, , , , ,

Why Invest in Health Insurance for Your Employees?

A study found that 70% of people don’t feel valued by their workplace. In that same study, 25% of people believed that their productivity at work would improve if they received employee benefits. When you show your employees you value their hard work, they will be more likely to strive to perform better. It’s part of why investing in health insurance for your employees is so important. 

 

Investing in health insurance is essential to ensuring a happy and healthy workforce. Navigating employee benefits that your employees actually want, can be a challenge. Not to mention the various requirements necessary for employers with 50 or more employees. So, why should you invest in health insurance for employees?

 

Learn more about Affordable Benefits, talk with one of our team members!

 

Employee Benefits Increase Employee Productivity

According to the CDC, employees who prioritize preventative care, such as annual check-ups, are more productive in the workplace. This may be attributed to a few different reasons. Whether they’re taking less sick time, or they’re less stressed about their health, improving focus on their work, whatever the outcome, is beneficial to you. 

 

As an employer, you want your employees to remain focused on their work to ensure ongoing success. Having to worry about their personal healthcare and that of their dependents drains their time and energy. While it can be time-consuming to set up proper health insurance, partnering with the right company can simplify the complexities involved.

 

Almost anyone in a management role knows the importance of employee morale in the workplace. A positive workforce yields positive results. One way to ensure your workforce remains positive is to provide benefits that match their needs. After all, employers who provide great benefits gain a better reputation for their business, while also increasing productivity, and decreasing turnover. 

 

When you partner with a broker who can guide you through the process seamlessly, health insurance doesn’t have to be complicated. They can help select plans that are right for your employees, help set up your virtual benefits, and serve as a go-to resource to answer questions that your employees may have. 

 

Why invest in health insurance for your employees?

 

How can Ancillary & Voluntary/Worksite Benefits Attract and Retain Top Talent? 

In today’s job market, employees require more than traditional benefit programs. Benefits like vision, dental, accident, term life, critical illness, and hospital indemnity insurance can provide your employees with additional coverage when they need it most.  These additional benefit options allow your employees to tailor their benefit coverage to their needs.

 

When employees are given the choice in their benefit programs, they are more likely to use them. And when employees use their benefits, as we said above, they are able to remain healthy and ready to work more often. 

 

Employees look for employers who offer voluntary benefits because these benefits give employees choice, they meet various needs of a diverse workforce, and they ensure employees remain financially stable. Offering voluntary benefits adds a level of insurance coverage that many workers have not previously had access to. Benefits beyond the traditional 401(k) and health insurance are vital to attracting the right talent for business. 

 

At Innovative HIA, we offer our clients comprehensive coverage that provides the complete solution for employers who want to provide affordable benefits to their workers. Service is our priority. We pride ourselves on our reliable, fast, and friendly team that makes compliance with ACA easy and affordable. 

 

You Remain Compliant with ACA Requirments – and Avoid Paying Hefty Fines

As an applicable large employer (ALE) you are required by the Affordable Care Act to provide benefits to 95% of your full-time or full-time equivalent employees. If you fail to do so, you will be subject to some pretty significant financial penalties. 

 

The Cost of Pentalty A 

If an employer fails to offer benefits to their full-time employees, they will be subject to a penalty of $2,700 per employee annually. Violations are assessed on a monthly basis. When broken down monthly, each month that an eligible employee is not offered coverage will earn you a $225. A large company with 5,000 employees that fails to provide proper benefits for its employees, could be subject to a $13,500,000 annual fine.

 

The Cost of Pentalty B

Penalty B is calculated for every full-time employee that was not offered minimum value coverage by their employer and went to the Health Insurance Marketplace and qualified for a premium tax credit. The annual penalty per employee in this scenario totals $4,060. Penalty B is also calculated on a monthly basis and when broken down to a monthly rate equates to $338.34 per employee. 

 

If a company failed to offer minimum value coverage to 100 ACA full-time eligible employees, or if the offered coverage was not affordable and they received a premium tax credit or subsidy on the exchange, the employer involved would be liable for an annual fee of $406,000.

