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AHPs are out – For Now

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.

Telemedicine – Impact your health care costs

Group health insurance premium are expected to rise 15-18% in 2019 and Telemedicine can be an important cost containment tool, for both employer and employee.

In a study of 17,000 telemedicine participants, hospital admissions dropped by 30% and doctor visits were reduced by 60%, for a savings of 45% in unnecessary doctor and emergency room visits. The American Medical Association states that 70% of doctor visits can be handled over the phone, and 50% of the emergency room visits are non-emergencies. Telemedicine’s savings in claim costs range from $300 for a single employee to more than $1,000 per year for a family of 4.

Telemedicine provides 24/7 medical access to employees as part of their benefit package. Advances in communication technologies make accessing professional medical opinions easier. This is particularly important if the network is strictly local, employees live in rural areas, or employees are worried about access to doctors while traveling.

In addition to the obvious convenience – patients/employees do not have to take time away from work for a medical appointment, sitting in the doctor’s waiting room, eliminating travel time – patients/employees have increased access to medical experts in many fields. Telemedicine puts the employee in touch with US Board Certified physicians in their state to treat common ailments; cold/flu, sinus infections, allergies, pink eye, etc.

What can employers do? – Employee Benefit Advisors recommends companies build a communication program to educate employees. In addition to informing employees the services that can be accessed via telemedicine be sure to include instructions on downloading your health insurance carrier’s app and login.

Interestingly, a bill submitted in New York proposes creating a task force to study how telehealth and telemedicine might help employees in workers comp. The task force would examine how connected health technology could improve outcomes for workers on worker’s comp, increase access to care providers and enable those providers to improve compliance with worker’s comp guidelines. The committee would also explore how telehealth and telemedicine could help employers and reduce fraud.

 

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

Group health insurance premiums to rise by 15-18% in 2019

Actuaries are predicting group health insurance premiums to increase 15-18 percent increase in 2019 due to a rise in health inflation.

Medical inflation is in the range of 18-24 percent across the country due to a rise in costs for medicines, medical equipment and hospitalization. Inevitably this will lead to a direct impact on the insurance costs for companies.

The premiums under group health plans are significantly lower than those of individual health insurance products. This is because of the number of people covered under the master plan and because the incidence of claims are lower.

Group health insurance loss ratios are almost 140 percent since some insurers were involved in heavy discounting to retain clients.

Increased non-communicable diseases are expected to increase employer-sponsored healthcare costs over the next three years. These diseases include heart disease, cancers, stroke, chronic respiratory diseases, diabetes, Alzheimer’s disease, mental illness and kidney diseases.

 

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

2019 ACA deadline dates for 2018 reporting

February 1, 2019
Employers start receiving 2018 tax year exchange notices
 

February 28, 2019
Deadline to file 1094-C/1095-C schedules if paper filing
 

March 4, 2019 (Previously January 31,2019)
IRS deadline to furnish 1095-C schedules for 2018 employees
 

April 1, 2019
Deadline to file 1094-C/1095-C schedules if electronic filing
 

April 15, 2019
Individual tax returns for 2018 are due
 

July 31, 2019
Form 720 (PCORI) for 2018 due from self-insured plans (includes self-insured employers)
 

August 1, 2019
Late filing deadline for annual IRS information filing for ACA
 

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

IRS Guidelines – Indexed for 2019

FICA
Social Security Tax is 6.2% on income up to $132,900 up from $ 128,400
Medicare Tax unlimited 1.45% to Unlimited

High Deductible Health Plans
Minimum Annual Deductible (Individual/Family) $1,350 / $2,700
Maximum Out-of-Pocket Limit (Individual/Family) $6,750 / $13,500

Health Savings Accounts
Individual / Family $3,500 /  $7,000
Catch-up Contribution $1,000

ACA Plan Limits

Out-of-Pocket Limits Individua; / Family $7,900 / $15,800

Flexible Spending Accounts
Health Care Flexible Spending Account Maximums $2,700
Dependent Care Spending Account Maximum $5,000

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

Parking (monthly) $265
Mass Transit Passes (monthly) $265

Compensation
Compensation Limit $280,000
Highly Compensated Employee Salary Amount $125,000
Annual Compensation for Key Employee $180,000
Defined Benefit Plan Limit $225,000
Defined Contribution Plan Limit $56,000

Retirement Plans
401(k) $19,000
401(k) Catch-up $6,000
403(b) $19,000
457(b)(2) and 124(c)(1) $19,000
457(b) Catch-up $6,000

IRA Limit $6,000/$7,000 for age 50+
Simple IRA Limit $13,000/$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.

Become a Mountain Man – A worthwhile New Years Resolution!

We can learn a lot from Mountain Men. Like taking the time to sharpen our saw.


The saw is like business operations. If you don’t take time to sharpen your methods and skills it could dramatically affect your business. Don’t be so focused on current day activities they don’t take time to evaluate operations to enhance results. Creating operational efficiencies is crucial to success.

As a Health Care Consultant / Broker and SCORE Volunteer I see it all too often. Here are two recommendations that I can help with that will pay long term dividends.

Health Care Consumption Audit – Health insurance is usually a company’s second highest operational expense. Creating a savings strategy for health insurance can create a significant contribution to the bottom line. Why not perform a Health Care Consumption Audit?

SCORE – Mentoring, workshops, turnaround consulting and advisory boards are all available through SCORE to help start and/or grow your business. SCORE mentors are experienced executives from diverse business backgrounds.

 

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

Why do hackers want your health care data?

