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New NRHA Health Care Program Offers Affordable Options

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Here’s a recent article published in the Hardware Retailing Magazine that features a combined effort with Custom Benefits Insurance Group Inc and North American Retail Hardware Association (NRHA)!  For the full article please visit: www.hardwareretailingarchive.com/i/144798 (pg. 62)

About the NRHA Health Care Program
NRHA has teamed up with insurance agency Custom Benefits Insurance Group, Inc. to offer a source for affordable health care coverage. In its simplest form, the program offers participants increased purchasing power to obtain better choices of high-quality healthcare coverage at lower costs. Costs are lowered because small businesses can pool their risk.
The NRHA Health Care Program offers little additional administrative work; all the support tools often associated with fully insured carriers such as Capital, HighMark and HealthAmerica; built-in incentives to encourage healthy behavior by plan members; and a focus on “avoidable” claim conditions to reduce unnecessary treatment costs using wellness and risk management tools.
“Next year is such a huge year for small businesses in regards to health insurance coverage,” says Bob Chiesa, president of Custom Benefits Insurance Group. “I am concerned businesses are going to get caught off-guard and have to deal with the ramifications of not preparing. I think this program offers solutions on so many levels.”
Custom Benefits Insurance Group has extensive experience in the insurance industry and features a portfolio of clients spanning the country, including companies with as many as several thousand employees to as few as two.

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Navigate Health Care Reform

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Here’s Your Opportunity to Navigate Health Care Reform at the National Hardware Show! Attend Industry Expert Bob Chiesa’s Presentation at the NRHA Village Stage on Tuesday, May 6th! 

As you plan your time at the National Hardware Show®, you won’t want to miss out on the opportunity to learn about the latest details and changes to the Affordable Care Act presented by Bob Chiesa, President of Custom Benefits Insurance Group.

The presentation will include a thorough analysis of the challenges employers are facing as a result of the affordable Care Act (ACA) including new employer mandates, taxes and fees. The recent change of requirements for employees will be discussed in detail as will three key solutions to help employers offset some of the impact of the
ACA. Included in this presentation are details of the NRHA Health Care Program

You also won’t want to miss the Affordable Care Act Q&A breakout session held specifically for those who cannot attend the morning presentation or who are looking for more in-depth information on what the ACA means for you. During this 45-minute session, Bob Chiesa will address your questions and discuss health care reform concerns from an objective point of view.

Don’t forget:  Reserve a place for both of these great presentations on your Tuesday, May 6th National Hardware Show® itinerary! For the presentation, visit the Village Stage from 11 – 11:45a.m. and the Breakout Session in Room N224 from 1 – 1:45p.m.  

For more information before the National Hardware Show®,contact Bob Chiesa, Custom Benefits Insurance Group, Inc. at: 888-201-7408 or cbigi@msn.com.

What Happens When Employees Decline Your Coverage?

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This article is from Blue Cross BlueShield – Anthem’s Blog

Beginning in 2016, employers who have 50 or more full-time or full-time-equivalent employees are required to offer health insurance to their full-time employees under the Affordable Care Act. Employees, however, do not have to accept the insurance, and inevitably, some will turn it down. The consequences for a business if an employee declines the employer-sponsored coverage depend on the nature of the health insurance offered and what employees do instead.

Plan Coverage Requirements

The Affordable Care Act requires health plans to cover at least 60 percent of the cost of services on average in order to qualify as minimum coverage (also known as the Bronze plan), according to Kaiser Family Foundation. In addition, coverage needs to be affordable, meaning that employee contributions are limited to 9.5 percent or less of household income, and plans must be offered to at least 95 percent of full-time employees. Employers whose plans pass these requirements will not be subject to penalties, even if their employees turn down health insurance from the company.

What Situations Do Not Trigger Penalties?

Regardless of your plan type, some scenarios will never trigger penalties. If you have employees who join their spouses’ plans, you will not be penalized. It’s also not a problem if you have employees who are Medicare-eligible and who choose to decline employer coverage in favor of Medicare. You may have chosen to offer insurance benefits to part-time employees as well as full-timers, but there is no penalty if part-timers turn down coverage.

If your plan is affordable and meets minimum essential coverage requirements, you will not be penalized if your employees decline your coverage and choose to buy insurance through the marketplace. If they have been offered affordable, minimum essential coverage, your employees will not qualify for government subsidies, although they may choose coverage through the marketplace for their own reasons. As long as insurance is offered to at least 95 percent of your full-time employees, you will not face penalties if some choose not to accept it.

What Causes a Company to Incur a Penalty?

The real difficulties arise if your company doesn’t offer minimum essential coverage and full-time employees end up qualifying for government subsidies when seeking coverage at federal or state health insurance marketplaces (sometimes called “exchanges”). Starting in 2016, businesses with at least 50 full-time employees will be subject to penalties if even one of their employees receives a subsidy, according to the IRS.

