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For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.
For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.
Good news Bronx/Westchester. Oxford and Montefiore Health System announced moments ago that they have reached an agreement effective December 1, 2021 for UnitedHealthcare and Oxford employer-sponsored plans, as well as UnitedHealthcare’s Medicare Dual Special Needs Plan.
This resolves a split since Jan 1, 2021 which affected a significant percentage of local residents as both companies have a critical size of the market. Westchester and Bronx populations total nearly 2.5 million people. While this contract is resolved with titanic and a few Hospital Systems and Insurers left in the market we expect to see this trend to continue.
See below the official press release.
UnitedHealthcare and Montefiore Health System have reached a multi-year agreement that restores access to Montefiore’s hospitals and physicians for people enrolled in UnitedHealthcare and Oxford employer-sponsored plans as well as UnitedHealthcare’s Medicare Dual Special Needs Plan, effective Dec. 1, 2021.
We recognize that the care Montefiore provides is not only important but also personal to our members and we also know the negotiations process may have been difficult for them. Our top priority throughout this process was ensuring the people and employers we’re honored to serve in New York have access to quality, more affordable health care, and this new agreement helps accomplish that goal.
We thank our members and customers for their support and patience throughout this process. We are honored to continue supporting the more than 3.7 million individuals across New York who depend on us for access to quality and affordable health care.
|Montefiore Hospital (Moses Campus)||Bronx|
|Children’s Hospital at Montefiore||Bronx|
|Garnet Health MedJack D. Weiler Hospital (Einstein Campus)ical Center||Bronx|
|Montefiore Wakefield Hospital (Wakefield Campus)||Bronx|
|Burke Rehabilitation Hospital||Westchester|
|Montefiore Mount Vernon Hospital||Westchester|
|Montefiore New Rochelle Hospital||Westchester|
|Montefiore Nyack Hospital||Rockland|
|Montefiore St Luke’s Cornwall Hospital||Orange|
|White Plains Hospital||Bronx|
|Montefiore Hutchinson Campus||Bronx|
|Montefiore Medical Group||Westchester|
|Montefiore Medical Specialists of Westchester||Westchester|
|Bon Secours Community Hospital|
BronxCare Hospital Center
Garnet Health Medical Center
Good Samaritan Hospital of Suffern
New York Presbyterian Hudson Valley Hospital
New York Presbyterian Lawrence Hospital
NYC Health + Hospitals Jacobi
NYC Health + Hospitals Lincoln
NYC Health + Hospitals North Central Bronx
St. Anthony Community Hospital
St. Barnabas Hospital
St. John’s Riverside Hospital
Westchester Medical Center
|2021 Empire Blue Cross Blue Shield|
|2021 Healthfirst Plans|
|2021 New Oscar Circle Plus|
For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.
Medicare Supplemental Plan F phased out for newly Medicare eligible? With the new 2022 open enrollment changes, it’s time to get the facts. Considering making changes to your coverage this fall or just want to learn more about this enrollment period?
During the Medicare open enrollment period – which runs from October 15 through December 7 – you can make a variety of changes (none of which involve medical underwriting):
While the Centers for Medicare and Medicaid (CMS) will no longer allow newly eligible Medicare beneficiaries to enroll in Medigap plans F and C, these plans aren’t disappearing completely. If you become eligible for Medicare before January 1, 2021 (and that’s everyone who can use the 2021 fall Medicare Open Enrollment Period), you can apply for these plans now and in the future—even if you aren’t already enrolled in Medigap.
If you become eligible for Medicare on or after January 1, 2020, you won’t be able to enroll in Plans F or C now or in the future.
In 2022, you’ll enter the donut hole when your spending + your plan’s spending reaches $4,430. And you leave the donut hole — and enter the catastrophic coverage level — when your spending + manufacturer discounts reach $7,050. Both of these amounts are higher than they were in 2021, and generally increase each year. Learn more about Part D.
Every year, insurers make small changes to their Medicare Advantage and Part D plans. Typically, these changes include changes in premiums, deductibles, and other costs. Keep in mind, the Medicare program may not finalize these changes until right before fall Open Enrollment.
See the latest Medicare premiums and deductibles now or come back in October. We’ll share finalized changes as soon as they become available.
