Posts Tagged ‘group health’

Many Important Health Care Reform Changes for Young Adults

Thursday, June 17th, 2010

While many young adults faced losing coverage as they aged off their parent’s plan, had no coverage in the case of an unexpected pregnancy, or merely had the bare necessities covered by their school plans, all can breathe a sigh of relief as health care reform promises to end their fears.

As mentioned in earlier posts, the most immediate change is coverage will be extended to overage dependents, as long as they are not offered other employer sponsored coverage, up through their 26th birthday. This helps ease the burden of uninsured claims, as many of these adult children would wait over two years before attempting to obtain their own coverage.

Another helpful option for these previously uninsured individuals is the fact that more than half of them will be eligible for either Medicaid in 2014, as their income is expected to be less than 133% or qualify for government subsidies if they decide to purchase private insurance through an exchange if they are earning 400% of the poverty level.

More relief serves in the fact that maternity coverage will be a mandatory inclusion on the plans, something that is either excluded completely or greatly restricted, depending on what state you reside in. This is most important during young adulthood, as is the need for access to contraceptives, which will also be covered.

The fact that lifetime maximums will be eliminated also sheds light on the current state of most university based plans. Many tend to cover only the most basic of health needs, and offer only limited protection for conditions that are considered eligible medical expenses. With the implementation of comprehensive coverage for all adult children, in spite of of any pre-existing conditions, we can breathe easy that coverage is in place should they need it. Regardless of how you feel about health care reform, we can all agree that all youths of our nation deserve health care coverage!

Health Care Reform – where it is headed?

Monday, May 17th, 2010

We are now well into the first year following the passing of the health care reform bill. However, we still are not completely sure of what the changes are going to be, and how it will affect all of us. While some portions of the bill are clear cut, such as extending coverage to overage dependents, many of the larger concepts remain to be fully explained. How are small and large businesses going to be able to afford coverage for their employees? How will the tax breaks help or hurt? How can coverage for all Americans remain affordable?

We have yet to see where this will take us, but we are going to do our best to keep up with each passing moment in the world of health care reform, and pass on the information to you. It will be a lengthy learning process, but we are jumping in headfirst to the plethora of information out there. It is our ultimate goal to get the answers you need!

Is There a Answer for COBRA Subsidies?

Monday, January 18th, 2010
Worries grow as those Californians who have been receiving assistance with their COBRA premiums are faced with losing financial assistance. As federal stimulus money dwindles, the 65% of premium formerly covered by this subsidy will expire, leaving many to make a tough choice – pay the premiums or go without coverage. COBRA (the Consolidated Omnibus Budget Reconciliation Act) was passed in 1985, allowing involuntarily terminated employees to keep their current health plan, and take over the payments for their monthly premiums. However, after many years and skyrocketing health care inflation, many people are finding that their COBRA premiums are exceeding their unemployment benefits.
 
If reports are correct in showing that 40% of newly employed people applied for the COBRA subsidy, these numbers can mean that the number of uninsured people will rise along with the lack of federal support. There are some plans in the works, however, which may bring some much needed relief:
 
HR 3930 would extend the period of eligibility through June 2010, increase the maximum duration of the subsidy to 15 months and end all subsidies at the end of December 2010.
 
S 2730 by includes the same provisions as the House bill and would also increase the federal subsidy from 65% of the premium to 75%, as well as expand eligibility to include employed people who lose health coverage because of involuntary reduction of hours.
 
COBRA Subsidy Laws are changing all the time. We will try and bring you the most updated information as we can. In the meantime, there are many websites to help you keep up with the changes. We are also happy to answer any questions you have!

Enhanced Dental and Vision Benefits for Diabetics with Anthem Blue Cross

Monday, January 11th, 2010

 Diabetic clients will be finding more comprehensive dental and vision benefits with Anthem Blue Cross starting 1/1/2010. These integrated benefits will help such individuals obtain the care they need to manage their conditions, and prevent diabetes related complications.

