On Thursday April 11, 2013 Innovative attended the Go Red for Women Lunch Event at Lucien’s Manor in Berlin, New Jersey. Today, heart disease is STILL the #1 killer of women, causing 1 in 3 deaths each year. But it can be prevented. Knowledge of the risk factors for heart disease and also the symptoms of a heart attack, which is different for women than for men, can help save your life or the life of someone you love. Tamala Edwards from 6ABC Action News served as the keynote speaker of this event that included breakout sessions with health and fitness experts and medical professionals. Attendees learned the concrete steps that women can take today for better heart health. The event was full of information and inspiration. Do you know your risk factors for heart disease?
Innovative Is Proud To Support the Seventh Annual American Heart Association Go Red for Women Luncheon!
Essential Health Benefits, Minimum Essential Coverage, Minimum Value Coverage – What’s The Difference?
The Patient Protection and Affordable Care Act (PPACA) uses terms that sound alike for three very different things. Here’s a closer look at these terms, and when they’re used.
Essential Health Benefits
Significantly affects individuals and small employers with a fully insured plan. Has a limited impact on self-funded and large insured plans.
Beginning in 2014, policies in the individual and small group markets* will be required to provide coverage for each of the 10 “essential health benefits” regardless whether the policy is purchased through or outside the exchange. Self-funded plans (regardless of size), large group plans, and grandfathered plans (regardless of size) do not have to cover all 10 essential health benefits, but they will not be allowed to put lifetime or annual dollar limits on an essential health benefit.
Each state will have its own “benchmark” essential health benefits package. The essential health benefit categories are ambulatory/outpatient, emergency, hospitalization, maternity and newborn care, mental health and substance use, prescription drugs, rehabilitative and habilitative services and devices (for example, speech, physical and occupational therapy), laboratory services, preventive and wellness services and chronic disease management, and pediatric services, including pediatric dental and vision care.
Minimum Essential Coverage
Affects most individuals and all employers with 50 or more employees (regardless whether its plan is self-funded or fully insured).
Beginning in 2014, most Americans will be required to have “minimum essential coverage” or pay a penalty with their tax return. (In 2014, the penalty will be the greater of 1 percent of income or $95.) A person will have minimum essential coverage if he or she is covered under an eligible employer-sponsored plan, an individual policy (through or outside the exchange), or a government plan (Medicare, Medicaid, CHIP, TRICARE, VA, etc.).
Also beginning in 2014, employers with 50 or more full-time or full-time equivalent employees will be required to offer minimum essential coverage to nearly all of their employees who work 30 or more hours a week, or pay a penalty. (If minimum essential coverage isn’t offered to at least 95 percent of full-time employees and their dependent children, a penalty of $2,000 per year per full-time employee, excluding 30 full-time employees, will apply.)
A clear definition of “minimum essential coverage” for employer-provided benefits has not been provided yet, but it appears that fairly basic medical coverage will be enough. “Eligible employer-sponsored coverage” includes any plan offered in the small or large group market in a state, as well as self-funded plans, unless the plan only provides “excepted benefits.” Excepted benefits are those that provide very limited medical coverage, like hospital indemnity, long-term care and cancer plans, on-site medical clinics, disability income and accident plans, and dental- and vision-only coverage. Plans with annual dollar limits on essential health benefits will not be allowed after 2014, so it is unlikely that a standalone HRA will provide minimum essential coverage.
Minimum Value Coverage
Affects employers with 50 or more employees (regardless whether its plan is self-funded or fully insured) and individuals who may be eligible for premium tax credits/subsidies.
Beginning in 2014, employers with 50 or more full-time or full-time equivalent employees that offer coverage that is less than “minimum value” will have to pay a penalty. (The penalty for not providing minimum value, affordable coverage is $3,000 for each full-time employee who obtains coverage through a public exchange and receives a premium tax credit/subsidy. Individuals will not be eligible for a subsidy if their employer offers them affordable, minimum value coverage.)
Minimum value coverage is coverage with an actuarial value of at least 60 percent – this means that on average the plan is designed to pay at least 60 percent of covered charges. (The employee would be responsible for the other 40 percent through the deductible, copays and coinsurance.) In the self-funded and large markets, employers will be able to use a calculator provided by the government, and possibly safe harbor plan designs, to make sure their plan meets the 60 percent standard. The proposed calculator can be found here (under the “Plan Management” section, look for Feb. 20, 2013 / Minimum Value Calculator): ): Regulations and Guidance | cciio.cms.gov. According to HHS, 97 percent of the employer-sponsored plans they surveyed already meet the 60 percent requirement.
