March 2013 – The Patient Protection and Affordable Care Act (ACA) has been the elephant in the room, consuming all of the air, attention, and to some extent fear, amongst Michigan legislators for the last 12 months. Thousands of hours have been dedicated to reviewing, evaluating and determining how, or IF the state would implement the myriad of provisions included in the Act. The debate continues to rage within the halls of the Capitol as Michigan legislators contend with the latest controversial provision of the ACA: expanding Medicaid eligibility.
Although most of the ACA was upheld by the Supreme Court last June, expanding Medicaid eligibility from the current 40 percent of the federal poverty limit to 133 percent was a provision ruled unconstitutional by the Supreme Court. Despite that ruling, Governor Rick Snyder included the expansion in his Fiscal Year 2013-2014 budget presented in February, and ever since, Michigan legislators, particularly Republicans, have been left questioning how to tackle the political conundrum.
The ACA requires increased “shared responsibility” payments to help provide health care costs to those who do not have health insurance. If adopted, the expansion could provide health insurance to an estimated 400,000 additional Michiganders. At the crux of the issue: dollars and cents. The federal government has promised to cover 100 percent of the expense of the expansion for the first three years (if passed, the change would become effective January 1, 2014). However, by 2020, Michigan would be responsible for funding 10 percent of the costs, which has some legislators cautioning warning ahead. Despite the eventual expense to the state, Governor Snyder believes the state would accrue significant savings by reducing expenditures in state programs currently providing services to this uninsured segment of society. Half of those accrued early savings would be dedicated to a fund that would help defray the costs of the expansion in the later years. The Administration believes the fund would cover expenses until Fiscal Year 2034-35, thus defraying costs for 20 years. As such, the Governor purports the investment is well worth a little legislative indigestion over a politically unpopular federal mandate.
The legislature has yet to act on the expansion and with increasing opposition from conservative and Tea Party interests, the proposal pits the Republican administration against Republican majorities in both the State House and Senate. It’s a political hot potato that has many political observers, small businesses and health advocates anxiously awaiting a decision in the latest controversy surrounding the ACA.
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March 2013 – On January 17, 2013, the Department of Health and Human Services released final regulations which provided sweeping changes to the rules update under privacy, security, enforcement, and breach notification requirements of the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic Health (HITECH) and Genetic Information Nondiscrimination Act (GINA).
Group health plans and business associates are required to comply with the regulations by September 23, 2013, unless otherwise stated in the regulations. With respect to the requirements on breaches of unsecured Protected Health Information (PHI), group health plans must still comply with the September 23, 2009 date. The following is a summary of the important changes under these final regulations.
1. Business Associates
Definition of Business Associate
Several updates and clarifications to the HIPAA definition of Business Associates (BA) have been included.
A person or entity becomes a BA by (i) meeting the definition of a BA and (ii) creating, receiving, maintaining, or transmitting PHI on behalf of a covered entity. Whether or not such person or entity has contracted with the covered entity and/or has entered into a Business Associate Agreement (BAA) is not determinative. Additionally, the type of PHI involved in the transaction does not matter — information is considered PHI if the information is related to a covered entity.
The definition of BAs also include:
• health information organizations;
• e-prescribing gateways;
• other entities that provide data transmission services with respect to PHI to a covered entity and that require routine access to PHI;
• entities that offers a personal health record to one or more individuals on behalf of a covered entity; and
• entities that maintain PHI, whether or not the entities actually review the PHI.
Subcontractors of BAs
The HIPAA’s BA provisions also apply to BAs’ subcontractors (persons or entities that provide services to a BA which involves PHI to fulfill its contractual duties) if the subcontractors create, receive, maintain, or transmit PHI on behalf of BAs. Group health plans are not required to enter into Business Associate Agreements (BAAs) with subcontractors, but the BAA must contain provisions that BAs will ensure that any subcontractors that create, receive, maintain, or transmit PHI on behalf of the BA agree to the same HIPAA restrictions, conditions, and requirements that apply to the BA.
