Number Of Uninsured Falls Again In 2015
Interesting article from Kaiser Health News about decreasing uninsured rates by Julie Rovner
The federal health overhaul may still be experiencing implementation problems. But new federal data show it is achieving its main goal — to increase the number of Americans with health insurance coverage.
According to the annual report on health insurance coverage from the Census Bureau, the uninsured rate dropped to 9.1 percent, down from 10.4 percent in 2014. The number of Americans without insurance also dropped, to 29 million from 33 million the year before.
The Census numbers are considered the gold standard for tracking who has insurance and who does not, because its survey samples are so large. It does change methodology from time to time, however (most recently in 2013), so years-long comparisons are not necessarily accurate.
Still, between 2013 and 2015, the first two full years the health law was in effect, the uninsured rate dropped by more than 4 percentage points. The total number of uninsured fell by 12.8 million. Meanwhile, the percentage of Americans with insurance for at least some part of the year climbed to 90.9 percent, by far the highest in recent memory.
“I don’t remember it ever being in the 90s before,” said Paul Fronstin of the Employee Benefit Research Institute, who has been tracking insurance statistics since the early 1990s.
The Obama administration was quick to take credit for the insurance improvements. “The cumulative coverage gains since 2013 have put the uninsured rate at its lowest level ever,” said members of the White House Council of Economic Advisers in a statement.
The 2015 report shows insurance gains across all income levels, ages and types of employment, although some groups did better than others. Young adults — specifically 26-year-olds — remain the most likely to lack coverage. Although the Affordable Care Act guaranteed that young adults could stay on their parents’ plans longer than in the past, that protection ends when they turn 26.
Among states, those that took the health law’s option to expand the Medicaid program for the poor saw greater gains in coverage than those that did not. “The overall decrease in the uninsured rate of 2.4 percentage points in expansion states, compared with 2.1 percentage points in no-expansion states,” said the report. The state with the highest percentage of uninsured residents remained Texas at 17.1 percent; the state with the fewest uninsured remained Massachusetts with an uninsurance rate of 2.8 percent.
The single largest source of health insurance remains plans provided by employers. An estimated 177.5 million Americans had employment-based coverage in 2015, which was up more than 3 million from 2013.
See the original article Here.
Source:
Rovner, J. (2016 September 13). Number of uninsured falls again in 2015. [Web blog post]. Retrieved from address https://khn.org/news/number-of-uninsured-falls-again-in-2015/
2016 Draft Forms & Instructions Released: Affordable Care Act Reporting Update
Great feature from The National Law Review by Damian A. Myers,
Since our last ACA Reporting Update, the extended deadlines to distribute Forms 1095-B and 1095-C to covered individuals and employees and to file the forms with the IRS have passed. The IRS has stated, however, that late forms can still be submitted via electronic filing and the forms that received an error message should be corrected. By many accounts, the first ACA reporting season presented numerous challenges. From collecting large amounts of data to compiling the forms, to working with service providers that faced their own unique challenges, to facing form rejections and error notifications from an inadequate IRS electronic filing system, employers and coverage providers faced obstacles nearly every step of the way. Nevertheless, most employers and coverage providers were able to get the forms filed and put the 2015 ACA reporting season behind them.
But, alas, there is no rest for the weary. In late-July, the IRS released new draft 2016 Forms 1094-B and 1095-B (the “B-Series” Forms) and Forms 1094-C and 1095-C (the “C-Series” Forms). Additionally, on August 1, the IRS released draft instructions to the C-Series Forms (as of the date of this blog, draft instructions for the B-Series Forms have not been released). For the most part, the 2016 ACA reporting requirements are similar to the 2015 requirements, subject to various revisions described below.
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Various changes have been made to the forms and instructions to reflect that certain forms of transition relief are no longer applicable. For example, the non-calendar year transition relief (for plan years starting in 2014) that applied in 2015 does not apply in 2016. Similarly, changes have been made to reflect that the “Section 4980H Transition Relief” is still relevant only for non-calendar year plans though the end of the plan year ending in 2016. The Section 4980H Transition Relief exempts applicable large employers (“ALEs”) with 50-99 full-time employees from penalties under Section 4980H of the Internal Revenue Code (the “Code”) and reduces the 95% threshold to 70% for other ALEs. The relief also exempts ALEs from having to offer coverage to dependents if certain requirements are met. For calendar year plans, the threshold is at 95% throughout 2016 and dependent coverage must be offered during each month of the year.
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The draft instructions to the C-Series Forms provide more detail and examples on how ALEs should prepare the forms. Instead of referring to “employers” throughout the instructions, the IRS has replaced that term in most cases with “ALE Member.” The reason for this change is to highlight the fact that each separate ALE Member must file its own forms. Examples related to completing the authoritative Form 1094-C highlight that each separate entity (determined based on employer identification number) is required to file its own authoritative Form 1094-C.