Health care information has a much longer shelf-life than other targets like credit cards, which become useless once a consumer gets a new card. Medical and insurance information has value for years.

Employers, if an employee is hacked that employee will be totally engaged restoring their accounts. Employee Benefit Advisors strongly recommends offering Credit/Identity Monitoring and Restoration as a voluntary employee benefit.

How can you protect yourself? We asked Bryan Barnhart, President of Infiltration Labs www.infiltrationlabs.com, Cyber Crimes Investigator,  and Digital Forensic Specialist, and primary instructor for the U.S. Secret Service Network Intrusion Response course. As a retired Police Detective and U.S. Secret Service Electronic Crimes Task Force Investigator (in short, he knows his stuff) he has a few basic tips.

Cyber Security for the Masses
Use strong passwords and don’t reuse passwords
Change passwords frequently
Use a password manager
Check if your email/password has been compromised: https://haveibeenpwned.com
Use Two-Factor Authentication (2FA) for all accounts: https://twofactorauth.org
Don’t use open Wi-Fi or networks you can’t vouch for
If you must open Wi-Fi, use a VPN – Think before you click: Don’t click links or open attachments in suspicious emails

Uncertain about the various cyber security monitoring services available? Contact Bryan or Myself, we don’t have a horse in the race, however we use the same service.

Cologuard vs Colonoscopy

Concerned about being at risk for colon cancer? Don’t like the idea of a colonoscopy? You may want to consider learning more about Cologuard, an at-home testing kit that screens you for colon cancer.

 What it is.
Cologuard is a noninvasive, prescription-only test. It’s designed for adults 50 years or older who are at average risk for colon cancer.

What it’s not.                 
Cologuard is not a replacement for diagnostic or surveillance colonoscopy in high risk individuals. If you have a medical history that includes colon cancer, polyps, or related cancers, it isn’t right for you.

How to tell if it’s for you.
The first step is to discuss the Cologuard testing kit with your healthcare provider. Once your healthcare provider approves the prescription, your kit can be ordered. It will be delivered right to your door.

How effective is it?
In 10,000 testing cases, Cologuard screenings discovered 92% of colon cancers and 42% of high-risk pre-cancers. Since both false positives and false negatives occur, Cologuard encourages positive-results patients to follow-up with a diagnostic colonoscopy. Negative-results patients are encouraged to participate in additional screenings at intervals.

 Will your insurance cover it?
Preventative Care / Screenings are covered at no cost under the Affordable Care Act. Cologuard is covered by most insurers with no co-pay or deductible for eligible patients (ages 50-75; at average risk for colon cancer; without symptoms). Cologuard is covered by Medicare and Medicare.

If your insurance provider doesn’t cover it or only covers part of the costs, Cologuard’s appeal department will assist you in creating an appeal letter to send to your insurance company.

The Cologuard screening is FDA-approved and has been in use since 2014.

 

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

New Rules for Short-Term Health Plans may help employees in transition

The new rule will allow individuals to purchase short-term, limited-duration health insurance coverage for a period of less than 12 months, and renew coverage for up to 36 months. Under current law, the maximum coverage period is less than 3 months, and cannot be renewed.

Short-term, limited-duration health insurance is:
• Not required to comply with the Affordable Care Act’s ban on pre-existing condition exclusions and lifetime and annual dollar limits.
• Not required to comply with the Affordable Care Act’s essential health benefits requirement, which requires individual health insurance policies to cover, among other things, hospitalizations, emergency services, and maternity care.

The short-term health plans are typically much less expensive than fully-insured plans found on the marketplace or coverage provided through an employer’s COBRA continuation option. An employee with pre-existing conditions may not be interested, however health employees may find the short-term policies much less expensive and opt for the coverage.

 

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

Dietary Impact on Health

Meet Jeanette, she has lupus. (A chronic autoimmune disease in which the body’s immune system becomes hyperactive and attacks normal, healthy tissue. This results in symptoms such as inflammation, swelling, and damage to joints, skin, kidneys, blood, the heart, and lungs.)

(Jeanette mentions PatientsLikeMe in her video. PatientsLikeMe is a free website where people can share their health data to track their progress, help others, and change medicine for good. It’s an online community with over 2,500+ conditions.)

Now, the rest of the story.

Jeanette says she turned to dietary changes when she stopped taking Plaquenil due to severe side effects, including retina damage. She started logging her food intake for a few weeks, she noticed how some of her favorite foods were causing issues ranging from stomach pains to full inflammation. That’s when she started paying close attention to what her body was telling her and realized she needed to do something about it.

Jeanette didn’t go on any specific diet at first, she started eliminating certain foods like sugar (which was causing major fatigue and pain), garlic (causing major inflammation in her knees), eggplants (fatigue and pain in her feet), bean sprouts (stomachaches) and alfalfa (full inflammation and full flare) — some of the known foods that lupus patients shouldn’t eat [learn more at lupus.org].

Then Jeanette noticed how meat was causing fatigue and noticed inflammation directly in her knees. She gave up red meat for two weeks, felt good and noticed a reduction of pain. Then she gave up chicken the following two weeks and felt even better. “It was so amazing that I decided to give it up for good.” After the first few months without meat, my doctor started noticing my blood work was improving drastically, so she began reducing her medications since she was no longer flaring or feeling pain. After a full year she reduced all medications to zero and even stopped infusions.

(Everyone is different, so these foods and dietary changes may not affect you the same way. Talk with your doctor or a registered dietitian about finding foods that work for you.)

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