United Benefit Advisors Insight and Analysis Blog

Top 5 Questions about Medicare Secondary Payer Rules

Posted by: Danielle Capilla    Apr 28, 2015 12:00:00 PM

Under federal regulations, Medicare is a secondary payer for many individuals who have an employer group health plan available to them, either as an employee or the dependent spouse or child of the employee. Generally the Medicare Secondary Payer rules prohibit employers with more than 20 employees from in any way incentivizing an active employee age 65 or older to elect Medicare instead of the group health plan, which includes offering a financial incentive. Although premium payment arrangement rules under the Patient Protection and Affordable Care Act (PPACA) provide a limited circumstance for reimbursing Medicare premiums, this option is not feasible for employers with more than 20 employees due to Medicare Secondary Payer rules.

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Topics: PPACA Affordable Care Act, Group health plans, Medicare, Medicare secondary payer

Group Health Plans That Do Not Cover Inpatient Hospital or Physician Services

Posted by: Linda Rowings    Nov 25, 2014 1:26:00 PM

Beginning in 2015, large employers must offer affordable, minimum value coverage to their full-time employees or potentially pay a penalty. Some companies have been marketing a plan that they state satisfies the minimum value requirement (an actuarial value of 60%), based upon a calculator provided by the Department of Health and Human Services (HHS), even though the plan does not cover inpatient hospital charges. In Notice 2014-69, HHS and the IRS state that plans that do not provide substantial coverage for physician and inpatient hospital services will not be considered minimum value plans, and that the result obtained through the HHS calculator should not be considered valid since that calculator was built on the assumption that a traditional plan design would be used. The agencies do recognize that some employers have already implemented these plans based on the calculator results, and the Notice states that a limited exception will be available to those employers. To be able to use the exception:

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Topics: Linda Rowings, 2015, In-Patient, Hospital, Physician, Group health plans

The Story Behind Minimal Changes in Plan Designs and Premium Rates

Posted by: Carol Taylor    Oct 29, 2014 9:00:00 AM

By Carol Taylor, Employee Benefit Advisor
D&S Agency, a UBA Partner Firm 

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Topics: health insurance exchanges, private insurance exchange, health marketplace, employee wellness, PPACA, retirement, small group employers, summary of benefits and coverage, SBC, benefit communication, benefit consultants, benefit management, compliance with health care reform, employee health, group health insurance, healthcare consumerism, health plan compliance, health reimbursement account, insurance solutions, medical plan, self funded health plans, Group health plans, small business, dependents, dependent insurance, family insurance benefits

Determining If Dental and Vision Plans Are “Excepted Benefits”

Posted by: Linda Rowings    Oct 16, 2014 9:00:00 AM

By Linda Rowings
Chief Compliance Officer, UBA 

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Topics: health insurance exchanges, private insurance exchange, health marketplace, employee wellness, PPACA, retirement, small group employers, benefit communication, benefit consultants, benefit management, compliance with health care reform, employee health, group health insurance, healthcare consumerism, health plan compliance, health reimbursement account, insurance solutions, medical plan, self funded health plans, Group health plans, small business, dependents, dependent insurance, family insurance benefits

Navigating Narrow or Focused Provider Networks (Part 2)

Posted by: Elizabeth Kay    Oct 14, 2014 3:04:00 PM

By Elizabeth Kay
Compliance and Retention Analyst
AEIS, a UBA Partner Firm

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Topics: health insurance exchanges, private insurance exchange, health marketplace, employee wellness, PPACA, retirement, small group employers, benefit communication, benefit consultants, benefit management, compliance with health care reform, employee health, group health insurance, healthcare consumerism, health plan compliance, health reimbursement account, insurance solutions, medical plan, self funded health plans, Group health plans, small business, dependents, dependent insurance, family insurance benefits

Skinny Plans and Minimum Value: Do these plans really pass the test?

Posted by: Carol Taylor    Oct 10, 2014 2:39:00 PM

By Carol Taylor, Employee Benefit Advisor
D&S Agency, A UBA Partner Firm

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Topics: health insurance exchanges, private insurance exchange, health marketplace, employee wellness, PPACA, retirement, small group employers, summary of benefits and coverage, SBC, benefit communication, benefit consultants, benefit management, compliance with health care reform, employee health, group health insurance, healthcare consumerism, health plan compliance, health reimbursement account, insurance solutions, medical plan, self funded health plans, Group health plans, small business, dependents, dependent insurance, family insurance benefits

What to Include in an SBC

Posted by: Linda Rowings    Sep 10, 2014 3:12:00 PM

A Summary of Benefits and Coverage (SBC) must contain:

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Topics: health insurance exchanges, private insurance exchange, health marketplace, employee wellness, PPACA, retirement, small group employers, summary of benefits and coverage, SBC, benefit communication, benefit consultants, benefit management, compliance with health care reform, employee health, group health insurance, healthcare consumerism, health plan compliance, health reimbursement account, insurance solutions, medical plan, self funded health plans, Group health plans, small business, dependents, dependent insurance, family insurance benefits

Religious Objections to Covering Contraceptives

Posted by: Linda Rowings    Sep 5, 2014 3:06:00 PM

On August 22, 2014, the Departments of Health and Human Services (HHS), Labor, and Treasury released an interim final rule and a proposed rule that provide some new accommodations to employers that have religious objections to covering contraception under their group health plans. The agencies also released a fact sheet on the rules and an alternate form that religious organizations (like religious hospitals, universities and charities) may use.

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Topics: health insurance exchanges, private insurance exchange, health marketplace, employee wellness, PPACA, retirement, small group employers, religious objections, contraception, religious opposition to contraception, benefit communication, benefit consultants, benefit management, compliance with health care reform, employee health, group health insurance, healthcare consumerism, health plan compliance, health reimbursement account, insurance solutions, medical plan, self funded health plans, Group health plans, small business, dependents, dependent insurance, family insurance benefits

Highlights of the SBC Requirement

Posted by: Linda Rowings    Aug 28, 2014 3:43:00 PM

With Fall open enrollment around the corner, most employers will need to provide a Summary of Benefits and Coverage (SBC) to eligible individuals. Here are some highlights of the requirement (as of August 2014):

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Topics: health insurance exchanges, private insurance exchange, health marketplace, employee wellness, PPACA, retirement, small group employers, benefit communication, benefit consultants, benefit management, compliance with health care reform, employee health, group health insurance, healthcare consumerism, health plan compliance, health reimbursement account, insurance solutions, medical plan, self funded health plans, Group health plans, small business, dependents, dependent insurance, family insurance benefits

Dependent Eligibility: Top Three Reasons Why You Shouldn’t Audit

Posted by: Bill Olson    Aug 26, 2014 11:02:00 AM

Recently, UBA Partner Mike Humphrey, Senior Benefits Advisor at The Wilson Agency, shared some great insights for those who are considering doing a dependent audit.  He points out three reasons why you shouldn’t do these audits and offers a much better approach to reining in costs associated with covering dependents that should no longer be on your plan.  Humphrey’s long tenure counseling large employers shows once again that sometimes quick-fix solutions for eliminating wasteful spending aren’t worth it in the end, no matter how well intended. Instead, simple changes to the up front enrollment process can avoid a lot of headaches and keep costs in line.

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Topics: health insurance exchanges, private insurance exchange, health marketplace, employee wellness, PPACA, retirement, small group employers, benefit communication, benefit consultants, benefit management, compliance with health care reform, employee health, group health insurance, healthcare consumerism, health plan compliance, health reimbursement account, insurance solutions, medical plan, self funded health plans, Group health plans, small business, dependents, dependent insurance, family insurance benefits