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Open Enrollment 2022-2023: What You Need to Know

What is Open Enrollment?

Open enrollment is the one period of the year where employees can sign up for health insurance or change a health insurance plan provided by the employer. Remember that this period also allows employees to disenroll in health insurance if they no longer wish to have coverage. 

 

The only exception to enrolling, changing a health insurance service, or disenrolling is through a qualifying event. Qualifying events can vary depending on the state the employee resides in.

Qualifying events include:

  • Marriage
  • Divorce
  • Having or adopting a child
  • Loss of insurance due to employment change or termination of employment 
  • Death of someone covered on the plan 
  • A dependent no longer qualifies as a dependent
  • Moving to a new state 
  • Becoming a U.S. citizen

When is Open Enrollment for Health Insurance? 

Open enrollment periods range depending on the healthcare provider and the state the employee lives in. Nationally, open enrollment periods begin on November 1st 2022 through January 15th 2023. In order for coverage to begin January 1st 2023, enrollees must enroll by December 15th.

 

Check here for Affordable Care Act (ACA) open enrollment dates by state. 

Is There Health Insurance That Doesn’t Use Open Enrollment?

Yes, a few health insurance policies do not have the same open enrollment restrictions that others do. This means that there aren’t restricted time periods when employers can sign up for insurance. It is available to them year-round.

 

Different types of health insurances that don’t follow open enrollment rules include:

  • U.S. government’s Children’s Health Insurance Program (CHIP)
  • Medicaid 
  • Short-term health insurance 
  • Travel insurance 
  • Supplemental insurance programs 
  • Medigap 

How Can Offering Voluntary Benefits Save Your Business Money? 

Voluntary benefits are offered by employers to their employees at no additional cost to the employer. They are often referred to as employee-paid benefits or supplemental insurance. The employer makes the benefits available to the employee, but the employee pays the full cost of the plan. It is not split between the two. 

 

This form of insurance is rising in popularity because it allows employees the flexibility to choose the type of insurance or health coverage that best fits their lifestyle instead of paying for coverage the employee does not want or need. 

 

Employer benefits of offering voluntary benefits include:

  • Reducing out-of-pocket health care costs
  • Access to group rates 
  • 100% of the insurance cost is paid by the employee 
  • Gives your employees choice in healthcare plans 
  • It is available to part-time and full time employees 
  • Helps your company attract and retain top talent (77% of workers say that benefits packages are an important part of deciding on accepting or rejecting a job offer)
  • Saves you billing time through automatic payroll deductions

 

At Innovative HIA, we provide comprehensive coverage plans for employers to provide affordable benefits to employees. Here, our voluntary benefit plans encompass:

  • Health
  • Dental
  • Vision 
  • Wellness/Lifestyle 
  • Financial 
  • Security 
  • Personal and miscellaneous 

Why is Employee Insurance Enrollment Important? 

Employee health insurance is important for businesses, especially Applicable Large Employees (ALE). Under the Affordable Care Act (ACA), ALEs who do not provide health insurance are penalized for every employee who is not offered health insurance.

 

This year, fines can range from $2,700 to $4,000 per employee not offered coverage. In comparison, offering our ACA compliant Minimum Essential Coverage (MEC) is an affordable way for ALEs to maintain coverage compliance. Look below for a cost comparison of how providing MEC benefits to employees saves your business money.

 

Besides avoiding hefty fines, employee health insurance provides the support employees need if they ever fall ill, and keeps employees healthy. One of the main benefits of coverage is that covered preventative care visits monitor any health concerns that may arise an employee cannot physically see or feel yet. 

 

Healthy employees are more present and productive at work. Employees who are supported through covered care gain access to resources that combat preventable illness, and are more likely to be positive, engaged and determined to do their best during work.

 

Another benefit of maintaining a healthy workforce is that it reduces the costs you as an employer must front when an employee takes sick leave or if you have to find someone to cover a shift.

