All posts tagged benefits

Congress approved the Health Insurance Portability and Accountability Act (HIPAA) to guard the privacy of personal medical information, and to give individuals the right to keep their health insurance coverage for pre-existing conditions in place even if they change jobs. The law has done this, providing important safeguards for patients. But it has also increased the red tape involved in medical care.

History

Congress passed HIPAA in August 1996, and the U.S. Department of Health and Human Services finalized standards for the electronic exchange, privacy and security of health information in 2002. The rules apply to health plans, health care clearinghouses, and to any health care provider, such as a doctor, who transmits health information in electronic form.

Significance

Congress intended HIPAA to protect individually identifiable health information. Any entity, including a physician’s office, a hospital or other health care facility, or an insurer, that deals with personal health information must follow strict rules about how to handle that information to avoid disclosing it to someone not authorized to see it. For example, Health and Human Services allows physicians and insurance companies to exchange individually identifiable health information to pay a health claim, but would not allow them to release it publicly. Penalties for violating the regulations include civil fines of up to $50,000 per violation, according to Health and Human Services.

Minimum Necessary

According to Health and Human Services, the privacy rule also requires physicians, hospitals, insurers, and other health care entities to use and disclose only the minimum amount of information needed to complete the transaction or fulfill the request. As a practical matter, for example, that means a physician should not send a patient’s entire medical file to an insurer if just one page from the record will suffice to answer the insurer’s query.

Portability

In addition to protecting patients’ privacy, HIPAA also limits the ability of a new employer plan to exclude coverage for pre-existing conditions. This means a person who has health insurance coverage can change jobs — and therefore health plans — without worrying that a condition they already have, such as diabetes or asthma, would not be covered under the new health plan. This was not always the case, according to the U.S. Department of Labor. “In the past, some employers’ group health plans limited, or even denied, coverage if a new employee had such a condition before enrolling in the plan. Under HIPAA, that is not allowed,” the Department of Labor says. HIPAA also prohibits discrimination against employees and their family members based on health histories, previous claims, and genetic information, according to the Department of Labor.

Pros of HIPAA

HIPAA, for the first time, allowed patients the legal right to see, copy, and correct their personal medical information. It also prevented employers from accessing and using personal health information to make employment decisions. And, it enabled patients with pre-existing conditions to change jobs without worrying that their conditions would not be covered under a new employer’s health plan.

Cons of HIPAA

However, HIPAA’s effects have not all been positive. The regulations increased the paperwork burden for doctors considerably, according to the American Medical Association. HIPAA has spawned a mini-industry of companies and consultants who help medical professionals comply with the law’s lengthy provisions. In addition, some professionals who deal with medical paperwork have become overcautious about releasing protected information. For example, some physician’s offices now refuse to mail test results, saying patients need to pick them up in person. And some hospitals require physicians to submit written requests on their own letterhead for information on a patient’s condition, when the law allows this information to be provided by phone.

Originally published by www.livestrong.com

Modern medicines have resulted in longer, more productive lives for many of us. Prescription drugs soothe sore muscles after a strenuous workout or manage the conditions of a chronic disease. Unfortunately, this use of prescriptions drugs can come with a hefty price tag.

Americans are spending more money on prescription drugs than ever before and the United States as a nation spends more per capita on prescription drugs than any other country. With the cost of some drugs exceeding thousands of dollars for a 30-day supply, this can translate into financial hardship for many Americans.

For employers sponsoring a medical plan, managing the cost of these prescription drugs is also becoming a task. Insurance companies and employers struggle with the ability to provide affordable medical plans, and the ever-increasing prescription drug costs are a primary driver of this difficulty. As a result, prescription drug plan designs are changing shape – moving to a model that helps push more of the cost of these drugs to the member along with increasing awareness of the true cost of the prescriptions.

Flat dollar copay plans have become an expected norm in medical plans for almost a decade. However, insurance companies underwriting fully insured medical plans and employers sponsoring self-funded medical programs now need to make modifications to these plan designs to manage the ever-increasing prescription drug costs. As a result, we are seeing more prescription drug plans combining some aspect of coinsurance along with or in place of the flat dollar copayments.

