Author Archive

IRS Guidelines – Indexed for 2021

By January 5th, 2021   Human Resources

FICA
Social Security Tax is 6.2% on income up to $142,800
Medicare Tax unlimited 1.45% to Unlimited

High Deductible Health Plans
Minimum Annual Deductible (Individual/Family) $1,400 / $2,800
Maximum Out-of-Pocket Limit (Individual/Family) $7,000 / $14,000

Health Savings Accounts
Individual / Family $3,600 / $7,200
Catch-up Contribution $1,000

ACA Plan Limits
Out-of-Pocket Limits Individual / Family $8,550 / $17,100

Flexible Spending Accounts
Health Care Flexible Spending Account Maximums $2,750 Maximum carryover $550
Dependent Care Spending Account Maximum $5,000
The dependent care FSA maximum is set by statute and is not subject to inflation-related adjustments.

Mileage & Transportation 
Standard Mileage Rates
56 cents per mile for business miles driven
16 cents per mile for medical or moving purposes
14 cents per mile driven in service of charitable organizations

Parking (monthly) $270
Mass Transit Passes (monthly) $270

Compensation
Compensation Limit $290,000
Highly Compensated Employee Salary Amount $130,000
Annual Compensation for Key Employee $185,000
Defined Benefit Plan Limit $230,000
Defined Contribution Plan Limit $58,000

Retirement Plans
401(k) $19,500
401(k) Catch-up $6,500
403(b) $19,500
457(b)(2) and 124(c)(1) $19,500
457(b) Catch-up $6,500

IRA Limit $6,000/$7,000 for age 50+
Simple IRA Limit $13,500/$3,000 Catch-Up

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Health Care Transparency

By December 8th, 2020   Compliance - ACA & Other, Healthcare, Human Resources

New transparency requirements on group health plans and health insurers in the individual and group markets were issued by the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments).

The final rule requires plans and issuers to disclose:

  • Price and cost-sharing information for a list of 500 services must be available via the internet for plan years beginning Jan. 1, 2023. All items and services are required to be available for plan years beginning Jan. 1, 2024.
  • In-network provider-negotiated rates and historical out-of-network allowed amounts on their website for plan years beginning Jan. 1, 2022.

The final rule also allows insurers that share savings with consumers—resulting from consumers shopping for lower-cost, higher-value services—to take credit for those “shared savings” payments in their medical loss ratio calculations.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Lifestyle Choices – Creating a Wellness Culture

By November 3rd, 2020   Healthcare, Human Resources

BenefitsPro ran an article saying… Changing lifestyle choices could cut $730B in annual health care spending and that more than a quarter of all health care spending is due to conditions such as smoking, diabetes and poor diet.

“Nearly three-quarters of a trillion dollars in health care spending can be linked to modifiable health risks, such as obesity, high blood pressure, and smoking…”

There are three key strategies that would prove to be very effective towards changing lifestyle choices.

(1) Preventative – Individuals have a responsibility to be examined at least periodically (every two years, yearly as we get older – I will let the AMA set the standard) and get their immunizations. Those that do receive a premium credit.

(2) Wellness / Biometrics – Smokers should be charged more (no need to argue why, everyone should be aware of the added health risks and costs). Premium credits for those actively managing and meeting standards for blood pressure, BMI, cholesterol, and blood sugar level. People with obesity appear to have triple the risk of hospitalization with COVID-19, compared to people without obesity, the CDC reports. Being severely obese may increase the risk by 4.5 times. – All these biometrics are key indicators of health. Control these factors and receive a premium credit, those that do not should pay more. They are costing everyone else.

(3) Genetics & DNA – Technology is a great tool. Let us use it to help predetermine the medical conditions which we are predisposed. Not to punish people with higher costs, but to be proactive. A lifestyle change at an early age could help prevent certain illnesses. Information can be kept confidential with case managers and not shared or used with underwriting. – i.e. If you knew you had a family history of cancer, breast or colon, you could be proactive and monitor the signs. Same principle for other genetic diseases.

An important part of any health care discussions is preexisting conditions.  No one should be denied coverage due to preexisting conditions. However, no one should be allowed to burden the system who carries no insurance, goes to the doctor, learns they need medical care and now applies for insurance. They should be required to apply for insurance, bear a heavy portion of the medical expenses for a year or two (contracted rate), and have the carrier assign a case manager.

How do we pay for preexisting conditions? – Every transaction, buying aspirin, medical procedures, hospital stays – anything medical related – should be charged a ‘PreX’ fee of 1 penny (maybe 2 depending on the accounting). The money would go towards funding preexisting conditions, nothing else. If it raises more than is needed the surplus can be used for cancer or other medical research.

 

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

What is Creditable Medicare Part D Coverage?