Actionable Ways to Increase Benefit Enrollment 

Actively encourage employees to sign up and renew health insurance during open enrollment, and especially before, so employees have time to prepare and choose a plan best suited for them.  

 

Employers can encourage employees to sign up for health insurance during open enrollment 2022 through:

  • PDF one-pagers: One-pagers have information about health benefits that are easily distributed around the office.
  • Pamphlets: Similar to a one-pager, pamphlets have information, graphics, and contact information for the employee.
  • Offer a point of contact: A knowledgeable employee within your business can answer FAQs and help employees find the right plan.
  • Text or email campaigns: Sometimes the most effective method of communication is through technology.
  • Pay stubs: Add information about enrollment to paystubs because employees receive them regularly.

Curious about how else your business can increase health insurance enrollment this year? Read our article here on how opt-in vs opt-out insurance policies make a bigger difference than you’d think.

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Why Innovative HIA is the Gold Standard of Customer Service

At Innovative HIA, we pride ourselves on offering:

  • Affordable Benefits
  • ACA Compliance, and
  • Exceptional Service


Today, we’d like to chat a bit more about the third element—the exceptional service we provide—and why Innovative HIA is, therefore, the gold standard of customer service for Minor Medical insurance providers.

(Hint: Our one-stop-shop benefits portal plays a large role in our successful customer service efforts!)

Let’s dive in.

How Innovative HIA Supports the Onboarding and Offboarding Processes

At Innovative HIA, we support businesses beyond providing Minor Medical coverage. We are proud to support the employee onboarding process so your human resources (HR) teams have more time to focus on the daily tasks that keep your business running.

This is why we offer a complete insurance solution that covers:

  • Implementation
  • Enrollment
  • Administration, and
  • Reporting

Our benefits professionals are fully equipped to support onboarding and offboarding procedures to eliminate the hassle for businesses.

How? Using our benefits portal.

Our Benefits Portal

Employee benefits administration can be a pain for any HR department. At Innovative HIA, we aim to simplify the process by giving you access to everything you need in one place.

Our one-stop-shop portal is proprietary and unlike any other. Our portal grants you access to all of the tools necessary to support a new hire (from beginning to end).

We eliminate the headache of unnecessary paperwork with benefits management portal access. You can:

  • Make plan changes
  • Order ID cards
  • Check claim status online
  • Track onboarding and offboarding
  • And more

Resources are only a click away.

Besides creating a seamless onboarding process with our all-in-one portal, we also provide video tutorials for our partners. These resources provide instructions that assist navigation through the portal.

Read on to view our enrollment portal walkthrough.

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How to Promote Healthy Habits in Your Employees

Exercise

Consistent exercise creates long-lasting health benefits. Promoting regular exercise improves heart health, lowers cholesterol, increases brain function, reduces cancer risk, lowers stress, improves sleep and so much more. 

All of these come together to facilitate a more productive lifestyle and work environment because your team is more capable of managing their stress and responsibilities. Additionally, healthy employees take fewer sick days and miss less work due to health-related concerns. Yet another example of how encouraging healthy habits promotes productivity in the workplace. A healthy team means you spend less on healthcare costs and more on reinvesting into your employees themselves. 

We suggest getting creative to encourage employee physical activity. Some suggestions include: 

  • Provide weekly group workout classes
  • Develop walking or running groups
  • Partner with local gyms or yoga studios to offer discounts or added benefits
  • Offer employees free or subsidized gym memberships
  • Create friendly exercise competitions 
  • Try a hula hoop challenge 

Preventative care

Visiting your doctor for an annual physical is one of the best long-term health strategies. You grow your health history and build a relationship with your physician. The routine physical exam keeps you up to date on important vaccinations, assesses lab results, and addresses any concerns your doctor or you may have. Additionally, attending these visits can potentially catch any more serious health issues that may arise before they become something potentially more dangerous. 

Wellness check-ups

Maintaining good mental health is just as important as physical health. Increasing awareness of stress management strategies and sleep habits can help employees stay well-balanced. Additionally, employees that are supported with access to resources to combat mental health are more likely to be positive, engaged, and determined.

