Recently Published Articles
Our President, Dorothy Cociu, is a frequently published author of industry articles. She became the Editor of the COIN (County of Orange Insurance News) insurance industry publication beginning August, 2016. (Posted with permission)
Making Healthcare Great Again… A Look Into The Trump Administration’s Likely Plan for Healthcare Reform and It’s Stance on the ACAU By Dorothy Cociu, RHU, REBC, GBA, RPA, LPRT
Health Plan Documentation: What You and Your Clients Need to Know By Marilyn Monahan, Monahan Law Office
ACA Nondiscrimination Rules—What Our Clients/Employers Need to Know—And Do! By Dorothy M. Cociu, RHU, REBC, GBA. RPA
View full copies of COIN (posted with permission of OCAHU).
HIPAA Desk And Field Auditing Public Data
We have gathered public data from the HHS/OCR website to assist you in preparing for potential HIPAA Desk Audits or Field Audits. For all HIPAA public desk and field audit information, go to https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/audit/
- HIPAA Desk Auditee Guidance
- Sample – Interview and Document Request for HIPAA Security Onsite Investigations and Compliance Reviews
- HHS Desk Audit Webinar Powerpoint and Webinar Q&A
- Phase 2 Audit Opening Meeting Webinar
We will continue to post pertinent auditing information here for your assistance!
Patient-Centered Outcomes Research Institute Fee
On May 13, 2016, HHS released the final rule prohibiting discrimination based on race, color, national origin, sex, age, or disability; enhances language assistance for individuals with limited English proficiency; and protects individuals with disabilities under Section 1557.
Under the rule, individuals are protected from the discrimination in health care on the basis of race, color, national origin, age, disability, and sex, including discrimination based on pregnancy , gender identity and sex stereotyping.
For more information, including a Summary of the Rule, Fact Sheets on Key Provisions, and FAQ’s on the final rule, click here.
ACA’s PCOR Fee For Self-Funded Health Plans Due July 31, 2015
Patient-Centered Outcomes Research Institute Fee
The Affordable Care Act imposes a fee on issuers of specified health insurance policies and plan sponsors of applicable self-insured health plans to help fund the Patient-Centered Outcomes Research Institute. The fee, required to be reported only once a year on the second quarter Form 720 and paid by its due date, July 31, is based on the average number of lives covered under the policy or plan.
The fee applies to policy or plan years ending on or after Oct. 1, 2012, and before Oct. 1, 2019. The Patient-Centered Outcomes Research Institute fee is filed using Form 720, Quarterly Federal Excise Tax Return. Although Form 720 is a quarterly return, for PCORI, Form 720 is filed annually only, by July 31.
Please refer to the following chart for the filing due date and applicable rate depending upon the month a specified health insurance policy or an applicable self-insured health plan ends.
For complete information, you can visit the IRS website at:
IRS Releases “Cadillac Tax” Guidance on the 40% Excise Tax on High-Cost Employer Sponsored Health Coverage
ANTHEM CYBER ATTACK – DATA BREACH
It was brought to our attention on February 5, 2015, that Anthem, Inc., the parent company of Anthem Blue Cross, is the victim of a highly-sophisticated cyber attack. Anthem has informed their TPA’s. which have notified us, that its member data was accessed, and information about our clients could be among the data.
Our TPA’s are working closely with Anthem to better understand the impact on its members. They are in turn notifying brokers about the situation as it becomes available.
> Download Data Breach Notice
> Important update from Anthem – Feb 9, 2015
> Anthem Breach Update 2-9-15 Encryption & Credit Fraud Alerts
> Anthem Beach Broker ToolKit and Talking Points
> Mecury News – “Anthem Blue Cross hack: What you need to know about the health insurer’s personal information breach”
> Employee Memo on Breach
> Anthem Breach official website
Beware of Phishing Email Scams
From Anthem: Since this initial information was released, we have heard that email scams (known as “phishing”) have begun. The following information is to assist you in avoiding further damage. Members who may have been impacted by the cyber attack against Anthem should be aware of scam email campaigns targeting current and former members. These scams, designed to capture personal information (known as “phishing”) are designed to appear as if they are from Anthem and the emails include a “click here” link for credit monitoring. These emails are NOT from Anthem. If you or one of your family members should receive these emails:
- DO NOT click on any links in email.
- DO NOT reply to the email or reach out to the senders in any way.
- DO NOT supply any information on the website that may open, if you clicked on a link in email.
- DO NOT open any attachments that arrive with email.
Anthem is not calling members regarding the cyber attack and are not asking for credit card information or social security numbers over the phone.
