8 renewal considerations for 2020

Are you prepared for open enrollment 2020? With renewal season quickly approaching, plan administrators have a lot of considerations to make regarding employee health plans. Read the following blog post from Employee Benefit News for eight things to consider this year.

The triumphant return of the Affordable Care Act premium tax (the health insurer provider fee).

This tax of about 4% is under Congressional moratorium for 2019 and returns for 2020. Thus, fully insured January 2020 medical, dental and vision renewals will be about 4% higher than they would have been otherwise. Of note, this tax does not apply to most self-funded contracts, including so-called level-funded arrangements. Thus, if your plans are presently fully insured, now may be a good time to re-evaluate the pricing of self-funded plans.

Ensure your renewal timeline includes all vendor decision deadlines.

As the benefits landscape continues to shift and more companies are carving out certain plan components, including the pharmacy benefit manager, you may be surprised with how early these vendors need decisions in order to accommodate benefit changes and plan amendments. Check your contracts and ask your consultant. Further, it seems that our HRIS and benefit administration platforms are ironically asking for earlier and earlier decisions, even with the technology seemingly improving.

Amending your health plan for the new HSA-eligible expenses.

In July of this year, the U.S. Treasury loosened the definition of preventive care expenses for individuals with certain conditions.

While these regulations took effect immediately, they won’t impact your health plan until your health plan documents are amended. Has your insurer or third-party administrator automatically already made this amendment? Or, will it occur automatically with your renewal? Or is it optional? If your answer begins with “I would assume…,” double-check.

Amending your health plan for the new prescription drug coupon regulations.

As we discussed in July of this year, these regulations go into effect when plans renew in 2020. In short, plans can only prevent coupons from discounting plan accumulators (e.g., deductible, out-of-pocket maximum) if there is a “medically advisable” generic equivalent.

If your plan is fully insured, what action is your insurer taking? Does it seem compliant? If your plan is self-funded, what are your options? If you can keep the accumulator program and make it compliant, is there enough projected program savings to justify keeping this program?

Is your group life plan in compliance with the Section 79 nondiscrimination rules?

A benefit myth that floats around from time to time is that the first $50,000 in group term life insurance benefits is always non-taxable. But, that’s only true if the plan passes the Section 79 nondiscrimination rules. Generally, as long as there isn’t discrimination in eligibility terms and the benefit is either a flat benefit or a salary multiple (e.g., $100,000 flat, 1 x salary to $250,000), the plan passes testing. Ask your attorney, accountant, and benefits consultant about this testing. If you have two or more classes for life insurance, the benefit is probably discriminatory. If you fail the testing, it’s not the end of the world. It just means that you’ll likely need to tax your Section 79-defined “key employees” on the entire benefit, not just the amount in excess of $50,000.

Is your group life maximum benefit higher than the guaranteed issue amount?

Surprisingly, I still routinely see plans where the employer-paid benefit maximum exceeds the guaranteed issue amount. Thus, certain highly compensated employees must undergo and pass medical underwriting in order to secure the full employer-paid benefit. What often happens is that, as benefit managers turnover, this nuance is lost and new hires are not told they need to go through underwriting in order to secure the promised benefit. Thus, for example, an employee may think he or she has $650,000 in benefit, while he or she only contractually has $450,000. What this means is the employer is unknowingly self-funding the delta — in this example, $200,000. See the problem?

Please pick up your group life insurance certificate and confirm that the entire employer-paid benefit is guaranteed issue. If it is not, negotiate, change carriers, or lower the benefit.

Double-check that you haven’t unintentionally disqualified participant health savings accounts (HSAs).

As we discussed last December, unintentional disqualification is not difficult.

First, ensure that the deductibles are equal to or greater than the 2020 IRS HSA statutory minimums and the out-of-pocket maximums are equal to or less than the 2020 IRS HSA statutory maximums. Remember that the IRS HSA maximum out-of-pocket limits are not the same as the Affordable Care Act (ACA) out-of-pocket maximum limits. (Note to Congress – can we please align these limits?)

Also, remember that in order for a family deductible to have a compliantly embedded single deductible, the embedded single deductible must be equal to or greater than the statutory minimum family deductible.

