FEDERAL JAN 1st SMALL GROUP ANNUAL OPEN ENROLLMENT WAIVER

FEDERAL JAN 1st SMALL GROUP ANNUAL OPEN ENROLLMENT WAIVER

A little-known requirement but most important under Affordable Care Act (ACA) is for Health Insurers must waive their minimum employer-contribution and employee-participation rules once a year. ACA requires a one-month Special Open Enrollment Window for January 1st coverage.

The special open enrollment period occurs November 15th through December 15th of each year, allowing eligible small group employers to enroll for coverage effective January 1st of the following year.

Background

The ACA has a section in it called the “guaranteed issuance of coverage in the individual and group market.” It stipulates that “each health insurer that offers health insurance coverage in the individual or group market in the state must accept every employer and individual in the state that applies for such coverage.” The section also states that this guaranteed issuance of coverage can only be offered during (special) open enrollment periods, and that plans can only be offered to applicants that live in, work in, or reside in the plans’ service area(s).

Participation and Contribution Requirements

In many states (including California and Nevada), carriers can decline to issue group health coverage if fewer than 70% of employees elect to enroll in coverage. Some carriers may have even tighter participation requirements.

Generally speaking, employees with other coverage (Medicare, other group coverage, individual coverage through the Exchange, etc.) are removed from the participation requirement calculation – though it varies by insurance carrier.

Furthermore, employer contribution rules require employers to contribute a certain percentage of premium costs for all employees in order to attain group health coverage. Some businesses struggle to meet these contribution requirements for a variety of financial reasons.

Problem Solved: Special Open Enrollment Period

Many employers want to offer coverage to their employees, but are denied because they struggle to meet participation and/or contribution requirements. Employers cannot force employees to enroll in coverage unless the employer pays for 100% of the employees’ premiums, which many employers cannot afford. Even with moderate to generous employer contributions, many employers still find young and lower-income employees waiving coverage. This was even more evident in 2019 with the ACA’s federal Individual Mandate non-compliance penalty reduced to $0.00.

The U.S. Department of Health & Human Services provides final guidance on this in regulation 147.104(b)(1): “In the case of health insurance coverage offered in the small group market, a health insurance issuer may limit the availability of coverage to an annual enrollment period that begins November 15 and extends through December 15 of each year in the case of a plan sponsor that is unable to comply with a material plan provision relating to employer contribution or group participation rules.”

If your employer groups are struggling with participation and/or contribution, the Special Open Enrollment Window is the time to enroll them in coverage.

For more help with the Special Open Enrollment Window contact us at info@medicalsolutionscorp.com or (855)667-4621.

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JAN 1 SMALL GROUP ANNUAL OPEN ENROLLMENT WAIVER

JAN 1 SMALL GROUP ANNUAL OPEN ENROLLMENT WAIVER

A little-known requirement but most important under Affordable Care Act (ACA) is for Health Insurers must waive their minimum employer-contribution and employee-participation rules once a year. ACA requires a one-month Special Open Enrollment Window for January 1st coverage.

The special open enrollment period occurs November 15th through December 15th of each year, allowing eligible small group employers to enroll for coverage effective January 1st of the following year.

Background

The ACA has a section in it called the “guaranteed issuance of coverage in the individual and group market.” It stipulates that “each health insurer that offers health insurance coverage in the individual or group market in the state must accept every employer and individual in the state that applies for such coverage.” The section also states that this guaranteed issuance of coverage can only be offered during (special) open enrollment periods, and that plans can only be offered to applicants that live in, work in, or reside in the plans’ service area(s).

Participation and Contribution Requirements

In many states (including California and Nevada), carriers can decline to issue group health coverage if fewer than 70% of employees elect to enroll in coverage. Some carriers may have even tighter participation requirements.

Generally speaking, employees with other coverage (Medicare, other group coverage, individual coverage through the Exchange, etc.) are removed from the participation requirement calculation – though it varies by insurance carrier.

