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Obamacare, Obamaco$t – What you’re not hearing

Here are some headlines you’re nor hearing unless you’re paying really close attention to the ACA (Affordable Care Act), aka Obamacare.

12 failed co-ops which were created under the Affordable Care Act could cost taxpayers $1.2 billion – Four of the remaining co-ops created under the Affordable Care Act are experiencing weak enrollment, which is another indication that the startups remain on shaky ground. Data show these four co-ops have not yet signed up a minimum of 25,000 members, a crucial threshold which allows them to cover costs.

UnitedHealthcare to Drop Obamacare Exchanges in most states by 2017 – UHC expects to loose $650mm this year.

Despite ACA, Patients Still Subject To Surprise Medical Bills – Surprise medical bills happen most often in an ER visit when a hospital contracts with medical providers – including doctors, surgeons, anesthesiologists, lab technicians – that do not accept the same insurance plans the hospital does.

The maximum out-of-pocket costs will rise – Consumers can expect to pay more for healthcare costs. OOP expenses will rise to $7,150 for an individual / $14,300 for a family. Placing a significant financial burden on middle-income Americans who need a substantial amount of care.

State Medicaid Agencies Want Congress to Repeal ACA Insurance Tax – Medicaid agencies want lawmakers to permanently repeal the tax on health insurers. The article says “most private health insurance plans have had to pay the tax themselves,” but “states that contract with Medicaid managed-care plans have had to cover the premium tax to ensure that the health plans receive actuarially sound rates.” Some 38 states and Washington, DC contract with Medicaid managed-care plans.

HealthCare.gov Continues To Be Vulnerable To Hackers – The GAO reports that security flaws ‘will likely continue to jeopardize the confidentiality, integrity and availability of HealthCare.gov.

It’s been six years since the ACA was signed into law. How’s it going?

 

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.

Up Up and Away – 2017 ACA Cost-Sharing Limits Released

HHS updated the annual limits based on the premium adjustment percentage for 2017. As a result, annual out-of-pocket expenses may not exceed $7,150 for self-only coverage or $14,300 for family coverage in 2017. – Why? It is an attempt to keep the premiums down. – I can hear the moans and groans of open enrollment already!

 

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.

Wellness Leads to Better Business & Higher Profits

A healthy, thriving workforce makes for a healthier business. Investing in health reduces health care costs, improves productivity.

Alternatively, poor health is bad for business. Chronic disease drives health care expenditures, which cuts into productivity and profits. Consider

  • 67% of our workforce is overweight
  • 1 in 4 has heart disease
  • 1 in 3 Americans has high blood pressure
  • $73 billion is the annual cost of obesity among full-time employees
  • $15s billion loss to employers annually due to absenteeism from workers who are overweight and have other chronic conditions
  • 45o million work days missed every year by full-time employees who are overweight and have chronic conditions

Wellness programs lead to prevention which means better business, higher profits.

 

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.

 

The Grandson’s Burden

Sixty-four year-old grandfathers incur nine times more medical expenses than their eighteen year-old grandsons. But under small group ACA adjusted community rating, their health premiums can be no more than three times the cost charged to their second generation progeny, who now pay more to subsidize their forefathers.

Female rates have always been within the 3:1 age ratio due to the expenses of childbearing years. So the major impact of ACA adjusted community rating falls on the cost of young men.

The ACA also eliminated health risk rating for small groups. Thus small employer groups composed chiefly of young male or healthy employees are paying much higher health premiums than necessary to cover their risk.

Many small employers are migrating from fully-insured plans that are priced by adjusted community rating to partially self-funded plans that are priced for their own employees’ actual age, gender, and health risk profile.

Employee Benefit Advisors can help you with Level Funding, Traditional Self-Funding, and Employer Group Stop Loss Captives. Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

A special thanks to TCC Benefits Administrators for the content in this blog.

2016 Benefits Notices

Employers have 14 required notices to provide to employees for review and selection of benefits include certain required notices. Do you know what they are? There are 3 required notices for all group health plans, 9 notices for particular designs and 2 other important notices. States may require additional notices.

Think you know the entire list? Would you like to review the list? Contact Employee Benefit Advisors to see the list, learn the due date for each notice and a link to US DOL website for sample notices and details. Send your inquiry to [email protected] with the subject line 2016 Benefit Notices.

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

Non-Discrimination Rules for Group Health Plans

With all the focus on ACA it’s good to step back and look at other regulations that may help with benefit designs. Many incorrectly think the ACA health insurance requirements is a one-size fits all model. However the ACA non-discrimination requirements have been delayed, indefinitely, and therefore are not a factor.

ERISA is the determining regulation. And under ERISA employers are generally free to set the eligibility rules for their group sponsored health plans under ERISA, so long as the rules do not unlawfully discriminate against certain employees.

Bona-Fide Employment-Based Classifications may be permitted. Distinctions among group participants in a health plan must be based on bona-fide employment-based classifications consistent with the employer’s usual business practice. Whether an employment-based classification is bona fide is determined on the basis of all the facts and circumstances, including whether the employer uses the classification for purposes independent of qualification for health coverage (for example, determining eligibility for other employee benefits or determining other terms of employment.)

