Myth vs. Fact #3

Myth vs. Fact: Myth #3: Business Owners Will Be Fined If They Don’t Notify Their Employees About the New Health Insurance Marketplace

As a business owner, it's important to understand how the Affordable Care Act may affect your business. However, with so many misconceptions about how the Affordable Care Act works, this can be difficult.

As part of our ongoing blog series, "Myth vs. Fact: The Affordable Care Act and Small Business," this week we're debunking another common myth: Business owners will be fined if they don't provide notification to their employees about the new Health Insurance Marketplace.

Fact: If your company is covered by the Fair Labor Standards Act, you must provide a written notice to your employees about the Health Insurance Marketplace by October 1, 2013. However, there is no fine or penalty under the law for failing to provide the notice.

Which Employers Must Provide This Notification?

Under the Affordable Care Act, all employers covered by the Fair Labor Standards Act (generally, those firms that have at least one employee and at least $500,000 in annual dollar volume of business), must notify their employees about the new Health Insurance Marketplace, whether or not the employer currently provides health coverage to its employees.

The Marketplace opens for enrollment in all states on October 1, 2013 and offers individuals and small business owners an online portal to find and compare private health insurance options.

Click HERE to read more.

Boiling Down the ACA

By Linda Rowings

October 25, 2013

 

A lot of employers and advisers might want a simple, at-a-glance way to see all the Affordable Care Act requirements that apply to their business(es). This is no easy task given group size, SHOP exchanges and self-funding variables. Let’s take a look at a few provisions that are effective for the plan year beginning on or after January 1.

 

Here’s what (non-grandfathered) large group insured plans (more than 50 employees) should be focused on:

• Eligibility waiting period maximum of 90 days
• Pre-ex not permitted on anyone
• Annual dollar limits prohibited on essential health benefits
• Protections for those in clinical trials
• Out of pocket may not exceed $6,350/$12,700
• Guarantee issue and renewal apply
• Revised wellness program rules

If you have a (non-grandfathered) small group (50 or fewer employees) insured plan, keep a watch on the following requirements that apply BOTH inside and outside the SHOP exchange:

• Modified community rating applies
• Essential health benefits (EHBs) must be offered
• Deductible generally may not exceed $2,000/$4,000
• Out of pocket may not exceed $6,350/$12,700
• Must meet metal levels (60%, 70%, 80%, 90%)
• Guarantee issue and renewal apply (subject to participation)
• Single risk pool
• Revised wellness program rules
• Eligibility waiting period maximum of 90 days
• Pre-ex not permitted on anyone
• Annual dollar limits prohibited on essential health benefits
• Protections for those in clinical trials

If you are a small OR large self-funded plan, the following requirements should be on your radar:

• Eligibility waiting period maximum of 90 days
• Pre-ex not permitted on anyone
• Annual dollar limits prohibited on essential health benefits
• Protections for those in clinical trials
• Out of pocket may not exceed $6,350/$12,700
• Revised wellness program rules
• Transitional reinsurance fee, including reporting

See the full article here

Myth vs. Fact #2

Myth vs. Fact: Myth #2: My State Isn’t Setting Up a Marketplace So The Affordable Care Act Doesn’t Affect Me

As a business owner, it’s important to understand how the Affordable Care Act may affect your business. However, with so many misconceptions about how the Affordable Care Act works, this can be difficult.

As part of our ongoing blog series, “Myth vs. Fact: The Affordable Care Act and Small Business,” this week we’re debunking another common myth: If my business is located in a state that isn’t establishing a state-based Marketplace, the Affordable Care Act doesn’t have any impact on me.

Fact: Every state will have an Affordable Insurance Exchange, or Marketplace, beginning in January 2014. States have the option of running their own Marketplace, partnering with the U.S. Department of Health and Human Services (HHS) to partially run the Marketplace, or opting for a Marketplace run by HHS.

More than half of states have decided to run all or part of their Marketplaces in 2014. Specifically, seventeen states and the District of Columbia have chosen to establish their own Marketplace and, seven additional states have opted to partner with the federal government to establish a Marketplace. States have the opportunity to choose to run more of their Marketplaces in each year following 2014.

Will the insurance options be different in a state-based Marketplace versus a federally-facilitated Marketplace?

