Healthy employees create competitive advantage
Originally posted September 24, 2013 by Emily Holbrook on https://www.lifehealthpro.com
It may come as no surprise to many that healthier employees are more productive employees, creating a competitive advantage for their employer. That's according to a recent study by Integrated Benefits Institute (IBI), a workforce health and productivity research and measurement organization.
The company studied 1,268 employees at 53 organizations and found that employees that work at companies with a strong commitment to a healthy workforce "spend more time working, work more carefully and concentrate better than employees at other organizations," according to the report.
“If a workplace sets a high priority on the health of employees — who, in turn, are healthier and have better job performance — then it can reasonably be said that an employer’s culture gives it a competitive advantage. Workplace culture reflects the priorities of company leadership and is an area where employers have some leverage to improve business performance,” stated IBI research director Kimberly Jinnett, PhD, the main author of the report.
The study also found:
- Not careful at work: Workers in an organization with a weak health culture reported not being careful at work “all” or “most of the time” more than three times more frequently than those who work in organizations with a strong health culture.
- Not working as often: 44 percent more employees who work in an organization with a weak health culture reported not working as often as they should have “all” or “most of the time” as compared with employees in organizations with a strong health culture.
- Not concentrating: 31 percent more employees who work in companies with a weak health culture reported they did not concentrate “all” or “most of the time,” compared with employees in organizations with a strong health culture.
- Getting less work done: There was no difference in the responses from those in a strong versus a weak health culture with regard to getting less work done — but employee health is a differentiating factor. Emotional distress and overall health strongly influence how much an employee accomplishes, and employees in organizations with a weak health culture have worse outcomes on both measures.
IBI President Dr. Thomas Parry said "as more employers recognize that health influences productivity, as well as health care costs, health outcomes such as absence, disability and presenteeism are being brought into the larger discussion of the business cost of poor health."
Of course, this is not the first time that research has shown the connection between poor employer health culture and employee ailments (and therefore, productivity) and it won't be the last. According to IBI, employers that wish to increase their focus on health-related job performance and its impact on the bottom line "should broaden their view from the individual health of employees to additional organizational factors, including health culture and employee well-being."
Companies are, albeit slowly, starting to see the link between employee well-being and productivity.
HR align benefits with business objectives
Originally posted September 24, 2013 by Jennifer Paterson on https://www.employeebenefits.co.uk
Reward and HR professionals are taking steps to ensure that the benefits they offer support the objectives of their organisation, according to research by the Chartered Institute of Personnel and Development (CIPD).
Its Aligning strategy and benefits survey, which is based on responses from 444 organisations, found there is also a strong correlation between workplace outcomes and transparency in employee benefits.
Organizations that prefer to be more transparent about their benefits schemes are more likely to have good employee relations, increased productivity rates, lower absenteeism, good employee retention and low pay discontent.
The research also found that, where respondents’ workforce comprised mostly graduates, there is a higher level of membership in defined contribution pension plans.
Charles Cotton (pictured), reward adviser at the CIPD, said: “HR professionals continually have to ensure that the reward provisions they offer in the workplace are in keeping with the shifting nature of work, and are aligned to both the needs of business and employees and integrated with other aspects of people management strategy.
“Failure to do so will result in inappropriate achievements, skills and behaviours being rewarded and recognised.
“What our research helps to illustrate is that HR [professionals] are not adopting benefits for the sake of it, but are choosing those that match what the firm is trying to achieve. It also shows the impact that employee benefits can have in the workplace in terms of employee retention, absence, productivity and relations.”
Bike and health expert advocates collaborative approach to wellness
Originally posted September 25, 2013 by Kathleen Koster on https://ebn.benefitnews.com
The workplace strategy for health improvement is easily expressed as a bicycling metaphor where bicyclists struggle with the uphill stretches and use caution to coast on downward slopes. Gary Earl, former vice president of benefits and health care for Caesars Entertainment Corporation, suggested employers could learn from the biking world when improving their wellness strategy, speaking during a panel discussion at the Benefits Forum & Expo in New Orleans on Monday.
