The NYS Department of Financial Services has reviewed individual and small group health carriers’ rate increase requests for 2015, and announced the results of their review.
Interestingly, North Shore LIJ Care Connect was the only insurer to request a rate reduction. With significant expansion steps they are well positioned for Wescthester, Bronx, NYC, SI, Queens and LI. These numbers are across the board and specific plan rate renewal may vary.
Reminder: Individual Exchange Marketplace opens Nov 2015. Rates will be posted upon Health Insurer’s release, check our site.
Individual Market
On average, insurers requested a 12.5 percent increase in health insurance rates for 2015 in the individual market. DFS reduced that average increase more than in half to 5.7 percent – which is below the approximately 8 percent average increase in health care costs.
Small Group Market
On average, insurers requested a 13.9 percent increase in health insurance rates for 2015 in the small group market. DFS reduced that average increase more than in half to 6.7 percent – which is also below the approximately 8 percent increase in health care costs.
You may view the DFS press release, which includes a recap of the increases requested and approved by clicking here.
For specific details on all available health plans in 2015, contact our team at Millennium Medical Solutions Corp (855)667-4621. We work in coordination with Navigators to assist with medicaid, CHIP Child Health Plus, Family Health Plus and Medicare Dual Eligibles. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
Employers incentivizing fitness by lowering lower insurance premiums in exchange for wearing fitness tracking bracelets. Bloomberg reports that BP Plc drive for occupational wellness offered an employee’s spouse the option “to wear a fitness-tracking bracelet from FitBit Inc. to earn points toward cheaper health insurance,” which is “an example of how companies, facing rising health expenses, are increasingly buying or subsidizing fitness-tracking devices to encourage employees and their dependents to be more fit.
” The article notes that UnitedHealth Group Inc. (UNH), Humana Inc. (HUM), Cigna Corp. (CI) and Highmark Inc. have developed similar programs, in which “consumers wear the device and the activity data is uploaded to an online system so it can be verified to give a person their reward.” The article notes, however, that “the moves also let employers and insurers gather more data about people’s lives, raising questions from privacy advocates,” one of whom notes that “when financial incentives are involved, Dixon said it forces employees’ hands and narrows the question of whether or not they should participate.”
Wear This Device So the Boss Knows You’re Losing Weight
To fight rising medical costs, oil company BP Plc (BP) last year offered Cory Slagle — a 260-pound former football lineman — an unusual way to trim $1,200 from his annual insurance bill.
One option was to wear a fitness-tracking bracelet from Fitbit Inc. to earn points toward cheaper health insurance. With the gadget, the 51-year-old walked more than 1 million steps over several months, wirelessly logging the activity on the device. Twelve months later, Slagle has added to his new exercise regimen by trading burgers for salads and soda for water, dropping 70 pounds (31.8 kilograms) and 10 pant sizes in the process.
“I can see my toes now,” said Slagle, a middle-school administrator whose wife, Kristi, works for BP in Houston. The company’s program, he said, is “pushing me to get off the couch and make the right decisions.”
Slagle’s wife is thrilled with his thinner frame — as is BP. His once-high blood pressure and cholesterol are now in a normal range, significantly lowering BP’s risk of covering treatments related to heart trouble or other medical problems.
Slagle’s experience is an example of how companies, facing rising health expenses, are increasingly buying or subsidizing fitness-tracking devices to encourage employees and their dependents to be more fit. The tactic may reduce corporate health-care costs by encouraging healthier lifestyles, even as companies must overcome a creepy factor and concerns from privacy advocates that employers are prying too deeply into workers’ personal lives.
Source: Cory Slagle via Bloomberg
Cory Slagle wore a fitness-tracking bracelet from FitBit Inc. to earn points toward… Read More
Insurers Too
Apart from BP, insurers includingUnitedHealth Group Inc. (UNH),Humana Inc. (HUM), Cigna Corp. (CI) and Highmark Inc. have also created programs to integrate wearable gadgets into their policies. The aim is to get people more invested in taking care of themselves. Consumers wear the device and the activity data is uploaded to an online system so it can be verified to give a person their reward.
