HR legislation
Health Care Reform: List of Preventive Services Without Cost-Sharing Released
Aug 9th
The Departments of Health and Human Services (HHS), Labor, and Treasury issued interim final regulations requiring new plans and issuers to cover certain preventive services without any cost-sharing requirements when delivered by network providers. Cost-sharing includes out-of-pocket costs like deductibles, co-payments and co-insurance. Employers should note that these required preventive services do not apply to grandfathered plans.
Under the new rules, services recommended by the U.S. Preventive Services Task Force (USPSTF) will generally be required to be provided without cost-sharing when delivered by an in-network provider in the plan years that begin on or after September 23, 2010 (except grandfathered plans). For recommendations that have been in effect for less than one year, plans and issuers will have one year from the effective date to comply. Thus, recommendations and guidelines issued prior to September 23, 2009 must be provided for plan years beginning on or after September 23, 2010.
Recommendations of the USPSTF appear in a released chart, which can be accessed by clicking here.
Preventive Services to Be Covered without Cost-Sharing
HHS reports that under the new rules, depending on age and plan type, individuals may have easier access to the following preventive services:
- Blood pressure, diabetes, and cholesterol tests
- Cancer screenings, including mammograms and colonoscopies
- Flu and pneumonia shots
- Routine vaccines ranging from routine childhood immunizations to periodic tetanus shots for adults, including diseases such as measles, polio, or meningitis
- Counseling from health care providers on such topics as quitting smoking, losing weight, eating better, treating depression, and reducing alcohol use
- Counseling, screening and vaccines for healthy pregnancies
- Regular well-baby and well-child visits, from birth to age 21
The interim final regulations also make clear that a plan or issuer is not required to provide coverage or waive cost-sharing requirements for any item or service that has ceased to be a recommended preventive service. For example, if a recommendation of the USPSTF is downgraded from a rating of A or B to a rating of C or D, or if a recommendation or guideline no longer includes a particular item or service, the service is not required to be provided without cost-sharing.
For more on preventive services under the Affordable Care Act, please click here, or view the chart of covered services by clicking here. You can also view a list of covered services for adults, women (including pregnancy) and children by clicking here. To view the interim final regulations, please click here.
To stay on top of HR industry news, trends and best practices, sign up for the Ascentis HR, Payroll and Benefits Newsletter today!
Preventive Services to Be Covered without Cost-Sharing
HHS reports that under the new rules, depending on age and plan type, individuals may have easier access to the following preventive services:
- Blood pressure, diabetes, and cholesterol tests
- Cancer screenings, including mammograms and colonoscopies
- Flu and pneumonia shots
- Routine vaccines ranging from routine childhood immunizations to periodic tetanus shots for adults, including diseases such as measles, polio, or meningitis
- Counseling from health care providers on such topics as quitting smoking, losing weight, eating better, treating depression, and reducing alcohol use
- Counseling, screening and vaccines for healthy pregnancies
- Regular well-baby and well-child visits, from birth to age 21
The interim final regulations also make clear that a plan or issuer is not required to provide coverage or waive cost-sharing requirements for any item or service that has ceased to be a recommended preventive service. For example, if a recommendation of the USPSTF is downgraded from a rating of A or B to a rating of C or D, or if a recommendation or guideline no longer includes a particular item or service, the service is not required to be provided without cost-sharing.
For more on preventive services under the Affordable Care Act, please click here, or view the chart of covered services by clicking here. You can also view a list of covered services for adults, women (including pregnancy) and children by clicking here. To view the interim final regulations, please click here.
To stay on top of HR industry news, trends and best practices, sign up for the Ascentis HR, Payroll and Benefits Newsletter today!
Electronic I-9s are a go!
Jul 23rd
The U.S. Department of Homeland Security (DHS) has issued a final rule confirming that employers and recruiters who are required to complete and retain the Form I–9, Employment Eligibility Verification, may sign this form electronically and retain this form in an electronic format. “E-Verify” is the electronic system facilitated DHS for this purpose. The final rule makes minor changes to an interim final rule announced in 2006.
