1095B and 6055 Reporting Requirements FAQ

1095B and 6055 Reporting Requirements FAQ

1095B and 6055 Reporting Requirements FAQ

Under Obamacare, the IRS needs to know if your coverage met health care reform standards.  The 1095-B is issued by Insurers on behalf of fully insured members directly to the IRS and send members a copy.  In short you don’t have to do anything other than reviewing the info and confirming accuracy. 1095B and 6055 Reporting Requirements FAQ

The IRS will accept any number of items to prove that a member had insurance including:

  1. insurance cards
  2. explanation of benefits  statements from your insurer
  3. W-2 Form or payroll statements reflecting health insurance deductions
  4. records of advance payments of the premium tax credit
  5. other statements indicating that you, or a member of your family, had health care coverage

6055 chart

What information is on the 1095-B form?

For each person covered on your policy, the 1095-B lists:

  • Name
  • Address
  • Date of birth
  • Taxpayer identification number (most likely a Social Security number)
  • Months of coverage with us

If you are missing the taxpayer ID or Social Security numbers for anyone on your policy, the Insurer send you a letter. It’ll explain why they need the information and how to send it to Insurers  securely.

How do I know if I should get a 1095-B form?

Insuerers send you a 1095-B form if:

  • You bought your coverage directly  and did NOT go through healthcare.gov.
  • You get employer coverage and it met the health care reform standards.
6055-1095-b-logo6056-1095-c-logo
6055 Reporting on Form 1095-B6056 Reporting on Form 1095-C
Provided by Insurer for insured medical plan; by employer for a self-insured medical planProvided by applicable large employer (ALE)
Provided to each covered “responsible individual” (e.g., employee, COBRA QB, retiree)Provided to each full time employee
Provided by March 31, 2016 for coverage in prior calendar yearProvided by March 31, 2016 for coverage offered in prior calendar year
Transmitted with employer’s Form 1094-B to IRS by May 31, 2016 (June 30, 2016 if filed electronically)Transmitted with employer’s Form 1094-C to IRS by May 31, 2016 (June 30, 2016 if filed electronically)
RESOURCE:
1095-B FAQ – Oxford 1095B reform-reporting-requirements-6055-external-FAQs copy
1096-C FAQ – https://360peo.com/compliance-consulting/form-1095-c-faq/
See IRS Extends 1094 and 1095 DEADLINE – https://360peo.com/irs-extends-1094-and-1095-deadlines/

If your organization can use a helpful audit on ACA, Payroll and HR please contact us today  (855) 667-4621 or info@medicalsolutionscorp.com.

 

This communication is not intended, nor should it be construed, as legal or tax advice. Please contact a competent legal or tax professional for legal advice, tax treatment and restrictions. Federal and state laws and regulations are subject to change.

 

AFLAC

AFLAC

AFLAC

 

AFLAC Get the AFLACTS

The AFLAC duck has become synonymous with Voluntary Supplememntal and Critical Illness benefits, see Consider Supplements to Primary Medical Plans.  Aflac answers the question to “how do I plug in the gaps of eroding medical benefits for employees”.  With office copays as high as $60, average hospitalization exposure of $2000, in-network $1000 deductibles for diagnostics and $100 ER copays this is becoming a valid concern.  

ADVANTAGES of A VOLUNTARY SUPPLEMENTARY BENEFIT.

Payment, not reimbursement:  the insured does not have to spend money up front, in terms of a deductible, in order to get the benefit. Having an accident or being diagnosed with a specific illness, such as cancer, triggers the payout. The employee doesn’t have to incur an expense and then wait for reimbursement. This is important because employees may be facing high deductibles in their medical plan coverage, so having the ready cash is a major help.

Not tied to medical plan: A common point of confusion with both accident and critical illness products is that their benefits are somehow “offset” by medical plan benefits. It’s important that the employee and the employer alike understand that these limited benefit policies perform as supplements to medical coverage, but are not in any way linked to them and their benefits are delivered with no offsets or reductions once policy requirements are met.

Use money in any way: The nature of medical plans is that insureds only get reimbursed for “qualified expenses,” which the insurer details within the program. With both accident and critical illness, since insureds receive a lump sum for particular injuries or diseases, they have no such restrictions on how they use the money. For example, a person who loses the use of a limb might use the accident policy’s payout to make home modifications that make life easier. Someone with a cancer diagnosis might wish to consult with a specialist across the country, and can use the critical illness policy’s payout for travel and lodging expenses. If an experimental treatment is not covered by a medical plan, the insured can use the critical illness policy’s payout to spend the $10,000 or more to pay for the treatment.

Direct and transparent: For most people, a glance at the list of potential injuries on an accident policy, or taking on the topic of dread diseases, can generate queasiness. Who really wants to think about winding up in a coma or fighting cancer? But the policy benefits are clear and transparent, unlike the sometimes-mystifying coverage rules in medical policies. Employees will get the message that, by offering these voluntary benefits, the employer is raising important financial-security issues and providing affordable solutions to address them.

