As a writing agent with MBPA, you now have the answers that you need to help you as an agent navigate reform. Health Reform Connect will give you:
• Access to our exclusive Health Reform Questions and Answers Hotlink.
This email link will give you opportunity to ask any specific question related to reform and your clients needs. Our team of experts will provide speedy answers to help you manage implementation of reform.
The ability to request the MBPA Health Reform team to make a presentation to your staff or for your client meetings to keep you abreast of recent changes in reform.
Employee Calculator: Who is a “large employer” under the Affordable Care Act
Small Business Health Insurance Tax Credit Calculator
Health Care Reform Business Checklist
HR and Business Legal Hotlines
SBC resources and templates for clients that are self-insured.
Expert Advice on Complicated Compliance issues and technical guidelines
Complimentary access to monthly webinars and seminars on Health Reform
Links and Feeds on the latest news on PPACA and Health and Human Services
A plethora of tools that you can use in your agency including client presentations, white papers, reform pdfs for your clients
Compliance Solutions such as W2 compliance and resources for payroll services
IRS and tax compliance, credits and penalty, information and tools.
To take advantage of these services, continue to write your Blues with the MBPA (cluster code “AL”). This is a complimentary additional service for all members taking advantage of the MBPA BCBSM insurance offerings.
Our service team is ready to help you at 888-277-6464.
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The Centers for Medicare and Medicaid Services (CMS) has published proposed registration procedures for Agents and Brokers to represent and sell qualified health plans on the Individual and Small Business Health Options Program (SHOP) Federal-Facilitated Exchanges.
The proposed registration process includes Agent-Broker personal identifying and contact information and, professional producer licensing information.
CMS has also proposed a training curriculum comprised of four modules…ACA Basics, Individual Market, SHOP Market and Access and Navigating the Web Based Individual and SHOP Exchanges. The training program could take 3-4 hours to complete through an online training course, and would include modules on topics such as allowable premium variations, eligibility and enrollment, eligibility for Medicaid and privacy provisions.
For additional information regarding the exchange producer registration process go to the CMS Website under the Paperwork Reduction Act of 1995 area, subject Agent/Broker Data Collection Federal Exchanges.
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Colonial Life’s new Group Accident Insurance is now available, which completes our comprehensive portfolio of group and individual voluntary benefit plans. Composite rates and a two-year rate guarantee are just a few highlights of this guaranteed-issue product, which offers four Health Savings Account-compliant plan options. Group Accident also features additional employer-optional benefits that can further expand coverage for employees:
Hospital Confinement Due to Covered Sickness pays additional benefits if a covered sickness results in a hospital stay.
Health Screening benefit pays one of three employer-selected benefit amounts if an insured has a covered screening test.
With this simple, affordable coverage solution, you can give your clients the options they need to offer a strong benefits package with out the cost of providing one. Learn more about our newest product by checking out the Group Accident flier. Talk to your local benefits representative Evette Kendzierski 586-243-6100 today about adding it to your clients’ benefit packages. Let’s set up an appointment to review in greater detail how these innovative benefit solutions can help you, your clients and their employees.
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By Bonnie Bochniak
Vice President, Government Relations MBPA/MFBA
February 2013 – The Michigan Business and Professional Association is asking the support of both the State House and Senate in appropriating the $30 million in federal grant funding available to lay the groundwork for establishing a health insurance marketplace for our state-federal partnership plan. The Association sent this letter to all legislators, as we feel our state resources should not be utilized in order to lay the groundwork for the federal health care plan. If there is federal funding to help defer that cost, we support accepting it.
Letter:
The Michigan Business and Professional Association representing over 20,000 small businesses statewide, ask for your support in appropriating the $30 million in federal grant funding available to lay the groundwork for establishing a health insurance market place for our state-federal partnership plan.
Our association did not support the formation of PPACA, and lobbied strongly against it. Despite our actions and the final outcome, it is the law of the land. We are moving forward to help our members, the business community, prepare for their future and give them the tools they need.
We believe that Michigan should be granted as much decision making power allowable by the federal health care law, which would be to establish a state-based exchange here in Michigan. Although, that is not the path our state has chosen, we still need to appropriate the $30 million in grant funding that has recently become available to begin our operations as a state-federal partnership, to comply with federal law.
We all understand that the $30 million in federal grant monies in no way ties our state to any permanent health care decisions; it merely gives us much needed revenue to begin technical compliance, while saving our general fund dollars. We understand the political ramifications in supporting this grant, but ask you to look beyond that and do what is best for Michigan. The time to act is now. This is the last remaining option we have for Michigan to maintain some control over decisions made in regards to our health care. Please support and pass the supplemental, providing us with the $30 million in federal funding our state desperately needs.
