Video Benefits Guy for Open Enrollment

ModernBenefitsConsumerBy Lori Legel, Senior Advisor, DBA Richmond

Open enrollment season is here! Now, more than ever, employers are looking for solutions to improve the employee communication process and experience, while still delivering valuable educational pieces to assist employees in making informed decisions. Video Benefits Guy is an online communication portal that can be used for both annual open enrollment and new hire onboarding.

Video Benefits Guy allows employers to develop and customize simple, yet consistent, messages about their benefits in a video format. Through this technology, employers can post messages to their employees, and create a customized experience using these videos. Employers also have the ability to find videos explaining the fundamentals of the benefits available to them and much more. The videos are fun to watch and the use of technology can help reduce the cost of materials, time and scheduling. The videos also provide clear and consistent messages to all employees regardless of their physical location.

Our extensive Video Benefits Guy library has educational videos explaining everything from insurance terms, to how employees can manage their healthcare costs, to the impact of the Affordable Care Act. The ability for employees to access these video, provides a great resource when introducing new benefits and solutions.

As an employer, if you –

  1. want to improve employee communication;
  2. save time for you and your employees, while still communicating a well understood and detailed benefits package;
  3. need to cater to your employees in various locations, as well as eliminate scheduling conflicts;

then the Video Benefits Guy can be the solution for your organization.  Please contact your benefits consultant for more information.

When It Comes to Health Carrier Mergers, Is Bigger Ultimately Better?


By Pete Gruenberg, Chief Operating Officer

As the January 1st, 2016 benefits renewal season and open enrollment process is in full swing for many employers, questions loom about the impact of the pending Aetna/Humana and Anthem/Cigna acquisitions, most predominately–is a bigger carrier really better? 

That’s the question CEOs from these carriers are currently defending in front of Congress and Justice Department officials who want to understand if these mergers will be a positive game-changer for employers and consumers or if they will limit competition and actually increase costs.

The review process will take months and stretch well past the current renewal season, leaving many wondering how it will all shake out. The range of outcomes will likely run the gamut from outright approval to divestiture in designated markets—to not approved—which is probably the most unlikely result. Overall, it’s not about any one deal, but how the approval of both transactions may adversely impact choice and affordability for the corporate and individual purchase of health insurance coverage. Let’s look at each deal and examine the implications of these consolidations and what the government may be most concerned about.

The Aetna/Humana deal at a high level combines Aetna’s strong nationwide employer-focused medical business with Humana’s large and very successful Medicare Advantage business. In the employer arena, there are some overlapping markets that may raise concerns from regulators and create a possible need for divestments, but our assumption is that the impact will not be significant. 

The Anthem/Cigna deal appears complementary in certain core areas, but has a couple of interesting dynamics. Anthem brings a real expertise in small group and individual exchange market presence. They provide significant national account capabilities in conjunction with their access to the nationwide Blue Card and all the Blue Cross Blue Shield (BCBS) plans across the country. Additionally, Cigna is a strong carrier in the mid-market and national account segments, with a compelling blend of medical plan funding options. Their expertise in group insurance and pharmacy benefit management are additional strengths. Like the Aetna/Humana deal, there may be added scrutiny in certain markets that regulators will examine very closely. 

The interesting twist facing Anthem/Cigna is not so much a regulatory issue, but more related to how the independent Blues organizations will respond to the ongoing access to the Blue Cross Blue Shield (BCBS) network in states where Anthem has no presence. Anthem is very dependent on these networks for multi-state employers. Cigna currently competes in many of the independent BCBS states, so the question remains, will they get the same access to the BCBS networks when they become part of Anthem? The assumption is no, but the merger will certainly test Anthem’s relationship with the BCBS Association. Anthem seems confident that there will be no disruption in their ongoing partnership with these independent BCBS organizations, but only time will determine the success of this aspect of the deal.

While the scrutiny of these mergers continues to unfold, carriers will increasingly be expected to answer the following questions:

  • Will medical premiums go down or rise more modestly in the future?
  • Will touted efficiencies and service levels improve the customer experience after the integration?
  • Will we see disruptions or expansion of choice in providers?
  • Will the carriers need to divest in certain markets where the consolidation will be deemed anti-competitive?

Stay tuned for these answers and more as we continue to monitor this rapidly changing area of the industry.

Small Businesses with HRA Plans Get Clarification

In June 2015, the IRS released draft forms for certain employers to use to meet their reporting obligations under the Affordable Care Act (ACA).  The instructions confirmed that employer-sponsored health reimbursement arrangements (HRAs) are subject to the ACA’s annual reporting requirements, regardless of employer size.  This was the first official guidance declaring that small employers with fully insured health plans indeed could have ACA reporting requirements.

