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News

News

 

August 13, 2015

BLUE CROSS BLUE SHIELD OF TEXAS TO DROP PPO FOR INDIVDUALS IN 2016

Blue Cross Blue Shield of Texas has announced that it will no longer offer it's popular individual Blue Choice PPO plans in Texas beginning January 1, 2016.  This change will affect about 367,000 members in Texas.  
 
The reason for the decision to eliminate the PPO for individuals, according to Blue Cross, is that the PPO is not sustainable due to adverse selection leading to poor claims experience.  The insurer says in 2014 they paid out $400 million more in claims than they received in premiums.
 
Blue Cross will continue to offer the HMO in every county in Texas.  However, as of this date, the HMO network of providers is significantly smaller than the PPO network.  This could translate into problems for members to find doctors in the HMO network.  Other products from Blue Cross may be available to individuals next year, but have not yet been announced due to pending approval by the government.
 
Individuals insured by Blue Cross under the Blue Choice PPO should receive a notice letting them know that the product will not be available next year.  If you are affected by this change and would like us to help with your insurance options for 2016, please contact us in November (during open enrollment).
 

 

January 26, 2015

DEADLINE FOR MEDICAL PLANS FAST APPROACHING

The deadline to enroll in an individual medical plan for 2015 is fast approaching.  February 15th is the last day of open enrollment.  After that, you can't enroll in an individual health plan unless you qualify for a special enrollment period due to a qualifying event such as losing coverage through your employer.
 
Many people have the misconception that this deadline only applies to individuals purchasing insurance through the federal exchange on the Healthcare.gov website.  That is simply not true.  If you need individual insurance, you must enroll by February 15th, even if you are buying insurance directly from the insurance company and not through the federal marketplace.  
 
"My advice is to talk to a qualified insurance agent immediately," says Tammy Woodard, a licensed insurance agent specializing in medical insurance.  "A knowledgeable agent will ask questions to identify whether or not you will qualify for a tax subsidy for your premiums.  That will help determine if it is best to buy through the federal marketplace or skip that and go directly to a chosen insurance company. But, don't do it on your own.  It costs the same amount to use an expert as it does to buy online and figure it out yourself, and trust me, it is a confusing mess right now."
 
Those people who had no health insurance in 2014 may find they are paying extra taxes when they file their tax return in April.  The penalty for not having insurance in 2014 is the greater of 1% of your yearly household income, or $95 per adult and $47.50 per child. Most families who don't purchase insurance, and are otherwise not exempt, will pay the 1% tax. In 2015, the penalty goes up to the greater of either 2% of your yearly household income, or $325 per adult and $167.50 per child.
 
Ms. Woodard, President of Woodard Benefits Group, with offices in Frankston and Plano, says, "It's smart to talk to a professional and find out what a plan will cost vs. the tax penalty.  Remember, if you opt out and pay the penalty you still don't have insurance coverage, so it is money totally wasted."
 

 

May 29, 2014

RISING EMPLOYER AND EMPLOYEE HEALTH PLAN COSTS CONTINUE

The ninth annual Milliman Medical Index report, which discusses increases in health care costs among employers and employees, as well as key drivers that will affect health care costs over the coming years, reveals an increase of nearly $2,500 in annual costs for the average family of four with employer-sponsored health care coverage over the last two years.
 

In 2014, the cost for health care for a family of four in an average employer-sponsored health plan is $23,215, more than double the $11,192 of 10 years ago. Of the spending for the average plan, the employer pays $13,250 or 58 percent.

The 5.4 percent growth rate from 2013 to 2014 is the lowest annual change since the first Milliman index was calculated in 2002.

Overall, the average share for employees is increasing, as indicated by the 73 percent increase in employee costs since 2007 compared to the 52 percent rise for the employer share.

Milliman outlined several factors affecting health care costs, such as the slow economy, provider engagement in cost control, and the high cost of specialty pharmacy. Other key findings included:

  • Employees assumed a greater percentage of the total cost of health care – payroll deductions and out-of-pocket expenses grew 32 percent in the last four years, while employer premium contributions increased by 26 percent.
  • Inpatient care and physician office services accounted for the majority of annual health care costs for an average family of four – 62 percent or approximately $14,500 in 2014.
  • Pharmacy costs for an average family of four increased by 4.5 percent since last year.
  • Employer subsidies for employee health care costs reached an all-time low since 2009.

 

March 7, 2014

FINAL RULES RELEASED ON INFORMATION REPORTING FOR EMPLOYERS AND INSURERS

 
On March 5, 2014, the Department of Treasury and the Internal Revenue Service (IRS) released final rules on two provisions: reporting health insurance coverage by large employers, and reporting minimum essential coverage by insurers and employers of self-insured plans. The guidance provides a streamlined process for reporting duplicate information required by both provisions – to both the IRS and respective employees.
 
While the first reporting will not be required until early 2016 for the 2015 calendar year, employers are encouraged to voluntarily report coverage information in 2015 for the 2014 calendar year.
 
Who must report to whom?
Employers with 50 or more full-time (including full-time equivalent) employees need to report all of the employees offered coverage throughout the calendar year to the IRS. Respectively, all employees named in this report must also be provided with a statement, and can simply be given a copy of the IRS form. Minimum essential coverage must also be reported annually to both the IRS and any individual named in the report as having such coverage.  
 
