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How Innovative HIA Makes Healthcare Affordable by Focusing on Insurance Needs

Innovative HIA makes healthcare affordable by focusing on the insurance needs of people and trimming away the things most people don’t actually want. How do we do it? Let’s discuss.

Innovative HIA Provides Affordable Care Act Compliant Benefits

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”

Minimum Essential Coverage (MEC) is a classification of insurance plans that meet the Affordable Care Act requirements for health insurance coverage. Plans that meet MEC requirements include marketplace, job-based plans, Medicare, and Medicaid.

MEC can be a cost-effective way to ensure that families are protected in times of need but employers aren’t overpaying for unnecessary services.

Why Do Employers Need to Offer Coverage?

Employers must offer at least Minimum Essential Coverage (MEC) to any benefit-eligible employee. Non-compliance will generally result in a penalty of $2,750 annually PER eligible employee. 

 

Innovative HIA provides benefits that will meet these requirements and keep employers from being penalized without making them pay for the services they don’t need. We offer affordable coverage for all clients, with a variety of options, including telehealth, vision, and dental voluntary benefits.

How Affordable Are Innovative HIA’s ACA Compliant Plans?

Many of Innovative HIA’s plans cost less than $100/month and include virtual health, worksite benefits, vision, dental, and ACA-compliant plans that are affordable for both employers and employees.

Innovative HIA plans also offer the bundling of medical and ancillary benefit options, making affordable healthcare options easy for employers. This is a significant contrast to many employers paying thousands of dollars a month for major medical coverage.

Let’s Talk Telehealth Services: Giving People Medical Care at the Right Place and Time

Telehealth services experienced a spike in popularity during the COVID-19 pandemic. Why? Telehealth services allow patients to stay home and keep others safe as well as work around a collection of other challenges, such as:

  • Problems finding childcare
  • Issues driving to or navigating a hospital due to a disability
  • Difficulty getting time off work

 

Innovative HIA’s virtual health and telemedicine services offer plan participants 24/7 access to their doctor, at no cost to them. They can speak to a licensed physician as and when they need, by phone or video, and find the complete solution to their health care needs.

 

Learn more about telehealth services.

Innovative HIA Gives Users What They Want: Hassle-free, Basic Care

Innovative HIA knows what the users of its insurance want, need, and expect: they want to go to the doctor when they need a check-up, they want to be able to get their kids registered for school with all their shots, and they want doctor visits and prescriptions to be as efficient and hassle-free as possible. 

Learn more about Innovative HIA and our benefit plans.  

Frank Crivello: Meeting Real-World Insurance Needs to Make Healthcare Affordable For All   

Frank Crivello, CEO of SBMA believes that success is not a destination, but a journey. He defines success as the balance of achievement and satisfaction.

“If you don’t like what you’re doing but you have a ton of money, that’s not success. If you do like what you’re doing and don’t have any money, well, that’s not success either,” he says.

Meeting the real-world insurance needs of people

Despite not having gone to Harvard or pursued advanced degrees, Frank achieved success just by learning from everyone around him.

“I’ve absorbed incredible insights and lessons from business owners and co-workers, from janitors and motivational speakers. Innovative HIA is successful because we listen to the needs of our brokers and the companies we serve, and then exceed expectations,” he states.

When Frank first started out in the insurance industry, he noticed that all the third party administrators were offering all kinds of products that their employer groups didn’t want or need. So when he built Innovative HIA, it was specifically to meet the real-world needs of the people they served. 

Innovative HIA provides ACA compliant benefits administration for large employers all across the US. The company’s offices and customer care center are located in sunny San Diego, CA.

“Insurance is not a new industry and, to be honest, major medical is not a place where much innovation takes place. At Innovative HIA we saw the opportunity to innovate in the MEC space, and seized the chance to really make a difference,” states Frank.

He notes that SBMA provides affordable coverage for all of its clients, with a variety of options, including telehealth, vision, and dental voluntary benefits. Their revolutionary idea was to offer plan participants real-world benefits they can actually use.

Providing affordable healthcare options for all

Innovative HIA benefit plans provide a complete solution for employers who want to provide affordable benefits to their workers. The firm offers the most competitive limited medical plans in the industry, with seamless benefits that work like major medical, ensuring ACA compliance for the employer at a price they and their employees can afford.

Many of Innovative HIA’s plans cost less than $100/month, and include Virtual Health, Worksite Benefits, Vision, Dental, and ACA compliant plans that both employers and employees can afford.

Innovative HIA plans also offer the bundling benefits of medical and ancillary options, making affordable healthcare options easy for the employers. Frank points out that not everyone wants to pay out thousands of dollars a month for major medical.

“Our benefits provide coverage for those who value acute care, prescription coverage, and regular DR visits, but don’t want to pay for comprehensive major medical. We created healthcare that costs between $40 to $125/month, by carving out the big ticket items to build plans that give people benefits they actually use. Practical, useable, affordable, and ACA compliant benefits for everyday people! That’s our revolution!” he declares.

Frank points out that, prior to the pandemic, the majority of patients preferred in-person doctor visits over telehealth options. However, when a contagious airborne virus appeared, telehealth options expanded dramatically. Almost all health insurance providers now have new, simple-to-use options.

