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White House Ends ACA Subsidies

October 13, 2017 | Leave a Comment

White House Announces ACA Subsidies Will End 10-13-17

The White House announced on Oct. 12 that it will end reimbursements for low-income individuals who purchase insurance through the Exchanges. The cuts are effective immediately.

This decision will likely affect the open enrollment period beginning Nov. 1. Some states have indicated their intention to sue the federal government to force these subsidies to be paid. However, until a federal court intervenes or Congress enacts an appropriation for these payments, it is possible that these cost-sharing reductions will no longer be paid.

For more information on the announcement that the White House will end ACA subsidies, please click here.

Posted in Blog, Health Care Reform Info, Legislative Alerts | Tagged  , ,

New Executive Order Designed to Change ACA Rules

October 13, 2017 | Leave a Comment

New Executive Order Designed to Change ACA Rules

On Oct. 12, President Donald Trump signed an executive order intended to change current ACA rules and reform the U.S. health care system by expanding choices and increasing competition. While it does not implement any immediate change, the order provides guidance for federal agencies to issue new regulations.

It will take time to see the full impact of the executive order, and it is unlikely any significant change will be seen before the Nov. 1 open enrollment period. All employers should continue to prepare for upcoming ACA requirements and deadlines.

The order is expected to relax regulations on association health plans, allowing individuals and small businesses to purchase health insurance policies across state lines and avoid certain ACA requirements.

For more information on the executive order and association health plans, click here.

Posted in Benefits, Blog, Health Care Reform Info | Tagged  , , ,

Updates on Replace and Repeal of the ACA: American Health Care Act Sent to the Senate

May 10, 2017 | Leave a Comment

AHCA sent to senate

On May 4, the U.S. House of Representatives voted to repeal the 2010 Affordable Care Act and replace it with the American Health Care Act. The new bill is now being deliberated by the Senate.

Although there is much media coverage surrounding the bill, all ACA requirements will remain in effect until the AHCA is passed by the Senate and signed into law by President Trump.

As the Senate considers the AHCA as it has been passed by the House of Representatives, it may pass or dismiss the bill in its entirety – or it could change the legislation so much that it passes a drastically different bill.

If the House and the Senate do pass separate versions of the bill, a committee will be formed to compromise and draft a hybrid of both bills. If a committee produces a hybrid bill, the Constitution requires that both the House and the Senate pass identical versions of the bill before it can be signed into law by President Trump.

This process may take weeks or months.

If it was signed into law as it stands now, the AHCA would make the following revisions to the ACA:

How will this affect your employer health plan?

  • Employer shared responsibility rules—

The ACA’s employer shared responsibility rules require applicable large employers (employers with 50 or more full-time employees) to offer an acceptable minimum level of health coverage to full-time employees and their dependents – or pay a penalty. Under the new bill, this provision will be canceled. However, Form 1094 & 1095 reporting requirements will remain.

  • Federal subsidies for small businesses—

In 2020, the ACHA will repeal the ACA’s small business tax credit.

  • Relief from Cadillac tax—

The start date of the excise tax on high-cost employer-sponsored health plans will be pushed back, so the tax will begin after Dec. 31, 2025.

How will this affect your employees?

  • Increases in HSA contribution limits—

The ACHA will increase the maximum Health Savings Account contribution limit beginning in 2018. Where the maximum out-of-pocket limit allowed by law is currently $3,400 for self-only and $6,750 for family coverage, the ACHA will increase those maximums to $6,550 and $13,1000 respectively.

  • HSAs covering prior expenses—

Under the new bill, HSA funds will be able to pay for health care expenses incurred prior to the start date of the HSA (at least for funds occurring after the start date of a high deductible health plan, given the HSA is opened within 60 days from the start date of the HDHP).

  • OTC medications—

Tax-advantaged HSAs will be able to be used for a wider variety of over-the-counter health purchases.

  • FSA limits—

The ACHA will repeal the ACA’s clause imposing a limit to the funds an individual can contribute annually to a health Flexible Spending Account.

How will this affect the health care exchange?

  • Individual mandate—

The ACA requires most individuals to obtain acceptable health insurance coverage for themselves and dependents or pay a penalty. Under the AHCA, this mandate will be repealed. Instead, the ACHA will impose a 30 percent penalty onto the premiums of small groups and individuals that have lapses in coverage.

  • Federal subsidies for individuals—

The ACA currently offers tax credits to low-income individuals who purchase health care coverage through the exchange. The AHCA will repeal these credits in 2020 and replace them with a monthly tax credit for all individuals.