Under the Immigration and Nationality Act, all U.S. employers, recruiters and certain other entities are required to verify the employment authorization and identity of all employees hired to work in the United States after Nov. 6, 1986. To comply with the law, an employer, or a recruiter or referrer for a fee, is responsible for the completion of a Form I–9, Employment Eligibility Verification (Form I–9), for each new employee, including United States citizens. The completed Form I–9 is not filed with the Department of Homeland Security (DHS). Rather, the Form I–9 is retained by the employer who must make it available for inspection upon a request by Immigration and Customs Enforcement (ICE) investigators or other authorized federal officials. Employers are required to retain a Form I–9 in their own files for three (3) years after the date of hire of the employee or one year after the date that employment is terminated, whichever is later.
In this final rule, DHS makes minor modifications to 8 CFR 274a.2 to clarify certain provisions that:
• Employers must complete a Form I–9 within three business (not calendar) days;
• Employers may use paper, electronic systems, or a combination of paper and electronic systems;
• Employers may change electronic storage systems as long as the systems meet the performance requirements of the regulations;
• Employers need not retain audit trails of each time a Form I–9 is electronically viewed, but only when the Form I–9 is created, completed, updated, modified, altered, or corrected; and
• Employers may provide or transmit a confirmation of a Form I–9 transaction, but are not required to do so unless the employee requests a copy.
To view the final rule in the Federal Register, please click here. For more on the federal E-Verify system, please click here.
COBRA Subsidy Widely Used by the Middle Class
Jul 8th
According to a recent Treasury Department survey, federal subsidies of health insurance premiums for the unemployed were widely used by the middle class during the recession. Many laid-off workers and their families maintained their health coverage as a result of the subsidy.
The American Recovery and Reinvestment Act of 2009 (ARRA) established a tax credit that paid 65 percent of the cost of health insurance premiums for eligible unemployed workers and their family members who maintained their health coverage through the federal COBRA continuing coverage program. Usually, individuals on COBRA coverage are required to pay up to 102% of the total cost of premiums. The Treasury Department estimates that for a typical family nationwide, the ARRA subsidy reduced the cost of COBRA from about $13,500 to $4,725.
The Treasury analysis is one of the earliest reports on the profile of unemployed individuals who obtained continuing health insurance coverage through the ARRA COBRA subsidy. The study surveyed more than 6,000 New Jersey workers receiving Unemployment Insurance in the fall and winter of 2009. The report found that between one-quarter and one-third of eligible unemployed workers enrolled in subsidized COBRA. In addition, roughly 15% of Unemployment Insurance beneficiaries received health insurance coverage through COBRA.
The report concludes that the subsidy appears to have been especially important for maintaining health coverage for middle-class families during the recession, and likely reduced the number of Americans who otherwise would have gone uninsured during the recession. A separate publication from the Treasury Department estimates that up to 2 million households were provided premium assistance in 2009, and over 300,000 claims were filed by employer tax reporting units through early 2010. The Treasury Department suggests that the availability of the program may have significantly slowed the growth of the uninsured population, which had been significantly increasing through Feb. 2009.
To view the Treasury Department report, please click here. To stay on top of HR industry news, trends and best practices, sign up for the Ascentis HR, Payroll and Benefits Newsletter today!
New Walking-Working Surfaces and Personal Protective Equipment Standards
May 25th
The U.S. Department of Labor’s Occupational Safety and Health Administration has proposed a rule to require improved worker protection from tripping, slipping and falling hazards on walking and working surfaces. A public hearing on the revised changes will be held after the public comment period.