Additional Clarifications Regarding BAs
• Banking and financial institutions are not BAs with respect to payment process activities, as identified in § 1179 of HIPAA, but if the bank or financial institution’s scope of activities exceeds the payment process activities, it will be considered a BA.
• Patient safety activities were added to the list of functions that may be undertaken as a BA and were added to the definition of health care operations.
• An insurer of a health plan product or insurance policy that is purchased by a covered entity is not a BA of the covered entity just by providing the insurance or product. In order to be considered a BA, the insurer must perform a function that involves PHI.
Direct Liability
BAs are now directly liable for complying with certain HIPAA privacy and security rules:
• Impermissible use and disclosure of PHI
• Failure to provide breach notification to a covered entity
• Failure to disclose PHI when required
• Failure to provide access to electronic PHI to an individual, his/her designee or a covered entity
• Failure to provide to a covered entity an accounting of disclosures
• Failure to comply with HIPAA security rules contained in 45 C.F.R. §§ 164.306, 164.308, 164.310, 164.312, and 164.314
• Failure to comply with the requirements relating to policies, procedures and documentation requirements of 45 C.F.R. § 164.316
• Failure to establish BAAs with subcontractors
2. Business Associate Agreements (BAA)
All Business Associate Agreements must be amended to include:
• Provisions requiring BAs to comply with the HIPAA security rule
• Provisions requiring BAs to report breaches involving unsecured PHI to covered entities
• Provisions requiring BAs to obtain satisfactory assurances that subcontracts agree to comply with the underlying BAA’s conditions and restrictions as applied to PHI
Additionally, the final regulations do remove the requirement that BAAs include a provision that required covered entities to report to the Department of Health and Human Services when a BA was out-of-compliance, was not able to cure the breach, and it was not possible to terminate the BAA between the covered entity and the BA.
The final regulations also provide for a grandfathered transition period for updating BAAs. If a HIPAA-compliant BAA was in effect prior to January 25, 2013 and is not renewed or modified between March 26, 2013, and September 23, 2013, the covered entity and BA may continue to operate under the current BAA for up to one year past the final regulation compliance date. That is, the BAA does not have to be amended until the earlier of: (1) the date the BAA is renewed or modified on or after September 23, 20133 or (2) September 22, 2014. This extension for compliance also applies to BAAs that contain automatic renewal provisions.
3. Notice of Privacy Practices
Notices of Privacy Practices (“NPP”) must now be amended to include the following information (in addition to the existing HIPAA requirements):
• A statement indicating that most uses and disclosures of psychotherapy notes (where appropriate), uses and disclosures of PHI for marketing purposes, and disclosures that constitute a sale of PHI require authorization;
• A statement that an individual has a right to or will receive notifications of breaches of his or her unsecured PHI;
• If the plan intends to use or disclose PHI for underwriting purposes, a statement that the plan is prohibited from using or disclosing PHI that is genetic information of an individual for such purposes; and
• If the plan intends to contact an individual to raise funds for the plan, a statement regarding fundraising communications and an individual’s right to opt out of receiving such communications.
For group health plans that post the NPP on their websites, the final regulations require that these plans must prominently post the changes or a revised Notice of Privacy Practices on websites by the September 23, 2013 compliance date; and provide the revised Notices of Privacy Practices, or information about the changes and how to obtain the revised Notices of Privacy Practices, in their next annual mailings to individuals then covered by the plans, such as at the beginning of the plan year or during open enrollment.
4. Breach Notification
Definition of Breach
The definition of what constitutes a breach has been changed. Breach is now defined as the acquisition, access, use or disclosure of PHI in a manner not permitted by the Privacy Rule which compromises the security or privacy of such information. However, the final regulations made no change to the existing exceptions to the definition of breach.
With the change to the definition of breach, the previously used risk of harm standard has been replaced with the rule that, unless one of the enumerated exceptions is applicable, an unauthorized use or disclosure of PHI is presumed to be a breach. To overcome the presumption, a covered entity or BA must show that there is a “low probability that the PHI has been compromised.”
