Among the issues the new set of FAQs address are the following:
•    In addition to the previously provided safe harbors, SBCs may be provided electronically in connection with online enrollment or renewal and to participants and beneficiaries who request the SBC online, as long as individuals have the option to receive a paper copy.  In addition, the electronic SBC can include some electronic features such as scrolling and expansion of columns and the SBC can be displayed on a single webpage.

•    For applicants in the individual market or for group health plan/sponsors, the SBC must be provided no later than seven business days after receiving a “substantially complete” application.  When coverage terms are under negotiation after an application was filed and the SBC information changes, the revised SBC need only be provided again on the first day of coverage.

•    SBC must be provided upon request to group health plan or sponsor shopping for coverage.

•    Combining SBCs or SBC elements to allow comparison may be done, but the full SBC for all benefit packages still must be available as required by the final rules.

•    The Departments confirmed that during the first year of applicability, they “will not impose penalties on plans and issuers that are working diligently and in good faith to provide the required SBC content in an appearance that is consistent with the final regulations.
The departments also are developing calculators to use as safe harbors to complete coverage examples.  Written translations of the SBC template are available in Spanish, Chinese and Tagalog, and soon will be available in Navajo.

The full text of the FAQ can be found at:

http://www.dol.gov/ebsa/faqs/faq-aca9.html.

Conference sessions focused on the application of the fiduciary standard for both individual investors and plan sponsors, the investment selection process, ongoing regulatory changes, and other topics related to fiduciary best practices.

Attendees also had the opportunity to attend breakout sessions led by industry luminaries including Dave Gray, Vice President of Client Experience at Charles Schwab; Fred Reish, Partner at Drinker Biddle and Reath; and Ron Rhoades, JD, CFP, Program Chair for the Financial Planning Program at Alfred State College.

“As in past years, our event’s presenters succeeded in educating and inspiring attendees.  In addition to learning a range of practice management strategies, they were encouraged to incorporate fiduciary ethics in all facets of their professional activities,” said Blaine Aikin, CEO of fi360.

Mark and Nicole took advantage of the opportunity to speak directly with other investment advisors, providers and administrators to share ideas about fiduciary best practices including the new fee disclosure regulations that take effect July 1, 2012.

http://www.nahu.org/education/programs/webcasts.cfm?ibcToken=a0a490fb-9052-4c36-bd08-d7da54f8f2ef.

Just a couple of highlights (there were many):
•    Premium subsidies and cost-sharing reduction subsidies will only be available via the Individual coverage exchanges (low-income people who buy coverage via a SHOP exchange are not eligible for subsidies)

•    Low-income people who have access to “adequate” and “affordable” group coverage cannot leave the group plan and buy coverage via an exchange

•    Employers will be required to help verify coverage in virtually any situation:
o    Whether or not any employee purchases coverage through an exchange
o    If an employer doesn’t offer coverage at all
o    After an employee enrolls in an exchange (and likely every year thereafter)

•    The small-business tax credits currently available to any qualifying small employers will only be available after Jan. 1, 2014, to employers purchasing coverage through a SHOP exchange

•    If an individual state elects to allow “large” groups to access an exchange on Jan. 1, 2017, or thereafter, and even one large employer elects to participate, all of the SHOP exchange requirements will apply to every insured large group in that state.  Examples: modified community rating rules (no more experience rating for an employer’s large group plan), minimum benefit requirements, guarantee issue, etc.

•    Private exchanges are not subject to SHOP exchange rules

•    Many items that require further regulatory guidance are noted

Research suggests that regularly practicing yoga may:
•    Improve mood and sense of well-being
•    Counteract stress
•    Reduce heart rate and blood pressure
•    Increase lung capacity
•    Improve muscle relaxation
•    Help with anxiety, depression and insomnia
•    Improve overall physical fitness, strength and flexibility

To get started, find a teacher with whom you feel comfortable. Ask about the physical demands of the type of yoga in which you are interested. Check into the training and experience of the teacher you are considering. Try different yoga studios until you find one you like. Some studios offer the first class for free.