With a Virtual Health medical professional on the line at any time of day or night, nationwide telehealth services help avoid unnecessary doctor visits, and provide numerous financial benefits to both healthcare providers and patients.

Telehealth services can help reduce transportation costs and save money for both patients and providers. Virtual visits aid in increasing patient retention, streamlining time on task, improving appointment compliance, lowering overhead costs, and reducing in-person liability.

Innovative HIA’s virtual health and telemedicine services offer plan participants 24/7 access to their doctor, at no cost to them. They can speak to a licensed physician as and when they need, by phone or video, and find the complete solution to their health care needs.

Flipping the MEC model on its head

Minimum essential coverage (MEC) is an insurance plan that meets the Affordable Care Act requirements for health insurance coverage. Plans under MEC include marketplace, job-based plans, Medicare, and Medicaid.

Prior to the Affordable Care Act, insurers would refuse to insure people with preexisting medical conditions. Those who had used too much of their medical coverage in the past were also at risk of losing it.

MEC ensures that all enrollees have access to insurance, regardless of their health status or the plan they choose. It can be a cost-effective way to ensure that families are protected in times of need. Frank points out that the MEC space has traditionally been filled by those providing minimum essential coverage paired with minimum service.

“We flipped the model on its head by providing gold standard service to accompany the government mandated MEC coverage that employers must offer to be ACA compliant,” he states.

Innovative HIA knows what the users of its insurance want, need, and expect. They want to go to the doctor when they need a check-up, they want to be able to get their kids registered for school with all their shots, and they want doctor visits and prescriptions to be as hassle-free as possible. 

Innovative HIA also knows what its employer groups want: Fast enrollment and off boarding, no hassle ID cards, no hassle claims, and coordinated technology that streamlines their experience. And finally, the firm makes brokers’ lives better by taking all the hand-holding off their plates. 

Brokers are able to provide employer groups not only with great rates and easy compliance with the ACA requirements, but they can also hand those employer groups off to Innovative HIA, knowing that there will be a gold standard support team handling every phase of their relationship, from the moment the group enrolls.

A respected leader who commands trust and faith

Frank defines his leadership style as casual, collaborative, and authoritative. “Don’t mistake that for authoritarian. I know what needs to be done, and am clear with everyone around me. I move fast, make decisions with certainty, and I pivot easily,” he points out.

As CEO, Frank ensures that Innovative HIA is on track to be the best in the industry. His relationships with the leading brokers keep his finger on the pulse of the industry, allowing Innovative HIA to be more agile, more responsive, and a better partner for its brokers, and employer groups, with the freedom to be the best ACA compliant MEC coverage provider in the industry.

Some of the people on Frank’s leadership team have been with him since the early days, which he feels is a testament to the strength of their trust and faith in him as a leader.

“Nobody gave me anything starting out,” Frank observes. “I had to earn everything from the ground up. That might make some people resentful, but not me. I’m grateful for all the hard work I put in to get here. The view from the top is amazing, especially if you took the stairs.”

Today, SBMA is the industry leader in providing MEC coverage. Over the past five years, the firm has grown to become the gold standard in customer service by building the technology to streamline all of its operations. “I see blue skies and market domination in our future. And, I’m just getting started!” states Frank.

As a father, Frank dotes on his two beautiful daughters who keep him grounded and balanced. “They’re everything to me. Watching them grow up, and creating a life for them where they see that hard work pays off, and that grit and determination is enough to succeed, gives me great satisfaction,” he says.

Frank’s parting advice to aspiring business leaders is to: LISTEN. Don’t let ego get in the way of learning. It’s easy to think you already know, or even to worry that someone will think you’re stupid if you don’t know the answer. Lose that perspective as fast as possible. If you can absorb everyone else’s knowledge and experience around you, you will accelerate your own trajectory to success.

Common Health Insurance Terms to Help You Understand Your Plan

If you’re considering purchasing health insurance, you may feel overwhelmed by the variety of terminology associated with it. From coinsurance to deductibles, there are numerous health insurance terms you should know before you enroll. But don’t worry; we’ve got you covered. We have translated some of the confusing terminologies around health insurance into plain English to help you better understand your health insurance coverage.

Let’s dive in.

Coinsurance

Coinsurance is a health insurance term that refers to the percentage of the cost of a healthcare service that you are responsible for paying after you have met your health insurance plan’s deductible. 

For example, if your healthcare bill is $1,000 and you have already met your deductible, and your coinsurance is 20%, you will be responsible for paying $200 (20% of $1,000), while your insurance company will pay the remaining $800. Coinsurance is one of the ways in which health insurance companies share the cost of healthcare services with their policyholders.

Copay

Copay refers to a fixed amount of money that you may need to pay out-of-pocket for a covered healthcare service or supply. For example, your health plan may require a $20 copay for an office visit or a $10 copay for a generic prescription. After you pay the copay, your health insurance plan will cover the remaining cost of the healthcare service or supply. 

Copays are a way for health insurance companies to share the cost of healthcare services with their policyholders. Copay amounts may vary depending on the type of healthcare service or supply, and the specifics of your health insurance plan.