Furthermore, employer contribution rules require employers to contribute a certain percentage of premium costs for all employees in order to attain group health coverage. Some businesses struggle to meet these contribution requirements for a variety of financial reasons.

Problem Solved: Special Open Enrollment Period

Many employers want to offer coverage to their employees, but are denied because they struggle to meet participation and/or contribution requirements. Employers cannot force employees to enroll in coverage unless the employer pays for 100% of the employees’ premiums, which many employers cannot afford. Even with moderate to generous employer contributions, many employers still find young and lower-income employees waiving coverage. This was even more evident in 2019 with the ACA’s federal Individual Mandate non-compliance penalty reduced to $0.00.

The U.S. Department of Health & Human Services provides final guidance on this in regulation 147.104(b)(1): “In the case of health insurance coverage offered in the small group market, a health insurance issuer may limit the availability of coverage to an annual enrollment period that begins November 15 and extends through December 15 of each year in the case of a plan sponsor that is unable to comply with a material plan provision relating to employer contribution or group participation rules.”

If your employer groups are struggling with participation and/or contribution, the Special Open Enrollment Window is the time to enroll them in coverage.

For more help with the Special Open Enrollment Window contact us at info@360peo.com or (855)667-4621.

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For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.

6 Advantages of a PEO during COVID-19

6 Advantages of a PEO during COVID-19

6 Advantages of a PEO during COVID-19

As COVID-19 unfolds, the importance of a PEO for a Small Business becomes evident. How can you protect your employees while also managing costs?  Here are examples of how our PEO clients have benefited.

 1. Rapid Law Changes

With recent CARES Act and FFCRA(Families First Coronavirus Response Act) to help struggling businesses, overwhelming info and regulations have mounted for the small business owner. Who is eligible for benefits? Tax credits? Furloughs and COBRA? Is their business Essential? Paid Sick Leave eligibility and additional tax credit entitlement?

PEOs provide a full team of experts who anxiously awaited the legislation, final rulings, and updates on all the Acts. They spend countless hours diving into legal jargon to answer business owners’ questions. Then, PEOs work alongside organizations to implement processes that assist in keeping the business compliant. They also help employees through the difficult time, with the livelihood of the business always in mind.

2. PEOs help with Paycheck Protection Program (PPP) loans through the CARES Act

Lenders are asking for historical payroll data and tax reports quickly produced by a PEO’s HRIS System. Many small businesses without HR help find these systems financially draining. Example: Needed 940/941 reporting is issued which can be sent to SBA Lender.  Also, several leading  PEO’s have supported clients with NYS Shared Loans Program.

Working with clients to understand options.

 3. Payroll Burden

Payroll administration is now a nightmare. Tracking the FFCRA emergency sick leave and expanded FMLA separately from regular sick and FMLA leave has thrown a wrench in many payroll processors’ systems. Add on any furloughed or terminated employee reporting and tracking, and now the job has doubled.

Instead, our PEO Clientsy are spending their time on mission-critical work that could make or break the business. Additionally, their payroll is processed by professionals who have the time and expertise to know the nuances of payroll and payroll tax laws with back up teams of professionals in place.

 4. Staffing Needs – On-Boarding and Terminations 

A minimum 75% of PPP loans must be spent on staffing costs.  Companies that had previously furloughed or terminated employees find they need to hire employees back. This comes with additional paperwork and many employee questions, such as whether benefits wait periods start over. 

Conversely, when businesses do need to furlough or terminate employees, the PEO is a great guide for compliance. The layoff process, COBRA,  paperwork including givernement reporting are supported. 

5. HR Excellence

Partnering with a PEO is much like gaining access to a full-service HR division, with a team of HR experts who are up-to-date with new and changing employment laws and able to identify ways to streamline your HR.

According to a report conducted by the National Association of Professional Employer Organizations (NAPEO), PEOs provide access to more HR services at a cost that is close to $450 lower per employee, compared to companies that manage their HR services in-house. 

