Tag Archive for: benefit plans

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.

Although you’ve likely heard of Obamacare, you may not know that Obamacare is synonymous with the Affordable Care Act. This healthcare law that passed in 2010 goes by a few different names. You may also see this law referenced as PPACA or ACA (the acronym for Affordable Care Act).

Below, let’s discuss what Obamacare or the ACA covers, its goals, when you can enroll, and more.

What Do Obamacare and the Affordable Care Act (ACA) Cover?

The Affordable Care Act was designed with three primary goals. To:

  • Make affordable health insurance available to more people…
  • Expand the Medicaid program to cover all adults with income below 138% of the FPL
  • Support innovative medical care delivery methods designed to lower the costs of health care generally.”

Additionally, there are sections of the ACA designed to help patients have access to affordable benefits. These sections include:

  • Quality, Affordable Healthcare for All Americans
  • The Role of Public Programs
  • Improving the Quality and Efficiency of Healthcare
  • Prevention of Chronic Disease and Improving Public Health
  • The Difference Between the ACA and Obamacare
  • Healthcare Workforce
  • Transparency and Program Integrity
  • Improving Access to Innovative Medical Therapies
  • Community Living and Assistance Services and Supports Act (CLASS Act)
  • Revenue Provisions
  • Reauthorization of the Indian Healthcare Improvement Act

From these sections came the 10 essential benefits that are included in minimum essential coverage (Minor Medical), which is defined as “any insurance plan that meets the Affordable Care Act requirement for having health coverage.”

These 10 benefits include:

  • Prescription drug coverage
  • Pediatric services
  • Preventative, wellness services, and chronic disease management
  • Emergency services
  • Hospital-stay coverage
  • Mental health and addiction services
  • Pregnancy, maternity, and newborn care
  • Ambulance patient services
  • Laboratory services
  • Rehabilitative and habilitative services and devices

Why Was This Healthcare Law Created?

Obamacare was designed to provide basic and affordable coverage for all Americans. Before Obamacare, those with pre-existing conditions could be refused coverage or charged more for their plan.

Obamacare ensures that insurance companies allow those with pre-existing conditions to receive the same care as those without. 

Now, minimum essential coverage plans exist that provide the services required by the ACA while simultaneously being affordable for employers and employees. 

These plans help both parties stay healthy while also avoiding the fines and penalties that come along with not having health insurance (especially for Americans living in states with individual mandates).

After all, minimum essential coverage isn’t a one size fits all service. There are different options and levels to choose from to create a plan best suited for your specific needs.

Learn more by reading our article, “What is Minor Medical and What Does It Cover?

When Can I Enroll in Obamacare?

Open enrollment is the one time of the year when employees can sign up for health insurance or change their health insurance plans.

If you choose not to enroll during the open enrollment period, your options to purchase coverage become limited. Why? You cannot purchase ACA-compliant coverage unless a qualifying event occurs.

Qualifying events include:

  • Loss of a job
  • Move to a new coverage area
  • Birth of a child
  • Loss of existing coverage
  • Family event (i.e. marriage, divorce, or death)

Depending on state requirements, employees can take advantage of open enrollment for the following year starting November 1 until approximately January 15th. Again, open enrollment varies on a state-by-state basis. States like California, for example, extend their open enrollment dates to January 31.

Read on to learn what happens if your employee misses open enrollment.

How does the Individual Mandate Affect Obamacare?

When Obamacare was first implemented, it contained a clause that required Americans to have health insurance. Those who didn’t have health insurance were required to pay a tax penalty. This tax penalty was repealed in 2017. 

However, the individual mandate is still in effect for some states in the U.S. 

Residents living in the following states have implemented individual mandates.

  • California
  • The District of Columbia
  • Massachusetts
  • New Jersey 
  • Vermont
  • Rhode Island

This means that people living in the states mentioned above must have health insurance or face state-mandated tax penalties. Read on to learn more about ACA employer penalties.

At Innovative HIA, our goal is to provide affordable ACA-compliant benefits to our clients. For more information about the plans that we offer or to enroll, get in touch with one of our brokers today.

The California Individual Mandate, originally signed into law in 2019, was a response to the federal individual mandate being struck down by the Trump administration.

 

This state law requires all California residents to obtain Minimum Essential Coverage (MEC) for a minimum of nine months, or they may face a tax penalty unless exempt.

 

Let’s discuss the individual mandate and what employers need to know, starting with a shorthand list of exemptions.

