NYC become the 3rd U.S. City to require Employer Transit Benefits following SF and Washington, DC. Beginning in 2016, the ordinance will require employers (not including government employers) with 20 or more full-time employees in New York City to provide full-time employees a pre-tax qualified transportation benefit program (excluding parking subsidies). It would mean that an estimated 450,000 more New York City-based employees will have access to the commuter tax break. That’s in addition to the 700,000 who already get the break.
“The ordinance will require private employers with 20 or more full-time employees in New York City to provide a pretax qualified transportation benefit program for their full-time employees.” For purposes of the ordinance, a full-time employee is one who works 30 or more hours per week.
Penalties:
While the new ordinance goes into effect January 1, 2016, it provides a six-month grace period, so penalties will not begin until July 1, 2016. Penalties for a first violation will range from $100 to $250. If an employer corrects the violation within 90 days of being notified, then penalties will be waived. If correction (the steps for which have not yet been described) does not occur, penalties for the first violation will apply and an additional penalty will apply, equal to $250 for each 30-day period in which the employer continues to fail to offer the required benefits.
Tax Savings:
The way the pretax commuter tax break works is employees exclude their transit commuting costs from their taxable wages up to the $130 monthly limit (there’s a separate $250 monthly limit for parking). If you’re in the 40% combined federal and state bracket and you put away $130 a month pretax salary to use for transit, you save $624 a year. This also saves the employer money because the employer doesn’t pay payroll taxes of 7.65% on every dollar set aside by employees pre-tax.
$130 transit maximum NEW $255 transit maximum for 2016
EE Savings @ 40% tax bracket = $1200/year
ER Savings (FICA) = $230/year
$255 parking maximum
EE Savings @ 40% tax bracket = $1,200/year
ER Savings (FICA) = $230/year
Next Step:
If you want your employer to add commuter benefits—so you’re eligible for the tax break–petition your HR department, and specifically ask for the pretax commuter benefits program (why wait until 2016?). To learn more about the NYC Transit Mandate, please visit the official website of the City of New York. To start a Transit benefit within 24 hours contact us today (855) 667-4621 or info@medicalsolutionscorp.com.
The first massive data breach of 2015 hit one of the country’s largest insurance issuers, Anthem, Inc., including Empire Blue Cross and Blue Shield and other related entities (Anthem). The incident reportedly affected over 80 million persons who are or were covered under a policy or program insured or serviced by Anthem. Th Anthem Facts or FAQs seek to provide helpful information to the millions of individuals affected. These communications address what is known about the incident, describe the kinds of information compromised, warn affected persons about potential email attacks, and advise that there is more information coming.
But there is not much information at this point for employers that are plan sponsors of group health plans. Is this really only Anthem’s problem? How well protected is YOUR business? In the event of a hack would you even realize this before its too late? We know that long before the attack the malware may have been sitting there latent as early as December. Even if you have IT service agreement will they insure and cover you in case of compromise hacks?
A critical component of combating the risks to your business represented by cyber crime and unintentional data breaches is to purchase a cyber liability insurance policy. Cyber coverage isn’t exactly new, but the need for it is increasing as the rate of cyber crimes rises.
FBI Executive Assistant Director Kenneth Bixby, the agency’s “point man” for cyber fraud, recently presented testimony before Congress regarding the bureau’s efforts to combat computer fraud. While attacks on large corporations like Target, Neiman Marcus, and Home Depot make the evening news, Bixby emphasized that smaller companies (those with fewer than 250 employees) are the targets of almost one third of all cyber attacks.
Last year, according to FBI statistics, federal agents informed over 3,000 U.S. businesses that their data had been hacked. In nine out of ten cases, these companies didn’t even know their computer systems had been breached until they were informed by the government.
Symantec estimates that attacks on small businesses increased 91 percent from 2012 to 2013, and experts believe the increase in software as a service and cloud storage solutions suggests that the problem is only going to get worse. As one security expert puts it: “Either you have been data breached or you just do not know that you have been data breached.”
The Cost of Data Breaches
In a separate Symantec-sponsored study, researchers identified the major direct and indirect expenses associated with business data breaches. They include:
Direct Costs: engaging forensic experts, providing customer hotline support and consumer credit monitoring subscriptions, discounts for future products and services.
Indirect Costs: in-house investigations and communication, the extrapolated value of customer loss resulting from turnover or diminished acquisition rates.
The same study pegs the per-record cost of a data breach at $188—32 percent for direct costs and 68 percent for indirect. This is just an average, however. According to researchers, the cost per record for data lost or exposed due to employee errors and system glitches is (on average) “cheaper,” coming in at $159 and $177 per record, respectively. In contrast, the cost associated with data loss or exfiltration from malicious cyber attacks is much more “expensive” at $277 per record.
A separate 2014 study by Kaspersky Lab tallied business losses for a given data breach “from $66,000 to $938,000 per organization, depending on the size of the company.” In addition, the Kaspersky study found that, in data breaches that involved business-to-business accounts, 43 percent of businesses terminated a business relationship following a reported fraud on their account, while 82 percent of companies indicated they would consider ending a business relationship with a company that suffered a data breach.
