Overwhelmed by ACA Reporting Requirements? The MBPA Launches 6055 & 6056 Reporting Program with BASIC

The Affordable Care Act (ACA) imposes demanding information reporting responsibilities on employers starting with the 2015 calendar year.  The reporting stipulation states that an information return will be prepared for each applicable employee, and these returns must be filed with the IRS using a single transmittal form (Form 1095-C & 1094-C).  The filing requirements are based on an employer’s health plan and number of employees.

The MBPA is pleased to offer members relief and assistance via our HR Solutions partner BASIC. BASIC offers two stand-alone ACA Filing solutions – below is the breakdown on the service Options available depending upon your Company’s needs.

Option #1

Year-End Filing

•    For employers with simpler ACA reporting needs
•    Ideal for Banks, Manufacturers, Medical Offices, Law Offices, and other employers with a low variable hour population
•    Perfect for employers with the ability to collect and report on enrollment data
•    Calculates employee count and number of forms for 1094-C
•    Produce, distribute and file forms 1094-C and 1095-C* (additional cost*)

Option #2

Monthly Tracking & Year-end Filing

•    For employers with complex variable hour employee measurements
•    Ideal for Restaurants, Schools, Casinos, Staffing Agencies and Retail
•    Determine Your Applicable Large Employer (ALE) Status
•    Categorize and Monitor Employee Eligibility Monthly (Full Time, Full Time Equivalent, Variable Hour and Seasonal)
•    Produce, Distribute and File Forms 1094-C and 1095-C* (additional cost*)

IRS Penalties

•    $3,000 per incorrectly classified employee who receives subsidy
•    $2,000 per FTE employee not offered coverage
•    $250.00 per incorrect filing

Promotional Pricing for BASIC’s Stand- Alone ACA Filing, with Option 1 or Option 2 is available for a limited time! 

Contact BASIC today for a proposal or for more information about any of BASIC’s HR Solutions speak with a sales consultant – Call 800.444.1922 x3 or visit

Understanding PPACA Reporting Requirements by Laura Kerekes

Very few of us are ready for the new PPACA reporting requirements. Many of us are aware that reports are due at year end, but haven’t even looked at the rules. Should we be concerned? The answer depends upon your company size and how your organization funds its group health benefits.

What are we talking about? The requirement mandates applicable large employers (those with 50 or more full-time equivalent employees) and small employers (under 50 full-time equivalent employees) sponsoring self-funded health plans to report on group health coverage offered to employees or to disclose that health coverage was not offered to employees in 2015. There are two reports employers must prepare: (1) an annual information return that is filed with the Internal Revenue Service (IRS), and (2) statements to provide to full-time employees about the group health plan coverage offered. As such:

* Internal Revenue Code § 6056 requires applicable large employers with fully-funded health insurance to provide the annual statement (IRS Form 1095-C) to each full-time employee detailing the employer’s health coverage offer.

* Internal Revenue Code § 6055 requires employers that provide minimum essential coverage under a self-funded (uninsured) plan to provide the annual statement to covered employees (either IRS Form 1095-B or 1095-C, based on company size).
* Employers also must file copies with the IRS using one of the Forms 1094transmittal documents.

The new reports are intended to help the IRS administer provisions under the Patient Protection and Affordable Care Act relating to the individual and employer mandates for health coverage. Specifically, the IRS will use    information reported by employers to determine:

* Whether applicable large employers failing to offer affordable minimum value coverage to full-time employees may be subject to potential penalties;

* If employees are (or are not) eligible for subsidies when they purchase health insurance in the individual health Insurance exchange; and

* Whether individuals who are enrolled in minimum essential coverage satisfy PPACA’s individual mandate.

The bottom line is that these are important tax forms with potentially serious financial consequences to employers. Under the employer shared responsibility provisions of PPACA, often called “play or pay,” year-end is when employers tell the government, through these reports, whether or not they chose the “play” option by providing their full-time employees and dependents affordable minimum essential health coverage that satisfies PPACA mandates or whether they may have to “pay” the employer shared responsibility premium penalties outlined in the law. Experts predict that these forms will receive a very high level of scrutiny by the government, so employers need to produce accurate and complete reports.