In the individual and small group markets, a “bronze” policy will have an actuarial value of 60 percent.
In a nutshell, then:
• Essential health benefits are the kinds of care small plans must cover
• Minimum essential coverage is what individuals must have and large employers must offer if they don’t want to pay tax penalties
• Minimum value coverage is what large employers must offer to avoid a different tax penalty
* It is still unclear what size makes a plan “large” or “small” under the essential health benefits rules. Clearly, a plan with fewer than 50 employees is “small” and a plan with more than 100 employees is “large.” States have the option to consider plans below 100 as “small” until 2016, but it is not clear yet how they make that choice. (It is clear that a plan is “large” under the minimum essential and minimum value requirements if there are 50 or more full-time or full-time equivalent employees in its control group.)
Managing Seasonal Allergies
The Worst Offenders
Seasonal allergy is caused by tree pollen in the early spring. During the late spring and early summer, the irritating pollen is usually from grasses. Weeds are the typical pollen source in late summer and into the fall.
Tree Pollen
In springtime, trees release huge amounts of pollen. Some common trees like pine, birch, alder, cottonwood, ash and cedar produce the most allergens. The lightest pollens are often the worst allergy triggers. Trees with large blooms like magnolias and dogwoods produce larger, heavier pollens. These trees depend on insects, not wind, to transport pollen. They tend to be lower in allergy potential.
Grass Pollen
Grass pollen levels are affected by temperature, time of day and rain. Ryegrass, Bermuda grass and Timothy are the worst offenders. If grass pollens bother you, it’s best to have someone else mow your lawn when possible. It’s also a good idea to keep your grass cut short.
Weed Pollen
About 75 percent of Americans who have plant allergies are sensitive to ragweed. But other weeds, including pigweed, nettle, curly dock, lamb’s-quarters, sheep sorrel and sagebrush, produce pollen allergens. Ragweed season runs from August to November.
Limit Your Exposure
If spring and summer spell sneezing season for you, consider these steps to reduce your exposure to pollen:
• Keep an eye on the pollen count, which is often included in weather reports. Stay inside as much as possible when it’s high.
• Pollen counts are highest in the early morning and on dry, windy days.
• Wear wrap-around sunglasses to keep pollen out of your eyes.
• Keep car windows closed. Turn on the air conditioning to prevent pollen from entering the car.
• Don’t lie on freshly cut grass.
• If you have to work outside when the pollen count is high, wear a dust mask.
• Change into clean clothes when you get home. Wash the clothes you wore outside.
• Keep your windows closed at night. If possible, use air conditioning, which cleans, cools and dries the air.
Is It a Cold or Seasonal Allergies?
If you tend to get a cold at the same time in the spring or fall every year, it’s possible you actually have a seasonal allergy. Viruses cause colds. Allergies are triggered by exposure to an allergen. Use this chart to help tell the difference.
| Symptoms | Cold | Airborne Allergy |
| Cough | Common | Sometimes |
| Fatigue, Weakness | Sometimes | Sometimes |
| Itchy Eyes | Rare or never | Common |
| Sneezing | Common | Common |
| Sore Throat | Common | Sometimes |
| Runny or Stuffy Nose | Common | Common |
| Fever | Sometimes | Never |
| Duration | 3 to 14 days | Weeks (for example, 6 weeks for ragweed season) |
| Treatment |
|
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| Prevention |
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Avoid those things you are allergic to such as pollen, house dust mites, mold, pet dander |
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Slow-Roasted Asparagus with Sesame Oil While asparagus is available year round, it’s plentiful and at its lowest price in the springtime. Slow roasting produces tender, bright green spears. The technique works well with green beans, carrots and parsnips, too. |
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Ingredients 1 ½ pounds fresh asparagus 1 tablespoon sesame oil 2 tablespoons less-sodium teriyaki sauce 1 tablespoon rice wine vinegar or cider vinegar
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Preparation
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Nutritional info (per serving) 55 Calories 3g Fat 0.5g Saturated fat 3g Protein 6g Carbohydrate 2g Fiber 163mg Sodium
Copyright © 2013 Alere. All Rights Reserved |
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Employers, Do You Know What You Need To Do Before January 2014 To Comply With PPACA?