Deductible

A deductible is the amount of money that you need to pay out-of-pocket for healthcare services before your insurance plan starts covering those services. For example, if your plan has a $1,000 deductible, you will need to pay the first $1,000 of healthcare services you receive during the year before your plan starts contributing to the cost of covered services. Once you’ve met your deductible, your insurance plan will begin to share the cost of healthcare services with you. The amount of the deductible can vary depending on the specifics of your insurance plan and is an important factor to consider when choosing a plan, as it can significantly impact your out-of-pocket costs for healthcare.

Essential Health Benefits

Let’s talk about Essential Health Benefits – a set of healthcare services that must be covered by plans in the Health Insurance Marketplace, as required by the Affordable Care Act. These benefits include emergency services, hospitalization, maternity and newborn care, mental health, prescription drugs, preventive and wellness services, pediatric services, and more. 

In-Network Providers

Understanding the difference between in-network and out-of-network providers is critical. In-network providers are a group of doctors, hospitals, and other healthcare providers that your health insurance plan has partnered with to provide care to its members. 

Out-of-Network Providers

When you receive healthcare services from a provider that has not partnered with your insurance plan to provide care to its members, this is known as an out-of-network provider. It’s important to note that using an out-of-network provider may result in additional costs for you, so it’s crucial to know which providers are in-network before receiving care.

Another important term to be familiar with is out-of-pocket cost, which refers to the amount you pay for health care services. This may include your deductible, coinsurance, and co-pays.

The out-of-pocket maximum is the most you’ll pay in a policy period, usually one year, before your plan starts to pay 100% of the covered Essential Health Benefits you receive. This limit must include deductibles, coinsurance, and co-payments, but typically does not count premiums toward your out-of-pocket maximum.

Monthly Premiums

Monthly premiums refer to the regular payments that an individual pays to their health insurance company in exchange for coverage. This payment can be made on a monthly, quarterly, or yearly basis depending on the insurance plan. 

The amount of the premium varies based on a number of factors, such as the type of coverage, the individual’s age, location, and the level of benefits they choose. It’s important to understand the cost of the monthly premium when selecting a health insurance plan, as it can impact your budget and overall financial health.

Preventative Care

Preventive care is health care services focused on keeping you healthy before you may become sick. These include routine check-ups, patient counseling, screening tests, and immunizations. Plans must offer these services at no cost to you when the services are provided by in-network doctors. This means they can’t charge a copayment or coinsurance, even if you haven’t met your deductible for the year.

Provider

Lastly, it’s important to understand what a provider is. This refers to a person or place you go to receive health care services. Examples include doctors, hospitals, pharmacies, and more. Check with your health insurance plan to find out if a provider is in-network or out-of-network.

By familiarizing yourself with these health insurance terms, you can better understand your coverage and make an informed decision when choosing a health insurance plan.

Still Have Questions?

We serve employers who want to offer their employees affordable benefits. We simplify the complexity of providing those benefits and ensure compliance with the Affordable Care Act. We provide affordable benefits for the everyday person. We are different because of our personal service, speed of implementation, and innovative approach to providing benefits coverage.

Learn more about us and our plans, here.

FAQs: ACA and ALEs – What You Need to Know

As an ALE, understanding the regulations set forth by the Affordable Care Act (ACA) can be a daunting task. The employer mandate, minimum essential coverage (MEC), minimum values, and affordability are all crucial guidelines that must be understood to avoid penalties.

In this blog, we will answer some frequently asked questions about ACA and ALEs to help you stay informed and compliant. We will cover topics such as what is an ALE, how to calculate workforce size, common ownership impact on ALE status, timing impact on ALE status calculation, the employer mandate, minimum essential coverage, and more. So, let’s get started!

First, What is an ALE?

An ALE, or applicable large employer, is a company or organization that employs at least 50 full-time equivalent (FTE) employees. The IRS defines a full-time employee as someone who works at least 30 hours per week or 130 hours of service per calendar month.

 Even if a company doesn’t have 50 full-time employees at all times, it just needs to average at least 50 FTEs per month in the current calendar year to be considered an ALE for the following calendar year.

How Does an Employer Calculate Workforce Size to Determine if They’re an ALE?

To determine if your company is considered an ALE, you must add the number of full-time employees and the full-time equivalent of your part-time employees. only U.S employees should be counted. 

To calculate the full-time equivalent of your part-time employees, take the total hours worked by all part-time workers in a month and divide by 120. Then add this number to the total number of full-time employees to get your total FTE count. If you have seasonal workers, they must be included in the FTE count, but you may be able to apply for an exemption if their hours cause the count to exceed 50 or more.

You are eligible for the seasonal worker exemption if you meet the following conditions:

  • Your total number of full-time employees (including FTEs) exceeds 50 for a maximum of 120 days in a calendar year.
  • The excess employees during this period are considered seasonal workers.

How Does Common Ownership Impact ALE Status?

To determine if a group of businesses are considered an ALE, they must be evaluated together as a controlled group. This applies even if the businesses are separate legal entities. If the controlled group is determined to be an ALE, each individual business within the group is considered an ALE, regardless of the total number of employees and is subject to the employer shared responsibility provisions (ESRP) of the ACA.

