Non-Conforming ACA Plans

With Health Care Reform in full swing beginning January 1, 2014, there will be many changes for employers who offer health insurance plans.  One of the requirements is that health insurance plans themselves have to meet certain ACA plan standards in order to be offered to the public.  If the health insurance plans are not able to meet the minimum requirements to be ACA compliant, these plans will no longer be offered by the health insurance carriers.  However, the Federal government has allowed the health insurance carriers to offer these non-conforming plans in 2014, but the Federal government has left it up to each State to decide if they would allow these plans to be offered in 2014.

Massachusetts has decided not to allow non-conforming health insurance plans to be offered beginning in 2014.  Therefore, Massachusetts will conform to make sure all of its health insurance plans meet the minimum ACA requirements set forth by the Federal government.  Health insurance carriers will no longer be offering health plans that do not meet these requirements.  Members can be assured beginning in 2014, their health plans will be ACA compliant. 

The health insurance companies have begun to make these ACA changes at the plan's renewal for companies with non-conforming health plans.  If you have questions regarding your health insurance plan, please feel free to contact our office.  Thank you and have a wonderful day!

Provision Changes to Flexible Spending Accounts

Last week, the Department of Treasury changed the provisions within the Flexible Spending Account regulations to allow participants to roll over a certain amount of unused funds at the end of the FSA's plan year.  The new regulation will affect current employers who offer Flexible Spending Accounts plans and for new Flexible Spending Account plans that are established in 2014.

Currently, participants who do not spend the full amount elected will lose any remaining dollars at the end of the plan year.  With the new provision, participants will be able to have up to $500 carried over into the following year's Flexible Spending Account plan year.  This provision is only permitted as long as the employer's plan does not incorporate an Extension Grace Period of more than two and a half month's.  For employer's who will begin to offer a Flexible Spending Account as a new benefit in 2014, this new regulation will allow them to carry over unused funds at the end of the FSA's plan year.

Adopting this plan provision requires a change to the current Plan Document and specific communications to employees.  If you have any questions regarding implementing this provision or the documentation requirements, please contact our office.

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Employer Notice Regarding Health Insurance Exchanges

Under the Patient Protection and Affordable Care Act (PPACA), health benefit exchanges will be operational on Jan. 1, 2014. PPACA requires employers to provide a notice to all benefits eligible employees prior to the beginning date of the exchange.

The notice informs employees about the existence of the health benefits exchange and gives a description of the services provided by the exchange. The notice also explains how the employee may be eligible for a premium tax credit or a cost-sharing reduction if the employer's plan does not meet certain requirements. The notice informs employees that if they purchase a qualified health plan through the exchange, they may lose any employer contribution toward the cost of employer-provided coverage, and that all or a portion of the employer contribution to employer-provided coverage may be excludable for federal income tax purposes. Lastly, the notice includes contact information for customer service resources within the exchange, and an explanation of appeal rights.  The notification requirement will take effect on October 1, 2013.  Employers who do not provide this notice to eligible employees by October 1^st will not be assessed a penalty but compliance is strongly encouraged.

Employers will need to provide new employees the notice within 14 days of their start date.  For current employees, employers will need to provide the notice to their employees no later than October 1, 2013.  For employees who may be electing COBRA, employers must also provide the notice with their COBRA letter as well.

Earlier this year, the Department of Labor provided employers with sample “Notices” to use if their company offered health insurance or if they did not offer health insurance.  Employers will be able to use this sample “Notice” until the Department of Labor creates a final version “Notice” for all employers to use.  Please click here to view the sample “Notice”.  Employers can click here to review the guidelines regarding the exchange notice.  If your company does not offer health insurance, please click here to view the “Notice” you have to provide to your employee population.

The notice must be provided in writing to all benefits eligible employees.  Alternatively, it may be provided electronically if the requirements of the DOL's electronic disclosure safe harbor at 29 CFR 2520.104b-1(c) are met.

If your company has any questions regarding these “Notices” or has general questions regarding the new Health Care Reform laws, please feel free to contact Ipswich Bay Advisors at our offices at 978.777.6554.

Thank you.