This outreach is from scam artists who are trying to trick consumers into sharing personal data. There is no indication that the scam email campaigns are being conducted by those that committed the cyber attack, or that the information accessed in the attack is being used by the scammers.
Anthem will contact current and former members via mail delivered by the U.S. Postal Service about the cyber attack with specific information on how to enroll in credit monitoring. Affected members will receive free credit monitoring and ID protection services.
ACA Employer Reporting Draft Forms Released
In July, 2014, the IRS released the Draft Employer Reporting Forms for the Affordable Care Act. All Applicable Large Employers (ALE’s) with 50 or more employees will need to report detailed information on the employer, the employees, the health plans you offer, whether or not you meet Minimum Essential Coverage (MEC) and Affordability Requirements. Even mid-size employers (50-99) who may qualify for a delay of the Large Employer Mandate will need to report, in order to qualify for the employer large group health plan requirements under ACA. If you do not properly track your reportable information, you will NOT qualify for the one-year delay of having to offer health coverage to your employees (proper reporting allows you to put off offering coverage or paying penalties for one year, until 2016).
Note that the forms released are DRAFT forms. The final forms, nor the instructions, have been released at this time.
To download the ACA Employer Reporting Forms, click here.
ABC clients can learn more about the ACA’s requirements through our video presentations on the Affordable Care Act. Clients only. User name and password required. Click here if you’re a client and would like to review the employer training video.
On Monday, February 10, 2014, the Obama Administration announced a delay of the Employer Mandate, requiring that they offer health insurance to full-time employees under the Affordable Care Act (ACA) for large employers with 50-99 employees for one year (2016). According to the announcement, this delay has no impact on the employers with 100 or more employees; large employers with 100+ employees must comply with the large employer pay or play mandate by January 1, 2015. Small employers with less than 50 employees are not required to offer coverage. More information will be posted as it becomes available.
>> Download the Employer Shared Responsibility Fact Sheet 2-10-14 from the US Dept of Treasury.
ACA Employer Mandate for Employers with 50 or More Employees Reporting Requirements Delayed One Year
On July 2nd, Mark J. Mazur, Assistant Secretary for Tax Policy at the U.S. Department of Treasury announced in a blog post a one year delay in the mandatory employer and insurer reporting requirements under ACA. “We have heard concerns about the complexity of the requirements and the need for more time to implement them effectively. We recognize that the vast majority of businesses that will need to do this reporting already provide health insurance to their workers, and we want to make sure it is easy for others to do so. We have listened to your feedback. And we are taking action.”
The Department of Treasury released guidance on this delay in Notice 2013-45, which basically states (in summary):
- “Both the information reporting and the Employer Shared Responsibility Provisions will be fully effective for 2015.” – The notice does not specifically address transition relief that had already been allowed for 2014 for employers contributing to multiemployer plans, for those that do not yet fully offer dependent coverage, and for those who have off-calendar plan years, including whether or not that transition relief will be extended into 2015. However, the wording “fully effective” and the fact that the notice deliberately did not extend existing transition relief into 2014 is telling.
- “Proposed rules for the information reporting provisions are expected to be published this summer.” – The National Association of Health Underwriters (NAHU) has heard that these rules are expected LATE summer and is expecting this in September. Also, the Department of Treasury has indicated to NAHU that they plan to gather input from stakeholders regarding the details of the proposed rule before they are issued, including from NAHU and their coalition partners.
- “Once the information reporting rules have been issued, employers and other reporting entities are encouraged to voluntarily comply with the information reporting provisions for 2014.” “Real-world testing of reporting systems and plan designs through voluntary compliance for 2014 will contribute to a smoother transition to full implementation for 2015.” NAHU encouraged its members after the release of this Guidance to meet with their employer clients immediately on these changes and continue with good-faith compliance efforts regarding the employer shared responsibility requirements and reporting provisions during the coming year. This extra compliance time can be used to better help clients make sound business decisions regarding the requirements without the risk of significant financial penalties in the first year of changed operations.
- “Individuals will continue to be eligible for the premium tax credit by enrolling in a qualified health plan through the Affordable Insurance Exchanges (also called Health Insurance Marketplaces) if their household income is within a specified range and they are not eligible for other minimum essential coverage, including an eligible employer-sponsored plan that is affordable and provides minimum value.” While the exchange-based subsidies will be awarded based on self-reported and voluntarily collected data in 2014, the guidance does make it clear that if an individual has a valid offer of affordable and minimum value employer-sponsored coverage, they will technically not be qualified for exchange-based individual subsidies to begin on January 1, 2014. Individuals who receive a subsidy inappropriately may ultimately face personal tax consequences too. Therefore, education of employees and the information employers provide to their employees about the status of their existing employer-based coverage and whether or not it meets the definition of minimum value and/or minimum essential coverage via 2013-2014 SBCs and the exchange notices are critical.