Cyber Liability Insurance
A critical component of combating the risks to your business represented by cyber crime and unintentional data breaches is to purchase a cyber liability insurance policy. Cyber coverage isn’t exactly new, but the need for it is increasing as the rate of cyber crimes rises. Also, many business owners don’t realize that cyber insurance often needs to be purchased as its own policy. As you begin looking into getting this crucial insurance for your company, it’s important to note that pricing and coverage will depend in large part on the details of your business, your data, your security measures, and your online presence.
Policies and coverages vary, but a cyber liability insurance policy generally covers the following:
Coverage for actual costs associated with a data breach: these can include consumer notification, customer support, and contracted credit monitoring services for those affected.
Liability for security/privacy breaches: protection from lawsuits and other actions resulting from the exposure of confidential customer information.
Asset recovery and restoration: the cost to restore, update, and/or replace hardware, software, or data assets damaged through cyber crime or by an unintentional loss or release of data.
Business interruption costs: coverage for additional expenses incurred and losses sustained as a result of a data breach.
Reputation management: protection from liability related to slander, libel, copyright claims, and other harm to your reputation resulting from activity on a business website or in social media.
Some policies also cover additional items, such as cyber extortion, cyber terrorism, and the cost of regulatory penalties or sanctions that may result from a breach of data.
If you think your existing business liability policy will protect you in the event of a breach of your company’s data, you’ll want to think again. Many business policies specifically exclude this type of risk because of the extreme variability between different companies’ risks and assets. If you’re not sure whether you’re covered, schedule an appointment to talk to your insurance advisor so you can be protected in the likely case of your company suffering a data breach.
Some of the elements of cyber-liability coverage may be interconnected or overlap with coverage from existing products, including those for business continuity, third-party supply chain issues, and professional indemnity. Even if this overlap does exist, a decent cyber-liability policy is not expensive and will save you headaches in the long run.
Talk with our cyber liability partner Mordy Littman and check if your business is protected at (855) 667-4621.
Safety & Loss Prevention Solutions
Improve safety, avoid lawsuits and increase profitability.
Employment Practices Liability Insurance
Protect yourself against claims made by current, former and potential employees.
Directors & Officers Liability Insurance
Provide financial protection for your board of directors and senior management.
“The deadline for individuals and families to enroll in a qualified health plan through NY State of Health is February 15, 2015. However, the Marketplace will provide additional assistance to those individuals who have taken steps to apply for coverage but have been unable to complete the enrollment process before the deadline. All applications and enrollments in health plans must be completed by the end of the day on February 28, 2015. Those who complete their enrollment after February 15, 2015 but on or before February 28, 2015 will have coverage starting on April 1, 2015.”
2/12/15
Last days for 2015 Individual Open Enrollment is ending this week. This deadline applies to both On and Off Exchange!
If you’re wondering about the penalty for not having insurance: yes, there is one, and no, you can’t really get out of paying for it. You’ll pay the penalty when you file your taxes for 2015. Even if you get coverage midway through the year, you’ll still need to pay a penalty for the months you weren’t insured. So get covered!
Think you might be eligible for a subsidy or aren’t sure?
You can check here at the New York State of Health Marketplace calculator. If you are eligible or think you might be eligible, you can contact the marketplace directly to purchase a plan or ask questions about financial assistance.
Please remember that during open enrollment you are permitted to switch carriers. Choose wisely because after February 15, one cannot switch plans until open enrollment 2015, unless you have a “qualifying event,” such as marriage, divorce, birth or adoption.
Individual Online Enrollment Resources for On and Off Exchange:
For NYS – To view Oscar’s plans, rates and simple online enrollment application, click here.
For more information on enrollment please contact our team at Millennium Medical Solutions Corp (855)667-4621. We have Spanish, Russian, and Hebrew speakers available.
On November 6th, the government issued their 22nd set of FAQs on ACA. This FAQ makes it clear that an employer cannot offer employees cash to reimburse the purchase of an individual policy.
Such an arrangement may be subject to a $100/day excise tax per applicable employee (which is $36,500 per year, per employee tax).
FAQs about Affordable Care Act Implementation (Part XXII)
November 6, 2014 Set out below are additional Frequently Asked Questions (FAQs) regarding implementation of the Affordable Care Act. These FAQs have been prepared jointly by the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Departments). Like previously issued FAQs (available at http://www.dol.gov/ebsa/healthreform/ and http://www.cms.gov/cciio/resources/fact-sheets-and-faqs/index.html), these FAQs answer questions from stakeholders to help people understand the new law and benefit from it, as intended.