Employers that offer high-quality, affordable coverage to essentially all of their full-time employees can be confident that they will not face penalties, even if some employees decide not to participate in the plan. Organizations with less generous health coverage offerings, however, will incur ACA-mandated penalties from the government if employees seek coverage at federal or state exchanges.

This content is provided solely for informational purposes. It is not intended as and does not constitute legal advice. The information contained herein should not be relied upon or used as a substitute for consultation with legal, accounting, tax and/or other professional advisers.

Source: This article is from Blue Cross BlueShield – Anthem’s Blog By David E. Williams | September 25, 2014

Complete Article: Making Health Care Reform Work Blog

Shopping for Health Care Coverage?

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This article is from Blue Cross BlueShield – Anthem’s Blog

Americans are natural shoppers. We like to find the best deal on pretty much everything we buy — except our health care coverage. When it comes to health care, people don’t really think about looking for a good deal, and this can be costly for your company and your employees. To help keep costs under control, there are a few effective shopping tips that you can share with employees.slideshow_image_1

Use Online Shopping Tools

The Internet has made finding deals on health care coverage much easier. FAIR Health and Healthcare Bluebook list the average prices of medical services and procedures. Whenever your employees need treatment, recommend that they double-check the price with these websites to make sure they’re being treated fairly. Your health insurance provider may offer additional tools that show the price based on the discount they have negotiated with a specific doctor or hospital. Those tools may require employees to log in on the insurance copmany’s website to get the information.

Ask for Lower-Cost Options

There are ways to get the same quality health care coverage at a lower cost. Generic prescription drugs are one popular strategy. Let your employees know that they should always ask for generics when possible. Generics are exactly the same medicine but come at a fraction of the price, as detailed by the FDA.

Another useful tip is for when someone needs surgery: Your employees should ask if it’s possible to have the procedure at an outpatient facility so that it doesn’t require an overnight stay at the hospital. Once again, the results are the same, but this decision can save thousands.

Some employees may assume they should go to the emergency room if they have a medical need at night or over the weekend when their doctor’s office is closed. For certain medical needs, like a stomachache or a rash, it’s less expensive and often faster to get treatment at an urgent care center or retail health clinic.

Stay in the Network

Your health care plan will have a network of qualified providers. Most plans let your employees see out-of-network providers, but the costs will be higher. Often, people forget to check the network when their regular doctor refers them to see a specialist. Recommend that your employees double-check that the doctor is in-network before seeing a specialist so that they don’t get hit with an extra fee. If the specialist is out-of-network, the employees can ask to see an in-network specialist.

Complete Article: Making Health Care Reform Work Blog

Source: This article is from Blue Cross BlueShield – Anthem’s Blog By David Rodeck | April 8, 2015

How do I choose the right size group coverage?

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Group size has long been a factor in designing health insurance plans for businesses. The Affordable Care Act is making group size even more important. Whether your business is a small or large group affects your choice of health insurance plans for employees.

Here’s what you need to know about figuring out your group size, and what it means if you offer health insurance to your employees.

Small versus large: it’s 50/50

In 2014, if you have 50 or fewer full-time equivalent employees, your business is a small group. That means the health insurance plan you choose for your employees must meet the same standards as plans for individuals and families. This is required by the Affordable Care Act. All of our small group plans meet these requirements.

We consider your business a large group if you have 51 or more full-time equivalent employees. The Affordable Care Act has different requirements for large groups, and they can choose from a wider selection of plans.

What are full-time equivalent employees?

An employee who works an average of at least 30 hours a week is considered full-time. So if you have 53 employees working 40 hours every week, you have 53 full-time equivalent employees. That means your business is a large group.

It gets a little more complicated if you have part-time or seasonal employees. You can count them so that they add up to full-time equivalents. Here’s a simplified formula:

  1. Add the total hours worked in a month by all part-time employees.
  2. Divide by 120.
  3. The result is the number of full-time equivalent employees.

Knowing how many full-time equivalent employees you have is important. They determine your status as a small or large group. You should get legal advice if you’re not sure how to figure this out.

Source: Blue Cross Blue Shield of Michigan

Complete Article – 

Defining Group Size

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In preparation for the 2016 Affordable Care Act (ACA) regulations, HAP is reviewing our groups that are currently considered “large,” but may be considered “small” in 2016. Group size will be determined by eligible employees. Employers with 1-100 eligible employees will be considered a small group in 2016; employers with 101+ eligible employees will be considered a large group in 2016.

How many eligible employees do you have?