How will employers know if this reporting requirement applies to them?Applicable large employers subject to this reporting include all employers with 50 or more full-time employees and full-time equivalent employees, including governmental and nonprofit employers. A full-time employee is generally defined as a common-law employee averaging 30 or more hours of service per week, and an hour of service includes each hour in which payment is made or due to the employee, including hours worked, vacation, holiday, paid time off, or other types of leaves. Small employers with under 50 full-time equivalent employees offering insured group health plan coverage are exempt from the reporting requirements, with one exception: Small employers sponsoring self-funded health plans are subject to reporting requirements under Code § 6055.

While PPACA offered some employers (those with 50–99 employees) transition relief in 2015 from potential employer shared responsibility coverage penalties, this relief does not extend to the new reporting requirements.

When must these be filed? The requirement applies for calendar year 2015 with reports due in early 2016:

• 2015 Form 1095 (employee statement): Due February 1, 2016.

• 2015 Form 1094 (transmittal  form with copies of Forms 1095-C): Due February 29, 2016 (or March 31, 2016, if filing electronically).

The due dates are the same as the due dates for Forms W-2 and W-3 for the same calendar year.

This should be simple, right?
Simple, probably not. Doable, absolutely yes. Keep in mind these are IRS forms.

ThinkHR recently conducted an informal poll of its customers to determine how knowledgeable they felt about the reporting requirements and learned that 75 percent were not confident that they knew enough today to file the reports. In addition, PricewaterhouseCoopers (PwC) conducted a survey in the first quarter of 2015 with 480 employers in 36 different U.S. industries that confirmed these new requirements are presenting challenges and many employers have not decided how they will comply.

The year is half over and for those employers that haven’t started collecting the required data, it is time to get started. While many employers believe that their payroll systems are capturing all of the data they need, this may not be the case. The PwC report revealed that 65 percent of survey participants indicated that the quality of the data available was a concern, because for many employers there are other systems outside of payroll that may be capturing the information needed, such as the company’s HRIS, benefits administration, time off and leave of absence administration systems as well as having data housed with outside third party vendors. The results also show that many of the survey participants are considering outsourcing this function to outside vendors. Because this information must be aggregated on a month-by-month basis, compliance managers are seeing the time slipping away to organize all of this information and determine the right solution.

What information should employers be collecting? Employers will need the following information in order to complete the reports:

    * Identifying information for the employer and employee, such as name and address.

    * Names of full-time employees for each month of the year.

    * Information about the health coverage offered by month, if any.

    * The employees’ share of the monthly premium for the lowest-cost self-only minimum value coverage.

    * Months each employee was enrolled in the coverage.

    * Months the employer met an affordability safe harbor with respect to an employee and whether other relief applied for an employee.

    * If the employer offers a self-funded plan, information about the covered individuals enrolled in the plan, by month.

    * Information about whether the employer offered coverage to 70 percent of full-time employees and their dependents in 2015 (after 2015, this threshold changes to 95 percent).

    * Total number of Forms 1095-C the employer issued to employees.

    * Information about members of the aggregated applicable large employer group, if any.

    * Full-time employee counts by month.

    * Total employee counts by month.

    * Whether employers are eligible for certain transition relief.

Tips to get started. To make the end of the year reporting easier, employers should:

1. Learn the details of the filing requirements and compliance requirements for the company.

2. Pull together the internal team (human resources, finance, and legal) to determine who owns this reporting responsibility and ensure that the company’s internal system(s) and third party vendors are capturing all of the data required for accurate and timely reporting.

3. Understand that the information will come from various sources, both inside and outside the company. Some of the information will be housed in benefits, payroll, and reporting time off data. For applicable self-funded plans, employers may need to start collecting Social Security numbers for dependents.

4. Determine if the reporting will be outsourced to a third party vendor and ensure that the information the vendor will need is available for reporting.

5. Review the organization’s compliance with the employer mandate rules. Employee hours of work and benefits eligibility must be captured monthly. If an employer does not count an employee’s hours of service accurately, the worker could be misclassified, and that could lead to an employer mandate (“play or pay”) penalty for failure to offer coverage, a penalty for violating the 90-day waiting period limitation, and/or lawsuits from the employee.