 Studies show that businesses in a PEO arrangement grow 7-9 percent faster, have 10-14 percent lower turnover, and are 50 percent less likely to go out of business.

 6. Affordable and Better Benefits

By joining a large group risk-pool a a PEO can help employers gain access to high quality employee benefits, such as health insurance options with stable and affordable rates. Due to costs, small businesses often find high-quality employee benefits out of reach.  The savings on health insurance alone can pay for the PEO itself.  

If you’re interested in hearing more about the advantages of partnering with a PEO, we’d love to talk to you. Fill out the form below or email info@medicalsolutionscorp.com for a FREE Consultation Today!

The information provided on this website is intended for informational purposes only.  Millennium Medical Solutions Corp. does not offer legal or medical guidance.  Those with legal or medical questions should seek appropriate assistance from a licensed professional.  Stay up to date by signing up for Newsletter and Coronavirus Dashboard below.

Learn how our PEO Partnership can help your group please contact us at info@360peo.com or (855)667-4621.

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For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.

ROI of a PEO 2019

ROI of a PEO 2019

The ROI on a PEO is 27.2% according to a new 2019 study released today by the National Association of Professional Employer Organizations (NAPEO) .

The new report focused solely on costs and calculated savings for PEO clients in five HR-related areas:

  • HR personnel costs
  • Health benefits
  • Workers’ compensation
  • Unemployment insurance (UI)
  • Other external expenditures in areas related directly to HR services (payroll, benefits, etc.)

An annual per employee savings of $1,775 is reached according to the study. Notable findings are lower employee turnover, higher rates of both employee and revenue growth, and enhanced employee benefit offerings.

PEOs provide HR, payroll, benefits, workers’ comp, and regulatory compliance assistance to small and mid-sized companies. By providing these services, PEOs help businesses improve productivity, increase profitability, and focus on their core mission. Through PEOs, the employees of small businesses gain access to employee benefits such as 401(k) plans; health, dental, life, and other insurance; dependent care; and other benefits typically provided by large companies. A copy of the full study is available here.    

Put You & Your Employees in Good Hands

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For more information on PEOs or a custiomized quote please submit your contact. We will be in touch ASAP. 

7 Ways Small Businesses Benefit from a PEO

7 Ways Small Businesses Benefit from a PEO

The number of small and medium-sized employers using professional employer organizations (PEO) continues to increase each year. Often, it is thought that the growth of the PEO industry is due mainly to the benefits business owners see from this partnership. However, owners aren’t the only ones who gain from working with a PEO. 

Small business employees, too, stand to benefit from the services and solutions offered by PEOs today. Let’s take a look at a few examples of the positive outcomes that small business workers see when their employer works with a PEO.

1. Better Benefits 

One of the most well-known advantages to using a PEO is gaining improved, modern benefits and perks. And while better benefits help employers retain and recruit talent, these enhanced perks often provide even greater for employees.

When working with a PEO, employees are given access to a wide-variety of personalized benefits, including:

  • Health insurance
  • Retirement benefits
  • Voluntary benefits (pet insurance, identity theft protection, financial and legal programs, telehealth programs, etc.)
  • Complimentary benefits (discount programs, employee assistance programs, etc.)

By having solid HR policies, a comprehensive benefit package, and employee perks, you are able to create a safe and happy workplace that helps you attract quality employees and retain them to reduce the cost of turnover.

2. Workers’ Compensation Savings

Over the last few years, the workers’ compensation market has gotten a lot tougher for business owners. PEOs help businesses secure competitive rates for workers’ compensation insurance. That can sometimes be challenging for start-up companies, companies with past losses or those with high-risk jobs. PEOs have flexible workers’ compensation programs with more affordable rates than stand-alone policies and staff who help manage the cost of claims, coordinate return-to-work programs and recommend safety training

In most cases, it will be a more cost effective option than the traditional market can offer. We can also include Employment Practices Liability insurance which covers lawsuits arising from wrongful termination, discrimination, and sexual harassment. Issues that are becoming more common in today’s workplace. 