Things that will not be changed by the ACHA include that coverage will still be allowed for children up to the age of 26 and there will be guaranteed availability and renewability of coverage.

Click here to read the American Health Care Act.

Posted in Benefits, Blog, Health Care Reform Info, Legislative Alerts | Tagged  , ,

House Republicans Release Legislation to Repeal and Replace the ACA

March 23, 2017 | Leave a Comment

On March 6, 2017, the House Ways and Means Committee and the House Energy and Commerce Committee each released budget reconciliation bills. These pieces of legislation are part of the House Republican’s American Health Care Act (AHCA), the legislation designed to repeal and replace the Affordable Care Act (ACA).

Though both bills must pass through the legislative process before becoming law, it is important to understand the potential changes to come if the legislation becomes effective. This article outlines the major changes proposed in the legislation:

  • Changes to the ACA
    The AHCA proposes to repeal both the individual and employer mandate penalties. It would also eliminate ACA-imposed taxes on over-the-counter medications, medical devices, prescription drugs and health insurance premiums.
  • Changes to Tax Credits
    The AHCA would repeal the ACA premium tax credits beginning in 2020 and replace them with a new age-adjusted, fixed-dollar refundable tax credit. The tax credit would be adjusted for inflation and be available only to people who are not eligible for employer- or government-sponsored health insurance. The AHCA would also repeal the ACA small business tax credit beginning in 2020.
  • Changes to Health Spending Accounts
    The AHCA would lower taxes on health savings account (HSA) distributions on nonqualified medical expenses to pre-ACA rates effective after Dec. 31, 2017, and allow both spouses to make catch-up contributions to one HSA beginning in 2018. The legislation would also repeal the contribution limits on flexible spending accounts (FSAs), effective for taxable years beginning after Dec. 31, 2017.
  • Changes to Health Insurance Markets
    The AHCA would repeal the cost-sharing subsidy program. It would also establish a continuous health insurance coverage incentive and the Patient and State Stability Fund, which is designed to lower patient costs and stabilize state markets.

The bills that make up the AHCA were primarily focused on what changes would be made to existing ACA rules. What will not change under the proposal?

  • Pre-existing Conditions
    The ACA mandate prohibiting insurers from denying or charging more for coverage to patients with pre-existing conditions would be preserved.
  • Coverage for Adult Children
    The AHCA would preserve the ACA’s rule allowing young adult dependents to remain on their parents’ plans until they are 26.
  • Cost-sharing Limits
    Out-of-pocket maximum limits imposed on non-grandfathered plans by the ACA would continue to apply. These limits are currently $7,150 for single and $14,300 for family coverage.
  • Annual and Lifetime Limits
    The AHCA would retain the prohibition on annual and lifetime limits on essential health benefits.

For more information, visit the Ways and Means Committee and the Energy and Commerce Committee websites.

Posted in Blog, Health Care Reform Info | Tagged  ,

Cornerstone’s Lecie Steinbaum Featured in St. Louis Business Journal

July 20, 2016 | Leave a Comment

SLBJ TOE 7.15Lecie Steinbaum, director of plan services and compliance for Cornerstone and chief operations officer of Cornerstone Employer Solutions, was featured in the July issue of the St. Louis Business Journal as an expert healthcare partner. Seated at the Table of Experts, Lecie other healthcare thought leaders in St. Louis discuss healthcare reform, technology advancements, and more.

Read the full discussion online here.

Posted in Blog, Health Care Reform Info

Health Care Reform Report Card

March 08, 2016 | Leave a Comment

March 23, 2016 will be the 6th anniversary of the passage of the PPACA, aka. ACA, aka. Obamacare, aka. Healthcare Reform. In those six years, many of the provisions have been implements, delayed or removed. It has survived two Supreme Court challenges and there have been many attempts to repeal the entire law. Let’s take a look back and see where we are today and the changes that have taken place.

Has health care reform lowered the cost of health insurance? According to the Kaiser Family Foundation’s 2015 Annual Survey, the average annual single premium is $6,251, family $17,545. Since the passage of ACA in 2010, that is a 24% single, 27% family increase. The five year period prior to the passage of ACA, 2005 – 2010, rates increased 25% single, 27% family. But looking at a one year period, rates only increased 4%.

High deductible health plans (HDHP) are lower in cost than the overall average for all plan types (PPO, POS & HMO). Participation in HDHP (H.S.A. qualified) has increase every year since 2006. In 2015, 24% of covered workers are enrolled in an HDHP. Since the passage of ACA in 2010, participation has increased 13%, with 20% of employers offering HDHP. I believe this trend will continue to increase, especially if premiums continue to rise.