“What employers want is the person to take an active role in their health,” said Dee Brock, who has incorporated wearable devices into wellness programs for Pittsburgh-based HighMark.
Privacy Flags
The adoption of wearable devices by companies and insurers is increasing as spending on corporate wellness incentives has doubled to $594 per employee since 2009, according to a study by Fidelity Investments and National Business Group on Health. Technology is creating new forms of wellness programs to measure whether employees are making improvements, similar to a trend in the car-insurance industry where drivers who put a monitoring sensor on their vehicle can earn lower rates based on how well they are driving, instead of their driving history.
Source: Cory Slagle via Bloomberg
Cory Slagle lost 70 pounds after starting to wear a FitBit given to him by energy…Read More
Yet the moves also let employers and insurers gather more data about people’s lives, raising questions from privacy advocates. Wearable gadgets are advancing beyond tracking steps, with sensors to monitor heart rates, glucose levels, body temperature and other functions.
“The focus on preventive health at the expense of privacy is dangerous,” said Pam Dixon, founder of the World Privacy Forum in San Diego, which focuses on health privacy issues. “Right now it’s tracking steps per day, and the reach isn’t that far with these devices, but in time it will be quite sophisticated.”
When financial incentives are involved, Dixon said it forces employees’ hands and narrows the question of whether or not they should participate. The gathering of health data also opens the door for people to eventually be charged more or less based on the information, she said.
Security Requirements
These are among the ethical questions still to be addressed about the appropriateness of companies tracking the physical activity of employees, said Harry Wang, a researcher for Parks Associates who has been studying the market. With wearable devices, collecting more sensitive information is likely to bring tougher government oversight, he said.
“There will be high levels of privacy, security and compliance requirements,” Wang said. “There will be high expectations from consumers about how the data will be used.”
Companies and insurers said they protect the privacy of people using wearable gadgets, and comply with federal laws that prevent employers from seeing certain health information about employees without consent. The wearable programs are voluntary and often administered by third-party vendors like StayWell, which works with BP.
Aggregated Only
As part of the BP program, employees who use a Fitbit to log 1 million steps earn half of the 1,000 points needed each year to qualify for lower co-pays, deductibles and out-of-pocket health expenses. BP bought 25,000 Fitbit devices for North American employees, including those at refineries and drilling rigs. Points can also be earned by getting an annual physical, taking an online health class and other initiatives.
“We think the device is easy to use, gets people aware of how little they are walking and helps trigger people to get active,” said Karl Dalal, director of health and wellness benefits at BP. “BP doesn’t see any of the data except in the aggregate.”
The market for wearable devices is small — about 2 percent of the 1 billion smartphones shipped globally last year — so creating interest from employers and insurance companies is key to growth. Some 22 million fitness-tracking devices will be sold this year, and 66 million by 2018, with about a third coming from corporate-wellness programs, according to Parks Associates. The incentives an employer or insurance company can offer is a way to keep people using the gadget, instead of throwing it in a drawer once the novelty wears off.
Targeting Businesses
Under the Affordable Care Act, the new national health-care law, companies can spend as much as 30 percent of annual insurance premiums on rewards for healthy behavior.
Technology companies are taking note. Apple Inc. (AAPL), which has new health-tracking software called HealthKit that will be released this year and is said to be developing its own wearable device, has talked with UnitedHealth, the biggest U.S. insurer, and Humana, about its health initiatives, executives at the insurance providers said. The companies wouldn’t provide specifics about the conversations. Apple declined to comment.
Fitbit has a sales force dedicated to pitching employers and insurance companies, and touts software to make it easier to log the activity of workers, down to specific individuals if a company wants, said Amy McDonough, who coordinates deals for Fitbit with companies. Other makers of wearable devices, including Jawbone, Samsung Electronics Co. (005930) and iHealth Lab Inc., have also targeted businesses.