 

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 Figures for 2016

FICA
Social Security 6.2% to $ 118,500
Medicare unlimited 1.45% to Unlimited

High Deductible Health Plans
Minimum Annual Deductible (Individual/Family) $1,300 / $2,600
Maximum Out-of-Pocket Limit (Individual/Family) $6,550 / $13,100

Health Savings Accounts
Individual / Family $3,350 / $6,750
Catch-up Contribution $1,000

Flexible Spending Accounts
Health Care Flexible Spending Account Maximums $2,550
Dependent Care Spending Account Maximum $5,000

Mileage & Transportation
Standard Mileage Rate
54 cents per mile for business miles driven (down from 57.5 cents for 2015);
19 cents per mile for medical or moving purposes
14 cents per mile driven in service of charitable organizations
Parking (monthly) $255
Mass Transit Passes (monthly) $255

Compensation
Compensation Limit $265,000
Highly Compensated Employee Salary Amount $120,000
Annual Compensation for Key Employee $170,000
Defined Benefit Plan Limit $210,000
Defined Contribution Plan Limit $53,000

Retirement Plans
401(k) $18,000
401(k) Catch-up $6,000
403(b) $18,000
457(b)(2) and 124(c)(1) $18,000
457(b) Catch-up $6,000

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

Cadillac (n.) best of its kind; standard of excellence

What else would you expect big government to call a 40% tax that is expected to hit 25% of employees in 2018 and 42% by 2028? The last major piece of Obamacare will impact consumers, corporations and union members.

The Impact? Middle-class workers could see a reduction in benefits. Companies in areas with high medical costs are more likely to be subjected to the Cadillac tax than those in lower-cost areas. Same for employers with unionized workers. Under scrutiny to be cut from the benefit package are the FSA, HSA and HRA accounts which provide tax-free dollars for out-of-pocket health costs. The law counts those contributions toward the thresholds for triggering the tax.

The Cadillac tax is 40 percent of the value of employer-sponsored plans that exceeds $10,200 for individual coverage and $27,500 for family coverage. The tax is levied on insurers and plan administrators, who are expected to pass it back to employers. The 40 percent rate is well above the income tax rates for most workers. If they don’t know it already, employees will learn, Obamacare came with Obamaco$t.

 

Employee Benefit Advisors provides employee benefits. We are a broker helping companies with their Health & Welfare Benefits. We also help companies revaluate PEO Services, deciding if a PEO is a good choice and if so selecting and implementing the PEO.

1095-C Reporting

This continues our review of the ACA reporting requirements. In our previous blog Employee Benefit Advisors mentioned we decided to do a little review because we’re getting questions from employers about their reporting requirements.

Who files Form 1095-C? Sponsors of both self-insured plans and insured plans must file Form 1095-C.  Payroll providers should have the capability to report the required information.

What does Form 1095-C report? The number of full time employees for each calendar month and lists coverage information for each full time employee.

What will the IRS do with the information reported on Form 1095-C? In 2015 employers with 100 or more (50 or more beginning in 2016) full time employees (including FTEs) must provide affordable coverage that provides MEC or be subject to penalty taxes for employees who receive subsidized coverage.  The information will be used to determine whether a penalty tax is to be assessed.

Are companies with fewer than 50 full time employees required to file Form 1095-C? No, only companies with 50 or more full time employees* are required to file. However only companies with 100 full time employees* are subject to the “play or pay” penalty for 2015. In 2016 companies with more than 50 full time employees* will be subject to the “play or pay” penalty. (*Including FTEs)

What Form 1095-C filing requirements apply to FSAs, HSAs or HRAs? Some employer contributions to an FSA, HSA or HRA can count toward the calculation of minimum value and therefore may affect 1095-C filing.

Note: Our previous blog discussed 1095-B reporting. If a plan sponsor of a self-insured plan is also required to file Form 1095-C, the Form 1095-B and Form 1095-C information can be combined onto one Form 1095-C filing.

 

Employee Benefit Advisors provides employee benefits. We are a broker helping companies with their Health & Welfare Benefits. We also help companies revaluate PEO Services, deciding if a PEO is a good choice and if so selecting and implementing the PEO.

1095-B Reporting

Employee Benefit Advisors decided to do a little review because we’re getting questions from small employers about their reporting requirements.

Who files Form 1095-B? The insurance company is required to file Form 1095-B if your company sponsors an insured plan. If self-insured, the plan sponsor is required to file Form 1095-B.

What information does Form 1095-B report? 1095-B reports the name, address and social security number of all individuals (employees, spouses, dependents and others) who are covered under an employer’s medical plan and the number of months during which the individual had at least one day of coverage.

What will the IRS do with the information reported on Form 1095-B? The IRS will use the information to verify which individuals have MEC through an employer and are therefore not subject to the individual mandate penalty tax.

Are companies with less than 50 full time employees (including FTEs) required to file Form 1095-B? Yes, the filing requirement applies to all employers who provide health coverage to their employees.

Are there 1095-B filing requirements for FSAs, HSAs or HRAs? No because by themselves they do not provide MEC.

What is the date that these forms must be filed? The forms must be filed with the IRS by February 28 (March 31 if reporting electronically) and copies of the forms must be provided to individuals by January 31.

 

Employee Benefit Advisors provides employee benefits. We are a broker helping companies with their Health & Welfare Benefits. We also help companies revaluate PEO Services, deciding if a PEO is a good choice and if so selecting and implementing the PEO.

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