Refresh your general Medicare knowledge
While the Medicare program changes a bit each year, much of it stays the same. It never hurts to refresh your Medicare knowledge. We recommend starting with an Overview of Medicare. This Medicare Glossary could come in handy, too, as you read through insurance documents. See
Medicare Part B premiums increased this year by about 2.7% or $4 per month and high-income surcharges also rose modestly in 2021. For 2022 the Standard Part B premiums are projected to be $158.50/month from $148.50/month in 2021 or a 6.7% increase.
The wealthiest senior couples will be paying more than $12,000 a year in Medicare Part B premiums. Part B (the base and the surcharge) covers doctors’ and outpatient services. Medicare Part B Income-Related Monthly Adjustment Amounts.
Medicare B also has a deductible, which increased to $203 in 2021, up from $198 in 2020. For 2022, the Part B deductible is projected to be $217. The Medicare Part B deductible only has to be paid once per year, unlike the Part A deductible, which has to be paid once per benefit period.
If you’re happy with your Medicare coverage, there’s no need to do anything during Medicare Open Enrollment. Provided your current plan is available next year, your coverage will auto-renew.
Although you could let Open Enrollment pass right on by without having to lift a finger, we recommend doing two things this fall to optimize your Medicare coverage.
If your plan is discontinued next year, you’ll receive a notice in the mail. If you miss this notice and fail to enroll in other coverage, you could lose your coverage.
If your plan continues in the following year, your insurer will send you an Annual Notice of Change (ANOC). Look over your ANOC carefully to make sure your plan will still meet your needs next year. If not, its time to consider other options.
No matter how you feel about your current plan, it’s usually a good idea to do a little shopping around during Open Enrollment. Since plans and premiums change annually, options that fit your situation even better than your current coverage could pop up. But if you don’t check, you’ll never know.
OPEN ENROLLMENT PERIOD for Medicare Advanatage and Medicare Part D Prescription Drug coverage. All individuals with Medicare can change their Medicare health plan and prescription drug coevrage for the next year.
MEDICARE ADVANTAGE DISENROLLMENT PERIOD. Those with MA plans (Part C) can leave the plan and switch to original Medicare.
MEDICARE SUPPLEMENT (Medigap) plans can be purchaded year-round but may require answering health questions to determine eligibility.
To download this entire document as a PDF, click here: Open Enrollment eBook
This Compliance Overview is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.
In preparation for open enrollment, Employers should review their plan documents in light of changes for the plan year beginning Jan 1, 2021. Below is an Employer 2 Open Enrollment Checklist including some administrative items to prepare for in 2020.
Health plan sponsors should also confirm that their open enrollment materials contain certain required participant notices, when applicable—for example, the summary of benefits and coverage (SBC). There are also some participant notices that must be provided annually or upon initial enrollment. To minimize costs and streamline administration, employers should consider including these notices in their open enrollment materials.
Effective for plan years beginning on or after Jan. 1, 2014, non-grandfathered health plans are subject to limits on cost-sharing for essential health benefits (EHB). The ACA’s out-of-pocket maximum applies to all non-grandfathered group health plans, including self-insured health plans and insured plans.
The ACA requires non-grandfathered health plans to cover certain preventive health services without imposing cost-sharing requirements (that is, deductibles, copayments or coinsurance) for the services. Health plans are required to adjust their first-dollar coverage of preventive care services based on the latest preventive care recommendations. If you have a non-grandfathered plan, you should confirm that your plan covers the latest recommended preventive care services without imposing any cost-sharing.
The ACA imposes a dollar limit on employees’ salary reduction contributions to a health flexible spending account (FSA) offered under a cafeteria plan. An employer may impose its own dollar limit on employees’ salary reduction contributions to a health FSA, as long as the employer’s limit does not exceed the ACA’s maximum limit in effect for the plan year.
The ACA set the health FSA contribution limit at $2,500. For years after 2013, the dollar limit is indexed for cost-of-living adjustments. For 2022 plan years, the health FSA limit is $2,850. The DFSA Rollover Maximum is $570.