According to the 2016 UBA Health Plan Survey, copay models are still the most popular, with a three-tier copay structure the most prevalent. Median retail copayments for these three-tier plans are $10 for generic drugs, $35 for preferred brand drugs (drugs on the carrier’s prescription drug list) and $60 for non-preferred brand drugs (drugs not on the carrier’s prescriptions drug list). While 54.5 percent of all prescription plans are copay only, approximately 40 percent of all prescription drug plans have co-insurance along with (or in lieu of) copays–a plan design that is particularly common among four-tier plans.

Coinsurance models have many unique designs. Some plans are a straight percentage of the cost of the drug; some may involve a maximum or minimum dollar copayment combined with the coinsurance. For example, a plan may require 40 percent coinsurance for a preferred brand drug, but there is a minimum copayment of $30 and a maximum copayment of $50. Typically, we see a higher coinsurance percentage for non-preferred brand drugs and specialty drugs. The member cost of the drug is calculated after any negotiated discounts, so members covered by a coinsurance plan are reaping the benefits of any discounts negotiated with the pharmacy by the pharmacy benefit manager (PBM).

Coinsurance plans do provide several advantages to managing prescription drug costs. Under a flat dollar copay plan design, members may not truly understand the full cost of the drug they are purchasing. Pharmacies are now disclosing the full cost of drugs on the purchase receipts. Yet, most consumers do not take note of this disclosure, focusing only on the copayment amount. When a member pays a percentage of the cost of the drug as in a coinsurance model, the true cost of the drug becomes much more apparent.

Another advantage of the coinsurance model is that it automatically increases the member share of the cost as the price of the drug increases. Under the flat dollar copayment model, as the true cost of the drug increases, the member pays a smaller portion of the total cost. When the member’s portion is determined by a coinsurance percentage, the member pays more as the cost of the drug increases.

As the costs of health care overall continue to increase, we all need to become better consumers of our healthcare. Members covered by a prescription drug plan with a coinsurance model will have a better understanding of the true cost of their prescriptions. As members become more aware of the true costs of their care, they make better health care decisions, managing the overall cost of care.

We expect to see prescription drug benefit plans change even more as the cost of health care – especially prescription drugs – escalates. These changes will likely result in more of the cost being pushed to the patient. There are resources available to patients for assistance with some of these out-of-pocket costs. It is vital for the patient to understand their costs and know how to maximize their benefits. In a few weeks, the UBA blog will highlight some of these resources and provide information on how to educate employees on maximizing their benefits and the industry resources available to them.

For all the cost and design trends related to health and prescription drug plan costs by group size, industry and region, download UBA’s Health Plan Survey Executive Summary.

By Mary Drueke-Collins
Originally Posted By www.ubabenefits.com

Being catapulted into the adult world is a shock to the system, regardless of how prepared you think you are. And these days, it’s more complicated than ever, with internet access and mobile devices being must-have utilities and navigating tax forms when they aren’t as “EZ” as they used to be.

Maybe you’re still living with your folks while you get established. Or maybe you’re looking forward to moving out of a rental and into a house or to tie the knot. Life insurance might be the last thing on your list of things to deal with or even think about. (You’re not alone.) But here are five things you might not know about life insurance—that you probably should.

1. Life insurance is a form of protection. If you Google “life insurance” you’ll get a slew of ads telling you how cheap life insurance can be, without nearly enough information about what you need it for. That’s probably because it’s not terribly pleasant to think about: this idea that we could die and someone we care about might suffer financially as a result. Life insurance provides a financial buffer for the people you care about in the event something happens to you. Think just because you’re single, nobody would be left in the lurch? Read the next point.

2. College debt may not go away. Did someone—like your parents—co-sign your student loans through the bank? If so, the bank won’t discharge that debt upon your death the way that the federal government would with federal student loans. That means your parents, or others who signed the paperwork, would be responsible for paying the full balance—sometimes immediately. Don’t saddle them with the bill!

3. If you don’t know anything about life insurance, it’s probably better if you don’t buy it off the internet. It’s what we’re used to: You find the thing you need or love on Amazon or Ebay or Etsy, click a few buttons, and POOF. It arrives at your door. But life insurance is a financial planning product, and while it can be as simple as a 20-year term policy for less than a cup of coffee each day (for real!), going through your options with an insurance professional can ensure that you get the right amount for the right amount of time and at a price that fits into your budget. And many people don’t know that an agent will sit down and help you out at no cost.