The provisions associated with health care reform pose many questions for employers, most importantly, what do I need to do and when? Here is a checklist of items to cross off your list before January 2014:
- Calculate and pay the Patient Centered Outcome Fee if the plan is self-funded (insurers are responsible for calculating and paying the fee for insured plans, but will likely pass the cost on)
- Expand the definition of first-dollar preventive care to include a number of women’s services, including contraception
- Reduce the maximum employee contribution to $2,500, if the employer sponsors a health flexible spending account (FSA)
- Withhold and extra 0.9% FICA on those earnings more than $200,000
- Provide information on the cost of coverage on each employee’s W-2, if the employer issued more than 250 W-2s in 2011
- Provide a notice about the upcoming exchanges to all eligible employees
REGISTER NOW!! Health Care Reform Lunch ‘N Learn Events in Weehawken and Marlton
Since the November Presidential election, Innovative has hosted eight Lunch N’ Learn events in New Jersey, Pennsylvania and New York, and we have just added two more! We will be having our first Weehawken event at The Chart House Restaurant this month on April 24th, and we will be back at Fleming’s Steak House in Marlton on Friday May 10th. Health care reform has created many questions for employers and we are here to help guide you through the process as the new regulations go into effect. All of our seminars are approved for 2 HRCI credits as well as 2 CPE credits in the states of New Jersey and Pennsylvania.
In this seminar Terriann Procida walks attendees through the timeline of requirements associated with PPACA, paying particular attention to the Play or Pay regulation. As a large employer you will be required to offer affordable coverage to your employees or you will pay one of two penalties: the “no offer” penalty or the “inadequate coverage” penalty. Have you considered how these two penalties may affect your budget? If you would like to learn more about Play or Pay, or any other aspects of Health Care Reform, please contact our office and we would be happy to help you.
Due to the outstanding turnout and feedback from these events, we are continually adding additional Lunch N’ Learn programs focused on Health Care Reform to our calendar in 2013 so please check our Innovative Academy tab for upcoming dates. SIGN UP EARLY!!! We had to close all of our recent events early in order to be able to accommodate all of our guests. We look forward to seeing you at our future events!
PPACA Update: External Claims Appeals Requirement
Applies to all nongrandfathered plans, whether fully insured or self-funded, and to all sizes of employers.
PPACA requires all nongrandfathered plans to follow detailed processes for claims appeals, including a process for external review that includes 16 consumer protections required under the NAIC model act. Due to practical difficulties meeting these requirements, interim rules were issued that only required these reviews to meet some of the consumer protections. The interim rules have now been extended, giving insurers and self-funded plans until Jan. 1, 2016 to meet the full external review requirements.
The notice extending the transition period for the external review process is here:
Technical Release No. 2013-01
Terriann to Speak about Health Care Reform at Tri-State HRMA’s 27th Annual Conference
Since the election in November, Terriann Procida has been educating employers about Health Care Reform, specifically the new Play or Pay regulation. Do you know what you need to do to begin budgeting for the 2013-2014 PPACA Provisions? Do you understand how potential penalties associated with Play or Pay may affect your bottom line? Register for this event or one of our upcoming lunch events to learn more about the Play or Pay regulation from Terriann which will help guide you in making the right decisions to prepare for the 2013-2014 PPACA provisions.
In addition to Terriann, Bette Francis, Chairperson for SHRM, is scheduled to appear as the keynote speaker. The event takes place Thursday May 2, 2013 at The Westin, Mt. Laurel, New Jersey. Please click this link to register for the “Oceans of Opportunities: Riding the Waves of Change” conference:
http://www.tristatehr.org/ProgramsEvents/AnnualConference.aspx
If you would like to register for one of our upcoming lunch events, please visit the “Innovative Academy” tab on our website or click here:
http://www.ibpllc.com/innovative-academy/default.aspx
PPACA Update: Certificates of Creditable Coverage
Affects all plans, whether fully insured, self-funded or grandfathered, and regardless of employer size, as of Jan. 1, 2015.
Because pre-existing condition limitations will not be permitted after the start of the 2014 plan year, certificates of creditable coverage would not need to be provided after Dec. 31, 2014. (This date would apply regardless of plan year.)
The notice regarding pre-existing condition limitations that is provided as part of open enrollment also will become obsolete.
