Viewing posts from: June 2016

2016 Updated Healthcare Reform Timeline (Version 16)

Posted June 29, 2016 by PHaynes

PPACA

If you want to see 10 pages of health reform in a 1 page timeline (well, 1 page for Employer and 1 page for Employees) then please visit our website (www.crawfordadvisors.com/news).  But, if you are looking for details specific to just a certain year or plan, then you can’t do better than this implementation timeline from The Kaiser Family Foundation.

Also, we’ve had several requests for a condensed version of the Employer Mandate rules and examples.  That is included here too.

Crawford Advisors’ Timelines & Employer Mandate Details

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**Don’t forget that the IRS indexed the Shared Responsibility fines under the Affordable Care Act. (See our 12/21/2015 post for complete details).

Department also update the payments due under ACA’s Shared Responsibility Structure

  • Question 13:  Under § 4980H(c)(5), in the case of any calendar year after 2014, the applicable dollar amounts of $2,000 and $3,000 under § 4980H(c)(1) and (b)(1) are increased based on the premium adjustment percentage as defined in § 1302(c)(4) of the Affordable Care Act (4.213431463 for 2015* and 8.316047520 for 2016**) rounded to the lowest multiple of $10. What are those amounts for calendar years 2015 and 2016?
  • Answer 13:  For calendar year 2015, the adjusted $2,000 amount in §4980H(c)(1) is $2,080 ($2,000 x .04213431463 = $84.27 plus $2,000 rounded down to $2,080), and the adjusted $3,000 amount in §4980H(b)(1) is $3,120 ($3,000 x .04213431463 = $126.40 plus $3,000 rounded down to $3,120).  For calendar year 2016, the adjusted $2,000 amount in §4980H(c)(1) is $2,160 ($2,000 x .08316047520 = $166.32 plus $2,000 rounded down to $2,160), and the adjusted $3,000 amount in §4980H(b)(1) is $3,240 ($3,000 x .08316047520 = $249.48 plus $3,000 rounded down to $3,240). Treasury and IRS anticipate that adjustments for future years will be posted on the IRS.gov website.
  • 2015  Sledge-hammer fine $2,080
  • 2015  Tack-hammer fine $3,120 ($260/month)
  • 2016  Sledge-hammer fine $2,160
  • 2016  Tack-hammer fine $3,240 ($270/month)

2017 Out-of-Pocket Maximums Reminders (these are on the timeline and the HSA-chart above):

  • The 2017 annual out-of-pocket maximums will be $7,150 for individual coverage and $14,300 for family coverage.
  • For HSA-qualified plans the annual out-of-pocket maximums will be $6,550 for individual coverage and $13,100 for family coverage

Unexpected Medical Bills More Difficult to Afford

Posted June 29, 2016 by Megan DiMartino

Healthcare costs are rising, including insurance deductibles, and Americans are finding it difficult to afford the unexpected medical costs.

The Associated Press-NORC Center for Public Affairs Research surveyed 1,008 U.S. adults between April 14 – 18, in regards to the economy and household finances and recognized the following findings:

  1. Of participants making less than $50,000 annually, 75% said they would have difficulty affording an unexpected bill amounting to $1,000.
  2. Of participants making between $50,000 and $100,000 annually, 67% said they would have difficulty affording a $1,000 surprise bill.
  3. Of households making more than $100,000 annually, 38% said they would at least have some difficulty coming up with $1,000.
  4. When faced with an unexpected $1,000 bill, a majority of participants said they wouldn’t likely have the money on hand to pay the bill. One-third of the participants said they would have to use a credit card or borrow money from the bank, friends or family to pay the bill. And 13% said they would forgo paying other bills to afford the surprise bill, while 11% said they would likely not pay the bill at all.

Source: Becker’s Healthcare | 66% of US citizens would struggle with a surprise $1k bill

For more information contact info@crawfordadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

AssuredPartners Webinar | Workplace Wellness: Is Your Program Compliant? ADA, GINA, ACA & More!

Posted June 27, 2016 by Megan DiMartino

AP Logo LargeJoin AssuredPartners NL Health and Productivity Managers as they help you navigate the often choppy waters of wellness compliance. During this session, certified corporate wellness specialists, Cary Seager and Kristin Meschler, will provide an overview of the current regulations surrounding worksite wellness programs and present case studies of some typical programs, detailing specific compliance considerations for each. If you have a worksite wellness program or are considering offering one, this will be a session you do not want to miss!

