HealthNet Update for 2015

HealthNet of Arizona, Inc. (HealthNet) is streamlining their Individual & Family Plan HMO portfolio for 2015 with fewer plans.

In 2014, Health Net offered more than one HealthNet CommunityCare HMO health plan in each of the metal tiers: Platinum, Gold, Silver, and Bronze.  We are expecting this to change for 2015.

Automatically, members who enrolled directly with Health Net (i.e., off the marketplace) will be moved to similar plans.  If you like the new plan, you don’t have to do anything to keep it.

However, your agent, L&A Services, Inc. is available to assist you in choosing a new plan for 2015 if you would like to explore your options.

Members who enrolled via the Marketplace are asked to go back to HealthCare.gov during Open Enrollment and actively choose the plan they want for 2015. Don’t forget you need your broker’s name (Benjamin Rosky) and National Producer Number (6747133) to ensure proper service.

Contacting the Marketplace is also necessary for members who qualify for tax credits to get the right amount for 2015.

Member Notifications

90-day plan closure notices to members mailed October 2, 2014.

NOTE:  Regulatory approval is still pending for 2015 plans. Once approved, plan information details will be communicated here.  Until then, Health Net does not have any plan information to release.

Can you keep your health plan?

Grandfathered health plans are those purchased with no major changes since March 23, 2010. Some insurance companies choose not to renew grandfathered health plans, while others are preserving these contracts. If your insurance company has not forced you off of your grandfathered plan yet, it is likely you will be able to continue your plan.

Grandmothered health plans are those purchased (or changed) after March 23, 2010, but before January 1, 2014. In an effort to facilitate the transition  from a grandmothered plan to a new Affordable Care Act-compliant plan, the federal government approved an extension for these plans, known as  ‘transitional relief’. Arizona also approved the transitional relief, but final decisions were left with the insurance companies. Below are a list of the insurance  companies and how they decided to handle their grandmothered small group and individual health plans in Arizona:

Company’s allowing you to KEEP your plan in 2015:

• BCBSAZ (Individual)
• BCBSAZ (Small Group) – if renewing 8/1 – 12/15
• Golden Rule (UH1 Individual)
• Humana (Small Group)
• Assurant Health (All)

Company’s that require a REPLACEMENT plan starting in 2015:

• Aetna (Individual)
• HumanaOne
• HealthNet – already transitioned to ACA plans

How long these plan will be extended for depends on the insurance company. Please refer to the notice you receive from your insurance company for details.

If your insurance company is not listed here, contact us and we can find out if your plan will need to be replaced in January or not.

In some cases, a new plan may be a better solution than your current plan. We recommend you contact your broker or L & A Services to review your options during the 2015 open enrollment, which runs from November 15th, 2014 – February 15th, 2015. After open enrollment, you must have a qualifying life event to purchase health insurance.

This information is accurate as of the day of this post, and is subject to changes made by the USA, the state of AZ, and/or the insurance companies themselves.

Surviving an DOL Audit: Employer ERISA Compliance Training

Blame it on the ACA…

In 2013, the Department of Labor hired over 1,000 auditors to collect $1.1 Billion in ERISA penalties for employers that are non-compliant with this federal law, which applies to all employee benefit programs.

It is estimated that 95% of all employers are not fully compliant with ERISA or new provisions of the Affordable Care Act which will leave many businesses vulnerable to fines.

Fines could range from $100-$1100 per person per day along with the legal fees that would come with an ERISA audit.  To help reduce this risk we are providing education and resources to help employers understand and decide how to handle these responsibilities.

In anticipation of this demand, we are informing you of four upcoming informational webinars on this subject.

You may attend at no cost in the comfort of your own office. Each will last approximately one hour, with 10 minutes for questions.  Times shown in Arizona time.

