Health & Benefits

Exchanges Explained

An Exchange is a New York State marketplace where small business employers, sole proprietors and individuals may shop for health insurance plans. The Exchange is an addition to your current health insurance options. There are two parts to the Exchange: 1. the Small Business Health Option Program (SHOP) 2. the sole proprietors and individuals program (Individual Exchange) The Exchange is a means of shopping

Large Employer Update

The Treasury Department has confirmed that the 2014 mandate for employers with 50 or more full-time workers has been delayed until 2015. This means that employers will not be subject to Federal penalties for not providing qualified health insurance in 2014. The Affordable Care Act requires that all employers with 50 or more full-time workers provide health insurance

HealthCare Benefits – Contraception

Recently the U.S. Department of Health and Human Services announced a broader opt-out provision for religious non-profits that object to providing health insurance that covers birth control for women. This is an update to the August 2012 mandate that all health insurance plans are required to cover FDA approved and prescribed contraceptive services. There has been significant objection by some due to the contraceptive component.

HealthCare Benefits – Policy Limits

A new day is coming. With the passage of the 2010 health care reform law, new group health plans that contain any “Essential Health Benefit” are prohibited from establishing any lifetime dollar limits on the value of those services. Previously, most policies had limits. So, if you had a serious illness, and you reached that limit, you would no longer be covered under that policy. There are still some grandfathered policies that have limits, but they are gradually being brought into line with the new policy. By the end of 2014, policy limits should be history.

Helping with Open Enrollment

It’s Open Enrollment time again for many companies. Those covered by Small Group plans, are fearful of what this year’s rate changes will bring. Premiums have risen sharply for the past several years. To manage the expense to the organization, increased co-pays and high deductible plans have typically been passed on to your employees. Federal Regulations Bring Change and Clarity
Due to The Patient Protection and Affordable Care Act (PPACA, commonly known as “Obama Care”), employers will see changes not only in price and coverage, but in how these changes are portrayed.

Controlling Health Insurance Costs

Despite the declarations of politicians, statistics show the cost of health insurance continuing to rise dramatically. Newton’s third law of physics, “for every action, there is an equal and opposite reaction,” applies in economics as well as physics. As our government continues to make “free services” available along with reducing payments, the costs are showing up in other areas. Quite simply, insurers are passing along the cost to the person who writes the checks. “Value-Based Purchasing” (kind-of a reverse version of pay-for-performance) and “Reduced Payments for Hospital Readmissions” are the two most

The Need for Healthcare Policies

Our national health care system has been through some tumultuous changes over the past few years, but this year, we have seen some of the impact - and we have been surprised a few times. Earlier this year, we received a call from a few organizations who had fewer than 50 participants in their health care plan. They had just received a letter of non-renewal from their long-standing (very large) health insurance provider. In fact, that insurer had decided to drop all health insurance policies with fewer than 50 participants.

Summary of Benefits and Coverages

A mandated revision to the Summary of Benefits Coverage (SBC) takes place on September 23, 2012. After this date, the SBC will be provided to all participants on the 1st day of their open enrollment and at critical decision-points (i.e. upon application for coverage, by the first day of coverage, if the information has changed, upon renewal, and upon request) without charge. According to the recently enacted legislation, the responsibility

Flexible Spending Account Changes

Beginning January 1, 2013, employees will be limited to $2500 per plan year for contributions to Flexible Spending Accounts. For those employees who are used to higher contributions, this change may facilitate re-evaluation of the sufficiency of the reimbursement level.

Medical Loss Ratio Rebates

The Medical Loss Ratio (MLR) is the percentage of premiums spent by the health plan on reimbursement for clinical services and activities that improve health care quality. This is all about ensuring that companies are spending enough money on preventative health care. For individual and small groups (groups of 1-50, though some states will use 1-100), the MLR is to be 80%, while