If you offer an HDHP to your employees that is compatible with an HSA, you should confirm that the HDHP’s minimum deductible and out-of-pocket maximum comply with the 2020 limits. The IRS limits for HSA contributions and HDHP cost-sharing increase for 2022. The HSA contribution limits will increase effective Jan. 1, 2022, while the HDHP limits will increase effective for plan years beginning on or after Jan. 1, 2022.
The following table contains the HDHP and HSA limits for 2022 as compared to 2021. It also includes the catch-up contribution limit that applies to HSA-eligible individuals who are age 55 or older, which is not adjusted for inflation and stays the same from year to year.
|Type of Limit||2021||2022||Change|
|HSA Contribution Limit||Self-only||$3,600||$3,650||Up $50|
|HSA Catch-up Contributions (not subject to adjustment for inflation)||Age 55 or older||$1,000||$1,000||No change|
|HDHP Minimum Deductible||Self-only||$1,400||$1,400||No change|
|HDHP Maximum Out-of-pocket Expense Limit (deductibles, copayments and other amounts, but not premiums)||Self-only||$7,000||$7,050||Up $50|
Under the ACA’s employer penalty rules, applicable large employers (ALEs) that do not offer health coverage to their full-time employees (and dependent children) that is affordable and provides minimum value will be subject to penalties if any full-time employee receives a government subsidy for health coverage through an Exchange.
To qualify as an ALE, an employer must employ, on average, at least 50 full-time employees, including full-time equivalent employees (FTEs), on business days during the preceding calendar year. All employers that employ at least 50 full-time employees, including FTEs, are subject to the ACA’s pay or play rules.
All full-time employees must be offered affordable minimum value coverage. A full-time employee is an employee who was employed on average at least 30 hours of service per week. The final regulations generally treat 130 hours of service in a calendar month as the monthly equivalent of 30 hours of service per week. The IRS has provided two methods for determining full-time employee status—the monthly measurement method and the look-back measurement method.
Audit your FTEs to determine if you have reached or exceeded 50 employees and are required to comply with the Family Medical Leave Act (FMLA) in 2022. Employers covered by the FMLA are obligated to provide their employees with certain important FMLA notices, so both employees and the employer have a shared understanding of the terms of the FMLA leave. Note that FMLA compliance requirements are different from ACA compliance.
An ALE may be liable for a penalty under the pay or play rules if it does not offer coverage to “substantially all” (95%) full-time employees (and dependents) and any one of its full-time employees receives a premium tax credit or cost-sharing reduction for coverage purchased through an Exchange. For employees who are offered health coverage that is affordable and provides minimum value are generally not eligible for these Exchange subsidies. The IRS lowered the 2022 employer health plan affordability threshold, or cost-sharing limit, to 9.61% of an employee’s income. The threshold in 2021 was 9.83%.
The ACA requires ALEs to report information to the IRS and to employees regarding the employer-sponsored health coverage on Form 1095-C. The IRS will use the information that ALEs report to verify employer-sponsored coverage and to administer the employer shared responsibility provisions (Code Section 6056).
In addition, the ACA requires every health insurance issuer, sponsor of a self-insured health plan, a government agency that administers government-sponsored health insurance programs and any other entity that provides minimum essential coverage (MEC) to file an annual return with the IRS and individuals reporting information for each individual who is provided with this coverage (Code Section 6055).
|1095 forms delivered to employees||Jan. 31 (extended to March 2)|
|Paper filing with IRS*||Feb. 28|
|Electronic filing with IRS||March 31|
Sponsors of self-funded plans and health insurance issuers of fully insured plans are required to pay a fee each year, by July 31st, to fund comparative effectiveness research. Fees will increase to $2.45 per covered life in 2020 and are next due July 31, 2021.
Healthcare Reform requires employers to report the aggregate cost of employer-sponsored group health plan coverage on their employees’ Forms W-2. This reporting requirement was originally effective for the 2011 tax year. However, the IRS later made reporting optional for 2011 for all employers.
The IRS further delayed the reporting requirement for small employers (those that file fewer than 250 Forms W-2) by making it optional for these employers until further guidance is issued. For the larger employers, the reporting requirement was mandatory for the 2012 Forms W-2 and continues.
