Employee Benefits Insurance

• Significant reduction in benefits
• Increase in coinsurance
• Increase in copay
• Increase to deductibles and out-of-pocket limits
• Employer decrease in contribution
• Modification of overall annual limit
• Modifications in fully-insure policy
   

Section 1251 of the Patient Protection and Affordable Care Act (PPACA), preserves the ability of consumers to maintain existing coverage by “grandfathering” existing group health  or individual plans where individuals were enrolled as of March 23, 2010. In addition, it allows: 

• Addition of family members
• Addition of  new employees
• Collective bargaining agreements Maintained until last of agreements terminates. 

When the insurance reforms become applicable to other plans, grandfathered individual and group plans must also meet the following requirements:

•  Issue a standard plan summary with standardized definitions
• Distribute summaries of material modifications 60 days in advance of any material change
• Waiting periods rules
• Restrictions on lifetime
• Annual limits
• Rules on rescission's
• Preexisting conditions
• Coverage for dependent children up to age 26 (2014 when the adult child is not eligible for an employer sponsored plan)

The Departments of Health and Human Services, Labor and Treasury issued the Interim Final Rules for Group Health Plans and Health Insurance Issuers relating to Dependent Coverage of Children to Age 26. This is what you need to know today.

Under the Patient Protection and Affordable Care Act, group health plans that offer dependent coverage for children are required to do so up to the age of 26. Coverage extension applies to plans that begin on or after September 23, 2010. For calendar year plans, the extension must be in place by January 1, 2011.

Along with the change in age, the new law only allows two eligibility requirements:

• Relationship between the participant and child. The definition of ‘child’ is not defined by the regulations. Therefore, plans will continue to define which children will be covered.
• Age of child – mandates coverage until the child attains age 26. 

1. Review current plan to determine compliance.
2. Communicate with vested parties regarding changes and dates.
3. Assess whether plan contribution needs to change (refer to regulations).
4. One-time Special Enrollment Notification – 30 day window.
5. Amend plan documents.
6. Communicate plan changes to participants.

Compliance requirements and guidance from the various government agencies, along with updates from insurance carriers is continuous. Why not consider utilizing the Employee Benefits Management experts of a Small Business PEO to assist. Management 2000 offers PEO Services. Put our Benefits Plan Administration Team to work for you, so you can run a business.

• State-based insurance exchanges open for business.  The exchanges are available to individuals and small businesses with less than 100 full-time employees (seasonal workers are not excluded).
• Annual dollars limits on coverage can not be required as of January 1, 2014.
• Waiting periods are limited to 90 days.
• Preexisting exclusions are prohibited on plans.
• Plans must include 'comprehensive health coverage' that includes the general categories defined in the legislation.
• U.S. citizen and legal residents are required to have health coverage. Those do not enroll in a plan will have to pay a penalty.
• Employers with more than 50 employees that do not offer group coverage and has one employee that received a premium assistance tax credit will be assessed a fee per for every full-time employee.  The first 30 employees are not counted.
• Large employers (more than 200 full-time employees) must automatically enroll full-time employees into a plan.
• In 2018, an excise tax will be applied to insurers of employer-sponsored health plans that have a total value that exceeds $10,200 for individual and $27,500 for family coverages.

• Small businesses tax credits for employers that purchase health insurance based on the number of employees and average annual wages.
• If you provide Medicare Part D subsidy to retirees, it will be eliminated in 2011.  You will need to account for the future loss on liability and income statements.
• Group and individual plans required to cover dependents up to age 26. 
• Group plans that are not grandfathered, will have to cover pre-existing conditions for children under the age of 19. 
• Federal grant program for employers providing wellness programs to their employees. 
• Employers must include health benefits on W2s during taxable years after 12/31/2010.
• Changes to Health Savings (HSA) and Flexible Spending (FSA) Accounts.
• Mandate to enroll employees in a new national public long-term care program, unless employee opts out.

In addition to helping our clients deal with specific employee relations matters, Management 2000 provides a broad range of services related to day-to-day operations. Just a few of these services include:

 
Benefits:

• Multiple programs for medical, dental, vision and supplemental insurance products;
• COBRA and HIPAA administration;
• Comprehensive benefits administration (including open enrollment and employee consultation.

Payroll:

• A variety of pay options (direct deposit, live checks, pay cards);
• Administration of deductions, including garnishments;
• Access to electronic timekeeping devices and Web based on-line payroll.

Human Resources:

• Forms and letters regarding offer letters, disciplinary actions, termination/layoff notices, and probationary warnings;
• Contact vendors to set up local accounts for pre-employment and post-injury drug screenings;
• Resource library for management and supervisory training, employee development and workplace compliance training.

For more information about Management 2000’s services, call (317) 549-2000.

• We will shop for the best available health plan, dental plan and vision plan
• We offer a 401k plan
• We offer flex spending for health and dependent care
• We offer a full line of supplemental products (AFLAC, long term and short term disability, life insurance, pre-paid legal and identity theft protection).
• We will handle all of your employee benefits administration.

For most of the past century, life insurance was a product that was marketed by agents who went door to door.  They reviewed folks needs across the kitchen table and often came by each month to collect the premiums.  Well, thanks to the internet, price of shoe leather and what not, this practice has pretty much gone the wayside.  Now, most people get life insurance through their work.  Many employees make the mistake of believing that the $10-$50k worth of life insurance provided under a medical plan is adequate.  Larger employers often offer higher options that can be purchased to protect their employees and their families.  Smaller firms barely have the resources to offer a health plan much less worry about life insurance optoins.  Enter the PEO and their Employee Benefits Management Team.  These folks can enable small employers to offer similar programs as their larger competitors.  Not only does this give better options to the employee, it helps the small guy retain valuable employees with stelllar benefits.  Life insurance is an important, often overlooked need that your PEO benefits department will help fill for you and your employees.