How to Obtain State Funding for Corporate Training Progams
Please join us on April 13th, 2011 for our most profitable Coffee Talk ever! Come learn how to increase employee morale and give your company a competitive edge- all at no cost to you through training grants available from the State of New Jersey. Seating is extremely limited, so rsvp today. For further details, click here.
Celebrate National Employee Benefits Day!
Did you know there was a day (April 4th) set aside to acknowledge benefits trustees, administrators and advisors for their role in providing quality benefits for their colleagues? In addition to a much-deserved pat on the back, this day serves as a perfect opportunity to evaluate your current employee benefit communication efforts and ramp up employee education about your benefit offerings. Here are some ideas to promote your benefits:
- Host a lunch-and-learn led by your Benefits Team.
- Send periodic emails or payroll stuffers to communicate benefits information.
- Host Q&A sessions for employees.
- Provide employees with Total Compensation Statements.
- Add a new benefit, such as walking programs, casual Fridays, monthly lunches or flexible scheduling.
Do not hesitate to contact us if you need any assistance to promote your benefits!
To Offset Health Care Cost Increases, Sweeping Plan Design Changes Expected
According to a survey recently released by Towers Watson and National Business Group, health care costs are projected to increase by 7 percent in 2011. Annual costs per employee are expected to reach $11,176 (up 7.6 percent from 2010). Employers are concerned not only with these expected rising costs, but also with the effects health care reform will have on their health plans over the next several years. Many companies are implementing more comprehensive plan design changes to address these concerns, such as:
- Increasing contributions for dependents, either through per-dependent contributions or spousal waivers or surcharges
- Discontinuing employer-sponsored retiree medical coverage or restructuring retiree programs
- Offering incentives or penalties to providers based on performance
- Focusing on wellness and rewarding or penalizing employees based on biometrics like weight and cholesterol
Health & Welfare Compliance Update
The last year brought many changes for health and welfare plans, but by far the most significant development was the passage of the health care reform law, the Patient Protection and Affordable Care Act (PPACA). The major items affecting employer-sponsored health plans in 2010 and 2011 include:
- Small business tax credit for qualified employers to purchase health insurance for employees
- Extension of dependent coverage for dependent children up to age 26
- W-2 reporting requirement to disclose the value of health coverage provided by the employer (optional for the 2011 tax year, mandatory for 2012 tax year).
- Elimination of lifetime limits on the dollar value of essential benefits and elimination of unreasonable annual limits
- Elimination of pre-existing condition exclusions for those under age 19
- Restriction on rescissions to cases of fraud or intentional misrepresentation of material fact, and policyholders must be notified prior to cancellation
- Coverage of preventive services without cost-sharing requirements for non-grandfathered plans
- Patient protections for non-grandfathered plans
- Nondiscrimination rules stating that fully-insured, non-grandfathered plans may not discriminate in favor of highly compensated individuals for plan eligibility or benefits*
- New appeals process for non-grandfathered plans
- Coverage for early retirees under the early retiree reinsurance program
- Limits on over-the-counter reimbursements without a prescription under FSAs, HRAs, HSAs and Archer MSAs, along with an increased penalty tax for HSAs and Archer MSAs
*As of last week, due to the amount of complaints and questions, Nondiscrimination testing for fully insured plans under the Patient Protection and Affordable Care Act (PPACA), Federal Health Care Reform, is delayed until the regulations are written, which will most likely be well into 2011. CBSI will provide further details and information as changes develop.
COBRA premium subsidy: The COBRA premium subsidy has been extended several times, with the final extension period through May 31, 2010. Although employers no longer have to provide the premium subsidy to individuals terminated after May 31, 2010, they will still have to administer COBRA coverage in accordance with the subsidy requirements for those individuals who are still eligible for reduced payments.
CHIPRA notice requirements: CHIPRA imposed a new notice obligation on employers that maintain group health plans in states that provide premium assistance subsidies for Medicaid or CHIP plans. These employers must notify their employees of potential opportunities for premium assistance.
GINA rules for employers and health plans: Employers may not discriminate against an individual on the basis of the individual’s genetic information for hiring, discharge, compensation or the terms, conditions or privileges of employment. Group health plans and insurance issuers may not adjust group premium or contribution amounts on the basis of genetic information, request or require individuals or their family members to undergo a genetic test, request, require or purchase genetic information prior to or in connection with enrollment or for underwriting purposes, or provide a reward or incentive for completing a health risk assessment or request genetic information as a part of a health risk assessment.
