Author Archive

2020 EMPLOYEE BENEFITS UPDATE

By November 12th, 2019   Compliance - ACA & Other, Human Resources

As we head into a new year, there will be some noticeable changes in employee benefits that you and your clients should be made aware of. The following list encompasses a few of the items you may expect to change:

Required Reporting
Effective January 1, 2020, Medicare Secondary Payer reporting will now include prescription drug coverage. Right now, this is an optional procedure. It is handled by insurance carriers and third-party administrators. Employers should be aware that they may get requests for information from those carriers and third-party administrators. A more detailed explanation can be found here.

PCORI Fee Elimination
The PCORI fee will be eliminated for plan years ending before October 1, 2019. If an employer’s plan year ends between October 1, 2018 and December 31, 2018, then the last PCORI fee for that plan should have been paid by July of 2019. This would generally include plans that have plan years beginning November 1, December 1, or January 1. All other plans will make their last PCORI fee payment by the end of July 2020.

Out-of-Pocket Maximum Increase
In 2020, out-of-pocket maximums will increase to $8,150 for self-only coverage and $16,300 for family coverage. This represents an increase of about 3.20% from last year. HHS requires that the individual out-of-pocket maximum be embedded for each individual within the family OOPM. You can refer to the 2020 Benefit and Payment Parameters found here.

Health Insurance Tax
The Health Insurance Tax (HIT) which has been on a moratorium for 2019, will make a return in 2020 unless Congress acts on pending legislation to delay or repeal. This would result in increased premiums ranging from 2.7% to 4% according to actuarial experts.

Employer Mandate Affordability
The affordability percentage used in the safe harbors will be reduced to 9.78% in 2020. Employers should review their contribution levels to make sure they are within the new percentage requirement.

Individual Mandates in the States
Effective January 1, 2020, California and Vermont will have an individual mandate that will require employer reporting to be completed in 2021. New Jersey, which already has an individual mandate in place, will have to complete the employer reporting in 2020.

Self-Funded Plans
Employers that self-fund may have different benefits that cannot be subject to annual and lifetime limits. Self-insured employers should reevaluate which state plan they use as their benchmark for purposes of determining which benefits cannot be subject to annual and lifetime limits.

2020 Employer Mandate Penalties
As they do each year, the Department of Health and Human Services (HHS) calculates the health insurance premium growth rate. That rate is then used to adjust the amount of the ACA employer mandate penalties. Although not finalized, the 2020 employer mandate penalties could be $2,570 for the (a) penalty and $3,860 for the (b) penalty.

There is a lot of pending legislation that Congress could still take up before the recess. Issues pertaining to a Cadillac Tax repeal, transparency in prescription drug prices (H.R.3), redefining a full-time employee, surprise billing, and employer reporting can all be potentially addressed in the coming weeks.

 

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

Top 10 health conditions costing employers the most

By October 22nd, 2019   Healthcare, Wellness

Employee Benefit News recently published a list of the 10 health conditions that are costing employers the most. They are:

  1. High-Risk Pregnancy
  2. Smoking
  3. High Cholesterol
  4. Depression/Mental Illness
  5. Hypertension/High Blood Pressure
  6. Heart Disease
  7. Arthritis/back/musculoskeletal
  8. Obesity
  9. Cancer
  10. Diabetes

Employee Benefit Advisors would like to point out that a least half the list is related to one’s weight. It prompts reposting the meat of EBA’s November 19th, 2014 blog.

The following was posted by one of my fellow CEBS (Certified Employee Benefit Specialist) colleagues. Employee Benefit Advisors has seen, time after time with our own clients, that weight loss is the number one factor to controlling health care costs.

“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.

My husband is 68 years old and was on high blood pressure, diabetes and cholesterol meds–pretty typical at this age. Oh, yes, and frequently had terrible heart burn. Lost 38 pounds and just had his annual physical. Doc took him off all his prescription meds and he no longer ever has heart burn. Go figure… How’d he do it? Cut way back on consumption of carbs/sugar. That’s it. Pretty simple. Nothing else…not even exercise. Now that he feels so good he has started to exercise on a regular basis.”

 

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

Employer medical benefit costs projections for 2020

By September 24th, 2019   Healthcare

Employer-provided medical benefit costs are forecast to rise 6.5% in 2020, outpacing general inflation by 3.8%. The expected increase for medical plans is due to a combination of higher costs for specialty drugs, moderate price increases for care and flat or decreasing health utilization. (Medical costs in the U.S. will rise more slowly compared to other regions around the world.)

Prices, not utilization, are the leading cause for healthcare spending. High deductibles and other cost sharing are two reasons for the decrease in utilization.

The primary drivers of health care claims are musculoskeletal, cancer, cardiovascular, diabetes and high blood pressure. It’s important to note the growing risks from unhealthy personal habits, i.e. physical inactivity, obesity, bad nutrition, ageing and excessive alcohol and substance abuse. Many of those risk factors can lead to chronic conditions that are difficult to treat and can contribute to long-term increases in medical costs.

