Thursday, 29 October 2015
The New Proposed Overtime Regulations - Webinar Invitation
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Benefits Advisors Network

Webinar Connection Invitation


To register for this webinar:
CLICK HERE
Password: NOR1815


Virtus Benefits Monthly Webinar Series

The New Proposed Overtime Regulations

In this webinar we will discuss what's included, what's not, and what to do to get ready.

 

November 18, 2015

12:00 pm to 1:00 pm  Eastern

11:00 am to 12:00 pm Central

10:00 am to 11:00 am  Mountain

9:00 am to 10:00 am  Pacific

8:00 am to 9:00 am  Alaskan 

    

Our Presenter:

Stacy Barrow, Esq.

Marathas, Barrow & Weatherhead / BAN Legal & Compliance Dept.

 


Legal Disclaimer: Benefit Advisors Network is not a legal entity and nothing herein should be construed as legal advice. Always consult an attorney on all legal and compliance matters. Benefit Advisors Network is not responsible for the accuracy of the information contained herein.

© Copyright 2015 Benefit Advisors Network. Smart Partners®. All rights reserved.

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Posted on 10/29/2015 12:59 PM by David Johnson
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Tuesday, 20 October 2015
Consider Hiring a Vet (or His or Her Spouse or Dependent)
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The Affordable Care Act's (ACA's) pay-or-play penalties apply only to so-called applicable large employers (ALEs).  An ALE is an employer that employs, on average, at least 50 full-time equivalent employees (FTEs) in the prior calendar year.  (For 2015 only, certain employers with between 50 and 99 FTEs on average in 2014 are exempt from pay-or-play penalties.)

Employers who are not interested in potentially incurring pay-or-play penalties under ACA but who are looking to expand their workforce beyond 50 FTEs should consider hiring a U.S. military veteran or his or her spouse.

In July, President Obama signed into law the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 (Transportation Act) which included an amendment to Internal Revenue Code (Code) Section 4980H, which sets forth the requirements of the ACA's pay-or-play penalties and, importantly, establishes rules for counting employees to determinate ACA status. The Transportation Act amended the Code by adding Section 4980H(c)(2)(F), which excludes those covered by Tricare and Veterans Administration insurance from the FTE headcount for purposes of determining ALE status.

In other words, an employer that has been maintaining its workforce at just below 50 FTEs may now expand its workforce by hiring a veteran or his or her spouse covered by Tricare or VA insurance and still not be considered an ALE for the ACA's pay or play requirements.

The legislation was passed into law at the end of July and most of D.C. takes a vacation for August, so the hope is that sometime soon the Internal Revenue Service will release guidance confirming for employers that they agree that the plain language of the amendment would exclude any spouse or dependent covered by Tricare or VA insurance, as well as the veteran him- or herself.

The new law is effective as of January 1, 2014, so employers who just went over 50 FTEs in 2014 should attempt to identify those current employees who might qualify for the exception, and should incorporate an identification process into their onboarding processes.  The federal regulators may also provide guidance on how employers might go about asking current or prospective employees whether they fall into this exception.  Clearly, there is nothing wrong with asking an individual if he or she is a veteran (and giving thanks for his/her service).  Care should be taken, however, in asking about Tricare or VA coverage.  Without proper guidance, employers will want to avoid appearing to suggest or recommend that a current or prospective employee opt into VA or Tricare coverage instead of the employer's insurance.

This new exclusion may provide a significant incentive to hire veterans and their families while providing relief to many small and mid-sized employers who have been "making do" with their current workforce size to avoid being subject to pay-or-play.  A rare occasion in which our representatives in Congress fashioned a true win-win.

Contact Us

If you have questions about this or any other matter concerning Business Benefits Contact Us Here

 


 

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Posted on 10/20/2015 8:48 AM by Peter Marathas, Esq.
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Monday, 12 October 2015
Trends in Prescription Drug Benefits - Webinar Invitation
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Benefits Advisors Network

Webinar Connection Invitation


To register for this webinar:
CLICK HERE
Password: PDB1021
 


VIRTUS

Trends in Prescription Drug Benefits

In this webinar we'll discuss the trending of drug prices and learn more about the factors impacting your pharmacy benefit costs and plan design options.

VIRTUS

October 21, 2015

12:00 pm to 1:00 pm  Eastern

11:00 am to 12:00 pm Central

10:00 am to 11:00 am  Mountain

9:00 am to 10:00 am  Pacific
 

Our Presenter:

Armand Dilanchian

Integrated Health Concepts LLC / BAN Pharmacy Dept.

