These days, managing an employee health benefit plan is NOT just that – companies face numerous reporting and compliance challenges that are continuously changing, which, in turn, has changed the game. And, the Affordable Care Act (ACA) has only upped the ante.
At EBSO, we have a full-time Compliance Department helping our clients with these challenges, guiding them through the rapidly changing ACA requirements and avoiding costly penalties. Our Standard ACA Compliance Services include your basic plan General Notice Requirements as well as mandated ACA reporting techniques and fees. From the Children’s Health Insurance Program (CHIP) Reauthorizations Act of 2009 to Patient-Centered Outcomes Research Institute Fee (PCORI) calculation, our health care reform compliance services help ensure that self-funded employer groups stay ahead of the game.
As a full-service third party administrator (TPA), EBSO offers all the ACA compliance resources necessary in today’s regulatory environment – from a comprehensive range of Health Care Compliance Management Solutions for our self-insured medical administration clients to a freestanding suite of ACA Reporting Services available to any employer group, regardless of how the plan is funded or administered.
With all these options, trusting EBSO to be your expert is a safe bet! To learn more and view a full list of Standard Compliance Services we offer, visit our website at: http://www.ebsobenefits.com/compliance-management.html.
Republicans in the House have proposed H.R. 1270, and bundled it with H.R. 5445, which would increase the maximum annual deductible HSA contribution to $7,800 for individuals and $15,000 for a family. These increases are from current levels of $3,350 for individuals and $6,750 for families, respectively.
Members of the House Rules Committee were prepared to vote on the procedures for bringing the package to the House floor this week. The Congressional Budget Office has estimated that the increases would cost the federal government more than $20 billion in revenue over a 10-year period. President Obama has expressed opposition to the effort, saying that it would only help higher income individuals.
A recent survey of more than 1,000 workers showed that allowing people to bring their pets to work can go a long way to build community and reduce stress. Experience shows that people converge around pets, especially dogs, promoting friendly conversations that otherwise wouldn’t have taken place.
One of the biggest concerns of small business owners continues to be the paid and unpaid leave bills passing out of committee. In the Senate, the Healthy Workplace Act S.B. 2147 would require all employers to provide up to 7 paid sick days each year. The House passed H.B. 3297, creating the Employee Paid Health Care Time Act, requiring any employer of one or more to provide paid healthcare time at a rate of one hour for every 22 hours worked for an employer of 50 or more and one hour for every 40 hours worked for employers with fewer than 50 employees.
The Federal Government isn’t the only governmental body pushing paid leave. Several states and even the City of Chicago are considering paid leave for a variety of hardships, from bereavement to bone marrow and organ donations. A 2015 survey by NFIB shows that the vast majority of small businesses already offer some type of paid leave, with many offering up to 2 weeks per year.
If you’re in an industry with significant turnover and varied work schedules, a Minimum Value Plan may be an affordable way to meet the requirements of the Affordable Care Act.
A Minimum Value Plan is one that pays at least 60% of the total allowed cost of benefits expected under the plan. And while a traditional fully insured plan might cost $300 per month for employee-only coverage, a minimum value plan may cost just over $100 while still providing ACA-mandated care and coverage for inpatient hospitalization.
Determining Minimum Value
Businesses may need help determining that their plan reaches “minimum value” under the ACA. To meet this standard, the plan must pay at least 60% of the total allowed cost of benefits, which can be a moving target. Recent regulations also require that minimum value plans must offer substantial coverage for both inpatient hospitalization and physician services.
It should also be noted that minimum value plans must still offer “minimum essential coverage” and coverage that is considered “affordable” under the ACA. Offering such a plan, without meeting these requirements, may still expose your organization to liability under ACA employer shared responsibility rules.
Though minimum value plans can be an affordable solution, future growth may be a concern, since only organizations with fewer than 50 full-time employees and full-time equivalents are exempt from ACA coverage requirements.
With research showing that the average cost of healthcare surpassed $11,000 per employee in 2015, stretching every healthcare dollar is a must. Since self-funding is the foundation from which so many cost control strategies emerge, we encourage you to take this step if you haven’t already done so.
Understand the Needs of Your Group
Since every employer group is unique, it’s imperative that you look closely at demographics, prior claims and medical conditions. The availability of meaningful data is one of the biggest advantages of a self-funded plan, and key to making sure that those with chronic conditions such as diabetes or hypertension are receiving the treatment and attention they need. If your administrator isn’t helping in this critical area, you have the wrong administrator!
Self-funded health plans involve several parts that need to be working together. If you think healthcare is complex, put yourself in the shoes of your members and their families. Programs such as utilization review, hospital pre-certification, disease management and healthcare coaching can go a long way in managing costs. Services like patient advocacy and telemedicine can help members get the care they need in an efficient setting. For example, while office visits cost about $130, a telemedicine visit can be equally effective at a cost of about $40. With so many variables available today, it’s easy to see why customer service and care coordination are as important to your bottom line as they are to your employees.