6. Finally, consider now the method of delivery of the reports, especially to employees. If considering electronic communications, get the process and the consents in place before the end of the year.

Get going with these tips to make the year end reporting process smoother. The time is now.

2016 Federally-facilitated Marketplace Agent Registration and Training is now Available

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that plan year 2016 Federally-facilitated Marketplace (FFM) agent and broker registration and training is now available. Training will be offered by CMS on the new Marketplace Learning Management System (MLMS), as well as through the following CMS-approved vendors:

•    America’s Health Insurance Plans, Inc. (AHIP)
•    National Association of Health Underwriters (NAHU)

Agents and brokers will access both the MLMS and CMS-approved vendor training via the CMS Enterprise Portal.
Agents and brokers who are new to the FFM and have not previously registered must create an FFM user ID on the CMS Enterprise Portal, where they must complete identity proofing, request the agent/broker role, complete training, complete an MLMS profile, and execute the applicable FFM Agreements. Returning agents and brokers who previously completed identity proofing or requested the agent/broker role as part of the registration process for a prior plan year do not need to repeat these steps during the annual registration renewal process. Please ensure that you are using the same FFM user ID that you used in prior plan years.
If you complete FFM agent and broker training through a CMS-approved vendor, you will still need to execute the applicable Agreements with CMS on the MLMS prior to assisting consumers with selecting and enrolling in health coverage through the FFM.
To ensure the best experience with the MLMS, please use Firefox or Google Chrome as your web browser. If you are unable to access the MLMS, this may be due to a large number of people currently using the system. The MLMS is a new system and we appreciate your patience as our technicians work to provide you with an improved experience over time. The best days and times to access the MLMS are typically Monday through Friday, between 5:00 PM and 11:00 AM Eastern Time and on the weekends.
For additional information please visit the Agents and Brokers Resources webpage. There are a number of links and documents which will help you to learn more about registering to participate in the FFM for plan year 2016. The website will be updated over the coming weeks with additional resources that help explain the registration process. CMS will also provide updates via email blasts, the monthly News for Agents and Brokers newsletter, as well as through Twitter (@CMSGov).
For questions, please contact the FFM Producer and Assister Help Desk at

Blue Alert: Win by Losing Registration Now Open – Get Your Clients Signed Up

What you need to know

Registration has started, and it’s time to get your clients registered for the 13th round of Win by Losing, our free weight-loss competition.

The official Win by Losing site was updated to provide the same valuable content while making it easier for teams to find the materials. Conveniently located at the top of the page, tabs quickly take participants to leaderboards, registration, frequently asked questions and our essential toolkits.

Visit the site to see just how easy it is to navigate.

Action item

Encourage your clients to sign up for the Win by Losing competition at

Time frame

Note the key dates for this fall’s competition:

• Sept. 14: Registration is open.

• Sept. 21: The competition kicks off.

• Sept. 25: Teams begin to submit their total pounds lost for each week by 5 p.m.

• Nov. 20: The competition closes.

How to register teams
Team captains will register at They’ll submit:

• Their company name

• Their email address

• The number of participating employees

Total group starting weight. This is used as the starting point from which we’ll track the company’s progress.

Questions? Contact your Blues sales representative or managing agent.

Blue Alert! Presentation of Taxes and Fees Will Be Updated for 2016 Quotes and Groupwide Changes

Taxes and fees have always been part of the premium charged but were displayed separately on quoting materials. Now certain federal and state taxes and fees will be included in the section that lists premium and stop-loss fees for medical, prescription, dental and vision coverage.

This new presentation follows similar changes to the 2016 renewal packages that we told you about in a recent Blue Alert.

When will quotes and groupwide changes show the new display?

Effective date                                                                Which display?                          

Before group’s 2016 renewal month                                    Current display: Taxes are shown separately from premium and stop-loss fees.
Effective as of the group’s 2016 renewal month                    New display: Only the total premium or stop-loss fee is shown.