Simplified claims: In most cases, to receive a benefit the insured simply provides the insurer with a claim form and applicable paperwork from a care provider that documents the injury or diagnosis of disease. With accident insurance, additional paperwork might be required to determine whether the claim stems from the insured taking part in certain inherently dangerous activities, such as bungee jumping or car racing, in which case benefits might be denied. Such restrictions will be clearly stated in the policy.

Ready availability: Generally, accident insurance payments are issued to employees without any pre-existing condition limitations. Critical illness insurance might require the employee to fill out questions on an application for coverage, although under certain conditions, employees may be eligible for a guaranteed issue offer without requiring answers to health questions. Regardless, employees would have a hard time finding either of these coverage options at such affordable prices outside of the group voluntary benefits context. Premiums of only $20 or $30 a month for each insured are common in these worksite products.

Family coverage: Depending on the carrier, the employee can opt to get coverage for a spouse and dependent children (up to a certain age) as well. This is a real advantage if a working spouse does not have coverage through his or her employer. But, this is equally important for spouses who work in the home, because household finances might be more constrained and thus make the additional policy benefits even more critical. In the case of children, the accident coverage usually pays benefits for non-professional sports injuries, a common occurrence. Depending on the injury, the out-of-pocket costs for emergency room services, copays and deductibles for medical care and follow-up physical therapy can quickly exceed $1,000. An accident policy typically would provide benefits to cover the lion’s share of those costs.

Portability: In most cases, accident insurance allows employees and dependents to continue the coverage after leaving the employer or retiring. For critical illness, there may be certain conditions involved, but the key is that most policies allow employees and dependents to continue enjoying these coverage options at group rates wherever life might lead them next.

For more information on how a work-site supplemental package would help you and your company please  contact us at (855)667-4621 info@medicalsolutionscorp.com today.

Health Republic NY Shutting Down Nov 30

Health Republic NY Shutting Down Nov 30

Health Republic Ending Nov 30Health Republic NY Shutting Down Nov 30

Breaking:   All Health Republic plans (Group and Individual) ending on 11/30according to early reports the healthcare Co-Op Health Republic NY will be shutting down Nov 30, 2015.   New York State Department of Financial Services (NYDFS), the New York State of Health Marketplace  (NYSOH), and the Centers for Medicare and Medicaid Services (CMS) announced additional actions regarding Health Republic Insurance of New York (“Health Republic”) and a transition plan for Health Republic customers.

TIMELINE:

  • Oct 28th – Utah Healthcare Co-Op shutting down end of 2015.  This sis the 5th Co-Op to shut downHealthCare Co-Ops Shut Down Tax Costs
  • Sept 25, 2015 – original announcement Health Republic NY is Shutting Down effective Dec 31, 2015.
  • June 2015 – With a spike in rate increase of 15-20% for 2016 to reflect unexpected high costs of new 200,000 membership the most affordable health plan was experiencing difficulties.  The insurer reported $130 million in losses during its first 18 months of operations, according to financial filings, even as it enrolled more customers than any other insurer. DFS did allow for a 13 percent increase in the second year and a 14 percent increase heading into 2016. Both were lower than what Health Republic requested, though, and were not enough to save the struggling insurer.
  • May 2015- Health Republic was dealt its death blow when it became clear that the Affordable Care Act’s risk corridor program would not be fully funded, said one source familiar with the company’s finances. A report from Standard & Poor’s in May said the program had only 10 percent of the funds needed to make payments.
  • Summer 2013 -Health Republic had borrowed $265 million to begin operations.

New Insurance Risk Corridors paid for by a combination of both consumer insurance premium surcharge tax of 2-3% and Health Insurers is suppose to reclaim capital to those that are less profitable.  Health Republic was owed approximately $147 million but was told by the Centers for Medicare and Medicaid Services to expect less than half that according to sources.

Regrettably, we all suffer when an Insurer exits the market.  Furthermore, it will be a while again when Federal funds earmarked to start a low cost affordable health plans will materialize again.  We are pulling for neighboring co-op Health Republic of NJ and hope this trend discontinues.

Our agency will be working closely with our clients to mitigate this exposure and transition smoothly for Dec 1, 2015.   Individuals on the Marketplace can contact the New York State Department of Financial Services Consumer Hot Line with questions regarding Health Republic by calling 1-800-342-3736. The Hot Line hours are weekdays (Monday through Friday) from 8:00 a.m. to 8:00 p.m., and Saturday from 9:00 a.m. to 1:00 p.m.

Please Click here to read the full Press Release from NYDFS.

 

Stay posted, more news to follow. Our Agency as in the past will be out and early in front positioning our clients for best options. For more information on this or to schedule a call please contact us info@medicalsolutionscorp.com today.