Samsung leads the smart wearable-band market, according to a report today from Canalys. The researcher estimated the wearable band market grew almost eightfold in the first half of 2014 from a year ago.
Insurance Link
Some employers are encouraging the use of wearables without the gadgets being tied to lower insurance rates. Houston Methodist, owner of a chain of hospitals in the Houston area, got about 6,000 Fitbits this year and is offering employees the chance to win $10,000 if they walk more steps than the company’s top executives. Fitbit said it also works with Time Warner Inc. (TWX) and Autodesk Inc. (ADSK)
“Walking alone isn’t going to beat diabetes, but it’s certainly going to help,” said Marc Boom, chief executive officer of Houston Methodist. “Being more active results in better health. That’s indisputable.”
Scotty’s Brewhouse
At Scotty’s Brewhouse in Indianapolis, where the $15 “Big Ass Brewhouse Burger” includes four quarter-pound beef patties and American cheese, owner Scott Wise offers an extra day of vacation for managers at his 11 restaurants who use a Jawbone UP device to log an average of 10,000 steps a day for three months. That has some managers like Brian Winnie exercising more to earn time off for a trip he wants to take to Memphis, Tennessee.
“Outside of work, I picked up riding my bike to add extra steps that way,” Winnie said in an interview.
Despite some early enthusiasm, many companies are waiting to see whether the use of wearables is a fitness fad. No major research has been done that shows the use of these devices leads to lower health-care costs and many employers want to know “if this is something that’s a passing trend or something that has staying power and can have proven results,” said Eric Herbek, who runs digital engagement for Cigna.
The gadgets have been worthwhile for Chris Barbin, CEO of Appirio Inc. in San Francisco. He said about 40 percent of his staff, which numbers around 1,000, participates in a voluntary fitness program that includes uploading their activity with Fitbit.
$300,000 Discount
While health costs weren’t the priority for the program, Barbin said that by sharing the data with the company’s health care provider he negotiated $300,000 off his company’s roughly $5 million in annual insurance costs by showing his staff is getting healthier. He said privacy protections are in place for those who want to keep the data secret. The program has become one of the most popular forums on Appirio’s internal social network, he said.
“We had an initial batch of data about people who had lost weight, and people who had moved from high risk to moderate risk,” he said. “When we could show all that information to our insurer, that’s pretty powerful.”
Kristi Slagle, whose husband slimmed down through BP’s program, isn’t concerned about privacy with the gadgets. She said the program injects more fairness into the system because those who are healthier currently end up shouldering more costs for those who aren’t.
“I like that BP is making people more accountable,” she said.
OK so this may not be the catatonic movie of our favorite State starring Zach Braff and Natalie Portman but just the same Oxford couldn’t resist using the same logical name for the new network. Starting Sept 1, 2014 Oxford will be offering the Oxford Garden State Network on all size NJ group business. The 18,000 Doctor and 65 hospitals network will answer the call for a flexible lower cost plan option.
Judging by the #1 selling plan – Oxford Liberty HMO the market supports a smaller lower cost quality network. Taking the same playbook Oxford unveiled their plan last Friday. The plan will cover members outside NJ only on emergencies. Unlike the Liberty HMO some plans options are non-gated plans not needing referrals to for access to a Specialist Doctor.
The Garden State Network provides access to the 21 New Jersey counties only.The Garden State Network does not provide national access to the UnitedHealthcare Choice Plus network. For NJ 1-50, up to 4 plan options can be selected and the Garden State products can be paired with Liberty and Freedom network options. With this network, employers can select which of the 13, in-network only plan designs available will work best for their needs and for the needs of their employees.
Oxford/United has been purchasing Provider groups since 2011 , see our post UnitedHealthcare Buying Medical Groups? This strategy of late is by no means exclusive to this Insurer but it is worth pointing them out as they are a national leading health Provider and worth paying attention to.