Webinar Details:

  • Tomorrow! Tuesday, June 28, 2016
  • 2:00 – 3:00pm EDT
  • No Cost to Attend

Register Now - CA Blue

About the Presenters:

Cary Seager specializes in delivering comprehensive workplace wellness strategies. Cary brings more than 14 years Employee Benefits experience to AssuredPartners NL. Focusing on groups with 100+ employees, she accesses clients’ needs for health and wellness to create an organized short and long-term strategic wellness plan that delivers both employer and employee satisfaction, brings behavior change, and ultimately drives a downward trend in medical, Rx and worker’s compensation claims. Cary is a certified Corporate Wellness Specialist (CCWS) and a Complete Health Improvement (CHIP) facilitator. She has a Master’s degree in Business Administration from the University of Findlay and a BS from Miami University with a major in Finance.

Kristin Meschler specializes in wellness and employer health & productivity solutions. Kristin brings more than 5 years of experience to AssuredPartners NL, with a background in worksite wellness, working with groups of all sizes to improve the overall health of their employees. Kristin supports AssuredPartners NL by creating and implementing cutting edge strategies and tactics for employers with the goal of bending the trend in healthcare costs and improving quality of life for all employees. Kristin has a BS from Murray State University and has received further training in all areas of holistic wellness including health coaching and lifestyle medicine.

For more information contact info@crawfordadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

PPACA FAQs Part 32 – COBRA Notice May Include Additional Information about Exchange Options

Posted June 23, 2016 by PHaynes

DOL_imageThe Departments (DOL, HHS, and IRS) have jointly issued a single FAQ confirming that group health plan administrators may include in their COBRA election notices information about Exchange coverage that goes beyond the information included in the DOL’s model notice.

As you may recall, the DOL revised its model election notice in 2013 and again in 2014 to include basic information about the Exchanges (federal and state Marketplaces).  See links below, or this Model Notices from the DOL’s site (in English).

FAQ Part 32 states that administrators may include additional information, such as:

  1. how to obtain assistance with Exchange enrollment (including special enrollment);
  2. the availability of financial assistance;
  3. information about Exchange websites and contact information;
  4. general information regarding particular products offered in the Exchanges; and
  5. other information that may help qualified beneficiaries choose between COBRA and other coverage options.

The Departments do encourage employer, plan sponsors and plan administrators to consider how they can help individuals maintain the coverage that would best suit their needs and they note that COBRA notices may be tailored to particular groups, such as young adults aging out of dependent coverage under their parents’ health plan.

FAQ-32 also includes a reminder that COBRA notices must be “easily understood by the average plan participant.”

While use of the DOL’s model COBRA notice is not required (not mandatory at all), many plans choose to use the model as the basis for their notices because it covers all the points that are required to be covered per federal guidance.  Naturally, you are expected to customize that to include helpful and relevant contact information, plan specific details, process for selecting and paying for coverage, etc.

Should you have any questions or concerns, please contact your Account Manager or Account Executive.

Links

COBRA Continuation Coverage – Resources for Employers:

 

HHS & OCR Final Rule on Nondiscrimination in Health Programs and Activities

Posted June 15, 2016 by Megan DiMartino

Human resources, personal audit and assessment center concept - recruiter look for employee represented by icon.

On May 13, the Department of Health and Human Services (HHS) and the Office of Civil Rights (OCR) issued a final rule on nondiscrimination in health programs and activities under Section 1557 of the Affordable Care Act (ACA), which protects classes of individuals whose health coverage may not be denied, cancelled, limited or refused based on race, color, national origin, sex, age, or disability.

The rule goes into effect July 18, 2016, but should a plan require a change in benefits design they are required to comply on the first day of the plan or policy year beginning on or after January 1, 2017.

All entities that are subject to nondiscrimination requirements must ensure that all their employer-sponsored plans are compliant.

Final rule key provisions and clarifications:

Expanded protection for transgender individuals
Certain services cannot be denied or limited due to an individual’s sex assigned at birth, gender identity, or recorded gender.

Required language assistance
Nondiscrimination notices and “taglines” must be made available to employees and the general public to explain how individuals can obtain language services.

  • Notices must be provided in at least the top 15 non-English languages spoken in a given state
  • Notices must be made available on physical premises, the web, and significant documents
  • Sample tagline – ATTENTION: If you speak [insert language], language assistance services, free of charge, are available to you. Call xxx-xxx-xxxx.

Communication assistance for individuals with disabilities
Notices must also be available to employees and the public on how individuals with disabilities can receive auxiliary aids and communication services without charge and in a timely manner.

Application to administrative services only (ASO) self-insured employer plans
Self-insured plan complaints are reviewed on a case-by-case basis to determine liability for discriminatory activity between the employer, insurer and/or third party administrator. Third party administrators of self-insured plans are generally liable for their own discriminatory actions. But with insured plans, the insurers are liable for any discriminatory benefit design. In the end, both plan types should be updated to be in compliance with the new final rule.