Investing in employee health and well-being is critical to the ongoing success of most businesses. Try different methods to promote wellness in your employees such as: 

  • Team retreats
  • Breathwork and reflection
  • Solicit the expertise of a sleep expert to educate your team on the importance of sleep
  • Keep work at work

All in all, promoting healthy lifestyles and providing employees with the tools to live successfully healthier lifestyles can lead to many benefits. Employees will be less likely to take sick days and more likely to stay loyal to your company and be happier in their work environment. Overall, you gain increased productivity in the workplace. 

If you’re looking for a comprehensive, affordable, ACA-compliant benefits plan to offer your employees, look no further. At SBMA Benefits, our goal is to provide affordable health coverage to help keep your employees healthy and promote their overall well-being. If you’re interested in offering SBMA benefits to your team, call or contact us today. 

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Safeguard Your Family’s Wellness This Back-to-School Season

School is back in session!

As a parent, we’re sure you’re excited that the summer chaos, coordinating camps and activities, and simply having your children around 24/7 have ended!

As you know, going back to school typically means your child gets sick more frequently. So, how can you safeguard your child and the rest of your family’s wellness this back-to-school season?

Below are a few tips.

Stay Up-to-Date on Immunizations and Vaccines

Vaccination requirements typically vary on a state-by-state basis or even in a school-specific district. To find out precisely what immunizations your child needs, contact your local school board.

The Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians recommend a few specific vaccines based on your child’s age. These are as follows:

By Age Two

A vaccination series of the following vaccines should be completed in all children by age two:

  • Hepatitis B
  • DTaP (diphtheria, tetanus, and pertussis)
  • Hib (Haemophilus influenzae)
  • Polio
  • Pneumococcus
  • MMR (measles, mumps, rubella)
  • Varicella (protects against chicken pox)

In addition, annual flu vaccines are recommended for infants from six to 24 months, as this age group is at high risk of complications from contracting the flu.

Hepatitis A vaccines may also be recommended starting at age 2 for those in high-risk groups or areas.

Age Four to Six

Typically, boosters are recommended between ages four to six for DTaP, Polio, and MMR. Those who are younger than nine and have not received the flu vaccine, need two doses of the vaccine given more than one month apart. After age nine, annual vaccination is recommended.

Children with asthma or lung diseases, sickle cell anemia, HIV, diabetes, and heart or kidney disease should receive the influenza vaccination annually.

Age 11 to 12

At around age 11 to 12, a pediatrician visit is recommended to review vaccinations and ensure all necessary immunizations have been provided. At this age, a hepatitis B, MMR, or varicella vaccine may be given if missed or incomplete at earlier ages.

Your child may also receive a combination of boosters for tetanus and diphtheria (if five years have passed since the last Td vaccine). Children with a high risk of complications from the flu should receive an annual vaccine. 

Attend Annual Checkups

Annual doctor’s office visits and check-ups can help prevent greater health issues later on down the line. These check-ups can help identify hearing and vision issues, malnutrition, and other lifestyle imbalances.

Hearing and Vision Issues

Vision and hearing losses are often overlooked in children at a younger age. These issues are difficult to identify if your child is not getting tested in their annual check-up for vision and hearing ability.

Identifying these issues early on can make a huge impact on your child’s ability to learn and engage both in school and at home.

Malnutrition

A child’s development depends on proper nutrition, both physically and cognitively. Malnutrition is an issue that impacts children globally, including in the U.S.

Annual checks and doctor’s visits can help give you greater insight into how your child is developing compared to other children of the same age. A slight change in nutrition can have a huge impact on your child’s ability to learn.

Infographic for "Safeguard Your Family's Wellness This Back-to-School Season"

MEC Covered Services for Children

To make sure your child can receive the care they need to remain healthy during the school year, you need proper insurance coverage.