- “This transition relief through 2014 for the information reporting and Employer Shared Responsibility Provisions has no effect on the effective date or application of other Affordable Care Act provisions.“ There are lots of provisions of the law that relate to the employer mandate requirements and reporting requirements, but aren’t contingent on them. Unless we hear otherwise through some type of other major announcement, those requirements and provisions of the law continue on unaffected. Provisions and requirements this guidance does not impact include, but are not limited to:
- The law’s health insurance market reforms that go into effect as of the first day of the plan year that begins in 2014. For example, these reforms include rating changes in the individual and small group markets, out-of-pocket limits for all markets, prohibitions on waiting periods of more than 90 days for all plans and many more.
- Individual mandate. The IRS will monitor compliance with the individual mandate through self-certification on each individual’s tax return.
- Health insurance exchanges. President Obama publicly affirmed on Monday that open enrollment is still expected to begin on October 1, 2013 for all state-based, partnership and federally facilitated marketplaces.
- The marketplace notice. Unless the administration issues an additional delay, all employers subject to the Fair Labor Standards Act (not just PPACA’s employer mandate provisions) are required to send a marketplace notice to all employees by October 1, 2013. Also, the plan affordability/minimum value information required to be provided in the notice is still required. Affordability/minimum value are not concepts limited to the employer mandate provisions of the law—they are concepts relevant to ANY employee (part-time, full-time, temporary, seasonal, etc) of ANY employer (regardless of size) who is eligible for employer sponsored coverage and who wishes to apply for a subsidy in the exchange.
- Summaries of Benefit and Coverage. Unless we receive additional guidance that indicates otherwise, the notices for the coming plan year must include information about whether or not a plan meet the minimum value or minimum essential coverage standards. These standards relate to the employer mandate provisions in the law, but they aren’t limited to it, and the SBC requirements are also unaffected by yesterday’s announcement.
- PCORI Fee. The first payment of this fee is due by July 31, 2013 for calendar year plans or a plans with year that ended in October or November of 2012. For fully-insured plans, the issuer will pay this fee, but for self-funded arrangements or plans that include both a full-insured and self-funded component, the payment responsibility lies with the employer.
- The transitional reinsurance fee and the new national health insurance premium tax. Both will be built into 2014 premiums. Other new taxes, like the medical device tax and pharmaceutical tax will also continue and impact coverage costs.
- W-2 Reporting requirements. These still apply for employers that issue more than 250 W2s.
- The limit on Health FSA salary reductions.
The California Department of Insurance (Dave Jones, Insurance Commissioner) released a press release shortly after the IRS blog post stating that employees of employers who do not provide health insurance will be able to purchase health insurance in California’s new health benefit exchange, and that many will be eligible for a premium subsidy.
For a copy of the IRS blog, click here.
For a copy of the Department of Insurance Press Release, click here.
For a copy of Notice 2013-45, click here.
NOW THAT THE SUPREME COURT HAS DECIDED THE FATE OF OBAMACARE, ADVANCED BENEFIT CONSULTING IS READY TO HELP YOU COMPLY!
THE ABC’S OF PPACA…
SBC ADMINISTRATION GUIDE
An affordable, simple 5 page guide that walks you through your employer administrative responsibilities for providing Summary of Benefits and Coverage (SBC’s) to your employees and beneficiaries.
ONLY $19.95 FOR A LIMITED TIME ONLY!
Discounts available for multiple orders/quantity.
|Click Here for Order Form|
Advanced Benefit Consulting can also help you create your SBC’s,
|Click Here for More Information, Pricing, and Request Form|
ACA Nondiscrimination Section 1557 Compliance
For Our Nondiscrimination statement for significant publications and signification communications that are small-size,
For our Tagline Informing Individuals With Limited English Proficiency of Language Assistance Services, Available in 15 Languages, Click Here
For our Nondiscrimination/Section 1557 Grievance Procedure, Click Here
Express Scripts Preferred Drug List
Effective January 1, 2015, those employer groups using Express Scripts for their Self-Funded Plans as their Pharmacy Benefit Manager (PBM), be advised that effective January 1, 2015, certain drugs will be excluded from coverage on the Preferred Drug List. They have provided a list of Preferred Drug Alternatives.
