On October 12, 2017, the White House released an Executive Order, signed by President Trump, titled “Promoting Healthcare Choice and Competition Across the United States.”

It is important to note that the Executive Order (EO) does not implement any new laws or regulations, but instead directs various federal agencies to explore options relating to association health plans, short term limited-duration coverage (STLDI), and health reimbursement arrangements (HRAs), within the next 60 to 120 days.

The Department of Labor is ordered to explore expansion of association health plans (AHPs) by broadening the scope of ERISA to allow employers within the same line of business across the country to join together in a group health plan. The EO notes employers will not be permitted to exclude employees from an AHP or develop premiums based on health conditions. The Secretary of Labor has 60 days to consider proposing regulations or revising guidance.

Practically speaking, this type of expansion would require considerable effort with all state departments of insurance and key stakeholders across the industry. Employers should not wait to make group health plan decisions based on the EO, as it will take time for even proposed regulations to be developed.

The Department of the Treasury, Department of Labor, and Department of Health and Human Services (the agencies) are directed to consider expanding coverage options from STLDI, which are often much less expensive than Marketplace plans or employer plans. These plans are popular with individuals who are in and outside of the country or who are between jobs. The Secretaries of these agencies have 60 days to consider proposing regulations or revising guidance.

Finally, the EO directs the same three agencies to review and consider changing regulations for HRAs so employers have more flexibility when implementing them for employees. This could lead to an expanded use of HRA dollars for employees, such as for premiums. However, employers should not make any changes to existing HRAs until regulations are issued at a later date. The Secretaries have 120 days to consider proposing regulations or revising guidance.

By Danielle Capilla
Originally Published By United Benefit Advisors

Are you an employer that offers or provides group health coverage to your workers? Does your health plan cover outpatient prescription drugs—either as a medical claim or through a card system? If so, be sure to distribute your plan’s Medicare Part D notice before October 15.

Purpose
Medicare began offering “Part D” plans—optional prescription drug benefit plans sold by private insurance companies and HMOs—to Medicare beneficiaries many years ago. Persons may enroll in a Part D plan when they first become eligible for Medicare. If they wait too long, a “late enrollment” penalty amount is permanently added to the Part D plan premium cost when they do enroll. There is an exception, though, for individuals who are covered under an employer’s group health plan that provides “creditable” coverage. (“Creditable” means that group plan’s drug benefits are actuarially equivalent or better than the benefits required in a Part D plan.) In that case, the individual can delay enrolling for a Part D plan while he or she remains covered under the employer’s creditable plan. Medicare will waive the late enrollment premium penalty for individuals who enroll in a Part D plan after their initial eligibility date if they were covered by an employer’s creditable plan. To avoid the late enrollment penalty, there cannot be a gap longer than 62 days between the group plan and the Part D plan.

To help Medicare-eligible persons make informed decisions about whether and when to enroll in a Part D drug plan, they need to know if their employer’s group health plan provides creditable or noncreditable prescription drug coverage. That is the purpose of the federal requirement for employers to provide an annual notice (Employer’s Medicare Part D Notice) to all Medicare-eligible employees and spouses.

Employer Requirements

Federal law requires all employers that offer group health coverage including any outpatient prescription drug benefits to provide an annual notice to plan participants. The notice requirement applies regardless of the employer’s size or whether the group plan is insured or self-funded:

  • Determine whether your group health plan’s prescription drug coverage is “creditable” or “noncreditable” for the upcoming year (2018). If your plan is insured, the carrier/HMO will confirm “creditable” or “noncreditable” status. Keep a copy of the written confirmation for your records. For self-funded plans, the plan actuary will determine the plan’s status using guidance provided by the Centers for Medicare and Medicaid Services (CMS).
  • Distribute a Notice of Creditable Coverage or a Notice of Noncreditable Coverage, as applicable, to all group health plan participants who are or may become eligible for Medicare in the next year. “Participants” include covered employees and retirees (and spouses) and COBRA enrollees. Employers often do not know whether a particular participant may be eligible for Medicare due to age or disability. For convenience, many employers decide to distribute their notice to all participants regardless of Medicare status.
  • Notices must be distributed at least annually before October 15. Medicare holds its Part D enrollment period each year from October 15 to December 7, which is why it is important for group health plan participants to receive their employer’s notice before October 15.
  • Notices also may be required after October 15 for new enrollees and/or if the plan’s creditable versus noncreditable status changes.

