Tag Archive for: benefit plans

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. 

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Difference Between Hospital Indemnity and Accident Insurance?

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.