Life Insurance Does A Lot More Than You May Realize

Talking about life insurance can be an uncomfortable topic for most of us. We all go to bed each night and assume that we will wake up the next morning as we always have. We all plan for vacations months in advance with the assumption that we will be there. We live our lives almost as if we will live forever. At the same time, every night on the evening news we hear about tragic stories within our local communities such as car accidents and violent crimes. We also hear stories of chronic health related illnesses, many of which are on the rise. And yet, only 51% of Americans have life insurance. Here is a look at why so many Americans and, more specifically, their families are unprotected:   43 % say that life insurance is too expensive. 31 % say that coverage is a low priority compared to other expenses. 14 % say they never thought about life insurance and don’t know much about it. 12 % don’t know where to start. 8 % note they don’t have time to research/learn about/explore their options. 6 % say that life insurance is too complicated. 5 % say the product is too stressful.   What do these numbers tell us? Well, they tell us that most of the uninsured are uninsured simply due to lack of knowledge and/or confusion about life insurance. If they only knew that life insurance is so much simpler than the health insurance that they must deal with every week. Very few Americans look to life insurance to fund expenses beyond simply replacing the income of a departed...

ACA Reporting Requirements

Applicable Large Employers (ALEs) must report information to the IRS regarding the health care coverage offered to full-time employees and full-time equivalent employees (FT/FTE). Once you’ve collected all the necessary information from your workforce, you must complete the three documents required for ACA compliance: the 1094-C, 1095-C, and the Written Statement to each employee. Form 1094-C Employer Transmittal Accounts for each of the following, per 2015 calendar month: Full-time employees Total headcount Whether Minimum Essential Coverage was offered Whether an applicable 4980H “Safe Harbor” was used Deadline for documents to be mailed: February 29, 2016 Deadline for document to be transmitted digitally: March 21, 2016 Form 1095-C Employee Statement Accounts for each of the following, per 2015 calendar month: Proof of offer of coverage (with code) Employee’s share of the lowest cost monthly premium Whether an applicable 4980H “Safe Harbor” was used Deadline for documents to be mailed: February 29, 2016 Deadline for document to be transmitted digitally: March 21, 2016 Written Statement of Each Covered Employee The employer’s name, address, and contact information The information for the employee on the return being filed Deadline for Statement Sent to Employee: January 31,...

4 Things to Know About the Affordable Care Act

The ACA is designed to reduce healthcare costs, expand coverage for the uninsured, and increase quality of care for people. The ACA can be confusing, making it difficult for many businesses to comply with the law’s requirements. In 2016, almost all businesses will be required to comply. To avoid hefty fines, here are four things to know about the requirements so you can remain compliant and penalty free in 2016: Are you an Applicable Large Employer (ALE)? If so, your business is subject to ACA requirements! To be considered an ALE, your company has to have 50+ full-time employees and full-time equivalent employees (FT/FTE). Calculating your total number of employees is difficult. That’s because the ACA classifies “full time” employment as 30 hours a week of work or more. Make sure to include both full-time employees as well as those who work the equivalent of full-time hours. Your business must offer “affordable” health insurance of “minimum value” to your employees: “Affordable” Health Insurance is less than 9.5% of annual household income. You can calculate the 9.5% from employees’ W2 wages, hourly pay rate, or the Federal Poverty Level for an individual. “Minimum Value” means employer-sponsored health plans must be designed to pay at least 60% of the total cost of medical services. You need to submit three key documents to guarantee compliance. If you’re an ALE, collected all the necessary info from your workforce, and made the necessary calculations, then it’s time to complete the three documents required for ACA compliance: the 1094-C, 1095-C, and the Written Statement to each...