The ACA requires health plans and health insurance issuers to provide an SBC to applicants and enrollees to help them understand their coverage and make coverage decisions. Plans and issuers must provide the SBC to participants and beneficiaries who enroll or re-enroll during an open enrollment period. The SBC also must be provided to participants and beneficiaries who enroll other than through an open enrollment period (including those who are newly eligible for coverage and special enrollees).
The SBC template and related materials are available from the Department of Labor (DOL).
If you have a grandfathered plan, make sure to include information about the plan’s grandfathered status in plan materials describing the coverage under the plan, such as SPDs and open enrollment materials. Model language is available from the DOL.
Under the ACA, non-grandfathered group health plans and issuers that require designation of a participating primary care provider must permit each participant, beneficiary and enrollee to designate any available participating primary care provider (including a pediatrician for children). Also, plans and issuers that provide obstetrical/gynecological care and require a designation of a participating primary care provider may not require preauthorization or referral for obstetrical/gynecological care.
If a non-grandfathered plan requires participants to designate a participating primary care provider, the plan or issuer must provide a notice of these patient protections whenever the SPD or similar description of benefits is provided to a participant. If your plan is subject to this notice requirement, you should confirm that it is included in the plan’s open enrollment materials. Model language is available from the DOL.
Group health plan sponsors should consider including the following enrollment and annual notices with the plan’s open enrollment materials.
The Consolidated Omnibus Budget Reconciliation Act (COBRA) applies to employers with 20 or more employees that sponsor group health plans. Plan administrators must provide an initial COBRA notice to new participants and certain dependents within 90 days after plan coverage begins. The initial COBRA notice may be incorporated into the plan’s SPD. A model initial COBRA notice is available from the DOL.
At or prior to the time of enrollment, a group health plan must provide each eligible employee with a notice of his or her special enrollment rights under HIPAA. This notice may be included in the plan’s SPD. Model language for this disclosure is available on the DOL’s website.
Group health plans covering residents in a state that provides a premium subsidy to low-income children and their families to help pay for employer-sponsored coverage must send an annual notice about the available assistance to all employees residing in that state. The DOL has provided a model notice.
Plans and issuers must provide notice of participants’ rights to mastectomy-related benefits under the Women’s Health and Cancer Rights Act (WHCRA) at the time of enrollment and on an annual basis. Model language for this disclosure is available on the DOL’s website.
Plan administrators must include a statement within the Summary Plan Description (SPD) timeframe describing requirements relating to any hospital length of stay in connection with childbirth for a mother or newborn child under the Newborns’ and Mothers’ Health Protections Act. Model language for this disclosure is available on the DOL’s website.
Group health plan sponsors must provide a notice of creditable or non-creditable prescription drug coverage to Medicare Part D eligible individuals who are covered by, or who apply for, prescription drug coverage under the health plan. This creditable coverage notice alerts the individuals as to whether or not their prescription drug coverage is at least as good as the Medicare Part D coverage. The notice generally must be provided at various times, including when an individual enrolls in the plan and each year before Oct. 15th (when the Medicare annual open enrollment period begins). Model notices are available on the Centers for Medicare and Medicaid Services’ website.
The HIPAA Privacy Rule requires covered entities (including group health plans and issuers) to provide a Notice of Privacy Practices (or Privacy Notice) to each individual who is the subject of protected health information (PHI). Health plans are required to send the Privacy Notice at certain times, including to new enrollees at the time of enrollment. Also, at least once every three years, health plans must either redistribute the Privacy Notice or notify participants that the Privacy Notice is available and explain how to obtain a copy.
Self-insured health plans are required to maintain and provide their own Privacy Notices. Special rules, however, apply for fully insured plans. Under these rules, the health insurance issuer, and not the health plan itself, is primarily responsible for the Privacy Notice.
Model Privacy Notices are available through the Department of Health and Human Services
Plan administrators must provide an SPD to new participants within 90 days after plan coverage begins. Any changes that are made to the plan should be reflected in an updated SPD booklet or described to participants through a summary of material modifications (SMM).
Also, an updated SPD must be furnished every five years if changes are made to SPD information or the plan is amended. Otherwise, a new SPD must be provided every 10 years.
