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Health Reform: Small Business Health Care Tax Credit

September 18, 2014August 24, 2014Ed MacConnell

Small Business Health Care Tax Credit Many small businesses are eligible for the Small Business Health Care Tax Credit to assist with the cost of health insurance coverage. To qualify, businesses must: Have an average of fewer than 25 FTE employees (based on a 40 hour work week and excluding owners, owners’ family members, and seasonal employees) Have average annual employee wages below $50,000 (augmented to reflect cost-of-living adjustments (COLA) as of 2014) (business owner salaries are not included in this calculation) Pay a uniform percentage or amount (at least 50%) of the cost of single coverage of each employee’s health insurance The tax credit is generally available only for… Read More

HR360: Employers Must Provide Exchange Notice at Time of Hiring

September 17, 2014September 15, 2014Ed MacConnell

Employers are required to provide an Exchange Notice (also referred to as a “Notice of Coverage Options”) to each new employee at the time of hiring as of October 1, 2013. For 2014, the notice can be provided within 14 days of an employee’s start date. Click below to read the bulletin from HR360: HR360_notice at time of hiring If you have any questions about the HR360 subscription, or exchange notices, please contact your Total Benefit Solutions account manager at (215)355-2121.

Health Reform: Network Adequacy Standards

September 15, 2014August 24, 2014Ed MacConnell

Health Reform: Network Adequacy Standards For QHP certification, a plan must have an adequate provider network available to its enrollees. A QHP must: Offer a network with a sufficient number of providers, including mental health and substance abuse providers, to ensure access to all services without unreasonable delay Include a sufficient number and geographic distribution of essential community providers to ensure reasonable and timely access to care for low-income and medically under-served populations in the QHP’s service area The Marketplaces offer only health insurance plans that are certified as qualified health plans, or QHPs. These QHPs must be licensed and meet certain transparency requirements. To become certified, a QHP… Read More

What is Small Group Defined Contribution-Private Exchange Solution?

September 12, 2014Ed MacConnell

What is Small Group Defined Contribution-Private Exchange Solution? With health care reform now being implemented, many employers large and small will consider this arrangement to offer their employees a quality, flexible, easy to use and competitive benefit package. Simply, the employer decides what dollar amount they will provide to each employee. The employee then uses that dollar amount as a “voucher” of sorts. With the voucher or credit in hand, each employee can choose a plan that best suits their needs from a menu of health plans. In the past, small group employers had to juggle the challenge of affordability and providing a quality benefit that worked for their entire… Read More

Amerihealth NJ: Effective Immediately Ending Spousal 2 Person Groups

September 11, 2014September 11, 2014Ed MacConnell

We received this e-mail today without any further guidance.: EFFECTIVE IMMEDIATELY: C-Corp Owner/Spouse orEmployee/Spouse groups no longer eligible for small group coverage. AmeriHealth New Jersey will no longer accept or renew Owner/Spouse or Employee/Spouse groups, including C Corporations. If you have any questions, please contact your AmeriHealth New Jersey broker representative. Click the link below to download the entire message. Amerihealth 2 person groups notification

Health Reform: Treatment of Interns for Employer Penalty Purposes

September 9, 2014Ed MacConnell

If large employers do not offer affordable, minimum value coverage to all “full-time employees” they can be penalized beginning in 2015. A full-time employee (“FTE”) is an employee under the common law standard who works on average at least 30 hours per week, determined monthly. Under the common law standard, an employment relationship exists when the person for whom the services are performed has the right to control and direct the individual who performs the services, not only as to the result to be accomplished by the work, but also as to the details and means by which that result is accomplished. Under this standard, an employment relationship exists… Read More

Health Reform: SHOP Marketplace Changes for 2015

August 29, 2014August 24, 2014Ed MacConnell

Health Reform: SHOP Marketplace Changes for 2015 In 2014, small businesses that offer coverage through an FF-SHOP Marketplace are able to offer their employees a single qualified health plan (QHP). In 2015, small businesses that offer coverage through an FF-SHOP Marketplace may be able to offer their employees a choice of QHPs and qualified dental plans (QDPs). To qualify for an FF-SHOP, a business must: Be located in an FF-SHOP’s service area (generally a state) Have at least one eligible common-law employee on payroll Have 50 or fewer full-time equivalent (FTE) employees on payroll This methodology includes part-time employees, but not seasonal employees (those working fewer than 120 days per… Read More

Health Reform: What is a Special Enrollment Period?

August 28, 2014August 24, 2014Ed MacConnell

Special Enrollment Periods Under certain circumstances, individuals may enroll in a QHP or change QHPs outside of the annual open enrollment period. These SEPs are based on certain triggering events or special circumstances. Events that permit an SEP include: Gaining or becoming a dependent through marriage, birth, adoption, placement for adoption, or placement in foster care Gaining status as a citizen, national, or lawfully present individual Loss of coverage (e.g., loss of Medicaid eligibility, QHP no longer available), except if enrollment is terminated based on failure to pay premiums, fraud, or enrollee initiated termination Determination that an individual is newly eligible or ineligible for advance payments of the premium tax… Read More

Health Reform: ACA Checklist for 2015/2106

August 26, 2014August 25, 2014Ed MacConnell

Health Reform: Affordable Care Act Business/Plan Sponsor Checklist for 2015/2106 This bulletin features a checklist, including descriptions of key topics, to guide you through Affordable Care Act compliance in 2015-2016. Click the link to download the ACA Checklist: ACA Checklist for 2015-2016-082214R Should you have any questions, please contact your Total Benefit Solutions Inc., account manager directly at (215)355-2121.