“Our job [as HR professionals] is to improve the lives of human beings. We’re responsible for that,” explained Earl, founder and team captain of Journey for Health Tour, for which Earl and his team are riding a bicycle 3,000 miles across America to promote health improvement.
While working for Caesars, Earl transformed the company’s outlook on wellness programs and health benefits from a cost-only perspective to an asset for the workforce and business.
“[My employer’s] vision was the traditional vision: to offer affordable benefit plans to employees and to reduce costs. We turned that upside down. We wanted to move it from an expense to an asset,” he said.
He created an affordable equation to prove his strategy would improve the population’s health by developing a mathematic equation to show company executives the value in this paradigm shift.
That equation illustrated how employees’ positive health experience and positive attitude generates an increase in productivity, sustainability and satisfaction, which would lead to an improvement in company earnings.
“We have to look at health benefits as an opportunity, an asset,” Earl stressed.
Earl believes HR and benefits professionals need to hold themselves accountable to improving population health and always passionately advocate wellness—not simply view this responsibility as part of a dry job description.
Over time, we have created the problems afflicting our health system and it’s our responsibility as a community to fix today’s prevalent issues, said Dr. David Whitehouse, MD, chief medical officer, UST GLOBAL, a fellow panelist at the conference session.
“The ecosystem of health and the obesity endemic exist because of modernization. During World War II there were food shortages and we developed preservatives [to make our food last longer]. We then wanted to make our lives more convenient, so we developed transport and we stopped exercising and walking. We have, in fact, through modernization and our own design for comfort, created the epidemic,” said Whitehouse.
Earl seconded that point, adding that these health issues “can’t be viewed in isolation. They are systematic problems, which means that they are interconnected and interrelated. We need to approach this by connecting all aspects of the community, whether it’s faith, safety, education, business or economic development—there’s a real balance to be able to draw them all together.”
He added that business owners could drive this change. “They don’t own that change but they can be a catalyst. By coming together in uncommon ways but for a common purpose stimulates the change,” he said.
Employers and company leaders must connect with communities to make significant change. Applying the bike metaphor again, Earl said that we need to encourage each other when facing uphill challenges and learn from one another to find solutions. And for those downhill stretches, Earl explained that in biking, “you don’t ever coast downhill; you want to keep that leg-mind momentum going.” Employers must also use caution to stay in control of their initiatives and keep forward momentum, without swerving off the edge of the road.
“You’re not going to improve an individual’s health without understanding what those social and environmental elements are,” Earl said. “You have to put in the energy.”
Employers can align medical groups and local systems by working with the community. They can make a customized approach through patient-centered medical homes, on-site clinics or Accountable Care Organizations. Whatever employers develop with their local groups, they must work together to fix the dramatic health issues Americans face and struggle with.
“If we don’t overcome our shyness and work collaboratively then we will live with the misfortunes of our unintended consequences,” said Whitehouse.
Health Q&A: ‘Obamacare’ Exchanges Start as Questions Abound
Originally posted September 30, 2013 by Alex Nussbaum on https://eba.benefitnews.com
Just don’t expect the usual ending to an election: a clear winner at the end of the day.
While the exchanges are expected to open on time, that milestone is unlikely to settle the 3 1/2-year grudge match over the Affordable Care Act. A long enrollment season, complicated by a threatened U.S. government shutdown and a growing list of technical glitches, means it may be as late as April before it’s known how many uninsured Americans sign up under the law.
While the shutdown won’t stop the roll-out, which is largely funded through mandatory appropriations that can’t be curtailed by congressional inaction, it’s an open question whether it will lessen public enthusiasm to enroll. In the meantime, technical glitches are beginning to surface.
People in Oregon, for example, won’t be able to enroll in a plan for the first few weeks unless they go through a broker or designated nonprofit groups, and the exchange in the nation’s capital won’t include premium prices until mid-November.
The Obama administration says other glitches are inevitable as the system starts up. The question is how serious and how long it takes the exchange to fix any issues. An extended crash or a problem calculating subsidies could be an embarrassment for the White House -- and sour consumers just as the administration tries to convince them to enroll.