We don’t expect there to be a difference since the Small Business Health Options Program (SHOP), which is part of the new Marketplace, will operate in all states. Small employers in all states will be able to compare a range of insurance options for their employees based on price, benefits, quality, and other criteria that may be important to them. This is true whether a business is exploring options for coverage in a state-based Marketplace or a federally-facilitated Marketplace. Also, every health insurance plan in the new Marketplace will offer coverage of “essential health benefits” like hospitalizations, doctor services, prescription drugs, rehabilitation and mental health services, pregnancy, and newborn care. Some employers may even be eligible for tax credits for their premium contributions.

Continue reading HERE

Standalone HRAs are out, as expected

Standalone HRAs will soon be a thing of the past. The Employee Benefits Security Administration, a division of the U.S. Department of Labor, provided a clarification on health reimbursement accounts late last week, ruling in a statement that HRAs are group health plans and therefore cannot have annual limits. The decision finalizes previous guidance that indicated government agencies would view HRAs in this way in compliance with the Affordable Care Act.

“I think people had suspected that standalone HRAs would not be viable after 2014,” says Linda Rowings, chief compliance officer for United Benefit Advisors, a group of independent brokerages throughout the U.S. “I think it’s very clear from this guidance that you can’t do standalone HRAs unless it’s for retirees or as a non-medical sort of benefit like dental or vision.”
The EBSA statement says, “a group health plan (or a health insurance issuer offering group health insurance coverage) may not establish any annual limit on the dollar amount of benefits for any individual.” In other words, because standalone HRAs would inevitably place a dollar amount on benefits, they will be tricky for any broker or plan to execute.

Continue Reading HERE

Confused by PPACA? Join the club

Benefits Selling’s annual employer survey finds PPACA is still professionals' biggest challenge:

 

By Ingrid Case

October 2, 2013

 

Benefits Selling’s annual employer survey found that many things are business as usual in the benefits world: For one thing, employers continue to try to restrain costs while attracting and retaining employees with the richest possible benefit packages.

 

About 67 percent of employers offer health care benefits. Slightly fewer than half of respondents offer health savings accounts, and just over 68 percent agreed that employees think health insurance is the most important benefit they have.

This year, though, the Patient Protection and Affordable Care Act is the big difference. A large majority of respondents — 80 percent — say that health care reform has made them rethink their employee benefit offerings.

(Benefits professionals still have a lot of questions about PPACA. Illustration by Sarah Hanson.)

Rampant confusion
Perhaps the biggest effect of PPACA so far is the confusion it’s created. Many businesses simply don’t understand their choices under the new law.

“I’m very disappointed with the way Obamacare is being handled. People are so confused.” That’s the word from Bruce Axler, principal at Axler Insurance Services in South San Francisco, Calif., where he works with businesses with from two to 25 employees.

“Most of them are wondering what Obamacare is going to do to them,” Axler says. “Some of them need to do nothing; others will need to make changes in order to avoid paying a penalty.”
Businesses of all sizes have upset owners and managers, agrees Ken Neathery, owner of Lone Star Insurance Services in Sherman, Texas. “They don’t understand it, even though they’ve read everything they can get their hands on. The larger the employer, the more questions they have,” he says.

In small groups, Neathery adds, “the questions are ‘What’s going to happen? What’s this tax I’m hearing about? Am I going to have to pay more?’ People know that things are changing this fall and they need to do something by next March, but they don't know anything else. We’re doing our best to tell them that this isn’t a catastrophe.”

Continue Reading HERE

Most employers say they’re ready for PPACA

Most Employers Say They're Ready for PPACA

More employers than might be thought are well ahead in preparing to meet the requirements of the Patient Protection and Affordable Care Act.

That’s according to a survey of HR managers conducted with the coming open enrollment season in mind. Wellness program consultant and provider Keas said its survey of more than 100 HR professionals found that three-quarters of them had taken steps to meet the law’s original Jan. 1, 2014 deadline. Another 58 percent were confident they would still be fully compliant with the act by January, despite the Obama administration decision to delay implementation of the employer mandate until January 2015.

Offering a less optimistic view on the question, Aflac on Wednesday released results of a much larger, but professionally broader, study that found that just 9 percent of respondents felt their employers were “very prepared” to meet the law’s requirements. Seven of 10 workers interviewed for the Aflac study said a very basic requirement of the PPACA — that employers communicate benefits package options to workers by Oct. 1 — had yet to happen.

The Keas “HR Executive Survey” identified top open enrollment pain points for HR managers in the reform era included educating employees about available benefits (47 percent) and getting employees to participate in benefits selection (22 percent).

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