MBPA could help save you thousands of dollars in health care premiums and avoid possible penalties.
With Michigan’s expanded Medicaid program, you could have employees that may be eligible to enroll in the Healthy Michigan Plan, which could save an employer thousands of dollars annually in health care premiums.
If you are an “applicable large employer” who currently does not offer coverage to substantially all of its full-time employees, this would be a proactive way to assist your employees in obtaining health care coverage before the ACA employer shared responsibility penalties take effect. (Applicable large employers with 50-99 full-time equivalent employees (FTE) will be subject to the employer shared responsibility penalties beginning in 2016. Those with 100 or more FTEs will need to start offering health benefits to at least 70% of their FTEs by 2015 and 95% by 2016 in order to avoid potential penalties).
If just 5 employees qualify and choose to enroll in the Healthy Michigan Plan, the employer could potentially save a minimum of $21,000.00 a year!
Although an employer cannot force or coerce employees to enroll in the Healthy Michigan Plan, by simply educating the employees on the Healthy Michigan Plan including potential cost savings to them and possibly better health coverage including lower co-pays and out of pocket expenses than their current group plan, why wouldn’t an employee choose it?
Who Could Qualify for the Healthy Michigan Plan? Individuals who…
• Are age 19-64 years
• Have income at or below 133% of the federal poverty level* ($16,000 for a single person or $33,000 for a family of four)
• Do not qualify for or are not enrolled in Medicare
• Do not qualify for or are not enrolled in other Medicaid programs
• Are not pregnant at the time of application
• Are residents of the State of Michigan
* Eligibility for the Healthy Michigan Plan is determined through the Modified Adjusted Gross Income methodology.
How can MBPA help?
MBPA’s On-Site Enrollment Team will meet individually with employees that may qualify and further evaluate eligibility requirements for the Healthy Michigan Plan. If the employee is found to be eligible and wishes to enroll in the Healthy Michigan Plan, our team will then process their application and provide the employee with any on-going enrollment assistance that may be needed. Also, we would be happy to discuss our onsite service program with your trusted health insurance advisor to ensure they fully understand how this service may benefit you and your employees.
For more information on this new program, contact Jennifer Werner (ext. 166) at 888.277.6464
On July 24, 2014, the IRS released Revenue Procedure 2014-37 to index the Affordable Care Act’s (ACA) affordability percentages for 2015 under the employer mandate. The IRS also adjusted upward the income level under which employees are exempt from the ACA’s individual mandate.
Employer Mandate Adjustment
An applicable large employer’s health coverage will be considered affordable for plan Years beginning in 2015 under employer mandate if the employee’s required contribution to the plan does not exceed 9.56 percent of the employee’s household income for the year, up from 9.5 percent. This increase also applies to the three safe harbors that the IRS created in the regulations.
The reason for the increase is that the employer mandate was originally meant to take effect in 2014 but was subsequently delayed until 2015 or 2016, depending on employer size.
Individual Mandate Adjustment
Revenue Procedure 2014-37 also adjusts the affordability percentage for the exemption from the individual mandate for individuals who lack access to affordable minimum essential coverage. For plan years beginning in 2015, coverage is unaffordable for purposes of the individual mandate if it exceeds 8.05% of household income (as opposed to 8% originally).
This change stems from the requirement that the IRS must adjust the affordability percentage to reflect the excess of the rate of premium growth over the rate of income growth for the preceding calendar year, with each subsequent plan year being adjust accordingly.
For a copy of Revenue Procedure 2014-37, please click on the link below:
http://www.irs.gov/pub/irs-drop/rp-14-37.pdf
If you have any comments or questions regarding any of the above information, please do not hesitate to call me at (708) 717-9638 or e-mail me at larry@larrygrudzien.com
https://mb-wp-uploads.s3.us-east-1.amazonaws.com/2024/04/MichBusiness-logo.png00michbusinesshttps://mb-wp-uploads.s3.us-east-1.amazonaws.com/2024/04/MichBusiness-logo.pngmichbusiness2014-08-22 16:00:452015-10-08 00:00:00IRS Increases ACA’s Affordability Percentages for 2015
Question: My client with 75 full-time employees terminated their group health plan in 2014. When would they be subject to the employer mandate penalty? How is penalty determined?