2020 Global Medical Trend Rates Report

 

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

What Is Blue Light? Why You Need to Protect Your Eyes

By September 10th, 2019   Healthcare

If you spend any time during the day looking at a screen, whether it be a smartphone, tablet, e-reader, LED TV, or computer, your eyes are exposed to blue light.

 What is blue light?

Natural sunlight is made up of many colors of light, from red to indigo to violet. We can’t see these colors because they blend together to make white light. Because the light looks white, it is hard to tell if your eyes are exposed to blue light. On the color spectrum, blue light is right next to UV light—both can be dangerous and damaging to the eyes.

But it’s not all bad. Blue light has some benefits. It can help you feel more alert and awake, improve your mood, and help you sleep better. We need blue light to feel healthy and happy.

The problem is when you spend too much time looking at a screen, you increase your eye exposure to blue light. Too much exposure to blue light can cause tired eyes, sore eyes, and difficulty focusing. Studies have shown that too much exposure to blue light can also cause age-related macular degeneration which can lead to blindness.

Most of us use computers and other electronic devices not only in our jobs every day, but at night when we get home. In other words, it is difficult to reduce our screen time! So how can you protect your eyes? Here are a few tips:

  • If you can’t reduce your amount of screen time, try to take breaks at least every hour to rest your eyes.
  • Filters or computer glasses are available that can reduce how much blue light is reaching your eyes. There are filters for nearly every electronic device that can help alleviate eye fatigue.
  • Avoid looking at a bright screen for two or three hours before bedtime, and sleep with the lights off rather than leaving on a lamp or night light. This will help you to improve your quality of sleep.

Thanks to Brooke Ellis, Director, Strategic Sales Communications at Solstice Benefits
https://blog.solsticebenefits.com/solstice-member-blog/what-is-blue-light-why-you-need-to-protect-your-eyes

 

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

Preventive Care Benefits Expanded

By August 6th, 2019   Compliance - ACA & Other, Healthcare

A new IRS notice expands the list of preventive care benefits that may be covered. Expansion provides coverage without a deductible for some chronic conditions.

“This notice expands the list of preventive care benefits permitted to be provided by a high deductible health plan (HDHP) under section 223(c)(2) of the Internal Revenue Code (Code) without a deductible, or with a deductible below the applicable minimum deductible (self-only or family) for an HDHP.”

Carriers / Plan Sponsors can now use a lower than the minimum deductible for the preventive care benefits, but still need a minimum deductible for the other services. The new change doesn’t affect what is generally considered “free preventive” but instead simply allows carriers / plan sponsors — if they wish — to start offering CDHPs which cover these additional items, while not endangering their ability to be combined with an HSA.

Thus, employees could still contribute to an HSA now that these services are considered to be preventive. These services would not need to be “free”; for non-HDHP group plans, it will not make a difference to the participant, but for someone in an HDHP plan who wants to contribute to an HSA, it’s a big deal.

The following treatments have now been classified as preventive care for the chronic conditions indicated.

  • Angiostatin converting enzyme (ACE) inhibitors (for congestive heart failure, diabetes, and coronary artery disease);
  • Anti-resorptive therapy (for osteoporosis and osteopenia)
  • Beta-blockers (for congestive heart failure and coronary artery disease)
  • Blood pressure monitors (for hypertension)
  • Inhaled corticosteroids (for asthma)
  • Insulin and other glucose-lowering agents (for diabetes)
  • Retinopathy screening (for diabetes)
  • Peak flow meter (for diabetes)
  • Glucometer (for diabetes)
  • Hemoglobin A1c testing (for diabetes)
  • International normalized ratio testing (for liver disease and bleeding disorders)
  • Low-density lipoprotein (LDL) testing (for heart disease)
  • Selective serotonin reuptake inhibitors (SSRIs) (for depression)
  • Statins (for heart disease and diabetes)

The change is effective July 17, 2019.

 

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

Is transparency coming to healthcare pricing?

By July 2nd, 2019   Healthcare

President Trump recently signed an executive directing federal agencies to increase healthcare price and quality transparency. The order specifically directs the of Departments of Labor, Treasury and Health and Human Services to issue guidance and propose regulations that would disclose negotiated rates, cost-of-care and de-identified federal healthcare data, and to expand the availability of Health Savings Accounts.

The order includes five main provisions instructing federal agencies to issue guidance that would:

  • require hospitals to disclose information about their negotiated rates in a format that’s understandable and usable by patients.
  • require insurance companies to provide patients with information about cost of care, including out-of-pocket costs, before they receive services.
  • develop a comprehensive roadmap for consistent, limited, consumer-centric quality metrics.
  • disclose de-identified federal healthcare data that protects patient and consumer privacy, enables transformation of the healthcare marketplace, and allows researchers to develop tools and analytics to allow patients to be at the center of their healthcare.
  • expand the availability of HSAs to cover direct primary care arrangements and healthcare sharing ministries, include more preventive services and products that can be covered in the deductible period, and issue guidance on the amount of funds that can be carried over at the remainder of the year for FSAs.

