COBRA Refresher: 4 Important Notices That You Need to Know About

COBRAAccording to the Consolidated Omnibus Budget and Reconciliation Act (COBRA), employers who offer a group health plan for more than 20 employees must offer temporary continuous coverage to qualifying beneficiaries after qualifying events.

A qualified beneficiary generally is an individual covered by a group health plan on the day before a qualifying event who is either an employee, the employee’s spouse, or an employee’s dependent child.

A qualifying event is a circumstance that would cause the qualified beneficiary to lose their group plan. The type of event determines the length of coverage offered, but continuous plans range between 18 and 36 months. Here are some examples of qualifying events:

  • The death of a covered employee
  • A covered employee’s termination or reduction of hours
  • The covered employee’s new entitlement to Medicare
  • Divorce or legal separation from a covered employee
  • A dependent child ceasing to be a dependent under the plan’s requirements

Employees must be offered health care, dental, vision, medical spending accounts, hearing, prescription, substance abuse, and mental health plans, but only if you offered those services under your group plan.

Generally, the qualified beneficiary pays the entire cost of the continuous coverage plus two percent to account for your administrative costs. Employees who take COBRA coverage for a disability can be charged 150% of their premiums for coverage after month 18.

Per regulations, employers are required to provide certain COBRA notices with specific information and timeframes, depending on the circumstances.  Failure to comply with these regulations can result in fines of $100 to $400 per day per qualifying beneficiary.

4 Notices Required by COBRA

General Notice

This document describes employees’ COBRA rights and the employer’s responsibilities. It must be given to each covered employee and each employee’s spouse within the first 90 days of coverage. It needs to have the following information:

  • Name of plan and contact information of the plan’s COBRA administrator.
  • A description of the coverage provided by the plan.
  • Instructions for beneficiaries to notify the administrator of qualifying events or disabilities.
  • An explanation of the importance of notifying the administrator about address changes.
  • A statement that the notice does not fully describe COBRA or the plan, and that more information is available through the plan’s administrator.

Click here to see a sample General Notice.

Election Notice

This document explains the employee’s rights to continuation coverage and how to elect it. The administrator must send an election notice to each beneficiary who loses their coverage due to a qualifying event within 14 days.

  • Name of plan and contact information of the plan’s COBRA administrator.
  • Identification of the qualifying event and qualified beneficiaries.
  • An explanation of the beneficiaries’ right to elect continuation coverage.
  • The date coverage will terminate if continuation coverage is not elected.
  • The process to officially elect the coverage.
  • Outcomes if coverage is waived or not elected.
  • How coverage might terminate early.
  • Premium information, including amounts, grace periods, and schedules.
  • The type and scope of coverage available and how it can be extended for disability or other qualifying events.
  • An explanation of the importance of notifying the administrator about address changes.
  • A statement that the notice does not fully describe COBRA or the plan, and that more information is available through the plan’s administrator.

Click here to see a sample Election Notice.

Unavailability of Continuation of Coverage Notice

Should an individual request continuous coverage, but the plan administrator determines that the individual is not entitled to coverage, the administrator must send a notice of unavailability. This simple document must be provided within 14 days of the original request and explain the reason for denial.

Click here to see a sample Unavailability of Continuation of Coverage Notice.

Termination of Coverage Notice

If an individual’s coverage is terminated early, the employer must provide a termination notice. This notice must include the following information:

  • The date coverage will terminate.
  • The reason coverage is being terminated.
  • Any rights the qualified beneficiary has under the plan (or the law) to elect alternative coverage, such as the right to convert the plan to a private policy.

There is no timeframe to provide this notice, but regulations say it should be delivered as soon as the decision to terminate coverage is made.

Click here to see a sample Termination of Coverage Notice.

Providing proper COBRA documentation with the right content is an important part of staying compliant with the legislation, but you also need to document the method, timing, and last address of your deliveries. This is for your protection in case you are required to provide evidence that you upheld your obligations.

For more information about disclosure rules (such as the allowed methods for delivery and specific timing requirements), see CFR 2520.104b-1(B). For a detailed breakdown of your obligations and FAQ’s, visit the Department of Labor’s website.