‘In Between’
“Is it going to be a train wreck, a complete failure? The answer is no,” said Dan Schuyler, a director at Leavitt Partners, a Salt Lake City-based health care consultant. “Is it going to be completely seamless and instantaneous? No. It is going to be somewhere in between.”
The exchanges are at the heart of the law’s efforts to cover more of the 48 million uninsured Americans. About 7 million people will use the system to buy subsidized insurance by the end of the first open enrollment period on March 31, according to congressional projections.
Republicans will spotlight any problem as proof the law is a disaster. Democrats say they’ll overcome technical glitches and the law will sell itself as the uninsured gain benefits. Polls show most Americans side with the skeptics.
“The lights will go on Oct. 1, but they may flicker,” said Jocelyn Guyer, a director at the Washington-based consultant Manatt Health Solutions. “I worry the most about people making premature judgments on the first couple of weeks.”
The Breakdown
Here’s a primer on what to look for, based on interviews with consultants, insurers, analysts and state and federal officials:
Q: Who runs the exchanges?
A: Fourteen states have their own on-line exchanges, with the rest run in whole or part by the U.S. government.
Q: Who will use them?
A: The exchanges are open to people who buy coverage on their own and employees of businesses with 50 or fewer workers, as well as those currently shut out of insurance because of cost or a medical condition.
Subsidies are available, on a sliding scale, to those making as much as four times the poverty level, which is $11,500 for a single person and $24,000 for a family of four. Those making less than 138% of poverty will be eligible for Medicaid if they live in one of the 26 states set to expand the program.
Sign-Up Numbers
Q: How many people will sign up early on?
A: Call it lowering expectations or a realistic assessment: either way, supporters say they don’t expect a flood of enrollees this week.
Insurance buyers have to pay their first month’s premium within 30 days of choosing a plan and the policies don’t take effect until Jan. 1. As a result, the Obama administration says most people will wait until late November or December. Another surge may come in March as the end of the enrollment period nears.
A: The exchanges will march on. That’s because the 2010 law relies primarily on mandatory spending, which congressional inaction can’t stop. It’s the budget category used for benefits such as Medicare, the U.S. health plan for the elderly and disabled, and Social Security.
The U.S. Health and Human Services Department said in a Sept. 27 memo it “would continue large portions of ACA activities, including coordination between Medicaid and the marketplace” in the event of a temporary shutdown.
Core Unaffected
“Many of the core parts of the health-care law are funded through mandatory appropriations and wouldn’t be affected,” Gary Cohen, the director of the Center for Consumer Information and Insurance Oversight at HHS, told reporters on Sept. 24.
Q: Okay, so most of the exchanges will be up and running on time. How do you access them?
A: If all goes as planned, those not covered through work will be able to go on line or dial a call-in center, learn if they’re eligible for tax credits and choose from a menu of private plans. The exchanges can be found atwww.healthcare.gov.
Q: Who won’t use them?
A: Most of us. People who have insurance through their jobs, about 55% of Americans, aren’t directly affected by the law and are automatically in compliance with its mandate that everyone be insured. So are older Americans covered through Medicare.
Individual Mandate
Q: Do I have to buy insurance?
A: Yes, or pay a fine. The law requires that most Americans be insured starting Jan. 1. That can be through work, a government program like Medicare or Medicaid, or by buying on the exchanges. Those who opt out face a penalty starting next year at $95 or 1% of household income, whichever is higher. By 2016, it rises to $695 per individual or 2.5% of household income, whichever is greater.
Q: Is the technology for the exchanges in place?
A: Building the exchanges has been a massive technical lift, requiring computer systems with real-time links to dozens of state and U.S. agencies and private carriers. The administration says the system is ready to go, albeit with delays and reduced capabilities in places like Oregon and Washington.
Company Mandate
Q: Has anything else been delayed?
A: The law requires that large companies offer benefits to anyone working more than 30 hours a week. In July, that rule was postponed until 2015 to ease the burden of compliance.
Last week, officials said a Spanish-language version of the federal website won’t be ready until mid-October and an exchange for small business workers won’t take enrollments until November. Nevada and California also won’t transmit names of new customers to insurers for about a month, Schuyler said.