Complicating matters, also ensure that no individual in the family plan can be subject to an out-of-pocket maximum greater than the ACA statutory individual out-of-pocket maximum.

Finally, did you generously introduce any new standalone benefits for 2020, like a telemedicine program, that Treasury would consider “other health coverage”? If yes, there’s still time to reverse course before 2020. Talk with your tax advisor, attorney, and benefits consultant.

Once all decisions are made, spend some time with your existing Wrap Document and Wrap Summary Plan Description.

For employers using these documents, it’s easy to forget to make annual amendments. And, it’s easy to forget, depending on the preparer, how much detail is often in these documents. For example, if your vision vendor changes or even if your vision vendor’s address changes, an amendment is likely in order. Ask your attorney, benefits consultant, and third party administrators for help.

SOURCE: Pace, Z. (Accessed 9 September 2019) "8 renewal considerations for 2020" (Web Blog Post). Retrieved from https://www.benefitnews.com/list/healthcare-renewal-considerations-for-2020

What’s in store for voluntary benefits in 2019

Voluntary benefits will continue to be popular with benefit managers who are trying to lower healthcare costs and retain employees. Read this blog post for more 2019 voluntary benefits trends.

Benefit managers are still catching their breath as the curtain closes on this year’s open enrollment season. But smart benefits managers are already evaluating new products and benefit changes for the 2019-2020 season.

Themes around cost-saving strategies concerning healthcare premiums will continue to resonate — but what else will happen in the upcoming year? Voluntary benefits will continue to hold the key for many benefit managers looking to lower costs and maintain value for employees by providing flexibility to a diverse workforce.

Voluntary benefits offer pivotal advantages to employers and employees alike. By offering these programs through an employer, employees often receive better pricing, plan designs and underwriting support compared to what is available on the individual market. Payroll deduction capability and enrollment as part of their normal core enrollment process and portability are also available.

Here are three voluntary benefits to watch in 2019.

Employee purchase programs.

Nearly one quarter of all Americans do not have adequate emergency savings, according to a survey by consumer financial services company Bankrate. This means that if they need to make a significant purchase, they are likely to withdraw a loan from their 401(k) plan.

Employee purchase programs help employees pay for items they may need immediately, but may not have the funds or credit available. These programs generally allow employees to spread out the payments on the purchased products — such as appliances, car tires or computers — over a period of time through payroll deduction. Young employees who are trying to establish credit while managing student loan repayments — and may be strapped for cash — can especially benefit from an employee purchase programs.

Group legal insurance plans.

Group legal plans are not new, but they are still valuable for employees. For a cost that is less than a cup of coffee, group legal plans provide employees with access to attorneys for will preparation, estate planning, dealing with elderly parents, traffic violations, real estate purchases, and document review and preparation. These plans offset the expense of professional legal representation and the time it takes to locate the right representation to handle legal matters.

These plans may be especially valuable to employees who are thinking of buying a house, adopting a child or planning for their estate. Still, group legal insurance plans are available to all employees, and can provide a buffer for workers who may need to navigate identity restoration after a theft or combat an unforeseen traffic ticket. These plans also save employees time and money when the need for a legal professional arises.

Student loan benefits.

Student loan benefits have been one of the hottest topics in voluntary benefits in 2018 and it’s not going away any time soon. An IRS private letter ruling this past August allowed one company to amend its 401(k) plan to allow employer contributions of up to 5% to individuals who contribute at least 2% to their student loan. This may just be the start to more legislation concerning student loan debt solutions.

In the interim, as the tuition debt crisis grows, employers are seeking ways to support their employees. There are several strategies that can be employed.

Some solutions can be offered at no cost, while others have administrative charges and the cost of contributions to factor in. For employers who have the budget, a student loan repayment plan may be the answer. There are many vendors who can partner with an employer to help develop a plan that is designed to meet the company’s goals.

Employers without a budget can seek a student loan solution partner that offers comprehensive educational tools such as written materials, debt navigation tools, FAQs, one-on-one counselors and webinars. Another option is to offer student loan refinancing. These lenders can help employees manage their debt. Even though refinancing is not for everyone, well-vetted student loan refinancing partners should be considered as part of a comprehensive student loan debt solution strategy. Understanding the approval rate is important, as well as whether there are any other incentives, such as a welcome bonus, that may be applied to the loan principal.