Mental health parity: The Mental Health Parity and Addiction Equity Act of 2008 expanded the existing parity requirements to prohibit plans from imposing higher copayments, deductibles or out-of-pocket limits on substance abuse treatment benefits other than on medical and surgical benefits. Also prohibited is excluding out-of-network treatment for mental health and substance abuse treatment benefits if out-of-network benefits are provided for medical and surgical benefits, and placing more restrictive limits on the number of covered office visits, days of inpatient coverage or the duration or scope of treatments available for mental health and substance abuse treatment benefits than those available for other types of medical treatment
FMLA rights for non-traditional families: FMLA rights were expanded for non-traditional families to include leave for employees who have a parental relationship with a child, regardless of the legal or biological relationship, to care for the sick child.
HITECH requirements: Under the HITECH Act, HIPAA has been expanded to impose additional obligations on business associates that required revisions to business associate agreements regarding notifications to individuals when their unsecured protected health information is breached. Safe harbor for small plan contributions: The Department of Labor issued a safe harbor regarding the timing of employee contributions to small welfare plans.
Coordination with TRICARE benefits: New regulations under TRICARE prohibit employers from offering TRICARE beneficiaries financial or other benefits as incentives not to enroll in, or to terminate enrollment in, a group health plan that is primary to TRICARE.
The 2010 Mid-Term Elections
The recent elections, held on November 2, 2010, are bringing big changes to Washington. Results of a few races are still to be finalized in the days after the elections, but it is already clear that we are looking at a new political landscape.
Republicans have taken control of the House of Representatives, gaining at least 60 seats there. These wins give the party the largest House majority it has had since the 1940s. However, Democrats are set to maintain a slim majority in the Senate.
Potential Health Care Reform Changes
Many Republican candidates included promises regarding health care reform in their campaigns. These promises ranged from making changes to the law to outright repeal. However, employers and plan sponsors should keep in mind that such changes will not be automatic or immediate. Any changes to health care reform will have to go through the same legislative process that the initial reform package endured.
Current House Minority Leader John Boehner (R-Ohio) is expected by many to become Speaker of the House. In the wake of the elections, Rep. Boehner has indicated that Republicans would move slowly with changes to “lay the groundwork before we begin to repeal” health care reform.
With a divided Congress, any efforts to completely repeal the legislation will face obstacles. Even if a full repeal could make it through the Senate, President Obama could still veto any repeal legislation. Because of that probability, some Republicans have indicated that that they would try to repeal the health care law “piece by piece,” using strategies like blocking funding or regulations. Other Republicans have also said they may try to replace, rather than repeal, parts of the law.
Provisions of the law that are likely to be targeted for revision or repeal include:
- The requirement for businesses to report payments in excess of $600 on a Form 1099;
- The employer responsibility provisions, which provide that employers can face penalties for not providing a certain level of health coverage to employees;
- The individual responsibility requirement, which imposes penalties on individuals who do not obtain coverage;
- The Cadillac Plan tax on high-cost, employer-sponsored health plans;
- The tax on manufacturers of medical devices; and
- Cuts to Medicare.
Republicans have also suggested changes to the planned health insurance exchanges, which will take effect in 2014, to give states more power in designing the exchanges. However, members of the GOP have also said that they may want to keep some of the law’s provisions that are popular with consumers. Some experts have warned that keeping some parts of the law while repealing others may not be practical.
Democrats are standing behind the health care package and some exit polls show that the public is split on whether health care reform should be repealed. However, party leaders, such as President Obama and Senate Majority Leader Harry Reid (D-Nevada) have indicated a willingness to revise some portions of the law, especially if changes will bring faster and more effective reform to the health care system.
What’s Next?
Despite all these changes, and potential future changes, the health care reform law as we know it is the law. Employers and health plan sponsors should make sure they are implementing the requirements as they become effective. If any changes are made to parts of the law that have already taken effect, there will likely be time for employers and plan sponsors to put changes into place.
Customized Benefit Solutions, Inc. will continue to update you on health care reform developments.
Horizon BCBSNJ- Free Flu Vaccination to Fully Insured Members
Horizon Blue Cross Blue Shield of New Jersey and CVS Caremark are offering vouchers for a free flu shot to fully insured members. Members can redeem the vouchers at CVS/pharmacy stores or MinuteClinic health centers for a no-cost flu shot. The vouchers will be mailed to members ages 18 years and older after November 10, 2010.
The Flu Voucher program provides members with an additional choice of how and where to receive their flu vaccination. The trial program is not meant to replace a member’s medical benefit of getting their influenza immunization from their physician. Members continue to have this option as part of their medical insurance.
For complete details, please click here.