Compliance of Premium Reimbursement Arrangements On September 13, 2013, DOL and the Treasury published guidance on the application of the market reforms and other provisions of the Affordable Care Act to health reimbursement arrangements (HRAs), certain health flexible spending arrangements (health FSAs) and certain other employer health care arrangements.(1) HHS issued contemporaneous guidance to reflect that HHS concurs in the application of the laws under its jurisdiction as set forth in the DOL and Treasury Department guidance.(2) Subsequently, on May 13, 2014, two FAQs were made available on the IRS website addressing employer health care arrangements.(3)
The Departments’ prior guidance explains that employer health care arrangements, such as HRAs and employer payment plans, are group health plans that typically consist of a promise by an employer(4) to reimburse medical expenses up to a certain amount. The Departments’ guidance clarifies that such arrangements are subject to the group market reform provisions of the Affordable Care Act, including the prohibition on annual limits under Public Health Service Act (PHS Act) section 2711 and the requirement to provide certain preventive services without cost sharing under PHS Act section 2713.(5) The Departments’ guidance further clarifies that such employer health care arrangements will not violate these market reform provisions when integrated with a group health plan that complies with such provisions. However, an employer health care arrangement cannot be integrated with individual market policies to satisfy the market reforms. Consequently, such an arrangement may be subject to penalties, including excise taxes under section 4980D of the Internal Revenue Code (Code). Q1: My employer offers employees cash to reimburse the purchase of an individual market policy. Does this arrangement comply with the market reforms? No. If the employer uses an arrangement that provides cash reimbursement for the purchase of an individual market policy, the employer’s payment arrangement is part of a plan, fund, or other arrangement established or maintained for the purpose of providing medical care to employees, without regard to whether the employer treats the money as pre-tax or post-tax to the employee. Therefore, the arrangement is group health plan coverage within the meaning of Code section 9832(a), Employee Retirement Income Security Act (ERISA) section 733(a) and PHS Act section 2791(a), and is subject to the market reform provisions of the Affordable Care Act applicable to group health plans. Such employer health care arrangements cannot be integrated with individual market policies to satisfy the market reforms and, therefore, will violate PHS Act sections 2711 and 2713, among other provisions, which can trigger penalties such as excise taxes under section 4980D of the Code. Under the Departments’ prior published guidance, the cash arrangement fails to comply with the market reforms because the cash payment cannot be integrated with an individual market policy.(6)
Q2: My employer offers employees with high claims risk a choice between enrollment in its standard group health plan or cash. Does this comply with the market reforms? No. PHS Act section 2705,(7) which was incorporated by reference into ERISA section 715 and Code section 9815, as well as the nondiscrimination provisions of ERISA section 702 and Code section 9802 originally added by the Health Insurance Portability and Accountability Act (HIPAA), prohibit discrimination based on one or more health factors. Offering, only to employees with a high claims risk, a choice between enrollment in the standard group health plan or cash, constitutes such discrimination. While the Departments’ regulations implementing this provision(8) permit more favorable rules for eligibility or reduced premiums or contributions based on an adverse health factor (sometimes referred to as benign discrimination), in the Departments’ view, cash-or-coverage arrangements offered only to employees with a high claims risk are not permissible benign discrimination. Accordingly, such arrangements will violate the nondiscrimination provisions, regardless of whether (1) the cash payment is treated by the employer as pre-tax or post-tax to the employee, (2) the employer is involved in the selection or purchase of any individual market product, or (3) the employee obtains any individual health insurance.
Such offers fail to qualify as benign discrimination for two reasons. First, if an employer offers a choice of additional cash or enrollment in the employer’s plan to a high-claims-risk employee, the opt-out offer does not reduce the amount charged to the employee with the adverse health factor. Rather, the employer’s offer of cash to a high-claims-risk employee who opts out of the employer’s plan effectively increases the premium or contribution the employer’s plan requires the employee to pay for coverage under the plan because, unlike other similarly situated individuals, the high-claims-risk employee must accept the cost of forgoing the cash in order to elect plan coverage. For example, if the employer’s group health plan requires all employees to pay $2,500 toward the cost of employee-only coverage under the plan, but the employer offers a high-claims-risk employee $10,000 in additional compensation if the employee declines the coverage, for purposes of discrimination analysis, the effective required contribution by that high-claims-risk employee for plan coverage is $12,500 – that is, the $2,500 required employee contribution for employee-only coverage under the employer’s plan plus the $10,000 of additional compensation that the employee would forgo by enrolling in the plan. Because a high-claims-risk employee must effectively contribute more to participate in the group health plan, the arrangement violates the rule that a group health plan may not on the basis of a health factor require any individual (as a condition of enrollment) to pay a premium or contribution which is greater than the premium or contribution for a similarly situated individual enrolled in the plan. Second, the Departments’ regulations generally permit providing, based on an adverse health factor, enhancements to eligibility for coverage under the plan itself but not cash as an alternative to the plan. In particular, the regulations permit providing plan eligibility criteria that offer extended coverage within the plan and subsidization of the cost of coverage within the plan based on an adverse health factor.