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As promised by the IRS last year, there are two new indicator codes for Line 14 of Form 1095-C. These new codes ask employers to indicate whether a conditional offer was made to a spouse. An offer of coverage to a spouse is conditional if it is subject to one or more reasonable, objective conditions. For example, if a spouse must certify that he or she is not eligible for group health coverage through his or her employer, or is not eligible for Medicare, in order to receive an offer of coverage, the offer is considered conditional.
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The draft instructions to the C-Series Forms reflect that the good faith compliance standard applicable to 2015 forms (under which filers could avoid reporting penalties upon a showing of good faith) no longer applies for 2016 ACA reporting. Going forward, reporting penalties may be waived only upon the standard showing of reasonable cause.
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The draft instructions to the C-Series Forms include new information related to coding for COBRA continuation coverage. There has been some uncertainty regarding how to treat offers of COBRA continuation coverage since the IRS removed relevant guidance from its Frequently Asked Questions website in February 2016. Similar to the 2015 instructions, the draft 2016 instructions provide that offers of COBRA coverage after termination from employment should be coded with 1H (Line 14) and 2A (Line 16) whether or not the COBRA coverage is elected. The new instructions now state that this coding sequence also applies for other, non-COBRA post-employment coverage, such as retiree coverage, when the former employee was a full-time employee for at least one month of the year.
In the case of an offer of COBRA coverage following a reduction in hours, the basic coding requirement is the same as in 2015 – the offer of COBRA coverage is treated as an offer of coverage on Line 14 of the Form 1095-C. The draft instructions expand on this basic requirement to explain how to code Lines 14 and 16 when the offer of COBRA coverage is not made to a spouse or dependent. In general, for purposes of Code Section 4980H, an offer of coverage made once per year to an employee and his or her spouse and dependents is treated as an offer for each month of the year even if the coverage is declined for the employee, spouse, and/or dependents. Under general COBRA rules, only those individuals enrolled in coverage immediately prior to the qualifying event receive an offer of COBRA coverage.
So how does this play out when an employee with a spouse and dependents elects self-only coverage during open enrollment and later loses that coverage due to a reduction in hours? The draft instructions treat the initial offer of coverage at open enrollment and the offer of COBRA coverage as two separate offers of coverage. To determine the proper coding, the employer must look at who had the opportunity to enroll at each offer. During open enrollment, the employee, spouse and dependent had the opportunity to enroll. Thus, until the reduction in hours and loss of coverage, the coding should be 1E (offer to employee, spouse and dependent) in Line 14 and 2C (enrolled in coverage) in Line 15.
In contrast, the offer of COBRA coverage was only available to the employee and, therefore, after the reduction in hours, the coding should be 1B (offer to employee only) in Line 14. If the employee does not elect the COBRA coverage, code 2B (part-time employee) could be inserted in Line 16. If, however, the employee does elect COBRA coverage, it appears that code 2C (enrolled in coverage) should still be inserted in Line 16. Although this latter coding sequence is likely intended to protect the spouse and dependents from being “firewalled” from a premium credit, there appears to be nothing to indicate that the employer should not be assessed a penalty for failing to make an offer to the employee’s dependents.
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The draft instructions for the C-Series Forms provide additional insight into how to calculate the number of full-time employees for purposes of column (b) in Part III of the Form 1094-C. The draft instructions clarify that the determination of full-time employee status is based on rules under Code Section 4980H and related regulations and not on other criteria established by an employer. Note that, currently, the draft instructions state that the monthly measurement period must be used for this purpose, but it appears that this is a mistake and that it should reference both the monthly measurement and look-back measurement methods. The IRS may clarify this in the final instructions.
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One important non-change in the draft instructions is that the specialized coding for employees subject to the multiemployer plan interim guidance remains in effect for 2016 reporting. The interim guidance provides that an employee is treated as having received an offer of coverage if his or her employer is obligated pursuant to a collective bargaining agreement to contribute to a multiemployer plan on the employee’s behalf, provided that the multiemployer plan coverage is affordable and has minimum value and the plan offers dependent coverage to the eligible employee. The coding for such as employee is 1H (no offer of coverage) for Line 14 and 2E (multiemployer plan interim guidance) for Line 16.
There will undoubtedly be tweaks to the draft instructions to the C-Series forms, but significant changes appear unlikely. Given that only five months remain in 2016, employers should start planning now for 2016 ACA reporting based on the draft instructions and make alterations as necessary when final instructions and other guidance is released.
See the original article Here.
Source:
Myers, D. A. (2016 August 4). 2016 draft forms & instructions released: affordable care act reporting update. [Web blog post]. Retrieved from address https://www.natlawreview.com/article/2016-draft-forms-instructions-released-affordable-care-act-reporting-update
Report highlights employers’ biggest concerns: ACA, new bias claims and OT regs
What are your top concerns as an employer? See what others had to say in the article by Tim Gould.