Expatriate Plans
Section 1557 of the ACA and the final rule do not apply to expatriate health plans, expatriate health insurance issuers, or employer plan sponsors of expatriate plans, as defined in the Expatriate Health Coverage Clarification Act (EHCCA).

Source: Cigna – Informed on Reform | Final Rule on Nondiscrimination in Health Programs and Activities

Links: HHS – Section 1557 of the Patient Protection and Affordable Care Act

HHS Factsheets: Protecting Individuals against Sex Discrimination 
Ensuring Meaningful Access for Individuals with Limited English Proficiency
Ensuring Effective Communication with and Accessibility for Individuals with Disabilities
Coverage of Health Insurance in Marketplaces and Other Health Plans

For more information contact info@crawfordadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

How to Survive a DOL Health & Welfare Plan Investigation

Posted June 13, 2016 by Megan DiMartino

Here are the best practices for plans chosen for investigation:

Investigation Concept. Button on Modern Computer Keyboard with Word Partners on It.1. Consider getting employee benefits counsel involved early
The DOL investigation process generally includes requests for a long list of documents ranging from plan documents to financial documents. Working with your employee benefits counsel from the beginning may help with the overwhelming process that awaits you with the large quantity of documents and broad, and sometimes vague, requests. Having knowledgeable counsel at hand may help correct or intercept any mistakes as well as be helpful in crafting appropriate responses to the DOL.

2. Confirm the scope of the document request
The DOL may request a year’s worth of claims data, but you may want to ask if the DOL
would be satisfied with a smaller, random sampling of claims data instead. This is
important if the requested information includes protected health information (PHI)
under HIPAA. A plan administrator must limit the disclosure of PHI to the “minimum
necessary,” so in doing so, you may reasonably rely on a representation from the DOL
that the requested information was the minimum necessary for its purpose.

3. Stay organized and document your disclosures 
This process could take months or even years, so while you find yourself free of any
requests while the investigator is processing the information, take that time to prepare
a log that records the documents requests, the documents produced and any notes
or comments you may have.

4. Prepare your employees for interviews
You may find it helpful to prepare your employees in case the DOL has to interview
them regarding the investigation. So to lessen the fear and anxiety, prep your
employees on what to expect and general best practices, such as answering questions
truthfully and if they do not know the answers to the DOL’s questions do not guess.

5. Carefully review findings and closing letters
The DOL will issue a “findings letter” toward the end of the investigation that explains
any violations they may have found. If you disagree, it is important to respond. Once
the terms in the letter are agreed upon, the DOL may refer your case to other
agencies for further investigation or to assess penalties. If no violations are found or
if all violations have been corrected, the DOL will then issue you a “closing letter.”

Source: Snell & Wilmer – SW Benefits Update | Five Ways to Survive a Department of Labor (“DOL”) Health and Welfare Plan Investigation 

For more information contact info@crawfordadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

How to Handle Tax Treatment of Wellness Rewards

Posted June 9, 2016 by Megan DiMartino

Man holding white piggy bank with dollar inside over black suit background.

The IRS recently released a memorandum on its views of the tax treatment of rewards under employer wellness plans.

Cash, Cash-Equivalent Rewards

The memorandum confirms that certain tax rules apply to employer-sponsored wellness programs, but coverage, such as health screenings and other medical care, under these programs are generally excluded from an employee’s income. But cash rewards or cash-equivalent rewards earned from a wellness program are different.

Per the IRS, if an employee earns a cash reward through the wellness program, the reward must be included in the employee’s gross income under Code Section 61 and is a payment of wages subject to employment taxes.

For a cash-equivalent reward, the fair market value of the reward must be included in the employee’s gross income and is a payment of wages subject to employment taxes.

Additional Clarifications

  • If employers reimburse all or a portion of the premiums paid by the employee through a cafeteria plan for the company’s wellness plan, those reimbursements will be included in the employee’s gross income and are payments of wages subject to employment taxes.
  • Although some non-cash benefits may be excludable as de minimis fringe benefits (e.g., a t-shirt for a company wellness plan), cash fringe benefits generally aren’t eligible to be treated as excludable de minimis fringe benefits.

Source: HR Benefits Alert | IRS: Here’s how to handle the tax treatment of wellness rewards

For more information contact info@crawfordadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

Manager Mistakes That Could Harm Your Organization’s Credibility

Posted June 7, 2016 by Megan DiMartino

Lawsuits against employers by employees has grown at a tremendous rate over the years and can cost serious time and money that can be better spent within your organization. There are even laws, such as the federal overtime law and the Family and Medical Leave Act (FMLA), that allows employees to directly sue their supervisors – directly hit their managers right in their personal bank accounts.