                                                                                        Note: For self-funded groups with stop-loss coverage, the display will still show the Michigan Claims Tax on a separate line.

More information on 2016 quotes

You should know that:

   * The new display will apply to quotes effective as of the group’s 2016 renewal month.
   * Disclaimers in 2016 quotes have also been updated.
   * Self-funded groups with stop-loss coverage will continue to display the Michigan Claims Tax as a line item that is separate from the stop-loss fees.

New business quotes effective as of Jan. 1, 2016, will also use the new display, with one exception:

New business quotes for experience-rated groups with 100 or more enrolled contracts and self-funded groups with 50 or more enrolled contracts will continue to show a separate column for taxes and fees that are included in the     premium. This display will be shown for groups that are new to Blue Cross Blue Shield of Michigan and Blue Care Network, as well as established groups who are adding a line of business or adding 33 percent or more in contracts to their plan.

Note: Quoting tools will be updated in time for 2016 quoting.

For more information about 2016 quotes and groupwide changes, please refer to this talking points document.

Note: The online Health Insurance Taxes and Fees Estimator will be updated in the near future. It will show a total of the estimated taxes and fees included in the premium.

Questions? Contact your Blues sales representative or managing agent.

Health Coverage: New IRS Guidance on Forms 1094 and 1095

The IRS has provided both new and updated Q&A guidance on the reporting requirements for applicable large employers under the federal tax code. As background, beginning in 2016,  applicable large employers must file Forms 1094 and 1095 to provide information to the IRS and plan participants about health coverage provided in the prior year.

The forms are used by the IRS to enforce employer penalties according to the federal tax code, as well as individual mandate and tax credit eligibility rules. The latest guidance consists of an updated Q&A document covering basic reporting requirements and a new Q&A document addressing more specific issues that may arise while completing Forms 1094 and 1095.

Here are some highlights:

* Clarifications on who must report. The guidance clarifies that an applicable large employer with no full-time employees for any month of the year is not obligated to report unless the employer sponsors a self-insured health plan in which any employee, spouse, or dependent is actually enrolled. In that case, it must still file Forms 1094-C and 1095-C even if it has no full-time employees. The guidance also confirms that an applicable large employer must file and provide Form 1095-C to all full-time employees regardless of whether they were offered coverage during the year.

* Controlled groups. Examples show how reporting differs where an applicable large employer reports for separate divisions and where applicable large employers are part of a controlled group. In the former situation, employees working for multiple divisions must receive aggregated information on a single Form 1095-C. In the latter situation, employees will receive a separate Form 1095-C for full-time employment with each applicable large employer in the controlled group.

* Qualifying offer method of reporting. The updated Q&As now address reporting under the qualifying offer method, which allows applicable large employers to furnish a simplified employee statement to employees receiving qualifying offers for all 12 months of the year. The Q&As emphasize that use of simplified statements is not available for employees who actually enroll in an applicable large employer’s self-insured health plan.

Note: No mention is made of the qualifying offer method transition relief available in 2015, which allows an applicable large employer to use a different simplified statement provided that it makes qualifying offers to at least 95% of its full-time employees.

* Delivery to employees. The guidance confirms that a Form 1095-C may be delivered to employees in any manner permitted for delivery of Form W-2, including hand-delivery. However, unlike Form W-2, employers need not furnish a midyear Form 1095-C upon an employee’s request following termination of employment.

* New hires and terminating employees. When reporting offers of coverage on Part II of Form 1095-C, applicable large employers may indicate that an offer of coverage was made for a month only if the offer would have provided coverage for every day of the month. Therefore, applicable large employers should report on Form 1095-C that no coverage was offered in the month an employee was hired (unless an offer of coverage extended to every day of that month). Similarly, if a terminating employee’s coverage ends before the end of the month of termination, the applicable large employer must report that no coverage was offered for the month. (In each case, the applicable large employer may be able to avoid liability for employer penalties under the federal code, even though coverage was not offered for the full month.) In contrast, when reporting coverage information under Part III of Form 1095-C, an employee should be reported as having coverage if the employee is enrolled on any day of the month.