Minimal gear is required for yoga. Wear comfortable clothes that allow you to move around easily (no shoes or socks needed). Sit on a non-slippery surface such as the floor or a mat. Most studios provide mats. Once you’re a yoga enthusiast, you may want to buy your own mat to tote around.

Even if you exercise regularly, remember that yoga uses completely different poses and muscle groups. Start slowly. Begin with one weekly yoga session, and try to do a bit more each time.

Yoga is generally considered to be safe in healthy people. Keep in mind that yoga’s stretches and poses should be felt only within the muscle, not within the body joints. Extreme pain, tingling and numbness are all signals that you are overstretching. Immediately inhale, then exhale and slowly come out of the pose.

A User’s Guide to Tai Chi
Tai chi is an ancient Chinese mind-body practice that combines movement, breathing and meditation. To an observer, a tai chi practitioner looks as if he or she is moving in slow motion. Millions of people, young and old, use this gentle martial art to relax their minds, tone their bodies and bring balance to their lives. According to the 2007 National Health Interview Survey, an estimated 2.3 million U.S. adults had used tai chi in the past 12 months.

People practice tai chi for various health-related reasons, such as:
•    To increase energy
•    To improve strength, coordination and flexibility
•    To improve balance and decrease the risk of falls, especially in elderly people
•    To increase range of motion in arthritic joints
•    To reduce stress
•    To improve sleep
•    To boost immunity to the shingles virus
•    For overall wellness.

Plan to take a class — a live instructor can observe what you’re doing and guide you to develop proper technique. Instructional books, videos and apps may help. Keep in mind that learning tai chi from a video or book does not ensure that you are doing the movements correctly and safely. Although you can do tai chi in any type of clothing, loose-fitting garments and flat, comfortable shoes or sneakers are recommended for ease of movement. Some prefer to do tai chi barefoot.

Tai chi is a relatively safe practice. There are some cautions:
•    As with any exercise regimen, if you overdo practice, you may have sore muscles.
•    Tai chi instructors often recommend that you do not practice tai chi right after a meal, or when you are very tired, or if you have an active infection.

To read our entire wellness article and see a delicious recipe for Blueberry Smash click here.

Innovative was once again thrilled to be a part of the Annual Tri-State HRMA Conference held at the Westin Hotel in Mount Laurel last Thursday.  We enjoyed meeting all of the attendees while promoting our 2012 UBA Health Plan Benchmarking Survey.  For anyone that started the survey there, they were rewarded with a delicious cake pop!  Once the survey is completed online, the chance to win the New iPad is within reach!

Please visit our Health Plan Benchmarking under the Resource tab on our website to participate.  Thanks to all who organized such a great event – see you next year!

This process for valuing and reporting employer health coverage goes to the heart of the ACA’s individual and employer mandates.  It will also help target a tax credit designed to help low-income individuals pay premiums for health insurance purchased through a state-wide insurance exchange.

“Minimum Essential Coverage” Versus “Essential Health Benefits”
The “individual mandate” (the constitutionality of which is now under review by the U. S. Supreme Court) refers to the ACA requirement that most U.S. citizens either have “minimum essential coverage” or pay a penalty on their federal income tax return.  The emphasis here is on “minimum.”  This requirement may be satisfied through virtually any type of health coverage – individual or group, private or governmental, generous or stingy.

Minimum essential coverage should be contrasted with “essential health benefits,” another ACA-created term.  This refers to the type of comprehensive health coverage that must be offered by any insurer whose individual or small-group policy is sold through an exchange.  Essential health benefits must include at least a benchmark level of coverage for each of ten specific categories of benefits.  Notice 2012-31 makes clear that self-funded employer health plans (as well as insured plans maintained by larger employers) need not meet this higher standard.

New Employer Reporting Requirements
To help enforce the individual mandate, a new Section 6055 of the Tax Code will require all providers of minimum essential coverage to report to the IRS on the individuals who receive that coverage.  In Notice 2012-32 the IRS indicates that final regulations under Section 6055 will likely make a health insurer responsible for reporting minimum essential coverage under any insured employer health plan, relieving the sponsoring employer of that obligation.  In the case of a self-funded employer plan, however, this reporting obligation will fall on the employer.  The IRS anticipates that this Section 6055 reporting would be done on an employee’s Form W-2.