SOURCE: Marcia, P. (28 November 2018) "What’s in store for voluntary benefits in 2019" (Web Blog Post). Retrieved from: https://www.benefitnews.com/opinion/whats-in-store-for-employers-and-voluntary-benefits-in-2019

Data transparency, debt consolidation and ID protection lead open enrollment wish list

In the thick of open enrollment season, savvy employers and benefit advisers have eased the onslaught of information with complex benefit jargon by spreading out employee sign-up before the mad fall rush. Employee Benefit Adviser spoke with Jeffrey Faber, HUB International Midwest’s chief operating officer, to discuss how employers are urging employees to save with data transparency tools, use interactive services to learn about new benefits and to sign up for identity protection.

EBA: How is open enrollment going for you and your clients?

Faber: We’re in the middle of open enrollment season and we are trying to lock down the last-minute decisions our clients have. Predominantly our business is a renewal business.

Our large groups have made their decisions already but our smaller groups are just finding out what their renewals are from the major medical carriers. We have our hands full trying to make sense of it all. But open enrollment is the focus. This is absolutely our busiest time of year. From mid-August to Halloween, and even mid-November, it seems to be getting longer and longer every year with all the nuances our clients require.

EBA: How does this enrollment season differ from previous years? Is there confusion over the ACA’s status? Is there a greater emphasis on voluntary benefits?

Faber: On the repeal of Obamacare, a lot of those decisions have been made too late for our employers to really have to pivot and they are unaffected largely by the executive orders and the talk from Congress. Of course, there's the specter that Congress will act and make a decision in the next couple of weeks, but that impact would probably be a 2019 event instead of a 2018 event.

On the voluntary benefits side, our clients are asking for financial and holistic tools to meet the employees where they live in regard to student loans, tuition assistance and debt consolidation services. ID theft has been a big conversation point in the last three or four months and has been heightened by the Equifax breach, but it started three years ago with the Target breach. A lot of employers want to understand their role in their employee’s lives,

And for voluntary benefits, most of our customers are moving to the consumer-driven model with higher deductibles, so accident insurance, critical injury insurance, and hospitalization – those are all nice bolt-on benefits for the medical benefits they have. It almost allows the employee to self-insure their own health. And HSAs and HRAs are still popular. We see a large uptick year over year over year.

EBA: Any other trends for this year’s open enrollment?

Faber: A few years ago, we joked that overall enrollment was the HR Super Bowl. It happened once a year, it was a three hour event with a bunch of commercials and no one really talked about it a week or two later.

Our clients have asked, what can we do the other 11 months a year? We have seen an increase in requests for interactive PDFs, on-demand video, and interactive guides directing folks to microsites or apps on their phone. We introduce these in April, May or June and if the employee needs this, they don't have to go back into their memory bank and access it, they can get it online. It is that year round learning that engages the customer.

EBA: Is this because employees are bombarded with information during open enrollment?

Faber: Yes and no. There is a lot of information that is required and that is distributed this time of year and there are a lot of decision points that they have to make for themselves and the benefit of their families. We put in place decision helping tools like Jellyvision’s ALEX and some other proprietary tools, that can help employees better make decisions.

But I think it is more toward trying to be a circuit breaker in an employee's head when they are accessing healthcare. That makes them stop and check, “Is this in network, do I have to get pre-authorization? How do I check for a lower cost across the street from a benefit provider?”

These things come out of the workshops this time of year, but if you are not hitting employees where they live at the time of use, you are missing those opportunities for significant cost savings. And not on just on the employer side but the employee side especially with high-deductible plans.

EBA: Is data transparency a big push for this open enrollment season?

Faber: Yes, especially when you consider that standalone imaging facilities are three to eight times less expensive than an in-house hospital facility. Employees need to understand that they will pay 100% of that cost until they meet that deductible in that consumer-driven plan, so there is every effort being made to make sure the employee is checking those transparency tools.

At open enrolment time, we make every effort to employees in the room to ID the nearest urgent care and ER facility, to write those down on a note card and put it in the visor of their car. So, they know at the moment of crisis to know where those places are and make decisions ahead of time.

EBA: Accountants say that from January to April 15, they don't see their families. Is it the same for you during open enrollment?