Medicare Part D Credible Coverage

All employers who provide health insurance coverage to their employees must provide a notice of Credible Coverage to all Medicare eligible employees.  The notice is to inform these employees the prescription drug benefit that is provided through the company’s health insurance plan is equivalent to or superior to the Standard Medicare Part D plan.  If a company’s prescription drug plan does not meet the credible coverage requirements, employers must still provide a notice to the eligible employees stating their plan does not meet this minimum requirement.  Employers must provide each Medicare eligible employee with this notice once a year.  The notice must also be provided to the dependents of the eligible Medicare employee.  The Centers for Medicare & Medicaid Services has provided employers with a template notice to use as guidance when generating these notices.  Please click here to view the sample notice provided by the Centers of Medicare & Medicaid Services for credible coverage.  If your company’s prescription drug benefit does not meet the minimum credible coverage, please click here for the Non-Credible Coverage Model Notice.

The last requirement employers are responsible for is to complete an online questionnaire provided by the Centers for Medicare & Medicaid Services.  This questionnaire will inform CMS if your company’s prescription drug benefit is credible or non-credible.  Employers should complete the online questionnaire roughly 60 days before their health insurance plan renews or is effective.  The questionnaire should also be completed if the plan is terminated or if there is any status change.  For these situations, the questionnaire should be completed in 30 days after the termination or status change.  Please click here to view the questionnaire employers are required to complete.

For more information regarding the distribution & completion of the Medicare Part D Credible Coverage Notice, please contact our office.

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Health Care Reform Simplified: Educating Employees

Beginning January 1, 2014, the rules and regulations of health care reform will be in full force.  Many employers are still trying to figure out how these new regulations will impact their company and their employees.  The rules and regulations associated with health care reform are confusing and are constantly being revised and implemented.  And not all employers have the time to focus all of their efforts on health care reform and its impact.  Thankfully, the Kaiser Family Foundation has made learning about health care reform simple.

The Kaiser Family Foundation identified the main components of health care reform and has explained them in a fun, animated presentation video.  By doing this, it will help employers and employees understand exactly what health care reform is, who is funding this reform, & how it will affect employees and employers.  The information provided is interactive and comical and will surely keep the viewer engaged in the presentation.  To view the animated presentation provided by the Kaiser Family Foundation, please click here.   This video is a great tool to provide employees information about health care reform. 

If your company has any questions regarding the upcoming regulations proposed by health care reform, please contact our office at (978)-777-6554.

Thank you.

Medical Loss Ratio (MLR) Rebates

Your company may have recently received information from your health insurance carrier regarding a Medical Loss Ratio Rebate.  As part of the Health Care Reform legislation it requires a certain percentage of the employers premiums go towards medical claims versus administration expenses.  In addition, Massachusetts has its own regulations and for small groups in Massachusetts it is 90%.  Your company may be entitled to a rebate check if your health insurance carrier contributed less than 90% of your group’s premium toward medical claims.   

There are two different ways the employer may use the refund.  The employer may keep the amount given to them and use it toward future premium costs.  Or the employer may give the refund back to the employees.  The health insurance carriers have begun to mail out the rebate checks to Massachusetts employers.  If you are unsure of how to distribute the refund, please visit the link below to the Department of Labor’s website for additional information.  Please visit “The Best Bottom Line” to remain up to date on health care reform as well as other HR related topics.  Please feel free to contact our office at (978)-777-6554 with any questions you may have.

http://www.dol.gov/ebsa/newsroom/tr11-04.html.

Thank You.

Repeal of Massachusetts Fair Share Contribution

On July 12, 2013, Governor Deval Patrick signed the 2013/2014 Massachusetts budget that includes the repeal of the Massachusetts Fair Share Contribution for employers.  This announcement from the Governor comes only a week after President Obama delayed the implementation of the Employer Mandate until 2015.  The Massachusetts Fair Share Contribution penalizes employers with 11 or more employees who do not comply with the state’s regulation to provide their employees with an affordable health insurance plan.  If employers did not offer their employees an affordable plan then employers would be subject to a fine of $295 per employee on an annual basis. 

The Patrick Administration felt that the repeal of the Massachusetts Fair Share Contribution will coincide with the Federal Employer Mandate regulation even though it will not take effect until 2015.  To remain up to date with the most recent health care reform regulations, please visit our blog The Best Bottom Line”.  If you have any questions about health care reform or the most recent Supreme Court rulings and how they may pertain to your company, please contact our office at 978.777.6554.

Thank you.

