NYC become the 3rd U.S. City to require Employer Transit Benefits following SF and Washington, DC. Beginning in 2016, the ordinance will require employers (not including government employers) with 20 or more full-time employees in New York City to provide full-time employees a pre-tax qualified transportation benefit program (excluding parking subsidies). It would mean that an estimated 450,000 more New York City-based employees will have access to the commuter tax break. That’s in addition to the 700,000 who already get the break.
“The ordinance will require private employers with 20 or more full-time employees in New York City to provide a pretax qualified transportation benefit program for their full-time employees.” For purposes of the ordinance, a full-time employee is one who works 30 or more hours per week.
Penalties:
While the new ordinance goes into effect January 1, 2016, it provides a six-month grace period, so penalties will not begin until July 1, 2016. Penalties for a first violation will range from $100 to $250. If an employer corrects the violation within 90 days of being notified, then penalties will be waived. If correction (the steps for which have not yet been described) does not occur, penalties for the first violation will apply and an additional penalty will apply, equal to $250 for each 30-day period in which the employer continues to fail to offer the required benefits.
Tax Savings:
The way the pretax commuter tax break works is employees exclude their transit commuting costs from their taxable wages up to the $130 monthly limit (there’s a separate $250 monthly limit for parking). If you’re in the 40% combined federal and state bracket and you put away $130 a month pretax salary to use for transit, you save $624 a year. This also saves the employer money because the employer doesn’t pay payroll taxes of 7.65% on every dollar set aside by employees pre-tax.
$130 transit maximum NEW $255 transit maximum for 2016
EE Savings @ 40% tax bracket = $1200/year
ER Savings (FICA) = $230/year
$255 parking maximum
EE Savings @ 40% tax bracket = $1,200/year
ER Savings (FICA) = $230/year
Next Step:
If you want your employer to add commuter benefits—so you’re eligible for the tax break–petition your HR department, and specifically ask for the pretax commuter benefits program (why wait until 2016?). To learn more about the NYC Transit Mandate, please visit the official website of the City of New York. To start a Transit benefit within 24 hours contact us today (855) 667-4621 or info@medicalsolutionscorp.com.
The U.S. Supreme Court ruled this morning that the Affordable Care Act may provide nationwide tax subsidies for people who purchase health insurance through an exchange. The Court considered a challenge to a provision of the ACA concerning whether subsidies were available only to those who purchased health insurance on an exchange “established by the state.” The Court, in King v. Burwell, ruled 6 to 3 in favor of upholding the eligibility for people to receive subsidies through either a state or federal health insurance exchange.
The opposite ruling would have had serious implications for the country due to the number of states relying on a federally-run exchange (37 states) and the number of customers who qualify for subsidies based on their income (about 85% of customers nationwide). The Government’s argument prevailing: defending the subsidies, the Government argued that if you look at the entire ACA and its history, it is clear that the subsidies are available to everyone who purchases insurance on an exchange, no matter who created it.
Please join us for upcoming Webinar on How to Prepare for Current and Future ACA Requirements.
Are you able to identify and address all of the ACA requirements? Have you developed a plan of action to help stay in compliance? This webinar will walk you through a three year case study and provide you with current and future solutions to help your group prepare for ACA challenges including the Cadillac Tax.
Some of the key webinar highlights include:
Will Federal subsidies stop in some states making residents unable to access subsidized Exchange coverage?
3 year case study providing a practical view
Will IRS information reporting still be required?
Could Congress step in and propose changes to the existing ACA law?
2015 – Section 125 changes including eligibility, PRAs, excepted benefits and FSA plans for higher OOP exposure
2016 – Renewal focus on HSA’s with a dollar for dollar matching contribution
2017 – Further conversation of reducing benefit costs utilizing post deductible HRA’s and consideration of Defined Contributions
Practical information you can use – a webinar you will not want to miss!
The King Ruling awaits As Supreme Court schedules more decision days. The decision is expected to be possibly on Thursday on the legality of the Health care subsidies. ISSUE RECAP: At issue is whether subsidies that 8.7 million people receive to help pay for their insurance are available in all 50 states, or only those that set up their own health insurance exchanges. (more…)
Great news for families with HSA and high deductible plans. Individual out of pocket maximums will apply EVEN UNDER A FAMILY POLICY. New federal health care reform law regulatory guidance ends lingering uncertainty on how much in out-of-pocket costs employers with high-deductible plans can require employees to pick up.