Navigating the rules and requirements of COBRA can be confusing and overwhelming. If you have questions or concerns, Sinclair Risk is here to help – Give us a call!

Shannon Hudspeth
Human Resource Director
shudspeth@srfm.com

Shannon Hudspeth

How to Get Your Truck Drivers to Actually Use Your Wellness Program

wellnessTruck drivers have unique health concerns. An NIOSH survey found that 50% are smokers and 70% are obese. They’re prone to heart disease, diabetes, high blood pressure, kidney failure, back problems, and motor vehicle accidents related to fatigue and stress. These problems can lead to a loss of their Medical Examiner’s Certificate and their CDLs.

You want your staff to be healthy, comfortable, satisfied with their jobs, and working regularly, so you’ve implemented a company wellness program. The problem is… Your drivers aren’t using it.

That’s not unusual. 60% of employees don’t use wellness programs because they aren’t aware of it or the company culture doesn’t truly support the program. (Most drivers who use wellness programs are women.)

So how do you get your fleet of drivers to take advantage of your wellness program?

Step 1: Gather input from your drivers

Wellness programs with the best performance and highest adoption rates are ones that meet your employee’s needs. If none of your drivers smoke, a quit-smoking incentive won’t be very effective.

Talk to your drivers and ask what type of program would make their lives better. It could be challenging to query your entire crew if you don’t see them often, but it’s worth the effort.

Step 2: Reward drivers for healthy behavior

A proper wellness program addresses a few key areas of people’s health:

  • Diet – Your program should not only instruct your drivers how to choose healthy foods, but help them acquire those foods when they are on the road. It’s not easy to eat well when your options are limited.
  • Stress – Deadlines and traffic cause stress, which can affect the body. Educate your drivers on methods to relax, such as meditation and exercise.
  • Exercise – Build your drivers’ schedules so that they have time to get some simple exercise.
  • Avoiding bad behaviors – Risky behaviors like drug use and smoking have terrible effects on our health and ability to work. 54% of truckers are smokers, so this is an important area to address.
  • Hygiene – On the road, there aren’t many places to stop for proper body care. Coordinate your drivers’ routes so they have chances to stop at facilities with the right amenities.
  • Sleep – Chronic sleep deprivation affects your drivers’ ability to work, as well as their safety. Your wellness program should reward drivers for taking adequate sleep stops.

Many programs educate their staff about these health concerns, but they fail to go far enough. You need to actively incentive your employees to take part. Award bonuses for achieving health goals like losing weight or visiting the doctor.

If your drivers have any unique needs that learned from step one, make sure to include them in your program as well.

Step 3: Get executives and managers to participate in the program

Instead of paying lip-service to the program, managers and leaders within the organization should participate as well. If your wellness program encouraged weight loss, follow the plans advice to take off a few pounds yourself so your employees can see the benefits of the program and that you’ve implemented practical solutions.

Step 4: Create a communication strategy

Your drivers can’t make use of your program if they don’t know about it, but traditional methods of communication can be tough for on-the-road people you rarely see.

Make use of text messaging and radio messaging (via CB radios, not FM/AM channels). Create a company Facebook page or group. Stuff messaging into their check envelopes. If you have access to their vehicles, leave information on the seat so they can’t miss it.

Furthermore, enlist “cheerleaders” who actively encourages other employees to sign up for your wellness plan. Choose cheerleaders who work in various departments and levels in your company. They should approach other employees like them in terms of position and pay scale, so that everyone is recruited by a peer (people feel more comfortable with the program when they enroll with others like them). You might need to incentive these persons with commissions.

Finally, never give up

Don’t expect to achieve your program adoption number in the first week. Your employees need time to become aware of the program and commit to using it. Be positive, sell the benefits, and always be available for wellness counseling and enrollment.

Jill Goulet
Risk Management Consultant
jgoulet@srfm.com

Jill Goulet

Is Your Healthcare Plan Covering People It Shouldn’t?

healthcare eligibilityIf you provide an employer healthcare plan, it’s vital to ensure only the correct people are covered. Comprehensive healthcare insurance is one of the most important benefits you provide to employees, so keeping premiums down matters to everyone.

