Update: Oxford/United and Mt Sinai Health Systems Split
Mount Sinai, UnitedHealthcare dispute terminating contract March 1, 2024 . What Oxford/United members need to know.
Health Care Reform Updates
Updated Guidance for Reporting Employer-Sponsored Health Coverage on Form W-2
Updated Guidance for Reporting Employer-Sponsored Health Coverage on Form W-2
New guidance from the IRS provides additional information for employers that are subject to the requirement under Health Care Reform to report the value of the health insurance coverage they provide employees beginning with 2012 Forms W-2 (generally furnished to employees in January 2013).
The requirement continues to be optional for smaller employers filing fewer than 250 Forms W-2 in the preceding calendar year unless and until further guidance is issued (but be sure to comply with any state-specific requirements regarding reporting the cost of health coverage provided to adult children).
New Guidance Updates Information on How to Report, Coverage to Include, and Determining Costs of Coverage
Among other things, the new guidance:
– Clarifies the application of the interim relief from the reporting requirement for employers filing fewer than 250 Forms W-2 for the preceding calendar year;
– Adds a new example that demonstrates that the reporting requirement does not apply to coverage under a health flexible spending arrangement (FSA) if contributions occur only through employee salary reduction elections; and
– Provides that employers are not required to include the cost of coverage under an employee assistance program (EAP), wellness program, or on-site medical clinic in the reportable amount if the employer does not charge a premium with respect to that type of coverage provided under COBRA to a qualifying beneficiary.
Additional Information
To read the new guidance in its entirety, see Notice 2012-9. You can also view the Frequently Asked Questions regarding this requirement from the IRS.
Health Insurers Cover Home COVID-19 Tests
Starting Jan 15 at-home CIOVID-19 tests will be free of charge.How Will this work with your Insurer? Types of COVID Tests? Call (855)667-4621
President Issues Health Care Plan Executive Order
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. For information about transparency providers and new tech tools contact us...
Clinton vs Trump on Healthcare
CLINTON VS TRUMP ON HEALTH CARE
CLINTON VS TRUMP ON HEALTHCARE
Clinton vs Trump Healthcare. A helpful overview from SHRM on the differences between the Candidates. They presumably agree on repealing the Cadillac Tax and well-needed price transparencies.
HILLARY CLINTON’S HEALTH CARE REFORM PLAN:
- Defend the Affordable Care Act. Clinton will continue to defend the ACA against Republican efforts to repeal it.
- Lower out-of-pocket costs like copays and deductibles. The average deductible for employer-sponsored health plans rose from $1,240 in 2002 to about $2,500 in 2013. Clinton believes that workers should share in slower growth of national health care spending through lower costs.
- Reduce the cost of prescription drugs. Prescription drug spending accelerated from 2.5 percent in 2013 to 12.6 percent in 2014. It’s no wonder that almost three-quarters of Americans believe prescription drug costs are unreasonable. Clinton believes we need to demand lower drug costs for hardworking families and seniors.
- Build on the Affordable Care Act and require plans to provide three sick visits without counting toward deductibles every year. The Affordable Care Act required nearly all plans to offer many preventive services, such as blood pressure screening and vaccines, with no cost-sharing at all. But because average deductibles have more than doubled over the past decade, many Americans would have to pay a significant cost out-of-pocket toward their deductible if they get sick and need to see a doctor. Clinton’s plan will build on the Affordable Care Act by requiring insurers and employers to provide up to three sick visits to a doctor per year without needing to meet the plan’s deductible first.
- Provide a new, progressive refundable tax credit of up to $5,000 per family for excessive out-of-pocket costs. For families that still struggle with prescription drug costs even after out-of-pocket limits on drug spending and free primary care visits, Clinton’s plan will provide progressive, targeted new relief. Americans with health coverage will be eligible for a new refundable tax credit of up to $2,500 for an individual, or $5,000 for a family, available to those with substantial out-of-pocket health care costs. The credit will be available to insured Americans with qualifying out-of-pocket health expenses in excess of five percent of their income, and who are not eligible for Medicare or claiming existing deductions for medical costs. This refundable, progressive credit will help middle-class Americans who may not benefit as much from currently-available deductions for medical expenses. This tax cut will be fully paid for by demanding rebates from drug manufacturers and asking the most fortunate to pay their fair share.