Some highlights of the plan designs available with the Oxford Garden State Network are below:
∙ Routine, in-network preventive care covered at 100 percent
∙ In-network only coverage
∙ Choice between 11 non-gated and two gated plan designs (gated plan designs will require a referral)
∙ Plan designs with copayments, deductible and coinsurance, and Health Savings Accounts (HSA) are available.
Sign up for latest news updates. Please contact us for immediate information on how to implement these initiatives for your group-specific needs at info@medicalsolutionscorp.com or Call (855) 667-4621.
IRS Releases Draft of Employer Reporting Form for Health Reform Law Compliance
Business Insurance
Story by Matt Dunning
Click Above
July 28, 2014
The Internal Revenue Service has issued draft versions of the reporting forms most employers will begin using next year to show that their group health insurance plans comply with the health care reform law.
The long-awaited draft forms, posted late Thursday afternoon to the IRS’ website, are the first practical application of employers’ health care coverage and enrollment reporting obligations under the Patient Protection and Affordable Care Act since the regulations were finalized in March.
The forms are the primary mechanism through which the government intends to enforce the health care reform law’s minimum essential coverage and shared responsibility requirements for employers.
Beginning in 2015, employers with at least 100 full-time employees will be required to certify that benefits-eligible employees and their dependents have been offered minimum essential coverage and that their employees’ contributions to their premiums comply with cost-sharing limits established under the reform law. Smaller employers with 50-99 full-time employees are required to begin reporting in 2016.
Additionally, self-insured employers will be required to submit documentation to ensure compliance with minimum essential coverage requirements under the reform law’s individual coverage mandate.
“In accordance with the IRS’ normal process, these draft forms are being provided to help stakeholders, including employers, tax professionals and software providers, prepare for these new reporting provisions and to invite comments from them,” the IRS said in a statement released Thursday.
The IRS said it expects to publish draft instructions for completing the reporting forms by late August and that both the forms and the instructions would be finalized later this year.
Last year, the Obama administration announced it would postpone implementation of employers’ minimum essential coverage and shared responsibility obligations under the reform law for one year, largely due to widespread complaints about the complexity of the reporting requirements.
Though several months have passed since the administration issued a simplified set of information reporting rules, many employers have delayed preparations for meeting the requirements until the forms and instructions are available for review, said Richard Stover, a principal with Buck Consultants at Xerox in Secaucus, New Jersey.
“A lot of employers really haven’t been doing anything about reporting requirements, even with the final regulations in place, because they were waiting for these forms,” Mr. Stover said. “This is something they’ve been anxious to see.”
Try These Natural Tricks to Fall Asleep More Easily
Seeing a physician for help with your sleeping problems? You might want to try complementary medicine as another way to help you get back to restful slumber.
Complementary medicine refers to forms of non-invasive therapies that a patient can use alongside conventional Western medicine. Nearly 40 percent of Americans use this approach for specific conditions or overall well-being, says the National Institutes of Health (NIH).
“Many complementary therapies have been shown, through high-quality scientific evidence, to be safe and effective,” says integrative medicine specialist Melissa C. Young, MD. She sees patients at Cleveland Clinic’s Center for Integrative Medicine.
Complementary therapies for insomnia comprise four categories: mind-body therapies, body-based therapies, biologically based therapies and cognitive-behavioral therapy.
Here’s a rundown of the four categories and how you can leverage them to get back to sleep:
Mind-body therapies
The mind is a key player when it comes to how easily you fall asleep and stay asleep. This is why people should try mind-body techniques first when they experience insomnia, Dr. Young says.
Examples of mind-body techniques include meditation, hypnosis, guided imagery, tai chi and yoga. These practices can help to calm people’s thoughts and help them to relax. They are particularly helpful for older adults.