One of the main causes of rising premiums and healthcare costs is when ineligible people continue to be covered on a healthcare plan. For employer-provided health insurance, ineligible people are typically:

  • Former employees who have now left your business.
  • Employees whose status has changed, meaning they are no longer eligible under the plan, or should be on a different plan.
  • Dependents of an employee, where the status of the dependent has changed.

Examples of ineligible people for a healthcare plan

The following situations could all cause people to become ineligible.

  • A dependent child who ages beyond the dependent eligibility requirements in the plan.
  • A former spouse who separated from your employee.
  • An employee who leaves your business.
  • An employee whose status has changed, for example through changing the number of hours worked or moving to a different position, and whose new status requires a different healthcare plan.

Creating a healthcare eligibility audit

You need a process to understand and remove people from your employer-provided healthcare plan. Here’s how to put an “Employee and dependent healthcare eligibility audit” together.

Understand the eligibility requirements of your current employer-provided healthcare plans

Go through any existing employer-provided plans and note down:

  • All employees currently covered by the plan.
  • All dependents currently covered by the plan.
  • Eligibility requirements for employees.
  • Eligibility requirements for employee dependents.
  • Benefits and coverage provided.

You may hold this information internally, or you can get the data from your broker or healthcare insurance provider.

Analyze your existing employee data

Match your existing employee data against the healthcare plan eligibility requirements. Check:

  • Any employee listed as being on the plan is still employed by you.
  • Any dependent listed on the plan is still a dependent on the employee.
  • The type of healthcare plan is appropriate for the status of the employee.
  • All eligibility requirements are being met by any active plan participants.

Find gaps in the data

It’s likely that you will find gaps in the information. You may not have the latest details of dependents or employees. Complete a gap analysis to understand the data you need to ensure only appropriate people are covered by the plan.

Carry out a healthcare eligibility audit to close any gaps

Once you know what data you need, you will need to audit the information with your employees. Approach each employee with the details of their health insurance for them and their dependents and ask if all the information is factual and correct. If it is, get them to sign off on the information.

If the data is incorrect, get it updated and see how it affects healthcare eligibility. Communicate this back to the employee.

Careful communication is key

You will need to communicate carefully throughout this process. Employees may see the eligibility audit as a tool for taking away healthcare coverage. It’s important to manage the message carefully — The audit ensures only appropriate, eligible people are covered. That means less cost-leakage and medical expenses on plans, which keeps premiums down and ensures the right people have the right coverage.

You may want to complete the healthcare eligibility audit every year. This will ensure your records are up to date and reduce the premiums you and your employees need to spend.

Jill Goulet
Risk Management Consultant
jgoulet@srfm.com

healthcare eligibility

Building Healthy Habits — Beat Holiday Indulgences and Feel Fantastic

healthy habitsEating and drinking is one of the great pleasures in life, and the holiday season is the perfect time to indulge. Celebrating with family and friends makes it easy to just have one more serving, an extra slice of cake, or another glass of wine. Of course, that can mean putting on a few more pounds than you’d like, so what’s the best way to shift that holiday weight?

Rather than starting up a new diet or exercise regime, it’s all about making small, positive lifestyle changes and building good habits — Here’s how to do exactly that.

Understand what you want to change most to get healthier

You can only change your lifestyle if you’ve got a good reason. Think about what your goals are when it comes to getting healthier — Is it losing weight, lifting a certain amount, walking up a steep hill without being out of breath, or something else?

Your goals should be short-term and easy to reach — If you want to lose weight it’s much better to aim at losing a couple of pounds a month than 25 pounds this year. So, choose one goal, write it down, and commit to it.

Focus on making one small change to your health at a time

If you try to do too much too soon, you’ll lose focus, get distracted, and it won’t last. That’s why getting healthier is all about making small, incremental changes that together add up to you feeling fantastic. Look at your goal and think about the one small thing you could do today to get towards it. For example:

  • Reduce your mid-afternoon snacks.
  • Drink one less beer during an evening out with friends.
  • Walk for 15 minutes each day.
  • Have one “meat free” day a week.

Then, make the change and stick to it.