Faber: (Laughs) I grew up in an accounting family and I can attest to that. It is all hands on deck but our goal is to help clients get their decisions out of the way in Q1 and Q2. We try to help them with decisions that don't require immediacy and don’t have to be made right away, like life and disability insurance, and voluntary and wellness benefits. You can make a lot of those decisions in April, May and June.



Albinus P. (30 October 2017). "Data transparency, debt consolidation and ID protection lead open enrollment wish list" [Web blog post]. Retrieved from address https://www.employeebenefitadviser.com/news/data-transparency-debt-consolidation-and-id-protection-lead-open-enrollment-wish-list-says-hub-international-midwest-coo-jeffrey-faber?feed=00000152-1387-d1cc-a5fa-7fffaf8f0000



8 tips to share with employees to ensure a successful open enrollment

Originally posted on https://ebn.benefitnews.com.

As open enrollment season approaches, benefit managers are moving into high gear as they prepare to answer employee questions and concerns about their 2015 benefits. And as employees take on more responsibility for their health care, it’s more important than ever for them to understand how they can make the most of the programs and benefits their employers are offering.

Here are eight tips from benefits consulting firm Aon Hewitt that benefit managers can share with employees to help ensure open enrollment runs smoothly.

1. Take an active role.

Employers are taking steps to make enrollment quicker and easier. “Many companies are designing the process so it is similar to an online retail shopping experience, where employees can access decision support tools and other resources that can help them narrow down their choices and weigh them against their specific needs,” says Joann Hall Swenson, health engagement leader at Aon Hewitt. “Employers are also stepping up their efforts to clearly communicate what is changing from previous years, using a variety of communication methods.” Encourage employees to take advantage of the resources you provide.

2. Assess your and your dependents’ health care needs.

Understanding their past needs and estimating their future needs will help employees determine what adjustments they may need to make in their benefits selections for 2015. Encourage employees to start by reviewing how much they’ve spent in the past year out-of-pocket, the costs of their regular prescriptions and the number of doctor visits they’ve had. If they are participating in a flexible spending account, encourage them to re-evaluate their contribution levels based on their actual and anticipated expenses for 2015. It’s also important to think about any life changes that may impact their decisions, such as an addition to the family or the development of a new medical condition that may impact health care expenses.

3. Evaluate your plan’s provider network.

Over the past few years, there have been many changes taking place in the provider community, including doctor’s groups joining together and hospitals and health systems re-contracting with insurers. As a result, health plan options may include vastly different combinations of doctors and hospitals than in the past. Most employers and health plans offer a number of tools and resources that can help employees assess the cost impact and quality of different providers as they make their enrollment decisions.

4. Evaluate whether a consumer-driven health plan is right for you.

CDHPs often have lower premiums, which make them an attractive option for individuals who want to reduce the costs taken out of their paychecks each month. While employees may have a higher deductible to meet, many employers couple these plans with health reimbursement accounts or health savings accounts, which employees can use to help pay for eligible out-of-pocket health care costs. HSAs are the most common, and allow employees to save money by contributing, on a pre-tax basis, up to $3,350 in 2015 or $6,650 if they have family coverage, with no use-it-or-lose-it rule. In addition, employers may also contribute to the HSA. It’s important for employees to understand how the employer’s contributions work so they can maximize this subsidy.

5. Determine the best source of coverage for your dependents.

If an employee’s spouse, partner or adult children have access to health coverage elsewhere, including through their employer, it may be more cost effective for them to enroll in this coverage instead of being covered by you. Encourage employees to carefully review and compare these plans to ensure they are choosing the coverage they need at the most favorable cost.

6. Take advantage of health and wellness programs.

Many employers offer a wide range of health and wellness programs, such as health assessments, weight loss programs and health coaching, to help employees get and stay healthy. Taking part in these programs can help employees understand their current health status, and they might even be able to take advantage of a financial incentive for doing so.

7. Understand how your employer coverage works in comparison to ACA exchanges.

2015 will be the second year of coverage available to Americans through the marketplaces, commonly referred to as “public exchanges.” In most cases, individuals with coverage through their employer will not be eligible for federal tax credits for purchase of insurance through the marketplaces. Employees can visit healthcare.gov to learn more about the marketplaces.