When the employer mandate applies:
Answer: January 1, 2015
The penalty tax applies to “applicable large employers.” An applicable large employer is an employer who employed an average of at least 50 “full-time employees” on business days during the preceding calendar year, as provided in Code Section 4980H(c)(2)(A).
For 2015, the final regulations provide an important new transition relief for employers with less than 100 employees. If the following conditions are met, no penalty tax will apply until 2016 for employers with 50 to 99 employees:
* Limited Workforce Size. The employer employs on average at least 50 full-time employees (including full-time equivalent employees) but fewer than 100 full-time employees (including full-time equivalent employees) on business days during 2014. For this purpose, the determination of the number of full-time employees (including full-time equivalent employee) is made in accordance with the otherwise applicable rules for determining status as an applicable large employer.
* Maintenance of Workforce and Aggregate Hours of Service. During the period beginning on February 9, 2014, and ending on December 31, 2014, the employer does not reduce the size of its workforce or the overall hours of service of its employees in order to satisfy the workforce size condition set forth above. A reduction in workforce size or overall hours of service for bona fide business reasons will not be considered to have been made in order to satisfy the workforce size condition.
* Maintenance of Previously Offered Health Coverage. Except as otherwise provided in this subsection, during the coverage maintenance period the employer does not eliminate or materially reduce the health coverage, if any, it offered as of February 9, 2014. For purposes of this section, in no event will an employer be treated as eliminating or materially reducing health coverage if:
** it continues to offer each employee who is eligible for coverage during the coverage maintenance period an employer contribution toward the cost of employee-only coverage that either (A) is at least 95 percent of the dollar amount of the contribution toward such coverage that the employer was offering on February 9, 2014, or (B) is the same (or a higher) percentage of the cost of coverage that the employer was offering to contribute toward coverage on February 9, 2014;
** in the event there is a change in benefits under the employee-only coverage offered, that coverage provides minimum value after the change; and
**the employer does not alter the terms of its group health plans to narrow or reduce the class or classes of employees (or the employees’ dependents) to whom coverage under those plans was offered on February 9, 2014. For purposes of this requirement, the term coverage maintenance period means (1) for an employer with a calendar year plan, the period beginning on February 9, 2014, and ending on December 31, 2015, and (2) for an employer with a non-calendar year plan, the period beginning on February 9, 2014, and ending on the last day of the plan year that begins in 2015.
* Certification of Eligibility for Transition Relief. The applicable large employer certifies on a prescribed form filed with the IRS that it meets the eligibility requirements set forth above.
Since the employer terminated its plan in 2014, it is not eligible for the special transitional rule and will be subject to the employer mandate penalty on January 1, 2015.
Determination of the Employer Mandate Penalty Amount:
Generally, the employer mandate penalty under Code Section 4980H(a) is equal to the number of all full-time employees (excluding 30 full-time employees) multiplied by 1/12 of $2,000 for each calendar month.
Since the employer terminated its plan in 2014, it is also not eligible to use a transitional rule that increased the 30 employee reduction to 80 employees.
For 2015, the employer would be subject to a penalty of 75 -30 = 45 X $2,000 or $90,000.
For More Information: If you have any comments or questions regarding any of the above information, please do not hesitate to call me at (708) 717-9638 or e-mail me at larry@larrygrudzien.com.
One of the fundamental flaws of the Affordable Care Act is that, despite its name, it makes health insurance more expensive. Today, the Manhattan Institute released the most comprehensive analysis yet conducted of premiums under Obamacare for people who shop for coverage on their own. Here’s what we learned. In the average state, Obamacare will increase underlying premiums by 41 percent. As we have long expected, the steepest hikes will be imposed on the healthy, the young, and the male. And Obamacare’s taxpayer-funded subsidies will primarily benefit those nearing retirement—people who, unlike the young, have had their whole lives to save for their health-care needs.