Preparing the Notice(s)
Model notices are available on the CMS website. Start with the model notice and then fill in the blanks and variable items as needed for each group health plan. There are two versions: Notice of Creditable Coverage or Notice of Noncreditable Coverage and each is available in English and Spanish:

Employers who offer multiple group health plans options, such as PPOs, HDHPs, and HMOs, may use one notice if all options are creditable (or all are noncreditable). In this case, it is advisable to list the names of the various plan options so it is clear for the reader. Conversely, employers that offer a creditable plan and a noncreditable plan, such as a creditable HMO and a noncreditable HDHP, will need to prepare separate notices for the different plan participants.

Distributing the Notice(s)
You may distribute the notice by first-class mail to the employee’s home or work address. A separate notice for the employee’s spouse or family members is not required unless the employer has information that they live at different addresses.

The notice is intended to be a stand-alone document. It may be distributed at the same time as other plan materials, but it should be a separate document. If the notice is incorporated with other material (such as stapled items or in a booklet format), the notice must appear in 14-point font, be bolded, offset, or boxed, and placed on the first page. Alternatively, in this case, you can put a reference (in 14-point font, either bolded, offset, or boxed) on the first page telling the reader where to find the notice within the material. Here is suggested text from the CMS for the first page:

“If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a federal law gives you more choices about your prescription drug coverage. Please see page XX for more details.”

Email distribution is allowed but only for employees who have regular access to email as an integral part of their job duties. Employees also must have access to a printer, be notified that a hard copy of the notice is available at no cost upon request, and be informed that they are responsible for sharing the notice with any Medicare-eligible family members who are enrolled in the employer’s group plan.

CMS Disclosure Requirement
Separate from the participant notice requirement, employers also must disclose to the CMS whether their group health plan provides creditable or noncreditable coverage. The plan sponsor (employer) must submit its annual disclosure to CMS within 60 days of the start of the plan year. For instance, for calendar-year group health plans, the employer must comply with this disclosure requirement by March 1.

Disclosure to CMS also is required within 30 days of termination of the prescription drug coverage or within 30 days of a change in the plan’s status as creditable coverage or noncreditable coverage.

The CMS online tool is the only method allowed for completing the required disclosure. From this link, follow the prompts to respond to a series of questions regarding the plan. The link is the same regardless of whether the employer’s plan provides creditable or noncreditable coverage. The entire process usually takes only 5 or 10 minutes to complete.

Originally Published By ThinkHR.com

When it comes to Employee Assistance Programs, confidentiality is a concern for both employers and employees. As an employer, it is helpful to understand the terms and processes your EAP uses to keep information confidential and ensure that your employees and your workplace are safe.

The Health Insurance Portability and Accountability Act (HIPAA) rules apply to EAPs and their affiliate providers. All information that is obtained during an EAP session is maintained in confidential files. The information remains confidential except in the following circumstances:

  1. An employee/client provides written permission/consent for the release of specific information. This can be done using a Consent to Inform or Release of Information form.
  2. The life or safety of the client or others is seriously threatened.
  3. Child abuse has occurred.
  4. EAP records are the subject of a court order (subpoena).
  5. Other disclosures required by applicable law.

Depending on the situation, an employee may use EAP services through a self-referral, guided-referral or mandated-referral

Voluntary or self-referrals are the most common. When an employee seeks EAP services voluntarily, all of the employee’s information, including whether he or she contacted the EAP or not, is confidential and cannot be released without written permission.

Guided referrals are an opportunity for the employer to encourage the employee to use EAP services when the employer senses there is a problem that needs to be addressed. This may occur when the employer identifies an employee who may be having personal or work-related difficulties but it is not to the point of mandating that the employee use an EAP. In the case of guided referrals, information disclosed by the employee is still kept confidential.