4. Social fundraising only goes so far. This relatively recent phenomenon has everyone thinking that they’ll just turn to GoFundMe if things go awry in their lives. But does any grieving person want to spend time administering a social fundraising site? The chances of going viral are markedly slim, and social fundraising sites will take their cut, as will the IRS. And there is absolutely no guarantee about how much—if any—money will be raised.

5. The best time is now. You’ll definitely never be younger than you are today, and for most of us, the younger we are the healthier we are. Those are two of the most important factors for getting affordable life insurance coverage. So don’t delay.

By Helen Mosher
Originally Posted By www.lifehappens.org

UBA’s compliance team leverages the collective expertise of its independent partner firms to advise 36,000 employers and their 5 million employees. Lately, a common question from employers is: If a health and welfare benefit plan has fewer than 100 participants, then does it need to file a Form 5500?

If a plan is self-funded and uses a trust, then it is required to file a Form 5500, no matter how many participants it has.

Whether the plan must file a Form 5500 depends on whether or not the plan is “unfunded” (where the money comes from to pay for the self-funded claims).

Currently, group welfare plans generally must file Form 5500 if:

  • The plan is fully insured and had 100 or more participants on the first day of the plan year (dependents are not considered “participants” for this purpose unless they are covered because of a qualified medical child support order).
  • The plan is self-funded and it uses a trust, no matter how many participants it has.
  • The plan is self-funded and it relies on the Section 125 plan exemption, if it had 100 or more participants on the first day of the plan year.

There are several exemptions to Form 5500 filing. The most notable are:

  • Church plans defined under ERISA Section 3(33)
  • Governmental plans, including tribal governmental plans
  • Top hat plans which are unfunded or insured and benefit only a select group of management or highly compensated employees
  • Small insured or unfunded welfare plans. A welfare plan with fewer than 100 participants at the beginning of the plan year is not required to file an annual report if the plan is fully insured, entirely unfunded, or a combination of both.

A plan is considered unfunded if the employer pays the entire cost of the plan from its general accounts. A plan with a trust is considered funded.

For smaller groups that are self-funded or partially self-funded, you’d need to ask them whether the plan is funded or unfunded.

If the employer pays the cost of the plan from general assets, then it is considered unfunded and essentially there is no trust.

If the employer pays the cost of the plan from a specific account (in which plan participant contributions are segregated from general assets), then the plan is considered funded. For example, under ERISA, pre-tax salary reductions under a cafeteria plan are participant contributions and are considered plan assets which must generally be held in trust based on ERISA’s exclusive benefit rule and other fiduciary duty rules.

By Danielle Capilla
Originally Posted By www.ubabenefits.com

Under U.S. federal law, employers must keep the payroll records of their employees or former employees for a certain length of time. The amount of time, however, varies according to which statute you refer to, which can make knowing how long to keep employee records confusing. By keeping in mind the required time limits under each statute as well as what payroll-related records the statute wants you to retain and why, you can more easily develop a system that keeps payroll records as long as the law requires.

Identification

Payroll records are, generally, any records that relate to the hours an employee works and the wages paid to him or her, according to the U.S. Department of Labor. Under the Fair Labor Standards Act, payroll records include information on the hour and day each work week begins; the number of hours worked in each work day and each work week; the total amount the employee earned working non-overtime hours; the regular hourly pay for any week in which the employee worked overtime; total overtime pay for each work week; the amounts of any additions or deductions to the employee’s pay each week; the total amount paid for each pay period; and the dates covered by each pay period, according to the U.S. Department of Labor. This information should be marked with the employee’s personal information, including name, address, occupation and sex. If the employee is less than 19 years old, also include his date of birth.

Applicable Laws

As of 2010, only two federal statutes require employers to retain payroll records for any length of time, according to the U.S. Department of Labor and the U.S. Equal Employment Opportunity Commission, or EEOC. These two statutes are the Fair Labor Standards Act and the Age Discrimination in Employment Act. For the FLSA and the ADEA, most payroll records must be kept for three years, according to the U.S. Department of Labor and the EEOC. Although the FLSA allows employers to discard some supplementary payroll records, including wage tables, after two years, the ADEA requires that employers keep these records for three years.