 

 

NEW 2016 Oxford Metro Network NY

NEW 2016 Oxford Metro Network NY

NEW 2016 Oxford Metro Network NY Image1

NEW 2016 Oxford Metro Network NY

Oxford has released an affordable new plan for 2016 and not a moment too soon.  With the recent exit of popular Health Republic of NY, Health Republic NY is Shutting Down, the market is starving for an affordable option.

Today’s largest networks with  in-network only GOLD  are  priced at  $9,000/single annually. They typically are accompanied with $50 copays and  non-office exposures of $1,000 deductibles and coinsurance percent in network. The new Metro network is approximately 25% smaller than NY Liberty network with up to 15% IN SAVINGS.  For example, an Oxford Liberty HMO Gold  is $745 vs  Oxford Metro Gold $650.

In 2015  Oxford’s Garden State Network  originated the same game plan of offering a third network in addition to FREEDOM and LIBERTY.  After all what good is a large network when one cannot afford to visit Providers? The third network answers the call for access to Providers with half the copays priced at approximately $1,500 less.

All Metal Levels will be included for all size groups including 1-99 & 100+. The new Oxford Metro plan will be limited to NY and NJ Garden State Network Providers. Referrals will be needed to see Specialists.  Importantly, most NY Hospitals will be participating with the EXCEPTION of NYU Health System, North Shore LIJ Health System (NorthWell Health) and Maimonides Medical Center. In addition, certain key medical IPA Groups such as Mt Kisko Medical Group are NOT in the network.

The Healthy NY and off-exchange Individuals will use exclusively this new Oxford Metro Network.


 

DOCTOR SEARCH:  Click Here

BENEFITS SUMMARY: OXFORD Platinum, Gold, Silver AND Bronze

Individual Sample Rates: Oxford 2016 NY Individual Rate Sheet

Individual Enrollment Forms: Oxford 2016-NY-MMS-Individual-application-Kit

Individual ON-Exchange UHC Network

Oxford Drug Formulary: Click Here

Oxford Metro FAQ. Click Here

Group Sample Rates:

Oxford sample Metro 2016 Rates

Platinum & GOLD

Oxford sample Metro 2016 Rates Bronze Silver

Silver & Bronze

 

 

 

 

 


ENROLL TODAY – Individual

3 steps:

1.  Initial Check Deposit: “Oxford Health Plans”.

2.  Proof of address:

  •  Valid New York State driver’s license
  • Voter Registration Card
  • Current income tax return, current lease or current utility bill
  • If mailing address is different than street address, please provide mailing address under separate cover

3.  Enrollment form below and mail back to:

Oxford  Individual Product Department

 14 Central Park Drive

 Hooksett, NH 03106

NOTE: Jan 15th deadline to submit  Feb 1, 2016  effective date.  Jan 31st is the deadline for a  March 1, 2016 effective date.

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Sign up for upcoming webinars and newsletters. Please contact us TODAY for a customized analysis for your group-specific needs at info@medicalsolutionscorp.com or Call (855) 667-4621.

Health Republic NY is Shutting Down

Health Republic NY is Shutting Down

HRNY ending 2016Health Republic NY is Shutting Down

BREAKING: The young Co-Op start up of 2014 will be shutting down Dec 31, 2015.  With  membership totals approx. 200,000+ the early exit comes as a shocking surprise despite their recent losses and  15-20% rate increase approved for 2016.

On Friday, a joint announcement came from the state Department of Financial Services, the Department of Health and the federal Centers for Medicare and Medicaid Services (CMS), with DFS directing Health Republic to cease writing new health insurance policies and begin an orderly wind-down of business.

“Given Health Republic’s financial situation, commencing an orderly wind down process before the upcoming open enrollment period is the best course of action to protect consumers,” said Anthony Albanese, acting superintendent at DFS. “Moving forward, we will work closely with New York State of Health and federal regulators to help ensure continuity of coverage for Health Republic’s customers.”CMS officials said decision was made after state and federal agencies determined it was likely Health Republic would become financially insolvent.

According to recent announcements Health Republic of NY was exiting the small group and individual markets for Mid-Hudson, Albany, and Utica/Watertown regions.  These counties include: Albany, Columbia, Delaware, Dutchess, Essex, Greene, Hamilton, Oneida, Orange, Oswego, Putnam, Rensselaer, Saratoga, Schenectady, Sullivan, Ulster, Warren, and Washington.  The reasoning was the high delivery costs driven by Provider consolidation, see https://healthrepublicny.org/media/2563/faqs-service-area-reductions.pdf.

With recent exits for Insurers such  Atlantis, Emblem Health/GHI and Empire blue Cross the transitions were handled differently.  Some allowed groups to see their plan through renewal anniversary date or end of year.  Further announcements are expected on transition of coverage.

Our Agency as in the past will be out and early in front positioning our clients for best options. For more information on this or to schedule a call please  contact us info@medicalsolutionscorp.com today.

 

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