The ACA includes annual IRS reporting requirements for health plans and applicable large employers (ALEs), i.e. those employers with 50 or more full-time and full-time equivalent employees.   A 2013 IRS notice clarifies that HRAs are considered health plans.  As such, they are responsible for complying with health plan requirements under the ACA.

Most understood that health insurance companies, employers with self-funded health plans and ALEs would need to report under Internal Revenue Code section 6055 or section 6056.  IRS released Notice 2015-68 clarifying reporting requirements for employer-sponsored HRA plans.  This came just in the nick of time for small employers who had begun to scramble after having learned they were suddenly subject to ACA reporting for their HRA plans, even though they were integrated with fully insured group health plans.

On September 17, 2015, IRS issued final reporting forms and instructions.  The revised instructions state that when an employer offers a minimum value health plan coupled with an HRA plan, only one of the plans needs to report.

The following chart explains the reporting requirements in light of the guidance in the final instructions: tableDI2

ICD-10 Medical Codes Changed on October 1- What Does This Mean?

Here are the answers to frequently asked questions.

What are ICD-10 codes?

ICD, or International Statistical Classification of Diseases and Related Health Problems, codes are the worldwide standard for tracking illness, injury and disease.  All health plans, medical facilities and physicians under Health Insurance Portability and Accountability Act (HIPAA) are required by federal mandate to use ICD-10 codes with dates of service of Oct. 1, 2015 or later.

Why the move from ICD-9 codes to ICD-10 codes?

The transition for medical providers and all insurance plan payers is a significant one since the 18,000 ICD-9 codes are to be replaced by 140,000 ICD-10 codes.  ICD-10 replaces ICD-9 and reflects advances in medicine and medical technology over the past 30 years. Doctors and hospitals use ICD codes to classify diseases, illnesses and injuries, and insurance companies use this information to process claims. The expanded code sets in ICD-10 allow for more detail in diagnosis and procedure codes.

Some of the codes appear strange, why are they needed?

Crazy ICD-10 codes have been published all over the internet like contact with a kitchen utensil, injury in an art gallery, crushed by an alligator, burn due to water-skis on fire, lips stuck to musical instrument, very low level of personal hygiene, struck by duck, walked into a lamp post, knitting accident, holiday exhaustion, etc.  The transition from the 1970’s based codes to today will provide health care givers and agencies like the Centers for Disease Control (CDC) more information on how to treat disease, what demographics are more likely to contract certain diseases, more specificity on illness and injuries like – which particular bone was broken, where someone was injured, how exposure to different outside factors may result in injury or illness, etc.  It is expected that this additional information will help to shape treatment protocols in the future, anticipate needed vaccines, and understand and communicate more specific prevention techniques

How does this affect me?  

The significant transition for medical providers and insurance companies could cause delays or errors in billing or claim payments, in the short term, as all affected businesses work to comply.  Watch your medical bills and explanations of benefits closely to make sure that information is represented correctly and you are receiving the right benefits.

New Reporting Requirements for Mid-to Large- Size Employers

New Reporting RequirementsAs the countdown to 2016 approaches, employers must begin to grapple with new annual reporting responsibilities related to the Affordable Care Act (ACA). In short, the IRS wants to know if, and what type of, health insurance, employers offered to full-time employees during 2015. The purpose is to determine whether employers and individuals owe the government money (i.e. whether penalties should be assessed) and who qualifies for tax credits.

There are two essential takeaways: 1) Now is the time to take action. 2)  It’s complicated…very complicated! While your benefits advisor can provide more details, here’s a look at some significant highlights for companies and organizations with 50 or more full-time and full-time equivalent employees.

1. Act Now

Don’t let filing deadlines mislead you into thinking you can delay taking action until next year. Proper compliance involves a lot of detailed prep work. In addition, while many companies plan to contract with third parties to manage the reporting process, some experts suspect these services may become inundated with business, and they are beginning to raise their prices.

Let’s take a look at key deadlines:

  • Feb. 1, 2016: Employee Statements are due. (Technically, the annual is Jan. 31, but in 2016 that day is a Sunday, so the regulations instruct employers to file on the next following Monday).
  • Feb. 29, 2016: IRS reporting is due for paper filings. (Again, the deadline is actually Feb. 28, which also falls on a Sunday next year).
  • March 31, 2016: IRS electronic reporting is due. (Employers issuing 250 or more individual statements must file electronically).