(9) An example in the Departments’ regulations illustrates that a plan may have an eligibility provision that provides coverage to disabled dependent children beyond the age at which non-disabled dependent children become ineligible for coverage.(10) Another example in the regulations illustrates that a plan may provide coverage free of charge to disabled employees, while other employees pay a participant contribution towards coverage.(11) However, in the Departments’ view, providing cash as an alternative to health coverage for individuals with adverse health factors is an eligibility rule that discourages participation in the group health plan. This type of arrangement differentiates based on a health factor and is outside the scope of the Departments’ regulations on benign discrimination, which permit only discrimination that helps individuals with adverse health factors to participate in the health coverage being offered to other plan participants. The Departments intend to initiate rulemaking in the near future to clarify the scope of the benign discrimination provisions. Finally, because the choice between taxable cash and a tax-favored qualified benefit (the election of coverage under the group health plan) is required to be a Code section 125 cafeteria plan, imposing an effective additional cost to elect coverage under the group health plan could, depending on the facts and circumstances, also result in discrimination in favor of highly compensated individuals in violation of the Code section 125 cafeteria plan nondiscrimination rules. Q3: A vendor markets a product to employers claiming that employers can cancel their group policies, set up a Code section 105 reimbursement plan that works with health insurance brokers or agents to help employees select individual insurance policies, and allow eligible employees to access the premium tax credits for Marketplace coverage. Is this permissible? No. The Departments have been informed that some vendors are marketing such products. However, these arrangements are problematic for several reasons. First, the arrangements described in this Q3 are themselves group health plans and, therefore, employees participating in such arrangements are ineligible for premium tax credits (or cost-sharing reductions) for Marketplace coverage. The mere fact that the employer does not get involved with an employee’s individual selection or purchase of an individual health insurance policy does not prevent the arrangement from being a group health plan. DOL guidance indicates that the existence of a group health plan is based on many facts and circumstances, including the employer’s involvement in the overall scheme and the absence of an unfettered right by the employee to receive the employer contributions in cash.(12) Second, as explained in DOL Technical Release 2013-03, IRS Notice 2013-54, and the two IRS FAQs addressing employer health care arrangements referenced earlier, such arrangements are subject to the market reform provisions of the Affordable Care Act, including the PHS Act section 2711 prohibition on annual limits and the PHS Act 2713 requirement to provide certain preventive services without cost sharing. Such employer health care arrangements cannot be integrated with individual market policies to satisfy the market reforms and, therefore, will violate PHS Act sections 2711 and 2713, among other provisions, which can trigger penalties such as excise taxes under section 4980D of the Code. Footnotes 1. See DOL Technical Release 2013-03, available at http://www.dol.gov/ebsa/newsroom/tr13-03.html, and IRS Notice 2013-54, available at http://www.irs.gov/pub/irs-drop/n-13-54.pdf. 2. See Insurance Standards Bulletin, Application of Affordable Care Act Provisions to Certain Healthcare Arrangements, September 16, 2013, available at https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/cms-hra-notice-9-16-2013.pdf. 3. Available at: www.irs.gov/uac/Newsroom/Employer-Health-Care-Arrangements. 4. These arrangements may be sponsored by an employer, an employee organization, or both. For simplicity, this section of the FAQs refers to employers. However, this guidance is equally applicable to HRAs sponsored by employee organizations, or jointly by employers and employee organizations. 5. Section 1001 of the Affordable Care Act added new PHS Act §§ 2711-2719. Section 1563 of the Affordable Care Act (as amended by Affordable Care Act § 10107(b)) added Code § 9815(a) and ERISA § 715(a) to incorporate the provisions of part A of title XXVII of the PHS Act into the Code and ERISA, and to make them applicable to group health plans and health insurance issuers providing health insurance coverage in connection with group health plans. The PHS Act sections incorporated by these references are sections 2701 through 2728. Accordingly, these referenced PHS Act sections (i.e., the market reforms) are subject to shared interpretive jurisdiction by the Departments. 6. See DOL Technical Release 2013-03, available at http://www.dol.gov/ebsa/newsroom/tr13-03.html, and IRS Notice 2013-54, available at http://www.irs.gov/pub/irs-drop/n-13-54.pdf. See also Insurance Standards Bulletin, Application of Affordable Care Act Provisions to Certain Healthcare Arrangements, September 16, 2013, available at https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/cms-hra-notice-9-16-2013.pdf. 7. Prior to the enactment of the Affordable Care Act, Titles I and IV of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, added section 9802 of the Code, section 702 of ERISA, and section 2702 of the PHS Act (HIPAA nondiscrimination and wellness provisions). Affordable Care Act section 1201 also moved those provisions in the PHS Act from section 2702 to section 2705. 8. 26 CFR 54.9802-1 (g); 29 CFR 2590.702(g);146.121(g). 9. 26 CFR 54.9802-1 (g)(1)(i); 29 CFR 2590.702(g)(1)(i);146.121(g)(1)(i). 10. 26 CFR 54.9802-1 (g)(1)(ii), Example 1; 29 CFR 2590.702(g)(1)(ii), Example 1;146.121(g)(1)(ii), Example 1. 11. 26 CFR 54.9802-1 (g)(2)(ii), Example; 29 CFR 2590.702(g)(2)(ii), Example;146.121(g)(2)(ii), Example. 12. See 29 CFR 2510.3-1(j).