Format

The ADEA does not require employers to keep payroll records in any particular format, as long as the records are available when the EEOC requests them, according to the EEOC. The FLSA does not require that time clocks be used to keep track of employee hours, according to the U.S. Department of Labor. Nor does the FLSA require that records be kept in a particular format. However, according to the U.S. Department of Labor, microfilm or punched tape should not be used unless the employer also has the equipment to make these formats easily readable.

Function

The purpose of maintaining employee payroll records under the Fair Labor Standards Act is to protect an employee’s rights to fair pay, according to the U.S. Department of Labor, including the right of covered, nonexempt workers to the minimum wage and to overtime pay. The records may also be used to ensure an employer is not employing children too young to work legally and is not employing children who may work legally for an illegal number of hours. Maintaining records under the Age Discrimination in Employment Act is intended to ensure an employee who discovers she may have been discriminated against due to his age is able to find the information necessary to prove or disprove her claim, according to the EEOC.

Considerations

Under the FLSA and the ADEA, payroll records are generally kept for three years following the date of an employee’s termination, according to the EEOC. The ADEA, FLSA, and other statutes may require an employer to keep different portions of an employee’s file for different lengths of time. For instance, while the ADEA requires payroll records to be kept for three years, it requires basic information about the employee to be kept only one year, according to the EEOC. To ensure your business meets all its recordkeeping retention requirements, consult a qualified employment law attorney.

By A.L. KENNEDY
Originally Posted By www.livestrong.com 

When we hear something’s magnetic, it’s likely the first thought that comes to mind is attraction. By definition, a magnetic force is the attraction or repulsion that arises between electrically charged particles because of their motion. What perfect framing for an organization – the desire to attract (or repel) people to help advance your organization. With this framing comes the assumption that there’s motion, which is, hopefully, a result of intentional action.

If we follow the thought of intentional action, there are seven steps (and many more details for each step that would be too lengthy to include here) that attract what’s desired and repel what’s not desired.

Seven Steps to Being a Magnetic Organization

1.  Decide what you want for the company

Simple, right? Yes. However, often an assumption is made that everybody knows what’s wanted. The best way to determine if you know what’s wanted is to ask the question, “Can I paint a clear, colorful and compelling story of the future?” This is one of the most important roles of leadership in an organization. Create, and tell a compelling story worthy of the effort it will take to get there.

2.  Get 100 percent buy-in from top leadership

It’s not enough for the CEO or owner to own the future story, every top leader who’s responsible for the performance and experience of employees and customers needs to be 100 percent committed to the future. This is perhaps the most telling test of how quickly and assuredly you will achieve the goals to support the future state. It’s critical to check for this buy-in up front as well as at key milestone points along the way.

3.  Communicate

As important as the first two steps are, a pinnacle point in the process is sharing with your employees, customers, and other stakeholders what you intend to do.

This is a step that is often overlooked and undervalued. If you ascribe to the rule of seven for marketing, it takes at least seven exposures for a person to hear something with the likelihood of remembering the message. Communicate often and keep your message clear and consistent. Also, keep in mind that people absorb information differently. This absorption is relative to learning styles. Presenting information will be accepted differently if someone is visual, aural, verbal, physical, logical, social, or solitary in their learning style.

As you design your communication plan, explore not only what you’ll share, but how you’ll promote the messages.

4.  Build Your Culture

This speaks to the actions necessary to achieve desired outcomes. It’s intentionally ordered after communication. Reinforce the mission of the company, or roll it out if it’s newly created. To move forward, you need every employee to be aware of the direction and expectations for the organization. Share organizational goals and keep leaders accountable to create alignment for their teams, including working with each person on their team to understand how his or her unique role fits into the overall picture. This will drive interactions that contribute to, or detract from, success.

Involve employees in the early phases of culture change and share quick wins. Consider including stories and testimonials from employees that show how the company is already making strides to get to the future vision.

Assure the right fit of employees. Clearly identify the top three expectations for each role and then find people who will be on fire to do these things well.

David Pink, in his book Drive, explores exactly what motivates people and claims that true motivation consists of: 1) autonomy, the desire to direct our own lives; 2) mastery, the desire to continually improve at something that matters; and 3) purpose, the desire to do things in service of something larger than ourselves.

