Special Enrollment Period Allows Small Businesses to Easily Qualify for Group Benefits

October 14, 2015

Are you a business owner with less than 50 full-time equivalent W-2 employees?


 The ACA has a little-known special open enrollment period from November 15 to December 15 where insurance companies must relax their rules…they cannot enforce any participation or contribution requirements.  This makes it possible for smaller employers to get group health insurance, even with only one participant.

The effective date for these policies will be January 1, 2016.  All employee and employer paperwork must be received by the carrier by December 15.   Standard community rates apply.

In addition, there are also tax credits available based on the size of your business and average employee income.

Another option for employers who have employees in good health is called a Level-Funding Option.  If you know which employees are going to enroll, providing employee health history can give you additional ways to save money on employee benefits.  This is available any time of year for employers with at least 10 participating employees.

For all your premium savings options, request a quote and/or contact L & A Services ASAP for one-on-one assistance throughout the entire process. We are certified to assist with shopping and selecting a plan, securing the coverage, and applying for any tax credits you may be eligible for.  Since this is a busy time of year for health insurance companies, the earlier you begin the smoother the process will be.


BCBSAZ 2016 Individual/Family Plan Renewal

August 27, 2015

bcbsaz logo

This week, Blue Cross Blue Shield of AZ (BCBSAZ) unveiled their new proposed plan and premium information for individuals and families in 2016.

There are many changes, and many customers will be required to take action to avoid losing coverage at the end of the year.  We are prepared to assist these customers with this process as early as September 9th.

Although BCBSAZ will be sending written notification to all affected members in the coming months, we wanted to provide the information in advance to help better prepare these customers for this year’s renewal.

These are the most important changes to know for 2016:

  1. Metal level plans (Platinum, Gold, Silver, Bronze) are considered ACA-compliant plans, since these were plans purchased and effective from January 2014 to now.
  • In 2015, these plans included three networks:  Statewide PPO, Alliance HMO, and Select HMO.   For 2016, BCBSAZ will only offer the two HMO networks in Maricopa County…the Statewide PPO plan is being deleted.   If you have an ACA-compliant plan with the Statewide PPO network, either purchased through the federal marketplace or directly from BCBSAZ, you MUST select a new plan by December 15th to avoid losing coverage on January 1st.  Customers living in all other counties will have access to the Statewide PPO network, as well as another regional network.  Note: the HMO plans do NOT require a primary care physician assignment, NOR do they require a referral to see a specialist.  However, it is important to check the list to make sure desired doctors participate in the network or else they are not covered.
  • The BlueEssential & Copay Complete plans have been deleted, so these customers will need to move to a new plan, as well.
  • For customers on a plan with either the Alliance or Select network, BCBSAZ will automatically enroll in the next closest available plan available for 2016.  This does not preclude you from changing your plan during open enrollment (November 1 – January 31), so contact our office if alternative choices are desired.
  • BCBSAZ ACA-compliant plans experienced an average rate increase of 21.4%.

2.  Grandmothered Plans are those plans purchased and effective between 2010-2013, and will include the word ‘Plus’ in the name of the plan.

  • All of these plans are being renewed without any changes to benefits or to the PPO network.
  • The average rate increase on these plans is 21.2%, however, the new rate will be guaranteed until April 30, 2017.  This will lock in the rates for a full 16 months.
  • Despite the increase, these plans continue to offer greater premium savings over the ACA-compliant plans.  Most customers in these plans will want to keep what they have.
  • Nothing is required to keep these plans, but customers still have the ability to either 1) change the deductible to lower the premium, or 2) consider moving to an ACA-plan during open enrollment (November 1 – January 31) if desired.  If a member moves away from a Grandmothered plan, they cannot get it back later.  We are able to assist with customers with this evaluation.
  • BCBSAZ will be sending a letter to each affected customer on October 12th.