Q: Will the coverage be affordable?
A: It depends on who you are and where you live. Six in 10 uninsured people will find insurance for less than $100 a month because of subsidies and expansions to Medicaid, the administration said last week. Those who make too much for assistance may be in for sticker shock: the same report said even bare-bones coverage, known as a bronze plan, will average almost $3,000 a year for individuals.
For families, the cost of mid-level coverage, a silver plan, ranges from $559 a month to $1,216 a month in 36 states where the federal government controls the exchanges. Tax credits will reduce the cost for many: a family earning $50,000 a year may find the price of a bronze plan cut to zero in some states.
Young and Healthy
Q: How will insurers cover the costs for all those added sick people?
A: By signing up the young and healthy. The administration said it needs about 40% of new enrollees to be in this group to help balance costs from older, sicker customers and keep premiums stable.
A: No. The polls indicate consistent confusion. Three in five say the law will raise medical costs, and more say they’ll be worse off under it than better, according to a Bloomberg National Poll conducted Sept. 20-23. Half also said Republicans should back off on demands to defund the law, a schizophrenic view that’s persisted for months.
Q: So does anybody like this law?
A: Yes. Sixty-one percent of Hispanics and 91% of blacks, according to a September poll by the Pew Research Center and USA Today. That could make the sales pitch easier because those two groups comprise the bulk of the uninsured in the U.S. – 47% of the total, according to an analysis by the Kaiser Family Foundation. The law also is designed to benefit people with pre-existing medical conditions: insurers will no longer be able to deny them coverage.
Big States
Q: What’s happening in the big states?
A: Supporters have focused on states such as Texas, Florida, Ohio and New Jersey, where many uninsured live and Republican governors refuse to help in enrollment. California, which has the most uninsured, is spending $100 million to promote its exchange while New York plans to spend $27 million to train community groups and brokers to assist consumers.
Q: How much help do consumers get?
A: The administration is spending $67 million to train health workers, hospitals and other groups, called navigators, to help people enroll. Grants didn’t arrive until August, though, and many began a two-week training course this month. If they’re not up to the task, enrollment may suffer.
“You’re going to have tens of thousands if not hundreds of thousands of individuals who have never been exposed to health insurance before -- don’t know what a premium is, what a deductible is,” said Schuyler, the Leavitt Partners consultant.
Changes Needed
Q: Do Democrats think the law needs to change?
A: Some have called for changes: Families of workers whose company plan doesn’t include dependents can’t get subsidies. A tax credit for small businesses has been criticized as ineffective. And there are bipartisan bills in Congress to change a provision that may encourage businesses to cut workers’ hours to avoid insuring them. A quick fix seems unlikely: Republicans say they won’t tinker with a law they consider fundamentally flawed.
Q: What’s happening with Medicaid?
A: While the government health program for low-income Americans is expanding under the law, about half the states have opted out. The Obama administration last week agreed to let Arkansas use the money to help poor citizens buy private insurance on its exchange. The deal could entice other states where Republicans have opposed the expansion.
Expense Rising
Q: Is Obamacare making health-care more expensive?
A: Time will tell.
Medical costs have moderated in the U.S. the past three years, offering some relief to the public and private sectors alike. Prices for medical care rose 1% in July compared with a year earlier, the lowest growth rate since the 1960s, according to U.S. Commerce Department data.
There’s a debate among economists about how much credit to give the health law compared with a weak economy and employer moves to curtail benefits. Obamacare supporters say at least some of the slowdown is thanks to regulations and pilot programs in the act aimed at reducing waste in the medical system.
13 things employers must do to be PPACA-ready
Originally posted September 25, 2013 by Dan Cook on https://www.benefitspro.com
Uncertainty over the impact of health care reform on their businesses has created plenty of anxiety among HR managers and those in the C-Suite.
A recent survey by ADP found almost half of large-company finance managers aren’t fully confident that they understand their responsibilities under the Patient Protection and Affordable Care Act. At small companies, the study found, just 28 percent of those surveyed have developed any sort of plan for controlling their health benefits costs in the wake of health care reform. At large companies, that percent rose to 40 percent — still not very confidence-inspiring.