In addition, make a habit of catching people doing the right things right. Recognition of work well done continuously reinforced will add fuel to building a positive culture. Finally, allow people to be who they are and find ways to insert moments of fun.

5.  Evaluate

There are many evaluation tools to help identify what’s happening. Asking for feedback from employees and customers can be a highly effective way to help understand where the best practices exist and where improvements are needed. Measuring what’s happening on a regular basis offers identification of value in processes and with products.

According to the Predictions for 2017 Bersin by Deloitte report, “Driven by the need to understand and improve engagement, and the continuous need to measure and improve employee productivity, real time feedback and analytics will explode.”

6.  Assess

The intention of assessment is to determine how things are going and then focus on improvement. The people who know the operations the best are the ones working the business. Trust your employees. As you understand the frustrations and barriers employees encounter, there’s an opportunity to reengineer how to tailor processes, deliver services, and provide products to support the changing needs of the customer.

7.  Adjust

When you identify what’s working and what needs to be changed – act with a sense of urgency to make the necessary changes. The organizations who adapt are the ones who have the greatest longevity. Market changes are constant and the ability to understand what’s happening and move toward what will occur in the future is not only admirable, but necessary for sustainability.

It’s obvious how these steps attract people with desired talents and attitudes to help advance your organization, but how will these same actions repel those who don’t align? When there’s consistent reinforcement of the culture, those who don’t fit will have a sense that your company just isn’t the right place for them, like trying to fit into a jacket that is too small or too large. This will be true for current employees and potential employees.

Not getting the results you want? Consider revisiting these actions – one step at a time.

 

By Joan Morehead
Originally Posted By www.ubabenefits.com

 

It’s not surprising that 2017 stands to be the year many will have an experience to share using a Telemedicine or a Virtual Doctor service. With current market trends, government regulations, and changing economic demands, it’s fast becoming a more popular alternative to traditional healthcare visits. And, as healthcare costs continue to rise and there are more strategic pricing options and digital models available to users, the appeal for consumers, self-insured employers, health systems and health plans to jump on board is significant.

Check out this short video and contact us to learn more!

 

I Have Life Insurance Through My Employer. Why Do I Need Another Policy? | Ohio Benefit Advisors

Categories: Blog, Life Insurance, Team K Blog
Comments Off on I Have Life Insurance Through My Employer. Why Do I Need Another Policy? | Ohio Benefit Advisors

One of the perks of having a full-time job with a good company is the benefits package that comes with it. Often, those benefits include life insurance coverage, which is great. And everyone who can get life insurance at work should definitely take it, as there are many advantages to company-funded life insurance, also known as group life insurance. These advantages include:

1. Easy qualification. Often, enrollment into group life insurance is automatic. That means everyone qualifies, as there is no medical exam required. So people who have preexisting health conditions, like diabetes or previous heart attack, can get life insurance at work, and may get a better rate compared with what an individual life insurance policy might cost them.

2. Lower costs. Employers’ insurance plans tend to be paid for or subsidized by the company, giving you life insurance at a low cost or even free. You may even have the option to buy additional coverage at low rates. Costs tend to be lower for many people because with group plans, the cost per individual goes down as the plan enlarges.

3. Convenience. It’s easy to subscribe to an employer’s life insurance plan without much effort on your part and if a payment is required, it’s easily deducted from your paycheck in much the same way as your medical costs are deducted.

These are all great advantages, but are these the only considerations that matter when it comes to life insurance? The answer, of course, is no.

Life insurance should first and foremost fit the purpose—it should meet your needs.

Life insurance should first and foremost fit the purpose—it should meet your needs. And the primary purpose of life insurance is to care for those left behind in the event of your death. With group life insurance, it’s often set at one or two times your annual salary, or a default amount such as $25,000 or $50,000. While this sounds like a lot of money, just think of how long that would last your loved ones. What would they do once that ran out?

There are several other disadvantages to relying on group insurance alone:

1. If your job situation changes, you’ll lose your coverage. Whether the change results from being laid off, moving from full-time to part-time status or leaving the job, in most cases, an employee can’t retain their policy when they leave their job.

2. Coverage may end when you retire or reach a specific age. Many people tend to lose their insurance coverage when they continue working past a specified age or when they retire. This means losing your insurance when you need it most.