3. Solve HR Issues  

Federal, state and local regulations related to HR are more voluminous and complex than ever. Most businesses don’t have the staff for the in-depth subject matter expertise needed to adequately navigate wage and hour regulations and ensure compliance with the full range of employment and tax laws. When small and mid-sized businesses work with a PEO, they get a team of compliance experts who stay current with all the rules and regulations that apply to employers. 

A PEO also helps manage HR risk by helping clients:

  • Create an employee handbook to include anti-discrimination and harassment policies
  • Familiarize themselves with wage and hour laws
  • Pay employees in accordance with the law
  • Pay employees in a timely manner 

4. Compliance Relief 

PEOs are responsible for staying up-to-date on the latest federal and state labor laws and  regulations. This not only saves you time, but also the frustration that comes with trying to make sense of and implement many of these changes. 

By staying up-to-date on these changes, you can avoid hefty fines and disgruntled employees.

5. Modern HR Tech

 This desire for modern technology has also become an expectation for HR tasks that employees are asked to perform, such as requesting PTO, going through benefit enrollment, and submitted their hours.

The majority of PEOs offer their clients the kind of HR tech that employees want and need. Some even have mobile apps that make tasks as simple as possible for employees!

And most PEOs, through their HR technology, can offer small business employees learning and development programs and software that much larger organizations use.

A great HRIS System is fundamental today. By meeting employee expectations, employers help boost the happiness and ultimately retention of their workforce.

6. Employee Happiness

 Enhanced benefits, robust learning and development programs, and easy-to-use, modern technology all help to boost the employee experience.

 For employees, increased happiness makes their connection to their work and employer greater. And for employers, happy employees mean improved productivity and lesser chance of turnover – studies from the National Association of Professional Employer Organizations (NAPEO) have shown that PEOs help their clients reduce turnover by 10% to 14%.

 A happier workplace and workforce are good outcomes for everyone and working with a PEO can help achieve these goals!

7. Competitive Business and Personal PEO Insurance Quotes 

360PEO can also provide competitive quotes on all of your personal insurance needs. We work with several industry partners to help clients find coverage for many commercial lines of insurance, such as Group Long Term Care Insurance, Executive Benefits, General Liability, Property, and Commercial Auto.

 We also offer personal lines insurance such as renter’s policies, home insurance, and life insurance.  

 

Learn how our PEO Partnership can help your group please contact us at info@360peo.com or (855)667-4621.

Put You & Your Employees in Good Hands

Get In Touch

For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.

NYS 2019 Final Rates Approved   

NYS 2019 Final Rates Approved   

NYS 2019 Final Rates Approved    

NYS has approved  2019 Final Rates last Friday. Small group rates will increase 3.8% and 8.6% for individuals.

As per NY State Law, Health Insurers are required to send out early notices of rate request filings to groups and subscribers see original –NYS 2019 Rate Requests.  Despite only 3 months of mature claims data experience for 2018  health insurers’ original requests were noticeably below average 7.5% for small group and 24% for individuals.  Ultimately NYS reduced this request substantially by approximately 50%.

Experts are concerned over the long term effects. Example, the Individual  mandate was removed last December by Presidential order. Without the Mandate anyone can drop insurance without penalty.  A comparable take away for similar auto insurance industry would be something like this -Drivers ought not be mandated to buy auto insurance as its a profit scheme by Insurers. While a popular decision this will hardly bend the curve long term and reduce competition.  Furthermore, the new order of Selling Across State lines makes NYS most unwelcoming.

OTHER STATES

Insurers have been filing to sell Obamacare plans that will go into effect in 2019, and in some states they appear to be pricing in for the fact that the mandate is going away next year. Other states are seeing mild increases, but that is in part because they saw significant hikes for the previous year.

