United Benefit Advisors Insight and Analysis Blog

The Rise of Four-Tier Drug Plans and Prescription Copays

Posted by: Carol Taylor    Mar 11, 2014 12:04:00 PM

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

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Topics: private insurance exchange, employee wellness, UBA 2013 Health Plan Survey, 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, HRA administration, pharmacy

Amazon-ize Benefits, Control “Leakage” and Heal “Over Insured Syndrome”

Posted by: Bill Olson    Mar 10, 2014 11:42:00 AM

If you are a mid-size employer (50-5,000 employees), you are likely considering a private exchange to affordably handle your benefits complexity (eligibility management, payroll deduction, billing and reconciliation, enrollment and claims issues, defined contribution automation, etc.) while reaping the benefits of cost certainty from a defined contribution model. Indeed, beyond the many advantages of private exchanges, they are particularly appealing to those who can’t afford high reliability organization (HRO), human resource information services (HRIS), Benefits Administration outsourcing and other similar services, since these services are all built in.  However, you may not know about three other advantages of private exchanges

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Topics: health insurance exchanges, private insurance exchange, health marketplace, health insurance premiums, employee wellness, 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, HRA administration

BREAKING NEWS - IRS, HHS RELEASE ADDITIONAL FINAL REGULATIONS

Posted by: Bill Olson    Mar 7, 2014 1:15:00 PM

On March 5, 2014, the Department of the Treasury and the Internal Revenue Service released the final employer-shared responsibility ("play or pay") reporting rules. The Patient Protection and Affordable Care Act (PPACA) requires reporting in support of the individual and employer-shared responsibility requirements and premium tax credit/subsidy eligibility, under Sections 6055 and 6056 of the Internal Revenue Code. Fully insured employers with fewer than 50 full-time or full-time equivalent employees generally will not need to report. Larger insured plans and all self-funded plans will need to file reports. The final rule will permit use of a single form to fulfill reporting obligations under both parts of the law.

On March 5, 2014, the Department of Health and Human Services (HHS) released a bulletin announcing that it will allow carriers to renew policies through October 1, 2016, that do not include all of PPACA's market reform requirements.  The extension is available for both individual and small group policies. The extension, which builds on an extension announced in November 2013 for 2014 renewals, is available only if permitted by the applicable state insurance department. Carriers would need to provide notices to policyholders advising the plan is not compliant with PPACA. All newly issued policies must meet all PPACA requirements.

HHS also released the final Notice of Benefit and Payment Parameters for 2015. This rule covers a variety of issues; of greatest interest are:
  • A confirmation that the transitional reinsurance fee for 2015 will be $44 per covered person
  • A confirmation that the fee will be collected in two parts, with the reinsurance contribution due early in the next calendar year and the treasury contribution due late in the fourth quarter of the next calendar year (so the 2014 fee will be due in January 2015 and fourth quarter 2015)
  • The maximum out-of-pocket (for all non-grandfathered plans) for 2015 will be $6,600 for single coverage and $13,200 for family coverage (this is less than originally projected)
  • The maximum deductible (for all non-grandfathered small group plans) for 2015 will be $2,050 for single coverage and $4,100 for family coverage (this is less than originally projected)
  • The maximum out-of-pocket for stand-alone pediatric dental essential health benefit coverage in the Marketplace for 2015 will be $350 for one covered child and $700 for two or more children
  • Open enrollment for the Marketplace for 2015 will be from November 15, 2014, through February 15, 2015 
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Topics: private insurance exchange, employee wellness, 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, HRA administration, UBA Benefit Opinions Survey

The Latest Information on Preventive Care: First Dollar Coverage, Frequency Guidelines

Posted by: Bill Olson    Mar 6, 2014 11:23:00 AM

On January 9, 2014, the Department of Health and Human Services (HHS), the Department of Labor (DOL) and the Department of the Treasury/IRS issued Frequently Asked Questions - Part XVIII. This document provides additional information about requirements in several areas. In the first of a three-part series, we will break down the details related to preventive care, out-of-pocket limits, and wellness programs.

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Topics: private insurance exchange, employee wellness, 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, HRA administration, UBA Benefit Opinions Survey

With Tectonic Shifts in Health Care, Employer Opinions Count Big-Time

Posted by: Bill Olson    Mar 4, 2014 1:04:00 PM

We’re asking some really interesting questions on the UBA Benefit Opinions Survey. Some of the answers (being compiled from what is shaping up to be the most comprehensive set of employers across all sizes, industries, and geography) are likely to surprise us all. Of particular interest, given the tectonic shifts in health care, the Benefit Opinions Survey is exploring the overall mindset related to an employer’s obligation to provide health care. What is your organizational attitude on the following statements:

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Topics: private insurance exchange, employee wellness, 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, HRA administration, UBA Benefit Opinions Survey

What “Play or Pay” Means in 2014

Posted by: Bill Olson    Jan 23, 2014 11:33:00 AM

As we inch closer to full implementation of the Patient Protection and Affordable Care Act (PPACA), the nation’s employers are facing a deadline about whether or not they will “play or pay,” with regard to offering employee benefits. Unfortunately, many still do not fully understand the options and various implications of their PPACA-related decisions.

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Topics: health insurance exchanges, ACA, private insurance exchange, employee wellness, PPACA, 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, HRA administration