REMINDER - Medicare Part D Notifications by 11/15/10
The Medicare Modernization Act provides access to prescription drug coverage to all Medicare eligible persons under the new Medicare Part D. The notice is mandatory for any Medicare eligible person whether due to age or disability and is for employees, spouses, dependents, COBRA or NJ, NY and PA continuants, or retirees.
Medical insurance carriers have been notifying their policyholders regarding the creditability of each group's prescription drug coverage. It is the plan sponsors' responsibility to notify their group's members.
It is the employers' obligation to provide all employees, retirees, and continuants who are Medicare eligible with information about their organization’s prescription benefits by November 15, 2010. Employees will use that information to help them formulate their personal decision to determine whether or not they will enroll in Medicare Part D prescription coverage. Click here for a sample creditable or non-creditable letter to assist you in your obligations. There are also Spanish versions available on the CMS website.
Creditable Coverage Disclosure to Centers for Medicare and Medicaid Services (CMS)
Most entities that currently provide prescription drug coverage to Medicare D eligible individuals (including employees, dependents, continuees, and those eligible for Medicare due to age or disability) must disclose to the Centers for Medicare and Medicaid Services (CMS) whether or not the coverage is "creditable prescription drug coverage." The disclosure must be provided whether the entity is primary or secondary to Medicare.
Group plan sponsors should follow the link below to complete the Creditable Coverage Disclosure form online.
HCR: IRS Delays Form W-2 Reporting Requirement
Reporting Requirement Delayed
The Patient Protection and Affordable Care Act (PPACA) requires employers to report the aggregate cost of employer-sponsored group health coverage on an employee’s Form W-2, beginning with the 2011 tax year. Although the information must be disclosed, the cost of the coverage remains tax-free to the employee.
On October 12, the Internal Revenue Service announced that it will delay the compliance date for this requirement. The IRS and the Treasury Department have provided the relief in order to give employers more time to make any necessary changes to their payroll systems or procedures in preparation for compliance with the reporting requirement.
The temporary relief from the reporting requirement is found in IRS Notice 2010-69. This notice states that reporting the cost of employer-sponsored group health coverage will not be mandatory for 2011 Forms W-2, which would be issued in 2012. Due to the extension, employers will have to include this information for the first time on the 2012 W-2s instead, which are not issued until 2013.
Specifically, the IRS has stated that employer will not be treated as failing to meet the reporting requirements for 2011, and will not be subject to penalties, just because it does not report the aggregate cost of employer-sponsored coverage on Forms W-2 issued for 2011.
This IRS and the Treasury Department also announced that they are anticipating issuing additional guidance on the reporting requirement before the end of 2010.
Compliance Steps for Employers
Although the requirement has been delayed, employers should use the additional time to ensure that they (or their payroll provider) are prepared to gather this information in advance of having to complete the Forms W-2. In doing so, they should make sure they can identify the applicable employer-sponsored coverage that was provided to each employee and be prepared to calculate the aggregate cost of that coverage. The aggregate cost of the coverage is to be calculated similarly to how the COBRA applicable premium is determined.
Employers may also have to address questions from employees regarding whether their health benefits are taxable under this new requirement. They can assure employees that the rule is a reporting requirement only, and does not mean they will incur additional tax obligations.
The Federal Health Care Reform legislation requires that plans (whether insured or self-insured) make coverage available to dependents under age 26 years for plan years beginning on or after September 23, 2010.
Dependents to Age 26 Years for Small and Midsize Groups:
Under Health Care Reform, groups must offer all eligible dependents a special enrollment period. Horizon BCBSNJ has decided to implement this Federal Health Care Reform rule simultaneously with its implementation of New Jersey Minimum Standards, which were effective September 8, 2010, for all Midsize (51 to 99 employees) plan designs and all Small Group plans.
This means that all Federally eligible children under age 26 years can enroll in their parents’ coverage, effective September 8, 2010, if applications are received on or by October 15, 2010.
- For all Small Group (2 to 50 employees) plans: Coverage will become effective on the date of receipt of the completed application or a future effective date, if requested.
- For all Midsize (51 to 99 employees) plans: Dependents must wait until the group’s next open enrollment period to enroll, and coverage will be effective on the open enrollment effective date.
Click here to read the release from Horizon.
Confused by how health care reform will affect your organization? Health care reform, in the form of the Patient Protection and Affordable Care Act brings many changes for employers and their health plans. Join CBSI for this free seminar to learn more about the recently passed legislation. The focus of the seminar will be the provisions effective 2010 and 2011. We will be holding the seminar on two different dates and two different locations for your convenience. If your health plan is renewing in November, December, or January, you do not want to miss this seminar! For more information, and to register, please click on the links below.
