This section is devoted the latest news and practical solutions that address the Design, Administration, Communication, and Funding Vehicle issues that Employers must take into consideration when trying to provide high quality, cost-effective, and administratively efficient employee benefit plans.
Benefit Briefs! – monthly newsletter published by Bushnell & Company.
ALERTS – Major late breaking employee benefit news items and regulatory announcements that we publish.
General Information – Published periodically by Bushnell & Company are news items about our firm, holiday greetings, and special events.
Industry Leaders – Thoughts & Interviews
- An interview with the most powerful woman in health care.
- Aetna CEO Mark Bertolini outlines “creative destruction” of healthcare.
Agent / Broker
The key Professional Designationsthat you should be looking for are described in this article. Did your agent / broker walk away sunburned, hung over with a new designation for their business card?
Insurance Agent Commissions: An insurance agent / broker who provides superior service and serves your needs in a way that you find acceptable is entitled to be compensated fairly. On the other hand, if you only see your agent / broker at renewal time occasionally bearing gifts or tickets to an outing and the service is less than adequate, or no new ideas are ever explored except to fully insure your employee benefit plan and collect a large commission then something is wrong. Look at your 5500 forms that are filed with the IRS and in particular the Schedule A. Are the commissions paid commensurate with the services provided?
For a great article on the impact of health care reform on Health Savings Accounts (HSA) click here.
Many experts think that the future of Health Care Plans is in Health Savings Accounts or HSAs – click here to read a thorough explanation published by Alston & Bird.
State Health Insurance Mandates – The list through 8/6/13 & you wonder why health insurance is so expensive.
Birth Control & Pregnancy Disability Act – The EEOC issued regulations in Dec. 2000 plans must cover birth control / contraceptive devices.
403(b) Plan Changes Proposed for 1-1-065 – There are some major changes on the horizon for 403(b) plan sponsors & participants
Spousal Coverage Surcharge – This is a must read article for employers who are trying to limit “financial leakage” involving double coverage.
Workers Out-Of-Pocket Health Care Costs Have Doubled in the Last 5 Years – Forbes
Consumer Driven Health Plans – good two page article on Myth vs. Reality Myth vs. Reality of CDHPs. There is another report that you may want to look at which addresses CDHPs and Disease Management. Recently Guardian Life Insurance Co. published a very good Executive Summary on the Benefits & Behavior of Consumer Driven Health Plans.
Minimum Value Plans (MVPs) ruled Illegal by IRS. How did anyone ever think that a medical plan that did not cover hospital costs met 60% Minimum Essential Coverage (MEC) threshold of the Affordable Crae Act?
Can an employer use Individual Polies and pay the premiums on a pre-tax basis to fund their employee benefit plan? For the 3rd time no! See DOL FAQ issued 11/6/14.
Top 10 Health & Welfare Items Often Overlooked at Year-End are here.
Fraud in employee benefit plans is becoming a bigger & bigger issue costing employers 3-10% of their annual spend. If you want to read what employers can do to stop this waste click here.
Third Part Administrators need to be supervised – see why TPA)
Outsourcing Overseas is losing its luster.
Have you ever been tempted to write a sarcastic communication piece after preparing those ridiculous Summary of Benefit Coverage statements in the fall of 2012? Here is the best ones that we have seen & no it was not sent, but is funny – look here.
Companies are encouraging employees to save for retirement according to Hewitt survey
Self-Funding – The whole story including pros & cons.
TPA Interview Checklist – Be prepared for your next meeting. (assumes that TPA also provides re-insurance)
Stop Loss Re-insurance – This is no place for amateurs or inexperienced agents or brokers. Unless you are an expert, the “gotchas” will turn the whole transaction into a very expensive mess.
Insurance & Employee Benefit Plans – What you need to know and what insurance agents don’t want you to know. They are not going to show you alternatives that reduce their commissions.
Medical bills are the leading cause of Bankruptcy, even with Health Insurance.
Long Term Care Insurance – a Shopper’s Guide prepared by the Texas Dept. of Insurance.
Work – Life Balance
The value of Time Off is more important than salary!
Information Overload got you down – read this article about how to manage it
Ted Carlson, a friend of the firm, wrote a great article in 2006 entitled Ten Practical Strategies to Reduce Health Care Costs. Many of the suggestions still hold true today.
Wellness Program / Plans
The issue of a wellness program/plans is a very interesting topic and extremely hard, if not impossible, to quantify in the short term. The only way to commit to a wellness program is for a five-year period after completion of health risk assessments that will guide you in what you need to address with your unique employee population group. Then, you can measure all the various employee benefit programs, workers comp costs, etc. Initially, it is very much of a “faith walk” for the employers. Below are a few links to articles that you may want to read.
The Power of Sleep
Health Care Reform – PPACA – Affordable Care Act – ObamaCare
The National Coalition for Health Care Reform published a very insightful report in 2004 that we thought that you would want to read. It set the table for what you are seeing today.
In March 2010, President Obama signed into law two multi-thousand page pieces of legislation that together comprise the large-scale reform of the American healthcare system. On March 23, 2010 he signed The Patient Protection and Affordable Care Act (P.L. 111-148) and on March 23, 2010 he signed the Health Care and Education Reconciliation Act (P.L. 111-152). Healthcare reform has now entered the regulatory phase: over the coming years, the Department of Health and Human services and the Centers for Medicare and Medicaid Services will be issuing instructions to states, providers, insurers, and other stakeholders on how they should implement the provisions of the new law. Click on the links above for copies of the actual legislation. For a comprehensive summary of the Legislation click here.