- Enforce and Broaden the ACA’s Transparency Provisions. Americans deserve real-time, updated, and reliable information to guide them in selecting a health plan, navigating changes to their out-of-pocket costs in their existing plan, choosing a doctor, and determining how much they will need to pay for a prescription drug. Clinton’s plan will vigorously enforce existing law under the Affordable Care Act and adopt further steps to make sure that employers, providers, and insurers provide this information through clear and accessible forms of communication so that Americans can make informed choices about their coverage and realize meaningful savings.
- Repeal the ACA “Cadillac Tax”
Source: https://www.hillaryclinton.com/issues/health-care/
DONALD TRUMP’S HEALTH CARE REFORM PLAN:
- Repeal ACA -Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.
- Tax deductible health insurance premium payments. Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. -Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty. The flexibility and security provided by HSAs will be of great benefit to all who participate.
- Price transparency. Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.
- Reform mental health programs. Families, without the ability to get the information needed to help those who are ailing, are too often not given the tools to help their loved ones. There are promising reforms being developed in Congress that should receive bi-partisan support.
- Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.
- Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.
Source: https://www.donaldjtrump.com/positions/healthcare-reform
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Healthcare Reform Resource
Click Above
2015 Individual Open Enrollment is Ending
7 Steps: Getting Ready to Buy Health Insurance
Top 10 List – Health Exchange Marketplace
Health Reform Nondiscrimination Provision
SEP and Qualifying Event Marketplace
Small Biz Tax Credit Calculator
Travel Insurance and Affordable Care Act FAQ
Health Reform Explained Video
Health Reform Summary By Kaiser
Young Adult Affordable Care Option
Health Exchange Marketplace Top Ten List
Health Exchange Marketplace Top Ten List
The Health Exchange also known as The Health Marketplace or Obamacare Exchanges are set to open in less than 12 hours. Are you ready or aye you like most asking What is an Exchange? Starting Oct 1 you can enroll until March 31, 2014, though you’ll generally need to sign up by Dec. 15 of this year, to be covered as of Jan. 1. You can find your state’s marketplace at healthcare.gov. The prices for the marketplace plans are likely to be similar to those sold privately. A plan that is also available on the exchange may be eligible for subsidies. Heres an easy top 10 list of what you need to know.
10. Locate your State Exchange
Look up your state’s exchange here and Healthcare.gov. Some states are running their own exchange, others are running it through the federal government see www.healthcare.gov. For NY Tri-State the sites are:
NYS – http://info.nystateofhealth.ny.gov See rates here
NJ – https://www.healthcare.gov/how-do-i-choose-marketplace-insurance
CT – https://www.accesshealthct.com See rates here
9. Individual Mandate Penalty
For 2014, the annual penalty is $95 or 1% of your income, whichever is greater. The penalty will increase over the first three years. Coverage can include employer-provided insurance, individual health insurance, Medicare or Medicaid.
| Health Insurance Individual Penalty for Not Having Insurance Pay the greater of the two amounts | ||
| Year | Percentage of Income | Set Dollar Amount |
| 2014 | 1% | $95 & $285/family max |
| 2015 | 2% | $325 & $975/family max |
| 2016 | 2.5% | $695 & $2,085/family max |
8. Individual Subsidies
Individuals who do not have affordable minimum essential coverage from their employer will be eligible for tax credit subsidies for their health insurance purchase on a state exchange if their income is below 400 percent of federal poverty level.
If you make under $45,960 or your family makes under $94,200, you could get a real break on health insurance costs More low-income people will also be eligible for free coverage under Medicaid For those eligible, the subsidies will cap the amount you pay for your exchange policy at between 2% and 9.5% of your income (on a sliding scale, based on your income). To find out how much you would pay, estimate your income for this year and plug it into any health subsidy calculator. You can also see estimate subsidies with these “health subsidy charts”.