Minimum essential coverage (MEC) offers an affordable coverage option to keep you and your family healthy at all times.

Some of the services covered for children include:

  • Alcohol and drug use assessments for adolescents
  • Autism screening for children at 18 and 24 months
  • Behavioral assessments for children at 0 to 11 months, one to four years, five to 10 years, 11 to 14 years, and 15 to 17 years
  • Bilirubin concentration screening for newborns
  • Blood Pressure screening for children at 0-11 months, one to four years, five to 10 years, 11 to 14 years, and 15 to 17 years
  • Blood screening for newborns
  • Cervical dysplasia screening for sexually active females
  • Depression screening for adolescents
  • Developmental screening for children under age three
  • Dyslipidemia screening for children at higher risk of lipid disorders at one to four years, five to 10 years, 11 to 14 years, and 15 to 17 years
  • Fluoride chemoprevention supplements for children without fluoride in their water source
  • Fluoride varnish for all infants and children as soon as teeth are present
  • Gonorrhea preventive medication for the eyes of all newborns
  • Hearing screen for all newborns; and for children once between 11 and 14 years, 15 and 17 years, and 18 and 21 years
  • Height, weight, and body mass index measurements for children at 0 to 11 months, one to four years, five to 10 years, 11 to 14 years, and 15 to 17 years of age
  • Hematocrit or hemoglobin screening for all children
  • Hemoglobinopathies or sickle cell screening for newborns
  • Hepatitis B screening for adolescents ages 11 to 17 years at high risk.
  • HIV screening for adolescents at higher risk
  • Hypothyroidism screening for newborns

These services in combination with preventative measures taken at home can help keep your family and your children safe during the back-to-school influx of sickness.

Looking to start a family or grow your current family? Take a look at one of our recent articles to learn about pregnancy and minimum essential coverage.

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Which Industries are Most Susceptible to ACA Penalties from the IRS?

While all organizations are susceptible to receiving IRS penalties, some industries are particularly vulnerable. These industries include home healthcare, staffing, restaurant, and construction industries.

Why are these industries under fire from the IRS? Let’s take a look.

These Industries Typically Have a High Number of Hourly Workers

Home healthcare, staffing, restaurant, and construction industries have a high percentage of hourly workers with varying schedules. This can make it difficult for employers to determine which employees are ACA full-time and require an offer of health coverage.

HR is often a non-centralized function, making it challenging to gather the data necessary for compliance.

High Staff Turnover Rates

These industries are often associated with a high employee turnover rate. This can make it difficult for employers to track employees as their benefits.

Workforces that Disproportionately Decline Health Coverage

Home healthcare, staffing, restaurant, and construction industries generally employ workforces that are more likely to decline offers of health coverage benefits. Employers may struggle to track declinations and face ACA penalties from the IRS.

How Can Organizations Ensure They Are Complying with ACA Requirements?

Employers can ensure they are ACA compliant by determining the accurate full-time and part-time status of employees under ACA. Employers may experience significant ramifications for misclassifying employees. 

Additionally, employers should familiarize themselves with their requirements under the ACA’s Employer Mandate. For example, employers with 50 or more full-time employees, or ALEs, must:

  • “Offer Minimum Essential Coverage (MEC) to at least 95% of their full-time employees (and their dependents) whereby such coverage meets Minimum Value (MV); and 
  • Ensure that the coverage for the full-time employee is affordable based on one of the IRS-approved methods for calculating affordability.”

Infographic for "Article Review Which Industries are Most Susceptible to ACA Penalties from the IRS?"

For more information, read on for the full article from the ACA Times.

These Industries are Most at Risk for ACA Penalties From the IRS

The home healthcare, staffing, restaurant, and construction industries are under fire from the IRS for failing to comply with the ACA. Organizations within these industries have been shocked to receive ACA penalty notices from the IRS that are in the millions of dollars.

Of course, all types of organizations – hospitality, manufacturing municipal governments, non-profits, and other industries – are receiving IRS penalty notices too. However, the four industries mentioned above seem to be getting more than their fair share.