What’s keeping C-level execs up at night? Just a few small concerns like the new overtime rules, a likely increase in bias claims based on sexual orientation, the Affordable Care Act and the threat of workplace violence.
Those are the takeaways from the 2016 Executive Employer Survey from Littler, the giant employment law firm. The fifth annual survey, completed by 844 in-house counsel, human resources professionals and C-suite executives from some of America’s largest companies, examines the key legal, economic and social issues impacting employers as the 2016 presidential election approaches.
Those pesky OT rules
As you well know, the Department of Labor (DOL) has advanced several regulatory initiatives that have brought the agency’s enforcement of federal employment laws to the forefront for employers. This concern is no doubt driven in large part by the recently finalized Fair Labor Standard Act overtime regs, which will dramatically increase the number of Americans who can qualify for overtime pay. Although respondents completed the survey in the weeks prior to the release of the final rule, 65% had already conducted audits to identify affected employees.
“Employers are clearly feeling the impact of the DOL’s increasingly aggressive regulatory agenda, most notably the new overtime regulations,” Littler attorneys Tammy McCutchen and Lee Schreter said in a joint statement.
They added a sobering note: “While it is encouraging that the majority of respondents started to prepare before the rule was finalized, more than a quarter (28%) said they had taken no action given delays in the rulemaking process. Given that the reclassification process can take up to six months and the rule is unlikely to be blocked from going into effect on December 1, 2016, employers should move quickly to ensure compliance.”
And participants are pretty sure the DOL’s going to be aggressive about making the new rules stick: The vast majority of respondents to this year’s survey (82%) expect DOL enforcement to have an impact on their workplace over the next 12 months, with 31% anticipating a significant impact (up from 18% in the 2015 survey).
Where are the presidential candidates likely to land on employment policies? The majority of respondents (75%) said income inequality (e.g., overtime rules, state equal pay, minimum wage laws, etc.) would be a significant priority of the Democratic candidate. Only 4% felt income inequality would be a significant priority of the Republican candidate.
Top regulatory and legislative issues
With the National Labor Relations Board’s recent expansion of the definition of a “joint employer,” 70% of respondents to the Littler survey expect a rise in claims over the next year based on actions of subcontractors, staffing agencies and franchisees. Approximately half of respondents predicted higher costs (53%) and increased caution in entering into arrangements that might constitute joint employment (49%).
As was the case in the 2015 survey, 85% of employers said the Affordable Care Act (ACA) would have an impact on their workplace in the next 12 months. While two-thirds said they do not expect a repeal of the ACA if a Republican is elected president this fall, respondents saw a greater likelihood of changes to individual provisions. Fifty-three percent said a Republican administration could lead to a repeal of or changes to the Cadillac excise tax and 48% saw a likelihood for changes to the play-or-pay mandate.
Social issues come to the forefront
Today’s companies are increasingly experiencing the incursion of social issues into the workplace, the survey indicated.
In the largest year-over-year change in Littler’s survey results, 74% of respondents expect more discrimination claims over the next year related to the rights of LGBT workers (up from 31% in 2015) and 61% expect more claims based on equal pay (up from 34% in 2015).
This change is driven by LGBT discrimination and equal pay ranking among the top enforcement priorities for the Equal Employment Opportunity Commission (EEOC), but it also mirrors key focus areas for the Obama administration, government efforts at the state and federal levels, and increased public awareness.
Preventing workplace violence
In response to tragic mass shootings across the nation, companies are taking a range of actions to keep their employees safe, including updating or implementing a zero-tolerance workplace policy (52%), conducting pre-employment screenings (40%) and holding training programs (38%). Only 11% of respondents said they had not taken any action because violence is not a concern for their company.
“Putting policies in place to increase awareness of workplace violence and ensure that employees understand how to report threats in the workplace are steps that all employers would be advised to take,” said Littler’s Terri Solomon, who has extensive experience counseling employers on workplace violence prevention. “Unfortunately, even though workplace violence – and particularly active shooter instances – are statistically rare, no employer is truly immune.”
See the original article from HRMorning.com Here.
Source:
Gould, T. (2016, July 13). Report highlights employers' biggest concerns: ACA, new bias claims and OT regs [Web log post]. Retrieved from https://www.hrmorning.com/report-highlights-employers-biggest-concerns-aca-new-bias-claims-and-ot-regs/
The ACA’s uncertain lifespan following the Cadillac Tax delay
Are you questioning how the ACA will continue with the delay of the Cadillac Tax? Neil Model gives a breakdown of the "what-ifs" scenarios.
Original Post from BenefitsPro.com on July 26, 2016.
Since the delay of the Affordable Care Act’s (ACA) “Cadillac Tax” provision, which was passed on December 18, 2015, some may be wondering how the ACA will be funded until 2020. I do not believe we have been given the answer.
