26 April 2011

Spring Flyer

No matter how long the winter, spring is sure to follow – Proverb

We sent out our spring “ForYour Benefit” flyer last week.  We hope you find the article  interesting and informative.  Any questions please call our office. Enjoy your spring!

17 March 2011

Affordable Care Act (ACA)

Provisions require detailed information regarding total number of employees as defined under the federal government guidelines for small and large group classification. This information will be provided to the government each calendar year and will be used to determine the carriers applicable medical loss ratio (MLR). This information will also be used to determine whether you (policyholder) and your enrollees are entitled to rebates. This request is for the federal MLR classification only and does not impact eligibility or participation requirements.

01 January 2011

Private Sector Employer Sponsored Health & Welfare Plans – 2011 Sample Notices and Model Language

Although the carriers may be providing this information to our clients, we at Benefits Consulting Group feel compelled to ensure you are kept in compliance with the continuous Health Care Reform changes.
Please Note: This list is not all-inclusive of your legal obligations when sponsoring a group health plan, and the samples and model language provided in this section are for illustrative purposes only. These provisions are not legal advice. It is strongly recommended that you seek the advice of legal counsel prior to adopting any document for purposes of satisfying a statutory or regulatory reporting or disclosure requirement.

Provisions arising out of the Patient Protection and Affordable Care Act are denoted with “PPACA”

•Children’s Health Insurance Program (CHIP)

•COBRA

•Grandfathered Plans – PPACA

•Health Care Coverage for Adult Children – PPACA

•HIPAA: Preexisting Condition Exclusions

•Lifetime Limits Exclusion – PPACA

•Medicare Part D

•Patient Protections – PPACA

26 December 2010

IRS Eases FSA Debit Card Rules

According to National Underwriter, the IRS says that personal health account debit card users can still use the card to buy doctor-prescribed over-the-counter (OTC) drugs at a wide range of stores after January 15, 2011. IRS Notice 2011-5 changes the prior requirement in IRS Notice 2010-59 that OTC drugs can only be purchased at retailers with ‘inventory information approval systems’ (HAS). Now, FSA and HRA cards can be used to buy OTC drugs without submitting receipts at many retailers that simply save information about the transactions. One new set of rules will apply to ordinary drug stores, other types of retailers that have pharmacies, and mail-order and web-based vendors that sell prescription drugs. A second, looser set of rules will apply to retailers that have health card merchant cards built into their debit card systems buyt have no pharmacy operations. The IRS wants to apply another set of rules – the rules given in Notice 2010-59 – to 90% pharmacies, or pharmacies that get 90% of gross receipts from the sale of items that the IRS classifies as medical items.

07 December 2010

All insured plans will be required to meet the MLRs…

According to the Business Insurance December 6, 2010, issue, a health care reform rule that caps how much insurers can spend on administrative costs is likely to cause headaches for employers that offer fully insured health plans to their workers. Self-funded plans also may be peripherally affected if insurers decide to cut back on services that are not included as medical expenses under the medical loss ratio definition that the Dept. of Health and Human Services issued last month, stating that only costs directly attributable to medical care and health care quality improvement can be included in health insurers’ MLRs. The MLRs were set at 80% for individual coverage and small groups and 85% for large groups. Under the Patient Protection and Affordable Care Act, health insurers must rebate to policy-holders any amounts in excess of the allowed respective 20% or 15%.

Because many employers offer at least one fully insured health plan to their employees, employers that receive a rebate must allocate to employees a sum that is proportionate to their individual premium contribution. MLRs and rebates will be calculated state-by-state. Carriers that fail to meet a state’s MLR requirements would have to give rebates to entities paying the premium; for employer plans, it will be paid to the employer, which has to allocate it proportionately to the employees. For example, an employer paying 50%, they would have to give 50% of it to the employees. Since most of the employer contribution schemes are more complicated, it can cause administrative complications. All insured plans will be required to meet the MLRs beginning January 1, 2011