1 More than benefits State of the Industry March 3, 2015
2 Cuatro s Bio
3 Untangling the Web - efg&m is on your Team! ERISA/Compliance TECHNOLOGY PPACA WELLNESS BENEFITS ADMINISTRATION Never hurry and never worry! E.B. White, Charlotte s Web
5 Impact of Health Care Reform Look back and progression through 2014 What does healthcare reform mean to me? Unlimited Lifetime Maximum Preventative care is covered at 100% Coverage up to age 26 for dependent children No pre-existing conditions Benefits must meet Minimum Value Coverage ACA plans have enhanced benefits Maximum calendar year out of pocket is $6,350/individual $12,700/family Includes deductibles, co-insurance, and ALL COPAYMENTS
6 2014 Health Care Reform Group Health Plans: Waiting Periods: Annual Dollar Amounts: Adult Dependent Coverage: Health Insurance Exchange: Waiting periods can no longer exceed 90 days Annual dollar limits on essential health benefits are completely prohibited. Such limits are permissible for non-essential health benefits Grandfather plans that offered dependent coverage were previously able to exclude those under age 26 who were eligible for other employer-sponsored coverage. This provision is no longer in effect. As of January 1, 2014, a state-based or federally facilitated health Insurance exchange is operational in each state. Health Insurance Coverage for individuals and small employer groups (groups 50 or fewer) maybe purchased through the exchange
7 2014 Health Care Reform (Individual Mandate) Individual Mandate: Citizens and legal residents are required to maintain minimum essential coverage. Those without such coverage will be penalized in the form of a tax. Penalties will be phased in as such : 2014 : $95 or 1 percent of household income. 2015: $325 or 2 percent of household income. 2016: $695 or 2.5 percent of household income Adjusted by cost of living thereafter
8 2014 Health Care Reform (Premium Tax Credit) Premium Tax Credits: Available to eligible individuals and families with incomes between 100 and 400 percent of federal poverty level (FPL) to purchase insurance through the health insurance exchanges. Individuals are eligible if they do not have affordable or qualified employer-sponsored coverage available through the exchange for lower income individuals in order to reduce out-of-pocket costs. The exchanges will administer the premium tax credits and cost-sharing subsidies.
9 2014 Health Care Reform (Guaranteed Availability) Guaranteed Availability of Coverage and Renewability Each health insurance issuer that offers health insurance coverage in the individual or group market (regardless of whether the coverage is offered in the large or small group market) is required to accept every employer and individual in the state that applies for coverage and desires renewal.
11 2015 Health Care Reform (Employer Mandate) Applicable large employers with at least 100 full-time employees (including equivalents) during a six-month consecutive period determined by the employer in 2014 may be assessed a penalty under the employer mandate if at least one full-time employee (e.g. one working 30 or more hours /week) receives a premium tax credit in the state exchange. Employees qualify for a premium tax credit if their income is percent of FPL and their coverage is unaffordable or does not meet minimum value.
12 Two types of potential penalties : 2015 Health Care Reform (Penalty Types ) Penalty A applies to employers that do not offer any coverage Penalty B applies to employers that offer coverage that is unaffordable (using one of three safe harbor methods ensuring coverage is not greater than 9.5 percent of household income) or does not meet minimum value (defined as 60 percent of actuarial value). Penalty A: Equals $2,000 times the number of full-time employees, less the first 80 Penalty B: Equals $3,000 times the number of full-time employees receiving the premium tax credit. Penalty B is capped at the amount paid under Penalty A. Neither penalty is tax deductible
13 2015 Health Care Reform (Transition Relief ) Transition Relief: Transition Relief is provided until 2016 for employers with full-time employees and equivalents who meet specific requirements to delay compliance. Non-calendar-year plans may be eligible for additional delay if certain requirements are satisfied.
14 Compliance Plan Reporting & Employer Notice Requirements ERISA Requirements Plan Document, SPD, Wrap document (Any size) Employer Notice Requirements to employees (Anysize) Medicare Part D Disclosure to CMS (Any size) Section 6056 Reporting (50+ FTE) Form 5500 (Generally, 100+ participants) Form W-2 Reporting (250+)
15 What employer s are experiencing right now Demand for : Automation Efficiency Scalability Employers & Employees ~ tools to make life easier
16 What employer s are experiencing right Job Market is hot: Benefits as a hiring tool Retention tool Increased Compliance Anxiety Need for support Pricing Pressure: now Health insurance rates still rising Dependent costs are a challenge