The people have spoken at least for now and they are saying they are unhappy. The storm clouds over Obmacare has ushered in GOP victories: +7 Senate + 13 House. 47% of those who cast ballots in the midterms said the 2010 health care law, which opened for enrollment a year ago, went too far. On the other hand, 26 percent said the law didn’t go far enough, CNN exit polls reported. Only 22 percent said Obamacare was just about right.
How will GOP use these powerful election gains on Obamacare?
GOP still will not have the needed 60 Senate Seats to repeal the Affordable Care Act. That said, they will now be able to pass budget rules on the legislation since the Courts ruled individual mandate penalty as a “tax”. Reinsurance funds such as Risk corridors could also be on the chopping block. Other examples would be the definition of “full-time” employee taxes on employer penalties (bipartisan support), medical devices & tanning salons etc.
According to Huffington Post article GOP-Controlled Congress Expected To Try To Repeal, Weaken ACA while Republicans have been “chomping at the bit to repeal Obamacare” since it was signed into law in 2010, even a GOP-controlled Congress is unlikely to undo the law. However, that won’t stop Republicans from forcing at least one vote on repeal. President Obama “would then swiftly veto it, but not before Democratic senators were forced to cast a vote very directly in support of Obamacare, which remains generally unpopular.” Additionally, the GOP might take aim at several provisions of the ACA, such as the individual mandate, the employer mandate, the Independent Payment Advisory Board, and the medical device tax. Some Senate Democrats would likely join them in eliminating or amending some of these measures.
A Democrat President governing with both Houses going GOP may not be so bad after all. The successful Clinton Presidency had to contend with the same balancing act. Two decades later, the key question is can both branches find a common ground and a productive working relationship?
For specific details on all available health plans in 2015, contact our team at Millennium Medical Solutions Corp (855)667-4621. We work in coordination with Navigators to assist with medicaid, CHIP Child Health Plus, Family Health Plus and Medicare Dual Eligibles. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
ERISA (the federal Employee Retirement Income Security Act) requires employers who are plan administrators of their group health plans to maintain and distribute summary plan descriptions (SPDs) to plan participants. The SPD describes important information about the plan in language that can be understood by the typical participant. The SPD must accurately reflect the contents of the plan and must include specific information required under federal law, much of which is typically missing from the benefits summaries and insurance certificates distributed by insurance companies.A Wrap SPD is designed to wrap around existing certificates of insurance and benefit plan booklets to provide the information necessary to comply with ERISA. The Wrap SPD includes required ERISA provisions and recommended information to “wrap” around the benefit summaries or booklets, insurance certificates and other relevant plan descriptions for each fully insured or self-funded plan option or component plan, including premium conversion plans, health reimbursement arrangements (HRAs) and flexible spending accounts (FSAs). To be compliant, the Wrap SPD and accompanying benefit plan component documents must be distributed to plan participants.
All ERISA-covered benefit plans, including group health plans and other welfare plans, must, by law, be administered in accordance with a written plan document. ERISA, HIPAA and other federal laws require the plan document to contain certain specified provisions. Many employers assume that insurance contracts for fully insured products are written plan documents. Insurance companies, however, draft their contracts to comply with state insurance laws and, as a result, the contracts do not contain many of the required or recommended provisions that protect the plan, the employer and plan fiduciaries. A Wrap Plan Document is designed to meet plan documentation requirements under ERISA and other federal laws and to incorporate all other welfare plans, insurance contracts and other relevant documents (such as premium conversion plans and flexible spending accounts) into a single plan. These materials can be kept together for administrative ease. The Wrap Plan Document provides additional legal protection for the employer and plan fiduciaries and can simplify plan administration.
No. While carriers do provide plan information, they typically will not provide the required provisions that must be included in an SPD and plan document. So an employer/plan administrator will not be in compliance and faces the risk of penalties and other complications if participants only receive a benefits booklet/summary or certificate of insurance.
The plan administrator (which is typically the employer) is the person specifically designated by the terms of the plan who is responsible for its management. If the plan does not make a designation, the plan sponsor (typically the employer that establishes or maintains the plan) is generally the plan administrator.
The SPD should be distributed automatically to all plan participants. The employer/plan administrator also must furnish copies of the most current SPD and plan document to participants and beneficiaries upon written request and must have copies available for examination. Copies should be furnished no later than 30 days after a written request.
Employers/plan administrators may be liable for serious penalties if they don’t provide an SPD or have a current plan document:
Failure to provide an SPD or plan document within 30 days of receiving a request from a plan participant or beneficiary can result in a penalty of up to $110/day per participant or beneficiary for each violation.
Lack of an SPD could trigger a plan audit by the U.S. Department of Labor (DOL).
Having documentation in order protects against disgruntled employees if issues regarding coverage arise.
Can the SPD be distributed electronically?