The proposed rule describes revisions to the Walking-Working Surfaces and Personal Protective Equipment standards to help prevent an estimated annual 20 workplace fatalities and more than 3,500 injuries serious enough to cause people to miss work. According to OSHA, the current walking-working surfaces regulations allow employers to provide outdated and dangerous fall protection equipment such as lanyards and body belts that can result in workers suffering greater injury from falls. Construction and maritime workers already receive safer, more effective fall protection devices such as self-retracting lanyards and ladder safety and rope descent systems, which these proposed revisions would also require for general industry workers. The current walking-working surfaces standards also do not allow OSHA to fine employers who let workers climb certain ladders without fall protection. Under the revised standards, this restriction would be lifted in virtually all industries, allowing OSHA inspectors to fine employers that jeopardize their workers’ safety and lives by climbing these ladders without proper fall protection.
Comments on the proposed rule can be submitted through regulations.gov. To view the proposed rule in the Federal Register, please click here. To view the press release, please click here.
Small Businesses May Qualify for a Tax Credit in 2010
May 18th
Certain small businesses and tax-exempt organizations that provide health insurance coverage to their employees may qualify for a special tax credit in 2010, according to the Internal Revenue Service. Included in the recently enacted health care reform legislation, the Patient Protection and Affordable Care Act, is a tax credit designed to encourage small employers to offer health insurance coverage for the first time or maintain coverage they already have. The following are eligibility rules and the amount of credit as explained by the IRS.
ELIGIBILITY RULES
Providing Health Care Coverage
A qualifying employer must cover at least 50 percent of the cost of health care coverage for some of its workers based on the single rate.
Firm Size
A qualifying employer must have less than the equivalent of 25 full-time workers (for example, an employer with fewer than 50 half-time workers may be eligible).
Average Annual Wage
A qualifying employer must pay average annual wages below $50,000. Both taxable (for profit) and tax-exempt firms qualify.
AMOUNT OF CREDIT
Maximum Amount
The credit is worth up to 35 percent of a small business’ premium costs in 2010. On Jan. 1, 2014, this rate increases to 50 percent (35 percent for tax-exempt employers).
Phase-Out
The credit phases out gradually for firms with average wages between $25,000 and $50,000 and for firms with the equivalent of between 10 and 25 full-time workers.
Three Simple Steps for Employers to Qualify
If you are a small employer (business or tax-exempt) that provides health insurance coverage to your employees, determine if you may qualify for the Small Business Health Care Tax Credit by following the three simple steps featured here.
Frequently Asked Questions
The IRS has issued 22 FAQs for employers on the Small Business Health Care Tax Credit, including the following topics:
- Employer eligibility
- Claiming the credit
- Determining average annual wages
- Calculating expenses
- Tax-exempt organizations
- Relief in 2010
To view this detailed FAQ page from the IRS, please click here.
Examples
The IRS has also provided several employer scenarios for the credit, including numbers of workers, part-time employees and non-profit groups. To view the scenarios, please click here.
For additional information on the credit, please visit the IRS site here.
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The Affordable Care Act Will Require that Employers Fully Disclose Cost of Health Coverage
Apr 30th
Starting in 2011, employers will be required to disclose the entire cost of “employer-sponsored” coverage on the employee’s Form W-2. Regardless of who pays for the coverage, the combined cost of coverage is determined by rules similar to those used to determine the applicable premiums for purposes of the COBRA continuation coverage requirements of group health plans.
Employers are required to report the total value of all policies. Applicable coverage does not include coverage for a specified disease, long-term care, accidents or disability income insurance, nor does it include salary reduction contributions to a flexible spending account or contribution to an Archer medical savings account or a health savings account of the employee or a spouse.
This provision requires only the disclosure of all coverage costs as an aggregate, and does not require a breakdown of the individual types or policies of the coverages involved. For example, if an employee has an employer-sponsored medical plan, a dental plan and a vision plan, the employer should report only the total costs of these plans, and not the costs associated with each individual plan.
Click here to read Section 9002 of the Patient Protection and Health Care Affordability Act.
Click here to read the H.R. 4872 – Health Care and Education Affordability Reconciliation Act o f2010 LEGISLATIVE NOTICE
To read more about how new healthcare legislation will affect your business, subscribe to the Ascentis HR, Benefits & Payroll News.
