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
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United Concordia Will Now Offer one of the Country’s Largest Dental Networks United Concordia, Dental Network of America®, LLC and DenteMax®, LLC have entered into a network sharing agreement to provide greater access and deeper discounts to our members and clients. This agreement will take effect for United Concordia for 2015 business. Click here to read more…
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The Department of Health and Human Services (HHS) notified U.S. territories (Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa and the Northern Mariana Islands) that the following Affordable Care Act provisions will no longer apply to insured plans sitused in the territories. Please click the link below to read the entire bulletin. Certain ACA Provisions Will No Longer Apply to U.S. Territories-082614R If you have any further questions please contact your Total Benefit Solutions account manager at (215)355-2121.
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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
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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
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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
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Medicare is no longer prevented from recognizing same-sex marriages Special Update: As a result of the June 2013 U.S. Supreme Court ruling invalidating part of the Defense of Marriage Act (DOMA), which denied federal benefits to legally married same-sex couples,Medicare is no longer prevented from recognizing same-sex marriages for determining entitlement to, or eligibility for, Medicare. The Social Security Administration is now processing requests for Medicare Part A and Part B Special Enrollment Periods, as well as reductions in late enrollment penalties, for certain eligible individuals in same-sex marriages. Click here for more information.
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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.
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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
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Individual Shared Responsibility Payment Amounts for 2014 and 2015 Tax Years The amount of the individual shared responsibility payment increases between 2014 and 2015. 2014: The annual individual shared responsibility payment is the greater of 1% of the taxpayer’s household income that is above the tax return filing threshold for the taxpayer’s filing status, or The taxpayer’s flat dollar amount, which is $95 per adult and $47.50 per child, limited to a family maximum of $285. However the total payment amount is capped at the cost of the national average premium for a Bronze level health plan available through the Marketplaces in 2014. 2015: The annual individual responsibility payment is… Read More
Continue ReadingWith 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.
Continue ReadingFMLA 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
Continue ReadingNew Guidance on Employer Payment Plans The IRS issued an FAQ addressing the potential consequences of an arrangement where an employer reimburses employees for the purchase of individual health insurance premiums on a tax-favored basis (referred to as an “employer payment plan”). For this purpose, individual health insurance premiums includes individual coverage purchased either inside or outside of the Health Insurance Marketplace. The FAQ follows up on earlier guidance describing these types of arrangements (Notice 2013-54). Click the link for more information: 060214_P_ERC_Employer_Payment_Plans (1)
Continue ReadingIn 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
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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
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Will you get financial help when you purchase health insurance? This handy new brochure from Humana is simple to understand. Download it today for a better understanding of your situation. You may qualify for help buying your health insurance. As always, contact us at Total Benefit Solutions Inc if you have any questions or concerns. We can be reached at (215)355-2121. Click here to download
Continue ReadingWhat 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.
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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
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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
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The Department of Labor (DOL) and its reporting agencies require employers to communicate certain information to their employees. In some cases, the DOL mandates notices to be posted in the workplace. Posting requirements vary based on the size of employer. The following information is required to be posted, depending on business and employer size: Job Safety and Health Protection (OSHA) Equal Opportunity Is the Law Fair Labor Standards Act (minimum wage) Employee Right for Workers with Disabilities (special minimum wage) Family and Medical Leave Act Rights Uniformed Service Employment and Reemployment Rights Federal Construction Project Notice Government Contract Notice Employee Polygraph Protection Act Migrant and Seasonal Worker Act Notification… Read More
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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
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The three agencies responsible for the implementation of health care reform (Treasury, Health and Human Services, and Labor) released a joint set of Frequently Asked Questions on cost sharing limits. Health care reform places a limit on the dollar amount of out-of-pocket expenses that a participant may be charged in a year. In 2014, that limit is $6,350 for self-only coverage and $12,700 for other coverage. In 2015, the limit increases to $6,600 for self-only coverage and $13,200 for other coverage. The guidance clarifies that if an out-of-network provider charges an amount greater than the amount allowed by the plan (i.e., balance bills the amount above the usual and customary… Read More
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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
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