 

At Innovative HIA, we have the most competitive affordable benefits available. We ensure the benefit plans you offer your employees are fully ACA compliant.  To achieve this, we process your 1094/1095s on your behalf. If there are ever any errors in your 1095 processing, we refile for you. No hassle to you, just compliant benefits.

 

Read on to learn more about how offering minor medical benefits is more beneficial than not. 

Article originally published on SBMA Benefits.

 

infographic explaining why employers should invest in health insurance for their employees

, , , , ,

What is the No Surprises Act?

The No Surprises Act (NSA) went into effect January 2022. This new law addresses surprise medical billing and requires new disclosures for employers, third party administrators (TPAs), brokers, and all participants in the healthcare industry including, but not limited to:

  • Hospitals
  • Hospital outpatient departments 
  • Ambulatory surgical centers  
  • Payors
  • Providers
  • Facilities 
  • Ancillary providers performing emergency and non-emergency services 

“[Surprise medical bills can] arise in an emergency when the patient has no ability to select the emergency room, treating physicians, or ambulance providers. Surprise medical bills might also arise when a patient receives planned care from an in-network provider (often, a hospital or ambulatory care facility), but other treating providers brought in to participate in the patient’s care are not in the same network.  

These can include anesthesiologists, radiologists, pathologists, surgical assistants, and others.  In some cases, entire departments within an in-network facility may be operated by subcontractors who don’t participate in the same network.  In these non-emergency situations, too, the in-network provider or facility generally arranges for the other treating providers, not the patient.”*

*Surprise Medical Bills, Karen Pollitz (Mar. 17, 2016). 

Now, patients are federally protected against surprise billing for the following services: 

  • Emergency Services *not including ground ambulance* 
  • Post Emergency Stabilization services 
  • Non Emergency Services provided at in-network facilities 

What are the Implications of the No Surprises Act? 

The Consolidated Appropriations Act (CAA), 2021 made major changes in the way that group health plans are regulated and operated. The addition of the No Surprises Act of 2022 adds complex new rules aimed at protecting against surprise billing and beefs up overall group health plan transparency. The many provisions require that plans provide:

  • A robust online price comparison tool
  • Advance explanations of benefits (EOBs)
  • Report claims information to state “all-payer claims” databases
  • Improve the accuracy of plan provider directory information
  • Remove gag clauses in vendor contracts
  • Examine and document compliance with mental health and substance standards
  • Report on pharmacy costs.

In addition, brokers and consultants to group health plans must disclose to plan fiduciaries the direct and indirect compensation they are paid each year. 

Collectively, these new rules impose potentially significant new regulatory and litigation risks on sponsors of group health plans. They also raise the standard for advisors who must keep their clients up to date on, and in compliance with, these new rules.

The new regulation takes the employee out of covering the cost of unexpected medical bills and puts processes in place for employers, insurers, and hospitals to resolve payment responsibilities for out-of-network medical bills. The goal of the No Surprises Act is to support individuals who receive emergency or needed medical services, but end up with a heavy medical bill that puts them in high unexpected debt. 

The new NSA regulations will create increased transparency in medical billing by providing coverage price lists, and potentially creating flat and/or set rates for medical services. The result of the NSA will be that insured individuals who receive medical treatment will not receive higher than expected bills for the treatments they are given. 

What Will the No Surprises Act Mean for Patients? 

Let’s frame the story: 

Andrew falls off the roof cleaning the gutters, the ambulance comes and takes him to the hospital where he is treated for emergency care by an anesthesiologist, a surgeon, and then, post-surgery receives rehabilitation care from a physical therapist.  The anesthesiologist is out of network, the surgeon is in-network and the PT is out of network. The hospital sends a bill to the insurer for $7,100.00.  

The insurer will have an agreed-upon contractual rate that is less than the billed amount, in this case, let’s set that at $4,600.00.  Andrew has insurance with a $1,000 deductible and a 20% co-pay, so he owes $1,720.00. The insurance pays the difference between Andrew’s responsibility and the agreed-upon amount (Contractual Rate) of $4,600.00, so the insurer pays the hospital $2,880.00.  