3.  New Dental Plan

  • BCBSAZ is now offering their group BluePreferred Dental plans to individuals and families.
  • Contact our office if interested in private PPO dental coverage from BCBSAZ

We suspect there will be many changes in 2016 from all of our carrier partners.  We know there will be many questions, and we are here to answer them.  Please keep in mind that this is an extremely high-volume time of the year, so time is of the essence…the sooner you take action, the smoother the process will go for you.

Thank you to all 266 of our individual BCBSAZ customers.  We look forward to serving you during this time of change.



February 5, 2015

bcbsaz logocignabannerHealthNet LogoAetna LogoHumana Logo

All individuals who have yet to enroll for health insurance coverage for 2015:  REMINDER – Sunday February 15th is the FINAL DAY of OPEN ENROLLMENT for the plan year 2015. 

Also, remember that the “shared responsibility payment” imposed for 2015 will be 2% of an individual’s adjusted gross income. Seek a tax expert if necessary. 

Those who still need to enroll for a policy and would like to see if their household’s income qualifies for a federal subsidy in the form of a tax credit or premium assistance you may CONTACT OUR OFFICE or go directly to Healthcare.gov to confirm the amount. 

Once your application is submitted call our office at 602-996-6010 for help choosing a plan.

Your enrollment has to be completed by Sunday 2/15/15 for coverage effective 3/1/15.    

At Healthcare.gov please include your agent, Ben Rosky’s information so L&A Services is established as your Broker Of Record (BOR).  Use the NPN number:  6747133.   

Email ben@lnaservices or help@lnaservices.com with any questions.  

Thank you.  We appreciate our friends and we value their trust in L & A Services, Inc. for their insurance needs for almost 30 years.

HealthCare Reform Update – December 2012

December 17, 2012

What Small Business Owners Need to Know

Small Businesses are classified in general as housing up to 50 employees, including self-employed in some states.

•   More than 97% of small business owners will NOT see an increase in the health care taxes they pay under the new law
•   Small Businesses with up to 25 employees & pay under $50,000 in wages are eligible for a tax credit.
•   Those who participate in 2013, qualify for a small business tax credit of 35%, and will see an increase to 50% in 2014.
•   Employers with over 50 full-time employees (see link below) fall into The Employer Responsibility provision.

How do I count the number of full-time employees (FTE)?

•    Getting all of your questions answered now is the role of any smart business owner.  The  U.S. Department of Health & Human Services has provided this guide specifically for the small employer.

The Federal Exchange

On Wednesday November 28, Gov. Jan Brewer announced that Arizona will not create a state-based health exchange but will leave that job to the federal government, as detailed in the Patient Protection and Affordable Care Act.

Citing the lack of clarity and guidelines from the federal government, Gov. Brewer announced   “Without clear federal guidance and instruction, I cannot in good conscience commit the taxpayers of my state to this costly endeavor.”

What does this mean for Arizona?  Information continues to flow from HHS regarding the Exchange requirements, but certainly the flexibility in how the Exchange is set up is now limited.

New Fees

As if insurance carriers didn’t have enough reasons to increase health plan premiums, here are some of the new fees & taxes imposed on plans for 2013 and beyond:

  • Patient-Centered Outcomes Research Fee (also known as the Comparative Effectiveness Fee)

    • This fee is charged to health insurance companies from October 1, 2012 until 2019, and will be used to fund clinical outcomes effectiveness research in an effort to increase the efficiency of medical care.
    • $1/covered life in the plan’s first year that ends on or after October 1, 2012, and before October 1, 2013;
    • $2/covered life for plan/policy years ending on or after October 1, 2013, and before October 1, 2014.
    • Fee subject to adjustment for increases in National Health Expenditures in future years.
  • Health Insurance Tax (HIT)
    • New tax imposed on health insurance companies starting at $8 billion in 2015, and increasing each year.  By 2018, the tax will be $14.3 billion.  The Joint Committee on Taxation estimates that HIT will exceed $100 billion over the next ten years.  Find the AHIP report here on estimated effects on premiums.
  • Federally Facilitated Exchange (FFE)
    • The Department of Health and Human Services recently proposed a ‘user fee’ of 3.5% of premiums for health insurers who want to offer policies in new federal exchanges coming in 2014.  The fee is meant to cover administrative costs of the new markets, which must be self-sustaining by 2015.
  • ‘Cadillac Plan’ Tax
    • Starting January 1, 2018, a 40% excise tax on excess benefits for employers offering high-cost, high-benefit health plans.   These plans are defined as those with premiums exceeding $10,200 for single coverage and $27,500 for family coverage in 2018.