How Does Timing Impact ALE Status Calculation?

When determining ALE status, it is important to consider the preceding calendar year. Employers who were established during part of the previous year will have their calculations adjusted accordingly. New businesses that did not exist on any day in the previous year will be considered an ALE if they anticipate and do employ an average of 50 or more full-time employees, including full-time equivalentsduring the current calendar year.

What is the Employer Mandate?

The employer mandate, also known as the Employer Shared Responsibility Provisions (ESRP), is a requirement under the Patient Protection and Affordable Care Act (ACA) that applies only to businesses that are considered Applicable Large Employers (ALEs). These employers are required to offer health insurance coverage that meets minimum essential coverage (MEC) and is considered affordable to their full-time employees and their dependents, or they may face penalties. 

Businesses that do not qualify as ALEs are not subject to these requirements or penalties. Only full-time employees, not full-time equivalents, are counted for the purpose of calculating penalties and the first 30 full-time employees are not factored into the calculation.

What is Minimum Essential Coverage?

The Affordable Care Act (ACA) requires that ALEs provide a minimum level of health insurance coverage, known as minimum essential coverage (MEC), to at least 95% of their full-time employees. This is to avoid paying penalties under the employer shared responsibility provisions (ESRP). 

To meet this requirement, ALEs must offer their employees the opportunity to enroll in a health insurance plan that meets the standards set forth by the ACA, such as those offered in the small or large group market, grandfathered health plans, or certified by the Health Insurance Marketplace.

How is Affordability Defined and Calculated?

To be considered “affordable” under the Affordable Care Act, a health plan’s cost for an employee cannot exceed 9.12% of their annual household income in 2023. This calculation is based on the employee’s salary and the lowest cost silver plan available for their age and location.

Does the Employer Mandate Require Coverage be Offered to Dependents?

The employer mandate under the ACA stipulates that ALEs must provide qualified and affordable health coverage options to their employees and their eligible dependents. According to the mandate, dependents are defined as an employee’s child under the age of 26, including adopted or placed for adoption children. It should be noted that spouses, stepchildren, foster children, or non-U.S. citizen children not living in the U.S. or a contiguous country do not fall under the definition of dependents.

When Would an Employer be Subject to Potential Employer Shared Responsibility Penalties?

There are two types of financial penalties for ALEs (Applicable Large Employers) under Section 4980H of the Internal Revenue Code. The first penalty (4980H(a)) applies to ALEs that do not offer Minimum Essential Coverage (MEC) to at least 95% of their full-time employees and dependents. The second penalty (4980H(b)) applies to ALEs that do not offer affordable coverage to their full-time employees and dependents.

If an ALE fails to meet these requirements and at least one full-time employee receives federal subsidies, such as premium tax credits for purchasing essential coverage through the Marketplace, the ALE will be subject to penalties. 

How Much are the Penalties for Failing to Meet the Employer Mandate?

The IRS updates the penalties for employer mandates annually. In 2023, the penalties are as follows:

  • Section 4980H(a) penalty: ALEs that do not provide Minimum Essential Coverage to 95% of full-time employees will face a penalty of $2,880 per full-time employee.
  • Section 4980H(b) penalty: ALEs that do not offer affordable or minimum value coverage will face a penalty of $4,320 per full-time employee.

These penalties may be adjusted based on the number of employees who received subsidies for coverage and how many months employees were not covered. The IRS will apply the higher penalty of the two options, meaning that both penalties cannot be imposed simultaneously.

Still Have Questions?

The best way for employers to remain compliant with healthcare laws is to consult with a team of professionals. Our team at Innovative Health Insurance Advisors understands the ACA and can help you stay up-to-date on any changes to the law. 

What Happens If Your Employee Misses Open Enrollment

There are strict deadlines for open enrollment each year. It opens nationally on November 1st, and closes on January 15th. Some states, such as New York and California, have extended deadlines through January 31st. Click here to see your state’s open enrollment period.

During this period, people have the opportunity to enroll in healthcare coverage, or change their plans. Failing to take action during this time can pose serious consequences because open enrollment is the time employers can take advantage of having health, dental, vision, life and other voluntary benefit insurance plans.

Enrolling after the deadline means that there is no way to make changes to your plan or enroll again until it opens back up a year later.

What Happens if Your Employee Misses Open Enrollment?

Employees who miss the deadline to sign up for health insurance during open enrollment could face a year without health insurance. In turn, those without coverage may have to pay an individual mandate penalty on their next tax return. However, there are a few options available to employees depending on their circumstances.

What Other Options Can You Provide to Your Employees?

Depending on the employee’s circumstances, they may be eligible to register for alternative coverage options.

Medicaid

Enrollment for Medicaid is open year-round to those seeing to apply. Eligibility is based on federal requirements that differ depending on the state. It extends coverage for:

  • Low-income adults
  • Children
  • Pregnant women
  • Elderly adults

Short-Term Health Insurance

Private insurance companies offer short-term health insurance policies. Most do not cover pre-existing conditions nor do they guarantee coverage because they are not required to fit ACA minimum essential coverage (MEC) benefits.

