients 65 and older. The Convenient Care Association estimates that 33% of Americans live within 10 minutes of a retail healthcare clinic. Walgreens has increased the variety of services at select Walgreens clinics from providing vaccinations to diagnosing and treating a number of chronic conditions. Clinics at select locations are open seven days a week, with extended evening and weekend hours, and offer walk-in service. Healthcare Clinics accept most major insurance plans and Medicare and Medicaid, and offer affordable, transparent pricing for those without insurance coverage. Healthcare Clinic’s board-certified nurse practitioners and physician assistants deliver patient-centric care, driving patient satisfaction rates that are consistently greater than 90%. For more information, visit www.walgreens.com.

Insurance Insider News:Insurance Insider News: Employees Unhappy with Benefits

by Leila Morris

When asked how they like their benefits, employees gave the lowest rating in six years, according to a survey from Unum. Only 47% say their benefits are excellent or very good. Only 33% say that the benefit education their employer provides is excellent or very good, and 28% say their benefit education is fair or poor. This is a reversal to the upward trend in ratings since 2009. Only 49% say their workplace is excellent or very good. Seventy-seven percent of workers who say their benefit package is excellent or very good also say the same of their employer. In contrast, only 17% of employees who say their benefit package is fair or poor also say that their workplace is excellent or very good. And 79% who say their employer’s benefit education is excellent or very good say the same of  their employer — compared to only 30% of those who say their benefit education is fair or poor. Bill Dalicandro, vice president of the consumer solutions group at Unum said, “This research underscores the value of an effective benefit education plan because when an employee understands their benefits, they tend to value them more and…may value their employers more for providing access to them.”

DOL limits employer contributions for medical FSAs

A recent technical release issued by the U.S. Department of Labor imposes severe dollar limits on employers wanting to make pre-tax contributions to the medical flexible spending accounts for eligible employees. READ MORE »

IRS Reiterates Prohibition of and Penalty for Pre-Tax Employer Reimbursement for Health Premiums

Recently, the IRS issued a Frequently Asked Questions (FAQ) list that reiterates earlier guidance disallowing pre-tax employer reimbursements for employee health care premiums. The FAQ also calls attention to the $100 per day, per employee penalty for non-compliance. The initial guidance from last fall indicated that pre-tax employer reimbursements for healthcare premiums would be categorized as group health plans and, thus, would not be permissible as they would not comply with the requirements for group health plans under the Affordable Care Act. Since that time, however, many people have attempted to find alternate solutions in order to continue the practice of reimbursing employee premiums in lieu of providing a full health plan. This latest FAQ and penalty announcement clarifies that the IRS is serious about disallowing this arrangement. We recommend that employers who still utilize a pre-tax health care premium reimbursement benefit discontinue this practice. Any advice that employers have heeded with regard to these benefits still being allowed, should be carefully reexamined in light of this most recent guidance and penalty reminder.

California Minimum Wage Increases July 1, 2014

Effective July 1, California will raise its minimum hourly wage from $8.00 to $9.00. The increase will also affect the minimum salary requirement for several categories of employees that are exempt from minimum wage and overtime requirements. The minimum salary of exempt executive, administrative and professional employees will increase to $3120.00 per month (twice the state minimum wage). Commissioned, inside sales employees’ minimum hourly rate will increase to $13.50 per hour (in order to maintain the one-and-a-half times minimum wage requirement for their exempt status).

We recommend that employers review the pay rates of both their non-exempt and exempt California employees to ensure that they are in compliance with the new minimum rates by July 1, 2014.

Five Ways health care spending can be curbed

Top Stories

5 ways health care spending can be curbed   Choosing Wisely is a national campaign, supported by several physician groups, business coalitions and Consumer Reports, to encourage physician and patient conversations about overuse and misuse of tests and procedures to help patients make smart care choices.Here are five situations where employers can encourage employees to have conversations with their physicians to ensure they choose care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm and truly necessary. READ MORE »

Health Care Reform with our HR platform

email us at info@amsinsure.com  , subject HR_ACA HR Demo    The Patient Protection and Affordable Care Act (PPACA) contains comprehensive health insurance reforms that require compliance by employer-sponsored group health plans. The material and links on this page is designed to help employers review their plan's compliance with the major health care reform requirements and to learn more about the topic. For even more information on Health Care Reform, please visit our library of trainings available for immediate viewing in the Training On-Demand section of the Training & Education tab above. Currently we have Health Care Reform trainings for small employers and large employers as well as a separate training all about the Employer Mandate. Please note that the lists on this page are for general reference purposes only and is not all-inclusive. These lists are also subject to change based on new government requirements or directives. If you have any questions regarding your company's obligations with respect to health care reform, please consult with an HR Professional or benefits insurance provider for specific guidance. Get our free HR platform and stay up to date and informed, its easy. info@amsinsure.com    subject   HR_ACA

Private health insurance exchanges gain traction with employers

Employers, others ditch old benefits model

For decades, the way employers offered health insurance coverage to their employees and retirees changed little. Now more and more companies are moving to a new health benefits delivery model using private health insurance exchanges.


Under the old model, employers, often with the assistance of consultants, brokers and agents, decided the insurers from which they would purchase coverage, the number and types of health plans they would offer employees, and how much they would contribute toward the cost of the coverage.
In addition, employers were deeply involved in plan administration, arranging and holding open enrollments for employees to choose one of the plans offered.


By contrast, with private insurance exchanges, employees and retirees select from a variety of health care plans and designs, with the employer's role largely limited to deciding how much of the premium it will pay.


While the move to private exchanges is not entirely new, there has been an accelerated shift in the past year, said Michael Thompson, a principal with PricewaterhouseCoopers L.L.P. in New York.
In the past few weeks, big and well-known industry-leading employers, including IBM Corp. and Walgreen Co., have disclosed that, starting next year, their employees or retirees will choose health care plans offered by insurers participating in private exchanges.


Rethink your companies choices and look to the Private Exchanges.

Those penalties can be stiff if you become a target of the IRS

The Internal Revenue Service has threatened employers with Affordable Care Act penalties of $36,500 per employee, per year, nondeductible. Makes those $2,000 and $3,000 penalties look like small potatoes, right?

The targets of this particular Q&A are employers who maintain “non-integrated” “employer payment plans.” These are new terms, which include reimbursement plans such as health reimbursement arrangements (HRAs, excluding retiree-only and excepted benefits HRAs). Those should generally have been eliminated by Jan. 1, 2014, or amended to be integrated with group health coverage.
The federal agencies dropped this bomb on employers on the cusp of open enrollment season last year, and many employers had to scramble into compliance. You could have done the math on the $100 per day excise tax. But the IRS puts this $36,500 figure into a Q&A for a reason: it wants to scare you. And employers need to know that a non-integrated employer payment plan is just one of many potential triggers of these potentially devastating excise taxes.


When I first blogged about health care plan self-audit, self-correction, and self-reporting compliance issues on Form 8928, no one seemed too interested. It’s time to get interested.


Caresani, a partner Porter Wright Morris & Arthur’s Cleveland/Akron, Ohio area, focuses her practice on employee benefits, ERISA and executive compensation. As editor of the firm’s employee benefits blog — Employee Benefits Law Report — and the ERISA preemption chapter of ERISA, A Comprehensive Guide (published by CCH), Caresani consistently reviews recent cases, legislation, regulations, and other employee benefits law developments and helps our clients understand how these changes may impact their organizations.

IRS Highlights Stiff Penalty for Reimbursing Individual Premiums

IRS Highlights Stiff Penalty for Reimbursing Individual Premiums