Education and Wellness
Once a self-funded plan design and professional administration are in place, employee education and wellness integration must follow. Few factors influence healthcare costs more than lifestyle choices and the need to make informed buying decisions. And whether it involves understanding benefits or choosing a high quality, efficient provider, studies show that members need more support. To help in this area, many TPAs are integrating online access to comparative data on costs and providers.
When you consider that we can only manage what we can measure, delivering meaningful information to members, when they need to make a healthcare decision, should result in happier, healthier employees and lower costs for all.
There are numerous reporting and compliance challenges that can make managing a health benefit plan quite perplexing. As a full-service third party administrator (TPA), EBSO provides a comprehensive range of Compliance Management Solutions for self-funded health plans they administer, such as:
- Standard Compliance Services
- ACA Reporting Services
- Legal Guidance & Support Services
EBSO Excels in ACA Reporting
Since many employers are not fully prepared for the complex ACA data gathering and reporting requirements that exist today, EBSO also offers a freestanding suite of ACA Reporting Services available to any employer group, regardless of how the plan is funded or administered. These services include options such as:
- Reporting 6055 – self-insured (NON-ALE)
- Reporting 6056 ALE not self-insured
- Reporting 6055 & 6056 – ALE who are also self-insured
- Populate 1094 and 1095 forms
EBSO offers all of the compliance resources necessary in today’s regulatory environment. With all these options, it’s time you trust EBSO as your ACA expert! To learn more, visit our website at: http://www.ebsobenefits.com/compliance-management.html
If your health plan is like most, finding ways to help members manage healthcare expenses is a top priority. Offering one or more tax advantaged healthcare spending account can help.
Health Savings Accounts (HSAs) – Employers and employees can contribute to an HSA tax free and funds can roll over from year to year. To qualify, a compatible health plan must have a minimum annual individual deductible of $1,300 or $2,600 for a family. All contributions count towards the annual maximum, which is $3,350 for individuals and $6,750 for a family. Catch-up contributions of $1,000 are allowed at age 55 or older.
Health Reimbursement Accounts (HRAs) – Like an HSA, this account can be used before a deductible is met and no minimum plan deductible is required. Unlike HSAs, only the employer can contribute; the account is not portable and the employer can approve a rollover provision.
Flexible Spending Accounts (FSAs) – Section 125 FSAs allow employees to defer part of their income to pay for medical expenses. Both the employer and employee can contribute, but the amount employees pledge to contribute cannot change during the year. If a required provision is in place, up to $500 can roll over to the next year.
The features of these accounts vary somewhat. HSAs offer great flexibility to the employee without an administrative burden for the employer. HRAs do not require a qualifying high deductible health plan, but only employers can contribute. FSAs allow the employee to contribute pre-tax dollars, but the use-it-or-lose-it requirement can be a disadvantage. For help in determining which option is most appropriate for your group, talk with your Third Party Administrator.
New rules mandated by the Department of Labor could affect many small businesses, driving up labor costs and creating more red tape. These rules, effective on December 1, 2016, raise the salary threshold for eligible workers from $23,660 to $47,476 and to $134,004 for highly compensated employees. This means that salaried workers earning less than $47,476 will now be eligible for time-and-a-half for every hour they work beyond 40 hours per week. While the rules were intended to help millions of workers, they assume that every business will absorb the increased costs and pay overtime, rather than limiting hours for salaried employees.
Research by the National Federation of Independent Business shows that nearly half of all small businesses will be affected by the mandate. NFIB foresees a slowdown in productivity if salaried employees are forbidden from exceeding 40 hours per week. Another concern is that some employees may be converted from salaried to hourly, effectively receiving a demotion.
The rules also include a mechanism to automatically update the salary and compensation levels every three years in order to ensure that they continue to provide useful and effective tests for exemption.
Summer is upon us and with it comes more outdoor activities, more sunscreen and, for some, more travel. What you may not expect summer to bring is the risk of the Zika virus. But, U.S. health officials warn that mosquitos carrying the virus could hit the mainland’s southern borders, starting with Florida and the Gulf Coast, in a few weeks.
Whether you’re traveling this summer or you’re staying put, the CDC says the best way to reduce your risk is to avoid bug bites by using repellent and covering your skin. If possible while traveling, choose hotels with screens or air-conditioning. While using both sunscreen and repellent, apply the sunscreen first, let it dry and then apply the repellent. However, you do not want to use products that contain both sunscreen and repellent and you should not spray repellent on the skin under clothing.
Pregnant women, especially those in their first trimester, are most at risk for the virus and should take every possible precaution and are advised to avoid affected areas. A current list of countries where Zika is active can be found on the CDC’s main site – http://www.cdc.gov.