Here’s why these industries are so susceptible to receiving ACA penalties:

  • HR is often a non-centralized function, making it challenging to gather the data necessary for compliance
  • They have a high percentage of hourly workers with varying schedules, making it difficult to determine who is ACA full-time and requires an offer of health coverage
  • They employ workforces that disproportionately decline offers of health coverage benefits, creating a heavier employer burden in tracking declinations
  • Employees come and go during the year with high staff turnover rates, increasing the employer’s burden to track all such employees
  • Per diem piece work and multiple rates of pay complicate the determination of pay rates and affordability
  • Reliance on payroll systems (or other software programs) that collate data and submit Forms 1094-C and 1095-C often result in a failure to let you know when the data used is inaccurate, which will trigger ACA penalties

Determining the accurate full-time and part-time status of employees under the ACA is arguably the first, and most important, step for ACA compliance. There are real ramifications for inaccurately classifying employees. 

Under the ACA’s Employer Mandate, ALEs, or employers with 50 or more full-time employees and full-time equivalent employees to:

  • Offer Minimum Essential Coverage (MEC) to at least 95% of their full-time employees (and their dependents) whereby such coverage meets Minimum Value (MV); and 
  • Ensure that the coverage for the full-time employee is affordable based on one of the IRS-approved methods for calculating affordability

ALEs that fail to comply with these requirements can be subject to Internal Revenue Code (IRC) Section 4980H penalties.

For example, let’s look at an employer that improperly classifies an employee as not full-time and does not make an offer of insurance. That employee goes to a government marketplace exchange to purchase health insurance and receives a Premium Tax Credit (PTC) that helps subsidize the cost of the health insurance purchased on the exchange. This can trigger the issuance of an IRS Letter 226J penalty notice under IRC 4980H. 

The penalty assessment will be applied to every full-time employee working for that employer during the course of the tax year, not just the employee obtaining the PTC. For the 2022 tax year, that penalty could be as high as $275,000 for every 100 employees.

The first step in the full-time status evaluation is determining which measurement method is best for your organization.

For organizations made up primarily of variable-hour employees, you will want to implement the Look-Back Measurement Method. If your workforce has mostly full-time employees and non-varying schedules, the Monthly Measurement Method will be best.

The most expedient step for employers is to get your ACA Vitals score. This will help determine your risk of receiving IRS penalties by analyzing your unique workforce composition.

Such a review can reap dividends by helping employers avoid significant ACA penalties from the IRS, particularly if those organizations have not been filing ACA-required information annually with the IRS. These organizations should file this information as soon as possible to avoid receiving an IRS penalty notice and to minimize potential penalties. 

The IRS is currently issuing warning notices to employers identified as having failed to file and furnish Forms 1094-C and 1095-C for the 2019 tax year via Letter 5699. If you have received one, contact us to have the penalty reduced or eliminated. We’ve helped our clients prevent over $1 billion in ACA penalty assessments.

If you are part of the home healthcare, personnel staffing, restaurant and construction industries, or any industry that relies on a significant mix of full-time and part-time employees, you are at serious risk of being penalized for not complying with the ACA.

We see daily how the IRS is enhancing its methods for identifying employers that are not complying with the ACA and sending them penalty notices. 

We regularly see the surprise and shock expressed by organizations that receive these penalty notices, many of them containing significant penalty assessments. 

We also see how these organizations could have avoided these penalty assessments by receiving help from experts that understand ACA and IRS regulatory requirements and know how to successfully meet those regulatory requirements.

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Telehealth: Can a Doctor Really Diagnose Over Zoom?

During the COVID-19 pandemic, telehealth services, such as Zoom diagnoses, became a necessity. These phone and video calls help patients protect themselves and others by quarantining and remaining safely in their homes.

However, after years of visiting healthcare professionals in person, many patients can’t help but ask the question: Can a doctor really diagnose over Zoom?

