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Employee benefits that benefit your business

Recent News & Updates

The insurance marketplace is ever-changing and Bene-Care is here to help. Below is some recent news that we would like our clients to be aware of.

 

Health Care Reform Update.

 

Bene-Care Agency Health Care Reform - Printable Update

 

With recent passages of the Patient Protection & Affordable Care Act and the Health Care & Education Reconciliation Act, the United States has collectively entered into new, uncharted territory as it relates to our health care system. Only a few of the bills’ initiatives will be implemented in 2010 as much of the legislation will be phased-in during the next three to four years. This correspondence is intended to update our clients on the major aspects of the bills as well as set some time parameters for future implementation of the legislation.

 

Changes for 2010

  • Small businesses are eligible for tax credits.

    - Small employers with less than 25 employees are eligible for tax credits, on a sliding scale, for up to 35% of the cost of employer contributions towards the health insurance premiums for tax years 2010, 2011, 2012 and 2013 (employer must contribute at least 50% of the premiums). The average employee salary must be below $50,000, excluding owners.

     

    - Maximum Amount: The credit is worth up to 35% of a small business' premium costs in 2010.  On Jan. 1, 2014, this rate increases to 50%.

     

    - Phase-out: The credit phases out gradually for employers with average employee wages between

     

    - $25,000 and $50,000 and for employers with the equivalent of between 10 and 25 full-time workers. 

    For more information on tax credits visit: http://www.irs.gov/newsroom/article/0,,id=220839,00.html

     

  • All group plans will be required to meet the discrimination tests associated with Section 105 of the IRS code ensuring that plans do not discriminate contributions in favor of highly compensated employees.
  • High risk pools for those who cannot obtain coverage due to pre-existing conditions will be established.
  • States will be required to develop and set up web-portals for information on affordable coverage, including group plans, Medicaid, CHIP, and the high risk pools.
  • Lifetime limitations will be removed from policies.
  • All plans must include coverage for dependents up to age 26.
  • All plans will cover pre-existing conditions for children 19 and under.
  • Emergency services will be covered regardless of whether or not the services are performed by a network provider.
  • New coverage appeals process.
  • Federal grant program for small employers providing wellness benefits to their employees.

 

Changes for 2011

  • Over the counter medications will no longer be eligible expenses through FSAs, HRAs, and HSAs.
  • Employers will be responsible for reporting the monetary value of contributions towards health insurance on W-2's, including HRA premium reimbursements.
  • Tax on distributions for non-qualified expenses from an HSA will go up from 10% to 20%.

 

Changes for 2012

  • All plans must provide four page benefit summaries to their employees with specific language as outlined by HHS (the US Department of Health and Human Services).

 

Changes for 2013

  • Medicare Hospital Insurance Tax on self-employed and employees with earnings greater than $200k for individuals, and $250k for joint filers (not indexed for COLA adjustments).
  • Additional 3.8% Medicare contribution for certain unearned income for individuals with adjusted gross incomes over $200k and $250k for those filing jointly.
  • The threshold for itemized deductions for unreimbursed medical expenses will increase from 7.5% to 10% of adjusted gross income.
  • $2,500 annual maximum established for medical FSA contributions (indexed for inflation).
  • Employers must provide written notice to employees on the existence of state based Health Insurance Exchanges.

 

Changes for 2014

  • States will be required to set up Health Insurance Exchanges to facilitate the sale of qualified benefit plans to individuals and employer groups.

    - The state can set up one exchange to service both markets or they can set up employer group exchanges and individual group exchanges separately.

     

    - States may choose to let larger employers (more than 100 employees) into the exchanges in 2017.

  • Requires all American citizens and legal residents to purchase qualified health insurance coverage.

    - Penalties imposed for non-compliance; either a flat dollar amount or a percentage of the individual’s income, whichever is higher.

  • New federal tax imposed for group plans equal to $2 per enrollee.
  • New annual taxes imposed on private health insurance companies based on net premiums.Exclusions based on pre-existing conditions will be prohibited in all markets.Sliding scale tax credits for non-Medicaid eligible individuals with incomes up to 400% of the Federal Poverty Level (FPL) to buy coverage.
  • Employers with more than 50 full time employees will be required to provide coverage that meets federal mandates.

    - Coverage must meet minimum essential benefit requirements to comply with the mandate.

     

    - When determining the number of employees, part time employees must be taken into consideration based on the aggregate number of hours worked.

     

    - Employers will face fines on ALL employees if even one employee receives a tax credit and purchases coverage through the exchanges.

     

    - Fines for non compliance are $2,000-$3,000 annually (depending on the circumstances) per employee excluding the first 30 employees (i.e. if the employer has 51 employees and is fined, they only pay the fine for 21 employees).

  • Individuals who receive coverage through their employer sponsored plan and have income up to 400% of the FPL are eligible for a tax credit to purchase coverage through the exchange instead of the employer coverage if:

    - The actuarial value of the employer’s coverage is below the minimum standard.

     

    - The employee’s contribution through the employer plan is greater than 9.5% of the employee’s family income.