By October 6th, 2020   Compliance - ACA & Other, Human Resources

Medicare Part D notices are due before October 15,2020. But what does that mean and how do you know if your coverage is creditable?

If you have any type of group health plan the notice is sent to advise plan participants as to whether their prescription drug coverage is “creditable.”

What is Medicare D Creditable Coverage? – The Medicare Modernization Act made it a requirement that entities that offered plans which included prescription drug coverage had to disclose to all Medicare-eligible individuals whether that prescription drug coverage was “creditable.”

Defining Creditable – For the purposes of this requirement, “creditable” means that the coverage is expected to pay as much as the standard Medicare prescription drug coverage. Among the 2020 parameters for what is considered “standard” under Medicare D are:

  • Deductible: $435.00
  • Initial coverage limit: $4,020
  • Out-of-pocket threshold: $6,350

Determination of Creditable Coverage
The prescription drug plan is deemed to be creditable if it:

  • Provides coverage for brand and generic prescriptions
  • Provides reasonable access to retail providers and mail order coverage
  • Is designed to pay on average at least 60% of participants’ prescription drug expenses

The plan must also satisfy one of the following criteria:

  1. The prescription drug coverage has no annual benefit maximum benefit or a maximum annual benefit payable by the plan of at least $25,000
  2. The prescription drug coverage has an actuarial expectation that the amount payable by the plan will be at least $2,000 annually per Medicare-eligible individual
  3. For entities that have integrated health coverage, the integrated health plan has no more than a $250 deductible per year, has no annual benefit maximum, or a maximum annual benefit payable by the plan of at least $25,000 and has no less than a $1,000,000 lifetime combined benefit maximum.

Notification
The creditable or non-creditable coverage notice must be provided to Medicare Part D eligible individuals who are covered or who apply for the plan’s prescription drug coverage. This includes active, retired, disabled, and COBRA beneficiaries and dependents. The notice must be furnished no later than October 14. The Part D Annual Election Period runs from October 15 through December 7 of 2020.

It is often difficult to determine which participants are Medicare D eligible, so the prudent solution is to send the notification to ALL plan participants prior to October 14. Click here for a guide that  provides a calculator methodology for determining creditable coverage.

There is also a necessary notification requirement for entities to complete the Online Disclosure to CMS Form to report the creditable coverage status of their prescription drug plan. The disclosure should be completed annually no later than 60 days from the beginning of a plan year, within 30 days after the termination of a prescription drug plan, or within 30 days after any change in creditable coverage status.

Penalties
While there are no formal penalties attached to non-conformance of the requirement, the Medicare-eligible individual may incur a late enrollment penalty if notification as to non-creditable coverage exists and that individual then attempts to enroll in a Medicare Part D plan.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Let the dogs out!

By September 8th, 2020   Healthcare Services, Human Resources

Surprise medical bill? – Surprise medical billing applies to fully-insured commercial insurance plans.   No federal laws exist to prevent surprise medical bills and of the states that do less than half provide comprehensive legislation.   Employees are confused when they receive a surprise medical bill and it generally reflects poorly on the company plan when it occurs.

Bill Dog was made for the moment a confusing medical bill arrives. Members can be confident before paying any medical bill. Bill Dog researches and explains every situation to our members.

  • What is the bill for?
  • What are the codes?
  • Are the charges too high?
  • I have insurance, why do I have this bill?
  • I am confused.

Bill Dog works directly with members, providers, and insurance companies to resolve issues, support appeals, and assist with price negotiations. Bill Dog provides an easy way to verify any medical bill so it can be negotiated and paid with confidence. It is easy to use. You can reach them by phone, chat, email or direct message. Codes and charges are verified. Billing errors are identified and corrected. Appeals and price negotiations are supported. It is results driven. Errors are identified and corrected — claims denials and out of network charges are verified.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

COVID-19 Disability Claims

By August 4th, 2020   Human Resources

Several clients have asked questions related to COVID-19 and their group disability insurance. Here’s a compilation of how carriers are administering claims.

Question: Is someone automatically disabled if he/she is placed under a quarantine related to the Coronavirus?

Answer: No. Standard policy language requires that an insured be disabled from his/her own occupation. Therefore, an insured is not automatically considered disabled if under a quarantine for any reason. However, some policies may contain quarantine provisions. It is important that you check your policy or (if self-insured) plan document, as this will dictate how claims are administered.

Question: Will a disability claim for an insured who is under a quarantine related to the Coronavirus be approved?

Answer: Possibly. Every claim is reviewed based on the disability policy language and the unique facts of the insured’s situation, including factors such as the diagnosis and medical certification; the progress of the virus/condition; the specific quarantine that the insured is subject to; and the insured’s ability to work remotely, among others.