Before the NSA, the hospital would then bill Andrew not only the $1,720 of his deductible + 20% co-pay but also the additional $2,500.00 to make up the difference between their billed amount and the agreed-upon Plan Recognized amount of $4,600.00. This brings Andrew’s total payment burden to $4,220.00. 

The No Surprises Act would eliminate the ability for hospitals to collect the difference between the Plan Recognized amount and their higher bill.

 

What Does the No Surprises Act Mean For Employers? 

Employers should have monthly internal governance meetings to go over:

  • Health plans
  • Broker commissions
  • What plans cover
  • What the percentage of enrollment is
  • Every aspect of the health plan design 

Does the No Surprises Act Include Telehealth Services? 

In short, yes, the No Surprises Act does include telehealth services. Patients who see a healthcare provider through a telehealth visit are expected to be charged the in-network rate. 

The Covid-19 pandemic brought on greater demand for telehealth providers, especially in emergency services. As healthcare systems continue to lean on virtual patient services, providers must be aware of preset rates negotiated between insurance contracts and the healthcare network. 

Healthcare finance says it best, “Independent physician groups, which include telehealth docs, must now accept a rate that someone else has negotiated.”

Patients are protected from costly, unexpected fines, however, experts believe these new changes will result in cost shifts in other areas to account for funds. 

 

What are the Transparency in Coverage Requirements? 

CAA Section 114  dictates that insurance carriers and self-insured plans allow policyholders/participants to compare the amount of cost-sharing they would be responsible for paying for a particular medical item or service.  This tool is to be provided by phone or on a website. 

The Transparency in Coverage (TiC) Regulation permits policyholders/participants to request their cost-sharing liability for a particular medical item or service through an online tool or in paper form. 

Both of these requirements are in place to provide clarity around medical billing for insured individuals.

What does the No Surprises Act Mean for Insurers? 

The transparency in coverage requirements necessitate that group health plans and health insurance issuers in the group and individual markets disclose on a public website in 3 separate machine-readable files the following:

  1. In-Network Rates: Payment rates negotiated between plans or issuers and in-network providers (excluding information related to prescription drugs that are subject to a fee-for-service reimbursement arrangement [reported separately].
  2. Out of Network Billed Charges: Historical pricing information showing unique allowed amounts and billed charges for covered items and services furnished by out-of-network providers.
  3. Prescription Drugs: In-network negotiated rates and historical net prices for all covered prescription drugs by plan or issuer at the pharmacy location level

These files must be updated monthly and must be made available without login, email, password, or other gated requirement to access the information.

What Does the No Surprises Act Mean For Brokers? 

Brokers must make sure they are fully informed about every aspect of the healthcare plans they are selling in order to comply with EOBs.  Additionally, brokers and consultants to group health plans must disclose to plan fiduciaries the direct and indirect compensation they are paid each year.

What Does the No Surprises Act Mean For Plan Sponsors/ Employers?

Internally, increased governance requirements mirror those for 401ks as dictated by the 1974 ERISA Act.  Employers and plan sponsors will be required to have monthly internal governance meetings of their Boards to review plan coverage.  Plan sponsors must know what their plans cover, what their broker fees are and they must provide access to the price comparison tools offered online by insurers.  

These increased internal governance requirements place a burden on the employer/ plan sponsor to be knowledgeable about the coverage offered and create increased liability for failure to implement required internal governance structures, policies, and procedures. 

How Do I Prepare for the No Surprises Act? 

With the NSA in full effect as of January 1, 2022, employers, insurers, and brokers must prepare for its disclosure requirements, internal governance requirements, and adherence to these new, stricter standards. 

 

As you prepare for the new year, refresh your memory on why millions of Americans enrolled in health insurance this enrollment season, and what it means for you, here. 

 

Article originally published on SBMA Benefits.

, ,

What Are the Advantages of the Affordable Care Act?

In 2010, The Affordable Care Act (ACA), aka Obamacare, was enacted to provide reform to the health insurance industry.

Overall, the Affordable Care Act aimed to accomplish 3 main strategies: make insurance affordable, emphasize prevention, and improve how health care is delivered.