The guidance, leaves intact the maximum out-of-pocket expenses employers can require employees to pay before health plan coverage kicks in: $6,850 for single coverage and $13,700 for family coverage when the rules go into effect in 2016.
An example illustrates how the HHS-imposed “EMBEDDED” limit on out-of-pocket expenses will work:
An employee and his or her spouse enroll in family coverage with an annual cost sharing limit of $13,000, and during the 2016 plan year, $10,000 of cost sharing payments are attributable to the spouse and $3,000 of cost sharing payments are attributable to the employee. Prior to the HHS’s clarification, the full $13,000 would be payable by the covered individuals because the $13,000 plan limit had not been reached on an aggregate basis. However, with the new EMBEDDED self-only limitation, the cost sharing payments attributable to the spouse must be capped at the self-only limit of $6,850, with the remaining $3,150 being covered 100% by the group health plan. The employee would still be subject to cost sharing, however, until the $13,000 plan limit is reached.
The biggest impact on the new cost-sharing rules will be on employers with high-deductible plans.
For the FAQs, visit: http://www.dol.gov/ebsa/pdf/faq-aca27.pdf
For more information and a free renewal evaluation please
HDHP Minimum Annual Deductible (No change from calendar year 2011):
Single – $1,300 (NONE, $1,300 in 2015)
Family – $2,600 (+$100, $2,500 in 2015)
HDHP Out-of-Pocket Maximum:
Single – $6,550 (+$100, $6,450 in 2015)
Family – $13,100 (+$200, $12,900 in 2015)
Age 55 Catch Up Contribution
As in 401k and IRA contributions, you are allowed to contribute extra if you are above a certain age. If you are age 55 or older by the end of year, you can contribute additional $1,000 to your HSA. If you are married, and both of you are age 55, each of you can contribute additional $1,000.
HSA/HDHP Market Growth
HSA holders own the assets in the accounts and can build up substantial sums over time. Enrollment in HSA-compatible insurance plans has increased to 10 million earlier this year, from 1 million in March 2005, according to, America’s Health Insurance Plans (AHIP), a trade group.
HSAs were authorized starting in January 2004. Since then, AHIP has conducted a periodic census of health plans participating in the HSA/HDHP market.
The number of people with HSA/HDHP coverage rose to more than 11.4 in January 2011, up from 10.0 million in January 2010, 8.0 million in January 2009, and 6.1 million in January 2008.
30 percent of individuals covered by an HSA plan were in the small group market, 50 percent were in the large-group market, and the remaining 20 percent were in the individual market.
14% of all workers in the private sector that have access to a Health Savings Account acc. to Bureau of Labor Statistics.
States with the highest levels of HSA/HDHP enrollment were California, Ohio, Florida, Texas, Illinois and Minnesota.
HSA Advantages:
Opportunity to build savings – Unused money stays in your account from year to year and earns tax-free interest. The HSA also gives you an investment opportunity.
Tax-free contributions and earnings – You don’t pay taxes on contributions or earnings.
Tax Free Money allowed for non traditional Medical coverage– As per IRS Publication 502, unused moneys can be used for dental,vision, lasik eye surgery, acupuncture, yoga, infertility etc. Popular Examples
Portability – The funds belong to you, so you keep the funds if you change jobs or retire.
Our overall experience with HSAs have been positive when employer funding is at minimum 50% using either the HSA or an HRA (Health Reimbursement Account-employer keeps unspent money). Traditional plans trend of higher copays and new in network deductibles has also led to the popularity of an HSA.
(Note that a health plan will not fail to qualify as a high deductible health plan merely because it provides certain preventive health services without a deductible, as required under Health Care Reform.)
Is your HSA compliant? Which pre-tax qualified HSA, FSA, HRA spending card is right for you? Please contact our team at Millennium Medical Solutions Corp (855)667-4621 for immediate answers.. Stay tuned for updates as more information gets released. Sign up for latest news updates.