More Taxes:  Attention high-income earners!  Americans subject to the taxes below are individual filers who earn adjustable gross income of more than $200,000 and married couples filing jointly with AGI of more than $250,000:

  • 3.8% on Investment Income
    • Effective January 1, 2013, the new tax will be imposed on unearned net investment income, including capital gains from stock sales, dividend income, bonds, mutual funds, annuities, loans and home sales.
  • 0.9% Medicare Payroll Tax:
    • Also effective January 1, 2013, an additional Medicare payroll tax of 0.9% will be imposed on earnings over the amounts specified above.  There is no additional Medicare payroll tax for employers.

We will provide updates on this and other taxes and fees regulations when they are finalized.

For a current, comprehensive tax overview, enjoy this excellent complimentary e-book put together by BenefitMall, one of our partners.

Regardless of how these new rules apply to you, there is no question change is expected.  L & A Services, Inc prides itself on the valuable guidance provided to every client, and this role grows more & more significant as the American healthcare system evolves.  You have questions; contact L & A Services for answers!

How an employer counts full-time employees for health care reform

December 17, 2012

Many of the Patient Protection and Affordable Care Act regulations apply differently to employers depending upon the number of employees.  For example, the coverage mandate does NOT apply to employers with < 50 full-time equivalents (FTEs).  Recently, guidance has been issued on how an employer is to count the number of full-time employees.  Below please find an unofficial guide* to how the government expects employers to calculate this number.

An Employer Defined:  Generally, “employer” would mean the entity that is the employer of an employee under the common-law test.  All employees of a controlled group under § 414(b) or (c), or an affiliated service group under § 414(m), are to be taken into account in determining whether any member of the controlled group or affiliated service group is an applicable large employer.

Full-Time Employee Defined:  A “full-time employee” is an employee who is employed on average at least 30 hours per week.  130 hours of service in a calendar month would be treated as the monthly equivalent of at least 30 hours of service per week.

An employee’s hours of service would include the following: (1) each hour for which an employee is paid, or entitled to payment, for the performance of duties for the employer; and (2) each hour for which an employee is paid, or entitled to payment by the employer on account of a period of time during which no duties are performed due to vacation, holiday, illness, incapacity (including disability), layoff, jury duty, military duty or leave of absence (except that it is contemplated that no more than 160 hours of service would be counted for an employee on account of any single continuous period during which the employee was paid or entitled to payment but performed no duties).

Steps to calculate the number of full-time employees:

•  Total the number of full-time employees (including seasonal workers) for each calendar month in the preceding calendar year;
•  Total the number of full-time equivalents (as defined below) for each calendar month in the preceding calendar year;
•  For each month, add the number of full-time employees and full-time equivalents; and
•  Total the 12 monthly numbers and divide by 12.

Seasonal Exemption

Seasonal employees: a worker who performs labor or services on a seasonal basis, as defined by the Secretary of Labor and retail workers employed exclusively during holiday seasons.

Under PPACA, an employer is not an applicable large employer if:

(1) its workforce exceeds 50 full-time employees for 120 days or less during the calendar year and
(2) the employees in excess of 50 during that period were seasonal workers.

What If There’s a Question of FT Status

Variable hour employees: based on the facts and circumstances at the date the employee begins providing services to the employer (the start date), it cannot be determined that the employee is reasonably expected to work on average at least 30 hours per week.