In support of this, the final regulations also identified four factors that must be evaluated by a covered entity or BA when determining whether PHI has been compromised:
1. What is the nature and extent of the PHI involved in the potential breach,
2. Who was the unauthorized user or recipient of the PHI,
3. Was the PHI actually received or viewed by the unauthorized user or recipient, and
4. To what extent has the breached PHI been mitigated.
The above four factors of the risk assessment are not determinative. Other factors may also need to be considered, depending on the individual circumstances of the breach. The risk assessment performed and conclusions reached by the covered entity or BA should be documented.
Additionally, the definition of breach has been changed by removing the exception for limited data sets that do not contain any dates of birth and zip codes.
Notice Requirements
Only a few changes have made to o the breach notice requirements. These include:
• A covered entity must notify the Department of Health and Human Services of all breaches affecting fewer than 500 individuals not later than 60 days after the end of the calendar year in which the breach was discovered rather than when the breach occurred
• Covered entities may delegate responsibility for breach notifications to a BA provided the BAA provisions provide that the BA has the same obligations that the covered entity has under the final regulations
• The plan is not required to incur costs to print or run a media notice, when it must provide notice of a breach to the media (i.e., breaches involving 500+ individuals in a state or jurisdiction). Also, media outlets are not obligated to print or run information about breaches when they receive notifications about them.
• The plan must provide notice within 60 days after the plan discovers the breach (rather than 60 days after the breach occurred), when the notice of a breach affects fewer than 500 individuals.
For this purpose, discovery means the first day on which an employee, officer other agent of the covered entity or BA knows or should know by exercising reasonable diligence of the breach.
5. Use and Disclosure of PHI
Use and Disclosure of PHI for Marketing Purposes
Individuals must now provide authorizations for certain communications where covered entities use or disclose PHI and receive financial remuneration for making the communications from a third party whose product or service is being marketed.
The Department of Health and Human Services clarified that remuneration related to marketing communications must be from or on behalf of the entity whose product or service is being described as well as it being in exchange for making the communication itself. Even if a BA, rather than the covered entity, receives the payment, the communication would be considered a marketing communication.
A covered entity must obtain an individual’s authorization prior to using or disclosing PHI about the individual for marketing purpose other than the following:
• treatment or health care operations activities that are made face-to-face, or
• The provision of a promotional gift of nominal value to the individual.
The definition of marketing does not include:
• refill reminders or other communications about a drug that is currently prescribed for the individual, as long as the financial remuneration received is reasonably related to the cost of making the communication
• promoting health in general, not promoting a specific product or service
• information related to government and government-sponsored programs
Use of PHI for Fundraising Purposes
If a covered entity (or a BA), uses an individual’s PHI for purposes of raising funds, the communication’s recipient must be provided with a “clear and conspicuous” opportunity to opt out of receiving any further fundraising communications. The method for “opting out” is left up to the covered entity to determine. However, the opt-out process may not create undue burden or more than nominal cost for the individual.
The use and disclosure of the following types of PHI can be used for fundraising:
• Demographic information relating to an individual,
• Dates of health care provided to an individual,
• Department of service information,
• Outcome information, and
• Health insurance status
However, the rule that when using PHI to make fundraising communications, the minimum necessary standard still applies and only the minimum amount of PHI necessary to accomplish the intended purpose may be used or disclosed is still applicable.
Prohibition on Sale of PHI
A covered entity or BA is only allowed to receive remuneration (direct or indirect) in exchange for the disclosure of PHI if an individual’s authorization is granted. The authorization must state that direct or indirect remuneration is being received in exchange for the PHI, unless an allowed exception applies. Sale of protected health information is defined as the disclosure of PHI by a covered entity or BA, where the entity or BA directly or indirectly receives remuneration from or on behalf of the recipient of the PHI in exchange for the PHI. The exceptions to the prohibition of the sale of PHI are:
• For public health purposes
• For treatment of the individual and payment purposes.