Young Adult Benefit Plan

Those under 26 years old are eligible to join their parent’s plan if that plan offers dependent coverage. This plan does not require the child to be employed, a student, or have a child. A caveat may include that registration for the child may need to occur during open registration. Rules and regulations for this may vary depending on plan type and state location.

Qualifying Events

If a qualifying event occurs, employees have the opportunity to change their plans.

Qualifying events are the only exception for employees to add or change health insurance after open enrollment deadlines. If any of the following occur, your employee is able to adjust or enroll in health insurance:

  • Marriage
  • Divorce if the divorce is counted as a qualifying event by the insurer, or the divorce causes a loss of health coverage
  • Death in the family
  • Birth of a child
  • Adopting a child
  • Loss of health coverage
  • Turning 26 and losing eligibility as a dependant
  • Becoming a United States citizen
  • Increased pay that moves the employee out of the Medicaid coverage gap
  • Change in income changing eligibility requirements
  • Grandfather or grandmother plan renewal
  • Moving to an area where there are different health plans
  • Changing jobs

Learn More

Employers who invest in their employees, and encourage them to take full advantage of their benefits increase productivity, and attract top talent. Learn more about why you should invest in healthcare for your employees here. 

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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

1094/1095 PCORI Compliance: What You Need to Know

Businesses that provide health benefits for their employee workforce must submit the right forms proving that they offered the required benefits. Now that 1094/1095 filing is complete, it’s time to prepare for federally mandated annual PCORI fees. Are you prepared? Let’s discuss 1094, 1095, and PCORI compliance. 

How Can Applicable Large Employers Stay Compliant? 

 

Applicable Large Employers (ALEs), employers with 50 or more full time employees, must offer Affordable Care Act (ACA) compliant health benefits to at least 95% of their workforce. Failure to do so can result in hefty fines and penalties from the Internal Revenue Service (IRS). 

The IRS can issue ALEs Penalty A or Penalty B fines for each employee that is not offered correct or compliant benefit plans. Employers can avoid unnecessary fines and penalties by offering ACA Compliant Minimum Essential Coverage (MEC). MEC benefit plans allow employers to provide affordable benefits to their employees without compromising their bottom line. 

In order to verify employers are, in fact, offering ACA compliant benefits, the IRS requires employers to fill out form 1094 and 1095. 

Employers must complete Form 1094, which is used to determine their liability for payment under the employers’ shared responsiblity provision. Form 1095, however, is used as a summary of healthcare information the ALE offers employees. 

 

What Can Innovative HIA Do For You?

 

One of the many services we provide at SBMA Benefits is 1094 and 1095 Form processing. We simplify the complexity of providing employee benefits while simultaneously ensuring ACA compliance. 

What’s included in our 1094/1095 processing?

  • Electronic filing of 1094 and 1095 forms annually 
  • PDF soft copies of 1095 for employee distribution 
  • 1095 error corrections refiling (if applicable) 
  • Mail distribution

 

What Happens After I Submit Forms 1094 and 1095?

After submitting Forms 1094 and 1095 by their due date, March 31st, employers must pay fees to the Patient-Centered Research Institute (PCORI) by July 31st. This year, however, the due date has been extended to August 2nd since the previously mentioned due date lands on a Saturday. 

 

What is PCORI and Why Do I Have to Pay Their Fees?

 

PCORI was created to improve the quality, quantity, timeliness, and trustworthiness of health information for patients. 

According to the PCORI, its mission is to “help people make informed healthcare decisions, and improve healthcare delivery and outcomes, by producing and promoting high-integrity, evidence-based information that comes from research guided by patients, caregivers, and the broader healthcare community.”

Employers are responsible for paying PCORI trust fund fees annually. The amount employers owe depends on the number of people enrolled in their offered benefits program. 

The fee is calculated based on the average number of individuals covered in a benefits plan- including spouses, dependents, retirees, and COBRA participants. Currently, PCORI fees are $2.79 per enrollee. In 2021, PCORI fees cost $2.66 per enrollee. 

The fee was slated to end in 2019, but was extended via Trump’s Further Consolidated Appropriations Act of 2020. For now, PCORI fees are extended through 2029. 

For more information read our article on what business owners should know about ACA Benefits in 2022. 

ALEs submit forms 1094 and 1095 to prove they provided ACA compliant benefits. Furthermore, they must prepare for annual PCORI fees.

Article originally published on SBMA Benefits.

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How does Innovative HIA support employee benefits administration?

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 enrollment portal houses everything you need for:

  • Onboarding 
  • Off boarding 
  • Enrollment 
  • Portal assistance 

Our employee benefits professionals have the knowledge and expertise that can save your company time and money. We aim to offer comprehensive benefit management, not only with our portal, but also as it pertains to ACA compliance, providing low-cost options, and offering fast and reliable service.

The convenience of SBMA’s employee benefits administration support allows your Human Resources department to work on their daily tasks and responsibilities without the headache of a difficult benefits administrator. Our one-stop-shop portal helps reduce the paperwork your HR department has to deal with and therefore, improves your bottom line.

Employer Resources

Our website is equipped with plenty of employer resources that give easy and secure access to your records and the ability to make plan changes at your fingertips (i.e. (enrollment portal, adding dependents, employee termination, and more). Adjusting benefit plans couldn’t be any easier with SBMA. Additionally, every task includes video tutorials, walkthroughs, and instructions. 