Affordable Care Act
NEW! Employers Beware- PPACA/Obamacare’s True Costs May Be Surprising
“The seminar gave me invaluable insight to the new PPACA rules and regulations.” – Bill Struett, VP Finance, Triangle Distributing Company
“The PPACA Binder that is provided is my “go to” source at all times on Health Care Reform questions that our clients (self-funded employers) ask.” – Mary Ann Wessel, Vice President, EBA&M Corporation
“Advanced Benefit Consulting is ahead of the game with PPACA training…Without this instruction, our company would have been headed toward confusion and penalties.” – Laura Robledo, Human Resources, Tri-West, LTD
>> Read more training workshop attendee testimonials.
Advanced Benefit Consulting is an employee benefit consulting firm and health insurance agency. We’ve been in business since 1985. Our goal is to take the employee benefit burden off of employers, allowing them to focus on their own businesses, but also allowing them to sleep well at night, knowing that they are taken care of regarding the myriad of compliance requirements (both state and federal) placed on employers. In this ever-changing world of Health Care Reform (PPACA), HIPAA, ARRA, COBRA, HITECH and more, we stand ready to assist you, and make your lives easier. We are committed to the best possible customer service…whether it’s a compliance question, a claims issue, or other…
On the agency side, we specialize in self-insured health plans but of course offer fully-insured plans and options. Our primary market is mid-size groups of 50 to 500 employees, but we also do smaller and larger groups. We offer all types of employee benefit programs, from self-insured medical, dental and/or vision, to fully insured medical, dental and vision, plus long-term and short-term disability, Section 125/Cafeteria Plans, Life Insurance, 401(k) plans, and more.
Consulting services are diverse and wide-spread. We are most well-known as HIPAA Privacy & Security Consultants, offering on-site implementation, a self-administration implementation manual with updates, and privacy training (both public and private). We offer a range of retail educational materials and services for employers and providers on HIPAA Privacy. We also do consulting, independent fiduciary and expert witness work on Self-Insurance, HIPAA Privacy, Security, Portability, ARRA and HITECH matters. Consulting services are done on an hourly or per-contract basis.
Groups of 100 or more covered employees are provided complimentary services such as HIPAA Privacy, Security, and HITECH consulting and implementation (IT services not included as complimentary but are available at discounted fees through our contracted HITECH IT Firm), and COBRA Administration. Groups of 50-99 may be eligible for most of these services, depending on premiums paid, etc. Ask us to evaluate your group to see if you qualify!
Health Care Reform
PPACA has changed the way we offer health care programs. SBC Preparation or SBC Administrative Guide, Grandfathered rules, Age 26 Dependents, Essential Benefit Determinations… It’s very complex, and mistakes can be costly. If you are a Grandfathered Plan, you must make certain you do not lose your status…. Count on us to assist you. As your employee benefit specialist team, we make it our responsibility to assist you with compliance. Tens of thousands of pages on PPACA and other regulatory matters exist or are pending and soon to be released… Let us help you… There is no need to be overwhelmed. Let us help to educate you and assist you overall with all phases of compliance.
Click Here For More Information
HIPAA Privacy, Security and HITECH
We are most well known for our knowledge and are an industry leader in HIPAA Privacy, Security and HITECH compliance. A nation-wide leader in this area, our team is ready to assist you with all phases of compliance for HIPAA Privacy, Security and HITECH. We offer on-site employer implementations, public and private privacy training, and a variety of retail products for easy self-administration and compliance, such as our employer manual, The ABC’s of HIPAA Compliance- An Employer’s Administrative Guide to HIPAA Compliance, video training (not available for Privacy Work Group Members – full-day training is available), posters and more… Let us guide you through the complexities of state and federal privacy laws for employers, as well as providers.
Click Here For More Information
Do you need privacy training? We offer public Privacy Work Group Training…. A full-day program for training your privacy officer and privacy work group. Can’t wait for our next public training? We are available to do on-site training as well for groups of 20 or more (smaller groups may also be trained but a flat fee will be charged).
Whether you’ve been self-insured for 20 years or a newcomer to this… We can help you. Our principals have over 40 years combined experience in self-insured health plans and can assist you in every component, from bidding excess coverages, to finding an administrator, to designing your plan, to writing your Plan Document and Summary Plan Descriptions, to helping you file your 5500’s. We are experts in the field of self-insurance, and we are ready to assist you!
Click Here For More Information
Employer Group Quoting
Are you looking for health coverage for your group, but also want a high level of expertise, and more than just a spreadsheet? We can assist you in all phases of quoting, for either self-insured or fully-insured plans… And not just quoting, but full implementation, compliance and the best customer service on the market…
Consulting Service and Expert Witness Services
Are you in need of a consultant or expert witness for employee benefit matters, such as self-insurance, HIPAA Privacy, Security and HITECH, or other areas mentioned in this website? Our President has years of experience as a consultant, independent fiduciary, and expert witness. One of her most known clients in the past was the United States Department of Labor!
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