 


Legal Disclaimer: Benefit Advisors Network is not a legal entity and nothing herein should be construed as legal advice. Always consult an attorney on all legal and compliance matters. Benefit Advisors Network is not responsible for the accuracy of the information contained herein.

© Copyright 2015 Benefit Advisors Network. Smart Partners®. All rights reserved.

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Posted on 10/12/2015 12:04 PM by David Johnson
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Thursday, 8 October 2015
Obama to Sign PACE Act, Allowing States to Define Small Group as 50 or Fewer Employees
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The New York Times has reported that the President will sign the Protecting Affordable Coverage for Employees Act (PACE Act), which amends the Affordable Care Act (ACA) to provide states the flexibility to define a "small employer" for group health insurance purposes as one with 50 or fewer employees on average in the preceding calendar year.  States may expand the definition of small employer to include companies with 51 100 employees if they wish, although they are no longer required to do so.  The PACE Act is a welcome relief to mid-sized employers in the 51-100 employee range who would have been newly reclassified as "small group" for insurance purposes starting in 2016. 

What is a small employer?

Historically, most states have defined a small employer for purposes of group health insurance as one with 50 or fewer employees.  The threshold is typically determined under one of three methods:  Average Total Number of Employees (ATNE); Full-Time Equivalents (FTEs); and Eligible Employees. 

It is anticipated that most states will retain the 50 employee limit in 2016.  However, our understanding is that the District of Columbia and several states (CA, CO, MD, NY, VA and VT) have already changed their definition of small group to 100 or fewer employees starting in 2016 (some transition relief may be available).  It is unclear whether these states will amend or repeal those laws to reflect the lower limit once again permissible under the ACA.

What does the ACA require of small group plans?

Certain requirements apply to small group plans under the ACA.  They must provide essential health benefits (EHBs), which is a package of benefits including items and services in ten categories including hospitalization, prescription drugs, and mental health benefits.  Large group and self-insured plans are not required to offer the EHB package.  Small group plans are also subject to strict community rating rules, which prohibit carriers from underwriting based on factors other than age (3:1 ratio limit), family size, geographic region, and tobacco status (1.5:1 ratio limit). 

Are all small group plans ACA-compliant?

Not necessarily.  In November 2013, the Centers for Medicare and Medicaid Services (CMS) announced a transition policy under which insurance carriers could continue to offer plans in the small group market that did not comply with certain of the ACA's market reforms, including the community rating rules and EHB package requirements.  

In March 2014, CMS extended this policy for two years to policy years beginning on or before October 1, 2016. This policy was of interest to many employers in the 51 100 employee range, who availed themselves of it in order to continue in plans that would have been reclassified as small group starting in 2016. It was also used by employers with 50 or fewer employees to avoid having to provide the full EHB package.

How have carriers and employers responded to CMS' transition policy?

This year, many mid-sized employers accepted "early renewals" from their insurance carriers.  Under this strategy, an employer renewed its policy issued in 2015 "early" typically by October 1, 2015.  This enabled the employer to avoid community rating and other mandates applicable to small group plans under the ACA until the start of its October 1, 2017 plan year (the October 1, 2016 plan year would fall within the transition policy).  See Sidebar.

What else does this mean for the ACA?

The PACE Act does not delay the ACA's employer mandate or its reporting requirements.  However, the Act has broad bipartisan support and perhaps signals that there may be more bipartisan adjustments to the ACA in the future.  Presidential candidates on both sides have signaled that they would explore repealing the ACA's excise tax on high-cost health plans (a/k/a the Cadillac tax) as well as the ACA's 2.3% tax on medical device manufacturers. 

In the meantime, mid-size employers who would have been reclassified as small group can breathe easier now that they'll remain large group as long as their state does not choose to expand its definition of small group.  They are not required to cover all EHBs and their carriers can go beyond the four limited underwriting criteria applicable to small group plans.

Contact Us

If you have questions about this or any other matter concerning Business Benefits Contact Us Here

 


This article is a service to our clients and friends. It is designed only to give general information on the developments actually covered. It is not intended to be a comprehensive summary of recent developments in the law, treat exhaustively the subjects covered, provide legal advice, or render a legal opinion.

Benefit Advisors Network and its smart partners are not attorneys and are not responsible for any legal advice. To fully understand how this or any legal or compliance information affects your unique situation, you should check with a qualified attorney.

© Copyright 2015 Benefit Advisors Network. Smart Partners®. All rights reserved.

 

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Posted on 10/08/2015 2:15 PM by Peter Marathas
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