Take pleasure in what you’re doing to create a healthier lifestyle

It’s important to feel positively about the changes you’re making, rather than seeing them as denying yourself. Be “in the moment” and conscious of how and why you’re making your choices. If you’re taking a walk each day, spend the time really enjoying and noticing your surroundings. If you’re reducing how much you drink, replace the beer or wine with a delicious fruit smoothie. Think about ways to positively reinforce what you’re doing.

When it comes to getting healthier, don’t do too much, too quickly

As you make changes, wait for them to become a habit and “stick” before you move onto something else. Ideally, you want your positive lifestyle changes to become effortless and part of who you are. That way, it will never feel like a chore.

Really feel the benefits of a healthier lifestyle

Positive reinforcement is vitally important. That’s why you want to notice the changes you’re making and the benefits they’re having. Appreciate the fact you don’t run out of breath when you’re hiking up a hill, or that you look great in the new clothes you’ve been able to buy. Reward yourself for creating healthy changes in your life.

It’s amazing how much you can do for your health if you set realistic goals, turn small changes into habits, feel the benefits, and take pleasure in what you’re doing. Of course, you can still have “cheat days” and overindulge from time to time. Now you’ll have the confidence you’re completely in charge of your lifestyle and the healthy choices you’ve made.

Heather Sinclair
Risk Management Consultant
hsinclair@srfm.com

Healthly Habits

Health Insurance and Large Groups — Understand How Your Premiums Are Calculated

?????????????????????????????????As an employer, one of the most valuable benefits you can offer to your employees is health insurance. For larger groups of 51 employees or more, you’ll likely have group health insurance coverage. This is a policy you’ll typically purchase from a broker (so you get the best deal) that you can then offer to all of your eligible employees. Around 98% of large employers (businesses with more than 200 employees) provide health coverage to some or all of their people.

These types of health insurance policies are great for your employees

Large group policies have several advantages over small group or individual health insurance plans:

  • The employer typically pays half or more of an employee’s premiums.
  • Premium only plans (POP) mean employees can pay premiums out of their pre-tax incomes.
  • This results in significantly subsidized premiums, meaning happier employees.
  • You get a healthier, better motivated workforce.

The health insurance cost is calculated slightly differently for large groups

The cost of large group policies is typically worked out when the employer decides to purchase, rather than being a fixed rate. The premiums, coverage, deductibles, and benefits are normally based on several factors:

  • The number of employees participating.
  • The type of coverage needed.
  • The amount of payments, deductibles, and benefits desired.
  • An employer’s prior claims history.

Individual employees don’t normally have to fill out health questionnaires, although employers may need to answer general questions on the health of their employees.

Other factors that can impact your health insurance premiums for large groups

Some insurers will also take the following into account:

  • The average age of the workforce.
  • Large claims that have been made by the employer previously.
  • The employer’s location — New York City is going to be more expensive than rural Wisconsin.
  • The gender makeup of the workforce.
  • The sector an employer works in — Premiums for constructions workers are going to be higher than for a retail shoe store.

All of these factors will feed into the calculations, coverage, benefits, and premiums.

Differences in health insurance premiums between small and large groups

If we look at a typical health insurance plan for a family, an employee will generally contribute:

  • In small groups — Around 35% of the premium.
  • In large groups — Around 25% of the premium.

There’s less of a burden on employees in large group health insurance plans.

If you’re a large employer, you must offer health insurance

The Affordable Care Act requires that employers of more than 50 people must offer affordable health plans to their ‘Full Time Equivalent” employees. The penalties for not providing this type of cover are:

  • Mandate Penalty — This comes into effect if an employer does not offer group health coverage. It’s calculated at $2,000 per employee, after the first 30 employees.
  • Qualification Penalty — This applies if an employer does not offer a “qualifying plan.” Qualifying plans must offer a certain minimum standard of coverage, and must be affordable to employees. The penalty is $3,000 per employee that does not get qualifying coverage and purchases a policy through the health insurance Marketplace.

The best way to make sure you get an affordable policy, and your employees get the coverage they need, is to use a specialist health insurance broker. They can help you navigate the complicated areas of health insurance and make sure you get the support you need to make the right choice.

