A fun visual transit infographic highlighting the benefits of public transportation by Credit Donkey. With NYC Transit Benefit Mandate for 2016 Employers with 20 or more full-time employees in New
York City must sponsor for 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.
Despite the requirement this visual highlights the inherent win-win of riding public transit. Furthermore, Employers exempt form the mandate such as smaller Employer or outside NYC ought to consider this as a benefit per at work. IMPORTANT: The popularity of the benefit for Employers have been a budget neutral perk that is offset by payroll tax savings. After all, the Employer is not required to fund the Transit/Parking only sponsor the plan.
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
EE Savings @ 40% tax bracket = $624/year
ER Savings (FICA) = $119/year
$250 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. Ask us about our enterprise payroll.
The rate requests for 2016 marked the first year in which insurers could rely on actual data from exchange enrollees. In many cases, insurers participating in exchanges in other states requested double-digit rate increases. New York is the second-largest state to receive final approval of its rate requests. Earlier this week, California insurance regulators approving an average rate increase of just 4 percent.
To the relief of customers of industry leader Oxford/UnitedHealthcare the rate increase for groups will be 3.9 to 6.5%. Importantly, the rates are a collective average and may range depending on one’s particular health plan. Additionally, Helath Insurers can opt to tweak or remove plans. Reminder: be sure to check back again our site in 30-60 days. Rates will be posted upon Health Insurer’s release. Also 2016 Individual Exchange Marketplace opens Nov 15th.
Individual Market
On average, insurers requested a 10.4 percent increase in health insurance rates for 2016 in the individual market. DFS reduced that average increase more than 30 percent to 7.1 percent – which is below the approximately 8 percent average increase in health care costs.
Starting on January 1, 2016, New York will add a new Basic Health Plan a.k.a ” Essential Health Plan” to the plans that can be purchased by lower income New Yorkers through NY State of Health. Households at or below 150 percent of the federal poverty level ($17,655 for a household of one; $36,375 for a household of four) will have no monthly premium for the Basic Health Plan. Those with slightly higher incomes at 200 percent of the federal poverty level ($23,540 for a household of one; $48,500 for a household of four) will have a low monthly premium of $20 for each adult.
The Basic Health Plan will provide the same covered services as other plans offered on the Marketplace. The Basic Health Plan has no annual deductible and lower copayments, making health care even more affordable for hundreds of thousands of New Yorkers. For example, a person who earns about $20,000 a year and uses moderate health care services including an inpatient hospital stay, prescription drugs and doctor’s visits, will pay about $730 a year for premiums and out-of-pocket costs under the Basic Health Plan in 2016 as compared to about $1,830 in 2015 if they were enrolled in a Qualified Health Plan.
Small Group Market
On average, insurers requested a 14.4 percent increase in health insurance rates for 2015 in the small group market. DFS reduced that average increase by 32 percent to 9.8 percent. A number of small businesses will also be eligible for tax credits that would lower those premium costs even further.
2016 Small Group Rate Actions – Overall Summary
Company
Requested
Approved
Reduction
Aetna Life
23.87%
21.47%
-2.40%
CDPHP HMO*
-19.84%
-19.84%
0.00%
CDPHP UBI*
16.56%
16.56%
0.00%
Emblem HIP*
29.74%
29.74%
0.00%
Empire Assurance
8.70%
3.40%
-5.30%
Empire HMO
9.21%
4.37%
-4.84%
Excellus*
13.90%
10.00%
-3.90%
Health Republic*
20.00%
20.00%
0.00%
HealthNow*
8.06%
0.66%
-7.40%
Independent IHA*
-15.60%
-15.60%
0.00%
Independent IHBC
-6.19%
-6.19%
0.00%
Managed Health
5.60%
3.94%
-1.66%
Metro Plus*
-0.81%
-0.81%
0.00%
MVP Health Plan*
7.28%
6.36%
-0.92%
MVP Services*
16.71%
15.90%
-0.81%
North Shore LIJ*
3.27%
3.27%
0.00%
Oxford OHI
13.61%
6.75%
-6.86%
Oxford OHP
10.58%
3.90%
-6.68%
United UHIC
18.79%
11.61%
-7.18%
All Companies Combined
14.41%
9.80%
-4.61%
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.
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.
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!
What to do with the 1095-A form you received in the mail?
