The first complaint was filed challenging the permissibility of reducing hours below 30 per week in order to avoid the Employer Penalty. The complaint was filed in a New York district federal court on behalf of 10,000 workers at Dave and Buster’s. The plaintiffs allege that their hours were cut so that Dave and Buster’s could avoid health care costs associated with expanding eligibility in order to avoid the Employer Penalty. Click the link below to download this bulletin. Reduction in Hours Subject to Lawsuit in New York – 73115R
Continue ReadingHealth Reform: Is Your Company Ready for the New Reporting Requirements?
Health Reform: Is Your Company Ready for the New Reporting Requirements? In 2016, employers with at least 50 full-time employees (FTEs) must provide Forms 1095-C to their employees and to the IRS. This new requirement applies to both insured and self-insured medical plans. The forms require, in part, tracking per each month in 2015 per each FTE: the tier of health plan coverage offered (e.g., employee-only, employee+spouse, or no coverage offered); the self-only premium an employee must pay for the lowest-cost plan that provides minimum value; and the reason why an employer would not be subject to a penalty for a particular month (e.g., employee is in a waiting period or the affordability… Read More
Continue ReadingHealth Care Reform: Taxes and Fees-PCORI Fee, Transitional Reinsurance Fee, Insurer Fee and Excise Tax
Health Care Reform: Taxes and Fees-PCORI Fee, Transitional Reinsurance Fee, Insurer Fee and Excise Tax From United Healthcare: Taxes and fees under the health reform law impact both fully insured and self-funded plans. But, they impact funding types differently. Employers with self-funded health plans submit applicable health reform fees directly to the government, and those with fully insured health plans will see fees prorated into their premiums. The fees are prorated over 12 months. Here is what you need to know about these fees and how they will impact your business. Please note that this document, provided by United Healthcare, has carrier specific language, however please contact your Total Benefit… Read More
Continue ReadingHealth reform: CMS releases SHOP HOW-TO video for employees
CMS releases SHOP video for employees The SHOP enrollment for employees video has been posted by CMS. Please keep in mind that the employer group needs to be set up on the SHOP first. Please contact your Total Benefit Solutions, Inc account manager if you have any questions about setting your organization up as a SHOP employer. Total Benefit Solutions, Inc is a certified SHOP independent broker. Click the video below to watch the video.
Continue ReadingCMS has approved applications from DE and PA to create state-based Health Insurance Marketplaces.
HR News Alert from HR360.com Brought to you by Total Benefit Solutions Inc June 17, 2015 Approval Dependent on Certain ConditionsThe Centers for Medicare and Medicaid Services (CMS) has conditionally approved applications from Delaware and Pennsylvania to create state-based Health Insurance Marketplaces.Background Exchanges (also known as Health Insurance Marketplaces) provide an option for individuals to buy private health insurance. The Exchanges also operate the Small Business Health Options Program (SHOP) as an option for qualified small employers to purchase employee health coverage. The U.S. Department of Health and Human Services (HHS) has issued final rules relating to Exchanges which include standards for their establishment and operation (among other things). The… Read More
Continue ReadingFAQs Further Clarify New Embedded Out-of-Pocket Requirement
As reported earlier, starting with the 2016 plan year, the self-only annual limitation on cost sharing for non-grandfathered plans ($6,850 for 2016) applies to each individual, even if the individual is enrolled in family coverage. On May 26, 2015, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Departments) issued new FAQs further clarifying this new rule, confirming that it applies to all non-grandfathered group health plans, including self-insured plans, large group health plans, and high deductible health plans. Click the link below to download the bulletin for further guidance. FAQs Further Clarify New Embedded Out-of-Pocket Requirement – 060115R
Continue ReadingSmall business tax concerns with SHOP
Initially created with the goal of helping small businesses comply with the requirements of the Patient Protection and Affordable Care Act (PPACA), the Small Business Health Options Program (SHOP) has not been meeting expectations. Click here to read the full story on Benefits Pro As always your Total Benefit Solution team is available to answer YOUR questions about the Small Business SHOP at (215)355-2121.
Continue ReadingHealth Reform: Q+A: Are we able to give a bonus to employees to sign up for health insurance?
