Tag Archive for: innovative HIA

School is back in session!

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

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

Below are a few tips.

Stay Up-to-Date on Immunizations and Vaccines

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

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

By Age Two

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

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

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

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

Age Four to Six

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

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

Age 11 to 12

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

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

Attend Annual Checkups

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

Hearing and Vision Issues

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

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

Malnutrition

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

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

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

MEC Covered Services for Children

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

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

Some of the services covered for children include:

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

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

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

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

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

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

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

First, What Are Telehealth Services?

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

Why is the American Medical Association Maximizing Telemedicine Service Options?

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

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

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

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

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

So, How Exactly Does Telemedicine Work?

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

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

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

What Medical Issues Can Telehealth Services Best Help Patients With?

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

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

Looking for Telehealth Services?

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

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

Read on for the pros and cons of telemedicine.

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

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

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

Who is Considered a Large Employer?

First, who is considered a large employer?

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

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

What Are ACA Benefits?

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

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

Additionally, ACA benefits cover birth control and breastfeeding support. 

The Employer Mandate (Penalty A)

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

The Employer Mandate (Penalty B)

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

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

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

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

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

The Individual Mandate

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

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

Infographic of ACA Penalty A and B Breakdown

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

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.

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.

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

Attention Brokers: Are you offering your ALE clients the most affordable Minor Medical Coverage (MEC)? How can you offer your applicable large employers a one-stop shop for all their needs? Benefits are no longer about simply meeting Minimum Essential Coverage options.  You need to offer worksite and voluntary benefits, telehealth options, call center availability, and easy portal management. Why should you offer these options to your employers? Because they want them.

In order for employers to attract and retain great talent, they need great benefit options. This means going beyond standard Minor Medical requirements and offering services that provide value and attract the best workers.

Let’s Start with Voluntary Benefits

Worksite and voluntary benefits include accident insurance, term life insurance, critical illness insurance, and hospital indemnity.

  • Accident insurance includes aid in payment for medical and out-of-pocket expenses that may occur due to an accident occurring.
  • Term life insurance includes a way to provide financial protection for loved ones while employees are working.
  • Critical illness insurance adds a safety net for those who are under-insured.
  • Hospital indemnity benefits help to offset high deductibles and out-of-pocket expenses so a hospital stay does not become a financial crisis.

Next, Consider Offering Your Employees Access to Telehealth Care 

With 24/7 access to doctors, telehealth–also known as Virtual Health–can help employees get care when they need it with added convenience. At Innovative HIA, we offer telehealth options that include behavioral health and therapy access, to give employees the ability to speak to a therapist whenever they need it.* In addition, it helps employees receive necessary prescriptions without having to go to a doctor’s office.

Employers look for convenience when looking for benefits, as a broker you can provide a one-stop-shop for all your ALEs benefits needs. This means 24/7 call center support and easy access to portal management, single-point billing, and US-based customer care.

At Innovative HIA, we offer portal management access to provide employers with the ability to make plan changes, order ID cards, and have them shipped within a few days, check their claim statuses, and give employees the ability to manage their own profiles.

With bilingual call center support, you’re getting licensed representatives to help manage enrollment and provide year-round support. All of our representatives are in-house, which means they understand your client’s needs.

Innovative HIA can provide a one-stop shop for all employers to handle their benefit needs. As a broker, it is your responsibility to provide your employers with the best possible options for their needs. Contact us to learn more!

For more information on how we support employee benefits administration, read our article here

Article originally published on SBMA Benefits

offer your clients the best mec plan