Yes, we are all ready for some football, but are you ready for the new Health care reform changes? Health care reform, in the form of the Patient Protection and Affordable Care Act, brings many changes for employers and their health plans. As sponsors of group health plans prepare to comply with health care reform’s many requirements, they need to be aware of how health care reform will affect their plans for the coming plan year. Many changes are effective on the first day of the first plan year beginning on or after September 23, 2010, or January 1, 2011 for calendar year plans. Use this checklist to ensure compliance for your health plan.
- Determine if you have a grandfathered plan
For non-grandfathered plans only:
- Amend plan to cover recommended preventive services
- Create or update your claims appeal process to comply with new requirements
- If fully-insured, amend plan to eliminate impermissible discrimination in favor of highly compensated employees
- Amend plan to include patient protections
- Amend plan to cover dependents up to age 26
For all plans:
- Amend plan to eliminate lifetime limits
- Eliminate or restrict annual limits on essential benefits
- Eliminate pre-existing condition exclusions for children under age 19
- If your plan includes an FSA, HRA, HSA or Archer MSA, amend it to reflect new requirements for those medical accounts
- Incorporate new rules regarding rescissions in coverage
- Provide a 30-day special enrollment opportunity for adult children up to age 26 eligible for coverage (if applicable)
- Provide a 30-day special enrollment opportunity to individuals who had previously reached the lifetime limit
Required participant notices:
- If you have a grandfathered plan, you must indicate that status in plan materials
- Notice that dependent coverage eligibility has been extended up to age 26
- Notice to those affected by a lifetime limit
- Notice to those in non-grandfathered plans regarding new patient protections
- Notice addressing new rules for OTC drugs and medical accounts
- Notice regarding new appeals process (for non-grandfathered plans)
- Going forward, provide 30-day written notice of any rescission in coverage
For a detailed checklist, please click here.
CBSI would like to invite you to an exciting and informative evening seminar designed to provide important information on Retirement Strategies in today’s turbulent and fluctuating market. Along with our partners, Reilly Financial Group and The Pavese-McCormick Agency, we will be addressing questions you may have regarding your retirement income planning, such as, "How much of your pre-retirement income will you need to maintain your standard of living in retirement?" or "How do you prepare for overcoming the three retirement hazards of Inflation Risk, Market Risk and Longevity Risk?".
When: Wednesday, September 29th from 6:00pm-8:00pm
Location: Pavese-McCormick Agency, 3759 US Highway 1 South Monmouth Junction, NJ 08852
If you are interested in attending, please contact us to RSVP. Refreshments will be served and please feel free to bring along a friend.
The health care reform law, which consists of the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA), makes some significant changes to accounts such as health flexible spending accounts (health FSAs) and health savings accounts (HSAs). These include:
- Reimbursement permitted for medicine or a drug only with a prescription (except for insulin).
- Contributions to health FSAs limited to $2,500 per year, subject to cost-of-living increases.
- Increased tax on withdrawals from HSAs and Archer MSAs not used for medical expenses.
This Customized Benefit Solutions, Inc. Legislative Brief describes the new rules related to these accounts and when the changes take effect.
Update: COBRA Subsidy Extension
Prior to leaving for Memorial Day recess, the House of Representatives discarded provisions from a jobs bill that would have extended the ARRA subsidy to help newly laid-off workers pay for health insurance under support of the Consolidated Omnibus Budget Reconciliation Act (COBRA). In efforts to trim spending, House managers dropped the COBRA extension from the American Workers, State, and Business Relief Act of 2010.
House leaders plan to address the lapse in COBRA extensions with a separate bill when they return to work on June 7th. Therefore as of today, eligibility for the COBRA subsidy remains for Involuntary Terminations on or prior to May 31, 2010 and will not cover new involuntary terminations after May 31, 2010.
Horizon BCBSNJ - Walgreens No Longer Participating in CVS Caremark Pharmacy Networks
Walgreens recently announced its decision not to participate on a go-forward basis in CVS Caremark’s PBM pharmacy networks for new and renewing clients.
CVS Caremark announced that Walgreens will be removed from its commercial pharmacy network in 30 days, effective July 9, 2010, and from its Medicare Part D pharmacy network, effective January 1, 2011.
This announcement was unexpected, and Horizon Blue Cross Blue Shield of New Jersey is working closely with CVS Caremark to ensure a smooth transition for members.
Click here to view Horizon BCBSNJ Brief Notes Vol. 19, No. 705, which includes additional information which may help you address any inquiries you receive.