• For the sale, transfer, merger or consolidation of all or part of a covered entity and for related due diligence purposes if the recipient of the PHI is or will become a covered entity
• For research purposes, if the remuneration is cost-based
• Services rendered by a BAA under a BAA at the specific request of the covered entity, as long as the remuneration is cost-based
• Providing an individual with access to the individual’s PHI
• As required by law
• For any other purpose permitted by HIPAA
Other Changes to Use and Disclosure of PHI
PHI stored in electronic devices such as photocopiers, fax machines, and other devices is now subject to the Privacy and Security Rules.
Covered entities are now permitted to disclose decedents’ PHI to family members and others who were involved in decedents’ care or payment for care prior to death, unless the covered entities know that such disclosure would be inconsistent with the decedents’ prior expressed wishes. If such disclosure will be allowed by the covered entity, it must be limited to PHI relevant to the family members or other persons’ involvement in the decedents’ health care or payment for health care.
Additionally, a covered entity may disclose proof of immunizations to schools in states that have laws that require the school to have such information prior to admitting a student. Although written authorization for the disclosure is not required, it is encouraged.
6. Changes to Patient Rights
Right to Access Protected Health Information
If individuals requests electronic copies of PHI that are maintained electronically in one or more designated record sets, covered entities must now provide access to the information in the electronic form and format requested by the individual, if readily producible.
If not readily producible, covered entities must provide the PHI in a readable electronic form and format which is agreed to by the covered entities and the individual, such as Word, Excel, text, HTML, or text-based PDF. Additionally, the final regulations provide:
• A plan must respond to such a request within 30 days of the request, with a one-time 30-day extension when necessary. If a plan takes the 30-day extension, it must provide written notice to the individual of the reasons for delay and the expected date for completing the request.
• If an individual declines any readily producible electronic format, the plan must provide a hard copy as an option.
• A plan can require individuals to make these requests for PHI in writing.
• A plan is not required to scan paper documents to provide electronic copies.
• If requested, a plan must transmit the copy of PHI directly to another person designated by the individual who is the subject of the PHI. If an individual directs the plan to send a copy of PHI to another person, the request must be in writing, signed by the individual, and clearly identify the designated person and where to send the PHI. The plan must implement reasonable policies and procedures to verify the identity of any person who requests PHI and implement reasonable safeguards to protect the information used or disclosed.
• With respect to PHI from an electronic health record in electronic form, a plan cannot charge more than labor costs in responding to an individual’s request. These costs may include skilled technical staff time spent to create and copy the electronic file or time spent preparing and explanation or summary of the PHI, if appropriate. A plan also can charge for the cost of supplies (such as CDs or USB drives) for creating the copy of PHI, if the individual requests the electronic copy on portable media, and associated postage.
Restrictions on Disclosures by Health Plans
The processes surrounding the requirement that covered entities must comply with an individual’s request to restrict disclosure of PHI to a health plan if certain conditions are met have been clarified. Under the final regulations:
• Health providers are not required to maintain separate medical records when a request to restrict disclosure is made, but they are required to use some method to identify which portions of the medical records are subject to the restriction request.
• If a restriction is requested where payment is pending, health providers must either make reasonable efforts at resolving the payment issues before disclosing PHI or should request payment in full at the time of the requested restriction.
• If an individual requests a restriction, it is the individual’s responsibility – not the health providers – to notify any other providers who might be impacted.
• HMO contractual requirements do not negate a provider’s responsibility to adhere to a request to restrict disclosures.
7. Penalties
Consequences of Noncompliance
The final regulations significantly increase covered entities and BAs potential exposure to civil monetary penalties and creates uncertain risk. First, covered entities and BAs will be liable under federal common law of the acts of their agents.