8. Take a holistic view of health and financial wellness.

As employees assess their health plan options for 2015, it’s important for them to look holistically at their health and financial well-being, including health care, income protection (e.g., life and disability insurance) and retirement planning. Does their spending reflect their needs and priorities? For example, if they aren’t contributing to your 401(k) plan, remind them that now might be a good time to start. Beginning to save earlier in their careers will help ensure they’re on track to meet their long-term savings goals.




For one year, White House revives health plans canceled under ACA

Originally posted November 14, 2013 by Tristan Lejeune and Brian M. Kalish on https://ebn.benefitnews.com

President Barack Obama announced that Americans whose health care plans have been canceled because they fall short of Affordable Care Act standards have been granted a one-year reprieve. With the decision, state governors and insurance commissioners would have the authority to keep would-be canceled plans active until the end of 2014.

“The Affordable Care Act is going to work for the American people,” Obama said from the White House briefing room in remarks that opened with sympathy and support for the typhoon-ravaged Philippines. Obama acknowledged that his team “fumbled the roll-out of the health care law,” but he hopes that extending existing plans will help win “back the confidence of the American people.”

The decision, which helps live up to a promise Obama made when pushing for passage of health reform, is couched as an administrative fix that says following ACA will not require insurance companies to upgrade their plan for individuals who have been in these existing plans so far. In what the White House is calling “an extension of grandfathering principle” Americans should now all be able to re-enroll in their current coverage so long as it is still offered by their provider.

“Two important things we require from insurance companies,” says the administration, “one is they notify consumers what protections these renewed plans do not include. And two, they notify consumers that they will have new options available on the marketplace that offer better coverage, and tax credits are available for many people.”

Insurers and participants in the individual and small group markets will not be considered noncompliant in these plans next year. This is a policy “targeted and very targeted” to those individuals who are in those policies today, it is not allowing to be sold to people not in plans. IN other words, the policy change only applies to extant plans; all new plans must comply with Obamacare in full.

Next year is an election cycle for 33 senators and the entire House of Representatives. This move will widely be seen as trying to appease voters furious about having their plans canceled after pledges were repeatedly made that exactly that would not happen.

State authorities can still decide to consider plans non-compliant next year and insist insurers get up to speed.

Obama said that Healthcare.gov enrollment is “absolutely not” where he wants it to be, “but there’s no question that there’s great demand for high-quality health care,” and he urged health care consumers not to try to throw out the baby with the bathwater and return to the landscape circa 2009.

“It’s important that we pretend that that’s not a place worth going back to,” Obama said. “And that’s why I will not accept proposals that are just a brazen attempt to overturn the law and go back to a broken system.”

He added: "This fix won't solve every problem for every person but it will help a lot of people. Doing more will require work with Congress."

Make Tax Day Also Enrollment Deadline, One Health Expert Says

Originally posted November 7, 2013 by Julie Appleby on kaiserhealthnews.org

With one small fix, the administration could satisfy calls from some members of Congress to extend the time people have to enroll in new health insurance through online marketplaces, a health policy expert says.

The fix would not create problems in the industry and would move the deadline to a point when many people have a little extra money, says Brian Haile, senior vice president for health policy at tax preparation firm Jackson Hewitt.

Haile says pushing the current March 31 deadline to April 15 would ensure more people have cash from tax refunds to buy insurance – and would not really change the effective date of coverage beyond the current deadline.

That’s because there is a mid-month cutoff for coverage to begin on the first day of the following month. Policies for those who sign up at the end of March or on tax day would be the same: May 1.

While no specific new open enrollment end date has been proposed by lawmakers, several members of Congress of both parties are considering legislation amid the ongoing difficulties with healthcare.gov, the federal insurance website operating in 36 states.

Insurers are generally opposed to an extension, saying they based their premium rates for next year on the idea that the enrollment period would end March 31. Delaying the penalty for not having coverage or extending the open enrollment period could result in higher premiums in the future, the industry’s trade lobby has warned.

Actuaries say that insurers assumed in their premium calculations that most people would sign up by mid-December for coverage to begin Jan. 1, granting them an entire year of premium revenue.