Horizon BCBSNJ-
Coverage for Dependents Under Age 26 Years Prior to Effective Date - Q&A
Horizon Blue Cross Blue Shield of New Jersey will allow covered individuals under age 26 to remain on their parents’ health insurance policies, effective May 1, 2010 for fully insured plans to help families avoid a gap in coverage. This is before the federal effective date of plan years beginning on or after September 23, 2010. Self-insured groups are also able to opt-in to this arrangement to prevent disenrollment of certain members who would otherwise be eligible for coverage on or after September 23, 2010.
The carrier's decision to apply this coverage early is causing some confusion. Click here to view Horizon BCBSNJ Brief Notes Vol. 19, No. 701, which includes questions and answers to help address the questions you may have.
Health Care Reform: Extension of Dependent Coverage
On March 23, 2010, President Obama signed into law the health care reform bill, the Patient Protection and Affordable Care Act. This legislation, along with the Health Care and Education Reconciliation Act of 2010, makes sweeping changes to the U.S. health care system, including an extension of health insurance coverage to young adult children up to age 26. Though many of the changes will be implemented over the next several years, the extension of coverage to young adult children takes effect in as little as six months from enactment. This Legislative Brief provides a summary of the provisions of the law requiring the extension of dependent health coverage.
Aetna, Amerihealth, and UnitedHealthcare Announces Early Extension of Dependent Coverage
Three carriers have announced that they will extend dependent coverage earlier than the federal legislation requires. For young adults who are graduating/ aging off their parents' policy, Aetna, Amerihealth and UnitedHealthcare will be continuing coverage for these individuals who would have otherwise had their coverage terminated. For more information, please click here for Aetna, Amerihealth, and UnitedHealthcare. Please note: UnitedHealthcare has not extended dependent coverage on Oxford policies at this time.
COBRA Premium Subsidy Extended Through May 2010
The American Recovery and Reinvestment Act of 2009 (ARRA) provided a temporary subsidy for the cost of COBRA continuation health coverage. The COBRA premium subsidy has already been extended twice, first in December 2009 and then in March 2010. On April 15, 2010, President Obama signed The Continuing Extension Act of 2010, extending the eligibility period for the subsidy. Employer-provided notices must be modified to include the additional subsidy period and the ability to reinstate COBRA for affected individuals. This Legislative Brief discusses this important development.
Breaks for Nursing Mothers Now Law
Among its many components, the recently passed health care reform bill included a provision that modifies the Fair Labor Standards Act (FLSA) to require employers to provide reasonable break time and a private place for female employees to express milk after giving birth. There are five requirements that employers must abide by:
- Employers must provide reasonable break time for nursing mothers.
- A private place other than a bathroom must be provided for the breaks.
- Compensation during the breaks is not required.
- Small employers need not comply if doing so would present an “undue hardship.”
- State laws that provide greater protection to nursing mothers still apply.
The section of the law with this provision took effect on March 23, 2010, so employers must immediately take action to comply with this law (except those in a state that already mandates breaks for nursing mothers). Employers should:
- Identify one or more private locations for nursing mothers.
- Review and modify relevant policies and procedures, including break policies, breast-feeding policies and employee handbooks.
- Communicate with managers supervisors about the changes.
On March 21, 2010, the U.S. House of Representatives passed major health care reform legislation, the Patient Protection and Affordable Care Act. The legislation was previously passed by the U.S. Senate in December 2009 and was signed into law by President Obama on March 23, 2010.
In addition to the main bill, the House also passed a budget reconciliation bill. The Health Care and Education Reconciliation Act of 2010 includes changes to the main bill sought by the House. These changes must now be passed by majority vote in the Senate, with any amendments agreed to by the House, and signed by the President before they take effect.
How Health Care Reform Will Affect Your Business
Although the reform package has yet to be finalized, major changes are looming. Some of the package’s provisions that will affect employers include:
- Employer Mandates. Effective in 2014, most employers with 50 or more employees must offer coverage to employees. Employers who do not do so may be subject to hefty penalties. The benefit plans offered will also have to meet certain requirements.
- Individual Mandates. Citizens and legal residents will be required to have a certain level of health coverage, or pay a tax penalty. These rules could restrict the usage of high deductible health plans and will decrease the chance that your employees will decline coverage under your plan.
- Coverage Subsidies. Small employers that provide health insurance for employees will be eligible for a tax credit. Also, employers who provide insurance to retirees over age 55 who are not eligible for Medicare are eligible for a temporary reinsurance program.
- Health Benefit Exchanges. In 2014, state exchanges will be established for small businesses and individuals to shop for health insurance. Larger businesses will be able purchase coverage in the exchanges in the future.