A separate reporting requirement will apply only to “large employers” (generally defined as those having 50 or more full-time employees).  Under Code Section 6056, a large employer must report the information needed to administer two other provisions of the ACA.  These are (1) a premium tax credit available to low-income individuals for the purchase of health insurance through an exchange, and (2) the “shared responsibility” penalty to be assessed against large employers that fail to offer health coverage meeting a “minimum value” standard, or that offer such coverage but charge a premium that is not “affordable.”  Notice 2012-33 solicits comments on this Section 6056 reporting requirement.

Importance of “Minimum Value” Determination
Under the ACA, an employer plan fails to provide “minimum value” if “the plan’s share of the total allowed costs of benefits provided under the plan is less than 60 percent of such costs.”  Citing a fall 2011 report by the Department of Health and Human Services (HHS), the IRS notes that approximately 98% of the individuals currently covered by employer-sponsored health plans receive coverage that meets this minimum value standard.

This minimum value determination is important to both employees and large employers.  An employee may not claim the premium tax credit for the purchase of health insurance through an exchange if the employee (or a family member) is eligible to enroll in an employer-sponsored health plan that meets this minimum value standard – unless the premium for that coverage is not “affordable” (a determination to be made on the basis of the employee’s household income).  This premium tax credit is also unavailable to any employee who is actually enrolled in an employer plan – even if that plan fails to provide minimum value or is not affordable.

If any full-time employee of a large employer receives this premium tax credit – either because the employer plan fails to provide minimum value or because it charges a premium that is not affordable – that employer may be assessed a “shared responsibility” penalty.  As explained in our May 2011 article, the formula used in calculating the amount of this penalty will depend on whether the “minimum value” standard has been met.  For this reason, large employers will need to value the coverage provided through their plans.

Proposed Valuation Methods

In Notice 2012-31, the IRS proposes the following three valuation methods:
•    MV Calculator.  HHS intends to develop a minimum value (MV) calculator that would allow sponsors of self-funded health plans to input a limited set of information on the benefits offered under a plan, including specified cost-sharing features such as deductibles, co-insurance, and out-of-pocket maximums.  The IRS expects that this information would be required for the following four “core” categories of benefits:  physician and mid-level practitioner care, hospital and emergency room services, pharmacy benefits, and laboratory and imaging services.  According to the fall 2011 HHS report, these four categories of benefits are the greatest contributors to a health plan’s value.

•    Safe-Harbor Checklists.  Rather than using the MV calculator, an employer whose plan provides benefits in all four of the core categories described above could rely on any of several “safe-harbor checklists” to be developed by HHS and the IRS.  Each such checklist would describe the cost-sharing attributes applicable to each of the four core categories of benefits.  An employer-sponsored plan would be treated as providing minimum value if its cost-sharing attributes are at least as generous as those shown in any of the safe-harbor checklists.

•    Actuarial Certification.  Plans with “nonstandard” features, such as quantitative limits on any of the core benefits (e.g., a limit on the number of physician visits or covered hospital days), could start by using the MV calculator and then have a certified actuary make the valuation adjustments needed to reflect the nonstandard features.  In certain cases, an employer would even have the option of engaging a certified actuary to make the entire calculation.

Under any of these three valuation methods, an employer could take into account any of its current-year contributions to an employee’s health savings account, or any amounts first made available during the year under a health reimbursement arrangement.  Doing so should make it easier for the employer’s comprehensive health plan to satisfy the minimum value standard.

Requests for Comments
All three of these Notices solicit comments.  Unfortunately, the deadline for submitting those comments is June 11, 2012.  This is likely to be before the Supreme Court has issued its ruling on the constitutionality of the individual mandate – and perhaps the entire ACA.

The maximum HSA contribution for an individual with self-only coverage under an HDHP will increase to $3,250 – up from $3,100 in 2012.  The maximum HSA contribution for an individual with family HDHP coverage will be $6,450 – up from $6,250 in 2012.  The “catch-up contribution” limit, for individuals who will attain age 55 by the end of the year, will remain at $1,000.