Insurers also are concerned that the problem-plagued federal healthcare.gov website has increased chances that the people who soldier through the hassles of enrolling are likely to be those with costly medical conditions who were shut out of coverage previously. Healthy customers are needed to balance the risk  – and cost — in the insurance pool. Add to that the talk of extending enrollment deadlines, and insurers see more revenue slipping away, eaten up by medical inflation and fewer months to collect premium payments during the year.

Looking at expected medical inflation for next year, every month’s delay probably corresponds to an average of two-thirds of 1 percent  higher cost for the insurers, said David Axene, fellow of the Society of Actuaries. “That starts to creep into the amount of margin built into rates.”

Haile, a former director of the Insurance Exchange Planning Initiative of Tennessee, argues that granting a short enrollment extension could help insurers pick up additional younger or healthier consumers. Some of those customers may have been sitting on the sidelines because they are strapped for extra cash until they get their tax returns.

Insurers “are not going to lose revenue, but will pick up some young invincibles,” Haile said.

Although federal officials are not talking about changing the enrollment period – they see getting the website fixed as the top priority — the administration has moved to resolve an issue about timing. The problem was that even though the law allows the enrollment season to continue until the end of March, anyone purchasing a policy after Feb. 15 would have faced a penalty. So the administration granted an extra six weeks for people to avoid a penalty in 2014 for not having coverage. The tax penalty is $95 or 1 percent of household income, whichever is greater.

Time for Open Enrollment

Originally posted by Susan M. Heathfield October 15, 2013 on https://humanresources.about.com

Open enrollment season is upon us, and as employers, we have an obligation to educate our employees about their benefits. Not just a "nice to," to help employees make good choices for their families, this education also lets employees know what their employer is spending for their benefits above and beyond their base salary. This helps employees understand and appreciate their complete compensation package.

How confused are employees about their benefits?According to Forbes, "How confusing is it? Three-quarters of Americans admit to making mistakes during open enrollment, according to a 2011 Aflac WorkForces Report. Just 40% of employees feel well-informed about the benefits their companies offer, and less than half (46%) feel their HR departments are extremely or very knowledgeable about those benefits, Aflac found."

This is why I have written about how educating employees is critical for their understanding and so they make good choices about coverage for themselves and their family. But, benefits are definitely misunderstood. In one recent study, employees estimated that benefits added 30% to their employer's costs to employ them. In fact, the figure was 43%.

I recommend an annual evening benefits review event, so spouses can attend, that emphasizes the cost of the benefits and how employees can best take advantage of the benefits they have for themselves and their families. You want to promote employee appreciation of their benefits.

What better time to offer such an event as during open enrollment when employees are making changes? Employers are already making insurance representatives available to talk to employees - or they should be - as employers are not benefits experts and should trust professionals that they have vetted. Why not extend an educational opportunity?

To provide the basics about open enrollment and to emphasize some must do areas for employers, I email interviewed Erich Sternberg, president of AlwaysCare Benefits of Baton Rouge, Louisiana. Take a look at our interview for a concise overview of open enrollment. Additionally, Erich supplies a list of steps he recommends every employee take during open enrollment.

Additional information about open enrollment is available from About.com's Michael Bihari, MD.


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.

Open Enrollment Tips Under Health Care Reform

Originally posted September 6, 2013 on https://www.thestreet.com

This year's open enrollment season for selecting workplace benefits comes just before some of the biggest changes of health care reform go into effect.

Never before has it been more important to pay attention as you choose a health plan for you and your family.

"You really need to do your homework this year," says Carol Taylor, an employee benefit adviser with D & S Agency Inc. in Roanoke, Va.

Here are 5 tips for open enrollment this fall.

1. Understand the health care reform individual mandate: You must have coverage.

Starting in 2014, federal law will require virtually everyone to have health insurance or face a tax penalty. So if your employer doesn't offer health insurance for next year or your company's health plan doesn't meet certain minimum standards, you'll need to shop for health insurance on your own. Your employer must let you know by Oct. 1 whether its health plan meets "minimum standards," says Taylor, a member of the National Association of Health Underwriters National Legislative Council.