Health Care Reform and Electronic Interface with Insurance Carriers
Apr 14th
By Les Goldstein, CEO, Ascentis
While there is currently a great deal of unknown concerning the recent health care legislation, we do know the following:
- We will all need to be flexible as we better understand the specific impact on individuals and corporations.
- The impact will occur over time as various aspects of the bill phase-in over a five year period.
- Companies that can more effectively communicate and administer their health care benefit programs will have an edge in the marketplace.
The last bullet is the one that most companies can deal with now, and along the way, accrue some pretty powerful advantages. These include the following:
- Employee self-service (ESS) capabilities allow employees to enroll in their benefits program through an easy-to-use, online interface. ESS can be deployed to employees through the Internet and can be accessed either from the office or at home. This ensures that employees have access to all plan information and are in a position to make their elections. ESS enhances morale by providing an easier enrollment process and, most importantly, eliminates the need to manage paper forms that tie HR personnel up with what is effectively an administrative task.
- An electronic insurance carrier interface allows the information received from employee self-service to be automatically transmitted to the insurance carrier in a format that can be easily received and processed by that carrier. This eliminates the need to take information that was entered by an employee and reduce it to paper before sending it to the insurance company. The elimination of manual handling and transcription errors makes this a very cost effective and efficient process.
In our collective desire to drive down health care costs, companies can take the above proactive approaches. In fact, inaccurate processes have caused businesses to inadvertently pay for health care coverage for employees that are no longer part of the company, as well as over-age dependents. It is estimated that these costs average about 8.5% of a company’s overall premium. This represents a major potential savings and this should be explored by all companies today.
One way to prevent over-charges is to automate reconciliation of carrier bills through a service such as Ascentis Carrier Connect. In conjunction with Ascentis Employee Self-Service, Carrier Connect supports a virtually paperless – and accurate – enrollment process, saving companies thousands of dollars.
How the Healthcare Bill Will Affect You
Apr 1st
By Andrew Keenan, VP of Sales and Marketing, Ascentis
We all know there has been a ton of posturing on both sides of the aisle over the new health care bill. But, how will it affect you personally? Below is an outline of the proposed changes in healthcare and a timeline of the proposed changes.
On March 21st, by a vote of 219-212, House Democrats voted through the Senate-passed bill (HR 3590) and also approved a budget reconciliation package (HR 4872) modifying the bill. Neither bill received a Republican yes vote. HR 3590 was signed into law on March 23rd by President Obama. Upon passage of HR 4872 by the Senate, and signature by the President, health care reform provisions will be finalized. If HR 4872 is amended in the Senate, then it will need to be sent back to the House to be voted on once again.
Timeline of certain provisions
90 days after enactment:
- Provides immediate access to high-risk pools for people who have no insurance because of preexisting conditions.
Six months after enactment:
- Bars insurers from denying or rescinding coverage due to sickness.
- Bars insurers from denying coverage to children who have preexisting conditions.
- Bars insurers from imposing lifetime caps on coverage.
- Requires insurers to allow young people to stay on their parents’ policies until age 26.
Within a year:
- Provides a $250 rebate to Medicare prescription drug plan beneficiaries whose initial benefits run out.
- Subsidies begin to aid small employers in providing health coverage to employees.
2011:
- Requires individual and small group market insurance plans to spend 80 percent of premium dollars on medical services. Large group plans would have to spend at least 85 percent.
2013:
- Increases the Medicare payroll tax by 0.9% and expands it to 3.8% on dividend, interest and other unearned income for singles earning more than $200,000 and joint filers making more than $250,000.
- State-based exchanges to be up & running.
- Provides subsidies for families earning up to 400 percent of the poverty level — or, under current guidelines, about $88,000 a year for a family of four — to purchase health insurance.
- Requires most employers to provide coverage or face penalties. Companies with more than 200 workers will be required to automatically enroll their employees in whatever insurance plan they offer. Companies with at least 50 workers are subject to fines if their workers end up receiving government subsidized coverage. The bill also contains tax breaks for small firms that provide employees with health insurance.