3. Your employer can change or terminate the coverage. And that can be without your consent, since the contract is between your employer and the insurer.

4. Your options are limited. This type of coverage is not tailored to your specific needs. Furthermore, you may not be able to buy as much coverage as you need, leaving you exposed.

Importance of Buying a Separate Life Insurance Policy
It’s for these reasons you should get an individual life insurance policy that you personally own, in addition to any group life insurance you have. Individual life insurance plans offer superior benefits, and regardless of your employer or employment status, they remain in place and can be tailored to meet your needs and circumstances.

Most importantly, an individual life insurance policy will fit the purpose for which you purchase it—to ensure your dependents continue to have the financial means to keep their home and lifestyle in the unfortunate event that you’re no longer there to care for them.

Originally Posted By www.lifehappens.org

DOL Asks for MHPAEA Related Comments; Clarifies Eating Disorder Benefit Requirements | Ohio Benefit Advisors

Categories: 21st Century Cures Act, ACA, Mental Health, Team K Blog, UBA, UBA News
Comments Off on DOL Asks for MHPAEA Related Comments; Clarifies Eating Disorder Benefit Requirements | Ohio Benefit Advisors

Earlier this month, the Department of Labor (DOL) provided an informational FAQ relating to the Mental Health Parity and Addiction Equity Act (MHPAEA) and the 21st Century Cures Act (Cures Act). This is the DOL’s 38th FAQ on implementing the Patient Protection and Affordable Care Act (ACA) provisions and related regulations. The DOL is requesting comments on a draft model form for participants to use to request information regarding nonquantitative treatment limitations, and confirms that benefits for eating disorders must comply with the MHPAEA. Comments are due by September 13, 2017.

The MHPAEA amended various laws and regulations to provide increased parity between mental health and substance use disorder benefits and medical/surgical benefits. Generally, financial requirements such as coinsurance and copays and treatment limitations for mental health and substance use disorder benefits cannot be more restrictive than requirements for medical and surgical benefits. Regulations also provide that a plan or issuer may not impose a nonquantitative treatment limitation (NQTL) unless it is comparable and no more stringent than limitations on medical and surgical benefits in the same classification.

On December 13, 2016, President Obama signed the 21st Century Cures Act into law. The Cures Act has numerous components including directing the Secretary of Health and Human Services, Secretary of Labor, and Secretary of the Treasury (collectively, the Agencies) to issue compliance program guidance, share findings with each other, and issue guidance to group health plans and health insurance issuers to help them comply with the mental health parity rules.

The Agencies must issue guidance to group health plans and health insurance issuers; the guidance must provide information and methods that plans and issuers can use when they are required to disclose information to participants, beneficiaries, contracting providers, or authorized representatives to ensure the plans’ and issuers’ compliance with the mental health parity rules.

The Agencies must issue the compliance program guidance and guidance to group health plans and health plan issuers within 12 months after the date that the Helping Families in Mental Health Crisis Reform Act of 2016 was enacted, or by December 13, 2017.

In the June 2017 FAQ, the DOL reiterated its request for comments on the following questions, originally asked in the fall of 2016:

  1. Whether issuance of model forms that could be used by participants and their representatives to request information with respect to various NQTLs would be helpful and, if so, what content the model forms should include. For example, is there a specific list of documents, relating to specific NQTLs, that a participant or his or her representative should request?
  2. Do different types of NQTLs require different model forms? For example, should there be separate model forms for specific information about medical necessity criteria, fail-first policies, formulary design, or the plan’s method for determining usual, customary, or reasonable charges? Should there be a separate model form for plan participants and other individuals to request the plan’s analysis of its MHPAEA compliance?
  3. Whether issuance of model forms that could be used by States as part of their review would be helpful and, if so, what content the model form should include. For example, what specific content should the form include to assist the States in determining compliance with the NQTL standards? Should the form focus on specific classifications or categories of services? Should the form request information on particular NQTLs?
  4. What other steps can the Departments take to improve the scope and quality of disclosures or simplify or otherwise improve processes for requesting disclosures under existing law in connection with mental health/substance misuse disorder MH/SUD benefits?
  5. Are there specific steps that could be taken to improve State market conduct examinations and/or Federal oversight of compliance by plans and issuers?