As always, please contact our Government Relations team with any questions. By phone: 888-277-6464 or by email: bbochniak@michbusiness.org. We value your feedback
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January 2013 – Some of the most talked about aspects of the Patient Protection and Affordable Care Act (PPACA) relate to the employer mandate provisions (often times referred to as “employer shared responsibility”) taking effect in 2014. With 2014 right around the corner, employers are starting to analyze their current health plans and determine what penalties, if any, they could be facing next year.
What Are The Employer Shared Responsibility Provisions?
Beginning in 2014, PPACA requires that large employers (those who employ 50 or more full-time employees (as defined by PPACA) or full-time equivalents) offer health coverage to their full-time employees and their dependents that is “affordable” and that provides “minimum value.” If an employer fails to provide such coverage, the employer could be subject to penalties on and after January 1, 2014.
Generally under PPACA, coverage will be deemed to be “affordable” if an employee’s share of the premium for employer-provided coverage would cost the employee more than 9.5% of that employee’s household income. Given that it may be difficult for employers to know an employee’s household income, the IRS has provided affordability safe harbors under which coverage will be considered to be affordable if the cost of that coverage would not exceed 9.5% of the employee’s W-2 wages from that employer, or if the coverage satisfies either of two other designed-based affordability safe harbors.
A health plan is considered to provide “minimum value” under PPACA, if the plan covers at least 60% of the total allowed cost of benefits that are expected to be incurred under the plan. Minimum value calculators will be made available by the IRS and the Department of Health and Human Services and employers will be able to input plan specific information on such items as deductibles and copays in order to determine if the plan provides minimum value.
Which Employers are Subject to the Employer Shared Responsibility Provisions?
Large employers with at least 50 or more full-time employees (defined as any employee working 30 or more hours per week for purpose of PPACA) or a combination of full-time employees and full-time equivalent employees will be subject to the employer shared responsibility provisions beginning in 2014. Employers with less than 50 full-time employees are not subject to the employer shared responsibility provisions.
In addition to full-time employees, employers must also add up the part-time hours for all part-time employees (those working less than 30 hours per week) in a month and divide by 120 to get the number of “full-time equivalent employees.” It is also important to note that the determination of whether an employer is a “large employer” for purposes of employer shared responsibility is made on a controlled group basis, so if an employer is part of a larger group of related companies, employers must take into consideration all employees of the entire controlled group in making this determination.
Under What Circumstances Will Large Employers Be Subject to Penalties?
In 2014, a large employer will generally be subject to the employer shared responsibility penalties under two circumstances:
1. A large employer does not provide health coverage to at least 95% of its full-time employees and their dependents, and one or more of its full-time employees receives federal insurance subsidies and obtains coverage on a State based exchange. In this case, the employer will face a penalty of $2,000 per full-time employee (minus the first 30 employees).
2. A large employer provides health coverage to at least 95% of its full-time employees and their dependents, but that coverage is deemed “unaffordable” or does not provide “minimum value.” If one or more of its full-time employees receives insurance subsidies and obtains coverage through a State based exchange, the employer will face a penalty of $3,000 per subsidized employee or $2,000 per employee (minus the first 30) whichever is less.
The IRS has indicated that it will contact employers to inform them of their potential penalty liability under PPACA’s employer shared responsibility provisions and provide them with an opportunity to respond before any liability is assessed or notice and demand for payment is made. The IRS has further provided that it will not contact employers regarding a given year until after employees’ individual tax returns are due for that year claiming premium tax credits and after the due date for applicable large employers to file the information returns identifying their full-time employees and the coverage that was offered for that particular year.
Stay Tuned!
2013 is sure to be a pivotal year in terms of health care reform guidance, and in particular with regard to the employer shared responsibility provisions. While the Agencies have issued preliminary guidance on this important issue, additional guidance and clarification are almost certain. Therefore, as we move closer to 2014, it is imperative for employers to work closely with their benefits consultants and legal counsel to ensure compliance with these complex regulations.
*This article is not intended to give legal advice. It is comprised of general information. Employers facing specific issues should seek the assistance of legal counsel.
