Tuesday, April 23, 2019

Carefirst Blue Rewards

It's not very often that you have chance to earn money back from your health care insurer.  Carefirst offers Blue Rewards and a way to do just that.

Blue Rewards-Health Incentive-From $100 to $175.  Financial Reward for
taking a more active role in your health.  Three Steps:

1)  Select a Patient-Centered Medical Home (PCMH) PCP and complete health screening with PCP or CVS Minute Clinic ($100)

2)  Answer on-line RealAge health assessment questions and consent to receive emails ($50)

3)  Re-Take the RealAge assessment after 6 months if you already  completed once during step 1. ($25)

Incentives are no longer result based.  All active employees on a Carefirst Medical Plan should participate as this is free money!  Additional incentives available for participation in health coaching.   The first two steps must be complete within 120 days of the plans effective date.  To get started you or your employees can visit: www.carefirst.com/sharecare.

Wednesday, March 13, 2019

UnitedHealth Group to Pass Drug Maker Rebates to Employer Customers

UnitedHealth Group and its pharmacy benefit manager, OptumRx, are expanding a new program that passes along pharmacy discounts they get from drug manufacturer rebates to all new employer customers.
The program will be for "all new employer-sponsored plans," taking effect Jan. 1, 2020, UnitedHealth and OptumRx said Tuesday. The effort builds on a program that began Jan. 1 of this year for people enrolled in UnitedHealthcare “fully insured commercial group benefit plans" who now have discounts applied when they fill their prescriptions at the retail pharmacy or through home delivery.
It’s the latest effort by health insurers and pharmacy benefit managers (PBMs) to pass along more prescription drug savings to customers in the face of intense criticism from employers, Congress and the Trump administration. The PBM’s share of rebates, which is the portion of the drug returned by the seller to the buyer, has turned into a nationwide controversy.
Rivals of UnitedHealth Group and OptumRx are also changing their business practices. Last year, for example, CVS Health, which owns the Caremark PBM and the health insurer Aetna, launched a “guaranteed net cost” pricing model that the company says returns 100% of drug rebates to its clients for better “predictability and pricing simplicity,” CVS executives said in December. And other PBMs like Cigna's Express Scripts subsidiary, have introduced programs with point-of-sale rebates for their clients.  
UnitedHealthcare and OptumRx said they “will only support new employer clients that incorporate point-of-sale discounts to consumers as part of their plan design” for new business proposals they receive for 2020. They expect the effort to save employers and health plan customers money, saying the “existing program has already lowered prescription drug costs for consumers by an average of $130 per eligible prescription.”
Excerpt from Forbes, Bruce Japsen 3-12-19

Friday, February 1, 2019

New HRA rules could allow businesses to circumvent ACA's employer mandate

Currently it is a violation of the ACA for large employers to allow health reimbursement arrangements to be used to help pay workers’ premiums instead of providing group health insurance. Under the ACA, large employers must offer affordable minimum essential coverage to 95 percent of employees in order to avoid penalties.

“Under current ACA rules there is a blanket prohibition, which a lot of employers in the under-200 employee market were bummed about. They would rather have a defined-contribution approach,” Welle said. 

The Trump administration under Executive Order 13813, issued in October 2017, proposed expanding the defined-contribution approach to employer health insurance coverage as part of an overall plan to repeal and/or replace the ACA and promote competition in U.S. health care. The proposals also included allowing association health plans and limited-duration, limited-benefit health plans. While legislation overturning the ACA seems dead, some rule-making continues.

Under the proposed HRA rules, employers generally would have to contribute a fixed amount into each individual HRA sufficient that any remaining premiums the employee would have to pay wouldn’t exceed a percentage of his or her household income to be considered affordable under the employer mandate, in order to avoid penalties, Welle said.

If finalized, the new rules wouldn’t take effect until Jan. 1, 2020, at the earliest. Welle said he believes that most large employers in the interim would probably continue to offer group health plans because they provide employers with a valuable recruitment incentive. In the latest statistics from Kaiser Family Foundation, roughly 16 million Americans were enrolled in the ACA marketplace or a Basic Health Program.