Executives know reform is going to rock their boat. When asked by ADP whether they thought the public insurance exchanges would have an impact on their company, half of small company respondents thought it would, while nearly 70 percent of large companies responded affirmatively.
To help employers get a better handle on the act’s requirements, ADP has come up with following recommendations for coping with health care reform.
EVALUATE
1. Know the requirements and deadlines:Don’t wallow in fears that are groundless with respect to your company. ADP says you should “invest the time and resources needed to clearly comprehend the act’s legal requirements and time frames in order to accommodate its tax implications and avoid penalties for non-compliance.” Establish a timeline with key milestones to help guide your process.
2. Determine administrative impact on your company: How will oversight of changes mandated by the PPACA increase administrative burden? “A prime example of an ACA provision with potentially large administrative impact is Shared Responsibility. Beginning in 2015, it requires tracking each employee’s full-time or part-time status every month, and maintaining that information as part of employee tax records.” Those kinds of requirements will clearly add to HR’s tasks, and may require additional manpower, at least while systems are being set up.
3. Calculate financial implications: There are myriad ways the mandated healthcare changes, reporting requirements, additional taxes, etc., will affect your cost of doing business. Coverage mandates for your benefits plan design, as well as reform-related taxes and fees, must all be taken into consideration. Over-budget for the short term at least.
EDUCATE
4. Create a written summary of benefits and coverage for employees: This is a four-page (or less) summary of your plan you must provide your employees with. It must be clearly written. Make sure you obtain acknowledgement of receipt of the SBC from employees.
5. Notify your employees of public exchanges: This is the notification of insurance options due Oct. 1. Is this required? Yes. Will you be fined if you don’t do it? Maybe not. Do it anyway. It’s a great way to communicate with your workers.
ENROLL
Sign ’em up: If you have at least 50 full-time employees, you have to offer them affordable health coverage. Make sure you offer the opportunity to enroll to all eligibles. Then develop a system to track, update and report on employee eligibility and enrollment to maintain ongoing compliance.
7. Enroll employees’ dependents: The law requires employers to offer coverage to qualifying dependent children of full-time employees up to age 26. You may also want to consider conducting a dependent eligibility audit, which typically show as many as 15 percent of dependents claimed by employees are not qualified for benefits.
8. Prepare for automatic enrollment: Employers with 200+ full-time employees will soon face new rules for enrolling new employees in the company’s group health plan. If you haven’t already, you’ll need to start thinking about solutions to address this requirement.
9. Assess your exchange/coverage options: Employers will generally choose from three different plan approaches for covering their employees – employer-sponsored plans, private exchanges and the new public exchanges created under the act. You’ll need to determine which works best for you, from both a financial and employee recruiting/retention standpoint.
EXECUTE
10 Get ready to define and track full-time and part-time employees: The act requires this tracking — it’s the basis for many calculations that are coming down the pike. Start tracking now so you won’t have to go back and try to recreate the data later.
11. Offer an employee wellness program: An earlier ADP study showed wellness programs are an increasingly popular strategy for offsetting the expense of healthcare – without passing on additional costs to employees.
12. Get a grip on your medical loss ratio rebates: These are sent to employers from their insurance carrier whenever health insurers do not spend at least a certain percentage of the prior year’s health insurance premiums on healthcare services. If you receive MLR rebate dollars, the plan must make a fiduciary decision about using the dough. A best practice is to communicate to your employees your intention as to how the MLR rebate will be used.
13. Limit employee flexible spending accounts (FSAs): Prior to the enactment of the act, the IRS permitted employers to determine the maximum amount an employee could set aside tax-free in a Flexible Spending Account. Going forward, you will need to enforce a $2,500 annual limit on all employee healthcare FSA contributions.
How much will Obamacare premiums cost? Depends on where you live
Originally posted September 25, 2013 by Sandhya Somashekhar and Sarah Kliff on https://www.washingtonpost.com
A 27-year-old in Austin who earns $25,000 could pay $85 per month for health insurance next year, and a family of four in St. Louis with income of $50,000 might face a $32 monthly premium, according to new federal data on health insurance rates under the Affordable Care Act.
