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FEDERAL JAN 2024  SMALL GROUP ANNUAL OPEN ENROLLMENT WAIVER

FEDERAL JAN 2024 SMALL GROUP ANNUAL OPEN ENROLLMENT WAIVER

Federal Open Enrollment (FOE)

Great news, during FOE groups will not be subject to any enrollment participation requirements!

FOE will run from 11/15 through 12/15. ​See below for submission timelines:

  • 12/1 effective date groups must be entered by 11/24
  • 1/1 effective date groups must be entered by 12/15​

A little-known requirement but most important under the Affordable Care Act (ACA) is that Health Insurers must waive their minimum employer-contribution and employee-participation rules once a year. ACA requires a one-month Special Open Enrollment Window for January 1st coverage.

The special open enrollment period occurs November 15th through December 15th of each year, allowing eligible small group employers to enroll for coverage effective January 1st of the following year.

Background

The ACA has a section in it called the “guaranteed issuance of coverage in the individual and group market.” It stipulates that “each health insurer that offers health insurance coverage in the individual or group market in the state must accept every employer and individual in the state that applies for such coverage.” The section also states that this guaranteed issuance of coverage can only be offered during (special) open enrollment periods and that plans can only be offered to applicants that live in, work in, or reside in the plan’s service area(s).

Participation and Contribution Requirements

In many states (including California and Nevada), carriers can decline to issue group health coverage if fewer than 70% of employees elect to enroll in coverage. Some carriers may have even tighter participation requirements.

Generally speaking, employees with other coverage (Medicare, other group coverage, individual coverage through the Exchange, etc.) are removed from the participation requirement calculation – though it varies by insurance carrier.

Furthermore, employer contribution rules require employers to contribute a certain percentage of premium costs for all employees in order to attain group health coverage. Some businesses struggle to meet these contribution requirements for a variety of financial reasons.

Problem Solved: Special Open Enrollment Period

Many employers want to offer coverage to their employees but are denied because they struggle to meet participation and/or contribution requirements. Employers cannot force employees to enroll in coverage unless the employer pays for 100% of the employees’ premiums, which many employers cannot afford. Even with moderate to generous employer contributions, many employers still find young and lower-income employees waiving coverage. 

The U.S. Department of Health & Human Services provides final guidance on this in regulation 147.104(b)(1): “In the case of health insurance coverage offered in the small group market, a health insurance issuer may limit the availability of coverage to an annual enrollment period that begins November 15 and extends through December 15 of each year in the case of a plan sponsor that is unable to comply with a material plan provision relating to employer contribution or group participation rules.”

If your employer groups are struggling with participation and/or contribution, the Special Open Enrollment Window is the time to enroll them in coverage.

For more help with the Special Open Enrollment Window contact us at [email protected] or (855)667-4621.

Put You & Your Employees in Good Hands

Get In Touch

For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.

NYS DFS 2024 Rates Approved

NYS DFS 2024 Rates Approved

Earlier today, the long-awaited NYS Dept of Financial Services approved 2024 health insurance rate requests. And it was worth it with small groups stabilized.  Small group rates increased by 7.4% and  12.4% for individuals.

As per NY State Law, Health Insurers are required to send out early notices of rate request filings to groups and subscribers. Despite only 3 months of mature claims data experience for 2023  health insurers’ original requests were noticeably above the average of 22%/individuals and 15.3% for small groups.

State Department of Financial Services officials asserted the rising cost of medical care — including in-patient hospital stays and rapid increases in drug prices — continued to be the main driver of health insurance premium increases. The final approved rates for 2024 would keep health insurers’ profit provisions at 1%, state officials added, noting they sought to limit those returns in light of ongoing inflationary pressures harming consumers. That said, in anticipation of spikes in claims submissions + overall inflation, a larger-than-average increase is needed. This is in addition to increases in pricing by hospitals, consolidated IPA groups, and pharmaceuticals.

Rate Factors

The state noted that the premiums increase main drivers are medications.  “Rising medical costs and inflation continue to put upward pressure on premiums,” said Superintendent Harris. “With our rate actions announced today, we continue to prioritize the financial well-being of consumers while ensuring that New Yorkers have access to a robust, stable health insurance market.”  Also, DFS, recognizing the continued uncertainty of the pandemic’s effect on consumers’ healthcare costs and the economy, held insurers’ profit provisions to a low 1%. 

Health Insurers

Oxford/Unitedhealthcare, notably, got only a 4.7% rate increase approval for next year. This is a sharp reduction from the original 15.5% request in part to disagreed anticipated costs, held reserves, overall market pricing, and reinsurance gained from ACA’s Risk Corridor.  See more info here, https://medicalsolutionscorp.com/risk-adjustment-reinsurance-and-risk-corridors/.

Small Group Market   

Almost 800,000 New Yorkers are enrolled in small group plans, which cover employers with up to 100 employees. Insurers requested an average rate increase of 15.3% in the small group market, which DFS cut by 52% to 7.4% for 2024, saving small businesses $607 million. A number of small businesses also will be eligible for tax credits that may lower those premium costs even further, such as the Small Business Health Care Tax Credit.