“But in the future, I see employers in the range of 50 to 200 employees who are burdened by the administrative responsibilities and the cost of administering health plans say this is a way they can do something for their employees but off-load some of the responsibilities. It is still developing and there is nothing to hang their hats on yet, but in 2021 or 2022 I can see the [smaller ones] saying this might be a good solution for us,” Welle said.

Pressly said the employers who right now are most interested in this are those with 50 to 100 workers and those who employ lots of part-time workers, as this could be a solution for providing coverage for them.  

But for larger employers, he said, “it looks really appealing but the way the rules are written if you roll it out for one class of employees, you will have to push it to all employees in that class and the benefits vary wildly from state to state.”

Employers and employees might not fully grasp all the differences between the individual health insurance marketplaces in the states and its limitations, and employer-sponsored group health insurance coverage, Pressly said. Resistance could arise when top executives accustomed to group health plans’ flexibility and coverage for expensive procedures such as in vitro fertilization encounter the limitations of many individual health insurance plans, including differences in what states require them to provide, he said.

In 2017, only 7 percent of the total U.S. population were in non group health insurance and 49 percent received employer-provided insurance. A combined 35 percent were on Medicaid or Medicare; 1 percent were on some other public plan and 9 percent were uninsured, according to the Kaiser.

Pressly said, “This goes hand-in-hand with state insurance markets and you really need to understand what that is, the cost and the coverage that is available to know what the ultimate employee experience is going to look like.”

Excerpt By:By MP McQueen | January 28, 2019 at 10:58 AM 

Thursday, January 10, 2019

Calendar of Health and Welfare Benefit Plan Compliance Tasks** and Dates

Action Item Due Date

Reporting of value of health coverage on Form W-2 January 31, 2019*
(Optional for employers issuing under 250 W-2's)

File ACA information reporting returns with IRS (for paper filing) February 28, 2019*

DOL Form M-1 (for MEWAs) March 1, 2019*
Disclosure of creditable/noncreditable status of prescription drug coverage to CMS March 1, 2019
Provide ACA information reporting returns to individuals March 4, 2019
Last day for flexible spending accounts with 2½ month grace periods March 15, 2019

File ACA information reporting returns with IRS (for electronic filing) April 1, 2019*

Form 990 or Form 8868 if requesting extension May 15, 2019

Summary of Material Modifications for prior year amendments July 29, 2019
Form 720 filing and payment of PCORI fee July 31, 2019*
Form 5500 or file Form 5558 to request an extension July 31, 2019

Form 990 (if on extension) or Form 8868 if requesting additional extension August 15, 2019

Summary Annual Report (if no extension) September 30, 2019

Provide notice of creditable/noncreditable prescription drug coverage to participants October 14, 2019*
Form 5500 filed if on extension October 15, 2019

Form 990 (if additional 3-month extension) November 15, 2019
Summary Annual Report (if on extension) December 15, 2019
Deadline for correcting DCAP discrimination test failures December 31, 2019

**Assumes calendar plan and sponsor tax year. Does not account for weekends, extended due dates other than for Forms 5500 and 990, short plan years, or new plans. The “weekend rule,” which extends due dates falling on weekends to the following Monday, generally applies to filing deadlines and certain other acts under tax rules.

*Date does not vary regardless of plan year

Monday, December 3, 2018

IRS Extends 2018 Reporting Due Dates for 1095 Forms Sent to Individuals

December 3, 2018

On Nov. 29, 2018, the Internal Revenue Service (IRS) announced extended deadlines for 2018 Minimum Essential Coverage (Section 6055) and Large Employer Shared Responsibility (Section 6056) reporting due to individuals in early 2019. The extended deadlines are as follows:

2018 Forms Sent to Individuals
Original Deadline
Extended Deadline
Form 1095-B
Form 1095-C
Employers and insurers are encouraged to provide the forms to individuals as soon as possible, but no later than March 4, 2019. Individuals who file their 2018 federal income tax returns before receiving their 1095-B and 1095-C forms will not be required to amend their income tax returns once they receive their forms. They should keep their forms, once received, with their tax records.