Anyone who has moved has been confronted with the question “How to Order Your Medical Records?”. Requesting your medical records may seem complex at first its simpler than one thinks.
1. Get a HIPAA release form. The federal law known as HIPAA entitles every person the right to access his or her medical records, receive copies of them, and request amendments to them.
2, Select your records. I would make this at least one month no more than 2 months This will give the office plenty of time to get you the records together. Specify the effective date, medical providers name, address, your name, address, medical record number ( you can get this from the staff) any identification numbers; i.e., Social Security Number or insurance ID number.
3. Submit forms. Fill out an authorization form giving one medical provider permission to share your records with another.Mark on that form which types of records you want included. Pay any fees that result.
4. Wait. The turnaround time under HIPAA can be 30 days. Most facilities, however, do not require that much time—many can fulfill a request in five to 10 days. Individual state laws may also dictate how quickly a facility must fulfill a request.
5. Follow up. In an imperfect world things can go wrong. What to do?
If your doctor has moved, you should be able to find your records at the practice she left. If that practice was affiliated with a hospital, the records may be housed within the hospital’s records system.
If your old provider says the records have been sent, but your new doctor’s office hasn’t received them, ask that they be re-sent. Doublecheck to make sure the old provider has the right contact information for your new one. You may find getting someone from your new doctor’s office involved could help. Having a nurse advocate for you, for instance, could put you in a better position.
If you’ve tried everything and are getting nowhere, offer to pick up the records yourself (but be aware that this may cost you), ask to speak with a manager or your doctor directly, or, as a final resort, contact your state medical board to file a complaint. This step is rarely necessary, but even suggesting you’ll have to go this route could get things moving on your request.
The Value of Requesting Your Records
There are many good reasons to request a copy of your medical records. Physicians don’t always share complete patient information or exchange a patient’s health records, so if a patient is seeing a new provider it is beneficial to ensure a copy of their record is sent to the new physician.. Also, it is beneficial for patients or caregivers dealing with multiple doctors and facilities to have all medical records in one place, which can then be used by providers to ensure thorough care.
Reviewing your record is an important way to ensure your provider has complete, correct, and up-to-date information, such as your known allergies. If you find information in your record that is incorrect or that you disagree with, contact the provider’s Health Info Management department.
Finally, it can be good for your health to keep a copy of your medical records, . Keeping an up-to-date copy of your health information will prevent redundant care, like repeat tests, and give all your physicians essential information about your health.
HSA-FSA-HRA: Whats the Difference? Health reimbursement arrangements (HRAs), health savings accounts (HSAs) and health care flexible spending accounts (HFSAs) are generally referred to as account-based plans. That is because each participant has their own account, at least for bookkeeping purposes. Under the tax rules, amounts may be contributed to these accounts (with certain restrictions) and used for health care on a tax-favored basis.
The Patient Protection and Affordable Care Act (PPACA) has added new requirements that affect HRAs and HFSAs. Most HFSAs and HRAs will need to be amended to meet the new PPACA requirements. HSAs generally are not affected by PPACA.
The chart below describes the main characteristics of these types of accounts, and should help you decide which is the best option for your particular situation.
Any employee who is also eligible to participate in a group medical plan sponsored by the employer; retired employees are eligible if most participants are active employees.
Any employee who is covered by a group medical plan sponsored by the employer (or if the employer chooses, by the spouse’s employer); retired employees are eligible (a retiree-only plan does not have to meet the medical coverage requirement).
Any employee who is covered by a high deductible health plan (HDHP), not covered by a plan that is not an HDHP, and not covered by any part of Medicare or eligible to be claimed as a tax dependent; individuals who are receiving Medicare may not contribute to an HSA.
May the employer impose additional eligibility requirements?
Yes, the employer may design the plan to cover whom it wishes as long as it meets the non-discrimination requirements.
Yes, the employer may design the plan to cover whom it wishes as long as it meets the non-discrimination requirements.
An employer may not limit the ability of an eligible employee to contribute to an HSA, but the employer may limit its contributions to employees participating in the HSA designated by the employer.
May an employee contribute to the account?