PPACA Update: Eligibility Waiting Periods
Affects all plans, whether fully insured, self-funded or grandfathered. Applies to all sizes of employers, as of the start of the 2014 plan year.
The agencies have issued proposed regulations that state that an eligibility waiting period cannot be more than 90 days. This literally is 90 calendar days — a plan that begins coverage as of the first of the month after 90 days of employment, or after three months of employment, will be out of compliance. If the 91st day falls on a weekend or holiday, the plan may not wait to begin coverage until the following work day — in that situation, the plan will need to begin coverage as of the Friday before the end of the allowed waiting period.
Example: Sam starts work on July 14, 2014. His coverage must begin on or before Oct. 13, 2014. If Sam’s employer is closed that day for Columbus Day and it cannot begin coverage because of the closure, his coverage must begin Friday Oct. 10.
The waiting period may be delayed until the employee meets the plan’s eligibility requirements — for example, if the plan does not cover employees who work fewer than 30 hours per week or employees in certain job categories, and an employee moves from ineligible to eligible status, the waiting period may begin as of the date the employee first moves into the eligible class. The agencies regard earnings and residual requirements under multiemployer plans as permitted types of eligibility requirements.
The proposed regulations confirm that a waiting period that is longer than 90 days is allowed for new variable hours employees while they complete their initial measurement period. The waiting period may be imposed after the measurement period is completed as long as both are completed by the first day of the month following completion of 13 months of employment.
Example: Ann is a variable hours employee because she is an on-call nurse. Ann’s employer uses a 12-month initial measurement period for variable hours employees and a 60-day waiting period. Ann is hired May 10, 2014. If Ann averages 30 or more hours per week during the initial measurement period, she must be offered coverage with an effective date of July 1, 2015 or sooner.
Plans that require a certain number of hours be completed to be eligible will be allowed to use an hours of service requirement of up to 1,200 hours. A waiting period of up to 90 days may follow completion of the hours of service requirement. Plans that allow employees to buy or bank hours will be permitted.
Individuals who are part way through a waiting period as of the start of the 2014 plan year must be credited with time prior to 2014, so that their total waiting period is no more than 90 days.
Example: Ed is hired Oct. 22, 2013 to work part-time. Ed’s employer has a calendar year plan and during 2013 it used a 6 month waiting period. Ed must be offered coverage with an effective date on or before Jan. 21, 2014, because that is Ed’s 91st day of employment. (It does not matter that Ed works part-time — the waiting period limit applies to both part-time and full-time employees.)
The proposed rule on eligibility waiting periods and certificates of creditable coverage is here:
Eligibility Waiting Periods – Proposed Rule
PPACA Employer Fees: Patient-Centered Outcomes Research Institute (PCORI) and Transitional Reinsurance (TRF)
The IRS and the Department of Health and Human Services have issued final regulations that provide details on two new, temporary fees that will be due as part of the Patient Protection and Affordable Care Act (PPACA). These fees will be calculated and paid directly by self-funded plans. The fees will be calculated and paid by insurers, although insured plans should expect these fees to be passed along.
Both the Patient-Centered Outcomes Research Institute (PCORI) fee and the Transitional Reinsurance Fee (TRF) are based on covered lives — that is, both employees/retirees and their covered spouses and children must be counted. The basic methods a plan may use to count members are the same under the two fees (although a plan may use one method for one fee and a different method for the other fee if it prefers). However, because the PCORI fee is based on a plan year, the PCORI count looks at the entire plan year. (Note that although PCORI is based on the plan year, the reporting and fee due date is always July 31.) In contrast, the TRF is based on a calendar year, even for non-calendar-year plans. TRF reporting of covered lives will be due Nov. 15 and the fee will be due early in the next January. To meet the Nov. 15 reporting date, for TRF purposes covered lives will only be counted for the first nine months of the calendar year.
The PCORI fee is small — $1 or $2 dollars per covered person per year — and will be in effect from 2012 through 2019. It is designed to fund research into the most effective ways of treating various diseases. The federal TRF will be $63 per covered person for the 2014 calendar year. It will be about two-thirds of that amount in 2015 and about half that amount in 2016, and then will expire. (States have the right to charge their own, additional TRF; states that wish to do so must provide details on the state fee by April 11, 2013. Few states are expected to add a state-level fee.) The TRF is designed to pay a portion of the cost for individuals with large claims.
To see a comparison of these two fees, please click the link: PCORI versus TRF Fees