Employee Benefit Advisors has long advocated greater price and quality transparency in healthcare and we commend the Trump Administration for putting forth this proposal.

The executive order is the president’s third major executive action on healthcare since taking office, after the order issued on his first day in office directing federal agencies to ease the regulatory burden of the ACA, and the order issued in October 2017 that led to the development of the rules on Association Health Plans, short-term plans and HRAs..

As with previous executive orders issued by President Trump, this order does not immediately trigger any executive action apart from the instructions issued to the federal agencies to develop regulatory actions. These will need to go through the traditional rulemaking procedures of providing a proposed rule for public comment before being able to enact any final rules.

It’s a good start.

Thanks to the National Association of Health Underwriters, NAHU,  for the blog content.

 

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

Silver-loading

By June 11th, 2019   Compliance - ACA & Other, Human Resources

Silver-loading refers to health insurers loading premium increases on the popular silver-level exchange plans to make up for the loss of Cost Sharing Reduction (CSR) payments. Loading premium surcharges onto silver plans boosted the size of the premium tax credits available to people with incomes below 400% of the federal poverty level. – The Trump Administration in an effort to end silver-loading has proposed changes to the current regulations.

Employee Benefit Advisor’s blog tends to focus on Human Resource and Benefit group related issues, like our monthly HR & Benefit Advisory publication. However, we believe silver-loading is an issue of interest to all in our field.

 

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

E-cigarettes: an effective quit smoking aid?

By May 14th, 2019   Healthcare

This may seem like a common sense Q&A. However, with the increasing popularity among younger employees you might want to arm yourself with solid stats and a good non-smoking educational program.

Part of the appeal is pod vapes look like a sleek high tech. Users try pod vapes because of the flavors. Problem is with every puff of flavor comes a high dose of nicotine. Some pod vapes have as much nicotine as an entire pack of cigarettes. Nicotine damages blood vessels and increases the risk of heart disease. Nicotine also affects the development of brain circuits and may increase the risk of mood disorders and problems with impulse control.

Users report feeling hooked on nicotine within days. Once hooked, there is a greater risk of using regular cigarettes or other tobacco products. Vape devices are also being used to smoke marijuana, which can affect how the brain develops in teens.

Many e-liquids contain nicotine and e-cigarettes deliver nicotine directly to the lungs. Vapes don’t have tar and some of the other chemicals that regular cigarettes have, they do have toxins that can harm your health. Toxins found in vapes include heavy metals, diacetyl – a chemical that can cause serious lung disease when inhaled, ultrafine particles that can damage lungs, and chemicals known to cause cancer.

The FDA has not approved e-cigarettes as a tobacco quit aid. There are seven FDA-approved cessation aids and medications that are proven safe and effective. Three types of nicotine replacement therapy (NRT) are available without a prescription: the patch, gun and lozenge. Two types of NRT are available with a prescription: the inhaler and nasal spray. There are two non-nicotine medications: Bupropion (Wellbutrin) and Varenicline (Chantix). None of the approved, regulated cessation aids deliver nicotine to the lungs.

Need help developing a cessation program? Tobacco Free Florida offers FREE nicotine replacement patches, gum or lozenges and FREE community, worksite, and clinic groups

 

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

2020 Cost Sharing Limits

By April 25th, 2019   Compliance - ACA & Other

Out-of-pocket expenses may not exceed $8,150 for self-only coverage or $16,300 for family coverage in 2020. – Ouch!

Employers will need creative solutions to help employees afford these limits. Hint: EBA can help.

 

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

AHPs are out – For Now

By April 2nd, 2019   Compliance - ACA & Other

A federal judge has ruled that two parts of the Department of Labor (DOL) rule expanding employers’ ability to join in Association Health Plans (AHPs) violate ERISA. The DOL AHP rule was formed to allow employers to band together to create health plans based on industry or geography.

The federal court opinion stated that the rule was an “end-run” around the Affordable Care Act, and that the DOL exceeded its authority when it defined “employer” in the rule to include associations of dissimilar employers. The court also struck down a part of the DOL rule that expanded memberships in AHPs to working owners without employees.

The plans at issue allow groups of small businesses and sole proprietors to band together to offer lower-cost coverage that doesn’t have to include all the benefits required by “Obamacare.” The plans also can be offered across state lines. The Judge ruled against AHPs because they go against established definitions of what constitutes an employer under federal law that governs workplace health and pension benefits. In particular, a decision that sole proprietors can be counted both as employers and employees.

The judge ruled treating sole proprietors like major employers “creates absurd results.” For example, said the judge, consider a hypothetical association of 51 sole business owners with no employees. Under the administration’s rule, they would in effect be counted as having 51 employees. Not only that, each of the 51 working owners would also be counted as an “employer” although they have “zero” people working for them. And the association also would count as an employer, for a total of 52 employers.

The Trump administration disagrees with the judge’s ruling on association health plans and is “considering all available options,” including an appeal.

EBA’s opinion is that anything that can help sole proprietors and small companies lower their health care cost is good thing. The judge made a bad ruling.

 

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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