Kristi R. Gauthier is a senior attorney in Clark Hill’s Birmingham office and concentrates her practice in Employee Benefits Law. Kristi has represented clients in a wide variety of employee benefits issues involving health and welfare benefits, as well as retirement plans. Kristi is admitted to practice in the State of Michigan, the U.S. District Court for the Eastern District of Michigan, and the U.S. Sixth Circuit Court of Appeals. She also is active in the legal community with memberships in the American Bar Association, the State Bar of Michigan, and the Oakland County Bar Association where she is a member of the Employee Benefits Committee. Kristi also serves as a member of the Clark Hill Diversity and Inclusion Committee. Kristi has lectured on various employee benefits issues, including ERISA compliance, healthcare reform, COBRA, section 125 plans, 403(b) plans and IRS plan correction programs. Kristi is also a co-author of the ABA publication ERISA Survey of Federal Circuits. Kristi was named a “Rising Star” by Michigan Super Lawyers in 2011.
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By Bonnie Bochniak
Vice President, Government Relations
MBPA/MFBA
January 2013 – Inside our nation’s new federal healthcare law, a $63-per-person annual fee will be charged to all health insurance plans beginning next year that will aid in financing the new law’s risk-adjustment mechanism. The new law’s reinsurance provisions are an effort to lessen the cost of pre-existing conditions and the new community rating requirements that will impact all individual and small group health insurance markets in 2014. The question remains, who will be responsible for paying the fee?
The regulation states that all health insurance plans that cover up to 190 million Americans are subject to the fee. So essentially, the fee will be assessed on all health plans, and it is possible that this cost might be passed onto the consumer. The cost might be further passed onto each employee, in larger companies, as their liability will be much greater.
Revenue:
In 2014 the $63 per-person fee is estimated to bring in $12 billion dollars and decreasing each year, the fee will total $8 billion in 2015 and $5 billion in 2016. As the legislation reads today, the fee will decrease, and ultimately be phased out in 2017, unless extended by Congress. Five billion dollars of the total collected amount will go towards offsetting the cost of early retirees on employer-sponsored insurance plans.
Where will this money go:
The revenue from the fee will be placed into a fund managed by the Health and Human Services Department (HHS). It will be utilized to lessen the burden placed on the insurance companies from the initial unpredictable costs of covering uninsured citizens with medical conditions. As under the law, by 2014, all insurers must accept all those that apply, regardless of their health and/or risk.
What’s next:
MBPA will keep you up to date as we receive more information on this regulation and many others that will impact your business and clients. As always, please contact our government relations team for any questions. By email at bbochniak@michbusiness.org or by phone: 586-393-8800.
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Join us for “A Detailed Look at Complying with the Employer Mandate in 2014”
Please join the Michigan Business & Professional Association for a Webinar on February 12, 2013 at 1PM (Eastern Time). This webinar will review the requirements for complying with the employer mandate in 2014.
In December 2012, the IRS and the Treasury released proposed regulations containing new guidance in how to comply with the employer mandate. This new guidance includes:
How to determine when an employer is a “large employer”
How to apply the penalty to controlled groups of employers
How to determine full-time employees
What employee hours are counted to determine full time status
When employers have to comply with plans with noncalendar plan years
When is a health plan is “affordable”
How school districts, unions and temporary agencies have to comply
The webinar will be presented by Larry Grudzien, Attorney at Law.
Title: A Detailed Look at Complying with the Employer Mandate in 2014 Date: Tuesday, February 12, 2013 Time: 1:00 PM – 2:00 PM EST
After registering you will receive a confirmation email containing information about joining the Webinar.
System Requirements
PC-based attendees
Required: Windows® 7, Vista, XP or 2003 Server
Mac®-based attendees
Required: Mac OS® X 10.5 or newer
Mobile attendees
Required: iPhone®, iPad®, Android™ phone or Android tablet
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The MBPA wants to ensure that the agent community is given the right tools and information to get you and your clients through Health Care Reform. The MBPA-MFBA is pleased to present Health Care Reform Connect™ to help you and your clients navigate reform.
Highlights of Health Care Reform Connect™ include:
LIC coursework discounts.
You can email healthreformanswers@michbusiness.org for quick, accurate answers to your complex questions for your clients and MBPA-MFBA members. Experts from across the country are available to MBPA-MFBA agents.
Webinars and workshops to address complex issues like SBCs, W2 reporting, and tax penalties/credits, along with timely reform updates to help you and your clients prepare.
Reform presentations and educational/compliance tools are available for you and your clients.
These services are available to MBPA-MFBA members through the agent community. Ensure you write your Blue Cross business with the MBPA with Sponsored Plan Acronym AL. MBPA’s “AL” has your back during reform.
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