 Diabetic Retinopathy can be a common occurrence, but is almost 90% preventable with proper vision care. Therefore, members who have the Blue View Vision plan and the 360 degree health program will be enrolled in the ConditionCare for Diabetes program. This program will help clients take a proactive role in managing their condition should a diabetic-related vision diagnosis occur.
 
Dental benefits will also be extended for diabetic clients, adding one additional dental cleaning or periodontal maintenance procedure every year. High blood glucose levels can help germs to build up on teeth and gums, and increase the probability of gum disease and ultimately tooth loss. Another concern is the fact that dental infections can worsen diabetes by causing hyperglycemia.
 
Please contact us with any questions regarding these vision and dental enhancements. We want to help you to get the care you need to stay as healthy as possible in 2010.

The Mental Health Parity and Addiction Equity Act of 2008

Wednesday, September 2nd, 2009

In October of 2008, the President signed the Mental Health Parity and Addiction Equity Act (MHPAEA), which provided some vital changes in the way group mental health and addiction benefits are to be covered. This ensures that those needing such coverage will not be denied or restricted in their ability to seek treatment.
 
The MHPAEA applies to Large Group plans; both self-funded and fully insured, and works to prevent the placement of dollar limits on mental health care. Instead, it ensures that mental health benefits and substance use disorders are covered just as any other medical or surgical benefits.
 
However, there are some snags. If the group plan does not currently have mental health benefits on their plan, they will not be required to add them to their current benefit package. Also, the number of covered visits may be limited, even if there is no visit limit imposed on regular medical visits. Cost sharing may be higher for mental health or substance abuse visits as well.
 
Though this law may only apply to large group plans, those individuals who are on small group or an individual/family plan will find the same protection under “Mental Health Parity”. You can click on www.ncsl.org to see state specific laws regarding mental health benefits.

Assembly Bill 1672 & What it means for Small Business Plans

Monday, May 18th, 2009

Small business owners in California received extra protection under the law for their rights with group health insurance when the law AB 1672 was passed in 1992. This new requirement required that group health insurance carriers provide coverage for employees covered under a group health plan, even if they have a pre-existing condition. This new law meant that insurance companies may not deny coverage, and if there is an exclusion period for a pre-existing condition, it must be kept to six months to one year. If an employee was covered by a health plan before joining the group health plan offered by their new employer, this coverage must count towards this exclusion period, as long as the employee’s coverage was enacted within 62 days of losing the previous policy.

Under law AB 1672, a group health insurance provider must renew a group health plan for a small business, as long as two conditions are met: there has been no fraud with the policy and all the premiums have been paid. This prevents insurance companies from offering a small business a group health plan and then arbitrarily canceling it later on.

Savings with a Premium Only Plan (Section 125)

Friday, May 8th, 2009

 The IRS has instituted a provision in Section 125 of their code. This provision allows for a simple change in your company’s payroll process that reduces your taxable payroll. Every premium contribution your employees make will be deducted from your overall taxable payroll amount. Here’s what you and your employees can expect with a Premium Only Plan or POP.

Employer Benefits

Lower Taxes – Every small business owner needs to take advantage of every tax break they can find. By using a POP plan, you are immediately lowering your taxes, which means that you can turn this additional revenue into more options for your business.

Happier Employees – When your employees make more money, they end up happier. By offering them the ability to use a POP plan, you are automatically putting more money into their pockets. You can use this fact as a way to attract and retain quality employees, particularly if other companies in your industry do not offer this type of plan.

Employee Benefits

Lower Taxes – In addition to lowering your own taxes, your employees will also reap this benefit from a POP plan. This reduction in taxes can be quite significant. This is achieved because your employees are allowed to make contributions to the POP plan with pre-tax dollars. When they become a member of a POP plan, they will also see a reduction in their FICA, federal and state taxes, when applicable. For employees who may have trouble making contributions towards their health plan, a POP plan can allow them to save money on their health plan through the benefits of lower taxes. Even though the premium amount may be the same as a regular plan, the tax savings that they will experience can help make up the difference.