Jill Goulet
Risk Management Consultant
jgoulet@srfm.com

Sinclair 7-22-15-14

Keeping Up With the Evolving Workplace

???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????With the age of Millennials gaining a stronghold in the workforce comes the dawn of the modern workplace. Times are changing surrounding how we hire and train, what we do to retain employees, and the dynamics within the office environment itself. Employees are seeing companies through different lenses these days, and employers have to rethink their employee strategies in order to attract and retain the best new talent.

Change is good, and if you want to keep up it’s time to let go of the past, embrace the present, and see into the future. The business landscape is evolving, and we’re going to discuss some things you can do to make sure you’re positioned to grow with it.

The Office in 2016

Increased technology, a path for growth, and a fresh view from management of workplace dynamics are what employees are expecting in today’s modern office. Millennials are vetting employers more deeply than ever and making choices on where they want to work based on culture, values, perks, and growth opportunities. Millennials want more than just a paycheck, and to attract the best up and coming talent, employers have to offer more. Let’s talk about what that means.

Keeping Up With The Times

One of the top criteria that Millennials use for deciding whether or not to sign on with a company is the quality of the management. Quality of management comes in many forms and is relevant on multiple levels. Here’s what I mean:

Technology: Does it seem like technology developments are moving faster and faster with each passing year? It seems that way, because it is that way. A company that doesn’t embrace and leverage new technology sends a message to employees (and potential employees) that you’re ok remaining stagnant and not so interested in embracing growth and change. This is a red flag for discerning Millennials who are ever-so-searching for upward growth.

Flexibility: As the workplace changes, so do our workdays. The traditional 9 to 5 is a thing of the past in many business settings, and employers are embracing more unconventional methods like implementing 4 day work weeks and allowing more telecommuting. This tells prospective employees that management takes a smart approach to cutting costs and streamlining operations which also allows for a more balanced work-life dynamic for the employee. It’s a winner with Millennial for sure.

Wellness: Employees expect more from the workplace in terms of personal development. They ask the question: If I spend 8 to 10 to 12 hours a day at my job, what am I getting out of it besides a sense of achievement and a paycheck? Wellness programs are an essential part of any companies’ employee strategy. An investment in the health and wellbeing of employees not only improves the quality of life for workers, it’s proven to increase productivity and it lowers insurance rates for the business.

What can a company do to keep up with the times?

Don’t be Fred Flintstone: Nothing is more frustrating for employees than outdated technology that slows down their day. Provide the right tools for your people and it goes a long way in improving their happiness and increasing their productivity. Assess and upgrade equipment as needed like; Phones, Computers, and Printers and if they say “Made in Bedrock” on the bottom, get an upgrade.

Limber Up: Consider some alternatives to the 8 hour workday if they make sense for your business model. Will a four day week work fly? Can some of your people telecommute part of the time? If the answer is yes, test out some of these options, they could save you money and increase productivity.

Take Care of Your People: If you don’t have a dedicated Wellness Program, get one started. A comprehensive wellness program is an attractive benefit for prospective employees and it will pay you back in spades, by way of:

  • Lowered health care costs.
  • Reduced absenteeism.
  • Higher employee productivity.
  • Reduced workers’ compensation and disability-related costs.
  • Reduced occurrences of injuries.
  • Improved employee morale and loyalty.

Step up Your Game: If you have a wellness program in place, great, you’re on the right track. Consistent growth and improvement of your wellness offerings tells employees that they mean something to the company and are worth the investment. Think about expanding your program and even throwing in some lifestyle benefits in the office like; Yoga classes, fitness areas, and even allowing pets in the office.

Millennials love to see that a company is invested in their personal and professional growth; I think we all like to see that. So, especially in this age of the evolving workplace it’s important for employers to stay up with the times, embrace the changes, and provide a culture that’s attractive to up and coming talent.

At Sinclair we’re dedicated to Employee Wellness. We look at an organization from every angle and we will customize a wellness program focused on developing a healthier and happier workforce in your business. Get in touch with us today to see what we can do for you.

Matt Bauer
President
mbauer@srfm.com

11 Smart Financial Moves You Have to Make

Millennials and Healthcare — What Are They Looking For?