The report, released Wednesday by the Department of Health and Human Services, showed significant variation in the insurance premiums that Americans shopping on the individual market could pay under the president’s health-care overhaul. Across the 48 states for which data were available, the unsubsidized monthly premiums could be as low as $70 for an individual and as high as $1,200 for a moderate plan for a family of four.
The average national premium for an individual policy will be $328 in 2014, before including any of the tax credits that will be available to low- and middle-income Americans to help them purchase coverage.
Officials say these prices will be affordable for people buying insurance through the government marketplaces slated to open next week.
“For millions of Americans, these new options will finally make health insurance work within their budgets,” Health and Human Services Secretary Kathleen Sebelius said.
Information about how much insurance plans will cost under the law, sometimes called Obamacare, has been dribbling out for months on a state-by-state basis.
But the report from the administration, which has been collecting rate information since the spring, offers the first comprehensive look at the effect of the law on many Americans — specifically those who buy coverage privately and not through their employers, as well as low-income uninsured people who are not poor enough to qualify for Medicaid.
Beginning Tuesday, those people will be able to log on to government Web sites called marketplaces to peruse their plan options, apply for government subsidies and sign up for coverage effective next year. That is when the requirement kicks in that virtually every American carry health insurance or face a fine.
The report also includes information for more than two dozen states that declined to set up their own marketplaces, leaving at least part of the job up to the federal government.
Premiums will vary significantly depending on an individual’s income, where she lives and what type of coverage she buys. A 27-year-old in Fairfax County, for example, could spend between $124 and $258 on a health plan, depending on how robust she wants it to be.
A family of four in Fairfax County that earns $50,000 could get a health insurance plan with no premium at all, because the federal tax credit would cover the bill.
Most people using the marketplaces will have incomes low enough to qualify for a government subsidy. A recent administration report found that 56 percent of the roughly 41 million uninsured people eligible for the marketplaces could pay monthly premiums of $100 or less.
Health experts say it is a good sign for consumers that premiums have come in lower than expected. Under the law, the plans must offer a basic set of benefits, including mental health and maternity care, which previously were not included in many private plans. Insurers are also forbidden from rejecting or charging people more because of preexisting conditions.
Many experts worried that those factors would drive up the cost of insurance. They partially credit competition on the marketplaces, where people will be able to directly compare plans from different insurance companies, for restraining premiums.
But they warn that premiums don’t tell the whole story.
The low rates are possible in part because insurance companies created special plans that include fewer in-network doctors and hospitals than many current plans.
This may not be a problem for healthy people who currently lack insurance. But those with illnesses may discover that their specialists are not covered by an exchange insurance plan. Low-income people accustomed to a certain community clinic may find that going there is no longer an option. And everyone may encounter long waits to see a doctor.
In addition, many of the lowest-cost plans may carry high deductibles, despite a cap imposed by the law that limits out-of-pocket costs to $6,350 per person per year.
“Despite the fact that the premiums are lower than expected, enrollees on exchanges are likely to face very high out-of-pocket costs before they hit their cap, and they are at risk of being in very narrow network plans that may or may not include all the providers they need access to,” said Caroline Pearson, vice president of health reform at the consulting firm Avalere Health, which did its own report on rates this month.
Some healthy people may also experience sticker shock on premiums. A recent analysis by the Manhattan Institute, a conservative think tank, found that some people who buy low-cost private plans today could see their rates jump by 24 percent.
What happens on Oct. 2?
Originally posted September 18, 2013 on https://ebn.benefitnews.com
Will you be ready for the day after the Affordable Care Act’s public exchanges go live?
At 2 p.m. ET on Oct. 2, EBN and EBA will offer a web seminar on issues relating to ACA implementation and what they mean for employers – whether or not they plan having their workers participate in ACA marketplaces. Hosted by SourceMedia’s Employee Benefit News Group Editorial Director David Albertson, the webinar will include speakers such as Rodger Bayne, president of the Benefit Indemnity Corporation.