The Cadillac Tax was to be imposed as a means of funding the ACA by penalizing employers for offering high-cost employer sponsored health insurance plans to employees. One must take into consideration that with continued double-digit healthcare premium increases, the so-called “high cost” plans are not so far-fetched for many more employer sponsored plans in the future. The Cadillac tax was also to double as an incentive for plan sponsors to look at less expensive plan alternatives by the time the tax would be imposed, which is now 2020.
The tax, were it not delayed, would have assessed a penalty of 40 percent for plans costing an employee more than $10,200 annually, and family plans costing an employee $27,500 annually. I have little doubt that the craftsman of the ACA actuarially assumed there would be more employers subject to penalties in future years, despite most efforts to curb premiums.
But because the tax has been delayed, questions about how the ACA will be funded until 2020 have arisen. While still some plan sponsors speculate about whether the ACA will ultimately be repealed, others are still preparing for 2020 by attempting to provide affordable plan options for their employees. This is and will become increasingly more difficult due to spiraling health care costs and corresponding premiums. I have heard it asked many times: “How much more can I impose on my employees?” Add to that concern the even greater Rx inflation due to new and very expensive drugs coming to market for Hepatitis C, rheumatoid arthritis and cholesterol.
Though there have been no definitive plans announced to supplement the funding that would have resulted from the Cadillac Tax, other taxes and fees have been responsible for the partial funding of health care reform, some paid by individuals, others paid by employers, including numerous taxes on medical device manufacturers, indoor tanning services, charitable hospitals that fail to comply with Obamacare requirements, brand name drugs and health insurers. Other fundraising for the ACA comes through the elimination of tax deductions for certain drug coverage and tax increases for those with a certain income threshold.
Since the ACA’s emergence, we have read about failed state exchanges, bankrupt cooperatives, and the significant losses the major insurance carriers have incurred participating in the federal exchanges. We have also seen the failure of the government to pay the subsidies to insurance carriers in the timely fashion promised and expected. With the various delays and elimination of ACA funding clauses, we all must wonder where the money to pay for ACA will ultimately come from. Does everyone have a mirror?
According to an article by Reuters with information from the Congressional Budget Office, U.S. taxpayers will ultimately be responsible for $660 billion this year alone as a subsidy to those receiving health insurance under the age of 65. Those figures are expected to rise to $1.1 trillion over the next decade.
The burden will not only fall on the backs of the consumer, but on employers that want to help lift the burden of the high cost of health care. And, providing major medical insurance might not be enough in today’s environment. Ultimately, it will come down to employers educating themselves on the most effective strategies and seeking the guidance from benefits brokers to come up with creative, alternative solutions that will make it easier for employees to live healthy lives.
As the lifespan of the ACA remains undetermined, employers need to educate and prepare as best as possible. Uncertainty, especially with the election around the corner, will be a key theme the rest of this year, particularly in the health care realm.
So, the question remains: Will the ACA keep fighting the good fight going forward, or will it crumble under pressure?
ACA Puts Employers Between A Rock And A Hard Place
A great article by Greta Engle on the upcoming challenges with the ACA.
Original Post from SHRM.org on July 8, 2016
The value of employer-sponsored health care recently has come under scrutiny from lawmakers as they look for solutions to reduce the federal deficit and alternatives to the Affordable Care Act (ACA). If you’re not a political junkie like me, let me provide some context.
Historically, one of the largest subsidies for health insurance comes from employment-based coverage. That’s because the federal tax system provides preferential treatment for health care coverage that people receive from their employers. Employers’ payments for health coverage are excluded from income and payroll taxes. And, most times, employee contributions are also excluded from income and payroll taxes.
There are many benefits of employer-sponsored health care coverage that Congress and specifically House Speaker Paul Ryan, who has commissioned a Task Force on Health Care Reform, should realize. For starters, the ability to offer health benefits sets an employer apart and can be a strong driver in a retention or recruitment strategy. American workers in today’s climate have an expectation of health care as part of their compensation package (remember the good old days when you were considered to have a professional job if your employer provided health benefits?) and employer-sponsored health benefits costs are pretax deductions. Additionally, flexible spending accounts (FSAs) and health savings accounts (HSAs) provide another savings tool for employees to avoid out-of-pocket expenditures coming from a household budget. These are just a few of the benefits.
While the ACA includes some provisions that should be applauded, as they’ve increased access and coverage, there are some provisions that have had an adverse effect—especially on employers. We’re now beginning to realize the costs associated with the ACA, and, in particular, how our economy has been impacted. Some Americans are now working part time or having their hours cut by employers seeking to avoid providing coverage under the full-time mandate of a 30-hour workweek. Then there’s my favorite topic: the excise tax, or “Cadillac tax,” that was delayed until January 2020. To avoid the anticipated tax, many employers have restructured their health benefits offerings or increased workers' deductibles and co-pays.