DFS SMALL GROUP MARKET RATE ACTIONS   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Indicates the Company will offer products on the NY State of Health Marketplace in 2024.

PEO Alternatives to Small Group

Before you consider renewing automatically, you should first find out what is a PEO so that you can know exactly what to expect from it. PEOs are large-group markets underwritten.  With the right PEO, you will be able to manage your business’s demand for growth and your employees as well.

Clients on average save 15-40% off the small group market. If you are looking for a complete insurance solution for your business, go to our website and check out our business insurance solutions. Contact us for more information today.

Learn how a PEO can make a difference for your group. For more information on how Employer-Sponsored Insurance and a PEO can make a difference for your small business please contact us at [email protected] or 855-667-4621.

 

 

 

 

Put You & Your Employees in Good Hands

Get In Touch

For more information on PEOs or a custiomized quote please submit your contact. We will be in touch ASAP. 

2023 Innovations That Will Change Business

2023 Innovations That Will Change Business

New technologies, evolving customer demands, societal shifts, and the COVID-19 pandemic are rapidly changing the business landscape. These factors paved the way for new innovations that can help companies cope with the demands of their target audience using technology and modern resources.

2023 Innovations that will change businesses

1. Adoption of Disruptive Technology

Robots that have Artificial Intelligence powers are said to be rising this year. Now that these robots can now accomplish tasks previously completed by humans only, employers are left to figure out the balance between the robots and their human employees.

When employers properly know what roles and responsibilities robots and humans have respectively, their business will surely flourish.

Now that everything seems to be possibly done online, cyber security has been strengthened.

However, since work has been almost done entirely remotely, different kinds of cyberattacks have been destructing the systems and software of businesses, whether they may be start-ups or have been in the industry for years.

3. Professional Employer Organization

Professional Employer Organizations, aka PEO, will be on the rise this 2023.

PEOs provide companies with HR and admin tasks and functions. Some of these functions are but are not limited to payroll, benefits, taxes, training, and compensation.PEOs are considered to be co-employment to companies. With these arrangements, start-ups no longer need to worry about mastering the whole aspects of human resource management. Instead, businesses can now focus on improving their growth.

PEOs for start-ups are considered to be one of the most important innovations for this year because it allows businesses to focus on marketing and strategizing their products or services. Removing the unnecessary burden that HR tasks and functions bring to employers and employees.

4. Remote Work

OK not new but trending nonetheless. This trend is real because it serves vested interests on both sides of the equation, especially as US continues to fail to manage traffic (and associated pollution), healthcare and childcare, which are all intertwined with remote work.

5. Going Virtual

Virtual Interfaces via AR(artificial reality), VR (virtual reality) or even Metaverse will be evolving. This is at the nexus of the natural progression of digital evolution and easy adoption especially true with hardware costs expected to fall below the $400 threshold. “You got your goggles?” will be the new “can we Zoom?” call to action.

Learn how our PEO Partnership can help your group please contact us at [email protected] or (855)667-4621.

Put You & Your Employees in Good Hands

Get In Touch

For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.

FEDERAL JAN 2024  SMALL GROUP ANNUAL OPEN ENROLLMENT WAIVER

Federal Open Enrollment Exclusion Deadline

A little-known exception for small businesses but most important under Affordable Care Act (ACA) is for Health Insurers must waive their minimum employer-contribution and employee-participation rules once a year. ACA requires a one-month Special Open Enrollment Window for January 1st coverage.

Background

The ACA has a section in it called the “guaranteed issuance of coverage in the individual and group market.” It stipulates that “each health insurer that offers health insurance coverage in the individual or group market in the state must accept every employer and individual in the state that applies for such coverage.” The section also states that this guaranteed issuance of coverage can only be offered during (special) open enrollment periods, and that plans can only be offered to applicants that live in, work in, or reside in the plans’ service area(s).

Participation and Contribution Requirements

In many states (including California and Nevada), carriers can decline to issue group health coverage if fewer than 70% of employees elect to enroll in coverage. Some carriers may have even tighter participation requirements.

Generally speaking, employees with other coverage (Medicare, other group coverage, individual coverage through the Exchange, etc.) are removed from the participation requirement calculation – though it varies by insurance carrier.

Furthermore, employer contribution rules require employers to contribute a certain percentage of premium costs for all employees in order to attain group health coverage. Some businesses struggle to meet these contribution requirements for a variety of financial reasons.

Problem Solved: Special Open Enrollment Period

Many employers want to offer coverage to their employees, but are denied because they struggle to meet participation and/or contribution requirements. Employers cannot force employees to enroll in coverage unless the employer pays for 100% of the employees’ premiums, which many employers cannot afford. Even with moderate to generous employer contributions, many employers still find young and lower-income employees waiving coverage. This was even more evident in 2019 with the ACA’s federal Individual Mandate non-compliance penalty reduced to $0.00.