Measurement Periods – Employers planning to use the Variable Hour Rule must make this decision NOW!

Initial Measurement Period – Between 3 – 12 months generally surrounding an employees’ date of hire during which the full-time determination is made.
Standard Measurement Period – Between 3 – 12 months generally surrounding the plan year during which the full-time determination is made. This is applicable to on-going employees.
Administrative Period – A period not exceeding 90 days, during which the full-time determination is made and the employee is subsequently enrolled if determined to be full-time (working an average of 30 or more hours per week)
Stability Period – The amount of time a Variable Hour employee must be on the health plan.

For calendar year plans, the twelve month Measurement Periods should have already begun.  For example: To be effective January 1, 2014 a standard measurement period = November 15, 2012 to November 14, 2013.

Large Employers (>50 FTE’s) -Shared Responsibility Penalty

•Penalty for not offering health coverage
•If an employer fails to provide its full-time employees (and their dependents) the opportunity to enroll in “minimum essential coverage,” and
•One or more full-time employees enrolls for coverage in an exchange and qualifies for a premium tax credit or cost-sharing reduction, then
•Employer penalty = $2,000 for each of its full-time employees in the workforce in excess of 30.
•This penalty is non-deductible.
•Penalty does not offset the cost of employee coverage.
•Although part-time workers are included in the FTE calculation, large employers are not required to cover part-time employees under the law.

Unaffordable Coverage
•If employer offers its full-time employees (and their dependents) the opportunity to enroll in minimum essential coverage, and
•One or more full-time employees enrolls for coverage in an exchange and qualifies for a premium tax credit or cost sharing reduction because:
•The employee’s share of the premium exceed 9.5% of income, or
•The actuarial value of the coverage was less than 60%, then
•Employer penalty = $3,000 for each full-time employee who receives a tax credit or cost-sharing reduction:

When Don’t Penalties Apply
•Employee is in their waiting period AND the waiting period is less than 90 days.
•Variable Hour employee is in their measurement period or worked an average of less than 30 hours per week.


*Courtesy of Ruthann Laswik, Blue Water Benefits

Supreme Court hears 4 issues in health reform case this month

March 19, 2012

On March 26th, the Supreme Court will hear a unpresidented 6 hours of oral arguments over three days from both sides of the Patient Protection and Affordability Act.  The case, NFIB vs Sebelius, is a lawsuit filed by the National Federation of Independent Business and 26 states against the federal government’s new national health care reform, signed into law by President Barack Obama in March of 2010.

The questions the Supreme Court asked lawyers to argue when the justices consider appeals of the health care overhaul:

  • Anti-injunction Act: Are private individuals and states barred from challenging the constitutionality of the individual mandate by the Anti-injunction Act, which prohibits legal challenges to taxes until after the tax is collected? Oral arguments are slated for March 26.
  • Individual Mandate: Did Congress exceed its authority under the Commerce Clause in requiring that individuals maintain “minimum essential coverage” beginning in 2014 or pay a tax? Called “the minimum coverage provision” by the Court, arguments will occur on March 27.
  • Severability: If the individual mandate provision is nullified as unconstitutional, is it “severable” from the rest of the legislation—allowing some or all of the remaining provisions to stand—or is the entire law nullified? Will be heard on March 28.
  • Medicaid: Did Congress exceed its authority in expanding the Medicaid program? Will also be heard on March 28.

This is the most significant case decision ever considered by the Supreme Court.  The final ruling is not expected until June or July, and there are a number of potential outcomes:

  • The entire law could be struck down
  • The entire law could be upheld
  • A portion of the law could be stuck/upheld
  • The case could be thrown out until after 2014 (Anti-Injunction Act)
  • Any variations thereof

With the presidential election in November, there is no doubt this decision will have a significant impact on the political landscape in the United States this year.  The potential changes to our national healthcare system emphasizes the importance of the ever-evolving role of your insurance advisor.