More Take-Home Pay – One of the most popular benefits of a POP plan is the ability for your employees to take-home more pay each month. With their contributions coming as pre-tax dollars and the reduction in their tax payments, this results into automatic savings that they can see on their paycheck each month.

Changes to Federal COBRA for 2009

Wednesday, May 6th, 2009

In February of 2009, President Obama signed into law the American Recovery and Reinvestment Act. Designed as part of the economic stimulus bill, this also provides some major assistance to COBRA coverage for certain individuals. Some of the major points to this bill are:

  • Will provide for a federal subsidyon the COBRA continuation coverage premiums for qualified beneficiaries due to involuntary termination of employment between Sept. 1, 2008 and Dec. 31, 2009 (Assistance Eligible Individuals)
  • Qualified beneficiaries will include the covered employee, the covered employee’s spouse, and covered employee’s dependent children. This means that the spouse or dependents of the involuntarily terminated employee will be eligible for benefits even if the employee does not elect COBRA.
  • There will be a federally provided COBRA subsidy of 65% of the amount owed by the Assistance Eligible Individual (AEI). A payment of 35% made by the AEI is considered payment in full. The remaining amount will be covered by the plan, insurer, or employer and will be reimbursed by the government via payroll tax credits. Note – this subsidy is not offered to health flexible spending account plans.
  • Those qualified beneficiaries that experienced involuntary termination of employment between September 1, 2008 and February 17, 2009 who did not elect COBRA during the initial 60 day period will now be provided another 60 day election period during which to elect COBRA coverage.

Please call or email us with any questions!

Saving Money on Small Group Plans

Thursday, April 30th, 2009

Businesses, especially those with fewer than 5 employees, are really bearing the brunt of the rate increases. However, there are still options out there to save you and your employee’s money.

Carriers are constantly revising their portfolios to meet your needs. For example, Anthem Blue Cross expanded its portfolio to include four new HMO options.

Other ways to save on your Group Health Coverage may be to consider adding on the Section 125 Premium Only Plan. This allows employees to pay certain medical expenses (i.e. their portion of the premium) before taxes are deducted from your paycheck. This increases the employee’s take home pay, and reduces Employer taxes.

Carriers are also offering programs to rival their competitors. For example, small businesses with a lower “Risk Adjustment Factor” may qualify for substantial rate reductions by changing to another carrier. Sometimes even just adding dental and life plans to your current group coverage can also aid in reducing your overall premium.

Please call us today to discuss your current group coverage and ways we can help you to save!

Keeping Employees Aware of Benefit Packages

Monday, April 27th, 2009

One of the most important things you need to do as an Employer offering health insurance is to make sure that your employees understand their benefit packages.

Here are some frequently asked questions that employees may have about their group health insurance plan:

How much do they have to pay?
As the employer in a group health insurance policy, it is your responsibility to provide at least some payment for monthly premiums for the policy.

It is important that your employees know exactly how much you will provide and what they will have to pay on the policy. Ideally, this should be answered before an employee signs up for your group health plan to avoid any confusion.

How high is their deductible?
In addition to their monthly premium amounts, your employees should have a clear idea of what their annual deductible will be.

This will help them decide on which plan will best suit their needs, and will be necessary if they plan on using a health savings account to help pay for their premiums.

Is the insurance plan HSA eligible?
With the popularity of health savings accounts growing, your employees will need to know if your group health policy is HSA eligible.

Are there any exclusions in the policy?
Group health insurance is just like any other type of insurance. There will be specific exclusions in your group health plan that your employees will need to know about.

For example, dental care may be excluded from coverage, or preventative screenings may be excluded. It is important to get a list of exclusions for your policy from your health insurance provider.

Will they have coverage for a pre-existing condition?
If your employees have pre-existing conditions, this can affect their group health coverage. They will need to discuss this with your insurance company representative to make sure that they will have the kind of coverage that they need.

These are just some of the important topics you will need to address. As your agent, we will also be happy to answer such questions on your behalf.


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