AB339 Could Bring Relief to Those That Require Expensive Specialty Drugs

Many people that suffer from chronic conditions such as asthma, hepatitis C, Cancer, MS, rheumatoid arthritis and others are feeling discriminated against due to the high cost of the drugs that they need.  These drugs are referred to as Specialty Drugs.  The emergence of these very high cost specialty drugs has led health plans and insurers to impose high copays and coinsurance on these drugs.  Such drugs are often placed on the highest cost tier of a drug formulary (commonly known as the “fourth tier” or the “specialty tier”) with coinsurance of up to 20%, 30% or even 40% as opposed to a fixed co-payment.  As a result, Californians that suffer from chronic conditions can face high out-of-pocket costs and may even exhaust their annual out-of-pocket limit of $6,500 with a single prescription in the first month! Fortunately, Consumer Protection Bill AB339 is currently moving through the California Legislature.  The point of AB339 is to get the patient out of the middle of the fight between the health plans and the drug companies by providing basic consumer protections, including a cap of no more than $250 per monthly prescription for most coverage, or $500 for products in the bronze tier. The bill must be approved by the Legislature by Sept. 11 in order to go to Gov. Jerry Brown (D), who has until Oct. 11 to sign or veto...

How To Avoid The Painful Surprise of an Unexpected Medical Bill

It has happened to most of us, we visit the doctor, provide our health insurance ID card for services and then receive an unexpected bill a few weeks later.  Over the past two years, nearly one-third of privately insured Americans have received an unexpected medical bill where their health plan paid less than expected.  With Annual Out-of-Pocket Maximums now over $6000 for an individual, these balance bills are often extremely difficult to handle.  To make matters worse, whether you’re disputing the charge or simply can’t pay, medical debts are quick to reach collection status.  According to the Consumer Financial Protection Bureau, one in five consumers have an unpaid medical debt on their credit report. Here are a few small, but important steps that you can take to avoid unexpected medical bills.   Call your insurer ahead of a medical procedure as some procedures require pre-authorization.  Carriers like to make sure that certain expensive procedures are medically necessary and if you have the procedure without making sure that it is authorized, you could get stuck with the bill. Familiarize yourself with your health plan. Dig into plan specifics related to deductibles, coinsurance and maximum out-of-pocket costs.  Deductibles and coinsurance can be confusing if you do not know how they work on your specific health plan.  Also, many people can be caught off guard by the individual vs family deductible. A quick email to your broker can help refresh your memory on material covered in your benefit orientation. Don’t assume that because your doctor or hospital is in-network, that you’re all clear. Some insurers have tiered-service networks, reimbursing some in-network providers...

Many Small Business Owners See Increase Due to The “Affordable” Care Act

It seems that just about every time we turn on the TV, get online or read a newspaper there is someone telling us how the Affordable Care Act is controlling the cost of healthcare.  Many small business owners strongly disagree as they look over their renewal for the coming year. Did you know? . . . . 90% of small business owners have received renewals showing an increase in premiums and 25% of these are facing increases in the double digits!  These increases are effecting small business owners across the country and in every industry.  Employers have been put in the tough position of having to find balance between two competing concerns: attracting and retaining talent to help build their business while at the same time, decreasing operating costs, including controlling health care expenses.  Many of these business owners now find themselves having to depend on their brokers more than ever to get creative and examine all available options in order to control benefit costs while still offering competitive benefit packages. Several years ago as the Affordable Care Act was approaching there were many in the industry that believed the broker would be a thing of the past.  As it turns out, brokers have never been more valued than they are...

Common Misconceptions About The New ACA Reporting Requirements – (Forms 1094C, 1095C and 1094B, 1095B)