41 states, plus D.C., will experience premium hikes
If you’ve been following this space, you know that I and two of my Manhattan Institute colleagues—Yevgeniy Feyman and Paul Howard—have developed an interactive map where you can see how Obamacare affects premiums in your state. (If you ever need to find it, simply Google “Obamacare cost map.”)
In September, we released the first iteration of the map, which included data from 13 states and the District of Columbia. We only had data from a few mostly-blue states because the remainder were mostly participating in the federal exchange, and the federal exchange—for reasons we now understand more fully—hadn’t released any premium information at that time. That analysis found that underlying premiums would increase by 24 percent in those 13 states plus D.C.
Obamacare’s supporters argue that these rate increases aren’t important, because many people will be protected from them by federal subsidies. Those subsidies aren’t free—they’re paid for by taxpayers–and so it is irresponsible for people to argue that subsidies somehow make irrelevant the underlying cost of health insurance. Nonetheless, it’s important to understand the impact of subsidies on Obamacare’s exchanges; later in September, we released a second iteration of the map to do just that.
Today’s release, with the third iteration of the map, contains both premium and subsidy data for every state except Hawaii. (Believe it or not, we’ve had success mining data from every exchange website but Hawaii’s.) This nearly-complete analysis finds that the average state will face underlying premium increases of 41 percent. Men will face the steepest increases: 77, 37, and 47 percent for 27-year-olds, 40-year-olds, and 64-year-olds, respectively. Women will also face increases, but to a lesser degree: 18%, 28%, and 37% for 27-, 40-, and 64-year-olds.
Biggest winners: NY, CO, OH, MA; Biggest losers: NV, NM, AR, NC
Eight states will enjoy average premium reductions under Obamacare: New York (-40%), Colorado (-22%), Ohio (-21%), Massachusetts (-20%), New Jersey (-19%), New Hampshire (-18%), Rhode Island (-10%), and Indiana (-3%). Most, but not all, of these states had heavily-regulated individual insurance markets prior to Obamacare, and will therefore benefit from Obamacare’s subsidies, and especially its requirement that everyone purchase health insurance or pay a fine.
The eight states that will face the biggest increases in underlying premiums are largely southern and western states: Nevada (+179%), New Mexico (+142%), Arkansas (+138%), North Carolina (+136%), Vermont (+117%), Georgia (+92%), South Dakota (+77%), and Nebraska (+74%).
If you’re interested in more details about our methodology, you can find them here. As with our past work, we calculated an average of the five least-expensive plans in every county in a state pre-Obamacare, adjusted to take into account those with pre-existing conditions and other health problems. We then did the same calculation with the five least-expensive plans in every county in the Obamacare exchanges. We then used these county-based numbers to come up with a population-weighted state average pre- and post-Obamacare.
Exchange plans narrow your choice of doctor, despite higher costs
The key thing to understand about our before-and-after comparison is that it is an average. If you’re healthy today, you will face steeper rate increases than these figures indicate. If you have a serious medical condition, however, and haven’t been able to find affordable health coverage as a result, you will do much better under Obamacare than the average person. Men will face steeper increases than women in most states, because women consume more health care than men do, and Obamacare forbids insurers to charge different prices on the basis of gender.
In addition, our comparison ignores other differences between pre-Obamacare and post-Obamacare plans. For example, in some cases, people looking for comparably-priced coverage on the exchanges will need to accept higher deductibles and other cost-sharing arrangements.
Importantly, post-Obamacare exchange plans will typically have narrow networks of physicians and hospitals, especially excluding those tied to prestigious medical schools. In today’s Wall Street Journal, Edie Sundby, who struggles with gallbladder cancer, argues that her pre-Obamacare access to leading academic cancer centers like Stanford has “kept me alive,” and notes that the plans available to her on the exchange don’t allow her to keep her doctor.
Elderly will receive massive subsidies, thanks to younger people
Thanks to community rating, a key feature of Obamacare, insurers are only allowed to charge their oldest customers three times the amount they charge their youngest customers. Because 64-year-olds consume on average six times as much health care as 19-year-olds, this rule has the effect of driving up the cost of insurance for young people.