Health Reform: 2015 Annual Open Enrollment Period

August 24, 2014Ed MacConnell

Annual Open Enrollment & Effective Dates The annual open enrollment period (AEP) for 2015 begins on November 15th 2014 and ends on February 14th 2015. The open enrollment period is the time when you can change, or purchase a new qualified health plan (QHP) on a guaranteed enrollment basis. You do not need a special election period, or a life change event to enroll during the annual open enrollment period. The chart below illustrates the effective dates for enrollments taken during the annual open enrollment period. Effective Dates for 2015 Annual Open Enrollment Period

Top 3 Consumer Worries About 2015 Open Enrollment

August 23, 2014August 22, 2014Ed MacConnell

With open enrollment 2015 for individual health insurance coming up in November, employees and clients are worried about the cost of health insurance, the number of uninsured, and Marketplace glitches. This is according to a new survey by Bankrate.com. Click here to read the story on the Zane Benefits website.

FMLA Proposed Rules To Recognize Same Sex Regardless of Residency

August 22, 2014Ed MacConnell

FMLA Proposed Rules To Recognize Same Sex Regardless of Residency The DOL is proposing to amend the regulatory definition of “spouse” under the Family and Medical Leave Act (“FMLA”) so that “spouse” for purposes of FMLA rights would include a same-sex spouse, regardless of where the employee and spouse live. This means the “place of celebration” will determine whether an individual is a spouse under FMLA, rather than the current rule which uses the “state of residence,” which recognizes a spouse under the law of the state in which the couple resides. Click the link to download the bulletin: 070714-P-ERC-FMLA_Proposed_Rules (1) Please contact you Total Benefit Solutions account manager at (215)355-2121 if… Read More

Total Benefit Solutions to partner with ThinkHR

August 22, 2014August 22, 2014Ed MacConnell

In another effort to enhance our client experience and bring value to our small business clients, Total Benefit Solutions is proud to announce that we have entered into an agreement to provide Think HR. Soon our clients will get an introductory e-mail with instructions on how to access their complimentary ThinkHR account. We expect to have this resource available to our clients in September 2014, just in time for this year’s open enrollment period! Think HR will help our clients: Stay up to date with the latest news and resources Remain compliant with best practices from HR professionals Build tools like job… Read More

Exchange Notification Reminder

August 15, 2014August 15, 2014Ed MacConnell

Exchange Notification Reminder The very busy renewal date of December 1, 2014, is fast approaching. This notice is to remind you that each employer group must give their employees a Marketplace (Exchange) notification. The first link below is for employer groups that currently do offer coverage. The second link below is for an employer that does NOT offer coverage to employees. Please remember this notification is for the states of Pennsylvania and New Jersey. The form also works for any employer who is based in an FFM (Federal Facilitated Marketplace) State. It is NOT compliant in NY, MD or any other state that provides their own State… Read More

What is HR360?

July 3, 2014July 3, 2014Ed MacConnell

What is HR360? HR360 is the premier online human resources library that features the most current federal and state laws for health care reform, COBRA, FMLA, and hiring and terminating employees. Clients of Total Benefit Solutions have HR360 as a complimentary resource. Watch this short video below and ask us today for your free trial membership, or how your organization can benefit from using Total Benefit Solutions Inc., and HR360. Call us for more information at 1(800)924-6718.

U.S. Supreme Court Contraceptive Ruling

June 30, 2014Ed MacConnell

In a 5-4 decision that was described by one of the dissenting Justices as a “decision of startling breadth”, the Supreme Court has ruled in Burwell v. Hobby Lobby Stores, Inc. that closely held for-profit corporations are not compelled to provide contraceptive coverage under the Affordable Care Act’s preventive care mandate if they object to that coverage on religious grounds. The decision is a “win” for Hobby Lobby who had challenged the contraceptive mandate saying it forced them to either violate their faith or pay fines. Click here to download the bulletin

What is Critical Illness Insurance?