Implementation Delay for Employer Mandate & Update on Supreme Court Rulings

The White House Administration announced on July 2, 2013, that they would be delaying the Employer Mandate portion of Healthcare Reform legislation until 2015.  The Employer Mandate requires employers with 50 or more full-time or full-time equivalent employees to offer a health insurance plan to employees that is affordable and meets the minimum actuarial value established by the Federal government.  Employers that do not comply with this regulation will be subject to fines and penalties.  A key component of the regulation is additional reporting requirements to the government by employers.  The government has acknowledged the complexity of these reporting requirements for employers and has decided to delay the implementation for one year.  The government hopes to provide employers with further guidance sometime this summer. This announcement leaves unchanged other provisions of the law such as the individual mandate which requires most Americans to carry health insurance.  Employees will still be allowed to buy their own health insurance through a state exchange; with the only change being that their employers won't be penalized next year if they do so.

Another important ruling was handed down by the U.S. Supreme Court on June 26, 2013.  This ruling identifies Section 3 of the Defense of Marriage Act to be unconstitutional.  Section 3 did not permit the marriage between two individuals of the same gender.  Same-sex marriages were recognized as legal by 12 states and the District of Columbia at the time of the ruling.  The decision does not force same-sex marriage on the states, which choose not to recognize same-sex marriage.  The impact of the ruling on employee benefit plans is significant.

For employer’s who operate in a state that currently allows or acknowledges same sex marriage, the following rules will apply. 

• Employers who offer a benefits program must not discriminate between spouses of the same sex or spouses of the opposite sex in regards to the benefits that are offered.  Spouses of the same sex are now entitled to the same benefits. 
• Employees and their spouse who participate in their company’s Section 125 plan are now eligible to receive their spouse’s contribution on a pre-tax basis.  
• Employers will now be responsible to offer continuation of coverage (COBRA) to an eligible spouse. 
• The same sex spouse will also now be entitled to their partner’s 401(k) benefit if he or she should happen to pass away. 
• Employees must be permitted to take family and medical leave to care for an ill same-sex spouse.

The healthcare and benefits industry will be constantly changing over the next several months.  To make sure your company is up to date with the latest rulings and regulations, please visit our Best Bottom Line articles for the most up to date information.  Please feel free to contact our office as well with any questions regarding these two significant announcements.

Thank you.

Employer Notice Regarding Health Insurance Exchanges

Under the Patient Protection and Affordable Care Act (PPACA), health benefit exchanges will be operational on Jan. 1, 2014. PPACA requires employers to provide a notice to all benefits eligible employees prior to the beginning date of the exchange.

The notice informs employees about the existence of the health benefits exchange and gives a description of the services provided by the exchange. The notice also explains how the employee may be eligible for a premium tax credit or a cost-sharing reduction if the employer's plan does not meet certain requirements. The notice informs employees that if they purchase a qualified health plan through the exchange, they may lose any employer contribution toward the cost of employer-provided coverage, and that all or a portion of the employer contribution to employer-provided coverage may be excludable for federal income tax purposes. Lastly, the notice includes contact information for customer service resources within the exchange, and an explanation of appeal rights.  The notification requirement will take effect on October 1, 2013 and penalties apply for noncompliance.

Employers will need to provide new employees the notice within 14 days of their start date.  For current employees, employers will need to provide the notice to their employees no later than October 1, 2013.  For employees who may be electing COBRA, employers must also provide the notice with their COBRA letter as well.

Earlier this year, the Department of Labor provided employers with sample “Notices” to use if their company offered health insurance or if they did not offer health insurance.  Employers will be able to use this sample “Notice” until the Department of Labor creates a final version “Notice” for all employers to use.  Please click here to view the sample “Notice”.  Employers can click here to review the guidelines regarding the exchange notice.  If your company does not offer health insurance, please click here to view the “Notice” you have to provide to your employee population.

The notice must be provided in writing to all benefits eligible employees.  Alternatively, it may be provided electronically if the requirements of the DOL's electronic disclosure safe harbor at 29 CFR 2520.104b-1(c) are met.

If your company has any questions regarding these “Notices” or has general questions regarding the new Health Care Reform laws, please feel free to contact Ipswich Bay Advisors at our offices at 978.777.6554.

Thank you.

How To Obtain and Use A Referral With Your HMO Health Insurance Plan

Medical procedures and services can be expensive especially if your doctor is not contracted with your health insurance carrier.  With all the changes in health care plan options, employees sometimes get stuck with medical expenses because they did not follow the rules of the HMO plan.  Here is a great refresher for using the referral services of the HMO plan.