Next, the assessment of penalties will be left to fact specific analyses and the Department of Health and Human Services’ discretion. There are four categories of HIPAAA violations that reflect increasing levels of culpabilities accompanied by four tiers of significantly increased monetary penalties. These include:
Tier 1: For violations in which it is established that the covered entity of BA did not know and, by exercising reasonable diligence, would not have known that the covered entity violated a provision, an amount not less than $100 or more than $50,000 for each violation
Tier 2: For a violation in which it is established that the violation was due to reasonable cause and not to willful neglect, an amount not less than $1000 or more than $50,000 for each violation
Tier 3: For a violation in which it is established that the violation was due to willful neglect and was timely corrected, an amount not less than $10,000 or more than $50,000 for each violation
Tier 4: For a violation in which it is established that the violation was due to willful neglect and was not timely corrected, an amount not less than $50,000 for each violation
A penalty for violations of the same tier will not exceed $1.5 million in a calendar year, but multiple violations of multiple requirements may be subject to the maximum penalty of $1.5 million times the number of requirements violated.
The maximum penalty amount will not necessarily be levied in all cases. There will be a determination based on factors including but not limited to: the nature and extent of the violation; the harm resulting from the violation; prior offenses or compliance of the entity involved; and the financial condition of the entity.
The final regulations provide insight into the application of penalties. In the case of a breach that affects multiple individuals, the number of violations will be based on the number of individuals affected. In the case of a breach that is continuous over a period of time, the number of violations will be based on the number of days that the entity did not have the breached information sufficiently protected. In the case of a breach involving violations of two or more provisions, a separate calculation may be made for each provision breached.
Increased penalty amounts may be levied if the violation due to willful neglect is not corrected within 30 days. Under the final regulations, for violations involving willful neglect, additional penalties may be assessed if the entity does not correct within 30 days. The 30 days begins to run when the entity first has actual or constructive knowledge of a violation due to willful neglect.
8. GINA Implementation
The Department of Health and Human Services’ proposals have be adopted to:
• Provide that genetic information is considered health information for purposes of HIPAA privacy rules and therefore subject to HIPAA privacy requirements;
• Prohibit all health plans that are subject to HIPAA privacy rules from using or disclosing PHI that is genetic information for underwriting purposes (except with regard to insurance issuers of long term care policies);
• Revise the HIPAA requirements relating to Notices of Privacy Practices for health plans that perform underwriting;
• Make conforming changes to definitions and other provisions of the HIPAA privacy rules; and
• Make technical corrections.
For a copy of the final regulations, please click on the link below:
Larry Grudzien is an attorney practicing exclusively in the field of employee benefits. He has experience in dealing with qualified plans, health and welfare, fringe benefits and executive compensation areas. He has more than 35 years of experience in employee benefit law and is an adjunct faculty member of John Marshall Law School’s LL.M. program in employee benefits and at the Valparaiso University School of Law, where he teaches a number of courses.
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March 2013 – The Patient Protection and Affordable Care Act (PPACA) has had a significant impact on the way in which employers and plan sponsors will administer their health plans. One of the more hotly debated issues involves the definition of “full-time employee” for purposes of PPACA. This definition directly impacts several important PPACA provisions, including the determination of applicable large employer status, employer shared responsibility penalty determinations and calculations and future automatic enrollment provisions.
Under PPACA, a “full-time employee” is defined as an employee who was employed on average at least 30 hours of service per week (or the monthly equivalent of 130 hours of service in a calendar month). This is a departure from what many employers have historically considered to be full-time, which was typically 36-40 hours per week. Despite a high volume of public concern and comment from the employer and plan sponsor community, the recently released proposed regulations relating to the employer shared responsibility provisions clarified that the Agencies opted to retain the 30 hours per week threshold.
An important item to note is that the most recent guidance clarified that the definition has changed from 30 or more hours worked per week (as was indicated in previous guidance) to 30 or more hours of service per week (or 130 hours of service per month). When determining an employee’s hours of service an employer must consider not only hours when work is performed, but also hours for which an employee is paid or entitled to payment even when no work is performed (vacation, holiday, illness, incapacity/disability, layoff, jury duty, military duty or leave of absence). The general rule is that all periods of paid leave must be counted (and not unpaid leaves). However, the proposed regulations also provide that periods of “special unpaid leave” must be counted towards hours of service. “Special unpaid leaves” refers to leaves of absence under the Family and Medical Leave Act of 1993 (FMLA), as amended, and the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA), as well as any unpaid leave on account of jury duty.