But there’s a double whammy. Because premiums for those nearing retirement can still be three times higher than those of younger Americans, elderly individuals will disproportionately benefit from Obamacare’s subsidies. The subsidies increase in proportion to the percentage of your income that is tied up in health insurance; for elderly people whose premiums are much higher, the subsidies are higher too.
And when I say young people, I particularly mean young men. A young woman of average income in the average state will experience little net change in premium costs, if you take subsidies into account; 40-year-old women will see an average increase of 9 percent, and 27-year-old women will see an average decrease of 5 percent. (However, as I noted above, women in good health will see meaningfully higher increases than these averages reflect.)
Let’s take the two extremes. If you’re a 27-year-old man, your average premium under our methodology, pre-Obamacare, is $133 a month. Post-Obamacare, that increases to $201. If you add in the subsidies that accrue to someone with the median income of a 27-year-old man, the net cost of Obamacare insurance goes down slightly to $188. That’s a 41 percent increase, despite the impact of subsidies.
If you’re a 64-year-old woman, on the other hand, your average pre-Obamacare premium was $430 a month. Post-Obamacare, the underlying premium increases to $545 a month. But when you factor in subsidies for the average 64-year-old woman, the net cost of Obamacare insurance drops to $292. That’s a 32 percent decrease, inclusive of subsidies, from pre-Obamacare premiums, and a 46 percent discount off of post-Obamacare prices.
The irony is that, in 2012, younger voters overwhelmingly supported President Obama, while older voters backed Mitt Romney. Obamacare, in the average state, is a massive transfer of wealth from the young to the old.
This all assumes, of course, that the exchanges eventually work
Right now, the headlines are dominated with stories about the deep and thorough dysfunction of the federally-built Obamacare insurance exchange. It’s a serious problem. If the exchanges aren’t fixed soon, the likely outcome is that older, sicker, and poorer people sign up, while everyone else goes without coverage. That, in turn, will imbalance the insurance pool in the exchanges, making its products more expensive and subsidy-dependent. Those facing cancellation of their existing coverage face the greatest risk under the worst-case scenario.
But there is a best-case scenario, especially from the standpoint of the law’s supporters. It’s that the exchanges eventually get fixed, and turn out to be popular, even among the young men—the “bros”—who bear the steepest costs under the new system. If they do, not only will Obamacare be here to stay, but the law could end up evolving into an effective replacement for our older, single-payer health-care entitlements, Medicare and Medicaid.
From where we stand today, unfortunately, there is no reason to believe that the Obama administration has a handle on the problems with the federal exchange. Young men seem no more likely to buy a costlier insurance product than they were to buy one, pre-Obamacare, that was more affordable. And so we should remain concerned about the likelihood of the law’s ultimate success.
https://mb-wp-uploads.s3.us-east-1.amazonaws.com/2024/04/MichBusiness-logo.png00michbusinesshttps://mb-wp-uploads.s3.us-east-1.amazonaws.com/2024/04/MichBusiness-logo.pngmichbusiness2014-08-20 11:26:132015-10-08 00:00:0049-State Analysis: Obamacare To Increase Individual-Market Premiums By Average of 41 Percent
On July 22, 2014, the U.S. Court of Appeals for the District of Colombia Circuit ruled 2-1 that the federal government may not provide tax credits to individuals that purchase their health insurance coverage through federally-facilitated exchanges established pursuant to the Patient Protection and Affordable Care Act (“PPACA”). Halbig v. Burwell, D.C. Cir., No. 14-5018 (D.C. Cir. July 22, 2014). A few hours later, the U.S. Court of Appeals for the Fourth Circuit upheld the federal government’s authority to provide tax credits to those who purchase their coverage through federally-facilitated exchanges. King v. Burwell, 4th Cir., No. 14-1158 (4th Cir. July 22, 2014).
Currently only 14 states and the District of Columbia have set up state-based exchanges. All other states have a federally-facilitated exchange with a few exchanges implemented as partnerships with states. PPACA enacted Section 36B of the Internal Revenue Code which provides tax credits as a form of subsidy to qualified individuals who purchase health insurance through exchanges that are “established by the State under Section 1311.” The IRS, through its rulemaking, interpreted Section 36B as providing the IRS the ability to also offer tax credits to individuals who purchase insurance on federally-facilitated exchanges. The plaintiffs in both cases challenged this interpretation.