The disparate treatment of partial months of coverage highlights the multiple purposes of Form 1095-C. Under the federal tax code, applicable large employers generally get credit for offering coverage for a month only if the offer applies to the full month — but an individual avoids the individual mandate penalty for a month by having coverage on any day of the month.

* Third-party reporting. The guidance verifies that applicable large employers may designate third parties to perform reporting on their behalf. The new Q&As confirm that a governmental applicable large employer may designate another governmental entity to accept reporting responsibility on its behalf; they also explain the allocation of responsibilities under various combinations of self-insured and fully insured coverage options.

* Reporting offers of COBRA coverage. New Q&As illustrate reporting under various COBRA scenarios. The guidance explains how sponsors of self-insured plans should report enrollment information for non-employee COBRA beneficiaries, such as former spouses. Qualified beneficiaries electing COBRA independently from the employee must receive separate forms, while those who have COBRA due to an employee’s election should be included on the same form that is provided to the employee. (As previously noted in the instructions to the final forms, reporting may be made on either Form 1095-B or 1095-C for individuals who were not employees at any time during the year.)

Several examples illustrate how an applicable large employer should complete Form 1095-C for full-time employees who receive a COBRA offer due to termination of employment or a reduction of hours. In general, a COBRA offer made due to termination of employment is reported as an offer of coverage only if the former employee enrolls in COBRA coverage and the employee’s cost of coverage reflects the COBRA premium for the lowest-cost, self-only coverage providing minimum value. In contrast, a COBRA offer made to an active employee due to a reduction of hours would be reported as an offer of coverage on Form 1095-C even if the employee declines COBRA coverage.

Note: Unfortunately, the example used to illustrate this final point does not extend more than 60 days after the loss of eligibility, so it is unclear whether the applicable large employer would still report that coverage is offered after the employee’s COBRA election period has ended.

With mandatory reporting starting in early 2016 (for 2015 coverage), understanding the complexities of the reporting requirements is critical. While some of the Q&As contained in this IRS guidance were previously addressed in the instructions to Forms 1094 and 1095, others provide helpful clarifications and new information. Employers subject to the reporting requirements should give careful attention to this and future guidance as the reporting deadline draws nearer.

BASIC ACA Elevate service options helps employers navigate three critical aspects of the Affordable Care Act (ACA). Our two solutions help you to determine your ACA classification status, manage employee hours for “Full-Time Equivalent” classification and complete the reporting requirements under section 6056. We provide two different service options to fit your company’s needs. ACA Elevate- Option 1 (Year-end Filing) provides year-end filing for those employers with simpler ACA reporting needs. Such as medical offices, banks, law firms and more. ACA Elevate- Option 2 (Monthly Tracking & Filing) is geared towards businesses that require monthly tracking along with year-end filing. Making it ideal for employers with multiple variable hour employees, such as restaurants, casinos, staffing agencies, and other companies with difficult measurement periods.

Blue Alert – Blue Cross, BCN reviewing effect of Supreme Court Same-Gender Marriage Decision on Their Current Policies

Blue Cross Blue Shield of Michigan and Blue Care Network are reviewing their policies on domestic-partner coverage as a result of the U.S. Supreme Court’s decision on same-gender marriages delivered on June 26, 2015. The court ruling announced that states must issue marriage licenses to same-gender couples and recognize same-gender marriages performed in other states.

If you receive questions from groups about this ruling’s effect on domestic-partner coverage, please tell them that we are assessing its effect and will let them know soon about any changes.

Blue Cross and BCN already cover legally married, same-gender spouses under individual coverage and allow groups the option of covering same-gender spouses.

Use the following information to help answer questions you may receive from groups on same-gender marriage and health care coverage:

  * Employer group products:
     Beginning on Jan. 1, 2015, the Center for Medicare & Medicaid Services required that health plans provide customer groups with the option of offering same-gender marriage coverage to their employees. Blue Cross and BCN:

        -Began offering this option to groups on Aug. 1, 2014, ahead of the CMS requirement
        -Have a process in place so that customer groups can elect to enroll same-gender couples

   * Individual coverage obtained on the Health Insurance Marketplace:
      In August 2014, Blue Cross and BCN began processing applications received through the Marketplace from same-gender married couples for Marketplace plans. CMS required health plans to accept applications from legally married,  same-gender couples for individual Marketplace plans by Jan. 1, 2015.