- Insurance Reforms. These reforms require policies to provide dependent coverage for children through age 26. They prohibit lifetime coverage limits, rescission of coverage except in cases of fraud, and imposing pre-existing condition exclusions on children. Many of these provisions will take effect in 2010. They may affect your benefits and how you administer your benefit programs.
The amount of information about the reform bills being released right now is staggering. Keep in mind that the passage of this legislation is just the beginning point, and the implementation and regulatory processes surrounding these measures will take years. The National Association of Health Underwriters (NAHU) has assembled two new charts to help explain the timeline for the implementation of the law. The first is a very detailed chart that explains how all of the new health insurance reforms in both the Senate bill and the reconciliation bill will impact private health insurance organized by effective date. The second chart is a simplified timeline that explains how both pieces of health care reform legislation will impact individuals and employers.
Customized Benefit Solutions Can Help You Get Ready for Changes
Health care reform will almost certainly involve sweeping changes to the benefits you provide your employees and how you provide them. However, it will most likely affect each business differently. CBSI can review your company’s benefits to help you prepare for the changing landscape. We can work with you to maximize the value of your employee benefits and minimize your costs and risk. We will keep on top of developments regarding health care and keep you informed.
COBRA Subsidy Eligibility Extended to March 31, 2010
An additional COBRA premium subsidy extension of 31 days was signed into law by President Obama on March 2 after being earlier approved by the Senate on a 78-19 vote.
Effective now, the government will continue to reimburse employers of health plans and subsidize 65 percent of the premium for workers who lose their jobs from March 1 through March 31, 2010. The extension is also available to employees who first lost group coverage due to reduced hours and were then laid off after March 1, pending to certain conditions.
Prior to the extension, employees laid off after Feb. 28, 2010, would have been ineligible for the subsidy.
The Senate will continue deliberation on legislation that would make the subsidy available to those laid off through Dec. 31, 2010, and would provide them with coverage for up to 12 months.
Of major concern regarding the changing legislation is the continued need for HR and benefits administrators to be knowledgeable on the extension. The Department of Labor will also have to issue new notices. The Department of Labor's Employee Benefits Security Administration has updated the introduction on the COBRA webpage at www.dol.gov/COBRA to reflect the Temporary Extension Act of 2010 and has added a link to the law. EBSA is updating the fact sheet, FAQs and other materials on the COBRA webpage.
Next CBSI Coffee Talk: April 14th in Florham Park, NJ
Coffee Talk is a complimentary seminar that features industry experts and is designed to educate, increase awareness, assist with compliance, and to provide an opportunity to network with other business professionals. Next month's topic:
HR: What You’re NOT Doing, That You Should Be Doing Right Now!
And
Strategic Employee Benefits Planning
Sample Topics Covered: NJ Paid Family Leave, Performance Management, Progressive Discipline, Employee Handbook Updates, CEPA, Sexual Harassment, Textual Harassment, Consumer Driven Health Plans, Wellness Programs, Total Compensation Statements.
For more information, click here. You may also register online.
HIPAA HITECH Act's Impact on Brokers
You will notice a change in the way we communicate with you in regards to protected health information (PHI). PHI is any information about health status, provision of health care, or payment for health care that can be linked to a specific individual. This includes but is not limited to medical applications with health questions, claims documentation that contains identifying information about the patient (name, address, social security number, etc.), and general email correspondence containing individually identifiable health information. Any email correspondence that contains PHI will be sent securely using encryption technology.
On February 17, 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act, was signed into law as part of the American Recovery and Reinvestment Act (ARRA). Among other things, the Act extended HIPAA privacy and security requirements to directly regulate business associates of covered entities and included stricter requirements for breach notifications. Many of these changes will become effective on February 17, 2010.
What does this mean for you? The first time you are sent a "secure" email, you will need to select a password in order to retrieve the email. Any future "secure" emails, you will continue to use your selected password. We hope this will be an easy transition for everyone. Please be assured that we will continue to treat with utmost care the confidential information entrusted to us and that we are prepared to comply with the requirements imposed upon business associates by the HITECH Act.
DOL Model Notice for CHIPRA Premium Assistance Subsidies
The Children’s Health Insurance Program Reauthorization Act of 2009 created new notice requirements for some group health plans. The U.S. Department of Labor has now issued a new model notice that employers can use in complying with the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).
- If an employer’s group health plan covers residents in a state that provides a premium subsidy, the employer must send an annual notice about the available assistance to all employees residing in that state (the Employer CHIP Notice).