Here are 12 manager mistakes that can harm your organization’s credibility in court, so use these as a checklist to prepare your personal employment-law defense:

Close-up of a vintage gavel, on blurred background, symbol of impartiality and rightness, judicial decisions, closed cases and justice

1. Sloppy documentation
Most discrimination cases are proven circumstantially, often through documents or statements made by managers – so make sure to always speak and write as if your comments will be held up to a jury someday.

2. Not knowing policies, procedures
If a manager admits ignorance to your organization’s policies and procedures, then juries will typically view that as purposeful, not forgetfulness. That’s why it’s vital that your managers understand your company’s policies, don’t make decisions based on a vague memory of these policies, and always double check either the policy or with HR before taking action.

3. Inflated appraisals
Inflated performance reviews can create credibility concerns if you later try to terminate someone based on “poor performance.” Be direct, honest and consistent.

4. Shrugging off complaints
Turning a blind eye to employees’ complaints because you’re “not a babysitter” or “boys will be boys” will hurt employee morale and jeopardize your standing in court.

5. Interview errors
When managers are asked “why did you reject certain candidates,” it is best that their answer is well-documented as they most likely won’t recall the reasons later. During interviews, stay away from any question that doesn’t focus on the central issue and never ask about age, race, marital status, children, day care plans, religion, health status or political affiliation.

6. Lack of legal knowledge
Juries will expect employer’s to know of all new developments in employment law. Refresh your knowledge regularly regarding your organization’s policies, read communications sent from HR and when in doubt, ask questions.

7. “Papering” an employee’s file
Over-documenting an employee’s file prior to termination will leave courts able to see the rush of disciplinary actions cited in the days leading up to the firing. Be consistent in documenting both the negative and positive performance and behavior of an employee. Keep a performance log for each employee, regularly making comments and notes.

8. Being rude, mean-spirited
Coming across as rude, insensitive and mean can make selling your case to a jury much harder.

9. Careless statements to feds
Managers may be called upon to help provide information and statements, so expect to see these introduced in trial. So keep your story straight, you don’t want to provide conflicting information.

10. Changing your story
Your credibility will be shot if you begin changing your reasoning for making adverse employment decisions (firing, discipline, demotion, etc.) midstream. Be forward with your employees about reasons for discipline.

11. Dictating accommodations
Under federal law, employers must make “reasonable” changes to the workplace to accommodate an employee’s disability. By law, a solution must be made through a give-and-take process, not by dictating the solution.

12. Firing employees too fast
You will stand a better chance of avoiding a lawsuit if you first try to improve the employee’s performance before firing, which could appear insensitive and potentially discriminatory.

Source: Business Management Daily – Leaders & Managers | The Dirty Dozen: Manager mistakes that spark lawsuits

For more information contact info@crawfordadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

HRCI* & SHRM** Pre-approved Crawford Advisors Webinar Series: Using Data Analytics to Change the Network Paradigm – Enhancing Benefits & Reducing Costs

Posted June 3, 2016 by Megan DiMartino

businessman working with modern technology as concept

Join Crawford Advisors’ Director of Data Analytics, Scott Mayer, for this complimentary, one-hour, HRCI* and SHRM** pre-approved webinar as he reviews how to identify more effective metrics to measure the cost efficiency of healthcare provider networks than by simply looking at average network discounts. HR departments often spend significant time reviewing network discounts to compare and contrast plan cost and efficacy. In this webinar, we will review how and why these metrics can be misleading, and alternatives to determine a more effective approach to improve plan benefits while reducing costs.

Topics will include:

  • Why and how network discounts can be an inefficient metric
  • How quality, as well as cost, can factor in to unit-cost spending
  • Sites of service and impacts on unit-costs
  • Diagnosis codes and impacts on unit-costs
  • Pharmacy language and Medicare Part B pricing

Webinar Details:

  • Wednesday, June 22, 2016
  • 1:00 – 2:00pm EDT
  • No Cost to Attend
  • This webinar is open to all HR and Finance Professionals – but not to brokers, agents, TPAs and PEOs.

Register Now - CA Blue


hrci_ap_preapprovedseal_2016_new*The use of this seal confirms that this activity has met HR Certification Institute’s (HRCI) criteria for recertification credit pre-approval. This activity has been approved for 1 HR (General) recertification credit hours toward aPHR, PHR, PHRca, SPHR, GPHR, PHRi, and SPHRi recertification through HRCI.

 

SHRM SEAL-Preferred Provider Recert_CMYK_2016_1.25in (R)**Crawford Advisors is recognized by SHRM to offer Professional Development Credits (PDCs) for SHRM-CP or SHRM-SCP. This program is valid for 1 PDC for the SHRM-CP or SHRM-SCP. For more information about certification or recertification, please visit shrmcertification.org.

 

For more information contact info@crawfordadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

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