Yes, as a general rule, materials required to be furnished under ERISA may be provided electronically if the plan administrator takes necessary measures reasonably calculated to ensure that the system for furnishing documents results in receipt of the material. Ways to ensure receipt of an SPD include using return-receipt or notice of undelivered email features, or conducting periodic reviews or surveys to confirm receipt. In addition, in order to provide materials electronically:
The administrator must take steps reasonably calculated to ensure that the system protects the confidentiality of personal information relating to the individual’s accounts and benefits;
The electronically delivered documents must be prepared and furnished in a manner consistent with the style, format and content requirements applicable to the particular document;
Notice must be provided to each participant, beneficiary or other individual, at the time the document is furnished electronically, that informs the individual of the significance of the document when it is not otherwise reasonably evident as transmitted (e.g., the attached document describes changes in the benefits provided by your plan) and of the right to request and obtain a paper version of such document; and
Upon request, the participant, beneficiary or other individual must be furnished a paper version of the electronically furnished documents.
Unless an individual has the ability to effectively access documents furnished in electronic form at any location where the individual is reasonably expected to perform his or her duties as an employee, and access to the employer or plan sponsor’s electronic information system is an integral part of an individual’s job duties, he or she must affirmatively consent to receive documents through electronic media. In the case of documents to be furnished through the Internet or other electronic communication network, consent must be given in a manner that reasonably demonstrates the individual’s ability to access information in the electronic form that will be used to provide the information. Prior to consenting, the individual must be provided a clear and conspicuous statement indicating:
The types of documents to which the consent would apply;
That consent can be withdrawn at any time without charge;
The procedures for withdrawing consent and for updating the individual’s address for receipt of electronically furnished documents or other information;
The right to request and obtain a paper version of an electronically furnished document, including whether the paper version will be provided free of charge; and
Any hardware and software requirements for accessing and retaining the documents
Click form below or call Call (855) 667-4621 today to initiate your special preview of our dynamic wrap document generator.
Adding a one-month orientation period may help an employer avoid complying with the new health benefits. Federal agencies are offering employers a benefits-free 30 day orientation period option in final regulations. There is also clarification on how employers must treat certain categories of new hires, as either FT , PT or Seasonal employees
The Final Regulations
These final regulations provide that the one month period would be determined by adding one calendar month and subtracting one calendar day, measured from an employee’s start date in a position that is otherwise eligible for coverage. For example, if an employee’s start date in an otherwise eligible position is May 3, the last permitted day of the orientation period is June 2. Similarly, if an employee’s start date in an otherwise eligible position is October 1, the last permitted day of the orientation period is October 31.
The new regulations implement part of the “employer shared responsibility mandate” provisions created by the Patient Protection and Affordable Care Act (PPACA). In all categories of new hire the e final regulations provide that one month is the maximum allowed length of an employment-based orientation period. For any period longer than one month that precedes a waiting period, the 90-day period begins after an individual is otherwise eligible to enroll under the terms of a group health plan.
When must an employer offer coverage:
The final regulations continue to provide that if a group health plan conditions eligibility on an employee’s having completed a reasonable and bona fide employment-based orientation period, the eligibility condition is not considered to be designed to avoid compliance with the 90-day waiting period limitation if the orientation period does not exceed one month and the maximum 90-day waiting period begins on the first day after the orientation period.
These final regulations apply to group health plans and health insurance issuers for plan years beginning on or after January 1, 2015.
When the Employer Might be Subject to a Penalty:
If at least one full-time employee of the employer buys health insurance in a public Exchange (Marketplace) and qualifies for a subsidy (either a premium tax credit or a cost-sharing reduction), the employer must pay a penalty.
There are two different types of penalties.
)The IRC section 4980H(a) penalty applies if a large employer offers coverage to less than 70% of its full-time employees in 2015 (or to less than 95% after the 2015 plan year). This penalty is $2000 annually or $166.67/month times the total number of “full-time” employees minus the first 80 (minus the first 30 after 2015). The penalty calculation does not include variable hour or seasonal employees who are in their measurement or administrative periods, even if they in fact worked on average at least 30 hours/week or 130/month during those periods. Nor does it include those who are in their stability periods but who did not qualify for coverage based on their hours worked during the associated measurement period.
IRC section 4980H(b) penalty. It applies if a large employer offers coverage to at least 70% of its full-time employees (95% after 2015), but for some full-time employees the coverage is either not “affordable” or does not provide minimum value. This penalty is $3,000 annually or $250/month for each full-time employee who buys health insurance in a public Exchange (Marketplace) and qualifies for a subsidy and for whom the employee cost for self-only coverage under the lowest-cost option available from the employer is more than 9.5% of the employee’s household income (or one of three safe harbors), or for whom the employer coverage offered does not provide at least minimum value. Again, the penalty calculation does not apply if the employee who qualified for a subsidy was a variable hour or seasonal employee who was in his/her measurement or administrative periods, nor does it include those employees who are in their stability periods but who did not qualify for coverage based on their hours worked during the associated measurement period. Additionally, the (b) penalty cannot be more than the (a) penalty would have been had it applied.
Summary and Employer Action Items
The bottom line is this:
If you hire a non-seasonal employee whom you reasonably expect (at date of hire) to work at least 30 hours/week or 130 hours/month, you must track hours each calendar month and offer benefits by the first day of the fourth month if the employee averages at least 130 hours/month for the first three months. This applies even if you hire this employee for a short-term position or a summer internship (unless you take the position, upon advice from your legal counsel, that a summer intern is a “seasonal” employee).