Body-based therapies
Body-based therapies can relax the body enough so that it is ready for sleep. These include massage and acupuncture, as well as energy techniques for stress reduction. Massage benefits everyone from infants to older adults and cancer patients. Acupuncture enhances sleep quality, especially if you’re feeling pain. Energy techniques include reiki, healing touch and therapeutic touch.
Biologically based therapies
Biological supplements aren’t sleeping pills. They help to balance your body’s chemistry and rhythm naturally, and make it easier to fall asleep.
Dr. Young says the most effective and popular biological treatments are:
Magnesium, a mineral supplement
Melatonin, a hormone that plays a role in sleep
Chamomile tea
I-theanine, a naturally occurring amino acid
Cognitive-behavioral therapy
Cognitive behavioral therapy for insomnia is a group of strategies that can help you to fall asleep faster, stay asleep and improve your sleep quality. At the same time, these strategies increase the overall amount of time you sleep. Cognitive-behavioral therapy is effective in the short- and long-term, and has minimal side effects.
Limit the time you spend awake in bed. If you find yourself still awake after 15 to 20 minutes, leave the bedroom and return when you feel tired. You should associate your bedroom only with sleep — not TV, emails from work or worry.
Create a sleep schedule—and stick to it. Wake up at the same time each day, no matter your nightly experience. This will help your body regulate its internal 24-hour sleep-wake cycle, otherwise known as your biological clock or circadian rhythm.
Practice good sleep hygiene. Part of getting good sleep is having healthy habits. Get regular exercise (but not too close to bedtime), develop a pre-bedtime relaxation routine, avoid or limit caffeine, avoid or limit naps to 30 minutes and limit your intake of alcohol.
Study up on sleep. It’s easier to change sleep habits when you know how and why people sleep, and which beliefs, behaviors and outside influences affect your sleep.
Consider cognitive therapy. Five mental processes influence insomnia: worry, selective attention and monitoring, distorted perception of sleep and daytime deficits, unhelpful beliefs about sleep and counterproductive safety behaviors. Cognitive therapy helps you to reverse these mental processes. Cognitive therapy is especially helpful in preventing relapse.
Relax. This is often easier said than done. This is why relaxation training from a sleep psychologist or a professional trained in services such as meditation, guided imagery or hypnosis may help. Results are not immediate, but last a lifetime.
Painful wait times at the doctor’s office… It’s an old story with few exceptions.
As a dad, I have to deal with many of the same issues of parenting that you deal with: sleepless nights , fevers and holding my kids down for shots (My wife did it once, I think, then she promptly retired from this job.). However, waiting at the pediatrician is not something I have to do. So, I can’t truly empathize with you on this one….
Because you guys know me and know I’m not one to defend the status quo…I’m going to go ahead and defend the status quo a little bit. Or, at least, sound like I am (whether I am or not).
Here are some (in my mind) acceptable reasons why wait times are long:
Scheduling – Doctors, pediatricians specifically, are often over-scheduled. We generally come out of school with the same amount of debt as our doctor friends who have entered more “lucrative” specialties. The only way to make up some of the difference (and pay back our loans) is to see more patients. Thus, patients are scheduled closer together. This normally does not cause problems…but stuff happens.
Emergencies – If you have a doctor with hospital privileges (especially one who goes to deliveries), emergencies will happen. Getting called to a C-section can ruin an entire afternoon for a busy pediatrician. Great partners (like the ones I had in Abilene) will try to pick up the slack while you are gone but it is a strain on the whole system. What about other little “emergencies”? The teenager who reveals during their well child exam that they are depressed and suicidal. The 6-year old getting an MRI for headaches that turn out to have been caused by a brain tumor. Yes, I could assign those conversations to someone else by referring to the ER or the specialist, but wouldn’t you want it to be your pediatrician walking you through that?