7. Small Business Subsidy – SHOP Exchange
A key change is that the small business health care tax credits will only be available ONLY through the SHOP Exchange marketplace in 2014. Small businesses with 25 or fewer employees who receive less than $50,000 a year in wages may be eligible for tax credits if they purchase the plan through the SHOP marketplace. These credits will cover up to 50% of the employer’s cost (35% for non-profits) for the first two years of coverage. Click here to read more about the small business health care tax credits.
6. Your income
not your assets, such as your house, stocks or retirement accounts – will count toward determining whether you can get tax credits. When you buy your plan, you estimate your income for next year, and your tax credit is based on that estimate. The next year, your tax returns will be checked by the IRS and compared against your estimate.
5. Pre-Existing Conditions Eliminated
Your insurer generally can’t drop you, as long as you keep up with your insurance premiums and don’t lie on your application. Generally, people will be able to enroll in or change plans once a year during the annual open enrollment period. This first year, open enrollment on the exchanges will run for six months, from Oct. 1 through March of next year. But in subsequent years the time period will be shorter, running from October 15 to December 7.
4. Essential Health Benefits Covered
Each plan covers 10 “essential health benefits,” which include prescription drugs, emergency and hospital care, doctor visits, maternity and mental health services, rehabilitation and lab services, among others. In addition, recommended preventive services, such as mammograms, must be covered without any out-of-pocket costs to you. More info here.
3. Ninety-Day Maximum Waiting Period
Group health plans and health insurance issuers may not impose waiting periods of more than ninety days before coverage becomes effective. This also applies to grandfathered plans.
2. Annual or Lifetime Limits
Group health plans, including grandfathered plans, may no longer include more than restricted annual or any lifetime dollar limits on essential health benefits for participants. Limits may exist in and after 2014 for non-essential benefits.
1. Not Everyone is Eligible
- Immigrants who are in the country illegally will be barred from buying insurance on the exchanges. However, legal immigrants are permitted to use the marketplaces and may qualify for subsidies if their income is no more than 400 percent of the federal poverty level (about $46,000 for an individual and $94,200 for a family of four).
- members of certain religious groups and Native American tribes
- incarcerated individuals
- people whose incomes are so low they don’t have to file taxes (currently $9,500 for individuals and $19,000 for married couples)
Conclusion:
There has been a lot of news about individual Obamacare provisions getting delayed – Obamacare Employer mandate Delayed. Some people may assume that means the health law is being slowly dismantled, or put off for an additional several years. .The Affordable Care Act is an extremely complicated law with a lot of moving parts, but ultimately, the biggest provisions are still moving forward. There will likely be more hiccups along the way. As the enrollment period opens for Obamacare’s new exchanges, industry experts predict there will probably be other issues that need to be ironed out — but that doesn’t mean the whole law is collapsing
Still confused?
Don’t be. These are the common questions that we are working through with our clients daily. Am I better off going SHOP Exchange vs. Individual for my business? Am I better off going off Exchanges or onto Private Exchanges? Whats my minimum employer contribution? Do I have to cover employee and dependents? Is dental and vision included? What happens to my Healthy NY when it shuts down Jan 1, 2014? What employer notices must I be posting?
Please contact our team at Millennium Medical Solutions Corp if you have additional questions regarding how SHOP Exchanges and Individual Exchanges can benefit you Stay tuned to our site for updates as more information gets released. Sign up for latest news updates.
Looking for Affordable Health Insurance? You can use this SINGLE PAGE form to get affordable health insurance quotes outside exchange and save money. If you are above 64 years, then use this link to Get FREE Medicare quotes from the most trusted carriers.
Resource:
- Click Above
Federal government health care site: www.healthcare.gov
Kaiser Health Reform Subsidy Calculator:http://healthreform.kff.org/subsidycalculator.aspx
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Health Exchange Notification Due Oct 1
Health Exchange Notification Due Oct 1 – Employers Must Distribute Required Exchange Notice
If your organization hasn’t done so already, you have until October 1 to inform employees about their option to enroll in a public health exchange under theAffordable Care Act.
Notice Must Be Provided to Current and New Employees. Following a delay in the original effective date, employers will need to comply with the new requirement to provide each employee a written notice with information about a Health Insurance Exchange (also known as a Marketplace) beginning this Fall.