When the excise tax goes into effect in 2020, employers will most certainly experience higher deductibles and increased out-of-pocket costs—resulting in employers dropping group health plan coverage. This tax MUST be repealed; at the very least, significant changes must be made to avoid those financial consequences to employees. Some of those changes include eliminating HSAs and FSAs from the calculation; removing the employee portion of premium contributions; and basing inflation on the national health care inflation trend rather than the Consumer Price Index, which was 1.5 percent for 2013.
Tinkering with the tax treatment of employer-sponsored health care is not a great idea, especially since more than 175 million Americans currently enjoy this benefit. Instead of targeting employer-sponsored health benefits, lawmakers should consider other financial options.
Employers and employees should be paying attention to this critical issue. The Task Force on Health Care Reform is on the fringes of recommending some tax implications that can shatter a business, threaten individuals’ financial stability and jobs across the U.S., and put employers between a rock and a hard place!
Originally posted on the SHRM Policy Action Center Blog.
Source:
Engle, G. (2016, July 8). ACA puts employers between a rock and a hard place [Web log post]. Retrieved from https://blog.shrm.org/blog/aca-puts-employers-between-a-rock-and-a-hard-place
Study quantifies skyrocketing copays for the insured
Dan Cook provides insight on reasons for the Skyrocketing copays in the article below.
Original Post fro BenefitsPro.com on June 28, 2016
There’s been considerable focus on health insurance cost-shifting to covered individuals and families since the passage of the Affordable Care Act. But much of the shift occurred before Americans started looking to insurance exchanges for less costly coverage.
That’s what a research team composed primarily of University of Michigan scholars found when insurance records for 2009 to 2013 were examined. The study found that inpatient hospitalization costs paid by patients rose 37 percent from 2009 to 2013, to the point that the average insured individual was paying more than $1,000 annually in shared costs.
The biggest driver of the increase were deductibles, which rose a staggering 86 percent during that period. Coinsurance was the second largest factor, rising 33 percent during that time.
Individuals bore a greater share of the cost increase than did those with family coverage, the study said.
“In 2013, total cost sharing was highest for enrollees in individual market plans ($1875 per hospitalization) and consumer-directed health plans ($1219). Cost sharing varied substantially across regions, diagnoses, and procedures,” the researchers reported.
But it wasn’t just the average amount that the research team found troubling. Some among the insured were hit much harder than others by out-of-pocket costs, and that bears further investigation.
“Wide variability in out-of-pocket spending merits greater attention from policymakers,” the report concluded.
Additionally, more attention should be paid to cost-sharing trends among those with insurance rather than focusing just on the uninsured, the study’s lead author Emily Adrion told Fortune.
“There have been so many stories about how much hospital costs are for the uninsured and underinsured, but what’s lost is how much people with insurance are paying,” she said.
Read the full article at: https://www.benefitspro.com/2016/06/28/study-quantifies-skyrocketing-copays-for-the-insur?ref=hp-news&slreturn=1468802076
Source:
Cook, D. (2016, June 28). Study quantifies skyrocketing copays for the insured [Web log post]. Retrieved from https://www.benefitspro.com/2016/06/28/study-quantifies-skyrocketing-copays-for-the-insur?ref=hp-news&slreturn=1468802076
States Offer Privacy Protections To Young Adults On Their Parents’ Health Plan
Michelle Andrews gives insight on how the ACA is impacting HIPPA and privacy for young adults. See her article below.
Original Post from Kaisher Health News on June 28, 2016.
The health law opened the door for millions of young adults to stay on their parents’ health insurance until they turn 26. But there’s a downside to remaining on the family plan. Chances are that mom or dad, as policyholder, will get a notice from the insurer every time the grown-up kid gets medical care, a breach of privacy that many young people may find unwelcome.
With this in mind, in recent years a handful of states have adopted laws or regulations that make it easier for dependents to keep medical communications confidential.
The privacy issue has long been recognized as important, particularly in the case of a woman who might fear reprisal if, for example, her husband learned she was using birth control against his wishes. But now the needs of adult children are also getting attention.
“There’s a longstanding awareness that disclosures by insurers could create dangers for individuals,” said Abigail English, director of the advocacy group Center for Adolescent Health and the Law, who has examined these laws. “But there was an added impetus to concerns about the confidentiality of insurance information with the dramatic increase in the number of young adults staying on their parents’ plan until age 26” under the health law.
Federal law does offer some protections, but they are incomplete, privacy advocates say. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a key federal privacy law that established rules for when insurers, doctors, hospitals and others may disclose individuals’ personal health information. It contains a privacy rule that allows people to request that their providers or health plan restrict the disclosure of information about their health or treatment. They can ask that their insurer not send the ubiquitous “explanation of benefits” form describing care received or denied to their parents, for example. But an insurer isn’t obligated to honor that request.