Mandatory or formal referrals usually occur when substance abuse or other behaviors are impacting productivity or safety. An employer’s policy may allow for putting the employee on a performance improvement plan and may even include a “last chance” agreement that states what an employee must do in order to keep their job. In these cases, employees are mandated by the employer to contact the EAP and a Release of Information is signed so the EAP can exchange information with the employer about employee attendance, compliance and recommendations.

In some cases, it may be advised to send the employee for a Fitness for Duty Evaluation or similar assessment to determine the employee’s ability to physically or mentally perform essential job duties, or assess for a potential threat of violence. These evaluations are performed by specially trained professionals and will come with an additional cost. If the employee has provided written consent, limited information may be released to the employer regarding the results of these evaluations.

By Kathryn Schneider
Originally Published By United Benefit Advisors

Quantitative research guides health care decision makers with statistics–numerical data collected from measurements or observation that describe the characteristics of specific population samples. Descriptive statistics summarize the utility, efficacy and costs of medical goods and services. Increasingly, health care organizations employ statistical analysis to measure their performance outcomes. Hospitals and other large provider service organizations implement data-driven, continuous quality improvement programs to maximize efficiency. Government health and human service agencies gauge the overall health and well-being of populations with statistical information.

Health Care Uitilization

Researchers employ scientific methods to gather data on human population samples. The health care industry benefits from knowing consumer market characteristics such as age, sex, race, income and disabilities. These “demographic” statistics can predict the types of services that people are using and the level of care that is affordable to them. Health administrators reference statistics on service utilization to apply for grant funding and to justify budget expenditures to their governing boards.

Resource Allocation

Heath care economists Rexford Santerre and Stephen Neun emphasize the importance of statistics in the allocation of scarce medical resources. Statistical information is invaluable in determining what combination of goods and services to produce, which resources to allocate in producing them and to which populations to offer them. Health care statistics are critical to allocative and production efficiency. Inevitably, allocation decisions involve trade-offs–the costs of lost or missed opportunities in choosing one economic decision over another. Reliable statistical information minimizes the risks of health care trade-offs.

Needs Assessment

According to Frederick J. Gravetter and Larry B. Wallnau, statistics “create order out of chaos” by summarizing and simplifying complex human populations. Public and private health care administrators, charged with providing continuums of care to diverse populations, compare existing services to community needs. Statistical analysis is a critical component in a needs assessment. Statistics are equally important to pharmaceutical and technology companies in developing product lines that meet the needs of the populations they serve.

Quality Improvement

Health care providers strive to produce effective goods and services efficiently. Statistics are important to health care companies in measuring performance success or failure. By establishing benchmarks, or standards of service excellence, quality improvement managers can measure future outcomes. Analysts map the overall growth and viability of a health care company using statistical data gathered over time.

Product Development

Innovative medicine begins and, sometimes, ends with statistical analysis. Data are collected and carefully reported in clinical trials of new technologies and treatments to weigh products’ benefits against their risks. Market research studies steer developers toward highly competitive product lines. Statistics indirectly influence product pricing by describing consumer demand in measurable units.

By Rae Casto
Originally Published By Livestrong.com

The IRS has released drafts of the forms and instructions that employers will use for 2017 reporting under the Affordable Care Act (ACA). It is expected that when the IRS releases final versions, the material will be virtually identical to the drafts.

Applicable large employers (ALEs) will use the following:

Employers that self-fund a minimum essential coverage plan will use the following:

Background

Applicable large employers (ALEs), who generally are entities that employed 50 or more full-time and full-time-equivalent employees in the prior year, are required to report information about the health coverage they offer or do not offer to certain employees. To meet this reporting requirement, the ALE furnishes Form 1095-C to the employee or former employee and files copies, along with transmittal Form 1094-C, with the IRS.

Employers, regardless of size, that sponsor a self-funded (self-insured) health plan providing minimum essential coverage are required to report coverage information about enrollees. To meet this reporting requirement, the employer furnishes Form 1095-B to the primary enrollee and files copies, along with transmittal Form 1094-B, with the IRS. Self-funded employers who also are ALEs may use Forms 1095-C and 1094-C in lieu of Forms 1095-B and 1094-B.