 

Watch the videos below to see just how easy navigating our portal is. 

 

Enrollment portal walkthrough

 

Adding Dependents walkthrough 

 

Termination walkthrough 

 

 

Partnering with us takes the burden off of your HR department and places it on us, your benefits administrator. Ready to get started? Reach out to us today. 

 

Innovative HIA supports HR departments with onboarding, off boarding, and more

Article originally published by SBMA Benefits.

Hospital Indemnity Policies: What You Need to Know

Health insurance is hardly a one size fits all industry. Different people need and want different coverage based on their lifestyle and what they can afford. Based on this and additional personal factors, people choose to enroll in various coverage plans. One policy type that someone might choose to opt into is hospital indemnity coverage. Let’s discuss the details regarding hospital indemnity coverage, who needs it, how much it costs, what it covers, and more.

 

What is Hospital Indemnity Insurance Coverage?

Hospital indemnity insurance is a supplemental coverage option that supports the financial aspect of your health coverage.

It is intended to cover the costs of hospital stays and emergency care that are not otherwise covered under a typical insurance plan. If you do have to take an unexpected trip to the hospital, you pay a fixed cost, instead. 

For example, without this supplemental insurance, if you have to take an unexpected trip to the hospital, you instead pay a fixed cost

Depending on the type of plan you have, hospital indemnity insurance benefits can go toward:

  • Deductibles
  • Coinsurance 
  • Transportation
  • Medication 
  • Rehabilitation  
  • Home care costs 
  • Various recovery expenses 

This coverage can be sponsored by your employer, a government plan, or by a private insurer. 

 

What Does Hospital Indemnity Insurance Cover?

Hospital indemnity coverage may vary slightly from one plan to another. However, it most commonly covers the following: 

  • ICU stays
  • Critical care unit stays 
  • Outpatient surgery
  • Continuous care 
  • Outpatient x-rays and laboratory procedures 
  • Outpatient diagnostic imaging procedures 
  • Ambulance transport fees
  • Emergency room visits
  • Physician office visits

Generally, plans have lower premiums compared to other insurance, but depending on your coverage, can increase.

 

Who Needs Hospital Indemnity Insurance Coverage?

The age-old adage, “accidents happen,” is around for a reason.

Accidents can’t be predicted or prevented, hence why they’re accidents. In some cases, however, certain people may be more inclined to need consistent hospital health services.

A hospital indemnity policy is a worthwhile benefit to have for someone who frequents the hospital or if you can afford the security that it provides.

Oftentimes patients may be surprised and overwhelmed by the bills and financial responsibility that follow a hospital stay. At SBMA, we believe it’s better to protect your finances with additional coverage.

Consider this policy for individuals with the following:

  • Chronic conditions that can lead to hospitalization (i.e. heart disease)
  • Upcoming surgery that could lead to extended hospital stays or care 
  • Women who are pregnant or expect to become pregnant (the supplemental coverage can cover additional days spent in the hospital after childbirth)
  • Peace of mind knowing there is coverage in case of an accident 

Although emergency services can create a financial burden, patients can have peace of mind now with the No Surprises Act protecting from surprise medical billing. Read on to learn more about The No Surprises Act.

How Much is Hospital Indemnity Insurance? 

There isn’t a fixed cost to this insurance policy. The cost, however, depends on a few factors:

  • The insurance company  
  • Your age 
  • Your sex
  • Your geographic location
  • Deductible amounts

Forbes found that on average, hospital indemnity insurance premiums can range from about $50 to $400 a month. Additional research found that the average 3-day hospital stay costs about $30,000.

Is Hospital Indemnity Insurance Worth It?

It depends on who you’re asking.

Investing in hospital indemnity insurance can be worth it—depending on your health, lifestyle, and future plans.

Ask yourself the following when deciding whether or not to add the supplemental insurance to your existing coverage:

  • How healthy are you? Consider the likelihood that you or a loved one will become hospitalized.
  • What does your current health plan cover? Look at your current healthcare plan to identify what it does and does not cover.
  • Can you afford the medical costs if an accident occurs? Forbes found that “over 36 million people in the U.S. are admitted to a hospital every year, many of whom may not be prepared for the cost.”

Answering these questions will help you decide if this additional policy is worth it for you.

 

Why Should Employers Offer Hospital Indemnity Insurance to Employees? 

Employers who offer hospital indemnity insurance to their employees add value beyond salary—without affecting their bottom line.

As employees consider the widening job market available to them, offering a competitive job opportunity that includes healthcare benefits and hospital indemnity can make you an ideal employer that attracts and retains the best employees. After all, 60% of employees rated benefits as very important in contributing to job satisfaction. 

Other benefits of offering this supplemental coverage to employees include: 

  • Increasing employee retention 
  • Increasing employee productivity
  • Increasing teamwork and organization
  • Improving overall financial savings for employers and employees

Want to learn more? Read our article “The Difference Between Hospital Indemnity and Accident Insurance” for more information.