Topic: ERISA Compliance and Surviving an Audit

Monday ‐ August 4, 2014 8:00 am
Register:  https://cc.readytalk.com/r/9jkadjcwq2a0&eom

Monday ‐ August 18, 2014 11:00 am
Register:  https://cc.readytalk.com/r/6n8d1c0ednv4&eom

Monday ‐ September 8, 2014 8:00 am
Register:  https://cc.readytalk.com/r/8af5br8d78ef&eom

Monday ‐ September 22, 2014 11:00 am
Register:  https://cc.readytalk.com/r/lwtp0dr39nwv&eom

Reserve your webinar seat now!

These webinars are complimentary, and offered as a value-added service to the employers we serve.  They are conducted by one of our preferred administrative services companies, TASC.  However, should you choose to outsource your ERISA compliance responsibilities, we always compare multiple companies to find the right fit for you.

Thank you for taking time out of your busy schedules for this important webinar.  Please don’t hesitate to contact our office with any questions or concerns.

Sincerely,

 

 

Ben Rosky, RHU

L & A Services, Inc
602-996-6010

Am I getting a check in the mail? Medical Loss Ratio Rebate Update

The Affordable Care Act requires insurance companies to spend a certain percentage of the premiums they collect on medical services & programs that directly benefit their insureds. If an insurance company fails to meet this requirement by not spending enough on medical benefits, they must issue a refund to the policyholders during the summer of the following plan year.  This is known as a Medical Loss Ratio Rebate.

These calculations are based on a number of aggregated factors, including the type of plan (small group, large group, or individual) and the state where the plan is set up.

Rebates for the 2013 plan year have already started. Below you will find general rebate information received from the different insurance companies for Arizona policyholders:

Company                                                                   Rebate?
HealthNet                                                                    None
BCBSAZ                                                                        Small Group only
Aetna                                                                            Yes
United HealthCare (Small Group)                           No
Aetna (Small Group)                                               HMO plans only
Assurant Health                                                        Small Group Only
IHC Health Solutions                                              Small Group Only

Individuals and families receiving a rebate may use it as they wish.

Employers, on the other hand, must spend the rebate for the benefit of the plan participants in a fair and equitable manner .  Contact us for recommendations on how to do this properly.

Health Insurance Marketplace Premium Subsidy Calculator

Health Insurance Marketplace Premium Subsidy Calculator

If you do not have access to health insurance through an employer and would like to determine if applying for a government subsidy under the Affordable Care Act would help you, this link will enable you to make a quick calculation in order to help decide.

If this calculator results benefit you, please call us for help.  If you are a DIY’er, follow our simple instructions here.

We are pleased to have already helped our clients receive tens of thousands of dollars in subsidies.  We hope you are next!

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ACA (a.k.a. OBAMACARE) 5 QUICK FACTS to KNOW for 2014

With much confusion about the implementation of the Affordable Care Act in 2014, let us validate some facts and dispel some myths that really matter to most Americans.

These are just a few of the more common questions.  Please do not fail to ask your question about your specific situation by calling or emailing our office.

1.  Will I have to pay a fine if I don’t have health insurance in 2014?

YES.  Starting in 2014, most U.S. citizens and legal residents will be required to carry health coverage* for the majority of the year or pay a penalty.  There will be exceptions for those with religious objections and for those whose coverage would cost more than 8% of their annual income.

2.  Isn’t my employer required to provide my health insurance next year?

NO.  While the law does impose penalties on some businesses that do not provide affordable coverage, it does not require employers to provide health coverage in 2014.  However, small employers may qualify for TAX CREDITS if they pay at least 50% of the cost of their employees’ coverage.   For more specific information on 2014 TAX CREDITS for small employers click here.

3.  Do I have to use a government website or the Federally Facilitated Marketplace (FFM) to obtain coverage?

NO.  No one is forced to use Healthcare.gov, also known as the FFM (Federally Facilitated Marketplace).  In fact, many will continue to obtain health insurance coverage the same way they do today.  If you already have government-based insurance like Medicare, Medicaid, or CHIP or have satisfactory insurance through your job, no action is required.  If you do not have access to health insurance through your job or these government programs in 2014 and make less than 400% of the Federal Poverty Level, it may be to your advantage to apply through the FFM.  This is the only way to get help with monthly premium costs and reduced out-of-pocket costs.  See our instructions.