Many were worried that ACA would cause employers to move more employees to part-time status to avoid the mandate and not have to offer health coverage. The survey found that employers with 50 or more full-time employees reported 4% switched employees from full-time to part-time status, & 10% changed part-time workers to full-time.

In the employer sponsored market, there have been changes for both larger and small groups.
There are a large number of small employers that are within the “transitional relief” period, which allows employers to stay on their pre-ACA plans and not be forced on to an ACA compliant, Obamacare, plan, yet. The main reason an employer would want to do this is because the ACA compliant plans are more costly. In one instance, the cost difference was over 130%! The “transitional relief” is scheduled to expire for renewal dates after October 1, 2017. At that time, small employers will have to decide if they will provide their employees an ACA compliant medical plan, or try to avoid the costly community rating by considering a partially self-funded model, or another type of arrangement, such as participating in a PEO.

This past October, the PACE Act was signed by President Obama to amend ACA allowing individual states to determine their own definition of a small group. In Missouri, as in many states, kept the small group definition up 50 employees. As a result, groups with 50 or more employees are still medically underwritten by the insurers to determine premiums. This was a significant change that helps stabilize the large group market.

Another change from the original bill is the dreaded “Cadillac Tax” has been delayed two years. This tax is a 40% excise tax on high-cost employer-sponsored health plans. It was scheduled to take effect in 2018 and according to a recent analysis by the Kaiser Family Foundation, about 1 in 4 employers could have offered health plans in 2018 that are expensive enough to be affected by the Cadillac Tax. This delay was part the year-end government funding package last year and changes the effective date from 2018 to 2020. There was talk about completely removing this tax, but it was only delayed for now.

Regarding individual health insurance market, the state and federal exchanges, or marketplaces, have been operational since October, 2013 and the individual mandate to have qualified health insurance became effective January 1, 2014. Many insurers have chosen to offer plan in these exchanges. There is no medical underwriting, no pre-existing condition limitations, and for those who qualify, some individuals receive government subsidies to help pay premiums. As a result, more people have medical insurance that were not able to obtain it before, either due to a pre-existing medical condition, or could afford the premiums.

Even with the individual mandate requiring everybody maintain health insurance, the insurance companies are still facing the challenge of getting young & healthy individuals to purchase coverage. Many individuals have still chosen to go without coverage, or they only purchase coverage in the year that they have a medical instance requiring care and cancelling the coverage when they are healed. As a result, some insurers are losing money by participating in the exchanges/marketplace. As a result, many of the plans available in the exchanges are more managed care. The plans have narrow networks, require primary care doctors and referrals to see specialists, and the prescription formularies have been paired down. If the insurers are not able to evaluate the risk, they need to take steps to control their costs. United Healthcare reported they lost $1 billion and is considering dropping out of the exchanges in 2017. Other insurers have pulled out of specific markets, or limit the types of plans that are available, some going as far as to only offering HMO plans, such as happened in Texas with Blue Cross of Texas. The big question is, is this model sustainable?

So all of this has been within the last 6 years. I have a feeling there are more changes to come…

 

written by: Brad Snitzer, Vice President, The Cornerstone Insurance Group

Posted in Benefits, Blog, Health Care Reform Info, Human Resources

“Report Cards” are due…but you have a bit more time!

January 15, 2016 | Leave a Comment

Under the current Administration, we have seen repeated delays of implementation of the ACA.   Pay or Play has been delayed on more than one occasion… Deadlines to sign up for individual coverage have been extended…  No different, employers will have two more months – or until March 31 – to give employees forms for reporting health coverage in 2015 (Form 1095-B for health coverage and 1095-C for employer provided health offering and coverage).

The deadline for reporting this information to the Internal Revenue Service has also been extended – in this case, by three months.  1094-B and 1094-C are due May 31 for those filing via paper and June 30th for those filing electronically.

While these delays have repeatedly drawn criticism, it has given employers the opportunity to consult with professionals and better ensure compliance.  Should you need help or perhaps a second opinion, we are happy to assist you in answering questions, like:

  • Who has to report?
  • What information do I need to report?
  • What if we weren’t required to comply with the employer mandate this year?
  • Do I use my payroll software for this or is there another option?
  • What are the penalties for not filing?