To qualify as an HDHP, a plan must specify a minimum annual deductible amount, with that amount based on whether the coverage is self-only or family.  Those deductibles have also been adjusted for inflation.  For self-only coverage, the annual deductible must be no less than $1,250 – up from $1,200 in 2012.  For family coverage, the annual deductible must be no less than $2,500 – up from $2,400 in 2012.

Finally, to qualify as an HDHP in 2013, the total annual out-of-pocket expenses (deductibles, copayments, and other amounts – but not premiums) may not exceed $6,250 for self-only coverage or $12,500 for family coverage.

Sponsors of HSA arrangements and/or HDHPs will want to incorporate these new dollar amounts into their 2013 open enrollment materials.

• The fees paid by insurers generally apply to any accident or health insurance policy issued with respect to U.S. residents.

• The fees paid by self-insured plan sponsors generally apply to plans established or maintained by an employer or employee organization (or by certain other entities, including VEBAs) that provide health or accident coverage, so long as any portion of that coverage is not provided through an insurance policy.  Policies and plans are not subject to the fees if they cover only excepted benefits.

• Also exempt are EAPs, disease-management programs, and wellness programs if they do not provide significant benefits in the nature of medical care or treatment.

• No exclusion is provided for retiree-only plans.

• Comment: Under the proposed regulations, plan sponsors of fully insured health plans are not responsible for the fees; only plan insurers are.

•    Definition of Self-Insured Plan Sponsor

• Controlled group rules do not apply to PCOR fees. Consequently, if a plan is maintained by more than one employer, each employer that maintains the plan will generally be responsible for filing and paying its portion of the fees.

• This result may be avoided if — before reporting and payment is due — an employer is designated in the plan document as sponsor, or designated as plan sponsor for purposes of the PCOR fee rules.

•    Multiple Self-Insured Arrangements

• If the same plan sponsor maintains more than one arrangement that provides self-insured accident or health coverage — e.g., if the sponsor maintains an HRA or health FSA in addition to major medical coverage — the arrangements can be treated as a single self-insured health plan if the arrangements have the same plan year.

• Comment: It seems unlikely that the minimal integration required in this context will be sufficient in other contexts, such as in connection with the exception to health care reform’s annual limit restrictions.

•    Average Number of Lives Covered:

• For self-insured plans, any one of three methods may be used to determine the average number of lives covered:

- an “actual count method” that takes into account the lives covered on each day during the plan year;
- a “snapshot method” based on the lives covered on one day during each quarter of the plan year (the snapshot method permits the number of lives covered by family coverage to be estimated by multiplying the number of participants by 2.35); or
- a “Form 5500 method” based on the number of participants as of the beginning and end of the plan year as reported on Form 5500 (under the Form 5500 method, the total number of lives is determined by simply adding the participant counts at the beginning and end of the year).

• Insurers cannot use the Form 5500 method, but they can use the actual count and snapshot methods as well as two other methods based on information reported to the NAIC or state regulators.

• For health FSA and HRA coverage that is not disregarded under the rule for multiple self-insured arrangements (or because it offers only excepted benefits), each participant can be treated as a single life, regardless of how many other individuals (e.g., spouse, dependents, and other beneficiaries) are actually covered.

•    Payment Process and Timing

• PCOR fees are to be reported and paid once a year, even though they are reported on IRS Form 720 (Quarterly Federal Excise Tax Return).

• Reports and payments for policy and plan years that end in a calendar year are generally due by July 31 of the following year.

• Comment: While the amount of the PCOR fee is, by itself, unlikely to drive plan design, it is one more factor to be taken into account. It may be most significant with respect to health FSAs and HRAs, since failing to adequately integrate one of these account-based plans with a sponsor’s self-insured major medical coverage (or to restrict the plan to excepted benefits) can result in effectively doubling the amount of the fee. (Note that integration with insured coverage will not lower total fees paid since the fee for insured coverage is paid by the insurer.)

The full text of the proposed regulation is available at http://www.gpo.gov/fdsys/pkg/FR-2012-04-17/pdf/2012-9173.pdf.