While the definition of full-time employee is uniform for all employer shared responsibility provision purposes under PPACA, the way in which an employer is permitted to count/measure the number of full-time employees differs for purposes of determining applicable large employer status and for purposes of employer shared responsibility penalty calculations. The determination of who is a full-time employee for purposes of the employer shared responsibility provisions involves complex rules and analysis. Therefore, employers should carefully review their workforce to determine which employees may be considered to be full-time for purposes of PPACA and work closely with their benefits consultants and legal counsel in order to be prepared for the fast approaching 2014 effective date.
*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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Please join the Michigan Business & Professional Association for a Webinar on March 21, 2013 at 2 PM (Eastern Time). This webinar will review all compliance issues with wellness programs in 2014.
This Webinar will be approximately 60 minutes in length.
This review of the new compliance requirements for 2014 includes:
From this Webinar, you will learn:
Review of the various wellness programs
The new requirements for alternatives
New limits for smoking cessation programs
Problems with the employer mandates
Issues with ERISA GINA and ADA
This will be conducted by Attorney Larry Grudzien. Title: Compliance Issues with Wellness Programs in 2014 Date: Thursday, March 21, 2013 Time: 2:00 PM – 3:00 PM EDT
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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To help member businesses reduce their costs, the Associations are providing complimentary services such as Section 125 Plans and Summary Plan Descriptions (SPD) documents to all dues paying members in good standing.
The adoption agreements are now compliant documents reflecting ALL the Health Care Reform Law changes as of January 2013. These documents are FREE to our members. The cost to non-members is $50 each.
New Summary of Benefits Coverage (SBC) Option:
Simply send us your clients SBC and MBPA-MFBA will make a combined SPD/SBC customized document. This service is available to all Association Members who have BCBSM insurance through MBPA or MFBA.
MBPA-MFBA will create a combined document in its original DOL mandated form with no alterations, as permitted pursuant to the DOL final regulations.
MBPA –MFBA will issue this combined document with a letter containing clear disclaimers about differences in distribution requirements for SBC’s and SPD’s, consulting their own legal counsel, etc…
NEW Material Modification Sheet Available:
Now Available for Summary Plan Description by request. Please contact the Membership Service Team at 888-277-6464 or info@michbusiness.org
What’s Different about MBPA-MFBA’s Summary Plan Descriptions?
The Employer Retirement Income Security Act (ERISA) guidelines make it mandatory for all businesses with 2 or more employees to provide employees with a Summary Plan Description. We continue to take a leading role in informing and helping our members meet their obligations under ERISA.
Types of benefits covered by Summary Plan Descriptions include: Medical, Long Term Disability, Short Term Disability, Life/AD&D and freestanding Dental/Vision.
The MBPA-MFBA SPD is a comprehensive document that satisfies the all Department of Labor (DOL) requirements for SPDs.
The MBPA-MFBA SPD can be tailored to cover all of an employer’s employee benefit plans, and is not limited to only insured medical or medical/vision bundled programs.
The MBPA-MFBA is essentially a “wrap plan SPD” under which an employer can combine all of its benefits into one plan and one plan document for ease of administration and for purposes of DOL reporting requirements (e.g. Form 5500s) for those employers subject to such reporting.
The MBPA-MFBA SPD can be used for both insured and self-insured benefits.
Section 125 Document:
The Section 125 Plan has a separate adoption agreement from the Benefits Wrap SPD adoption agreement. The Benefits SPD adoption agreement is one compliant document rather than creating 5 different forms for different types of plans.
For Section 125s: 1) Download the adoption agreement from our Agent Pavilion; 2) complete it IN WORD FORMAT and return it to us at info@michbusiness.org with your complete contact information, 3) we will complete the materials and return them to you within two working days.