Written by: Ben Crowder, Consultant, The Cornerstone Insurance Group

Posted in Benefits, Blog, Health Care Reform Info, Human Resources

Cadillac Tax Delayed

December 18, 2015 | Leave a Comment

The House of Representatives passed legislation that will delay the Cadillac/excise tax for two years. The provision was included in a $1.1 trillion omnibus government spending and tax-break package. It is now headed to the Senate and is expected to pass later today. President Obama is expected to sign it into law next week.

The Cadillac tax calls for a 40% excise tax on the amount of the aggregate monthly premium of each primary insured individual that exceeds the year’s applicable dollar limit, which will be adjusted annually to the Consumer Price Index (CPI) plus 1% initially and then CPI. Given that the pace of medical inflation is well beyond that of general inflation, the tax is destined to outgrow itself in short order and many employers will be impacted by the cost of the tax and the enormous compliance burden that the tax creates. Mercer estimated that a third of employers would be subjected to the tax by 2018 when it was originally set to kick in, and that 60% of employers could be hit by 2022. Because of the projected wide reaching effect of the tax, many employers may be deterred from offering coverage.

The delay of the Cadillac/excise tax is effective for 2018 and 2019, meaning that without further legislative adjustment or repeal, the tax will now be scheduled to take effect beginning in January 2020. Language in the package also permanently makes the tax deductible to employers and calls for a study by the comptroller on appropriate age and gender adjustments in consultation with the National Association of Insurance Commissioners (NAIC).

Questions?

Please contact your Cornerstone Consultant or email us at cig@cornerstoneinsurancegroup.com

Posted in Benefits, Blog, Health Care Reform Info

Don’t Play? Soon? You’ll Pay!

February 06, 2015 | Leave a Comment

Don’t Play?  Soon?  You’ll Pay!

Much has changed in the world of individual health insurance coverage.  Terminology such as guarantee issue, community rating and open enrollment didn’t exist until Healthcare Reform and the Individual Mandate changed the healthcare landscape and required individuals to obtain health insurance coverage, or face a penalty.

Though the Individual Mandate has been in place since 2014, recent polls and slower than anticipated national enrollment figures, suggest that a large percentage of Americans are still unaware of their obligation to obtain health insurance.  For those that choose to go uninsured in 2015, you’ll likely be subject to a penalty based on a percentage of your household income or a flat fee – whichever is higher.

The good news?  You have time….though not much.  Open enrollment runs through February 15th, for a March 1, 2015 coverage effective date.  After that, you cannot obtain coverage unless you qualify for a Special Enrollment Period.

With a few short days remaining, let us know how we can help.  As Individual Coverage Consultants with The Cornerstone Insurance Group, Joanna Vidakis and Angela Gain can help bring solutions that speak to an individual’s specific circumstances.

The clock is ticking.

Read more about this by clicking here.

Posted in Benefits, Blog, Health Care Reform Info

DOL Audit Triggers

December 16, 2014 | Leave a Comment

A DOL audit can be triggered for a variety of reasons. Some audits can be avoided through careful administrative efforts; other audits are initiated through no fault of your own.

Common triggers for a DOL audit include these preventable causes:

  • Participant complaints. If any of your plans’ participants complain to the DOL about potential ERISA violations, your plan will likely be subjected to an audit. For example, according to a DOL audit summary, 775 new investigations in 2013 resulted from participant complaints.
  • Incomplete or inconsistent information. The DOL is more likely to investigate a plan that has incomplete answers on the plan’s Form 5500, or if information you report is inconsistent from year to year.

Another reason your plan might be selected for a DOL audit is due to the DOL’s national enforcement priorities or projects, which focus investigative resources on certain issues. According to the DOL, the following are areas of heightened importance for audits:

  • Major case enforcement. EBSA is focusing on major cases in order to best protect areas that have the greatest impact on plan assets and participants’ benefits.
  • Employee contributions initiative. EBSA is focusing on delinquent employee contributions in order to help protect employee contributions to their 401(k), health care and other plans.

In addition to these priorities, the DOL also has several national enforcement projects that receive investigative emphasis:

  • Contributory Plans Criminal Project
  • Fiduciary Service Provider Compensation Project
  • Health Benefits Security Project
  • Rapid ERISA Action Team
  • Employee Stock Ownership Plans
  • Voluntary Fiduciary Correction Program

DOL audits can be triggered by negligence or mistakes on your part, or because your plan falls within one of the areas in which the DOL is focusing its investigative efforts.

Regardless of why you are selected for an audit, you need to be prepared. Contact The Cornerstone Insurance Group today for the information you need to avoid DOL triggers, as well as tools to help you prepare for and navigate an audit.

Posted in Benefits, Blog, Health Care Reform Info, Human Resources