Claims submitted listing a diagnosis of Coronavirus will be processed in compliance with all applicable contract provisions. In general, to be eligible to receive benefits, an insured must provide proof that he/she is:

  • Under the care of a Health Care Provider who is certifying the insured’s disability; AND
  • Unable to perform his/her occupation in the workplace or at home via remote access.

If the employee is symptomatic, then he/she may have a qualifying condition under FMLA (or even the ADA) which would require him/her to take leave. An important consideration is that the employee must be quarantined and not able to return to work. To the extent the quarantine is optional and the employee is symptomatic, the employee may also qualify for FMLA.

Situations involving furloughs or layoffs may be more complex. This may include eligibility for coverage for those who were actively at work prior to a furlough or layoff on a prior carrier’s policy. How will pre-existing conditions be administered? What about employees whose hours are reduced below the minimum hours required in the policy definition for eligibility? – There are many scenarios that may need to be reviewed by a broker with in-depth knowledge of contract language and claims experience.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Bringing People Back to the Workplace Safely & Efficiently

By June 23rd, 2020   Healthcare, Human Resources

Key to bringing people back is developing and implementing industry best practice safety and wellness protocols.

Meridian’s temperature sensing Personnel Management Kiosk is designed to help protect the health and safety of both employees and guests by helping prevent anyone with a temperature or those without access from entering a facility.

Features

  • Temperature Verification
  • Facial Identification
  • Temperature Threshold Alarms
  • Pedestal & Countertop Configurations

Designed to monitor multiple kiosks in remote locations it is ideal for businesses requiring system security and remote performance management.

Temperature Management Solutions help balance the need to get back to business as quickly as possible while ensuring workplace health and safety. Easy to setup and use. Potential integration, current and development, will make this product a powerful monitoring service tool. More information available at www.meridiankiosks.com.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

OSHA Recommends that Employers Encourage Workers to Wear Face Coverings at Work

By June 16th, 2020   Compliance - ACA & Other, Healthcare Services

As businesses open and employees return to work, large numbers of employees of workers will be required to wear faces masks in the workplace.

The Occupational Safety and Health Administration (OSHA) has published a series of answers to frequently asked questions (FAQs) regarding the use of masks in the workplace to help employers provide a safer work environment. The guidance outlines the differences between cloth face coverings, surgical masks and respirators.

Guidance includes:

  • Cloth face coverings are not considered personal protective equipment and employers are not required to provide them. (Employee Benefit Advisors believes this is an extremely important as it could provide the employer a layer of liability protection.)
  • OSHA generally recommends that employers encourage workers to wear face coverings at work.
  • Cloth face coverings are not a substitute for social distancing measures.
  • OSHA suggests following CDC recommendations, and always washing or discarding cloth face coverings that are visibly soiled; and
  • Employers must not use surgical masks or cloth face coverings when respirators are needed.

Click here for more information.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

COVID-19 and Fat People

By April 28th, 2020   Healthcare

I posted Fat People Have Issues November 19th. 2014. – Medical Issues.

Once again, before offending anyone – I posted the politically incorrect title in hopes of getting more people to read. I like fat people, many of my friends are fat. And to be honest, I would like to lose a few lbs. So please take it in good humor. I do not need hate mail. I also recognize some people have genetic challenges.

The statistics for COVID-19 are showing 94% of the deaths have underlying medical conditions, 88% have two conditions and 19% at least one. Elevated blood pressure is the number one underlying medical condition at 53%, overweight 42%, diabetes 32%.

One of the most effective ways to ensure quality healthcare services is to not need it in the first place. All those overweight, please raise your hand. All those currently being treated for a preventable healthcare issue raise your hand. Employee Benefit Advisors has seen, time after time with my own clients, that weight loss is the number one factor to controlling health care costs.

One my biggest beefs with Obamacare is that it did nothing to promote a healthy lifestyle. A good BMI can resolve many medical issues. Maintaining a proper BMI has the potential for the doctor to remove you from your high blood pressure, cholesterol, diabetes, and other medications.

As for COVID-19, it is recommended people with underlying conditions stay home during phase 1 and 2 of the reopening of the economy.

Want more info on the Dietary Impact on Health? Check out https://ebafl.com/dietary-impact-on-health/

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Florida Department of Health

By April 21st, 2020   Healthcare, Human Resources

The Florida Department of Health has received accolades from the Presidential Response Team during the daily briefing. Doctor Deborah Brix has mentioned several times it is an ideal resource and one that other states should try to emulate.

Florida Health 201 Novel Coronavirus Response (COVID-19) https://floridahealthcovid19.gov/. The site includes the county-specific Surveillance Dashboard I mentioned in my previously blog.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

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