Here are some (in my mind) unacceptable reasons why wait times are long:
Too Much Time Out-of-Room for the Doctors – I heard a story once about a doctor whose patients complained that his wait times were too long. He in turn complained to his staff that they were too slow. Come to find out, every morning, before he saw any patients, he sat down at his desk and read the entire paper, cover to cover. He had patients waiting 15 minutes completely ready for him to see but was sitting in the back office. 15 minutes might not be terribly inconvenient but that 15 minutes, on a bad day, will turn into 30-45-60 minutes that could have been avoided. Reading the paper may not be much of a temptation these days, but spending time on the computer doing other stuff is huge. I have to make a point not to be on Facebook, Twitter and other social media during patient care time. I do my social media and blogging before patients arrive and at lunch.
Poor Work-Flow in the Office – In Abilene, I had a very hard working MA and LVN (shout out to Nikea and Beth!) that understood how important this issue was to me. There are other ways to know if work-flow is the problem but one thing is certain: if you can’t see your first patient of the day in time, then there’s something wrong.
Chronic Over-Scheduling – While I do understand the issues related to scheduling, I don’t excuse the doctor for always having a schedule such that they run behind every day. Something can be done.
Now, you can read over this and take it however you want, but keep this in mind: you almost always have a choice in medical care. Unless your child needs a specialist for which there is only one in town or you live in such a rural area that there is only one provider, you have a choice. When we make any choice, we prioritize what’s important…someone might choose to see a doctor they love and tolerate the fact that their wait times are longer (but continue to complain on Facebook about it-I get it, it’s ok). Other people might drive more miles to see one they love. The choice still lies in the hands of the parents.
Ultimately, waiting anywhere is hard. Waiting in the doctor’s office is especially hard when you have a sick child, no one slept the night before, and the only appointment available was right in the middle of nap time.
I promise to keep working on those things that I can do in order to shorten your wait time and you can stay tuned for tomorrow’s post:
Justin Smith is a pediatrician who blogs at DoctorJSmith. He can be reached on Twitter @TheDocSmitty.
This post has absolutely little to do with employee benefits but more with the unprecedented lopsided score. With the World Cup 2014 lopsided score of 7-0 making history I cannot restrain myself. It is well worth pointing out that I have an incredible respect for the game of Soccer and its beauty. The cerebral parallels of battlefield strategy and true international game is inescapable. Besides this sport deserves more the moniker “Football” than American Football.
Having said that, Soccer will simply never take off in USA. In any sport a team can trail and have a shot of a comeback. Perhaps this meritocracy or a “can-do spirit” is what makes this country great. Americans should be able to make progress in any game, overcoming obstacles and changing rules. Americans are an optimistic people. We like scoring too much to enjoy a game that is more about preventing success than achieving it.
Maybe this is also why the underdog is beloved. Regardless, if a team is down in Baseball by 3 runs its possible to come back in the last inning. How many times has Joe Montanan engineered a comeback victory down by 10+ points and 5 minutes left?
In the beautiful game of soccer there is NO shot! Say a team trails by more than a goal with even 20 minutes left a come back is virtually an impossibility. The opponent can contract and play super D. There is NO redemption.
From a broadcasting revenue standpoint its a major snooooze fest when a team is down by 1+ score. After-all, in the United States we vote with our dollars do we not?
Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), an individual who was covered by a group health plan on the day before the occurrence of a qualifying event (such as a termination of employment or a reduction in hours that causes loss of coverage under the plan) may be able to elect COBRA continuation coverage upon that qualifying event. Individuals with such a right are referred to as qualified beneficiaries.
Under COBRA, group health plans must provide covered employees and their families with certain notices explaining their COBRA rights. A group health plan must provide each covered employee and spouse (if any) with a written notice of COBRA rights “at the time of commencement of coverage” under the plan (general notice). A group health plan must also provide qualified beneficiaries with a notice which describes their rights to COBRA continuation coverage and how to make an election (election notice).