The short answer: Yes, doctors can absolutely provide accurate diagnoses and medical assistance over a video call. Telemedicine services help patients receive the care they deserve at the right time and place.

Read on to learn more about how to utilize telehealth services. Let’s start with a definition.

First, What Are Telehealth Services?

Telehealth, also commonly referred to as common medicine, allows healthcare providers to connect with patients without an in-person visit. Telehealth services are provided primarily online or via smartphone through video chats or phone calls.

Why is the American Medical Association Maximizing Telemedicine Service Options?

The American Medical Association is working to maximize telemedicine service options to revolutionize healthcare. While the highly contagious nature of the COVID-19 virus drove this change, telehealth can help patients facing other medical issues or illnesses as well as those who may struggle to get to the doctor in person.

How Can Telehealth Help Patients Who Struggle Going to the Doctor?

Patients may struggle to attend in-person visits to the doctor for many reasons. For example, many patients may have difficulty getting time off work or may be responsible for watching children at home and find it challenging to find a sitter.

Additionally, telemedicine services can also help those who have had non-urgent medical care postponed due to the pandemic or patients whose medical resources are greatly limited in their area.

Patients should not have to receive less than the medical care they deserve because of these difficulties. Telehealth services allow patients to easily hop on a video visit and get the same results as going to the doctor.

So, How Exactly Does Telemedicine Work?

Drs. Francavilla Brown and Boyd told AMA that telemedicine “is easier than people think it is to incorporate into a practice.”

With technological advancements typically come progress and challenges. Physicians who have tried implementing telemedicine have identified these challenges, and have come up with a few solutions.

One challenge is patients may not have a good signal to support their doctor’s visit. The trouble with a weak signal may make the appointment longer, or impossible for someone who really needs it. Another challenge physicians have identified is booking appointments to be a televisit for doctor’s offices. The patient must call the office to ensure their appointment is virtual.

What Medical Issues Can Telehealth Services Best Help Patients With?

While telehealth services may not be the best option for detecting major issues, it has been great for reassessing and monitoring patients who have known problems. It can also be used to adjust medications, answer questions, and share information.

These services also help people avoid unnecessary hospital visits, which helps to give advice at a distance, save time, and reduce costs for both patients and doctors. Not only will it help avoid hospital visits when they aren’t necessary, but it will also give patients in the hospital the ability to discharge sooner by monitoring their vitals with telemedicine.

Looking for Telehealth Services?

Virtual visits with your doctor may begin to become the new normal in a post-COVID world. At Innovative HIA, we offer telemedicine services at competitive prices. Learn more about our services.

Infographic of "Can a Doctor Really Diagnose Over Zoom?"

Read on for the pros and cons of telemedicine.

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ACA Penalty A and B Breakdown

All applicable large employers (ALEs) must comply with the Affordable Care Act (ACA), which requires employers to offer minimum essential coverage to all employees.

If an employer does not comply with this employee coverage requirement could lead to penalties for the employer and potentially an IRS audit.

Below is a breakdown of ACA penalties A and B, and how they could affect your company.

Who is Considered a Large Employer?

First, who is considered a large employer?

Any company or organization that has an average of at least 50 full-time employees or “full-time equivalents (FTEs) is considered an applicable large employer.

*For the purposes of the ACA, a full-time employee is someone who works a minimum of 30 hours a week.

What Are ACA Benefits?

The ACA was created in 2010 to offer more affordable health benefits to a wider range of people. Any ACA-compliant benefit plan must cover these 10 health benefits:

  • “Ambulatory services
  • Emergency services
  • Hospitalization
  • Pregnancy, maternity, and newborn care (before and after birth)
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services 
  • Preventative and wellness services and chronic disease management 
  • Pediatric services”

Additionally, ACA benefits cover birth control and breastfeeding support. 

The Employer Mandate (Penalty A)

Employers must offer at least Minimum Essential Coverage (MEC) to any benefit-eligible employee. Non-compliance will generally result in a penalty of $2,500,000 PER eligible employee.