17 UMMMM What are other employers doing?
18 Contribution Strategy & Plan Design a). Multi-Option (Base & Buy-Up Plans) - employers basing contribution percentage on the lower cost (Base) plan. b). Exploring cost sharing strategies such that employees have skin in the game c). Cost sharing may allow employers to contribute towards dependent costs Dependents find individual health insurance as a viable option Ancillary lines offered as a voluntary product
19 Offering worksite benefits such as Cancer, Critical Illness, etc. Accepting 2014 Transitional Relief (keeping current plan) rather than moving to ACA compliant plans to save premium Level or Self-Funded Options Multi employer plans through outsourced HR and payroll (PEO platforms)
20 DOOR # 1 GROUP FULLY INSURED PLANS
21 DOOR # 2 INDIVIDUAL / CONSUMER
22 DOOR # 3 SELF-FUNDED PLAN
23 DOOR # 4 MULTI-EMPLOYER PLAN
24 Redefining Small Group- becomes 99 employees and under (community ratings, age based rates) Compliance Audits-take inventory Leverage efg&m Benefits Subject Matter Experts Compliance, Wellness, Self-Funded, Alternative Strategies, Technology Solutions Let efg&m illustrate our latest technology to take benefits enrollments and administration to the next level Don t forget four doors Small Group Fully Insured, Individual/Consumer, Self-Funded, Multi-Employer plans
25 CASE STUDY # 1 An employer came to us and asked if she could reimburse their employees for participating in their plan s wellness program and, if so, how are those reimbursements taxed?
26 YES, it s legal to reimburse employees for a wellness discount or reward, but it MUST ALWAYS be taxed as regular income. Even if it s a gift card or any other gift is given, it must be taxed per tax guidelines. Many employers overlook taxing these rewards because they consider them nominal or insignificant, but that leaves it to the employee to pay taxes on these incentives and we think that negates the reward aspect.
27 CASE STUDY # 2 Test your knowledge regarding Health Savings Accounts: Can anyone open an H.S.A.? How much can I contribute to an H.S.A.? 2014? 2015? When is the deadline for contributing to an H.S.A.? Is there a Catch-up provision? Can I use my H.S.A. $$ for another family member not covered on my health plan?
28 Can anyone open an H.S.A.? No, to open a H.S.A. you must have a High Deductible Health Plan. How much can I contribute to an H.S.A.? 2014? $3,300/$6, ? $3,350/$6,650 When is the deadline for contributing to an H.S.A.? April 15 th Is there a Catch-up provision? Yes, age 55+ can contribute an additional $1,000 per year Can I use my H.S.A. $$ for another family member not covered on my health plan? Yes, you can utilize H S A funds for ANY eligible medical expenses.
29 CASE STUDY # 3 If I have a self-funded plan, which of the following reporting is required? A Reporting B. W2 Reporting C. 6055/6056 D. All of the above
30 Reporting requirements for self-funded plans are similar to fully insured in many ways. Self-funded groups have to file a form 5500 if applicable each year and in the future they ll have to report 6055/6056 data just like fully insured. ** The difference is that self-funded plans have to submit their PCORI and transitional reinsurance fees directly to the IRS whereas with fully insured plans, the carrier submits the fees on behalf of the group.
31 CASE STUDY # 4 COMPLIANCE Q1 Employers rather than insurers are responsible for the following Plan Filing and Reporting that are applicable to them except: A. Form 5500 B. Section 6056 Reporting C. PCOR Fees and Filing on a fully insured medical plan D. Form W-2
33 CASE STUDY # 4 COMPLIANCE Q2 The following apply to all group sizes except: A. ERISA compliance B. FMLA C. Medicare Part D Disclosure to CMS D. Distribution of Notices to Employees
35 CASE STUDY # 4 COMPLIANCE Q3 The following plans are exempt from ERISA compliance: A. Church B. Governmental C. Tribal D. All of the above are exempt
37 FRIENDLY REMINDER!! **Free** Simply Move Workouts for Beginners KAYLA FANNING, Certified Wellness Consultant with efg&m, will lead sessions for all ages / levels Every Saturday in March 10am -11am Balcones District (flyers located on each table)
38 Thank you to the following Gold Sponsors!
39 Thank you to the following Bronze Sponsors!
40 Thank you to the following carriers for sponsoring this luncheon!
41 Untangling the Web - efg&m is on your Team! ERISA/Compliance TECHNOLOGY PPACA WELLNESS BENEFITS ADMINISTRATION Never hurry and never worry! E.B. White, Charlotte s Web
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