Information is reported on a calendar-year basis regardless of the employer’s health plan year or fiscal year.

Changes for 2017

The 2017 forms and instructions are similar to the 2016 materials, although there are some changes for items that no longer apply or to simplify or clarify the information. Some of the changes include:

  • Removing references to transition relief options that are no longer available to ALEs.
  • Confirming the multiemployer interim relief rule remains in place for ALEs that contribute to a multiemployer plan (e.g., union trust).
  • Updating references for items that have been adjusted for inflation, such as the affordability percentage (9.69 percent for 2017).
  • Adding a note in the instructions for Form 1095-C, line 16, stating that “There is no specific code to enter on line 16 to indicate that a full-time employee offered coverage either did not enroll in the coverage or waived the coverage.”

In general, the forms and instructions are very similar to the versions used last year. Since the reporting requirements have been in place for several years now, employers and their advisors should have little trouble in working with the new materials for 2017.

Due Dates

The due date to furnish 2017 forms to individuals is January 31, 2018, while the due date to file copies with the IRS, including the appropriate transmittal form, will depend on whether the employer files electronically or by paper. Entities that provide 250 or more forms to individuals are required to file electronically with the IRS.

The due dates for 2017 reporting are:

  • January 31, 2018: Deadline to furnish 2017 Form 1095-C (or 1095-B, if applicable) to employees and individuals.
  • February 28, 2018: Deadline for paper filing of all 2017 Forms 1095-C and 1095-B, along with transmittal form 1094-C or 1094-B, with the IRS.
  • April 2, 2018: Deadline for electronic filing of all 2017 Forms 1095-C and 1095-B, along with transmittal form 1094-C or 1094-B, with the IRS. (April 2 is the first business day following the usual due date of March 31.)

Summary

Employers are encouraged to work with experienced vendors, tax advisors, and payroll administrators to review how the ACA reporting requirements apply to their situation. The required forms are important IRS documents and preparers should use the same level of care that would apply to employee W-2s.

 

Originally Published By ThinkHR.com

A health flexible spending account (FSA) is a pre-tax account used to pay for out-of-pocket health care costs for a participant as well as a participant’s spouse and eligible dependents. Health FSAs are employer-established benefit plans and may be offered with other employer-provided benefits as part of a cafeteria plan. Self-employed individuals are not eligible for FSAs.

Even though a health FSA may be extended to any employee, employers should design their health FSAs so that participation is offered only to employees who are eligible to participate in the employer’s major medical plan. Generally, health FSAs must qualify as excepted benefits, which means other nonexcepted group health plan coverage must be available to the health FSA’s participants for the year through their employment. If a health FSA fails to qualify as an excepted benefit, then this could result in excise taxes of $100 per participant per day or other penalties.

Contributing to an FSA

Money is set aside from the employee’s paycheck before taxes are taken out and the employee may use the money to pay for eligible health care expenses during the plan year. The employer owns the account, but the employee contributes to the account and decides which medical expenses to pay with it.

At the beginning of the plan year, a participant must designate how much to contribute so the employer can deduct an amount every pay day in accordance with the annual election. A participant may contribute with a salary reduction agreement, which is a participant election to have an amount voluntarily withheld by the employer. A participant may change or revoke an election only if there is a change in employment or family status that is specified by the plan.

Per the Patient Protection and Affordable Care Act (ACA), FSAs are capped at $2,600 per year per employee. However, since a plan may have a lower annual limit threshold, employees are encouraged to review their Summary Plan Description (SPD) to find out the annual limit of their plan. A participant’s spouse can put $2,600 in an FSA with the spouse’s own employer. This applies even if both spouses participate in the same health FSA plan sponsored by the same employer.

Generally, employees must use the money in an FSA within the plan year or they lose the money left in the FSA account. However, employers may offer either a grace period of up to two and a half months following the plan year to use the money in the FSA account or allow a carryover of up to $500 per year to use in the following year.