Yes, up to the lesser of $2,500 (indexed to $2,550 for 2015) or the maximum set by the plan (any carryover does not apply toward the $2,500 cap).
No.
Yes, up to the total contribution limit ($3,350 in 2015 for self-only coverage and $6,650 in 2015 for family coverage); individuals aged 55 or greater may contribute an additional $1,000.
May an employer contribute to the account?
Yes, up to two times the employee’s contribution plus $500.
Yes.
Yes, up to the total contribution limit described above.
May another person or entity contribute to the account?
No.
No.
Yes – anyone may contribute to an HSA, up to the total contribution limit.
Does the spouse’s coverage matter?
No.
An employer may – but is not required to — integrate the HRA with coverage through the spouse’s employer.
Yes. If the employee is covered by a non-HDHP through the spouse (which may include an HFSA or an HRA), the employee will not be eligible to contribute to an HSA.
Is a formal account required?
No, a notational/ bookkeeping account is allowed.
No, a notational/ bookkeeping account is allowed.
Yes, a trust or custodial account is required. Generally this is done at a bank or credit union.
Should a Section 125 cafeteria plan be used?
Yes – the HFSA must be part of a Section 125 plan.
No – an HRA may not be part of a Section 125 plan.
An HSA may, but need not be, part of a Section 125 plan. Including in a Section 125 plan will allow the employee to contribute with pre-tax dollars and allow the employer to meet the Section 125 non-discrimination rules instead of the comparable contribution rules.
What health expenses may be reimbursed?
All medical expenses allowed by Code Section 213 (which includes dental and vision expenses), except long term care services, may be reimbursed. Premiums may not be reimbursed.
All medical expenses allowed by Code Section 213 (which includes dental and vision expenses), may be reimbursed. Health premiums may be reimbursed for group coverage if not reimbursing (directly or indirectly) employee’s pre-tax premium. The cost of premiums for individual policies may not be reimbursed.
All medical expenses allowed by Code Section 213, except premiums (unless for COBRA, long-term care insurance or Medicare supplemental, which may be reimbursed).
May non-health expenses be reimbursed?
No.
No.
Yes, but income taxes and a 20% excise tax will apply.
Are limits on reimbursable expenses allowed?
Yes. An employer may exclude specific expenses if it wishes. It also may design the plan to be a “limited purpose” FSA to interface with an HSA option. Limited purpose FSAs typically only reimburse dental, vision and/or preventive care expenses, retiree expenses, or expenses in excess of the IRS high deductible.
Yes. An employer may exclude specific expenses if it wishes. It also may design the plan to be a “limited purpose” HRA to interface with an HSA option. Limited purpose HRAs typically only reimburse dental, vision and/or preventive care expenses, retiree expenses, or expenses in excess of the IRS high deductible.
No.
Whose expenses may be reimbursed?
The employee, spouse, children under age 27 and tax dependents, if the expense was incurred during the coverage period.
The employee, spouse, children under age 27 and tax dependents, if the expense was incurred while coverage is in effect.
The employee, spouse, children under age 27 and tax dependents – even if the person is not eligible to set up their own HSA – if the expense was incurred after the HSA is established.
How are expenses reimbursed?
Employee submits substantiated expense to claims administrator. May be paper or debit card.
Employee submits substantiated expense to claims administrator. May be paper or debit card.
Employee pays expense from HSA. May be paper or debit card. Employee is responsible for maintaining record to substantiate expense.
May expenses be reimbursed after employment terminates?
COBRA may be elected, generally until the end of the plan year in which termination occurred.
COBRA may be elected. Employer may design plan to allow reimbursement after termination, but employee must be given option to decline that extended coverage.
Yes.
May unused contributions be carried over from year to year?
Generally no; however, plan may be designed to allow carryover of up to $500 into next year or a grace period to incur claims attributable to prior year for up to 2-1/2 months.
Yes, if plan allows.
Yes (the account is the individual’s).
May an employee access funds before they have been contributed?
Yes – under the HFSA rules the employee must have access to the full planned contribution for the year on the first day of the coverage period.
Not required, but plan may be written to allow full access at start of year.
Generally no, although in certain situations the employer may advance contributions.
May planned contributions be changed mid-year?