The DOL is also asking for input on a draft model form that participants, enrollees, or representatives could use to request information from their health plan or issuer regarding NQTLs that may affect their MH/SUD benefits.

The Cures Act also requires that benefits for eating disorders be consistent with the requirements of MHPAEA. The DOL clarified that the MHPAEA applies to any benefits a plan or issuer may offer for treatment of an eating disorder.

By Danielle Capilla
Originally Posted By www.ubabenefits.com

What Employers Need to Know about the Senate Proposed Healthcare Bill | Ohio Benefit Advisors

Categories: ACA, ACA Repeal, Benefits, Blog, Health Care Reform, UBA News
Comments Off on What Employers Need to Know about the Senate Proposed Healthcare Bill | Ohio Benefit Advisors

On June 22, 2017, the United States Senate released a “Discussion Draft” of the “Better Care Reconciliation Act of 2017” (BCRA), which would substitute the House’s House Resolution 1628, a reconciliation bill aimed at “repealing and replacing” the Patient Protection and Affordable Care Act (ACA). The House bill was titled the “American Health Care Act of 2017” (AHCA). Employers with group health plans should continue to monitor the progress in Washington, D.C., and should not stop adhering to any provisions of the ACA in the interim, or begin planning to comply with provisions in either the BCRA or the AHCA.

Next Steps

  • The Congressional Budget Office (CBO) is expected to score the bill by Monday, June 26, 2017.
  • The Senate will likely begin the voting process on the bill on June 28 and a final vote is anticipated sometime on June 29.
  • The Senate and House versions will have to be reconciled. This can be done with a conference committee, or by sending amendments back and forth between the chambers. With a conference committee, a conference report requires agreement by a majority of conferees from the House, and a majority of conferees by the Senate (not both together). Alternatively, the House could simply agree to the Senate version, or start over again with new legislation.

The BCRA

Like the AHCA, the BCRA makes numerous changes to current law, much of which impact the individual market, Medicare, and Medicaid with effects on employer sponsored group health plans. Also like the AHCA, the BCRA removes both the individual and the employer shared responsibility penalties. The BCRA also pushes implementation of the Cadillac tax to 2025 and permits states to waive essential health benefit (EHB) requirements.

The BCRA would change the excise tax paid by health savings account (HSA) owners who use their HSA funds on expenses that are not medical expenses under the Internal Revenue Code from the current 20 percent to 10 percent. It would also change the maximum contribution limits to HSAs to the amount of the accompanying high deductible health plan’s deductible and out-of-pocket limitation and provide for both spouses to make catch-up contributions to HSAs. The AHCA contains those provisions as well.

Like the AHCA, the BCRA would remove the $2,600 contribution limit to flexible health spending accounts (FSAs) for taxable years beginning after December 31, 2017.

The BCRA would allow individuals to remain on their parents’ plan until age 26 (the same as the ACA’s regulations, and the AHCA) and would not allow insurers to increase premium costs or deny coverage based on pre-existing conditions. Conversely, the AHCA provides for a “continuous health insurance coverage incentive,” which will allow health insurers to charge policyholders an amount equal to 30 percent of the monthly premium in the individual and small group market, if the individual failed to have creditable coverage for 63 or more days during an applicable 12-month look-back period.

The BCRA would also return permissible age band rating (for purposes of calculating health plan premiums) to the pre-ACA ratio of 5:1, rather than the ACA’s 3:1. This allows older individuals to be charged up to five times more than what younger individuals pay for the same policy, rather than up to the ACA limit of three times more. This is also proposed in the AHCA.

The ACA’s cost sharing subsidies for insurers would be eliminated in 2020, with the ability of the President to eliminate them earlier. The ACA’s current premium tax credits for individuals to use when purchasing Marketplace coverage would be based on age, income, and geography, and would lower the top threshold of income eligible to receive them from 400 percent of the federal poverty level (FPL) to 350 percent of the FPL. The ACA allowed any “alien lawfully present in the US” to utilize the premium tax credit; however, the BCRA would change that to “a qualified alien” under the definition provided in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. The BCRA would also benchmark against the applicable median cost benchmark plan, rather than the second lowest cost silver plan.


By Danielle Capilla
Originally Posted By www.ubabenefits.com