Topics of the hour-long, real-time seminar are set to include updates on the functionality of state and federal exchanges, the mandate that employers educate on health care marketplaces, the union push for qualified health plans and enrollment in individual and small business exchanges. The web event is designed for businesses of all sizes, as well as the brokers, advisers and third parties who consult and assist them.
Americans at large remain demonstrably confused over ACA and its applications; wise plan sponsors will use benefits communication to stay ahead of the curve on employee inquiries. Any further delays of ACA mandates will also be discussed.
HHS delays SHOP Web enrollment launch
Originally posted September 26, 2013 by Allison Bell on https://www.lifehealthpro.com
The U.S. Department of Health Human Services (HHS) is pushing the launch of the federal small-group public exchange Web enrollment system back to November.
The delay in the Small Business Health Options Program (SHOP) online enrollment system start affects only the states in which HHS will be running federally facilitated exchanges (FFEs).
States that are running their own state-based exchanges can still get their Web-based SHOP enrollment systems going Oct. 1, the official launch date for the new Patient Protection and Affordable Care Act (PPACA) public health insurance exchange system.
The delay will also have no direct effect on the FFE individual exchange program.
Reuters is reporting that Obama administration officials told it that small employers in FFE states will still be able to enroll in SHOP plans Oct. 1 by filling out paper forms or calling an FFE call center.
John Greene, a vice president at the National Association of Health Underwriters, said his group has learned that agents and brokers will be able to sell SHOP plans Oct. 1.
“It won’t be an electronic train,” Greene said. “It will be a little horse and buggy. But they can still get it done.”
Having the ability to start the SHOP enrollment process before the federal exchange Web enrollment system could help brokers get an edge over that system in the SHOP market.
The initial exchange enrollment rules call for employers to make payments by Dec. 15 to have coverage take effect Jan. 1.
The SHOP will be open to employers with 50 or fewer full-time employees. Some small employers that sign up for coverage through the SHOP and have relatively modestly paid employees can qualify for temporary small-group health insurance tax credits. The Congressional Budget Office has predicted that the SHOP program will be much smaller than the individual exchange program and may attract employers with only a few million employees.
The initial exchange enrollment rules call for employers to make payments by Dec. 15 to have coverage take effect Jan. 1.
The SHOP will be open to employers with 50 or fewer full-time employees. Some small employers that sign up for coverage through the SHOP and have relatively modestly paid employees can qualify for temporary small-group health insurance tax credits.
HHS is saying that it will open a call center aimed specifically at small employers Oct. 1. Employers can call the center at (800) 706-7893 from 9 a.m. to 7 p.m. EST.
HHS also is working with the Small Business Administration to organize SHOP webinars.
About 40,000 agents and brokers have been trained to sell SHOP coverage, HHS says.
How the Affordable Care Act affects your 2013 tax returns
Originally posted September 16, 2013 by Roger Prince on https://www.mainebiz.biz
As Affordable Care Act deadlines approach, most of the discussion heard on the street concerns the individual health insurance mandate and the expected opening of the state and federal insurance marketplaces this fall. Lost in the shuffle are the tax increases related to the ACA. Most of these changes impact high earners, but thresholds differ depending upon the tax provision in question. For anyone in the affected income categories — and there are many in Maine — the increases are significant.
Which taxpayers will be affected?
The accompanying chart outlines some of the important tax increases imposed as a result of the ACA and more recent legislation. The increases generally affect single filers with an adjusted gross income (AGI) above $200,000 and married couples filing jointly above $250,000. Some of the tax increases don't kick in until single AGI hits $400,000 and married filing jointly AGI hits $450,000.
How to mitigate the impact
As with any increase in marginal tax rates, a focus on income deferral and upfront tax planning can help soften the blow by reducing the amount of income that qualifies for the new tax rates. There are a number of strategies for income deferral, some of them employer-initiated and some handled by the individual. For example, employers might decide to redesign their 401(k) or 403(b) plans to provide for greater employer non-elective contributions (such as profit-sharing allocations) for certain types or groups of employees. A company might also decide to offer deferred compensation as part of an incentive program using so-called "synthetic" equity tools such as Phantom Stock or Stock Appreciation Rights. In these forms of compensation, the benefit is tied in various ways to the value of hypothetical shares of stock set to be paid out on a specified later date.