MillenialsAs the fastest-growing generational group, millennials (people born between the mid-1980s and the turn of the century) are a vital part of a strong workforce. If you want to attract millennials to your business, it’s important to understand what they need and more importantly, what they want.

In addition to a good salary and a positive work environment, the benefit millennials are most interested in is healthcare. In fact, since the Affordable Care Act came into force, the number of uninsured millennials has fallen from 23% to just 11%. Insured millennials are better for your business too — Insured millennials are more likely to report being in good or excellent health (79%) than uninsured millennials (62%).

With health insurance being front and center, and increasing options for employment, how do you attract and retain the best young talent? An important part is providing the right health benefits. Let’s explore a few options.

The health services millennials are most interested in

It’s important to provide health insurance plans to cover the main concerns millennials have about their health, this includes:

  • Accident and emergency coverage — Catastrophe can strike at any time. Millennials are less concerned with insurance against long-term, chronic illnesses than they are against accidents and other critical emergencies. A health plan that has good coverage for emergency room visits and treating acute conditions fits in well with their needs.
  • Doctor visits — Reasonable copay amounts for doctor and specialist visits rank highly with millennials.
  • Immunizations and wellness — Staying healthy is near the top of the millennial’s agenda. This includes vaccination for flu and human papillomavirus vaccine (HPV). wellness programs also play a part in helping to keep people healthy and reduce stress.
  • Alcohol and depression screening and counselling — Depression, anxiety and other mental illness affects a disproportionate number of young people. Access to therapy, treatment, and counsellors is critically important.
  • Sexual and reproductive health — Contraception, birth control, and sexual health are vital to millennials. Pregnancy, birth, breastfeeding support, and infant care are also high on the agenda for millennials wanting to start families.

 Keeping health premium costs down for millennials

Another important consideration is the cost of premiums, and the trend here is clear — Millennials much prefer low-premium, high-deductible health plans. For many millennials, cost is the most important factor when it comes to health insurance. In fact, two thirds of them said a premium of more than $200 a month is unaffordable. Clearly, with a premium that low, high-deductible plans are really the only choice.

Another option is to give millennials various options in terms of their overall benefits package — Perhaps they can trade off some vacation days for a lower insurance premium?

Addressing other health concerns

It’s not just premiums and coverage that are important to millennials. Many are concerned that being ill or injured for an extended period of time would mean they would get fired. Make sure you have clear employment policies in place that address these concerns — What are implications for someone’s employment if they are unable to work for the medium or long-term?

Another benefit you can offer is making it easier for millennials to transfer off of their family health plan. Children can stay on their parent’s plan until they’re 26 years old, so providing a convenient and easy way to switch will definitely help.

Make it clear that the Affordable Care Act requires everyone to be insured by law. Being uninsured just isn’t an option unless they want to pay yearly fines when they report their taxes. Clearly explain the benefits of health insurance and make it easy for people to start paying their premiums and enjoying their coverage.

Jill Goulet
Risk Management Consultant
jgoulet@srfm.com

Sinclair 7-22-15-14

Making Healthcare Hit Home — How to Explain Group Benefits to Your Employees

group benefitsGroup Benefits are both the most important and the most valued benefit provided by employers. American workers regularly cite healthcare as one of the main factors affecting their employment decisions – good or bad. A good group plan provides your people with peace of mind and helps them be happier and more confident in life and work.  In the end, it’s a game changer on many levels when it comes to employee retention and satisfaction.

It’s a shame then that so many people find health plans confusing — whether it’s benefits, coverage, deductibles, premiums, or copays, the bewildering number of choices makes it difficult for employees to make the right decision. Let’s face it – insurance is complicated.

Why is choosing health insurance difficult for employees?

There are many reasons for this including:

  • The sheer number of plans available.
  • The difference in benefits and coverage between plans.
  • Not understanding how premiums and out-of-pocket costs will affect finances.
  • Differences between in-network and out-of-network providers.
  • And many more areas…

 How to make the decision easier

There are several things you can do to make things easier for your team, they include:

Get your employees involved in choosing and educating about group benefits:

Get your managers and team leaders involved so they have a good understanding of all group benefit options and are comfortable discussing it with their direct reports. A great idea would be to create a Benefits Team within your organization. Here’s how: take one employee from each department and create a team. Involve them in the process of decision making when it comes to all areas of group benefit insurance. This way, if a change in benefits is necessary, employees are armed with the reasons why. They can educate others on their team and throughout the company. This helps ward off any negative discussions around changes that are going to happen with your company’s group benefit structure, whether it’s dental, medical, short term disability (STD), long term disability (LTD), etc. Ensure that group benefit insurance is presented both team or company meetings and via one-on-ones if needed.