Insurers have concluded that fewer people will enroll without the mandate than otherwise, so in some places they are pricing their plans higher based on the assumption that sicker people will be left behind, which will increase medical costs for those left. It is well worth pointing out that in recent years the loss federal risk reinsurance corridor funds account for 5.5 percent of the rate increase.

How are neighboring States doing?

In NJ, not that bad.  Last year the average increase were 5.5% for small groups and some popular plans such as  Horizon Blue Cross Blue Shield’s  OMINA  increasing only 4.8% increase.   This year the increase is only 5.2.  Other insurers offering EPO and HMO plans in the individual market for 2019 include Oscar Health and Oxford Health Plans.

With individual mandate repeal fewer people will buy health insurance raising the prices for those who do. NJ Banking and Insurance Department officials said premium prices would have increased, on average, by 12.6 percent.

For CT market, on the other hand, things are much worse at least for the individual marketplace with average 25% rate increases last year.  The 2019 proposed rate increases for both the individual and small group market are, on average lower, than last year: The proposed average small group rate increase request is a 10.22 percent and ranges from -5.0 percent to 21.1 percent. This compares to the average increase request of 18.06 percent requested last year.The proposed average individual rate increase request is 12.3 percent and ranges from -10.9 percent to 31.0 percent. This compares to the average increase request of 25.51 percent requested last year.

Final plan rates in New Jersey & CT will be finalized and released in the fall, state officials said. ACA open enrollment begins Nov. 1

  • Trend: Trend is a factor that accounts for rising health care costs, including the cost of prescription drugs, and the increased demand for medical services.
  • Uncertainty in Washington:
    • Removal of penalty for individual mandate: The elimination of the penalty means that individuals who are typically younger and healthier would have no inducement to participate in the insurance pool, which could further destabilize the market. Lack of participation shrinks the pool and increases the cost of insurance to the remaining members.
    • Short-duration health plans and Association Health Plans: Still pending are final federal regulations on non-ACA compliant short-duration plans, which may have implications for the ACA risk pool. Also, Connecticut along with other state insurance regulators, are awaiting clarification from the federal government on new federal regulations allowing association health plans, which could further shrink the ACA risk pool.

 A bipartisan group of congressional representatives has discussed an agreement to extend and guarantee the payments, but it’s unclear whether they could do so by the new filing deadline of Sept. 5. A lawsuit filed by Congress against the Obama administration to challenge the payments is still pending. In addition, Trump has repeatedly threatened to withhold payments to insurers that reduce cost-sharing – deductibles, copays and coinsurance – paid by low-income customers. More than half of New Jersey’s marketplace customers receive that assistance, and without it, most would be unable to afford coverage.

Finally, a tax on health insurance premiums has been reinstated in 2018 after a one-year “tax holiday” approved by Congress for 2017. That contributed 2.3 percent to the rate hikes that insurers requested for 2019 and for  2019

SMALL GROUP MARKET VS.  INDIVIDUAL MARKET

Importantly, small group market is still more advantageous than individual markets unless one gets a sizable low-income tax credit. Overall, about 350,000 individual plan consumers will be affected by the price hike, while more than a million users will be hit by higher small group fees. Last year, Blue Cross Blue Shield released a study showing Obamacare user costs were 22 percent higher than people with employer-sponsored health plans, while UnitedHealth plans to exit most Exchanges see –  Breaking: Oxford Exits Metro Indiv & Oxford Liberty HMO 2017.

The correct approach for a small business in keeping with simplicity is a Private Exchange and with our large buying group PEO partnerships. This is a true defined contribution empowering employees with a choice of leading insurers offering paperless technologies integrating HRIS/Benefits/Payroll.  Both employee and employers still gain tax advantage benefits under the business.  Also, the benefits, rates and network size are superior under a group plan as the risk are lower for small group plans than individual markets.

Learn how a PEO Partnership can help your group please contact us at info@360PEO.com or (855)667-4621.

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