4.  Are premium rates going to be affected?

IT DEPENDS.  All plans must meet the requirements of the ACA in 2014 so the game has changed.  No one can be denied coverage for pre-existing conditions.  Women will no longer pay more than men.  How rates are affected will depend on individual factors, place of residence, the insurance company and whether you will receive a subsidy.   Talk to a broker for advice on all your options (see #5 below).

5.  Can I still use a broker for advice and coverage?

YES.  In fact, the federal government is encouraging broker involvement to make the process easier for the consumer.  Agents must be certified to assist those wishing to purchase insurance through the FFM.  Our agents are certified to assist businesses and consumers find the best path to affordable health insurance whether that’s through the government’s FFM or directly from the top carriers in the industry.  Plus, L&A Services, Inc doesn’t charge our clients for our services.

*Warning:  Not all health coverage is qualified, so contact a broker to make sure your coverage meets the new ACA standards.

HealthCare Reform Update – December 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!

Donut Hole Fix for Medicare Beneficiaries

Seniors are concerned that in the next 2 months they may fall into their ‘donut hole’, if they have not already.  While in the ‘donut hole’, out-of-pocket costs for prescription drugs increase for Medicare beneficiaries.   As a solution to this common problem, we have found a way to significantly reduce these costs during this time.

Accepted at thousands of pharmacies, the Arizona Rx Card is a complimentary prescription card that has saved hundreds of dollars in prescription costs for our clients, relatives and friends on Medicare.  We would like to see others use this card to save hundreds more!

Not only does the free card reduce prescription costs up to 78%, the Medication Pricing Guide also allows patients to ‘shop around’ for the best price on the drugs they need based on where they live.  Check your prescriptions here and you will find major price differences between one pharmacy and another.  You must use the Arizona Rx Card to receive the special pricing, and you can download as many as you need on this website.

The Medicare drug plan ‘donut hole’ is scheduled to close entirely by 2020.  Until then, we must find other ways to help our medical dollars stretch further, particularly for those high cost prescription drugs.  We believe this card is one solid solution you and your family members can use right away.

If you have any questions about this card,  please contact L & A Services, Inc at 602-996-6010.

What is this Summary of Benefits & Coverage (SBC)?

Video: The ABC’s of SBC’s Starting September 23rd, the Summary of Benefits & Coverage (SBC) provision within the Patient Protection & Affordable Care Act (PPACA) requires that insurance carriers, employers and brokers provide standardized benefits disclosures to clients. Given the significant penalties for noncompliance with this mandate, it is imperative that you understand the timelines and responsibilities that you are facing.

What is a Summary of Benefits & Coverage (SBC)? A Summary of Benefits & Coverage (SBC) is a document specified in PPACA that standardizes and summarizes the benefits provided by an individual or employer group health plan.  The document must meet several standards for readability, accessibility to specified non-English language populations, and must use plain language and examples to provide recipients information they need to comprehend and compare their benefits. It is accompanied by a glossary of terms called the Uniform Glossary.

Who is responsible for creating and distributing the SBC? Creating the SBC document is generally the responsibility of the Insurer (carrier) for fully-insured group and individual health plans and the Insurer/Third Party Administrator (TPA) for self-insured health plans.  Distributing the SBC is generally the responsibility of the Insurer for individual plans, the Insurer and Employer for fully-insured group plans, and the Insurer and TPA for self-insured health plans.