The Employer Mandate (Penalty B)

Employers must offer a minimum value plan that meets 60% actuarial value including hospitalization services.

The MV plan must be offered at a maximum contribution of 9.86% of the employee’s income – YOU pay the difference.

For example, take a California minimum wage employee: A $10.00/hour employee working a minimum of 30 hours per week has a maximum employee contribution of $128.18 per month.

If the plan cost is $300, YOU pay the difference of $171.82 per month. 

Non-compliance will generally result in a $3,750.00 penalty PER employee who enrolls in coverage through the state exchange AND receives a premium subsidy.

The Individual Mandate

The individual mandate went away starting January 1st, 2019 for the majority of Americans.

Those individuals living in the District of Columbia, Massachusetts, or New Jersey will continue to be penalized for the individual mandate.

Infographic of ACA Penalty A and B Breakdown

These penalties can add up to a lot of expenses for your business. At Innovative HIA, we want to help you avoid any potential penalties for lack of proper insurance. Contact our team at Innovative HIA for more information regarding your employer benefit needs.

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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

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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.

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What Does PHI Stand For?

The healthcare industry has many acronyms to keep track of.

 

For example, HIPAA for the Health Insurance Portability and Accountability Act, CDC for Centers for Disease Control and Prevention, and more. When it comes to keeping your personal records as secure as you want them to be, let’s dive into PHI, what it stands for, and why it’s important for you.

What Does PHI Stand For?

PHI stands for Protected Health Information. PHI is part of HIPAA regulations that protect patients’ personal health information. Under the act, patients have the right to disclose or withhold their information as they see fit.

What is PHI?

PHI is a national standard that any entity—businesses, converted entities, etc.—must uphold if they have private records. They must protect PHI, physical and electronic, from anyone without proper consent from obtaining it.

 

PHI includes an array of personal information that makes a person identifiable, including:

 

  • Name
  • Birthday
  • Phone number
  • Social security number
  • Photos
  • Medical records
  • Address
  • Unique identifiers

 

ePHI is any type of protected health information that is stored electronically. 

Why is PHI Important?

PHI should stay personal and private. The patient should be the one who can disclose who they want to grant access to their personal medical records. This helps keep hackers and identity thieves away from patients’ private information.

What is the Difference between PHI and ePHI?

ePHI, as mentioned earlier, is electronically protected health information. Electronic data is more easily accessed and shared, which makes ePHI more protected by federal law. ePHI must meet the HIPAA Security Rule, HIPAA Privacy Rule, and the HITECH Act.

 

All are set in place to protect patients’ personal information from the wrong hands.

What is HIPAA? 

The Health Insurance Portability and Accountability Act was created in 1996 to keep patient health information safe and secure. Under HIPAA, PHI can only be given with patient consent. 

 

Covered entities must always follow and enforce HIPAA law. Different types of covered entities include:

 

  • Health care providers
  • Business associates
  • Health care plans
  • Health care clearinghouses

 

Maintaining HIPAA compliance keeps personal information secure and builds trust between patients and covered entities.

 

How Does HIPAA Protect Your PHI?

 

The HIPAA Security Rule requires covered entities to protect against reasonab

ly anticipated threats to the security of PHI. Covered entities must implement safeguards to ensure the confidentiality, integrity, and availability of PHI; however, HIPAA is not technology-specific and the exact safeguards implemented are left to the discretion of the covered entity.

 

HIPAA requires physical, technical, and administrative safeguards:

  • Physical safeguards for PHI data include keeping physical records and electronic devices containing PHI under lock and key.
  • Technologies such as encryption software and firewalls are covered under technical safeguards.
  • Administrative safeguards include access controls to limit who can view PHI information. It is a requirement that staff are provided HIPAA security awareness training.

Have more questions? Visit our Frequently Asked Questions page here. 

PHI stands for Protected Health Information. It protects patients’ identifiable information from falling into the wrong hands.

 

Article originally published on SBMA Benefits.