- The first Employer CHIP Notice must be sent by the first day of the first plan year beginning after February 4, 2010, or May 1, 2010, whichever is later. For employers with calendar year plans, the notice must be sent by January 1, 2011.
- Employers that fail to send the required notices may be subject to penalties of $100 per day.
COMPLIANCE WITH CHIPRA
General CHIPRA Requirements
CHIPRA created additional special enrollment rules for group health plans, effective April 1, 2009. These rules permit employees and dependents to enroll in an employer’s group health plan when they lose eligibility under a Medicaid plan or CHIP or become eligible for a premium assistance subsidy under Medicaid or CHIP.
CHIPRA also added new notice requirements for employers that maintain group health plans in states that provide premium assistance subsidies under a Medicaid plan or CHIP. These employers must notify their employees in writing of the potential opportunities available for premium assistance. CHIPRA provides for civil penalties of up to $100 a day for failure to comply with the new requirements.
Premium Assistance Subsidies
States may offer eligible low-income children and their families a premium assistance subsidy to help pay for employer-sponsored coverage. These states may choose to pay the subsidy as a reimbursement to an employee for out-of-pocket expenses or directly to the employer. Employers may choose to opt out of being directly paid a premium assistance subsidy on behalf of an employee. As of January 22, 2010, 40 states offer some type of premium assistance subsidy.
Using the Model Employer CHIP Notice
Employers may use the model notice as a national notice to meeting their obligations under CHIPRA. Employers could also choose to prepare their own notices, or modify the model notice. For example, an employer may want to provide more comprehensive information regarding states where it has a larger workforce or leave out information about states where no employees reside. Employers should be sure to include at least the minimum relevant state contact information for any employee residing in a state with premium assistance.
The information in the model notice is up to date as of January 22, 2010. The DOL will update the model each year to reflect any changes in the number of states offering premium assistance programs or the contact information for those states.
Deadlines for Providing the Notice
The notice must be provided, free of charge, on an annual basis. The first notice must be provided by the first day of the first plan year after February 4, 2010, or May 1, 2010, whichever is later. This rule gives employers with plan years beginning in March or April some extra time to comply. Employers with calendar year plans will have to provide the notice by January 1, 2011.
Delivery of the Notice
The Employer CHIP Notice does not have to be provided in a separate mailing. Plans may combine the notice with other plan materials, such as open enrollment packets or summary plan descriptions, if:
- The materials are provided by the deadlines for providing the Employer CHIP Notice;
- The materials are provided to all employees entitled to receive the Employer CHIP Notice; and
- The Employer CHIP Notice is a separate document so that employees can appreciate its significance.
The notice must be provided in writing in a manner calculated to be understood by the average employee. It must be provided by first-class mail. Alternatively, it may be provided electronically if DOL electronic disclosure requirements are satisfied.
For a copy of the model notice, see www.dol.gov/ebsa/pdf/chipmodelnotice.pdf.
UPDATE: Continuum Health Partners' Network Participation
UnitedHealthcare/Oxford and Continuum Health Partners (CHP) have provided notice to one another of their intent to terminate their agreement effective January 1, 2010. This termination will apply to UnitedHealthcare and Oxford commercial products, as well as the Medicare and Medicaid lines of business.
A two month, state-mandated cooling off period will apply to all fully-insured, commercial, Medicare and Medicaid members, which means that all fully-insured members will continue to have access to Continuum facilities on an in-network basis through February 28, 2010. Fully-insured commercial members and their employers who have visited a Continuum hospital in the past 12 months, as well as those who live in the area surrounding a Continuum hospital, will be notified of the termination. Medicare and Medicaid members who have received services from a Continuum hospital in the past 12 months also will be notified of the termination.
Notices began mailing to affected commercial group employers and members on Friday, January 15, 2010 to help them prepare for this change, as follows:
■ Fully Insured Commercial Employers (UnitedHealthcare; Oxford). Notice sent to employers with employees who have received services at a Continuum hospital in the past 12 months, and those that have employees who live near a Continuum hospital, advising that Continuum hospitals will be considered out-of-network for fully insured members as of March 1, 2010.
■ Fully Insured Commercial Members (UnitedHealthcare; Oxford). Notice sent to members who have received services at a Continuum hospital in the past 12 months and those who live near a Continuum hospital, advising that Continuum hospitals will be considered out-of-network for fully insured members as of March 1, 2010.
The cooling off period does not apply to commercial self-funded (ASO) employer groups and members. Notices were sent to affected commercial self-funded groups and members last month in advance of the contract expiration date of December 31, 2009, to give those groups and members proper notice of this change. As of January 1, 2010, all services rendered at Continuum hospitals to members of self-funded groups are being treated as out-of-network.