The plaintiffs in Halbig and King generally argued that the availability of tax credits increased the number of people who must purchase health insurance or pay a penalty. With tax credits available, the federally-facilitated exchange health plans would be provided at a reduced cost and, therefore, these plaintiffs would not qualify for the unaffordability exemption from the individual mandate penalty. In addition, the plaintiffs in Halbig argued that offering tax credits would expose large employers to penalties for failing to offer coverage to their full-time employees under the employer-mandate provisions. An “applicable large employer” will face penalties if one of its full-time employees purchases health insurance on a federally-facilitated exchange and receives or is able to receive an applicable tax credit.
The D.C. Circuit analyzed whether an exchange established by the federal government is an “exchange established by the State under Section 1311” of PPACA. The appellate court found that there was no textual basis provided by PPACA sections regarding exchanges or elsewhere in PPACA that could lead the court to determine a federally-facilitated exchange is, in fact or legal fiction, established by a state. Therefore, the appellate court held that Section 36B did not authorize the IRS to provide tax credits for insurance purchased on federal-facilitated exchanges. The appellate court also rejected the federal government’s argument that adopting the plain language of Section 36B would lead to absurd results when interpreting other PPACA provisions and that the IRS’ rule must be given effect in order to accomplish Congress’ broad policy goals of near-universal coverage and lower health insurance premiums.
Conversely, the Fourth Circuit found that while the pertinent language of PPACA was ambiguous, the IRS’ interpretation of Section 36B was based on permissible construction of the statute. Unlike the D.C. Circuit, this appellate court was primarily persuaded by the IRS rule’s advancement of the broad policy goals of PPACA including near-universal coverage and determined that without the tax credits the economic framework supporting PPACA would be destroyed.
The Obama administration announced on the same day of the court decisions that the Department of Justice will request an en banc hearing for the Halbig case. If the Halbig decision withstands appeal, a significant amount of individuals receiving tax credits via a federally-facilitated exchange will no longer be able to receive tax credits to assist them in purchasing health insurance that is now mandatory for most people. Currently Arizona, Delaware, New Jersey, Pennsylvania, Illinois, Michigan, and West Virginia have either federal exchanges or partnership plans between the federal and state government which could be impacted by this decision. Maryland, Washington D.C. and Virginia have state exchanges which are unaffected by the D.C. Circuit ruling.
If you have any questions about the subject matter of this e-alert or about health care reform in general, please contact Ed Hammond at ehammond@clarkhill.com or (248) 988-1821; Kristi Gauthier at kgauthier@clarkhill.com or (248) 988-5854; or Doug Ellis at dellis@clarkhill.com or (412) 394-2367.
https://mb-wp-uploads.s3.us-east-1.amazonaws.com/2024/04/MichBusiness-logo.png00michbusinesshttps://mb-wp-uploads.s3.us-east-1.amazonaws.com/2024/04/MichBusiness-logo.pngmichbusiness2014-07-24 16:00:572015-10-08 00:00:00Contradictory Court Rulings on Tax Credits for PPACA Federal Exchanges by Kristi R Gauthier
Set out below is an additional Frequently Asked Question (FAQ) regarding implementation of the Affordable Care Act. This FAQ has been prepared by the Departments of Labor, Health and Human Services (HHS), and the Treasury (collectively, the Departments). Like previously issued FAQs (available at http://www.dol.gov/ebsa/healthreform/), this FAQ answers a question from stakeholders to help people understand the law and benefit from it, as intended.
Disclosure with respect to Preventive Services
Q: My closely held for-profit corporation’s health plan will cease providing coverage for some or all contraceptive services mid-plan year. Does this reduction in coverage trigger any notice requirements to plan participants and beneficiaries?