The following question came to us recently from a small group client. Send us your question and we may use yours in the future! Question: Are we able to give a signing up bonus to encourage employees to sign up for health insurance or will that be an issue with health care reform? Answer: An employer may provide bonuses at its discretion as long as the amount is reported as taxable compensation. Federal law prohibits employers from providing incentives to certain employees (such as Medicare-eligible persons) to discourage them from enrolling for group health coverage, but there is no prohibition against incentives to encourage enrollment. The bonus would be taxable compensation… Read More
Continue ReadingGroup Health Plan Notices 2015 CALENDAR
Group Health Plan Notices 2015 CALENDAR From our partners at HR360: This calendar/checklist is designed to help companies review the key reporting and notice requirements that may apply to their employer-sponsored group health plans under ERISA , the Affordable cxare Act, Medicare and more. Please note that this list is for general reference purposes only and is not all-inclusive. Note: ERISA and benefit requirements are complex, and your plan’s responsibilities may vary depending on the individual circumstances surrounding your company’s plan. Employers who have questions are encouraged to consult with their plan administrators, the U.S. Department of Labor’s Employee Benefits Security Administration, the Internal Revenue Service, or a knowledgeable employment law attorney… Read More
Continue ReadingHealth Advocate: Medical Health Advisor
Total Benefit Solutions, Inc now offers the Medical Health Advisor benefit! Watch this short video and ask us how your organization can benefit from offering this personal health advocate service to your employees!
Continue ReadingRelief for Small Employers Reimbursing Individual Policies
An employer cannot offer employees cash to reimburse the purchase of an individual policy, whether or not the employer treats the money as pre-tax or post-tax to the employee. Such arrangements (called “employer payment plans”) are subject to the market reform provisions of the Affordable Care Act (“ACA”), including prohibition on annual limits and the requirement to provide certain preventive services without cost sharing with which it cannot comply. These arrangements may be subject to a $100/day excise tax per applicable employee (which is $36,500 per year, per employee). Click the link below to read the bulletin: Relief for Small Employers Reimbursing Individual Policies – 031915R
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Employer Guide to Pay or Play Shared Responsibility
The Affordable Care Act’s Employer Shared Responsibility (ESR) provision — often called “the Employer Mandate” or “Play or Pay” — requires large employers to offer health coverage to their full-time workers or face a potential penalty. Small employers with fewer than 50 full-time and full-time-equivalent employees are exempt. Play or Pay takes effect January 1, 2015, although special transition relief rules will allow some employers to delay compliance for several months or into 2016. The concept behind Play or Pay is simple: To play, the employer must offer health coverage to full-time employees that work on average 30 or more hours per week. Employers that fail to offer coverage, or… Read More
Continue ReadingIRS won’t penalize those who received wrong tax info from FFM
The Internal Revenue Service will not try to collect additional taxes from those taxpayers who have already filed their taxes after receiving incorrect information from the federal health insurance marketplace, Healthcare.gov click here to read the story
Continue ReadingIs your small business eligible for the health care tax credit? Find Out-Health Care Tax Credit Estimator
Does your small business: Have 25 employees or less? Pay at lest 50% of the employee’s health insurance premium? Have average employee earnings of under $50,000 annually? Then you may be eligible for the health care tax credit! Click here for the CMS HCTC estimator tool. As always contact your Total Benefit Solutions account manager at (215)355-2121 if you have any questions about the SHOP Marketplace of the Small Business Health Care Tax Credit.
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IRS Penalties for Small Employers Reimbursing Individual Health Insurance Premiums Will Not Apply Until July 2015
IRS Penalties for Small Employers Reimbursing Individual Health Insurance Premiums Will Not Apply Until July 2015 IRS Notice 2015-17 provides limited transition relief from the assessment of excise taxes for small employers who reimburse, or directly pay, the premium for an employee’s individual health insurance policy. Prohibited Plans An “employer payment plan” is an arrangement under which an employer reimburses an employee for some or all of the premium expenses incurred for an individual health insurance policy, or an arrangement under which the employer uses its funds to directly pay the premium for an individual health insurance policy covering the employee. Pursuant to prior agency guidance, employer payment plans are… Read More
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Reality Check: The Price Of Not Buying Health Insurance
MINNEAPOLIS (WCCO) — Minnesotans have until Feb. 15 to sign up for health care insurance or pay a tax penalty. Click here for the full story Still need insurance? Click here!
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New tax form for individuals with coverage from the Health Insurance Marketplace
Beginning in January 2015, the Health Insurance Marketplace Health and Human Services will be issuing a new 1095-A tax form to individuals who purchased coverage through the Health Insurance Marketplace. If you or anyone in your household enrolled in a health plan through http://www.healthcare.gov you should receive the new tax form in the mail. You should use this form when filing your 2014 federal income tax return. For more information visit www.IRS.gov/ACA or www.healthcare.gov/taxes or contact your tax advisor. The following publications are also available: Health Care Law: What’s New for Individuals & Families This is a large publication with many details. 3 Tips: The Marketplace and taxes Regarding your tax forms and… Read More
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Updated Healthcare Reform Calculators
Total Benefit Solutions Inc. has updated our healthcare reform calculators on our website, http://www.totalbenefits.net Calculators include: How much tax credit is my small group eligible for? What are the conditions required to get the tax credit? Pay or Play Mandate penalty-What is my risk as a group? Individual Subsidy Calculator Click here to get to our healthcare reform calculators.