NOW, Two Easy Ways to Get Your Client’s SPD for Active Members:
1) Let Us Do It For You:
Access an SPD adoption agreement from our Agent Pavilion
Complete it and e-mail it back to us IN WORD FORMAT at info@michbusiness.org, being sure to provide your complete contact information
We complete and return the documents within two working days.
2) Create Your Own On-Line (NEW):
Go to our Agent Pavilion and click on Summary Plan Description on the main menu.
Follow the instructions to create your client’s plan…..you can save it in your client’s ‘library’ for their/your future use.
We look forward to continuing to provide you and your clients with the most up to date and easily accessible services in this important area.
If you have questions or are in need of assistance, please contact our Member Services Team at 1-888-277-6464 or 1-586-393-8800.
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The MBPA and MFBA are partnering with Management Impact and EctoHR, Inc., two established, Michigan-based companies, providing free expert consultation services and tailoring the best human resources practices and solutions at discounted prices for your groups.
MBPA/MFBA Members receive a free consultation and discounted services
Provide a primary point of contact for all your human resources needs.
Initial Assessments
Provide a confidential review and assessment of legal regulation issues and areas of concern that should be addressed to meet current and future needs and compliance.
Handbook Development and Updating
Complete an analysis of policies and procedures and make recommendations for creation and/or modifications for local, state, and federal compliance.
Recruitment Services
Develop and enhance recruiting programs to align the right people in the right roles.
Pre-employment Background Checks
Make informed hiring decisions using criminal histories, personality profiles and more!
Training, Coaching, and Mentoring
Design training and employee development directly around organizational needs.
Performance Management
Evaluate, design, develop and maintain effective/objective performance measures/metrics.
Wellness Initiatives
Develop, implement, and provide on-going support for promoting employee wellness.
Let us Make your Business Better, contact us at: (888)277-6464 Fax (586)393-8810 www.michbusiness.org
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Under Sections 1311 and 1413 of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) must develop and provide each state with a single, streamlined enrollment application form. States also may elect to develop and use their own application, with approval by CMS.
On January 29, 2013, CMS published the draft online and paper applications for the Individual Marketplace and the Small Business Health Options Program (SHOP).
What is the Individual application process?
CMS is designing the online application to be a dynamic process that will tailor the required data to the applicant’s individual circumstances and responses to specific questions. As provided in previous rulemaking, individuals will be able to submit an application online, through the mail, over the phone or in person.
The goal is to solicit enough information during the application process so that in most cases no further inquiry will be needed. The Marketplace will begin taking applications for coverage when open enrollment begins on October 1, 2013.
How is the online application intended to work?
The online system will be designed to catch inadvertent errors instantly and verify most information immediately. It will also allow individuals to save information through a unique user account and access instant help resources.
The length of time it takes to complete the application will vary depending on whether a person is applying for Marketplace-only coverage or coverage in an Insurance Affordability Programs (e.g., Medicaid, CHIP and advance payment of the premium tax credit).
Do applicants have to apply online?
Individuals are encouraged to apply online, but there will also be a separate paper application. Applications can be submitted without all required information. The instructions indicate that an eligibility determination will be available within one to two weeks of submitting the application.
The application includes a reminder about the availability of financial assistance, highlighting that a family of four with an annual income of $92,000 may qualify for help.
What is the Employer Coverage Form?
An Employer Coverage Form is available to help applicants obtain necessary information about access to employer-sponsored coverage, which pertains to eligibility for Insurance Affordability Programs (Medicaid, CHIP and advance payment of the premium tax credit). This form can be taken to an employer, who will provide information about the employer-sponsored coverage (e.g., eligibility for coverage; minimum value standard; cost of lowest cost plan).
In addition to the information identified above, CMS plans to develop online help resources such as pop-ups and links to explanations. CMS believes these resources will help individuals successfully complete the online application. This information is expected to be developed in the next several weeks.
How does the SHOP application process differ from the Individual process?
While much of the information for the Individual application process aligns with the SHOP guidance, some things differ greatly, for example, for SHOP:
Eligibility application does not contain questions about employee finances.