General Notice: The general notice must be furnished to each covered employee (and their spouse if covered under the plan) not later than the earlier of: (1) 90 days from the date on which the covered employee or spouse first becomes covered under the plan or, if later, the date on which the plan first becomes subject to the continuation coverage requirements; or (2) the date on which the administrator is required to furnish an election notice to the employee or to his or her spouse or dependent.
Election Notice: The election notice must be provided to the qualified beneficiaries within 14 days after the plan administrator receives notice that a qualifying event has occurred.
Some qualified beneficiaries may want to consider and compare health coverage alternatives to COBRA continuation coverage, such as coverage that is available through the Health Insurance Marketplace (Exchange). Qualified beneficiaries may be eligible for a premium tax credit (a tax credit to help pay for some or all of the cost of coverage in plans offered through the Exchange) and cost-sharing reductions (amounts that lower out-of-pocket costs for deductibles, coinsurance, and copayments), and may find that Exchange coverage is more affordable than COBRA.
The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) specifies that an employer that maintains a group health plan in a State that provides premium assistance for the purchase of coverage under a group health plan is required to notify each employee of potential opportunities currently available for premium assistance in the State in which the employee resides.
The Department of Labor has model notices that plans may use to satisfy the requirement to provide the general notice and election notice under COBRA, and the notice regarding premium assistance under CHIPRA. The COBRA model election notice was revised on May 8, 2013 to help make qualified beneficiaries aware of other coverage options that would soon become available in the Marketplace. Recently the DOL issued a Notice of Proposed Rulemaking, as well as updated versions of the model general notice and model election notice that reflect that the Exchange is now open and that better describes special enrollment rights in Exchange coverage. The DOL is also issuing a revised CHIPRA notice with similar updates related to Marketplace coverage.
Sign up for latest news updates. Please contact us for immediate information on how to implement these initiatives for your group-specific needs at info@medicalsolutionscorp.com or Call (855) 667-4621.
Adding a one-month orientation period may help an employer avoid complying with the new health benefits. Federal agencies are offering employers a benefits-free 30 day orientation period option in final regulations. There is also clarification on how employers must treat certain categories of new hires, as either FT , PT or Seasonal employees
The Final Regulations
These final regulations provide that the one month period would be determined by adding one calendar month and subtracting one calendar day, measured from an employee’s start date in a position that is otherwise eligible for coverage. For example, if an employee’s start date in an otherwise eligible position is May 3, the last permitted day of the orientation period is June 2. Similarly, if an employee’s start date in an otherwise eligible position is October 1, the last permitted day of the orientation period is October 31.
The new regulations implement part of the “employer shared responsibility mandate” provisions created by the Patient Protection and Affordable Care Act (PPACA). In all categories of new hire the e final regulations provide that one month is the maximum allowed length of an employment-based orientation period. For any period longer than one month that precedes a waiting period, the 90-day period begins after an individual is otherwise eligible to enroll under the terms of a group health plan.
When must an employer offer coverage:
The final regulations continue to provide that if a group health plan conditions eligibility on an employee’s having completed a reasonable and bona fide employment-based orientation period, the eligibility condition is not considered to be designed to avoid compliance with the 90-day waiting period limitation if the orientation period does not exceed one month and the maximum 90-day waiting period begins on the first day after the orientation period.
These final regulations apply to group health plans and health insurance issuers for plan years beginning on or after January 1, 2015.
When the Employer Might be Subject to a Penalty:
If at least one full-time employee of the employer buys health insurance in a public Exchange (Marketplace) and qualifies for a subsidy (either a premium tax credit or a cost-sharing reduction), the employer must pay a penalty.
There are two different types of penalties.
)The IRC section 4980H(a) penalty applies if a large employer offers coverage to less than 70% of its full-time employees in 2015 (or to less than 95% after the 2015 plan year). This penalty is $2000 annually or $166.67/month times the total number of “full-time” employees minus the first 80 (minus the first 30 after 2015). The penalty calculation does not include variable hour or seasonal employees who are in their measurement or administrative periods, even if they in fact worked on average at least 30 hours/week or 130/month during those periods. Nor does it include those who are in their stability periods but who did not qualify for coverage based on their hours worked during the associated measurement period.