Here at Innovative HIA, we offer various comprehensive health care plan options in addition to supplemental coverage options—such as hospital indemnity coverage. For details about our plans or to enroll today, contact us directly or speak with one of our experienced brokers.

 

understand if you nees hospital indemnity

Article originally published on SBMA Benefits.

Tips to Combat the Negative Effects of Sitting

Sitting is now one of the most common daily activities. Increased desk jobs and a bigger than ever stay-at-home workforce have contributed to more sedentary lives.

 

In fact, over a quarter of Americans sit for more than eight hours a day, and most sit for six to eight hours a day according to a report by TIME.

 

They call the results of sitting “the new smoking” because of the negative impacts it can have on your body. Do you sit all day? Are you tired of tight hamstrings or back pain?

 

Let’s dive into what sitting does to your body and how you can combat those negative effects daily.

What Does Sitting Do to Your Body? 

Sitting doesn’t seem like it should or would be such a dangerous activity for your body. After all, you aren’t doing much—but that could be the point.

 

There are both long and short-term effects that sitting for long periods of time can have on your body. After all, they don’t call it the “new smoking” for no reason. Below are some details.

 

  1. Sitting can lead to weight gain because you spend less time moving/ exercising.
  2. Use it or lose it! You start to lose muscle in your legs and glutes because they don’t have to work to hold you up, which can cause muscle atrophy.
  3. Sitting is linked to increased lung, uterine, and colon cancer.
  4. Those who sit for longer periods of time are more likely to suffer from anxiety and depression.
  5. Sitting can lead to tight muscles, especially tightness in your hamstrings.
  6. Your body can experience back pain from poor posture (i.e. hunching over a computer screen for prolonged periods of time).
  7. You can also experience stiff shoulders and neck pain from bad posture.
  8. There is a higher risk for heart diseases like strokes and heart attacks. 
  9. Sitting for long periods of time is linked to an increased risk of diabetes and can also lead to varicose veins. 
  10. Sitting can cause deep vein thrombosis (DVT).

 

There are many negative effects of sitting that can be detrimental to your health. But how do you combat them when you have to work a desk job?

Combatting the Effects of Sitting 

Just because you’re sitting all day doesn’t mean that you can’t combat its negative effects —you can. (After all, this article was written while standing!)

 

Here’s our guide on how you can combat the negative effects of sitting all day.

1. Stand While You Work

As mentioned before, you can stand while you work. Take advantage of standing desks so you can alternate from a seated to a standing position throughout the day. This will help get blood flowing through and also build muscle.

2. Walk During Meetings 

If you can, walk or stand during your scheduled meetings or calls if you don’t have to be at your desk. Plug in earbuds to move while the call takes place.

3. Take Movement Breaks 

Use your breaks to walk around and help avoid staying sedentary. It’s okay to start small and work your way up to longer breaks. This might look like walking up and down your stairs, around your office, or going for a quick stroll outside. Use your best judgment to find out what type of movement you like the most.

4. Stretch During the Day 

Plug in a quick and easy stretch when you wake up, take your lunch break, or take a few minutes in the middle of your day. Here’s a link from healthline for an easy five minute stretch.

 

Stretching can help you recenter and refocus, boosting your productivity during the day. 

5. Take Walks

Working straight throughout the day without breaks isn’t healthy or productive. Schedule time to take a quick walk.

6. Keep Yourself Hydrated 

While you’re reading this, drink a glass of water. Staying hydrated is great for your health and refilling your water bottle forces you to get up and move. 

7. Set Timers to Stand and Move  

Yes, it’s easy to start on a project and then look up only to realize a few hours have flown by. During that time, you were probably sitting hunched over your laptop or workspace.

 

So, consider setting a timer on your computer, phone, or watch to remind yourself to get up and move!

A Final Note

Adding walking as a healthy habit can take time and practice. It’s okay that it may not come naturally or immediately. As you slowly integrate it into your life, have patience if it doesn’t happen immediately. Little movements daily will benefit your health in the long run.

 

Did you know that people who use their health insurance are healthier than those who don’t? Read the different minimum essential coverage options available to you to continue making health habit choices. 

 

Sitting has been dubbed the “new smoking.” Add walks throughout your day to combat the negative effects of a sedentary life.

Original article published on SBMA Benefits. 

What Business Owners Should Know About ACA Benefits in 2022

Applicable Large Employers (ALEs) are businesses that have at least 50 full-time, or full-time equivalent employees in one calendar year. Under federal law, they must provide at least 95% of their employees and their children up to age 26 with Affordable Care Act (ACA) compliant coverage. 

 

Why? Because the ACA was designed to make healthcare services affordable to more people. 

 

Businesses that are considered ALEs that fail to meet ACA requirements will end up paying fines and penalties by the Internal Revenue Service (IRS). These fines can range from $300 – $4000 per employee who is not offered ACA compliant benefits.

 

Minimum Essential Coverage (MEC) is one of the most comprehensive and affordable ACA-compliant plans employers can provide to their workforce. Basic benefit plans meet the minimum ACA requirements while simultaneously supporting a healthy workforce. 

 

As we look to the next year, it’s important to understand how changes in insurance and federal law may affect their ACA compliance. What does a business owner need to look out for in 2022 to remain ACA compliant?