It is important to note the IRS has not extended the due date for filing 2018 Forms 1094-B, 1095-B, 1094-C, or 1095-C with the IRS. The deadline remains February 28, 2019, for those with 250 or fewer forms filing by paper, or April 1, 2019, if filing electronically.

The IRS also extended its transition relief with respect to penalties if good faith efforts are made to comply with information reporting requirements.  Read the IRS notice on reporting extensions

Excerpt from Cigna Health Plan

Note: Employers with less than Full Time Equivalent employees and fully-insured, the carrier will take care of this filing.

Thursday, November 8, 2018

Medicare Eligible Beware: COBRA Is Dangerous When Electing Part B


Advocates have seen an increase in the number of Medicare beneficiaries who have delayed enrolling in Medicare Part B, thinking, erroneously, that because they are paying for and receiving continued health coverage under COBRA, they do not have to enroll in Medicare Part B. COBRA-qualified beneficiaries who have delayed enrollment in Medicare Part B do not qualify for a special enrollment period (SEP) to enroll in Part B after their COBRA coverage ends. (They may, however, qualify for a SEP to enroll in Part D at that time if the drug coverage they had under COBRA constitutes creditable coverage.) Only individuals who delay enrolling in Part B because they are covered under an employee group health plan (EGHP) by reason of "current" employment may take advantage of the SEP rules. Individuals on COBRA do not meet the definition of having current employment status.


Medicare Part B – The consequences of delayed Part B enrollment can be severe.  Generally, the beneficiary who does not enroll during his or her initial enrollment period and who is not entitled to a SEP must wait to enroll in the next general enrollment period (January – March), with benefits starting on July 1 of that year. Further, there is a 10% late enrollment penalty added to the standard monthly premium for every 12 months of delayed enrollment in Part B. The penalty has no durational limit.

Under Part D, the penalty is 1% of the national base beneficiary premium in a given year times the number of full, uncovered months of eligibility without other creditable drug coverage. A Part D eligible individual must pay the late penalty if there is a continuous period of 63 days or longer at any time after the end of the individual's initial enrollment period during which the individual meets all of the following conditions: (1) The individual was eligible to enroll in a Part D plan; (2) The individual was not covered under any creditable prescription drug coverage; and (3) The individual was not enrolled in a Part D plan.

from Center of Medicare Advocacy

Monday, October 15, 2018

Maryland law allows small employer income tax credit for paid sick leave

Recently enacted legislation (SB 134, Chapter 571) provides an income tax credit to certain employers with less than 15 employees which provide paid sick and safe leave to their employees. The legislation is effective July 1, 2018.
As we previously reported, effective February 11, 2018, employers of 15 or more employees are required to provide paid sick and safe leave to their employees. Employers with less than 15 employees must at least provide unpaidsick and safe leave to their employees.
Small employers offering paid sick leave may take state income tax credit
Effective July 1, 2018, certain employers of less than 15 employees that provide paid sick and safe leave to their employees may apply for a refundable credit against Maryland state income tax. In order for the employer to be eligible for the tax credit, the employer must have provided paid sick and safe leave to a qualified employee who earns 250% or less of the annual federal poverty guidelines for a single-person household (According to the bill's analysis, in 2018, 250% of the annual federal poverty guidelines for a single-person household is $30,350.)
The credit is equal to the lesser of $500 for each qualified employee or the total amount of qualified employer benefits accrued by qualified employees. A business must apply for and receive a tax certificate from the Maryland Department of Commerce to claim the credit. The Department will within 45 days approve or deny all applications that qualify for the credit on a first-come, first-served basis. The Department may issue tax certificates not exceeding $5 million annually.
SB 134 takes effect July 1, 2018, and applies to tax year 2018 and beyond.
Excerpt from Earnst and Young Article dated 7-27-2018