 Provide a more limited number of health insurance plans

Research shows the more choice consumers are given, the more difficult it is to make the right choice. Think about providing five or six plans as “core” choices, but give employees the option to choose other types of plan if they need them.

Centralize all health insurance information in one place

Link to or create a good comparison of healthcare plans, that show benefits, co-pays, premiums, coverage, and other key elements side-by-side, so people can contrast and compare. Provide supporting material, examples, and context that discusses what the plans cover and how they would work in real life. Your health insurance provider or broker can help with this.

 Get your insurance broker to talk to your team

Your health insurance broker is an expert. Invite them to talk to your employees about the importance of making the right decision. Have them clearly explain the various options open to them and let your employees ask questions and share concerns.

Keep health insurance simple

Explain health coverage in simple terms. Have a person available – ideally your broker, who can answer questions from your team on the options open to them. Provide follow up information people can download and use to understand their coverage.

If you’re changing carriers, explain the reasons why

Sometimes you might need to change your insurance carrier. If you need to do this, provide very clear, simple explanations of how benefits and coverage are changing. Let people know exactly what benefits are being removed, what’s being gained, and any changes to existing benefits. If necessary, provide the reasoning behind changing insurers.

Above all, remember that health insurance is confusing to most people. Be completely transparent, provide simple, useful information, answer questions and ensure employees understand their responsibilities. Rely on your broker to help with the hard tasks – that’s what they are there for!

Jill Goulet
Risk Management Consultant
jgoulet@srfm.com

Sinclair 7-22-15-14

Why medium-sized groups should steer clear of the Obamacare marketplace

affordable care actWhile the Affordable Care Act has helped over 20 million people get health insurance, it’s not always the best choice. Although it’s been a tremendous asset to millions of self-employed, part-time employees, and others who weren’t covered before, it’s not always right for employers. If you’re a medium-sized (or larger) employer or administering a medium-sized or bigger group, Obamacare isn’t for you. Here’s why.

An inconsistent approach to health plans

There are dozens of plans available on the ACA marketplace. Although this choice is a great thing for individuals, when it comes to understanding and implementing this across your business, it’s going to be an administrative nightmare.

There’s a huge variance in the types of plans, benefits, premiums, copays and deductibles offered by all the different plans and insurers. Combine this with confusion over networks and coverage, and your HR department will spend much of their time just trying to understand the myriad differences.

If you can offer your employees a simple and defined set of health insurance plans, it’s much easier for them to get the right information and understand all of the various benefits and payments they need to make for health insurance coverage. This means less confused, happier employees.

Obamacare may not offer the most cost effective plans

Premiums for ACA marketplace plans have been increasing year on year, and subsidies vary depending on an employee’s income. This combination of variable premiums and subsidies means an employee may not necessarily be getting the best deal through the open marketplace.

A dedicated health insurance broker can negotiate prices on health insurance plans on your behalf, and pass the cost savings onto you and your employees. If you’re employing more than a few employees, you can get good discounts for “economies of scale.”

You’ll lose your free health insurance broker

Don’t underestimate the value a good health insurance broker can provide. As experts in health insurance they can:

  • Provide helpful information to you and your employees.
  • Answer any questions about health insurance, premiums, and coverage.
  • Work closely with your HR department to give employees the information they need.
  • Negotiate better prices with insurers on your behalf.

Increased worry and confusion among your employees

No one wants to spend too long worrying about their health plan. Most people just want to know they’re properly covered, that their premiums are reasonable, and that their health will be taken care of. When you offer a clear and defined set of health insurance plans, that makes things easier for everyone. The combination of a single point of contact in HR, proper information about health insurance, and support from a broker, gives your employees the confidence they need.