If you hire a non-seasonal employee and you cannot reasonably determine at date of hire if they will work on average at least 30 hours/week (130 hours/month), you can track their hours over their “initial measurement period” and not offer benefits until the associated “stability period,” if the employee averaged at least 130 hours/ month during the measurement period. The stability period might not begin until 13-14 months after the date of hire.
If you hire an employee who meets the new definition of a “seasonal employee,” you can track their hours over their “initial measurement period” and not offer benefits until the associated “stability period” if they averaged at least 130 hours/month during the initial measurement period. You do not have to offer benefits by the first day of the fourth month.
A copy of the final regulations can be obtained by clicking on the link below:
Sign up for latest news updates. Please contact us for immediate information on how to implement these initiatives for your group-specific needs at info@medicalsolutionscorp.com or Call (855) 667-4621.
Obamacare Midsize Employer Mandate Delayed Till 2016.
For small businesses employing 50-99 the Treasury Dept is not requiring compliance of the Employer Mandate until 2016. Companies with 100 workers or more could avoid penalties in 2015 if they showed they were offering coverage to at least 70 percent of their full-time workers, the Treasury said.
The large group employer mandate had been originally delayed until 2015 in July 2013 see- Obamacare Employer Mandate Delayed, More Guidance. Employers with the equivalent of 50 full-time workers or more had to originally offer coverage or pay a penalty starting at $2,000 per worker beginning in 2014.
Employers with 100 or more full-time employers will have to comply with the Internal Revenue Code Section 4980H “play or pay” provision Jan. 1, 2015. Companies with 100 workers or more could avoid penalties in 2015 if they showed they were offering coverage to at least 70 percent of their full-time workers, the Treasury said.
Under the new rules, companies would be allowed during the phasing-in year to offer coverage specifically to a subset of employees, such as those working 35 hours or more a week, the Treasury said.
Treasury also set new rules for how the requirement would apply to workers such as volunteers and seasonal employees, saying that employers wouldn’t be penalized for failing to offer those people coverage, regardless of the number of hours they were working. Teachers, however, wouldn’t be considered part-time workers even if they were away over the summer, and adjunct faculty would have a special arrangement for how their classroom hours should be counted.
The penalty the employer pays would be based on the number of full-time workers that the employer employs. For purposes of calculating the penalty, the employer would not have to include part-time and seasonal workers in the calculations. Under PPACA, only workers who are not offered group health coverage are eligible to apply for exchange coverage.
The coverage must encompass a core set of benefits and be affordable – which the law defines as premiums costing no more than 9.5 percent of an employee’s income – and the employer must pay for the equivalent of 60 percent of the cost of coverage for workers but not their dependents.
As reported in Washington Post: “Administration officials said that organizations with a large number of volunteer employees – such as firefighters and first responders – would not have to provide coverage, along with those hiring seasonal employers who work six months or less in a given year. Teachers will not be considered part-time just because they do not work for three months during the summer, officials added, while the status of adjunct faculty will be calculated on a formula where they would receive credit for 2¼ hours of service per week for each hour they spent teaching or in the classroom.”
Many Employers are asking for flexibilities of defining FT as higher than 30 hours. The law has already had unintended consequences with shift in employment hours especially in industries such as dining, entertainment, services and construction.
Other transitional relief contained in the regulations include:
For employers with between 50 and 99 employees, the employer mandate is delayed until 2016. Note that an employer must provide a certification to take advantage of this relief.
Employees in positions for which the customary annual employment is six months or less generally will be considered seasonal employees and not full-time employees.
When employers are first subject to the employer mandate, they can determine whether they had at least 100 full-time employees in the previous year by referencing a period of six consecutive months, rather than an entire year.
For purposes of determining coverage in 2015 only, employers may use a measurement period (the period used to determine whether a variable-hour employee is a full-time employee) of six months, with respect to a stability period (the period following the measurement period, during which the variable-hour employee must be offered coverage) of up to 12 months.
Employers with non-calendar year plans must comply with the employer mandate at the start of their 2015 plan year, rather than on January 1, 2015.
For more information regarding both Exchanges – Individual Exchanges or SHOP please contact our team at Millennium Medical Solutions Corp (855)667-4621. We work in coordination with Navigators to assist with medicaid, CHIP Child Health Plus, Family Health Plus and Medicare Dual Eligibles. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
After three (3) years of spirited debate, numerous lawsuits, and a Supreme Court ruling, the individual mandate kicked in January 1, 2014. Individuals must have health insurance or pay a tax (as defined by the Supreme Court). As an employer what should you be prepared for this year?
It has been an eventful year for the American health care system, to say the least. More parts of the Patient Protection and Affordable Care Act (PPACA) have gone into effect and the launch of the health care exchanges across the country is now under way. There have been numerous challenges to the PPACA and many of its components. The U.S. Supreme Court has ruled the Act’s individual mandate constitutional, but continues to examine the constitutionality of other aspects of the law.