UnitedHealthcare and Oxford will continue to negotiate in good faith with Continuum Health System and will make every effort to reach a mutual agreement prior to the termination date of February 28, 2010, for fully-insured membership.
Hospitals in the Continuum Health System include:
- Beth Israel Medical Center
- Roosevelt Hospital
- St. Luke's Hospital
- Long Island College Hospital
- The New York Eye and Ear Infirmary
Below is a list of Neighboring Hospitals in UHC/Oxford's network:
Manhattan
- Bellevue Hospital
- Harlem Hospital
- Hospital for Special Surgery
- Lenox Hill Hospital
- Manhattan Eye, Ear & Throat Hospital
Memorial Hospital for Cancer and Allied Diseases (also known as Memorial
Sloan-Kettering) - Metropolitan Hospital Center
- Mount Sinai Medical Center
- New York Downtown Hospital
- New York Presbyterian Hospital - Columbia University Medical Center
- New York Presbyterian Hospital - Weill Cornell Medical Center
- NYU Hospital for Joint Diseases
- NYU Hospitals Center (Rusk Institute & Tisch Hospital)
- St. Vincent’s Hospital & Medical Center
Neighboring Hospitals in Brooklyn
- Coney Island Hospital
- Kingsbrook Jewish Medical Center
- Kings County Hospital Center
- Lutheran Medical Center
- Maimonides Medical Center
- New York Community Hospital of Brooklyn
- The Brooklyn Hospital Center
- The New York Methodist Hospital
- University Hospital of Brooklyn
- Woodhull Medical and Mental Health Center
- Wyckoff Heights Medical Center
Impact on Physician Participation
At this time, there will be no physician terminations from any of our networks due to the termination of Continuum Health Partners. This is in compliance with a court ruling to allow those —1,200 providers who currently have sole admitting privileges to a Continuum hospital to remain participating in our network; pending the outcome of an arbitration ruling.
Impact on Benefit Payments
Members seeking care from providers who have admitting privileges at Continuum Health Partners in addition to another UnitedHealthcare participating facility: These providers have been notified that Continuum hospitals are non-participating as of March 1, 2010 and their patients' elective hospital admissions should be directed to the participating facility where they have privileges. Any emergency hospital admission to a Continuum hospital will continue to be reimbursed on an in-network basis.
For members receiving care from physicians with sole admitting privileges to a Continuum hospital: As a result of a recent judge ruling, elective hospital admissions for patients of physicians with sole admitting privileges to a Continuum hospital must receive services on an in-network basis. This policy will remain in effect until an arbitration ruling is rendered, at which time we will communicate the outcome to you. (Note: We do not have a date for this hearing at this time.)
Please keep in mind:
• UnitedHealthcare/Oxford will have transitional care guidelines in place so members who have scheduled or ongoing medical treatments at a Continuum hospital will continue to get care as appropriate.'
• Fully insured commercial, Medicare and Medicaid members will continue to have access to Continuum facilities on an in-network basis through the New York State cooling off period, which ends February 28, 2010.
• UnitedHealthcare/Oxford continue to negotiate in good faith with Continuum Health Partners and hope to reach an agreement with them in the near future.
• Members will not lose coverage as a result of this contract termination.
Experience Individual Health Insurance Made Easy!
Now is the time to prepare your business and employees for the flu season:
- Update or create a pandemic flu plan and communicate the plan to employees.
- Educate employees about flu prevention and to stay home when they are ill.
- Develop flexible leave and/or telecommuting options for employees to stay home when ill or to care for sick family members.
- Publish flu information on your company website for employees to access.
- Institute contingent plans for critical business functions in the event of sick employees or other business interruption.
On August 13, 2009, P.L. 2009, C. 115 was enacted. The law, effective February 9, 2010, requires that carriers provide certain benefits for the treatment of autism and other development disabilities. The Act took effect on February 9, 2010, however benefits may not start right away. For existing plans, the benefits take place on the renewal date of the health plan on or following February 9, 2010. For new plans issued on or after February 9, 2010, the Act goes into effect when the new plan is issued.
To view the NJ Department of Banking and Insurance (NJDOBI) Bulletin 10-02, click here.
Also, there is some helpful information on the Autism Votes website.
Reminder! The EEO-1 Report is required to be filed with the U.S. Equal Employment Opportunity Commission’s EEO-1 Joint Reporting Committee. The filing deadline for the 2009 EEO-1 Survey is September 30, 2009. The preferred method for completing the report is the Web-based filing system. For more information see http://www.eeoc.gov.