What information must be reported?
The final rules provide for a single, consolidated form to streamline the information being reported. Employers and insurers can complete their respective portions of the form and submit them separately. Large self-funded employers can complete both parts of the combined form for information reporting. This form can be used for reporting to both the IRS and employees.
 
The forms have not yet been provided by the IRS, but will require information to help determine eligibility for the premium tax credit, such as:
  • Employer information, including contact information and the number of full-time employees
  • The lowest cost employee monthly premium for self-only coverage for minimum value coverage offered to the employee
  • Information on each full-time employee to whom coverage was offered and identifying information, such as Social Security Number
The bottom half of the form includes information for insurers or self-insured employers to report, which will help administer compliance of the individual mandate and eligibility of premium tax credits:
  • Information about the insurer or entity providing coverage, including contact and other business information
  • Which individuals are enrolled, identifying information of those individuals, and the months in which they are enrolled
Special rules to further simplify
Special rules have been provided to further simplify reporting and offer transitional relief for employers that provide a “qualifying offer” to any of their full-time employees. A qualifying offer is two-fold: 1) offering an employee self-only coverage that meets minimum value (60% of costs) and provides self-only coverage at a cost of no more than 9.5% of the Federal Poverty Level, and 2) offering coverage for the employee’s family, including spouses and children.
  • Large employers can take advantage of simplified reporting obligations when they extend qualifying offers to employees for all 12 months of the year. They can report basic employee identification data and the fact that they received a full-year qualifying offer. These employers can also give the named employees a copy of that notice or a standard statement confirming the full-year qualifying offer.
  • Large employers who extend a qualifying offer to employees for fewer than 12 months of the year can use a code to report to both the IRS and the named employees. This code indicates that the qualifying offer was made for each of those months.
  • A phased-in option for 2015 is available for large employer who can certify they have made a “qualifying offer” to at least 95 percent of their full-time employees and their families (spouses and children). These employers will have simplified reporting method for their entire employee population, and can provide employees a standard statement regarding the coverage offered and potential eligibility for premium tax credits.
  • Large employers that can certify they have offered affordable minimum value coverage to at least 98% of the employees named in the report do not have to identify full-time status.
Can employee statements be provided electronically?
The regulations do allow for statements to be provided electronically, but only if an employee agrees in writing to receive them electronically. The electronic statement and consent must satisfy strict requirements and an employee must be permitted to withdraw consent.
 
When are the first reports and employee statements due?
The first reports to the IRS will be required no later than March 1, 2016 for 2015 calendar-year coverage (February 28 is a Sunday). However, if the report is filed electronically, it will be due no later than March 31, 2016.
 
The first statements to employees will be required no later than January 31, 2016 for the 2015 calendar year.

 

July 31, 2012

Health Care Reform - Important Employer Updates for 2012 

 
A number of important provisions in the Affordable Care Act (ACA) will have an impact on the marketplace in 2012. These are some of the key issues for employers. Other ACA-related issues may be of equal or greater concern to different individuals and businesses.
 
W-2 Reporting: Employers must begin preparing this year to report on employees’ 2012 W-2 forms, to be issued in January 2013, the aggregate cost of their employer-sponsored coverage. For purposes of this reporting requirement, “applicable employer-sponsored coverage” includes coverage under any group health plan made available to an employee by the employer, regardless of whether the employer or the employee paid the cost. Applicable coverage as defined includes major medical and employer flex credits contributed to a health flexible spending arrangement (FSA), if the flex credits exceed the employee’s salary reduction to the FSA.
 
Employers are required to report the cost of coverage provided under hospital indemnity, other fixed indemnity or specified disease or illness policies only if the employers contribute to the cost of that coverage or if the coverage is purchased by employees on a pre-tax basis through a cafeteria plan.  Employers do not need to report the cost of wellness programs, employee assistance programs (EAP) and on-site clinics unless the employers include the cost of these benefits when charging COBRA premiums.
 
MLR Reporting: The medical loss ratio (MLR) provision requires health plan issuers to meet new minimum medical spending requirements of 85 percent in the large group market and 80 percent in the small group and individual markets. Using 2011 data, insurers in 2012 begin to face the possibility of paying rebates to policyholders if the MLR thresholds are not met.
 
Summary of Benefits and Coverage: Insurers and group health plans must provide a summary of benefits and coverage document to enrollees/potential enrollees at specific times, including during enrollment and re-enrollment. This may sound simple, but the rules dictate everything from font size, to number of pages allowed, to exact wording to be used to be in compliance. The new rules also require 60-days-prior-notice to enrollees when a health plan or issuer modifies the terms of the plan or coverage and the change impacts a previously issued SBC.  The requirement is effective for open enrollment activity that begins on or after September 23, 2012.
 
Women’s Wellness: Non-grandfathered plans effective on or after August 1, 2012 must include 100 percent coverage of women’s preventive services when performed by an in-network physician.  
 
The Patient-Centered Outcomes Research Fee: Health insurance issuers and sponsors of self-funded group health plans will be assessed an annual fee to fund patient-centered outcomes research. The fee is imposed for a limited number of years, beginning in 2012 and ending in 2019.
 
Wellness Incentives: A five-year/$200 billion grant program will be available to small employers (less than 100 employees) that did not provide a wellness program as of March 23, 2010. The program was slated to open up in 2011, but guidance has not yet been issued that would clarify various aspects of the program, including the application process. Guidance is expected in 2012.
 
 

 

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