Individuals can defer or eliminate taxes in a higher-tax environment with various retirement savings strategies as well as tax-effective investment strategies. Individuals should get advice from both investment advisers and tax professionals to make sure their investment strategies coincide with a prudent tax strategy. The key is to be sure that the current income and investment structure maximizes the after-tax return.
Changes in the medical expense deduction
Regardless of income level, the unreimbursed medical expense deduction will now be available only for those medical expenses in excess of 10% of AGI, compared to 7.5% before. There is a temporary exemption from this requirement for individuals ages 65 and older and their spouses from 2013 through 2016. Individuals and their spouses who are 65 years or older are still allowed to deduct unreimbursed medical care expenses that exceed 7.5% of their AGI.
Other ACA steps
Employers have other compliance steps and opportunities under the ACA for this tax year. Among them:
- Employers that have employees who earn more than $200,000 will have to look at the potential for additional Medicare withholding.
- Employers that issued 250 or more W-2 forms in 2012 must report the cost of employer-sponsored health coverage for 2013 on the 2013 W-2 forms.
- Small employers (those with 25 or fewer full-time equivalent employees) that offer group health insurance might be eligible for the small business health care tax credit. The credit can be as much as 35% of employer premiums (25% for not-for-profits.) The maximum credit will increase to 50% in 2014 (35% for not-for-profits.) The credit is only available if the employer is paying at least 50% of the total premiums.
As always, everyone's particular tax situation is different. It is safe to say that tax planning for 2013 and thereafter will be more important than ever given the potential loss of tax adjustments and higher marginal tax rates imposed by the ACA and more recent legislation.
HHS releases federal exchange rates
Originally posted by Allison Bell on September 25, 2013 on https://www.benefitspro.com
With the public exchanges under the Patient Protection and Affordable Care Act preparing to open their phone lines and their Web enrollment sites Tuesday, the Obama administration is getting closer to revealing what federal exchange plans might actually cost.
A health policy office at the U.S. Department of Health and Human Services on Wednesday released a report showing what the average starting price for individual bronze, silver, gold and catastrophic exchange coverage will be for a 27-year-old in each state in which HHS will be running a "federally facilitated exchange."
The report also shows what the starting price for each level of individual coverage will be in the biggest city in each FFE state; what a 27-year-old individual coverage buyer with an annual income of $25,000 and access to exchange tax credits would pay for the lowest-cost coverage out of pocket; and what a family of four with an annual income of $50,000 would payout-of-pocket if it did or did not have access to the tax credits.
In Texas, for example, the average cost of the cheapest bronze coverage available to a 27-year-old would be $139 per month. The average cost of the cheapest gold coverage available would be $225 per month.
In Houston, the state's largest city, bronze coverage for the 27-year-old would start at $138 per month.
A look at medically underwritten 2013 rates available from eHealthInsurance.com for a 27-year-old who lives in Houston suggests that typical carriers there would now charge that consumer about $100 to $300 for coverage per month, with a majority charging $100 to $200 per month.
The family of four might have to pay $727 per month for silver coverage if it had no tax credits. Tax credits could cut the monthly cost of the coverage to $282.
Vermont posted preliminary exchange rates in April, and State Refor(u)m has posted a map showing that 27 states and the District of Columbia had at least posted preliminary rates for their state-based or federally facilitated exchanges as of Monday.
HHS — the parent of the Centers for Medicare & Medicaid Services, the agency running the exchanges — has repeatedly postponed the release date for FFE rate information without explaining why.
Some states have used state public records laws to justify releasing FFE exchange plan information on their own.
Other states, including Texas, have treated the FFE plan rates as confidential information.
HHS officials said the cost of the "second lowest cost silver plan" in the District of Columbia and 47 states is 16 percent lower than what HHS had expected, based on Congressional Budget Office projections.
HHS Secretary Kathleen Sebelius said in a statement that high prices have shut many consumers out of the health insurance market in the past.
"We excited to see that rates in the marketplace are even lower than originally projected," Sebelius said.