With so much changing within our healthcare systems it can be easy for employers to become overwhelmed and flat out confused!  One of the major sources of headache and confusion pertains to the ACA reporting requirements which will take effect in 2016 for the reporting year 2015.  Listed below are some of the biggest misconceptions to be aware of.   Misconception #1: Penalty relief is available for ALL types of reporting errors. The Truth: Penalty relief is provided for incomplete or incorrect information provided on the 2015 statements however the relief is only provided to those that can show good faith efforts to comply.  Those seeking penalty relief must also be able to show that their reporting information was submitted on time. Misconception #2: All employers are required to file electronically. The Truth: Only entities that have 250 or more returns are required to file electronically.  Entities with less than 250 returns can chooses to file electronically or on paper. Misconception #3: Large employers that offer self-funded and fully-insured health plans will be required to use both sets of forms (1094C, 1095C and 1094B, 1095B). The Truth: Employers that offer both types of health plans will only be required to complete Forms 1094C & 1095 C since 1095C includes separate sections for reporting each of the two plan types. Misconception #4: Only large employers that sponsor group health plans are required to report. The Truth: In addition to the large employers, employers of ANY SIZE that are self-insuring their employees must also report this information to the IRS on their covered employees. Misconception #5: Employers that qualify for transition...

SeeChange Health Insurance exits CA market

SeeChange Health Insurance has announced that they will withdraw from the California market effective January 1st, 2015.  Coverage with SeeChange will end at midnight Dec. 31, 2014.  All groups that are currently enrolled with SeeChange should have a plan in place to transition carriers as soon as possible.  New policies will be written under ACA guidelines, and Q4 rates are readily available.  Please contact us via telephone or email for assistance with shopping for a new carrier to meet your employee benefit...

Rates are Going Up and Down at Blue Shield in the 4th quarter.

Decreasing rates for ACA plans: Blue Shield has announced that rates under the Affordable Care Act (ACA) plans will receive a reduction. The reduction for HMO plans will be 1.8% while the reduction for PPO plans will be 7.7% Increasing rates for “Grandmothered plans: On July 7, 2014 Governor Brown signed Senate Bill 1446 (aka. The Grandmothering Law) into effect. This law allows small groups renewing between October 1st – December 1st to keep their current non-ACA plans (Grandmothered plans) in effect for another year. Those opting to keep their non-ACA plans for another year can expect rate increases of 1.2% for HMO plans and 9.9% for PPO plans. What does it all mean and which plans work best for me? • Companies with a younger demographic could see significant savings by switching to ACA plans. The ACA plans rate each employee based on their date of birth therefore a 30 year old employee will pay the rate for a 30 year old. Grandmothered plans have age-banded rates which means that a 30 year old is paying the same as a 39 year old. • Companies with an older demographic may be better holding off with Grandmothered plans for another year for the same reasons that a company with a younger demographic would benefit from switching (due to age-banded rates). • Companies that have many employees with families may also be better off sticking with the Grandmothered plans since the ACA plans will rate each dependent individually. In other words, a family of five that switches to an ACA plan can expect a separate rate for each family member based on...

Grandmothering Rules for Anthem Blue Cross of CA

The ABC’s of Grandmothing Groups qualifying – Groups with an anniversary date in the 4th Quarter may participate in the opportunity to Grandmother their Legacy plan; 2014 October, November, December anniversary dates ONLY. Renewals – 4th Quarter renewals will be specific to the group’s current Legacy plan only. Automatic – 4th Quarter Groups will AUTOMATICALY stay on their LEGACY plan. If a group wants to move to an ACA plan, they must fill out and submit the ACA Opt-In form (attached) by the 10th of the month before the renewal date. For example, if a group has an October 1st renewal date and is interested in moving to ACA plans the Opt-in form must be to Bedrosian & Associates by 9/10/14. No exceptions 411 – It is VERY important to remember that no exceptions will be made for: pre-4th Quarter Groups to participate, Opt-In Due Dates missed, or for groups that Opt-In to an ACA plan then decide they want out. Important Dates: July 18 – October Legacy renewals will be released (eRenewal & GA CD’s) July 18 – October ACA renewal will be posted. July 21st – October Legacy renewals mailed to Bedrosian & Associates July 24th – October Legacy renewals mailed the company. Other important information: Movement – The group will have the option of only the plans currently available to their group; members will be able to move into different plans currently available to the group. OPT-IN Rules– Groups wanting to move from a Legacy plan to an ACA plan MUST Opt-In to do so. The Opt-In form must be received by Anthem no later than the 10th...