Attached below is the link to the web page with information on Premium Tax Credits and Form 1095-A. The resources on this link provide information on Form 1095-A, including Frequently Asked Questions and the toll free numbers provided for assistance.The resources on this page provide information about your Form 1095-A from NY State of Health. The Form 1095-A is used to reconcile Advance Premium Tax Credits (APTC) and to claim Premium Tax Credits (PTC) on your federal tax returns.
I didn’t apply to NY State of Health for financial assistance. Can you tell me if I can claim the PTC on my tax returns for 2014?
Who is in my tax family? How do I figure out if someone is a dependent?
How do I report health care coverage on my tax return?
How do I report the information from Form 1095-A on my tax return?
Do I need to complete Form 8962?
How do I complete Form 8962 on my tax return? How do I use the Form 1095-A to complete my Form 8962. What counts as income? What is my FPL?
Do I owe money to the IRS? Will I get a refund from the IRS? How much tax credits will I have to repay to the IRS? How much extra in tax credits will I get from the IRS?
I am self-employed. Can I claim my NY State of Health premiums as a business expense on my tax returns?
I had to pay back tax credits or got extra tax credits. Should I estimate my income differently for 2015?
How do I claim an exemption from the Individual Responsibility requirement?
Do I owe an Individual Share Responsibility Payment?
What income needs to be considered when calculating the Individual Shared Responsibility Payment?
I enrolled in a health plan with financial assistance and my income is now less than 100% FPL. Am I still eligible for the PTC?
If you have questions about Form 1095-A, Minimum Essential Coverage, PTC or the SLCSP table, call Community Health Advocates’ Helpline at 1-888-614-5400.
If you think we made a mistake on your 1095-A, call NY State of Health at 1-855-766-7860.
If you have questions about Form 8962 or other tax-related questions, visit www.irs.gov.
Please take the time to review. For more information, please
单击此处，了解 简体中文 保费税收抵免和 Form 1095-A 的相关信息。
Cliquez ici pour accéder à des informations sur les crédits d’impôt pour cotisation d’assurance et sur le Form 1095-A en français.
Klike la a pou jwenn enfòmasyon sou Kredi nan Taks sou Prim ak Form 1095-A nan Kreyòl Ayisyen.
Per ricevere maggiori informazioni in italiano sul credito d’imposta sul premio (Premium Tax Credit, PTC) e sul Form 1095-A, cliccare qui.
한국어로 된 보험료 세금 공제(Premium Tax Credits, PTA) 및 Form 1095-A에 대한 정보가 필요하신 경우 여기를 클릭하십시오.
Нажмите здесь, чтобы получить информацию о налоговых вычетах за страховые взносы и форме Form 1095-A на русском языке.
Haga clic aquí para obtener información en español acerca de los Créditos tributarios para la prima y el formulario 1095-A.
WestMed Medical Group has now joined the North Shore LIJ’s insurance – CareConnect Network! This is not a purchase. This partnership expands their footprint and makes CareConnect a compelling fit for individuals and groups located in Westchester. In addition, CareConnect has just announced CareConnect’s Network Expansion! Yale-New Haven Health and all their facilities are now in-network with CareConnect. Tools are available to search for providers with updated expansion to be added shortly.
A combined Hospital Insurance system is an intriguing concept thats not all that new. Pittsburgh’s UPMC has been delivering the same model in Western PA successfully. In NYS an integrated medical approach is new on the other hand and challenging in an open competitive loop. A high quality smaller network that is priced affordably and can offer Patient Concierge like service may be what the market is asking for. They may also be in a better position to manage patient health and Preventative Medicine. For Jan 2015, NSLIJ CareConnect will have a 20% reduction in most regions such as Westchester and NYC. For new rates, benefits and provider listings click – CareConnect NSLIJ
For more information, please
Press Release#
Award-Winning WESTMED Joins CareConnect!
We’re pleased to announce our continued network expansion with the addition of WESTMED Medical Group. With this practice, CareConnect members now have more access in Westchester County:
• 289 physicians in eleven office locations • On-site laboratory and radiology services • Four urgent care centers • Three NCQA recognized programs including the patient-centered medical home and diabetes Stay tuned as we continue to add access for your groups around the CareConnect service area
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.
No More Surprises – NY Surprise Medical Bill Law
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