    Off-Marketplace individual products:
    Blue Cross and BCN already enroll same-gender married couples in our off-Marketplace individual products. Legally married, same-gender couples may submit an application for enrollment in an off-Marketplace product online at

Please refer to the Same-gender marriage coverage FAQ for more information. We’ll release additional information in the future.

Questions? Contact your Blues sales representative or managing agent.

The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an educational tool only and does not replace a more rigorous review of the law’s applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. As required by U.S. Treasury regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code.

Blue Alert – Comprehensive FAQ About Taxes and Fees is Available

We’ve combined health care taxes and fees information for both the Affordable Care Act and the state of Michigan into one frequently asked questions document.

Which Taxes and Fees Are Discussed In The New, Comprehensive FAQ?

ACA Taxes and Fees                                                                   State of Michigan Taxes and Fees

* Comparative Effectiveness Research Fee                                        * Michigan Claims Assessment Tax
(also known as the Patient-Centered Outcomes Research                    (also known as the Health Insurance Claims
Institute Fee, or PCORI Fee)                                                              Assessment, or HICA)

* Federal insurance premium tax
(also known as the Health Insurance Tax, or HIT)                              * Michigan Insurance Premium Tax
                                                                                                        (also known as the state insurance premium tax)
* Reinsurance Fee
(also known as the Transitional Reinsurance Fee, or TRF)

* Risk Adjustment Fee

* Marketplace Fee

* High-Cost Health Plan Excise Tax

This comprehensive FAQ will be updated as further guidance is issued from the federal government or the state of Michigan.

Note: If you have questions about quotes, renewals and groupwide changes, read this FAQ about 2016 renewal packages and premiums as well as these talking points.

Questions? Contact your Blues sales representative or managing agent.

Blue Cross Blue Shield of Michigan and Blue Care Network Provide Rebates to Small Business Customers

Several months after Blue Cross Blue Shield of Michigan announced that we are reducing insurance rates for many of our small employer customers in Michigan, another dose of good news is on the way.

Because of lower-than-expected medical costs in 2014, Blue Cross and Blue Care Network are able to refund many of our small employers (with fewer than 50 employees) a small percentage of their 2014 premiums.

A letter (with a check enclosed) will be mailed to more than 24,000 small employers by Sept. 30 to notify them of a rebate of just under 2 percent of their 2014 premiums paid for BCN and one-tenth of 1 percent of premiums paid for Blue Cross.

Why are Blue Cross and Blue Care Network providing rebates?
Plainly and simply, it’s the law.

Months in advance, our actuaries predict the expected use and cost of medical and pharmacy services.

Under the Affordable Care Act, 80 percent of a premium must go to health care claims for small group and individual coverage, and 85 percent for large group employer premiums. By this calculation, many of our small group customers qualified for a rebate this year.

We work every day to keep health care costs down and provide high-quality health care coverage for our customers. We’re committed to addressing health insurance costs through:

For example, our unique and comprehensive partnerships with doctors and hospitals — including our Patient-Centered Medical Home and Value Partnerships  quality improvement programs — are helping to manage medical trends downward by eliminating unnecessary costs and promoting better health for our members.

Do your groups get a rebate?
Managing agents will be contacting agents with groups receiving a rebate.

Timing and requirements
We are required to send rebates directly to employers. Employers are responsible for using the rebate according to federal requirements. For church and non-federal governmental plans, employers must either:

•    Use it to lower the subscriber’s portion of the premium for the upcoming year.
•    Give covered employees a cash refund of the rebate. The federal rules have a number of options for the employer to calculate this amount.

For the federal requirements on how to distribute the rebate if the group is not a church or governmental plan, please visit

We are also required to notify the groups’ employees of the rebate. We will mail this notification a week to 10 days after groups receive their checks. We will notify employers and their employees by Sept. 30, 2015.