Employers are required to provide the written notice to each current employee not later than October 1, 2013, and to each new employee at the time of hiring (within 14 days of the employee’s start date) beginning October 1, 2013. Two model notices are available from the U.S. Department of Labor:
Model Notice for Employers Who Offer a Health Plan
Model Notice for Employers Who Do Not Offer a Health Plan
Employers must provide the notice to each employee regardless of plan enrollment status (if applicable) or of part-time or full-time status. Employers are not required to provide a separate notice to dependents or other individuals who are or may become eligible for coverage under the plan but who are not employees.
The notice may be provided by first-class mail, or, alternatively, it may be provided electronically if certain requirements are met. More information on the notice requirement is available from the U.S. Department of Labor.
IMPORTANT: The model notice contains an optional section about employer-sponsored coverage details. The model notice is three pages long and contains an optional section on page three (questions 13 though 16). An employer is in no way obligated to provide the optional information requested on the model notice. Also, an employer may modify the notice as long as the end result corresponds to the overall basic content guidelines. However, the employer should carefully weigh the value of providing additional information about the cost and value of the employee’s group health plan options.
Technically, the law does not impose any fines for failing to provide the notices. However, the Affordable Care Act is intertwined with other laws (this particular provision is embedded in the FLSA in a new section, 8A), so it is considered a good idea to comply to avoid possible legal complications.
Who Must Receive the Notices?
Notices must be given to all employees, whether or not they work full time, and regardless of whether they are currently receiving health benefits. The October 1 deadline is to give these notices to all employees. After October 1, the notices must be given to new hires within two weeks of coming on board.
The notices must “be provided in writing in a manner calculated to be understood by the average employee,” says the Department of Labor (DOL) in Technical Release 2013-02. They can also be provided via e-mail, but only to employees for whom accessing e-mail is “an “integral part of the employee’s duties” and who can access the system easily.
Which Employers Must Send the Notices?
The notice requirement must be met by employers that must comply with theFair Labor Standards Act (FLSA). In general, the FLSA applies to employers with one or more employees who are engaged in, or produce goods for, interstate commerce. For most firms, a test of not less than $500,000 in annual dollar volume of business applies.
The FLSA also specifically covers the following: hospitals; institutions primarily engaged in the care of the sick, the aged, mentally ill, or disabled who reside on the premises; schools for children who are mentally or physically disabled or gifted; preschools, elementary and secondary schools, and institutions of higher education; as well as federal, state and local government agencies.
Model Notices
The DOL has issued a pair of model notices you can use. One is for employers which currently offer health benefits and another for those which do not. On Part B of the forms, you will see information the employees will need if they plan to purchase coverage on the exchange, assuming they are eligible.
The Part B information would allow employees who apply to their state’s exchange (or the federal version, if no state-run exchange exists) to complete a required questionnaire to determine their eligibility for the program.
The model notice for employers that do currently offer health coverage features a lot of slots for information about your health plan in Part B. Since the law doesn’t actually require you to provide the information, and because some of the information may be hard to dig up employers may decide to disregard some or all of Part B, especially if the information is uncertain or likely to change, employers to be “cautious about volunteering too much information.”
Ask us about our Online Notification Tool developed by our payroll partner. Be sure to visit our section on Health Care Reform for information on other notices required to be provided and to download additional model notices available for employers and group health plans.
FSA – What is a Health FSA
FSA – What is a Health FSA?
A health care FSA can reimburse you or help you pay for eligible health care expenses not covered by your health plan. The portion of your paycheck you put into your FSA is taken out before you pay federal income taxes, Social Security taxes and most state taxes. It’s a great way to save money.
Example FSA Savings
| Without FSA | With FSA | Savings | |
| Family co-payments | $80 | $48 | $32 |
| Contact lenses and solution | $400 | $240 | $160 |
| Over-the-counter items | $300 | $180 | $120 |
| Braces and dental co-insurance | $2,520 | $1,512 | $1,008 |
| Yearly Total: | $3,300 | $1,980 | $1,320 |
Tax Savings
Generally, contributions you make to your FSA are not subject to federal income taxes or social security taxes. In most instances, there are no state taxes taken out either. The amount you may save depends upon:
- The amount you put into your FSA
- The tax percentage you would normally pay on that money (tax bracket)
Let’s say you want $2,000 taken out of your paycheck this year to put into your FSA. The money you direct to your FSA is taken out of your check before taxes are taken out. That reduces your taxable income by $2,000.