Insurers have shifted more and more of the health care cost burden to enrollees through high deductible, higher co-pays and fixed benefits plans. An increasing number of payers are using Medicare based pricing, data analytics and wellness programs in their efforts to control ever rising costs. Narrow networks are popping up across the country as a vehicle for cost control.
Whatever the New Year brings, we look forward to supporting you in your continuing efforts to control costs while maintaining a high standard of care.
The New Year Ushers in Health Care Reform
All employers will have to pay additional taxes on their health insurance plans which may result in about a 5% average increase in premiums.
Waiting periods for benefits may not exceed 90 days from the date of hire. This will be effective with your 2014 renewal.
Small group employers (2-50 employees) will have to include pediatric dental and vision in their 2014 health plans.
Small employers who qualify for the Small Business Health Care Tax Credit, and want to take advantage of the tax credit, must purchase their health insurance through the SHOP Marketplace. Yes, as your broker, we can assist you with the SHOP Marketplace.
Applicable Large Employers are employers with 50 FTE (full-time equivalents) or more, and must offer affordable and minimum value coverage to full-time employees (employees who work 30 hours or more per week). Employers must offer minimum value coverage to dependents, but do not have to meet the affordable test. Employers are not required to offer coverage to spouses. Penalties for not offering coverage have been delayed until 2015. However, we do not know if penalties will begin January 1, 2015 or with the 2015 health insurance renewal; awaiting a response from the IRS.
Applicable Large Employers who have variable hour employees, employees who have a fluctuating schedule, should select a measurement period (3, 6, 9, 12 months) and begin tracking hours to determine if variable hour employees meet the 30 hour requirement.
Employers who issued 250+ W-2 forms for the 2012 tax year will need to include the cost of health insurance on their W-2 forms for the 2013 tax year. Other employers may voluntarily include the cost of health insurance on their employees’ W-2 forms.
Individuals who do not have coverage in 2014 will be subject to a penalty which will be calculated one of two ways, whichever one is higher applies.
$95 per person, $47.50 for individuals under 18; the maximum penalty for a family under this calculation is $285.
1% of yearly household income; the maximum penalty is the national average yearly premium for a bronze plan.
The fee increases every year. In 2015 it’s 2% of income or $325 per person. In 2016 and later years it’s 2.5% of income or $695 per person. After that it is adjusted for inflation.
Individuals who are uninsured for just part of the year, 1/12 of the yearly penalty applies to each month the individual is uninsured. Individuals who have coverage for one (1) day during a month will be considered to have coverage and not pay a penalty for the month. Individuals who have a short gap in coverage, who are uninsured for less than 3 months, may not be required to pay a penalty for those months.
Health Care Reform 2014 Compliance Checklist – Click Here.Please contact us if you have questions, if you need assistance with SHOP Marketplace, or you have employees who need assistance getting individual coverage to avoid the penalty.
SHOP Exchange Delayed One Year. The White House just announced that the online Small Business Health Marketplace also known as SHOP Exchange has been delayed until 2015. Small businesses will still have the option to purchase coverage through the new marketplace but will not be able to do so online. Instead, until next fall, employers with fewer than 50 workers will need to work through a broker or agent to buy health plans for their employees.
The Small Business Health Options Program, or SHOP Exchange, has already had a troubled launch with multiple delays as the Obama administration has focused much of its efforts on launching the individual insurance marketplace where Americans can shop for subsidized health insurance coverage.
Small businesses buying coverage will still be eligible for small business tax credits to bring down the cost, according an administration memo. Also, businesses can still purchase the same plans and same rates available on Off-Exchange. Medical Insurance premiums through the business is an ordinary tax deductible expense.
According to NY Times Article, Online Health Law Sign-Up Is Delayed for Small Business – “The announcement of the delay, just before Thanksgiving, is reminiscent of the way the White House announced, just before the Independence Day weekend, a one-year delay in the requirement for larger employers to offer health insurance to employees.”
The recent setback is the latest in a stream of missed deadlines, including a postponement for a Spanish language sign-up tool announced this week. The administration also recently pushed back the enrollment deadline for individuals: People who sign up by Dec. 23 can get coverage that starts on Jan. 1. In an earlier delay, businesses with more than 50 workers were given until 2015 to meet the requirement to provide health insurance without paying a penalty. And the deadline date for individuals to avoid penalties for failing to get coverage was pushed back six weeks.
If you should have any further questions regarding the SHOP program or comments about the above or the attached, please let us know. We will continue to monitor this issue and all ACA implementation in an effort to keep you informed of new developments. In the meantime, please visit our https://360peo.com/about-us/blog to view past blogs and Legislative Alerts.
Last year, according to FBI statistics, federal agents informed over 3,000 U.S. businesses that their data had been hacked. In nine out of ten cases, these companies didn’t even know their computer systems had been breached until they were informed by the government.
Safety & Loss Prevention Solutions
Employment Practices Liability Insurance
Directors & Officers Liability Insurance