The U.S. Department of Health & Human Services provides final guidance on this in regulation 147.104(b)(1): “In the case of health insurance coverage offered in the small group market, a health insurance issuer may limit the availability of coverage to an annual enrollment period that begins November 15 and extends through December 15 of each year in the case of a plan sponsor that is unable to comply with a material plan provision relating to employer contribution or group participation rules.”

Timeline:

The annual Federal Employees Health Benefits (FEHB) Open Season is taking place from November 14, 2022 – December 12, 2022 this year. The annual open season provides federal employees, annuitants, and other eligible individuals the opportunity to review their plan options, make changes, and enroll for the upcoming benefit year that begins January 1, 2023.

Employers, if your group struggling with participation and/or contribution, the Special Open Enrollment Window is the time to enroll them in coverage.

Contact us today.

 

For more help with the Special Open Enrollment Window contact us at [email protected] or (855)667-4621.

Put You & Your Employees in Good Hands

Get In Touch

For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.

NYS 2023 Final Rates Approved

NYS 2023 Final Rates Approved

Yesterday, NYS Dept of Financial Services approved 2023 health insurance rate requests yesterday. Small group rates increased by 7.9% and  9.7% for individuals.

As per NY State Law, Health Insurers are required to send out early notices of rate request filings to groups and subscribers see original –2023 NY Small Group Carrier Rate Filings.  Despite only 3 months of mature claims data experience for 2022  health insurers’ original requests were noticeably above the average of 16.5%/individuals and 19% for small groups. For example, regulators last year approved average rate increases of 3.7% for individuals and 7.6% for small group plans. Over 1.1 million New Yorkers are enrolled in individual and small group plans impacted by the rate increases, the state agency noted.  

The recent COVID-19 surge irony reflected a lower cost utilization due to COVID-19. The average medical-loss ratio, which represents the portion of premiums spent on medical claims and quality improvement, was 70% in recent years years. That said, in an anticipation of spikes in claims submissions + overall inflation, a larger than average increase is needed. This is in addition to increases in pricing by hospitals, consolidated IPA groups, and pharmaceuticals.

Rate Factors

The state noted that the premiums increase main drivers are medications.  “Rising medical costs and inflation continue to put upward pressure on premiums,” said Superintendent Harris. “With our rate actions announced today, we continue to prioritize the financial wellbeing of consumers while ensuring that New Yorkers have access to a robust, stable health insurance market.”  Also, DFS, recognizing the continued uncertainty of the pandemic’s effect on consumers’ health care costs and the economy, held insurers’ profit provisions to a historically low 0.5%. 

Health Insurers

Oxford/Unitedhealthcare, notably, got only a 6% rate increase approval for next year. This is a sharp reduction from the original 16.8% request in part by disagreed anticipated costs, held reserves, overall market pricing, and reinsurance gained from ACA’s Risk Corridor.  See more info here, https://medicalsolutionscorp.com/risk-adjustment-reinsurance-and-risk-corridors/.

Small Group Market   

Almost 850,000 New Yorkers are enrolled in small group plans, which cover employers with up to 100 employees. Insurers requested an average rate increase of 16.5% in the small group market, which DFS cut by 52% to 7.9% for 2023, saving small businesses $632.4 million. A number of small businesses also will be eligible for tax credits that may lower those premium costs even further, such as the Small Business Health Care Tax Credit.

DFS SMALL GROUP MARKET RATE ACTIONS   

NYS DFS Approval 2023 Health Insurance Rates

*Indicates the Company will offer products on NY State of Health Marketplace in 2023.

PEO Alternatives to Small Group

Before you consider renewing automatically, you should first find out what is a PEO so that you can know exactly what to expect from it. PEO’s are large-group markets underwritten.  With the right PEO, you will be able to manage your business’s demand for growth and your employees as well.

Clients on average save 15-40% off the small group market. If you are looking for a complete insurance solution for your business, go to our website and check out our business insurance solutions. Contact us for more information today.

Learn how a PEO can make a difference for your group. For more information on how Employer-Sponsored Insurance and a PEO can make difference for your small business please contact us at [email protected] or 855-667-4621.

 

 

 

 

Put You & Your Employees in Good Hands

Get In Touch

For more information on PEOs or a custiomized quote please submit your contact. We will be in touch ASAP. 

CareMount Medical Now on Empire Blue Access and Connection Networks

CareMount Medical Now on Empire Blue Access and Connection Networks

On September 1, 2022, Empire BlueCross BlueShield will begin partnering with CareMount Medical, the largest independent, multi-specialty group in New York State, to provide access to affordable care throughout New York City, Westchester, Putnam, Dutchess, Columbia, and Ulster counties.

CareMount will now be part of Empire’s Blue Access and Connection Networks for all Large Group and Small Group members. This will mean greater access to more affordable care throughout Westchester and surrounding markets.

Contact us to learn how Empire can fit your employee’s needs.  

Empire Strikes Back – 2022 Health Plans

Learn more about how we are successfully helping navigate SMB for 25+ years. If you have any questions or would like additional information, please contact us at 855-667-4621 or [email protected].

For information about transparency providers and new tech tools contact us at [email protected] or (855)667-4621.

Put You & Your Employees in Good Hands

Get In Touch

For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.