In addition, HIPAA’s privacy rule says that people can ask that their health plan communicate with them at an alternate location or using a method other than the one it usually employs. Someone might ask that EOBs be sent by email rather than by mail, for example, or to a different address than that of the policyholder. The insurer has to accommodate those requests if the person says that disclosing the information would endanger them.
A number of states, including California, Colorado, Washington, Oregon and Maryland, have taken steps to clarify and strengthen the health insurance confidentiality protections in HIPAA or ensure their implementation.
In California, for example, all insurers have to honor a request by members that their information not be shared with a policyholder if they are receiving sensitive services such as reproductive health or drug treatment or if the patient believes that sharing the health information could lead to harm or harassment.
“There was concern that the lack of detail in HIPAA inhibited its use,” said Rebecca Gudeman, senior attorney at the National Center for Youth Law, a California nonprofit group that helps provide resources to attorneys and groups representing the legal interests of poor children. She noted that HIPAA doesn’t define endangerment, for example, and doesn’t include details about how to implement confidentiality requests.
Concerns by young people that their parents may find out about their medical care leads some to forgo the care altogether, while others go to free or low-cost clinics for reproductive and sexual health services, for example, and skip using their insurance. In 2014, 14 percent of people who received family planning services funded under the federal government’s Title X program for low-income individuals had private health insurance coverage, according to the National Family Planning and Reproductive Health Association.
Even though most states don’t require it, some insurers may accommodate confidentiality requests, said Dania Palanker, senior counsel for health and reproductive rights at the National Women’s Law Center, a research and advocacy group.
“Inquire whether there will be information sent and whether there’s a way to have it sent elsewhere,” Palanker said. “It may be possible that the insurer has a process even if state doesn’t have a law.”
Insurers’ perspective on these types of rules vary. In California, after some initial concerns about how the law would be administered, insurers in the state worked with advocates on the bill, Gudeman said. “I give them a lot of credit,” she said.
Restricting access to EOBs can be challenging to administer, said Clare Krusing, a spokesperson for America’s Health Insurance Plans, a trade group. A health plan may mask or filter out a diagnosis or service code on the EOB, but provider credentials or pharmacy information may still hint at the services provided.
There’s also good reason in many instances for insurers and policyholders to know the details about when a policy is used, experts say. Policyholders also may have difficulty tracking cost-sharing details such as how much remains on the deductible for their plan.
In addition, “if a consumer receives a filtered or masked EOB, he or she has no way of knowing whether their account has been compromised or used as part of fraudulent activity,” Krusing said.
Read the full article and learn more at: https://khn.org/news/states-offer-privacy-protections-to-young-adults-on-their-parents-health-plan/
Source:
Adnrews, M. (2016, June 27). States offer privacy protections to young adults on their parents’ health plan [Web log post] Retrieved from https://khn.org/news/states-offer-privacy-protections-to-young-adults-on-their-parents-health-plan/
5 Top Employee Benefits Questions and How to Answer Them
Original Post from BenfitsPro.com
By: Monica Majors
Legislative changes continue to markedly affect the health benefits marketplace. Employers and their workers face challenges on a number of fronts. Along with those challenges come questions that range from current and future requirements of health care reform, to providing adequate plan coverage that serves employees well.
By understanding the top-of-mind employer benefit issues and responding to them appropriately and effectively, brokers and advisors can better serve existing clients, attract new ones, and help employees protect themselves and their families going forward.
1. How can I meet my employees’ needs?
A key concern of today’s employers is making sure benefits they offer for both prospective and current employees are competitive. Businesses recognize the role a solid benefit program plays in attracting and keeping good talent, and they want to know what is included in plans offered by their competitors.
Brokers serving the health benefits marketplace can best serve customers by knowing the current market landscape well, speaking confidently about it and sharing that knowledge with customers. Key to this knowledge is understanding what the employer currently offers, what types of employees make up its workforce, what their needs are, and what gaps may currently exist.
Then, talk with insurers and learn what industry and market insight they may possess based on geographic and industry-specific factors. Search out findings made available from insurance- and customer-specific industry research organizations and trade associations. You can also mine data from within your own office, such as aggregated customer information by industry.
Integrate all of this information with comprehensive benefit offerings available from the carriers you represent, and show employers how they can gain a competitive market advantage with the right benefit plan.
2. How can I control my costs?
The question of controlling costs is common for obvious reasons. Small groups, in particular, are looking for creative ways to keep their health benefit expenses down. Brokers can address this question by understanding current offerings and combining that with knowledge of the plans available through the carriers they represent.
Understanding the various coverage tiers available and sharing that knowledge with employers is key. Often, implementing a health benefit program that meets the minimum required coverage levels brings the lowest cost.
Other cost-reduction strategies include addressing coverage for dependents or part-time employees. Some employers may consider eliminating dependent coverage or reducing contributions for this coverage. Also, determine with the employer the cost versus the benefit of including part-time staff in the plan. Employers may need to make tough decisions to maintain viable programs for employees.