By Danielle Capilla
Originally Published By United Benefit Advisors

On August 22, 2017, in AARP v EEOC, a federal court found that regulations allowing employers to offer large incentives under workplace wellness programs were arbitrary. The court did not vacate (nullify) the rules due to concerns about disrupting employers’ existing programs. Instead the court has ordered the responsible agency, the Equal Employment Opportunity Commission (EEOC), to review and reconsider its regulations.

Background

The EEOC regulates and enforces provisions of the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA) that affect workplace wellness programs. Employers with 15 or more workers generally are prohibited from requiring employees to undergo medical exams or answer disability-related questions (unless needed for certain job-related health/safety exams). An exception is allowed for wellness programs that are “voluntary,” but the meaning of voluntary has long been debated.

For many years, the EEOC failed to issue regulations defining voluntary while at the same time unofficially asserting that programs were not voluntary if the employee was required to provide private health information to earn a reward or avoid a penalty. In 2015, the EEOC finally proposed rules on the matter, which were finalized in 2016 and took effect January 1, 2017. In an about-face from its prior assertions, the EEOC rules allow employers to offer wellness program incentives of up to 30% of the health plan’s cost. The AARP, on behalf of its membership, sued in federal court alleging that the 30% threshold was too high to be considered a voluntary program.

(The Health Insurance Portability and Accountability Act (HIPAA), a separate federal law primarily regulated by the Department of Labor (DOL), not the EEOC, permits group health plans, including wellness programs, to offer incentives of up to 30% of plan cost. AARP did not challenge the HIPAA rules. HIPAA’s incentive cap applies only to health-contingent programs, however, while the EEOC’s ADA and GINA rules are broader and include both participatory-only and health-contingent wellness programs.)

In AARP v EEOC, the U.S. District Court for the District of Columbia found that the EEOC failed to justify how it had determined its new definition of a voluntary program. The court ordered the EEOC to reconsider its regulations and to file a status report by September 21, 2017 that includes a proposed schedule for the review.

Employer Considerations

Last week’s court ruling did not vacate the EEOC’s wellness program rules. They remain in force and employers may use them as guidance in designing and administering their workplace programs. At the same time, however, employers will want to be mindful that the current rules are under review and may be revised in the future. Also, employers whose wellness programs offer large incentives for providing individual health information need to consider whether their program may be challenged through private litigation. Employers are encouraged to work with their benefit advisors and legal counsel to ensure their wellness programs are consistent with rules under HIPAA, and, if applicable, under the ADA and GINA.

Originally Published By ThinkHR.com

Small employers, those with fewer than 100 employees, have a reputation for not offering health insurance benefits that are competitive with larger employers, but new survey data from UBA’s Health Plan Survey reveals they are keeping pace with the average employer and, in fact, doing a better job of containing costs.

According to our new special report: “Small Businesses Keeping Pace with Nationwide Health Trends,” employees across all plan types pay an average of $3,378 toward annual health insurance benefits, with their employer picking up the rest of the total cost of $9,727. Among small groups, employees pay $3,557, with their employer picking up the balance of $9,474 – only a 5.3 percent difference.

When looking at total average annual cost per employees for PPO plans, small businesses actually cut a better deal even compared to their largest counterparts—their costs are generally below average—and the same holds true for small businesses offering HMO and CDHP plans. (Keep in mind that relief such as grandmothering and the PACE Act helped many of these small groups stay in pre-ACA plans at better rates, unlike their larger counterparts.)

PPO Plan Average Annual Cost per Employee

Think small businesses are cutting coverage to drive these bargains? Compared to the nations very largest groups, that may be true, but compared to average employers, small groups are highly competitive.

By Bill Olson
Originally Published By United Benefit Advisors

Switching over to AEIS Advisors was the best decision we’ve made this year. Ronald and his team were able to identify discrepancies on our billing statements which got missed by our last broker, and they saved us over $8,000 in credits! AEIS has proven to be an attentive and caring company, looking out for the best needs of their clients."

- Director of Operations

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