Look out for Increased Insurance Premium Costs 

First and foremost, health insurance premium costs are increasing for business owners this year. The baseline for affordability percentage, or the maximum percentage of an employee’s income they can contribute to their employer-sponsored self-only coverage, has lowered, therefore there is a greater cost to the business owner. 

 

In 2021, the affordability percentage was 9.83%, however, the threshold for 2022 is decreased to 9.61%. 

What does this mean for business owners? 

Business owners who provide ACA-compliant benefits to their employees will now have to cover the difference between last year’s and this year’s affordability threshold. 

 

If an employee makes $40,000 a year, they could only contribute a maximum of $3,932 towards health coverage plans in 2021. That same employee can now only contribute $3,844 per year in 2022. The employer is now responsible for the $88 difference. 

 

The lowered affordability threshold makes healthcare more affordable for employees but will be an additional financial responsibility for employers. 

Understand the American Rescue Plan (ARP)

The American Rescue Plan (ARP), created by the Biden Administration, was built to lower insurance premiums for lower and middle-income families. It temporarily reduced the affordability threshold to 8.5%. 

 

These lowered premiums contributed largely to this enrollment season’s record-breaking number of people enrolling in health insurance. 

Evaluate Grandfathered Group Health Plans 

Health plans are considered grandfathered plans if they existed and have covered at least one person as of March 23, 2010. These plans do not have to comply with certain ACA rules. Some plans may lose their grandfathered status if specific changes are made to reduce benefits or increase costs to employees or dependents. 

 

As a business owner, it’s important to look for those grandfathered plans that may have lost their grandfathered status. Ensure all elements of the plan design remain ACA-compliant. One specific area that grandfathered plans may not include in the latest ACA requirements is preventative services without cost-sharing.

 

It’s also important to keep records that document the plan’s terms that were in effect on March 23, 2010. This helps to verify existing grandfathered plans. 

Review Plan Documents for Changes 

Plans undergo changes over time. Review any changes to make sure your plan documents are aligned with any changes– new and old. 

 

All group health plans must:

Ensure waiting periods are met

The waiting period is a period of time that must pass before coverage is effective for an employee or their dependents. This waiting period must not exceed 90 days.

Confirm annual dollar limits are not covering essential health benefits 

The essential health benefits are the services that must be covered under the Affordable Care Act. If the plan you’re using limits the number of visits to health providers or limits the days of treatment, you must verify that the visit/day limit does not amount to a dollar limit.

Verify there are not any pre-existing condition exclusions 

Exclusions for pre-existing conditions cannot be imposed on any individual, regardless of their age. 

 

Unless there are certain HRAs, make sure there is not an employer payment plan in place.  

Lastly, as an employer offering ACA-compliant benefits, it’s important to ensure that there are not any employer payment plans in place. These payment plans are used by an employer to reimburse employees for some or all of the premium expenses for their health insurance policy. 

 

Non grandfathered group health plans must: 

Make sure out-of-pocket costs for essential health benefits don’t go over $8,700 for individuals and $17,400 for family coverage.

Give Employees and Dependents Required Notices 

Be aware of the required notices employees and their dependents might receive so you are prepared to submit these notices appropriately. 

 

Employees and their dependents must receive the proper notices such as: 

 

  • Health insurance exchange notice: written notice related to the Health Insurance Marketplace for all new employees within 14 days of their start date.
  • Summary of benefits and coverage: Confirm the contractual arrangement with your carrier to a third-party administrator and any notice of plan changes no later than 60 days prior to the effective date of the change.

Be Aware of “Pay or Play” Responsibilities 

ALEs, as mentioned before, are responsible for providing employees with healthcare benefit coverage options. Make sure you know your business’s status as an ALE, and that you are complying with the rules and regulations. 

 

If you know your status as an ALE, revisit the type of group health plan coverage you’ll offer your full-time or full-time equivalent employees

Prepare forms 1094 and 1095

Each year, the IRS requires ALEs to send their employers 1094 and 1095 documents to fill out to make sure their employers are complying with ACA requirements. It also helps the IRS ensure ALEs are offering coverage, and verify the type of coverage they are offering. 

 

The forms for the 2021 calendar year are due in early 2022. Fill them out early and accurately to avoid missing any information. 

 

Learn more about forms 1094 and 1095 here. 

Other Updates to Review

Depending on the employer and the health plan, other action item updates might need to be reviewed. The list below outlines certain actions employers might need to take to continue being compliant with ACA regulations in 2022. 

 

  • Medicare Tax for High Earners should be withheld (0.9%) from employees who make $200,000 or more in a calendar year
  • Monitor the coverage of preventative services guidelines 
  • Distribute the medical loss ratio rebate as appropriate 
  • Employers who have certain self-insured health plans must report and pay Patient-Centered Outcomes Research Institute (PCORI) fees by July 31st, 2022
  • Report health coverage costs on W-2 forms 
  • Confirm compliance with Section 1557 Nondiscrimination requirements if applicable. 

 

For more information about ACA compliance, and how to avoid the fines and penalties associated with being uncompliant, read our article, here.

business owners need to be aware of ACA updates this year

 

Article originally published on SBMA Benefits.