Employers need to consider other costs that may come into play. For example, new IRS and ACA reporting requirements for employers to notify employees about new mandates bring with them administrative expenses. While they may not be able to eliminate these costs, brokers can help provide guidance and increase awareness around the changing requirements. They can also recommend approaches that might help employers streamline the process to reduce the impact of the requirements.
3. What about exchanges?
Employer questions about health benefit exchanges are prevalent. How do the exchanges align with the employer’s desire to deliver benefits in a cost-effective manner? What advantages do they offer? What are the drawbacks? Brokers need to be familiar with individual and group exchanges — both private and public.
Brokers working with some employers may find that certain tax advantages come along with using a public exchange. Private exchanges offer other benefits, from cost-management tools to a broader set of administrative support options and a choice of benefit options that extend beyond basic medical coverage. Group or employer-focused exchanges are becoming increasingly popular as a way to efficiently manage health benefits. Brokers should become familiar with the pros and cons, as well as processes involved.
It’s important to understand the advantages for different employer groups, as well as the reputation and satisfaction levels of exchanges, and use that knowledge to help employers select the right option.
4. What’s on the horizon?
Large employers are concerned about looming changes. They wonder how new regulations—for example, the Cadillac tax —may affect them in the future. Brokers need to be knowledgeable about what is coming down the pike, and how to minimize negative resulting impacts.
Preparing for the Cadillac tax, for example, may require a strategy shift. While the tax is primarily levied against health plans for coverage deemed “too rich,” it will ultimately affect employers and workers. Health plans are likely to pass off at least some of the costs to employers in the form of higher premiums. Employers may then pass costs off to workers in the form of higher cost-sharing arrangements. Of course, employers will have to consider how this will impact employee retention and recruitment.
The Internal Revenue Service posts helpful information about the ACA’s requirements on employers on its website: irs.gov/affordable-care-act. The Centers for Medicare & Medicaid Services website is another valuable resource: cms.gov/cciio/.
5. Why you?
The final top question may be one employers don’t explicitly ask; but it’s one you need to answer: “Why should I use you as a broker?” How is it that you set yourself apart from other brokers — industry knowledge, market strategy or customer service? Brokers need to carefully and clearly explain benefit plan designs, educate employers, guide them through the maze of changes in the benefits arena, and explain all the implications.
Building knowledge is the first part of the answer. Learn about laws, regulations and your employers’ workforce attributes. Learn more about the products offered by carriers and through the exchanges. Combine that knowledge with employer and employee data you capture to design programs that can help employers attract and retain good workers. Work with financially strong carrier partners to find and deliver the right benefit plans, and consider offering your clients a multi-year strategy where appropriate. And leverage administrative, technology, client portals and other resources your carrier partners offer.
Be sure to document and explain the advantages you can bring to the employer. Also, encourage satisfied customers to provide testimonials, directly and on social platforms, and then share these testimonials and references to help differentiate yourself and your shop from your competitors.
By understanding the needs of your clients, offering cost control solutions and keeping businesses apprised of changes on the horizon, you set yourself apart from other brokers and demonstrate your value as a trusted adviser. New and existing clients will come to you year after year for help in designing affordable health benefit plans that will attract and hold onto good workers.
How to Avoid Penalties Under the Affordable Care Act
Original Post from SHRM.org
By: Lisa Nagele-Piazza
2016 is expected to be the most expensive year for businesses complying with the Affordable Care Act (ACA), said David Lindgren, senior manager of compliance and public affairs for Flexible Benefit Service Corporation, a benefit administrator headquartered in Rosemont, Ill.
It’s the first year for dealing with ACA reporting, which many employers will have to complete by the end of June, Lindgren said during a concurrent session at the Society for Human Resource Management 2016 Annual Conference & Exposition.
There are more than 30,000 pages of guidance about the law, but Lindgren said the ACA is fairly easy to comprehend. “Of course, many people would disagree with me,” he noted.
“It’s not necessarily easy to comply with the ACA, and it’s not financially inexpensive, but most of the rules aren’t overly complicated,” he said.
The federal agencies that regulate the ACA have said they intend to monitor all businesses for compliance. This may not be realistic, but employers should keep in mind that more auditing can be expected.
Lindgren identified 30 penalties associated with noncompliance and provided insight on how to avoid them.
Employers can choose to pay the penalties for noncompliance, but steep fines are often attached, he said. For example, market reform violations carry a penalty of $100 per participant per day, up to $500,000 for each violation.
Employees Must Receive Notices
Some noteworthy penalties to avoid are those associated with the failure to provide required notices to plan participants, including a written notice of patient protections.
Lindgren said sometimes employers aren’t clear about who has been designated to provide this notice. “A lot of times the insurance company thinks the employer provided it and the employer thinks the insurance company did,” he said. “So it’s important to double check who is in fact giving the notice.”