Plan administrators that are required to file a Form 5500 (> 100 participants in plan) must provide participants with a narrative summary of the information in the Form 5500, called a summary annual report (SAR). The plan administrator generally must provide the SAR within nine months of the close of the plan year. If an extension of time to file the Form 5500 is obtained, the plan administrator must furnish the SAR within two months after the close of the extension period.
Group health plans that include wellness programs may be required to provide certain notices regarding the program’s design. As a general rule, these notices should be provided when the wellness program is communicated to employees and before employees provide any health-related information or undergo medical examinations.
Enhance Your Employee Benefits Package. A competitive benefits package is key to keeping and attracting top talent. Assess your current benefits package and consider making necessary adjustments to include options, such as expanded mental health support, for example.
Review Employee Records. The fourth quarter is a good time to review your employee records and check record retention guidelines. Don’t forget to dispose of outdated termination and outdated job applications properly. With W2s around the corner, make sure all addresses and information are updated.
Develop and Distribute Your 2022 Calendar. Create and distribute a calendar outlining important dates, vacation time, pay dates, and company-observed holidays for 2022.
Review and Update Employee Handbook. Review your employee handbook to make sure it is up-to-date and addresses areas, such as employment law mandates, new COVID-related policies, guidelines for remote working, privacy policies, compensation and performance reviews, social media policies, attendance, and time-off, break periods, benefits, and procedures for termination, discipline, workplace safety, and emergency procedures.
PLEASE NOTE: This information is for general reference purposes only. Because laws, regulations, and filing deadlines are likely to change, please check with the appropriate organizations or government agencies for the latest information and consult your employment attorney and/or benefits advisor regarding your responsibilities. In addition, your business may be exempt from certain requirements and/or be subject to different requirements under the laws of your state. (Updated Oct. 3, 2021)
On Sept. 24, 2020, President Donald Trump issued an executive order outlining his health care plan, called the America First Health Care Plan. This Legal Update video explains further.
The IRS has released the 2021 Health Savings Account (HSA) inflation adjustments. To be eligible to make HSA contributions, an individual must be covered under a high deductible health plan (HDHP) and meet certain other eligibility requirements.
HSA Annual Contribution Limit
$3,550 – Single; $7,100 – Family
HDHP Minimum Annual Deductible
$1,400 – Single; $2,800 – Family
HDHP Out-of-Pocket Maximum
$6,900 – Single; $13,800 – Family
Age 55+ Catch-Up Provision
$1,000- Single; $2,000 – Husband/Wife
As in 401k and IRA contributions, you are allowed to contribute extra if you are above a certain age. If you are age 55 or older by the end of the year, you can contribute an additional $1,000 to your HSA. If you are married, and both of you are age 55, each of you can contribute an additional $1,000. A savvy strategy for high-income earners is to invest the money in your HSA for the long haul. Once you’re 65, you can take out tax-free distributions to cover Medicare premiums. If you withdraw money at that point for non-medical uses, you pay the same tax as you would on withdrawals from a pretax 401(k). But you can also take money out tax-free to reimburse yourself for prior years’ out-of-pocket medical expenses if you have the old receipts.
You can even use an HSA to save on a typical trip to the CVS. Thanks to a tax relief provision tucked in the last Covid-19 stimulus package, you can use the money you stash in an HSA or FSA (more on those later) for over-the-counter medications like Tylenol or Flonase as well as menstrual products like tampons and pads. That reverses Obamacare restrictions on OTC meds requiring a doctor’s prescription for them to be eligible for reimbursement.
HSA holders own the assets in the accounts and can build up substantial sums over time. Enrollment in HSA-compatible insurance plans has increased to 10 million earlier this year, from 1 million in March 2005, according to, America’s Health Insurance Plans (AHIP), a trade group.
HSAs were authorized starting in January 2004. Since then, AHIP has conducted a periodic census of health plans participating in the HSA/HDHP market.
Our overall experience with HSAs has been positive when employer funding is at a minimum 50% using either the HSA or an HRA (Health Reimbursement Account-employer keeps unspent money). Traditional plans trend of higher copays and new in-network deductibles has also led to the popularity of an HSA.
Plan sponsors should update payroll and plan administration systems for the 2021 cost-of-living adjustments and should incorporate the new limits in relevant participant communications, such as open enrollment and communication materials, plan documents, and summary plan descriptions.