MEC Exemptions

According to the State of California Franchise Tax Board, some exemptions include:

 

  • An individual’sincome is below the state tax filing threshold
  • A coverage gap consists of three consecutive months or less
  • Coverage is not affordable based on the income reporting in your state income tax return
  • If the cost of the lowest plan, whether marketplace or employer-sponsored, is more than 8.09% of income on an individual’s tax return
  • The cost of the lowest employer-sponsored family plan, including dependents, is more than 8.09% of the household income
  • Non-citizens who are not lawfully present in the state
  • Those who are living abroad or are residents of another state
  • Members of a health care sharing ministry
  • Enrolled in limited or restricted-scope Medi-Cal or other similar coverage
  • Those in federally recognized tribes are eligible for services through an Indian health care provider or the Indian Health Service
  • Those in jail, except for incarceration, pending the disposition of charges

 

These exemptions typically must be claimed on your state income tax return.

 

While the individual mandate went into effect “to reduce the number of uninsured individuals and families,” it also has implications for employers in California. Moreover, the law requires additional reporting from specific organizations.

Employer Reporting Required by the Individual Mandate

Employers must report insurance information to the Franchise Tax Board (FTB) of California by March 31. The data reported includes the enrollment participation of employees and their dependents.

 

Employers with an insurance provider who reports to the FTB are not required to report in addition to their provider.

What are the Penalties for Not Reporting Insurance Information to the FTB?

Employers who do not meet the filing deadlines of the FTB are subject to a $50 penalty for every employee receiving coverage.

 

Individually, there is a flat penalty per household member or 2.5% of the gross household income, whichever is higher. If an individual does not obtain coverage for the entire year, they would be subject to a minimum fine of $800. 

Why Are There ACA Reporting Requirements for Employers?

For applicable large employers (ALE), the FTB introduced these reporting requirements to help enforce the state’s healthcare mandate.

 

Employers who offer self-insured or employer-sponsored plans must report individual enrollment through Form 3895C unless their insurer reports via Form 1095-B. 

 

These reports allow the FTB to verify an individual’s coverage and identify who must pay an individual shared responsibility provision (ISRP).

 

This sounds like a lot, but don’t worry. At SBMA, we take care of all ACA reporting required for the ALEs we work with. We submit Forms 1095-B and 1095-C to ensure you comply with ACA requirements.

Individual Mandates in Other States

Individual mandates are becoming a more common practice in states other than California. The current states who have individual healthcare mandates include:

 

  • California
  • The District of Columbia
  • Massachusetts
  • New Jersey
  • Rhode Island, and
  • Vermont

 

Read this article “What are the Advantages of the Affordable Care Act?” to learn more.

A Final Word

As an employer, it is essential to understand the individual mandate to ensure you remain compliant with reporting requirements and avoid hefty fines.

The best way to stay on top of these requirements is to partner with an insurance provider who handles your reporting. Learn more about benefit plans, here.

Navigating the similarities and differences between individual and voluntary benefits can seem challenging. Which ones do your employees want? What can employees get from individual benefits that they can’t from voluntary? How can benefits attract and retain great talent?

 

Here is a list of the major similarities and differences between the two to help you navigate what benefits you want to provide.

Similarities 

  • Customizable options: Both benefit options have multiple coverage options available. These customizations give people the ability to change their options to cater to their needs, their family size, and their budget.
  • Dependent coverage: You have the ability to add eligible dependents, like your spouse and children, for an additional charge.
  • There are various areas that are covered: Both types of insurance cover dental, vision, disability, and life insurance.

Differences 

  • Voluntary benefits are sponsored by your employer: Voluntary benefits are only offered through employer-sponsored healthcare plans. Those who are not employed do not have access to voluntary benefit options. The employer also chooses what options are offered and what the coverage levels are. As an employer, this can be a great way to differentiate your company.
  • Individual insurance is completely paid for by an employee: Some business owners pass the cost of voluntary benefits on to their employees, though it is not required. Some employers will also cover a portion of voluntary benefit elections for their employees. With individual coverage, the employees take the entire cost.

At Innovative HIA, we understand how important your employees are to your organization. Offer your employees the most options for coverage. When you offer your employees more options when it comes to benefits, they will likely have higher engagement levels as they feel you care for their wellbeing. Contact us to learn more about the voluntary benefits you can offer your employees.

 

Read on to learn more about how you can add value to your existing benefits plans. 

 

Article originally published on SBMA Benefits.

infographic on how to navigate individual and voluntary benefits

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

Navigating insurance policies can be challenging for anyone. There isn’t a way to predict the future, so how can you know what you will need? There are so many options available, how can you decide?

Voluntary benefits can help supplement insurance policies that may not cover all of your employees’ needs. There are many options when it comes to voluntary benefits with a few differences. What’s the difference between hospital indemnity policies and accident insurance? Here’s a breakdown.

Accident Insurance 

Accident insurance is an option to help supplement out-of-pocket expenses for potential expenses incurred when an accident occurs. This insurance is used to cover expenses that your standard health insurance plan cannot cover.