To meet the minimum standards under health reform, employers must offer coverage at the "bronze level," which is one of the four levels of coverage defined under health reform provisions. The other three are silver, gold and platinum. They are based on actuarial value, which measures the amount of financial protection the policy offers, or the percentage of health costs a plan would pay for an average person. For a bronze plan, the insurance would cover 60 percent of all health care costs for an average person. Enrollees, on average, would be responsible for paying 40 percent of the costs.

If you're shopping for an individual health plan, you can buy one from an insurance company directly or through your state's new health insurance marketplace. The online health insurance marketplaces, sometimes called exchanges, are scheduled to open for business Oct. 1. Coverage can begin Jan. 1.

If you're not eligible for coverage through an employer or your employer's plan doesn't meet government standards, then you might qualify for a tax credit to save money on premiums when you buy a marketplace plan. People who earn up to 400 percent of the federal poverty level -- that's $94,200 for a family of four in 2013 -- will be eligible for premium subsidies in the form of tax credits. People who earn up to 250 percent of the federal poverty level will be eligible for lower deductibles and copayments.

2. Don't assume your family will qualify to save money in the new marketplaces.

Think you can get a better deal in the new marketplace than what your employer is offering? Maybe not. If you and your family have access to affordable employer-sponsored health insurance that meets minimum standards, then you and your dependents are not eligible for premium tax credits or help with cost-sharing - which includes aid in paying deductibles, copayments or co-insurance -- in the new marketplaces. You can shop there, but you'll pay full price.

"Affordable" means you pay no more than 9.5 percent of your household income toward the coverage for yourself. The amount you pay for your dependents to be covered on the employer-sponsored plan isn't factored into the equation. So even if you have to pay a bundle to keep your dependents on the employer plan, they're still not eligible for subsidies in the marketplace if the portion you pay to cover yourself is deemed affordable and they have access to the employer plan.

That could put a lot of moderate-income families with a sole breadwinner in a financial bind, says Mindy Anderson-Wallis, president of Employee Benefit Solutions of Indiana in Lafayette, Ind.

3. Compare benefits and health insurance plan networks.

Check out the provider networks of the plans you're offered to make sure your doctors and preferred hospital system are included, especially if you have a serious or chronic condition and are undergoing treatment. Given all the standards that must be met, one way health plans may cut costs is to cut the provider networks, Taylor warns.

You pay substantially more out of pocket to see providers outside the network with a preferred provider organization (PPO) plan. Except in special circumstances, you typically pay for the full cost of services for providers outside the network with a health maintenance organization (HMO) plan.

4. Understand that your employer doesn't have to offer coverage in 2014, and it won't have to offer coverage to your spouse.

Starting in 2015, the Patient Protection and Affordable Care Act will require employers with at least 50 workers to provide affordable health insurance for workers and their dependents or pay a penalty. The so-called employer mandate was supposed to go into effect in 2014, but the Obama administration delayed implementation for a year.

Still, most employers are gearing up for the mandate, and there's one tricky technicality you should know. The federal government will define dependents as children, not spouses. So even when the employer mandate goes into effect, your workplace won't have to offer coverage to your spouse.

Nobody knows yet how this will play out, but Anderson-Wallis says she doesn't think the definition of "dependent" will have much impact.

"I don't think we'll see large employers not continue to cover spouses," she says. "Benefits are seen as a way to attract and retain employees."

If your spouse isn't eligible for employer-sponsored coverage, then he or she will qualify for a tax credit to save money on a health plan in the new marketplace if your household income is less than 400 percent of the federal poverty level.

5. Crunch the numbers and pick the health insurance plan with the best value.

Compare the out-of-pocket costs of each health plan if your employer offers a choice of plans. Your costs include:

  • Deductible.
  • Doctor visits, urgent care and emergency room copayments.
  • Co-insurance -- the percentage the health plan pays after you satisfy the deductible.
  • Prescription drug copayments or co-insurance.
  • Your portion of the premium.

Consider how often you go to the doctor, the medicines you take and what services you might need in the next year. Run some scenarios to see how much each health plan would cost, and choose one that meets your unique needs.

"Don't just roll the dice without calculating," Anderson-Wallis says.

9 items to tackle ahead of the Oct. 1 deadline

Originally posted September 6, 2013 by Dan Cook on https://www.benefitspro.com

Enrolling employees for the 2014 company health plan will put plan managers to a test like they’ve never seen before. Those that haven’t already immersed themselves in the details are going to be working some very late nights in the next couple of weeks.