IRC section 4980H(b) penalty. It applies if a large employer offers coverage to at least 70% of its full-time employees (95% after 2015), but for some full-time employees the coverage is either not “affordable” or does not provide minimum value. This penalty is $3,000 annually or $250/month for each full-time employee who buys health insurance in a public Exchange (Marketplace) and qualifies for a subsidy and for whom the employee cost for self-only coverage under the lowest-cost option available from the employer is more than 9.5% of the employee’s household income (or one of three safe harbors), or for whom the employer coverage offered does not provide at least minimum value. Again, the penalty calculation does not apply if the employee who qualified for a subsidy was a variable hour or seasonal employee who was in his/her measurement or administrative periods, nor does it include those employees who are in their stability periods but who did not qualify for coverage based on their hours worked during the associated measurement period. Additionally, the (b) penalty cannot be more than the (a) penalty would have been had it applied.
Summary and Employer Action Items
The bottom line is this:
If you hire a non-seasonal employee whom you reasonably expect (at date of hire) to work at least 30 hours/week or 130 hours/month, you must track hours each calendar month and offer benefits by the first day of the fourth month if the employee averages at least 130 hours/month for the first three months. This applies even if you hire this employee for a short-term position or a summer internship (unless you take the position, upon advice from your legal counsel, that a summer intern is a “seasonal” employee).
If you hire a non-seasonal employee and you cannot reasonably determine at date of hire if they will work on average at least 30 hours/week (130 hours/month), you can track their hours over their “initial measurement period” and not offer benefits until the associated “stability period,” if the employee averaged at least 130 hours/ month during the measurement period. The stability period might not begin until 13-14 months after the date of hire.
If you hire an employee who meets the new definition of a “seasonal employee,” you can track their hours over their “initial measurement period” and not offer benefits until the associated “stability period” if they averaged at least 130 hours/month during the initial measurement period. You do not have to offer benefits by the first day of the fourth month.
A copy of the final regulations can be obtained by clicking on the link below:
Sign up for latest news updates. Please contact us for immediate information on how to implement these initiatives for your group-specific needs at info@medicalsolutionscorp.com or Call (855) 667-4621.
COBRA members have a special enrollment period extension according to new CMS guidance. If you have individuals eligible for, or currently enrolled in COBRA you can enroll them on the Individual Exchange through June 30th 2014. Direction from The NY State of Health confirms that current COBRA Eligible Individuals have been granted a one-time open enrollment window.
Therefore, anyone who does not like his or her current COBRA coverage or cost, can now switch to Individual Exchange!
ASpecial Enrollment Period (SEP) is the time outside of Open Enrollment that allows individuals and families facing special circumstances (Qualifying Life Events) to enroll in a Qualified Health Plan. Eligible individuals have 60 days to enroll after their Qualifying Life Event.
Individual or dependent loses minimum essential coverage due to: job loss; employer no longer offers coverage; divorce; death of a spouse; becoming ineligible for Medicaid or Child Health Plus; expiration of COBRA; or health plan is decertified
Marriage, birth, adoption, or placement for adoption
Gaining status as a citizen, national, or lawfully present individual
Consumer is newly eligible or ineligible for tax credits and/or cost sharing reductions
Permanent move to an area that has different health plan options
Marketplace staff or contractor enrollment error
Qualified Health Plan violated a provision of its contract
American Indians can enroll or change plans one time per month throughout the year
Other exceptional circumstances, as defined by HHS
To ensure your clients get great health insurance get in Contact us at (855)667-4621!
Find us on the Health Insurance Marketplace where you may qualify for help to pay for your health insurance
CLICK HERE TO DOWNLOAD PDF – 
Try These Natural Tricks to Fall Asleep More Easily
Orientation Period for New Hires