Typical medical insurance directly pays the medical provider, and you receive the bill later. Accident insurance, on the other hand, pays the cash directly to you, then you choose the best way to use that money.

What Exactly Does an Accident Insurance Policy Cover? 

There are quite a few expenses accident insurance covers that your traditional health insurance plan may not. These can include:

  • Emergency room visits
  • Ambulance rides
  • Helicopter transportation
  • Hospital admission charges
  • Diagnostic exams
  • Follow-up treatments
  • ICU and rehabilitation unit care
  • Physical therapy

Ambulance transportation can be extremely expensive. Investing in accident insurance could save you thousands of dollars.

Deductibles for many medical insurance plans can also cost thousands. Other insurance simply doesn’t cover hospital stays, ambulance rides, or other non-preventative care. Accident insurance can be a great backup plan.

How Much Does My Insurance Go Up After an Accident?  

Unlike claims filed for car insurance or homeowner’s insurance, the premiums on accident insurance do not increase after an accident or diagnosis of an illness. In other words, covering an ambulance ride with insurance will not impact the premium.

The Affordable Care Act (ACA), created in 2010, halted any insurers’ ability to adjust insurance rates due to medical history or gender.

Now, once you are insured, your premiums will not increase as a result of filing a claim. However, premiums increase steadily over time due to healthcare inflation, increased prescription costs, and rises in chronic illnesses. Many insurance policies implement a fixed annual rate increase that in no way is based on claims filed on accidents.

As Verywell Health explains, “the overall rates for everyone on the plan will typically go up from one year to the next, based on the total claims that were filed by everyone on the plan. But they’ll go up by the same percentage for people who filed big claims, people who filed small claims, and people who filed no claims at all.” Rates reflect the usage of the group, not the individual.

What is Hospital Indemnity Insurance? 

Hospital indemnity insurance is very similar to accident insurance. Whether you choose one over the other or get both will depend on your lifestyle, expenses, and savings. It is also used to supplement any expenses incurred outside of your health coverage.

Hospital indemnity insurance provides a set cash payment to use for any bills you need to pay. This is especially helpful for paying housing, bills, and living expenses if you are unable to work.

What Does Hospital Indemnity Insurance Cover? 

Hospital indemnity insurance coverage depends on the plan and coverage options you choose. Some things covered under a typical hospital indemnity plan include:

  • ICU stays
  • Critical care unit stays
  • Outpatient surgery
  • Continuous care
  • Outpatient x-rays
  • Laboratory procedures
  • Outpatient diagnostic imaging procedures
  • Ambulances
  • Emergency rooms
  • Physician office visits

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

Is Hospital Indemnity Insurance Worth It? 

It’s important to consider your own personal health and wellbeing when deciding on purchasing hospital indemnity insurance. Since this insurance does not cover typical doctor’s visits or prescription medication, it really depends on you and your lifestyle.

Keep in mind:

  • Your personal health—are you or your family members more likely to be hospitalized?
  • What level of coverage does your current health insurance plan cover?
  • Are you financially able to cover unexpected health costs?
  • How much would a hospital indemnity plan cost over time vs. the cost of benefits received?

This plan may give you peace of mind, and the support you need during an unexpected accident. However, if the plan does not seem like something you need, or if you are able to cover the price of an emergency out-of-pocket, you may not need hospital indemnity insurance.

So, How Do You Decide Which Coverage to Invest in? 

The important distinction between the two types of insurance is how often you frequent the hospital. If you have hospital indemnity insurance and do not go to the hospital, you will not get paid benefits. However, accident insurance plans apply to both hospital stays and treatment from your primary care doctor. Consider a few things before you make your decisions.

Consider Your Lifestyle

Do you enjoy running, hiking, and other activities that may be more prone to accidents? Accident insurance might be your best choice.

Do you have kids who play sports or are constantly playing outside? Accident insurance may be for you. If you lead a relatively healthy, active lifestyle, accident insurance might be a better option for you.

If you have a chronic health issue or have dependents with chronic health issues, hospital indemnity insurance may be a better bet for you.

How Much Money Do You Need to Get By?

If you live alone or if you are a relatively young person with fewer financial responsibilities, accident insurance is a great option to ensure you are covered for whatever comes your way.

 

Sometimes, the best solution may be to have both coverage options. If you have children, own a home, own a car, and have other expenses, purchasing both will give you the best coverage.

Consider How Much You Have Saved for Emergencies

If you don’t have a large amount of savings, (e.g. enough to cover three months of expenses), a small monthly premium for accident insurance may make sense for you. On the other hand, if you have enough money to cover potential accident expenses or medical expenses, and support your lifestyle, but a large hospital bill might drain your savings, hospital indemnity insurance may be the smarter option.

Curious about other benefit plan options available to you? Read our article about voluntary affordable benefits here.

Article originally published on SBMA Benefits.