Eligible employees include full-time employees (those who receive a W-2 form) who are employed, on average, at least 30 hours of service per week, plus full-time equivalent employees (FTEs).Group Insurance

To calculate the number of eligible employees, you need to first separate your full-time employees from all others. All of the “other” employees need to be calculated as full-time equivalent employees, as follows:

  1. Add all of the hours for the non-full-time employees for the month and divide the total number of those hours by 120. This gives the number of FTEs.
  2. Then add the number of FTEs to the total number of existing full-time employees to determine how many eligible employees there are.

For example:

ABC Company has 60 full-time employees (employed 30 or more hours per week on average). They have 20 employees employed an average of 15 hours per week.

20 employees x 15 hours per week x 4 weeks = 1200 total monthly hours worked by part-time employees

1200/120 = 10 full-time equivalent employees

60 full-time employees + 10 full-time equivalent employees = 70 eligible employees

At a very high-level, some of the ACA requirements for small groups and large groups include:

Small groups (1-100 in 2016)

If offering group health care coverage, the group must purchase a Qualified Health Plan (QHP). QHPs are ACAcompliant plans that cover Essential Health Benefits and follow established limits on cost-sharing. All QHPs are grouped in different metal levels – Platinum, Gold, Silver and Bronze – based on actuarial value, or the percentage of health care costs the plan covers. Premium prices are determined using per member/per month rating, the zip code of the business, and age rating ratio no greater than 3 to 1. These factors do not include health status, gender or industry type. This will be effective with the group’s 2016 renewal date.

Large groups (101+ in 2016)

In 2016, the employer must offer affordable health insurance coverage to at least 95 percent (currently 70 percent) of its full-time workers and their children and pay for at least 60 percent of the coverage. If not, the employer will be subject to taxes (Employer Shared Responsibility Payment).

External References:

The above information is for general guidance only. HAP recommends that you consult with your insurance agent and/or tax advisor to help understand the ACA regulations as they relate to employer group size.

Source: HAP – HAP.ORG

Women’s dental care during pregnancy suffers

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Cigna study finds majority of pregnant women suffer oral health problems, but 43% don’t get dental checkups
Preventive dental checkups are important throughout one’s life, and, arguably, even more essential during pregnancy. All infections in the mother, including tooth decay and gum disease, may pose a risk to the baby’s health as well. However, Cigna released a national survey finding that 43% of women don’t go for a dental checkup while expecting even though 76% admit to suffering from oral health problems during pregnancy, such as bleeding gums or toothaches.

Hormonal changes during pregnancy can worsen certain oral health conditions such as gingivitis and more serious gum disease. The survey found that only 55% of women rate their oral health as very good or excellent during pregnancy, a drop from 63% pre-pregnancy. Without a checkup, women might not even be aware of problems beginning to affect their teeth and gums. More than a third (36%) of expectant mothers admit that it has been more than a year since their last preventive dental visit. Cost is the primary reason why pregnant women say they skip dental checkups, even among those with dental benefits.
“Dental checkups are so important that most dental benefit plans cover preventive care visits every six months with no or low out-of-pocket costs. Some dental benefit plans even have special maternity programs with additional services like extra cleanings or discounts on oral health prescriptions,” said Dr. Miles Hall, Cigna’s chief clinical dental director and licensed dentist.

Find an executive summary of the survey results here

Source: Cigna

‘Cadillac Tax’ Delayed for Two Years

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Today, Congress passed a two-year delay of the 40 percent excise tax on high-cost employer-sponsored health plans, also known as the “Cadillac Tax.” This delay was part of a year-end tax extender and government funding package, the Consolidated Appropriations Act, 2016, known as the “Omnibus.” President Obama is expected to sign these changes into law.

The Omnibus includes several key changes pertaining to the Affordable Care Act:
Excise Tax
Implementation of the 40 percent excise tax is delayed from 2018 to 2020. While the tax was originally non-tax deductible, the Omnibus changes that treatment and makes the tax deductible.
The 40 percent excise tax applies to the cost of employer health plan coverage exceeding certain threshold amounts, which were originally set for 2018 at $10,200 for individuals or $27,500 for families. These thresholds are indexed and will be higher on the delayed effective date in 2020. The Omnibus also calls for a study on how to determine adjustments to these thresholds to reflect age and gender differences between businesses.
Many employers, unions, insurers and industry groups have opposed the tax based on concerns around administrative and financial burdens for employers and adverse outcomes for employees.
The delay allows the government additional time to propose regulations. It also provides opportunity for stakeholders to provide comments, as well as prepare their long-term health benefits strategies.
Health Insurance Industry Fee (a.k.a. Health Insurer Tax)
The Omnibus also suspends the Health Insurance Industry Fee for 2017. This fee began in 2014 and only impacts insured health plans.
We encourage you to bookmark Cigna’s health care reform website, http://www.informedonreform.com/, where we continuously update information as it becomes available.

Source: Cigna