August 28, 2014
By Peter Freska, CEBS, Advisor
The LBL Group
A United Benefit Advisors Partner Firm
I have sat with hundreds of employers that want to make a difference. They want to make a difference in how their teams work, how productive the employees are, and better yet…in how they, as an employer, can attract, retain and engage the best and brightest people for long-term sustainable (profitable) growth of the organization. But many companies fall short. And, while most employees are 100% engaged when they start a new job, a recent Dale Carnegie Training study indicated that only 29% are fully engaged. In another article entitled “Overcoming Employee Disengagement,” the author mentions that the “2013 RAND Health Study found that less than half of employees (46%) participate in health risk assessment (HRA) or clinical screenings, and out of those identified as needing a wellness program, less than one fifth chose to participate.” (August 2014, Benefits Magazine) The point of the article was simple, that people create their own barriers to success.
August 25, 2014
No matter who you are, no matter where, the Affordable Care Act, one of the largest pieces of legislation in recent history, will affect you…and not always in ways you can foresee, and not always in ways that give creaence to what the ACA is meant to do.
First, it is about access and not affordability – individual applicants will be able to get coverage without concern about existing medical conditions, nor waiting periods once they are covered.
Second, it is about insurance and not medical care – many of the rules imposed on carriers have changed, but not the rules on how health care will be provided.
Third, there is an act – played out in various scenarios and requiring action on everyone’s part: individuals who are required to have coverage, large employers who must provide coverage, carriers and the health care industry who pay new taxes, and taxes on the rich, taxes on the middle class, and the payment of higher costs in nearly all cases.
July 24, 2014
On July 22, 2014 two Courts of Appeals issued decisions that address whether only people who live in states that have state-run Marketplaces (which are also called exchanges) are eligible to receive premium tax credits or subsidies under the Patient Protection and Affordable Care Act (PPACA). One court held that the subsidy should only be available to people covered by state-run Marketplaces, and the other ruled that people should be eligible for subsidies regardless what type of Marketplace their state has.
The IRS is responsible for implementing and interpreting the premium subsidies part of the law. It has ruled that all eligible individuals are entitled to a subsidy regardless whether they live in a state that has a state-run Marketplace or a federally-run Marketplace. The basic issue in these cases is whether the IRS is bound by one sentence in PPACA, which says that a taxpayer “enrolled through an exchange established by a State” is subsidy-eligible, so that only a person enrolled in a state-run Marketplace is eligible for a premium subsidy, or whether the IRS had the authority to look at PPACA as a whole and conclude that it would not make sense to limit subsidies to people in state-run Marketplaces, and therefore interpret the law to mean a person enrolled in any Marketplace is subsidy-eligible.
July 2, 2014
On June 30, 2014 the U.S. Supreme Court issued a decision in a case generally referred to as the Hobby Lobby case. Hobby Lobby is a family-owned for-profit corporation. The family that owns Hobby Lobby strongly believes that it would violate their deeply held religious values and obligations to provide coverage for four of the types of contraception that non-grandfathered plans must cover as preventive care. (The four drugs — two types of IUDs and two types of “morning after pills” — operate in a manner that violates their belief that life begins at conception.) Hobby Lobby sued HHS on the basis that the requirement to cover these contraceptives violates the Religious Freedom Restoration Act of 1993. The Court held that:
- Because Hobby Lobby is closely held it can have religious beliefs even though it is a corporation.
- HHS can achieve its aim of providing no-cost contraception to employees and dependents in another, less intrusive, way, such as by directly covering these costs for employees who work for companies with religious objections to covering them, or by using a certification of religious objection similar to the process currently being used for non-profit religious organizations.
As is often the case with Supreme Court opinions, the next steps have not been specified.
May 27, 2014
To meet federal requirements, large health plans must obtain a national health plan identifier number (HPID) by November 5, 2014. For this requirement, a large health plan is one with more than $5 million in annual receipts. The Department of Health and Human Services (HHS) has said that since health plans don’t have receipts, insured plans should look at premiums for the prior plan year and self-funded plans should look at claims paid for the prior plan year. Small health plans have until November 5, 2015, to obtain an HPID.
Although this requirement applies to all health plans, as a practical matter the insurer will obtain the identifier number for fully insured plans. All self-funded plans will need to obtain the number, even if they use a third party administrator (TPA) to pay claims.
What is an HPID?
An HPID is an all-numeric, 10-digit identifier that will be used as the plan’s unique identification number for all HIPAA-covered transactions.
Why must health plans obtain an HPID?
One of the goals of the Health Insurance Portability and Accountability Act (HIPAA) is to pay claims more efficiently. Efficient electronic processing requires standardization, and the HPID requirement is part of that standardization and automation effort. Plans will be required to use HPIDs in specified HIPAA standard transactions by November 7, 2016.
April 11, 2014
Tacked into the Medicare provider payment fix bill was a repeal provision that removed the $2,000 single deductible maximum. The bill passed the U.S. House of Representatives in late March, passed the U.S. Senate on March 31 and was signed into law on April 1.
While small group plans were operating under a waiver program from the Department of Health and Human Services (HHS) with respect to the deductible limit, the waiver was only valid until 2016. At that time, the small group definition expands from two to 50 full-time equivalent employees to two to 100 full-time equivalent employees. Originally, the waiver was only for bronze level plans, as it was quite difficult to get to the actuarial value level with that low of a deductible. Some state insurance commissioners however, allowed it for plans other than those at the bronze level.
What does this mean for employers? Immediately, smaller employers will see no change. Insurance carriers must file their new plans and rates well in advance, so we may not see changes for at least a year on the benefit plans where the insurance commissioners took the HHS waiver verbatim.
Groups in the 50 to 100 full-time equivalent market will not see any changes, at least until 2016 when several market reforms will be applicable. These include limiting plan choice to the metal levels (Bronze, Silver, Gold, and Platinum), coverage of Essential Health Benefits (EHBs), age ratio limitations on premiums, and pediatric dental and vision mandates.
The best news from this will be the flexibility it will allow employers to have higher deductible plans, so they can utilize Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs), not only to save premium dollars, but to help employees and their families with the higher deductibles.
April 8, 2014
In order for the Internal Revenue Service (IRS) to verify that individuals and employers are meeting their shared responsibility obligations and that individuals who request premium tax credits are entitled to them, employers and issuers will be required to provide reporting on the health coverage they offer. The reporting requirements are in two separate sections of the Patient Protection and Affordable Care Act (PPACA) — sections 6055 and 6056. Reporting will first be due early in 2016, based on coverage in 2015.
On March 10, 2014, the IRS published final regulations implementing this reporting requirement. However, the actual forms that will be used for this reporting have not yet been provided. A number of details will not be available until the reporting forms and instructions are released. The IRS says that a draft of the forms and instructions will be available soon.