- Requires most people to obtain coverage or face penalties. People who elect not to get insurance will have to pay a penalty of $695 per year or 2.5% of income (phased in before 2016).
2018:
- Imposes a 40 percent excise tax on high-end insurance ($27,500 for family coverage).
Major Provisions of the Bill
- Coverage to an estimated 32 million uninsured Americans
- Expanding eligibility for Medicaid
- Increases Medicaid provider payment by 20%
- Implementation of an individual mandate requiring all citizens to purchase insurance
- Reducing and eliminating the Part D donut hole
- Reducing Medicare provider funding for both Medicare Advantage plans and provider payments
- Tax-free treatment of Medicare Part D drug subsidy will be eliminated
- Introduction of State based “Exchanges” that will allow individuals and small businesses to purchase insurance
- Employer “shared responsibility” requirement to provide affordable coverage to full-time employees
- Elimination of pre-existing condition exclusions
- Increasing dependent eligibility to age 26
- Federal subsidies to help low-income individuals afford coverage
- Small business tax credits
Provisions that will affect Employers
- Elimination of lifetime maximums
- Elimination of cost-sharing for preventive care
- Provide coverage for full-time employees or pay a penalty
- Pay an excise tax on high cost coverage exceeding $10,200 for singles and $27,500 for families.
- Maximum 90 day waiting period
- Increasing wellness incentives to 30% of premium
- W-2 reporting of health coverage beginning in 2011
- Access to a reinsurance pool for early retiree programs
- Insured plans can no longer discriminate in favor of highly-paid employees under insured plans
- Coverage of dependents to age 26
- Auto-enrollment of new hires for employers with 200 or more full-time equivalent employees
- $2,500 cap on FSA contributions
- Shared responsibility provision for both full and part-time employees
- Cost impact if employees receive income-based assistance for health insurance exchange coverage
- Free choice voucher for certain low income employees whose employers charge more than 8-9.8% of family income
Other Provisions
- Introduces a new HHS role in overseeing health plan rates
- Expands fraud and abuse programs for Medicare and Medicaid
- CLASS Act program is created which is a voluntary, payroll deduction funded long-term care program
Financing
- Industry fees on insurers, pharmaceutical companies and manufacturers
- High risk tax on tanning salons
- Increased Medicare taxes for high earners by .9%
- New taxes on dividend, interest, rental, royalty, capital gains for individuals with incomes over $200,000
- Reducing Federal payments allocated to Medicare Advantage plans and Medicare provider payments
- Penalties on employers who do not offer affordable coverage
- Penalties for individuals who do not elect coverage
- Excise tax on “high cost” coverage
- Elimination of tax-free treatment of Medicare Part D drug subsidy
This information was generously provided by AH&T Insurance, Seattle, Washington.
Model Employer Children’s Health Insurance Program Notice
Feb 12th
On February 4, 2009, President Obama signed the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009. CHIPRA includes a requirement that the Departments of Labor and Health and Human Services develop a model notice for employers to use to inform employees of potential opportunities currently available in the State in which the employee resides for group health plan premium assistance under Medicaid and the Children’s Health Insurance Program (CHIP). The Department of Labor was required to provide the model notice to employers within one year of CHIPRA’s enactment.
Through a notice in the February 4, 2010 FEDERAL REGISTER, the Department’s Employee Benefits Security Administration (EBSA) announces the availability of the Model Employer CHIP Notice. The notice provides the “form and content of notice” as well as the “timing and delivery of the notice” while outlining the requirements for addition of state-specific information.
To quickly generate and send this (or any future) notices to your employees, use the Employee Correspondence Wizard (ECW) in Ascentis HR. Create your notice or use the template provided by the Department of Labor here for the Model Employer CHIP notice. Once your notice has been built, open ECW from Employee Manager and create a new correspondence batch. By walking through the ECW you can print or email the notice to all employees you select. Lastly, select to attach the notice to each employee’s record through the ECW as a note. Now your work with this notice is done!
For detailed instructions on using the ECW see the “Employee Correspondence Wizard” section of the Help documentation included in Ascentis HR.