Knowing your health insurance plan and which providers you can and cannot see is a great way to keep your medical costs down.  If you are currently enrolled in a HMO plan, you are required to select a primary care provider.  A primary care provider is a doctor who you will see for your annual physical, sick visits, or any injuries you may have throughout the year.  Your primary care provider is the one who will determine if your illness or injury is severe enough that it would require you to see a specialist.

In a HMO plan, you cannot see a specialist without a referral from your primary care provider.  If you went to a specialist without a referral, you would be responsible for the full cost of the appointment.  If your primary care provider determines you need to see a specialist, he or she will refer you to a specialist who is in the network.  By referring you to a specialist who is in the network, this allows you to only be responsible for a small copayment for the appointment.  Typically, the primary care provider is responsible for coordinating the referral with the health insurance company and the referring doctor.  Members who are new to HMO plans may think they can go to any doctor they want.  However, if they choose a doctor who is not in the network or receive care from a specialist without a referral, they will responsible for the full cost of the appointment or procedure.

To learn more about HMO plans & referrals and how they work, feel free to contact our office at (978)-777-6554.

Thank you.

Form I-9 Revised

There was a new Employment Eligibility Verification Form I-9 form made available to employers on Friday, March, 8 2013.  For companies that will be hiring new employees, the new Form I-9 should be used during the hiring process.  If an employer plans on rehiring any former employees, the employer must use the revised Form I-9 as well.  The new Form I-9 will be coded in the bottom right hand corner of the document.  To verify you have the most up to date Form I-9, please make sure the code being used is (Rev. 03/08/13)N.

There are several differences between the revised Form I-9 and the old one.  The new revised Form I-9 provides the new hire with more detailed and in depth instructions.  Unlike the old I-9 forms, the new form is compiled into two pages with added fields for the new hire to enter in his or her e-mail address and phone number.  Employers will still be allowed to use the old I-9 forms which are coded as (Rev. 08/07/09Y or 02/02/09N).  Employers will only be able to use these old forms until Tuesday, May 7, 2013.  After this date, employers will have to transition to the new revised I-9 forms.

If you have not obtained a copy of the revised Form I-9, please visit the U.S. Citizens and Immigration Services website.  Once you are at this website, please click the I-9 central link which is located under the Verification tab on the right hand side of the website.  For any questions regarding the new Form I-9, please contact Ipswich Bay Advisors at (978)-777-6554.

Thank you. 

2013 Massachusetts Insurance Mandates

Massachusetts appears to be ahead of the pack when it comes to health care reform compared to some other states across the U.S.  Massachusetts has already implemented health insurance exchanges and cooperatives which allow individuals to shop for more affordable health care.  Roughly around 98% of the population in Massachusetts is covered under a health insurance plan.  This percentage is among the nations highest which allows our state to be a model for all the other states.  Recently, Massachusetts has also passed into law these new health insurance mandates which will take effect in January 2013.

Coverage for Hearing Aids

Children who are affected by hearing loss or hearing impairments will be relieved to know health insurance carriers must provide coverage for their hearing aids.  Insurance carriers must provide up to $2,000 in coverage to go towards a single hearing aid or any services associated with obtaining a hearing aid.  If a family meets the $2,000 maximum, they will have to wait 3 years for this amount to reset.  This new benefit will be available for any individual who is younger than 21 years of age.

Cleft Lip/Palate Treatment

Health insurance carriers are required to cover certain services for children who are affected by a cleft lip or cleft palate.  Some services that will now be covered are restorative dental and medical surgeries as well as speech therapy.  Coverage will be provided for any child who is under the age of 18.  Please check with your health or dental insurance carrier to see what services or procedures would be covered.

Physician Assistant’s

When health insurance members have to go see their primary care provider for any services or procedures, they will now have the opportunity to have these procedures covered by the doctor’s physician assistant.  Health insurance carriers are now required to consider physician assistants equal to a primary care provider.

Coverage for Birth Control

For employer sponsored health insurance plans that renew on or after August 1, 2012 some birth control methods will be covered at 100% with no copayment to the member.  This new regulation is part of the Affordable Care Act and Health Care Reform.  To see if your birth control method is covered at no cost to you, please call your health insurance carrier member service team on the back of your ID card.

If you have any questions regarding these new state mandates, please contact our office at (978)-777-6554.

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