2. The Devil is in the Details

Proper compliance involves filling out the correct form with the appropriate information at the right time. There are different forms for Employee Statements and IRS reporting. Companies with 50 or more full-time and full-time equivalent employees have separate requirements than those with fewer such employees. Other variables include whether a company is self-insured, the type of insurance offered and eligibility of each employee during each month of 2015. For example, if a part-time employee with no benefits became a full time employee with health insurance and was then terminated with COBRA coverage, the information required to be reported for that individual would change at least twice during the year.

Corporate ownership issues also impact the process. Among the considerations that could affect the way a company files include whether it is part of a controlled group of companies.

In addition to full-time employees, employers must include information about the following employee classifications, which are all coded differently:

  • Retirees
  • Non-eligible employees
  • Variable hour employees in measurement period

Finally, an employer must be sure to design its plan offering and recordkeeping systems properly to be certain to be compliant with its ACA obligations, as well as to collect and report the correct data.  Employers need to be sure they have properly addressed applicable large employers (ALE) status, which classes of employees receive an offer of coverage, whether their plan designs are affordable and provide the required minimum value and other critical ACA concerns.  Once an employer has addressed these issues, it can focus on the right reporting solution.

3. Consider Utilizing a Third-Party Administrator

By now, the complexity involved in this type of reporting should be obvious. That’s why many companies are turning to external vendors for help. Frankly, the cost is usually fairly reasonable considering the value provided. Ask your benefits advisor for recommendations – some may have negotiated proprietary pricing for their clients.

The source typically most prepared to handle your ACA reporting requirements would be your existing payroll service provider. And, because of the need, new ACA reporting companies are being established. It is essential to ask questions to determine the scope of services provided – even with an established vendor. Among the factors to address with your representative:

  • Do your ACA reporting services include sending the required filing to the IRS and distributing forms directly to employees? If not, can this be an added service?
  • Do you already have all of the required information elements, or do we need to provide additional information?
  • Please confirm your organization takes responsibility to determine the proper codes to be included on the form. If not, what is the process to complete this?
  • What is the timing for you to file the information?
  • Are there additional costs for this service, and if so, please confirm the cost structure.
  • If our employees have questions regarding the forms, do you provide call center services so they can speak to a representative?

4. Be Aware of Compliance Penalties

Employers will face penalties of up to $250 per return and employee statement for failure to comply. There is an annual cap of $3 million for entities with gross receipts in excess of $5 million; or a $1 million annual cap for those with not more than $5 million in gross receipts.

There is some good news, however. The IRS will not impose penalties in 2016 if an employer files incomplete or incorrect forms, as long as it demonstrates a good faith effort to comply. However, this exception does not apply to untimely filings or employee statements. Also, if a third party administrator helps with filing, this does not relieve employers of related liabilities.

For more information about ACA reporting requirements, contact your benefits advisor.

5 Things That Matter Most

Employee benefits have become increasingly complex and costly for both employers and employees. Though benefits are still considered an important factor in recruiting and retaining the best employees, the task of managing benefits has become more difficult while costs continue to rise and regulations increase.  Employers want to spend more time managing their business, not benefits!

Ask an employer what matters most to them when it comes to benefits, and their concerns are almost always the same: Continue reading

Is Level-Funding in Your Future?

rxcareorg_healthcare_fullby Jeff Van Spankeren

  • ACA redefines small group to businesses with 51- 100 employees
  • Small businesses need alternatives to manage costs
  • Level funding offers best of fully and self-insured plans

New ACA Definition of Small Group Employer

Many small businesses are bracing for changes ahead. Beginning January 1, 2016, the Affordable Care Act (ACA) redefines “Small Group Employer” to include businesses with 51-100 employees. Up until now, small group was defined as business with 1- 50 full time or full-time equivalent employees. (Employers with 101+ employees will continue to be classified as “Large Group Employer”). What does this change mean for businesses in this group size? It could mean an increase in premiums and that new ACA provisions and regulations will apply. Both of which can negatively impact businesses’ bottom line and plan design choice.

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Check ACA Reporting Off Your “To-Do” List

iStock_filesBy:  Elvia Tito, Advisor 

The Affordable Care Act (ACA) created a number of federal reporting requirements for employers and health plans. However, many employer groups have put off addressing the legal responsibility of complying with the reporting requirements . . . and time is running out.

Do you know your reporting obligations?  Does your team have the administrative support it needs to create and file the necessary reports?  We can help you assess your needs and comply with the regulations.

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A Daily Habit With a Huge Impact

daily-habitsoriginally published by Business Insider

Snuggling up next to your kids to read them a bedtime story isn’t just helping you bond with your little one.

We’ve known for a while that reading to children is a great way to help kids learn how to read for themselves.

But recent research also suggests that storytime has other benefits as well. Here are four of the main reasons why reading to children — especially when you do it regularly — could be crucial:

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