As you can see, the combination of a simple and consistent approach to health insurance is better for you and your people. When you combine that with better pricing, expert support, less administration, and more confident employees, it just makes sense to talk to your health insurance broker. They’ll help you decide which plans are best for your people, and give you the service and expertise you and they need to make an informed choice.

Jill Goulet
Risk Management Consultant
jgoulet@srfm.com

Sinclair 7-22-15-14

 

Changes from the Affordable Care Act in 2017 — What you need to know

Doctor Tablet Computer Affordable Care ActThe Affordable Care Act is making some changes in 2017 and if you’re providing health insurance via a group plan you need to make sure you’re compliant. Here’s a quick guide to the main changes and what you need to do to ensure you meet all the new guidelines and regulations.

Remember, we’re here to help, so if you have any questions about any of this, please do get in touch. The main changes include:

  • Grandfathered plans — Check your plan is still grandfathered.
  • Deductibles amounts — Changing deductibles for EHB and HSA plans.
  • Employee contributions — Changes to FSB contribution limits from employees.
  • Group plan information — Changes to how information on group benefits and coverage is provided to employees.
  • Reinsurance — No reinsurance fees for self-funded plans in 2017.
  • Large employers — Must offer health plans if you have more than 50 full-time employees.

Grandfathered plans — Check grandfathered status for 2017

You likely have a “grandfathered plan” if the plan was already in existence when the ACA came into effect in March 2010 and it hasn’t had significant changes since then. Grandfathered plans can retain their old benefits, premiums, and other features and fees so long as they don’t have prohibited changes made.

  • If your plan has been grandfathered, check that there aren’t any changes being made that will make it lose the grandfathered status in 2017.
  • If it does lose grandfathered status, you’ll need to ensure it meets all of the regulations and guidelines that the ACA requires.

Essential Health Benefits (EHB) and Health Savings Accounts (HSA)  High Deductibles plans — Amounts changing in 2017

Under the ACA, the Out of Pocket maximum fee for EHBs can’t exceed $7,150 for self-only coverage and $14,300 for family coverage in 2017.

  • Check your plan’s out of pocket maximums to make sure it complies with these guidelines.
  • If you have a Health Savings Account (HSA) plan with high deductibles, make sure those deductibles are below the ACAs allowed limits. In 2017 that’s $6,550 for self-only and $13,100 for families.

Health Flexible Spending Account (FSA) contributions changing in 2017

The amount an employee can contribute, pre-tax, to a health spending account was $2,550 in 2016 and may be increased in 2017. Note that this amount does not apply to employer contributions or to contributions to other benefits such as dependent care assistance.

  • Check to see what the new FSA limit is in 2017, it’s normally announced at the end of the year.
  • If you aren’t able to get that information, use the 2016 limit of $2,550.

Summary of benefits and coverage (SBC) information needs to be updated

The ACA has strict guidelines on how information on benefits and coverage is provided to plan members. In 2017, these guidelines are changing, and a new template will be introduced for SBC information.

  • Use the new SBC template for open-enrollment plans or plans starting on or after April 1 2017.

Reinsurance fees in 2017 — Applies if you are a self-funded plan

From 2014 through 2016, self-funded plans needed to pay fees to a transitional reinsurance program. Starting in 2017, reinsurance fees no longer apply, although your 2016 fees will be due in 2017.

  • Submit the 2016 reinsurance form and make the appropriate payments for the 2016 benefit year.

Applicable Large Employers (ALE) will be subject to penalties if they do not provide appropriate insurance coverage to full-time employees

ALEs must offer affordable health coverage to their full-time employees. They will be penalized if any full-time employee receives a subsidy for health coverage through an Exchange.

  • Calculate the number of Full Time Equivalent (FTE) employees — These are individuals working, on average, more than 30 hours a week or 130 hours a month. If you have more than 50, you are likely an ALE.
  • Ensure that you have proper health care coverage in place for your full time employees in 2017.
  • Report the coverage to your employees and the IRS.

If you’ve got any questions about how this affects you, we’re only a phone call away. We’ve got the experience and expertise to talk you through any changes you need to make.

Jill Goulet
Risk Management Consultant
jgoulet@srfm.com

Sinclair 7-22-15-14