Questions? Contact your Blue Cross or BCN sales representative or managing agent.

Important Update: What You Need to Know About Transition 2.0

The Affordable Care Act (ACA) expands the small group market to encompass all employers with 100 or fewer full-time equivalents (FTEs), as of January 1, 2016. This change will have significant impact on groups with 51-100 FTEs, as it will entail a shift into member level rating, metal level plans, and Custom Select prescription drugs. Blue Cross® Blue Shield® of Michigan and Blue Care Network (BCBSM and BCN) have devised strategies for this market segment designed to meet the needs of groups based on their unique demographics.  These strategies are in line with the delays allowable by the ACA under Transition 2.0.

Action Benefits would like to remind agents of the multiple opportunities Transition 2.0 creates for both existing and new-to-Blue business. We have an extensive Transition 2.0 resource library available in the Documents Resources section of our agent website, This section contains forms, marketing pieces, and news articles to guide you through this transition period with your groups.  

The Group Transition Tool is expected to be available on June 15, 2015, on the BCBSM agent portal at, and will offer specific insight as to which strategy will benefit each of your Transition 2.0 eligible groups. The Transition Tool will provide estimated premium changes associated with moving to small group status, and will be an instrumental tool in helping you make recommendations for each group.  

In addition, Action Benefits will be sending agents a list of their impacted groups (if applicable) prior to June 15, 2015. Also, you should expect to be contacted by Action Benefits and BCBSM account representatives to offer assistance in the Transition 2.0 decision for each group.

Action Benefits has also created two helpful quick reference guides that outline the various scenarios for existing and new business, and highlight important deadlines.  We strongly encourage you and your staff to review these job aids prior to discussions with your groups.

As a reminder, BCBSM and BCN have several options available to help customers through this transition:

Transition 2.0:  Allows groups to maintain large group products and rating.  The Blues will renew all January 2016 to October 2016 groups as large groups unless notified by the agent.

Renewal month shift: Allows groups to transition to the small group market sooner, or remain a large group status longer. More details about this option can be found in the Existing Business Transition 2.0 Job Aid.

2015 alternative product offering: Allows groups to modify current benefits today, as well as introduce a lower cost plan to be used as an offering at renewal in 2016 (details regarding adding an alternative plan are being developed).

Self-funding: Allows groups to shift to self-funded coverage to avoid small group product and rating changes.

Private exchange: Employers may choose a defined contribution approach on GlidePathSM.

Existing Business Transition 2.0 Job Aid
Click on the link above for extensive details and important deadlines regarding your existing business.

Remember, all groups of 51-100 FTEs must transition to small group rating and products by their renewal in 2017.

Questions regarding Transition 2.0 and your existing groups? Please contact the Action Benefits Agent Relations Team at 248-356-8585. Our team is well-informed and ready to assist you in determining the best strategy for your affected groups.


New-to-Blue groups interested in maintaining large group status and delaying the transition to small group rating and products will experience the greatest benefit (and delay) by renewing October 1, 2016. The Blues understand that not all groups will find enrolling October 1, 2015 viable, and have developed long and short rating options which will allow groups enrolling any month prior to the end of 2015 to set an October 1 renewal date at the time of enrollment.

Groups that delay their transition to small group rating and products via Transition 2.0 will receive 2016 renewal rate increases capped at or below 9.9 percent (not including taxes and fees). However, all groups must transition to small group rating and products at their renewal in 2017.

New Business Transition 2.0 Job Aid
Click on the link above for extensive details and important deadlines regarding new business opportunities.

Questions regarding Transition 2.0 and new business opportunities, including exciting new-to-Blue incentives for agents? Please contact the Action Benefits Service Representative at 866-501-8727.

Action Benefits is an Authorized Managing Agent for Blue Cross Blue Shield of Michigan and Blue Care Network. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.

The information contained in this communication is highly confidential and is intended solely for the use of the individual(s) to whom this communication is directed. If you are not the intended recipient, you are hereby notified that any viewing, copying, disclosure or distribution of this information is prohibited. Please notify the sender, by electronic mail or telephone, of any unintended receipt and delete the original message without making any copies.