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2014 Compliance Bulletin Compilation
Download our 2014 Compliance Bulletin Compilation, featuring all of our released compliance bulletins for the entire year! Topics include, Health Savings Accounts, The Individual Mandate, Employer “pay or play” mandate, exemptions, FSA carryovers and much, much more. All of the bulletins are in an easy to search format for your convenience. 2014 Compliance Compilation – Download As always please contact your Total Benefit Solutions account manager at (215)355-02121 if you have any further questions or concerns.
Continue ReadingPlan cost inaccuracies found on HealthCare.gov
Consumers who have complex medical diagnoses that require specialty drugs should carefully examine the health insurance plans offered through the public exchange system to avoid incurring high costs for those drugs. But that task will be complicated by inaccuracies on the public exchange website. That’s the conclusion of an analysis of public exchange plans by Avalere Health. The study, in which researchers went through all available plans looking for “hidden” drug costs, found that silver plans in particular tend to place such drugs in specialty tiers in their 2015 formularies. Avalere said that 17 percent of silver plans contain two or more specialty drug tiers that will drive up out-of-pocket… Read More
Continue ReadingTotal Benefits Introduces New Compliance and Health Reform Education Center
Total Benefits Comply is our new Compliance and Health Reform Education Center where we will keep a copy of our health care reform bulletins throughout the year, in an easy to view format, along with short informative videos. This new resource makes it easier to quickly find the answers to your reform questions and download a short, to the point bulletin. At Total Benefit Solutions Inc., we are dedicated to providing the information and advice that our clients need to remain compliant and make informed healthcare decisions. If you have any further questions please contact you Total Benefit Solutions account manager at (215)355-2121 Click here for Total Benefits Comply.
Continue ReadingHR 360: How to Calculate Pay or Play Penalties
HR 360: How to Calculate Pay or Play Penalties: Make sure you are ready for 2015 with our basic step-by-step guidance on calculating pay or play penalties. This attorney-reviewed guide, provided by our partner HR360, makes it easy to understand how to calculate ACA penalties. HR360 is provided as a service to Total Benefit Solutions clients. If you have any additional questions regarding this bulletin, or the Affordable Care Act, please contact your Total Benefit Solutions account manager at (215)355-2121 Download How to Calculate Pay or Play Penalties
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IBC: Effective January 1, 2015, HIPAA Certificates of Creditable Coverage are no longer required
On February 24, 2014, the United States Departments of Health and Human Services issued a final rule that addressed the requirement to provide HIPAA Certificates of Creditable Coverage (HIPAA Certificates) under the Affordable Care Act (ACA). As the ACA prohibits pre-existing condition exclusions, the new rule eliminates the requirement to provide HIPAA Certificates beginning December 31, 2014. What does this mean for members? Previously, when coverage was terminated for a member or his/her dependents, Independence Blue Cross (Independence) issued a HIPAA Certificate. Because the ACA prohibits the application of pre-existing condition exclusions, which applies to both grandfathered and non-grandfathered health plans, these certificates are no longer required. Effective January, 1,… Read More
Continue ReadingCMS: New Transparency Tool Launched
Today, the Centers for Medicare & Medicaid Services (CMS) increased transparency and oversight of health insurance premiums by launching a new tool designed to help consumers easily review rate increases requested by insurance companies in every state. Under the Affordable Care Act, every premium rate increase of 10 percent or greater for non-grandfathered coverage in the individual and small group markets must be reviewed and made available for public scrutiny. Consumers can visit https://ratereview.healthcare.gov and enter a state or insurance company name into the new consumer friendly tool to find out about proposed or finalized health insurance company rate increases. The tool currently contains information on rate increases for… Read More
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IBC: Important information about member outreach for IRS reporting
From Independence Blue Cross: As you may know, the Affordable Care Act (ACA) requires all health insurers to report certain information about health care coverage to the Internal Revenue Service (IRS) for individuals with fully insured commercial health plans. This information includes an individual’s Tax Identification Number, which is typically the Social Security Number (SSN). The purpose of the IRS reporting is to help ensure that Americans have minimum essential coverage as required by the ACA. This is commonly referred to as the individual mandate. Independence Blue Cross (Independence) has determined that we do not have SSNs on file for some of your customers’ employees and/or their covered dependents. The… Read More
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