In 2011, after a number of cases made their way through the U.S. District and Appellate Courts, the US Supreme Court agrees to hear the Florida case, that was joined by 25 other states, on the constitutionality of the requirement to purchase health insurance that is in the Law. In March 2012, the Supreme Court heard 3 days of oral arguments. For complete copies of the transcripts and/or to listen to the oral arguments, go to www.SupremeCourt.gov. For a summary of the arguments on Monday March 26, Tuesday March 27, or Wednesday March 28, just click on the days that have are linked to the summaries.
On June 28, 2012 the United States Supreme Court, in one of the most historic decisions in our lifetime, upheld the the constitutionality of the individual mandate. In the 5-4 decision authored by Chief Justice Roberts, the Supreme Court found that the individual mandate provisions of the PPACA were constitutional as a tax. The relevant quote from the section on the mandate is as follows: “Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax. This is sufficient to sustain it.” If you would like to read the decion, the link is here.
In a somewhat surprising move, the U.S. Supreme Court agreed on Friday November 7, 2014 to hear the case regarding the legality of providing participants subsidies in the 34 states who have chosen not set up a health insurance exchange, because of differing opinions in 2 decisions from the US Court of Appeals. It all hinges on the 4 words “established by the State”. The law is clear that subsidies are available only to participants in state exchanges and not the federal exchange. The impact of this decision could be monumental to the future of ObamaCare. Without the subsidies, some experts have predicted that approximately 75% of the approximately 7,000,000 participants would lose their subsidy and could no longer afford the coverage. A decision is expected in June. Subsidies is an excellent summary of the issues. On June 25, 2015 the Supreme Court announced its decision to uphold the tax subsidies for individuals who obtain health coverage in a state that has a Federal Exchange and not a State Exchange. The Court’s 6-3 opinion in King v. Burwell, for both the majority and the dissenters, can be read here. In addition, our friends at the Groom Law Group have prepare a very good background paper on this decision of allowing the tax subsidies for the Federal Exchange elections that we encourage you to read.
With this decision, the implementation of the Affordable Care Act aka ObamaCare is essentially complete. Employers must continue to make plans to implement the employer “shared responsibility” mandate in 2015 and in 2016 for smaller employers. Planning must continue in order to implement the new IRS reporting requirements, that some consider extremely burdensome, which will be due in January 2016 for 2015 activities, with associated penalties, audits, etc. for noncompliance. In addition, the Cadillac still tax looms on the horizon for 2018.
Without question, the political rhetoric on the Affordable Care Act aka ObamaCare will continue and escalate, especially as we enter a Presidential campaign season, but for now, the debate in the Supreme Court is over.
GrandFathered Plans – Concurrent with when Health & Human Services Secretary, Kathleen Sebelius went before a House congressional committee on October 30, 2013 to defend and explain the problems that have plagued the HealthCare.gov website since it went live on October 1st, with just a week of testing, millions of Americans were getting cancellation letters from their health insurance carrier. That was when the general public learned all about Grandfathered Plans for the first time. We have been wrestling with Minimum Essential Coverage and Grandfathered Plans issues for our clients since March 23, 2010, when the legislation was signed into Law. President Obama promised on numerous occasions “that if you liked your health care plan, you could keep it, period.” That was not quite accurate as the public is now learning. Here are the sources for that contradict that statement.
- The IRS published Internal Revenue Bulletin (IRB) 2010-29 on July 10, 2010 that addressed the loss Grandfathered status and anticipated, in Section 5, that 40-67% of individual plans (10,000,000 – 15,000,000) would not be Grandfathered. Click here to read the IRB.
- President Obama promised that “if you like your existing plan, you can keep your existing plan, period”. The Washington Post accuses President of breaking that promise on 10/29/13 – here is the link to that article. Further, on 10/30/13, The Fact Checker service at the Washington Post published a follow up article that deemed it worth 4 Pinocchios – see their article here.
- Forbes even weighed in with a well-researched article on 10/31/13 about how massive the impact of this change will be on our fellow Americans – read the article here.
Health Insurance Exchange Shopping Sites – While you are waiting for HealthCare.gov to be fixed by December 1, there a great website that is a very fast and is a simple tool to allow you to look up the Health Insurance Exchange Plans offered in each state. You can then drill down by state, county, family size, ages, tobacco use, household Modified Adjusted Gross Income, etc. It show which plans are available, deductible, co-insurance, premiums and subsidy, if any – go to www.ValuePenguin.com.
Oregon abandons its state health care exchange after spending $134MM – going to cost another $78MM to fix – switch to federal HIX cost $6MM. Maryland adopts Connecticut exchange.
US Supreme Court Justice Sonia Sotomayor stopped birth control mandate in 2014.
We assume that you have been reading about Jonathan Gruber, the economics professor at MIT and one of the principal architects of ObamaCare and all these videos that have surfaced of late. The most famous one was calling the American people “stupid” and that is why they packaged ObamaCare is complex as they did. Congress took him to the Woodshed recently, and even the states where he had been consulting, are now starting to question his healthcare modeling. There is an interesting article dealing with Vermont and its woes.
NEW WEBSITE: A new website, created by the private sector, www.GoHealth.com was launched on Nov. 24, 2013. They have been working on for over a year and is the backbone of GoHealthInsurance.com which 2,000,000 people are currently using. It offers online shopping and telephone support. It will let you enroll in the Health Insurance Exchange Plans because it has access to the CMS hub to verify income, age, elegibility for subsidies, etc. The website is paid by the insurance companies for each person who signs up. We tested it on Nov. 25 & 26 and it works great and is really fast to navigate. All plans are there and the subsidies are included.
Our friends at Ernst & Young have shared with us a very comprehensive analysis on the 2012 Presidential and Congressional elections that affects the Fiscal Cliff, Tax Reform, Health Care and Financial Services. The link to the document is here.
Rosie O’Donnel’s recent heart attack is being touted as a wakeup call for women – look here.