Generally no. An employee may make a mid-year change only if allowed under the Section 125 change in status rules.
Yes (may require plan amendment and participant communications).
Yes – even if employee is contributing to the HSA through a Section 125 plan.
Do non-discrimination rules apply?
Yes, the Section 125 and the Section 105(h) rules apply.
Yes, the Section 105(h) rules apply.
Yes, either the Section 125 or the comparability rules apply.
May an employee participate in multiple accounts?
May participate in an HSA if HFSA is limited purpose; pays after HRA unless plan provides differently.
May participate in an HSA if HFSA is limited purpose; pays before HFSA unless plan provides differently.
Could also participate in a limited purpose HFSA or HRA.
Are a plan document and SPD required?
Yes (unless a government or church plan).
Yes (unless a government or church plan).
Not for HSA; will need for related HDHP.
Is a 5500 required?
If 100+ participants in the HFSA unless a government or church plan.
If 100+ participants in the HFSA unless a government or church plan.
No.
Is W-2 reporting required?
No, provided the HFSA is an “excepted benefit.”
No (reporting is currently optional).
Employer contributions are reported in Box 12 with code W; do not include in “cost of coverage” reporting under code DD.
Does the PCORI fee apply?
Not if an excepted benefit (if owed, fee is only due on employees, not dependents).
Yes, if HRA is the only self-funded plan using that plan year (fee is only due on employees, not dependents).
No.
Does the health insurance provider fee apply?
No.
No.
No.
Does the TRF apply?
No.
No.
No.
Do contributions apply to Cadillac tax?
Yes (both employer and employee).
Yes.
Yes (employer; probably employee if made through a Section 125 plan).
Do contributions apply toward minimum value determinations?
No.
Yes, if may only be used for cost-sharing (deductible, coinsurance, copays).
Yes.
Do employer contributions apply to affordability determinations?
No.
Yes, if may be used for premiums and/or cost-sharing.
No.
Qualifies as “minimum essential coverage”?
No.
Yes (if provides any medical benefits).
No.
Do HIPAA privacy requirements apply?
Yes.
Yes.
Not to HSA; may apply to related HDHP.
Is a Medicare Part D notice required?
No.
Yes, unless integrated with the Rx coverage.
Not for HSA; will need for related HDHP.
To qualify as an excepted benefit, an HFSA must be offered in conjunction with a group medical plan and the employer’s contribution cannot exceed two times the employee’s pre-tax contribution to the HFSA plus $500.
Beginning in 2014, HRAs must be available only to individuals actually covered by the group medical plan (or the spouse’s group medical plan if the plan provides). Participants must be given the option to decline further HRA reimbursement annually and when their employment terminates.
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4/15/15
This information is general and is provided for educational purposes only and is subject to change. It is not intended to provide legal advice.
You should not act on this information without consulting legal counsel or other knowledgeable advisors.
With first new star rankings released yesterday by CMS (Center for Medicare & Medicaid Services) this will be a little easier for consumers. The role of Government in medical transparency have long been touted as a qualitative and cost factor. The patient experience Star Ratings will make it easier for consumers to use the information on the Hospital Compare website and spotlight excellence in health care quality.
The Hospital Compare star ratings relate to patients’ experience of care at almost 3,500 Medicare-certified acute care hospitals. The ratings are based on data from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) measures that are included in Hospital Compare. HCAHPS has been in use since 2006 to measure patients’ perspectives of hospital care, and includes topics like:
• How well nurses and doctors communicated with patients
• How responsive hospital staff were to patient needs
• How clean and quiet hospital environments were
• How well patients were prepared for post-hospital settings
Only 251 hospitals–or 7 percent of those ranked–received a five-star rating under the new system, Kaiser Health Newsreported. The largest share of hospitals (40 percent) received three stars, including highly respected institutions such as Cedars-Sinai Medical Center in Los Angeles, NewYork-Presbyterian Hospital in Manhattan and Northwestern Memorial Hospital in Chicago. Only 3 percent of hospitals netted one star.