  • Waiting periods in excess of 90 days are prohibited.
  • Requirement for employers to provide benefit vouchers that eligible employees can use to purchase coverage through the exchanges.

    - The amount of the voucher is equivalent to the employer contribution for the most expensive premium plan offered.

     

    - If the voucher is of greater value than the total cost of the plan through the exchange, the excess belongs to the employee.

     

    - Employee’s income cannot exceed 400% of the FPL.

     

    - Eligible employees are those whose contribution towards employer’s coverage is greater than 8% of the premium, but does not exceed 9.8% of the employee’s household income.

  • Catastrophic-only policies available for those ages 30 and younger.
  • Employers with more than 200 employees or full time equivalents will be required to automatically enroll all new employees into the employer sponsored health coverage.

    - This requirement might be implemented earlier should congress make additional changes.

  • Expansion of Medicaid for all individuals making up to 133% of the FPL.
  • Mandatory state premium assistance programs set up to help eligible individuals who have employer sponsored coverage.

    - States will also create non-Medicaid plans for those individuals whose income falls between 133%-200% of the FPL that don’t have access to an employer sponsored plan.

     

Changes for 2018

 

  • A 40% excise tax will be placed on “Cadillac plans” with aggregate values that exceed $10,200 for singles and $27,500 for families. These amounts will be subject to COLA adjustments.

 

These bullet points are intended to summarize two very complex bills at a high level. Both bills include significant mandates and processes that are still open for interpretation and have yet to be clarified. As your Benefits Advocate, providing you with up to date information on the various components of the legislation will be our utmost priority. Please be assured that we will continue to communicate with you on new regulations, compliance, and tax incentives and how they will impact your business.

 

Should you have additional questions on any aspects of the legislation, please contact your Bene-Care Account Consultant or our main phone line at 1-800-333-1673.

 

For a printable PDF version of this update, please click here.

 

Children's Health Insurance Program Reauthorization Act (CHIPRA).

Click here for a printable version of this important notice.

 

As your benefits advocate, Bene-Care is prepared to educate you on the government's ever-changing regulatory mandates and provide the tools necessary to ensure your compliance.

 

In 2009 the Children's Health Insurance Program Reauthorization Act (CHIPRA) reauthorized the Children’s Health Insurance Program (CHIP). This program preserves the financial assistance to provide coverage for millions of low-income, uninsured children, and pregnant women.

 

CHIPRA mandates that fully-insured and self-funded groups within New York State annually notify employees about their potential eligibility for state premium assistance under Medicaid or CHIP. CHIPRA requires that group health plans allow employees and dependents who are eligible, but not enrolled in, a group health plan to enroll in the plan under two scenarios:

  • The loss of eligibility for coverage under a state Medicaid or CHIP program
  • The employee or dependent becomes eligible for the premiums assistance subsidy under Medicaid or CHIP

 

An employee must request this special enrollment within 60 days of the loss of coverage or within 60 days of when eligibility is determined.

 

Located below is a model notice that was recently released by the U.S. Department of Labor. The notice describes the CHIPRA provisions and lists contact information for the states that offer premium assistance through their CHIP and Medicaid programs. If your business is located in a state listed in the notice or has employees that reside in one of these states, you are required to send the notice to all of your employees on an annual basis.

 

Please note: Groups that renew or renewed their plan year between February 4, 2010 and April 30, 2010 are required to send the model notice to their employees by April 30, 2010. All other groups must provide the notice to their employees before their next plan year renewal date and on an annual basis thereafter.

 

Penalties for Failure to Comply
CHIPRA provides for civil penalties of up to $100 a day for failure to comply with the new notice and disclosure requirements.

 

For additional information about CHIPRA, please visit the U.S. Department of Labor's website at www.dol.gov. If you have any questions or concerns regarding this letter please give our office a call at (585) 347-1300, Monday through Friday from 8:30am to 5pm.

 

CHIPRA Model Notice (click for PDF)

 

National health care debate and potential changes.

We realize our country’s insurance marketplace is in the midst of widespread potential changes. As a trusted advocate since 1973, we promise to keep our clients informed of all concrete changes when they become fully implemented at the state and federal level.

 

Dependent to 30 coverage.

On July 29, 2009, Governor David A. Paterson signed into law Chapter 240 of the Laws of 2009 (click for bill text), which extends the availability of health insurance coverage to young adults through the age of 29. This law is sometimes referred to as the “Age 29” law, because it permits young adults to continue or obtain coverage under a parent’s policy through the age of 29. A list of frequently asked questions can be found on the NY State Insurance Department website.

 

The law provides two distinct ways in which coverage may be extended: a “young adult option” and a “make available” option. These options are being handled differently by each insurance company and we ask that you contact Bene-Care for more information on this topic.

 

 

Bene-Care Expands as Health Care Reform Heats Up

An insurance broker specializing in health care coverage for upstate New York businesses is re-investing in Monroe County. A new office space on Creek Street in Webster accommodates the needs of a growing staff at Bene-Care...
Click here to read more (YNN Rochester link).