To whom, and when does the SBC have to be provided? The SBC requirement applies to all individual & employer group health plans, regardless of Grandfathered status under PPACA.  Each medical or health insurance plan offered must have its own SBC, with the notable exception of stand-alone dental or vision plans not integrated with a comprehensive medical or health plan and some integrated FSA, HRA, and HSA financial components. The SBC must be provided to all plan participants, beneficiaries (dependents), special enrollees and prospective enrollees upon request or upon certain enrollment events and anniversaries.  If participants and beneficiaries/dependents reside at a single address, a single SBC may be distributed. For Individual and Family Insurance Plans:   * Applies to all applications/requests submitted after September 23rd, 2012.   * Provided by the insurance carrier to the individual and beneficiaries directly.   * Must be provided within 7 business days of a request or the application date.  For Employer Group Insurance Plans:   * Applies to all plans with a Plan Year beginning on or after 9/23/2012. SBCs must be provided to all participants and beneficiaries who enroll or re-enroll through an open enrollment period (including re-enrollees and late enrollees) that begins on or after September 23rd, 2012. SBCs must also be provided to participants and beneficiaries who enroll in coverage other than through an open enrollment period (including newly-eligible and special enrollees) on or after September 23rd, 2012.   * Provided by the insurance carrier to the employer and/or broker (TPA for self-insured).   * Must be provided within 7 business days of a request or the application date.   * Must be provided to currently eligible employees with open enrollment materials (as applicable above) and 30 days prior to the policy year anniversary for auto-renewals.   * Must be provided to new employees at enrollment (w/enrollment materials) as above.   * Must be provided to special enrollees within 60 days of enrollment (due to event).   * Other deadlines apply for mid-year changes and renewals with material changes.

Some examples of this requirement in application: ABC Company, Inc. Plan Year 9/1/2012 – 8/31/2013    No SBC required for existing/new EEs until 9/1/2013   ABC Company, Inc. Plan Year 10/1/2012 – 9/31/2013  Plan year requirement met. Open Enrollment held 9/22/2012  No SBCs required for Open Enrollments before 9/23 New Employee Hired 9/24/2012    SBC required for New Employee hired after 9/23 EE/Dep requests SBC 9/22/2012   No SBCs required for requests prior to 9/23 EE/Dep requests SBC 9/24/2012   SBCs required (7 days) for requests on/after 9/23    ABC Company, Inc. Plan Year 10/1/2012 – 9/31/2013  Plan year requirement met. Open Enrollment held 9/24/2012  SBCs required for Open Enrollments on/after 9/23 New Employee Hired 9/24/2012    SBC required for New Employee hired after 9/23More information is available at www.healthcare.gov.If you have any questions about this legislation and its requirements, please contact your insurance broker. We appreciate your business, and look forward to serving you! Please be advised that this information is provided for informational use only, and does not constitute, nor should it be construed, as legal or tax advice.  The summaries and examples provided are for illustrative use only.  Please refer to the full text versions of 26 CFR § 54.9815-2715 and P.L. 111-148 § 2715 for further information. SOURCE:  Black Gould & Associates

ACA Battle Headed to Supreme Court

Week of October 3, 2011
Appeals filed last week by the U.S. Department of Justice, a number of states and a business group make it all but certain that the U.S. Supreme Court will decide constitutional questions related to the Affordable Care Act (ACA) next year before the presidential elections. Last week the Justice Department filed a petition formally asking the Supreme Court to promptly consider the constitutionality of the ACA by reviewing the 11th Circuit Court of Appeals’ prior ruling. The Department is appealing a decision by a three-judge panel of the U.S. Court of Appeals in Atlanta holding that the ACA’s requirement that all Americans purchase health insurance is unconstitutional. Lawyers for 26 states challenging the ACA also pressed the court to hear the case speedily, as did the National Federation of Independent Businesses (NFIB). While the Justice Department wants the high court to uphold the constitutionality of the health care law, the states and NFIB want the court to strike down the entire law, not just the individual mandate. Federal court decisions on the constitutionality of the law so far have been split.
Exerpt from Aetna’s Health Reform Weekly Oct 3, 2011