Participants must also be provided with a summary of benefits and coverage in a standardized format. Lindgren likened this format to a nutrition label on a can of soup.
A participant should be able to easily compare the benefits to other plans, such as a spouse’s plan, just as the nutrition facts for two cans of soup can be easily compared.
There is a standardized template for the summary of benefits and coverage on the Department of Labor website.
The requirement to provide a summary of benefits and coverage applies to medical plans, but not to dental or vision plans.
The summary should be distributed at the time of open enrollment and special enrollments related to qualifying events, as well as at the request of participants and when a material modification has been made to the plan.
Although there is no penalty attached for noncompliance, employers must also provide written notice about the health insurance marketplace to new hires within 14 days of their start date.
This applies even for organizations that don’t offer benefits and even to those employees who aren’t eligible for benefits, Lindgren said.
There are some exceptions. For example, if an employer isn’t subject to the Fair Labor Standards Act, then it doesn’t have to provide the marketplace notice.
Exceptions for Grandfathered Plans
Grandfathered plans aren’t subject to some of the requirements under the ACA. This includes plans purchased on or before March 23, 2010, that haven’t made certain material changes.
Lindgren noted that employers with grandfathered plans must provide written notice to participants notifying them that it is a grandfathered plan and describing what that means for participants.
If participants aren’t provided this information, the plan will lose its grandfathered status, Lindgren said.
HR Takes the Lead
Benefits compliance isn’t just a human resources issue anymore, but HR often takes the lead in compliance efforts, according to Lindgren.
However, other departments, such as finance, legal and information technology, are increasingly getting more involved.
Are You Ready for the Marketplace Notices?
Original Post from ThinkHR.com
By: Laura Kerekes
Under the Affordable Care Act (ACA), each Health Insurance Exchange (Marketplace) must notify employers when they have an employee who has received a government subsidy to enroll in a health plan through the Marketplace. These notices will begin being sent to employers in the coming weeks and months, either individually or in batches. Because the notice procedure is being phased in, you may or may not receive notices, even if you have employees who received subsidies through a Marketplace. Here’s what you need to know.
Reason for Notice
These notices, also called 1411 Certifications in reference to the pertinent section of the ACA, will be sent to employers as part of the government’s verification efforts regarding persons who received Marketplace subsidies for individual health insurance. Marketplaces want to confirm whether the individual was eligible for, or enrolled in, an employer’s health plan since those facts can affect someone’s eligibility for subsidies.
You may receive a notice (similar to the sample found here) for each employee that received a subsidy to enroll in insurance through a Marketplace. The notice only informs you that the employee was granted a subsidy — it is not a notification that you have been assessed any penalty. Under the ACA’s play or pay rules, penalties may be assessed later by the Internal Revenue Service to applicable large employers for failing to offer full-time employees affordable minimum value coverage; however, play or pay penalties, and notice of them, are a separate process entirely.
What You Should Do
- Even if you do not believe that any of your employees obtained individual coverage through a Marketplace, be on the lookout for these notices because you have 90 days from the date of the notice to file an appeal, if necessary. Notices may go to a subsidiary instead of the parent company or to a particular worksite instead of the employer’s main office, depending on the information the employee provided to the Marketplace. Alert all departments and worksites to watch for mail in envelops from a government agency or insurance Marketplace.
- Important:Keep these notices confidential because employers are prohibited by law from discriminating or retaliating against employees who may receive subsidies. Consider segregating functions so staff involved in reviewing notices is separate from staff involved in employment or benefit plan decisions.
- Establish your audit process for reviewing any notices you may receive and for filing appeals when appropriate. Confirm that the information is correct based on your employment and payroll records. If you are an applicable large employer subject to the ACA’s play or pay rules, you also should check if the employee was a full-time employee and, if so, whether you had offered affordable minimum value coverage to the employee. Read more about the notice and appeal process here.
- File an appeal within 90 days of receipt of the notice if any of the information is incorrect. To do this, be sure to retain the notice and follow the directions for appeal. Remember that these notices will not advise you of any penalties on large employers, so appeals at this stage are to correct any mistakes in employment information. In addition:
- If you are a small employer and not subject to the ACA play or pay rules, you are not impacted directly but your appeal may alert the Marketplace that the individual was enrolled in your group health plan and not eligible for subsidies.
- If you are an applicable large employer who is subject to the ACA’s play or pay rules, you should be proactive in appealing the Marketplace’s subsidy determination if any information is incorrect. (An applicable large employer generally is one that employed an average of 50 or more full-time and full-time-equivalent employees in the prior calendar year. Related employers in a controlled group are counted together.) Although Marketplaces cannot access play or pay penalties, your appeal may help establish the facts and head off later penalty action by the IRS.
You may not receive Marketplace notices, but if you do, be prepared, review them thoroughly, and appeal incorrect information quickly.