Brokers cannot use the paper application, so employers who choose to use a broker will apply online.
Employers are required to attest that they are offering coverage to all full-time employees and to submit an employee roster.
Employers will receive a follow up notice on their eligibility within 3 to 4 weeks of submitting a paper application.
The Employer Coverage Form does not apply at all for the SHOP.
Comments on these draft application materials are due February 28, 2013.
Where can I find more information?
You can view two YouTube videos – one for an individual and one for a family of three – demonstrating the online application experience. In addition, the draft online and paper applications for the Individual Health Insurance Marketplace and SHOP are available at:
Individual Application for Eligibility and IAPs
SHOP Employer Application
SHOP Employee Application
You may have heard the Health Insurance Marketplace (Marketplace) previously referred to as the Exchange. The Health Insurance Marketplace is the official name adopted by the Department of Health and Human Services (HHS) and BCBSM/BCN. The Blues agree this is a more consumer-friendly term.
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Changing health care regulations and rising costs are creating benefit gaps and knowledge gaps. To help you and your clients with these issues, we’ve partnered with Colonial Life & Accident Insurance Company. At no direct cost to your business, Colonial Life can help you save time, fill gaps and add value to your benefits program.
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1-to-1 benefits counseling and education on all benefits – including wellness.
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CCH HRAnswersNow access, a valuable online HR library.
Hassle-free benefits administration through secure, web-based services.
Imagine the time and resources you could save with:
Fewer questions and hours spent educating employees about their benefits.
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Increased employee satisfaction and retention – which means being able to attract and retain top talent.
Colonial Life’s voluntary benefits, such as accident, cancer, hospital confinement indemnity, and critical illness, are designed to help employees pay for what their health insurance doesn’t and add financial protection for their future. Employees choose the benefits that best meet their individual and family needs.
Colonial Life’s coverages share important features:
Benefits are paid directly to the employee, unless specified otherwise, regardless of insurance the employee may have with other insurance companies.
Employees can keep most plans when they retire or change jobs with no increase in premiums.
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By Bonnie Bochniak
Vice President, Government Relations
MBPA/MFBA
March 2013 – With the October 1, 2013 date of open enrollment approaching for individuals wanting to participate on the federal healthcare exchange, many people are feverishly scanning the draft enrollment process to get a feel for what lies ahead.
At first blush, the process for a family of three is a 15-page application. The outline of the online version has 21 steps, with some having additional questions. After submitting your application, the plan then is sent through three major federal agencies, including the IRS, who examines your paperwork, double checking your identity, income and citizenship. The analysis of your application is supposed to happen in real time, if you apply online.
The initial application process is step one, as this lets you and the federal government know if you qualify for any financial assistance. Since the PPACA is means-tested, lower income individuals will qualify for the most financial support when paying premiums. If you or your spouse had a change in financial status that the federal government isn’t aware of, that might qualify you or disqualify you for financial assistance, additional paperwork would have to be submitted and additional questions answered.
After the financial portion is complete, then the individual, family or business, moves onto choosing which health plan suits them best. Choosing a health plan will require additional steps, and a general knowledge of insurance terminology. The federal government states that this process should take individuals on average 30-45 minutes to complete, with the ability to walk away from their computer to gather needed materials, and save their place on the program.
The unanswered question still remains, will individuals be able to navigate on the web portal themselves, or out of frustration will they opt out and go back to the private market. The general feedback is that this application and choosing one’s own healthcare will be more complex and take more time to fill out than the estimated 30-45 minute timeframe. This then beckons to question the necessity for the insurance agent’s role both on and off the exchange to help navigate individuals towards the right plans for them, their families and/or their business.
From what we have seen thus far, the role of the insurance agent will be needed now more than ever before, to help guide an individual, a family or a business both on and off the exchange. As we move closer to the January 1, 2014 deadline, more details will become available, and we will share those with you. As always, please contact our government relations team at bbochniak@michbusiness.org or by phone at 586-393-8800.
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