Let’s say you normally pay 30 percent in federal, social security and state taxes on your income. In this example, you would enjoy a tax savings of 30 percent of the $2,000. In other words, you could get a $600 tax savings on the $2,000 you directed to your FSA.
This example should not be taken as tax advice. See a tax advisor to seek the best advice for your situation. To see how much you may save, check out Aetna’s FSA Savings Calculator.
Your Contribution
Ready to decide the amount you want in your FSA? It’s good to plan ahead.
- Consider the medical, vision or pharmacy costs not covered by a health plan. Need dental work? How about contact lenses? Buy cold medicine, aspirin and sunscreen throughout the year? Your FSA may help pay for these items and more.
- Also look at family changes that might have an impact on your expenses.
Due to Health Care Reform the IRS now limits the amount you can put into a health care FSA. The IRS limitation for FSA contributions is $2,500 per employee. Your employer may also set a minimum amount you can contribute. Review your enrollment materials to learn the minimum and maximum amounts you can set aside in your account.
Just remember this: FSA dollars are “use-it-or-lose-it” funds. Account balances cannot be carried over from year to year. If you have any unused funds at the end of the plan year, or at the end of any applicable grace period, those funds will be forfeited. That’s an IRS requirement. So estimate what you want to direct to your FSA carefully.
For help deciding how much to contribute, check out the FSA Savings Calculator.
Medical FSA contributions limited to $2,500 per year – Jan 2013 UPDATE
Starting in 2013, you can set aside up to $2,500 per year into a medical Flexible Spending Account, or FSA. This limit applies to each plan, not each person on the plan. FSAs, also called Flexible Spending Arrangements, are funds that you can use to pay certain types of health care expenses. Not all employers offer FSAs as part of their benefits.
What’s good about FSAs? They’re tax-free. What’s not so great? At the end of the year, what you don’t use, you lose, unless your plan has a grace period. So before you fund your FSA, estimate how much of your expenses would qualify for FSA reimbursement. That way, you don’t set aside more than you’re likely to spend.
Not sure what you can use your FSA funds for? Think out-of-pocket health care expenses – medical, dental and vision charges not paid by your insurance. Some FSAs reimburse dependent care expenses. Check your FSA for details.
Here’s what’s different
Before 2013, there was no limit on how much you could put into your FSA. Now, the most you can contribute is $2,500 per year. Also, there’s a new rule on medical spending accounts like FSAs. You can use FSA funds for over-the-counter medicine only if you have a prescription. Keep this in mind when planning your FSA contribution.
How it impacts you
If you don’t have an FSA, this doesn’t affect you. But if you have one, you can only set aside $2,500 or less. This puts a limit on your tax savings. But it also limits your loss if you end up not using all of your FSA funds.
Will the FSA contribution limit stay at $2,500 every year?
No. It will be adjusted yearly for inflation.
Does this new rule mean I need to have an FSA?
No. But if you have a lot of health care expenses that can qualify for reimbursement, it might be a good idea. Especially if you pay about the same each year.
Does the $2,500 limit apply to other types of spending accounts?
No. The limit only applies to FSAs. It doesn’t affect your health reimbursement arrangement (HRA), health savings account (HSA) or medical savings account (MSA).
Will my FSA funds roll over to the next year?
No. You’ll lose any FSA dollars left at the end of your plan year, so plan your contribution well. Some employers give you a grace period after the end of the year to use your FSA funds.
What happens if I use my spending account funds for nonqualified expenses?
Funds used for nonqualified expenses will be taxable and may be subject to 20% tax penalty. This only applies to Health Savings Account and Medical Savings Account funds.
Do I need a prescription to use my spending account funds for insulin?
No. You can use your spending account funds to purchase insulin without a prescription.
Click below to find an infographic and full explanations of these benefits to help clients make informed decisions. Ask us about our preferred SMB Payroll Partnership Program – (855)667-4621.
Pre-Tax Benefits for Your Small Business