John Haslinger, vice president for strategic advisory services at ADP, helped BenefitsPro.com compile a list of the essentials that must be executed in order to comply with the law and avoid sanctions.

Haslinger strongly advises that companies take these requirements seriously. He said the government’s decision to delay the corporate plan sanctions piece of the PPACA until 2015 doesn’t let anyone off the hook as far as meeting all the other requirements by Jan. 1. And many items must be completed by Oct. 1.

Here, then, are nine items you need to check off your 2014 checklist to stay out of the PPACA’s woodshed.

1. Notice of coverage or exchange notification: It’s up to employers to notify every employee, covered by a company health plan or not, of the health care options available to them through the insurance exchanges created by the Patient Protection and Affordable Care Act. This notification must be in an employee’s hands no later than Oct. 1. Employers hired after Oct. 1 have to be notified within 14 days.

Suggestion:  If you haven’t started this process, hire a third-party administrator with knowledge of the process to do it for you.

2. The Transitional Reinsurance Fee: This is the $63-per-covered-employee fee that plan sponsors and insurers must pay. The money goes to fund insurance for high-risk individuals. Employers and insurers have to report their enrollment numbers to the feds by Nov. 15. You’ll get an invoice back in a month, if all goes as planned, and the bill will come due a month later.

Suggestion: Set aside a good chunk of dough now to cover the cost.

3. Essential health benefits: This section of the PPACA requires non-grandfathered health plans to cover 10 essential health benefits as follows:

(1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services;(9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care.

For newly hired full-time employees who come on board after Jan. 1, coverage must be made available no longer than 90 days after hire.

Suggestion: State EHBs may vary, so make sure you know the requirements where you live.

4. Defining and counting your eligible full-time employees: The PPACA has redefined full-time employees for purposes of healthcare coverage. Now, employers must offer coverage to anyone who works an average of 30 hours a week. Calculating the 30 hours can be tricky, so you need to know the details. For instance, hours an employee is paid to work aren’t the only ones you count. You need to include the hours you pay someone not to work, such as vacation time, and hours of unpaid leave, such as jury duty. Having a good fix on who your eligible employees will be come Jan. 1 is critical to meeting the requirements of the law. To provide good data to the feds when they ask for it in 2015, employers will have to start tracking hours beginning this Oct. 1.

Suggestion: If you have put this exercise off because of the delay for sanctions until 2015, start counting now. You’ll need data from 10/1/13. Just because you don’t face sanctions doesn’t mean it isn’t essential to have a handle on this number.

5. 90-day waiting period: Under the PPACA, a group health plan or health insurance issuer offering group health insurance coverage must offer health coverage to new employees within 90 days of their hiring. No more “we’ll get you covered if you survive six months here.”

Suggestion: You might want to test potential hires out as contractors to make sure they’re a fit before you’re committed to coverage after 90 days.

6. Preventive services must be offered without cost-sharing: This requires group health plans to cover recommended preventive services without charging a deductible or co-pay/coinsurance. Grandfathered plans are generally excluded from complying with this provision. Among these services are immunization, well-woman visits, screening for gestational diabetes, screening for sexually transmitted diseases, well baby visits, and others.

Suggestion: If your benefits package includes a wellness program, you’ve got more assignments to complete before Oct.1. The idea behind these new rules is that all employees, regardless of their physical condition, should be able to meet the incentives built into wellness programs. Among the requirements:

7. Reasonable accommodations: Some employees, for various reasons, cannot meet the requirements established by wellness programs, so there must be options available for them built into the system.

8. The program must be designed to promote health or prevent disease: Wellness program goals must be tied to direct health benefits. Also, the goals established must not be “overly burdensome.”

9. Rewards must be available to all similarly situated employees: Again, because employees present a range of medical conditions, including some that may thwart them from achieving a reward, the conditions present in a given workplace have to be considered when designing the incentives and goals. Notice must be given to these employees of the options available to them.

Suggestion: Have a wellness program professional review your program to make sure that it is fair to all, truly promotes better health and includes incentives that any employee making a reasonable effort can hope to enjoy.