The Guidelines provide a general overview of the requirements, limitations, and exceptions of COBRA and the excise tax.  Notable highlights from the Guidelines include:

•    Some insight into the IRS’s approach to COBRA enforcement.  By way of example, the Guidelines provide that when an employer contends that an employee was ineligible for COBRA rights because he was terminated for “gross misconduct,” an auditor may consider whether the employee was granted unemployment compensation benefits, whether the employee grieved his termination under a collective bargaining agreement and the results of any proceedings related thereto, and in some circumstances witness accounts regarding the alleged gross misconduct.  If the employee was awarded unemployment compensation benefits and/or won an arbitration regarding his termination, the Guidelines note that the employer may have failed to comply with COBRA.

•   A  list of documents to be requested by an auditor during a COBRA audit.
•  A list of interview questions for an auditor to ask of the responsible parties in order to examine and address specific areas for noncompliance.

COBRA penalties and related damages may arise in two ways. First, potential notice-related penalties of up to $110 per day, per violation, that may be imposed by the federal courts under ERISA’s civil enforcement provisions, plus attorneys’ fees, and possible recovery by the complaining individual in the main enforcement action. Second, the employer or administrator may be subject to COBRA’s excise tax of $100 for each day that a violation continues.  These excise taxes may be substantial – and are effectively capped at $500,000 for employers and $2 million for third party administrators.

Employers and administrators should prepare now to structure their COBRA compliance practices and procedures to avoid getting bitten by COBRA’s civil penalties and/or excise tax.  In doing so, it is recommended that employers and administrators conduct self-audits, following the Guidelines, to rectify any potential mistakes or problems with their practices and procedures before the IRS selects them for an audit.

]]> http://blog.ibpllc.com/blog/revised-audit-guidelines/feed 0 http://blog.ibpllc.com/blog/healthy-supermarket-grab-and-go-meals http://blog.ibpllc.com/blog/healthy-supermarket-grab-and-go-meals#comments Thu, 05 Apr 2012 18:53:49 +0000 Terriann http://blog.ibpllc.com/?p=752 Long work hours and unfinished to-do lists often push our healthy eating habits to the back burner.  But being too busy doesn’t have to be your excuse for ordering a pizza or picking up dinner at the drive-thru window.  More and more, health-conscious consumers are relying on their supermarkets as a place to grab a freshly made, healthy meal.  Consumers’ increasing focus on eating fresh, healthy foods has presented a huge opportunity for supermarkets’ prepared foods programs.  Storeowners also recognize the economic challenges many shoppers are currently facing:  As gasoline and food prices climb, shoppers are looking for less expensive alternatives to restaurant takeout.

Consider these healthy options from your supermarket grab-and-go:

•    Rotisserie chicken that can be added to salads or shredded for burritos or chicken salad.
•    Go to the seafood counter and have them steam your shrimp, clams or lobster right there.  You’ll also find ready-to-cook kebabs and pre-seasoned fish steaks in the seafood case, as well as sushi.
•    Soup it up!  Made from scratch soups are also available to buy by the cup, pint or quart.  Broth-based soups with lots of vegetables are filling yet low in calories.
•    Pre-washed salad and slaw mixes make salad prep a breeze.  Butternut squash comes peeled and cubed, ready for steaming or roasting and broccoli comes without the tough stems.

There are also pitfalls that you should be careful to avoid:

•    Fried chicken, fried fish and anything fried should be avoided.  The calorie, fat and sodium levels are all likely to exceed healthy limits.
•    Pasta dishes, especially mac ‘n cheese, tend to be very high in calories.  And they’re rarely prepared with whole grain pastas.  If you’re hungry for pasta, choose a dish that’s made with a red sauce and lots of vegetables.  Be sure to watch portion size, too.
•    Expand your palate and explore some of the many ethnic dishes available in today’s deli case.  The foods often include healthy beans, lentils or veggies that don’t show up as often in mainstream American foods.
•    When purchasing prepared entrees, think about smaller portion size.  That leaves plenty of room on your plate for a big salad of mixed greens plus veggies, fruit and whole grain roll or rice pilaf.

]]> http://blog.ibpllc.com/blog/healthy-supermarket-grab-and-go-meals/feed 0