Consumers will now see 12 HCAHPS Star Ratings on Hospital Compare, one for each of the 11 publicly reported HCAHPS measures, plus a summary star rating that combines or rolls up all the HCAHPS Star Ratings. These star ratings will be updated each quarter. Also, the Nursing Home Compare site already uses star ratings to help consumers compare nursing homes and choose one based on quality.
Dark, Milk or White – Which Chocolate Is Best for Your Heart? (Infographic)
From our wellness partner, Cleveland Clinic
Chocolate is good for blood flow, which means it’s good for your heart. But not all chocolate is created equal. Find out about the healthy antioxidants and what else is inside so you can make the best choice of chocolate for your heart health.
Consumer complaints about receiving inadequate reimbursement from their insurers for medical services that they received outside of a provider network have been answered by New York’s “Emergency Medical Services and Surprise Bills” law. As of March 31, 2015, consumers will have protection from “surprise” medical bills for emergency medical services and certain out-of-network medical services.
The state of affairs today for small business plans offering both in and out of network is an exception with only 2 insurers in Downstate covering out of network at catastrophic high deductible levels. For Individual Marketplace it is even more dire with NO OUT OF NETWORK coverage at all.
The Problem. This has been a pattern in recent years and posted in Out of Control Out of Network Charges (March 2012). According to an investigation report commissioned by Governor Cuomo recognizing the unexpected out-of-network claim problem. Officials say that this is now “an overwhelming amount of consumer complaints.” Some examples cited in the report An Unwelcome Surprise – “a neurosurgeon charged $159,000 for an emergency procedure for which Medicare would have paid only $8,493.” Another example: ” a consumer went to an in-network hospital for gallbladder surgery with a participating surgeon. The consumer was not informed that a non-participating anesthesiologist would be used, and was stuck with a $1,800 bill. Providers are not currently required to disclose before they provide services whether they are in-network.” The average out-of-network radiology bill was 33 times what Medicare pays, officials say.
The blog post goes on to say “Today, 90% of SMB members have in network only benefits but the few remaining consumers are paying for eroding out of network benefits with little transparencies and necessary protection from new out of network billing practices. The NY Dept of Financial services is calling for providers in non-emergency situations to disclose whether or not all services are in-network, what out-of-network charges will be and how much insurers will cover.”
Balance Bill Protection. The long awaited bill passed last April protects patients from out-of-network providers from “balance-billing” consumers for emergency care or when patients can’t choose their doctors. Balance-billing occurs when health workers who don’t accept a patient’s insurance try to collect the difference between their charge and the insurer’s reimbursement.
Provider Disclosure Requirements. Hospitals will now be required to disclose anticipated charges. Patients most often receive these surprise bills in emergency cases, when they can’t choose the doctors who treat them. Its not unusual for a Provider to come into the picture who may read your tests or touch you thats not in network. Under the new law all medical providers will have to notify patients before treatment if they don’t take their insurance. If not, patients will be required to pay only a regular co-pay as if the provider was in network.
Providers will need to provide patients with disclosures of the health plans with which they participate and the names of the providers that may be billing them. They are also required to disclose procedures to follow with the an independent dispute-resolution entity (IDRE) which will be the arbiter of disputes under the law if a patient feels that a bill is inappropriate.
Network Adequacy. While the Affordable Care Act didn’t address surprise bills, the government has imposed network adequacy requirements that prevent health plans from having too few providers, which may reduce the number of cases where patients find themselves inadvertently out-of-network. New York will now require doctors and hospitals to disclose their network status before treatment in non-emergency procedures. Insurers will have to update online provider directories within 15 days of a change.
Prior to the Surprise Bill Law, these network adequacy rules only applied to health maintenance organizations (HMOs) and other “managed care” plans. HMO’s normally have more Provider/Insurer responsibility shifting form the patient. As with most non-HMO plans, however, the responsibility rests with patient to make sure everything is pre-authorized and in network is possible. Starting next month Health plans that are also based on more comprehensive PPO and EPO are also required to be certified as having provider networks that can meet the health needs of their members without having to rely on more expensive out-of network services.
A patient protection law is a welcome respite form the unfair unwelcome surprises out of one’s control. Common sense finally prevails!
NYC Transit Benefit Mandate for 2016
No More Surprises – NY Surprise Medical Bill Law