Over a decade later, it’s challenging to ignore the new standards that were derived from the original push to pass this legislation. While the act originally caused disagreements nationwide, there are clear advantages to be noted that have resulted from ACA.

Make Insurance Affordable 

The first of the strategies that Obamacare aimed to accomplish was to make health insurance affordable for all Americans.

Oftentimes many assume that they have a clear understanding of the finances of their insurance coverage. However, after landing in the hospital or experiencing a need for emergent care, they would find themselves slapped with high deductibles, unexpected bills, and low maximum coverage. ACA was responsible for making changes to such events.

ACA was able to lower insurance costs for Americans in a variety of ways. The first of which was the provision of tax credits for insurance to middle-class Americans. By limiting out-of-pocket expenses to a maximum of $8,150 for individuals and $17,100 for families, in addition to extending the accessibility of Medicaid beyond 100% poverty level, health insurance became more affordable for many.

In addition to these initial cost caps, ACA allowed parents to keep their children on their medical plans until they reached age 26. It also established the Small Business Health Care Tax Credit, which serves to benefit businesses with less than 25 full-time employees. It provides such businesses with a tax credit that covers up to 50% of their contribution to their employees’ health insurance coverage.

Emphasis on Preventative Care 

The second strategy that ACA addressed was putting emphasis on preventive care. Prevention focuses on the promotion of a healthy lifestyle and frequent check-ups to attempt to identify and target potential health issues before they escalate.

The ACA enacted a list of 10 essential benefits that all insurance plans must cover. They include:

  1. Preventive and wellness visits, including chronic disease management
  2. Maternity and newborn care
  3. Mental and behavioral health treatment
  4. Services and devices to help people with injuries, disabilities, or chronic conditions
  5. Diagnostic lab tests
  6. Pediatric dental and vision care
  7. Prescription drugs
  8. Outpatient care
  9. Emergency room services
  10. Hospitalization

In addition to establishing these initial benefit requirements, ACA was responsible for expanding treatment for mental health, addiction, and chronic diseases. From an insurer’s perspective, these are often the most expensive patients for whom to provide ongoing care. ACA put emphasis on programs to combat and prevent this prolonged treatment including those that focus on smoking cessation and combating obesity.

ACA also eliminated lifetime and annual coverage limits and denial of coverage due to pre-existing conditions. Insurance companies are not able to drop or deny you coverage because you have a pre-existing condition, made a mistake on your application, or because you’ve been recently diagnosed with a life-threatening disease. Additionally, they are not allowed to require new members to wait more than 90 days before coverage starts.

Lastly, ACA changed the way that insurers spend premium dollars. It declared that 85% of premium dollars paid by insured members must be spent on healthcare services and quality improvement. If these requirements are not met, insurers are required to provide covered members with a rebate.

Improve Health Care Delivery 

The final strategy that Obamacare aimed to tackle was improving how health care is delivered by doctors and hospitals.

One example of such was the establishment of Accountable Care Organizations. Rather than ACA paying for each individual test, procedure, and visit, these organizations were designed to receive coverage payments based on the care and well-being of patients. So far, these organizations have shown significant results. As such, the ACA has continued to encourage them.

Additionally, ACA encouraged the transition to digital medical records. Traditionally, medical records were kept on paper and transferring them required doing so be done by mail or fax. Now, keeping electronic medical records provided a safer, more secure filing system that provided ease of transfer.

ACA also targeted the reduction of fraudulent doctor/supplier relationships. It provided guidance to states reviewing excessive insurance rate hikes and required background checks of all nursing home staff to prevent abuse of seniors.

Overall, the Affordable Care Act, or Obamacare, provided significant advantages to the healthcare industry. The Act was designed to best benefit both insurance suppliers and recipients to ensure that patients in need receive the best care possible without breaking the bank while still ensuring that the insurance industry was not crippled in the process.

While few fully recognize the benefits that were established as a direct result of the Affordable Care Act, many of the implemented changes have since become a recognized standard across the healthcare industry.

Innovative HIA provides a complete solution for ALE employers who want to provide affordable, ACA-compliant benefits to their workers. Our streamlined technology and personal services provide a complete solution for our clients and their employees. Learn more about what we do, here.