June 30, 2014February 8, 2015Ed MacConnell

Why Critical Illness as a “wrap” plan Because: They’re more affordable than you might think. They’re available for employer groups, individuals and seniors. They make selecting a health plan easier. They provide peace of mind against a catastrophic event and large out of pocket expenses. They’re person and portable, it doesn’t matter where you get your health insurance from, having your own critical illness plan makes it better. Many clients have asked how they can supplement their employees coverage when they get enrolled through the affordable care act healthcare.gov marketplace. Employers are permitted to offer wrap plans that consist of “excepted benefits”, meaning they are not regulated by the affordable… Read More

Health Care Reform Updates: Updated Model COBRA Election Notice

June 10, 2014Ed MacConnell

Updated Model COBRA Election Notice Includes Information Regarding Health Insurance Exchanges Revised Notice Informs Individuals of New Coverage Alternatives A revised Model COBRA Election Notice is now available for group health plans to inform eligible employees and dependents of the right to continuation of coverage under federal law and how to make an election when a qualifying event occurs. The updated model notice includes information regarding coverage alternatives that will be available through the new Health Insurance Exchanges (also known as Marketplaces). COBRA Election Notice Requirement COBRA (the Consolidated Omnibus Budget Reconciliation Act) generally applies to group health plans sponsored by employers with 20 or employees (including both full-… Read More

Introducing the AFLAC Individual Dental Plans

May 31, 2014Ed MacConnell

Introducing AFLAC Individual Dental Ask us today for more informtion on an AFLAC Individual Dental plan. Just call our office at (215)355-2121 and a dedicated member of our client service team will be happy to answer your questions or send you detailed benefit information.

IRS Highlights Stiff Penalty for Reimbursing Individual Premiums

May 25, 2014May 25, 2014Ed MacConnell

From Health Care Reform Digest: Since the IRS and Treasury published Notice 2013-54 in September 2013, pre-tax employer reimbursement of an employee’s individual health insurance premiums has been a hot topic of conversation. Historically, many employers have provided this type of benefit in lieu of offering a group health plan – a strategy that now needs to be reevaluated as a result of regulations implementing the Patient Protection and Affordable Care Act (PPACA). Q1. What are the consequences to the employer if the employer does not establish a health insurance plan for its own employees, but reimburses those employees for premiums they pay for health insurance (either through a qualified health… Read More

Nuts and Bolts of the Small Employer Tax Credit

May 20, 2014Ed MacConnell

This presentation is intended to convey general information about the employer health care tax credit under the affordable care act and is not an exhaustive analysis. Information contained in this presentation may change as guidance develops. Total Benefit Solutions inc and Emerson Reid do not provide legal or tax advice. For advice specific to your situation, please consult an attorney or other professional. Click here to download “nuts and bolts” Download Small Business Health Care Tax Credit FAQ’sFAQs

Informal Guidance Clarifies Rules HSA Eligibility and Health FSA Carryovers

May 17, 2014May 16, 2014Ed MacConnell

Near the end of 2013, the IRS issued Notice 2013-47 that permits a cafeteria plan to provide for the use of up to $500 of any unused amount remaining in the health FSA in the immediately following plan year (the “carryover” provision). This provision is optional, requires a plan amendment, and cannot be offered if the cafeteria plan allows a grace period. One of the outstanding questions around the carryover provision is the effect it has on HSA eligibility. Recently, the Office of Chief Counsel for the Internal Revenue Service issued a memorandum that informally addresses the interaction of the carryover on HSA eligibility and provides some solutions that may allow an individual retain… Read More

Calculator May Help Small Businesses Determine SHOP Eligibility

May 15, 2014Ed MacConnell

Calculator May Help Small Businesses Determine SHOP Eligibility The U.S. Department of Health & Human Services has developed a Full-Time Equivalent (FTE) Employee Calculator to help small employers determine whether they qualify for the Small Business Health Options Program (SHOP). Background SHOP is available as an option for qualified small employers to purchase employee health coverage. The federal government is running the program in states that chose not to operate their own SHOP Marketplace (Exchange). For 2014, employers are generally eligible to purchase health coverage through the federally-facilitated SHOP Marketplace if they have 50 or fewer full-time equivalent employees (FTEs), including part-time employees. (For example, 2 part-time employees… Read More

Aetna: Important updates to our Pennsylvania Small Group eligibility guidelines

May 1, 2014Ed MacConnell

This briefing is applicable to all brokers writing Pennsylvania based employers We have updated our eligibility guidelines as it relates to sole proprietors, owners, partners, W-2 employees and husband / wife groups for 2014. These updates have been made to maintain compliance with state and federal requirements. Please review the updates we have outlined below. We thank you for your continued collaboration. The following applies to Small Group Pennsylvania new business and renewals: The definition of an employer is now one W-2 common law employee. This accommodates an owner with at least one “enrolling” W-2 common law employee who is not a spouse and not an owner. Sole proprietors, owners… Read More

IBC: Individual Dental and Vision PPO’s Now Available!

April 29, 2014April 29, 2014Ed MacConnell

Please be advised that Independence Blue Cross (IBC) is offering a new portfolio of Dental and Vision Care plans for adults (aged 19 and older) featuring low out-of-pocket costs and access to a large network of providers. These plans will be available for sale online, by phone, and by mail beginning on April 30, 2014, for June 1 effective dates. Offering individual customers Specialty Services products like Adult Dental and Vision Care emphasizes customer choice and helps give members the protection they need by protecting one of their most valuable assets — wellness. 15% discount on Bundled Dental and Vision IBC offers two Dental PPO plans and two Vision Care… Read More

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