A: Yes. For plans subject to the Employee Retirement Income Security Act (ERISA), ERISA requires disclosure of information relevant to coverage of preventive services, including contraceptive coverage. Specifically, the Department of Labor’s longstanding regulations at 29 CFR 2520.102-3(j)(3) provide that, the summary plan description (SPD) shall include a description of the extent to which preventive services (which includes contraceptive services) are covered under the plan. Accordingly, if an ERISA plan excludes all or a subset of contraceptive services from coverage under its group health plan, the plan’s SPD must describe the extent of the limitation or exclusion of coverage. For plans that reduce or eliminate coverage of contraceptive services after having provided such coverage, expedited disclosure requirements for material reductions in covered services or benefits apply.
See ERISA section 104(b)(1) and 29 CFR 2520.104b-3(d)(1), which generally require disclosure not later than 60 days after the date of adoption of a modification or change to the plan that is a material reduction in covered services or benefits. Other disclosure requirements may apply, for example, under State insurance law applicable to health insurance issuers.
For More Information:
If you have any comments or questions regarding any of above information, please do not hesitate to call me at (708) 717-9638 or e-mail me at larry@larrygrudzien.com
Thank-You, Larry Grudzien – Attorney-At-Law
https://mb-wp-uploads.s3.us-east-1.amazonaws.com/2024/04/MichBusiness-logo.png00michbusinesshttps://mb-wp-uploads.s3.us-east-1.amazonaws.com/2024/04/MichBusiness-logo.pngmichbusiness2014-07-23 16:00:352015-10-08 00:00:00FAQs Released About Affordable Care Act Implementation (Part XX)
DETROIT, June 10, 2014 – Blue Cross Blue Shield of Michigan intends to more than double its product offerings in the 2015 individual market this November. Blue Cross and its HMO subsidiary, Blue Care Network, filed 41 total product options with the Department of Insurance and Financial Services (DIFS) on Sunday, with the intent to offer these plan options to Michigan consumers during the 2015 open enrollment period that begins Nov. 15, 2014. The new products and their prices require regulatory approval – and the products cannot be sold to consumers until Nov. 15.
“Blue Cross has expanded our product portfolio to ensure people in all situations and income ranges can find quality, affordable health coverage with us,” said Terry Burke, vice president for Individual Business at BCBSM. “Blue Cross will continue efforts to provide trusted advice and guidance to people with questions. As Michigan’s leading health insurer, our expanded product options and new networks are designed to allow people at all income ranges to look for the right coverage based on their health needs. Consumers can select from a variety of Blue Cross options – everything from very comprehensive coverage that carries a higher premium, to low-premium plans that meet the needs of cost-conscious consumers.”
During 2015 open enrollment, Blue Cross intends to continue to offer its products to residents of all 83 Michigan counties – something only Blue Cross did during 2014 open enrollment. Highlights of the 2015 offerings include:
•Two new affordable product lines available in southeast Michigan, allowing cost-conscious consumers to select from additional affordable health plan options
?Metro Detroit Exclusive Provider Organization (EPO)
?Lower cost product options with more than 5,000 doctors in-network
?Coverage in Wayne, Oakland, Macomb, Livingston, St. Clair and Washtenaw counties
?Includes 25 hospitals in 8 hospital systems
?Metro Detroit HMO
?Offering coverage in Wayne, Oakland and Macomb counties
?Includes at least 12 hospitals in 4 hospital systems
•New plans with a designation of “extra,” which pays for unlimited primary care physician visits before deductible; unlimited specialist office visits with up to four visits before deductible; and generic prescription drugs before deductible; co-pays will apply
•A new Platinum-level plan offering both a low deductible and out-of-pocket maximum, that also includes comprehensive dental and vision coverage
Both Blue Cross and Blue Care Network will offer plans at the Gold, Silver, Bronze and Catastrophic levels. The new Blue Cross Platinum-level plan will be an option for consumers seeking a richer benefit structure.
“For years, Blue Cross has collaborated with Michigan health care providers to improve care and control costs, while providing broad access. These relationships give Blue Cross the ability to offer insurance plans with prices that meet consumer demand for value in the new marketplace, however that value is defined by the purchaser,” Burke said. “Products like our new Southeast Michigan EPO will expand choice for consumers shopping for a low-cost health insurance plan backed by quality local doctors and hospitals. Our Platinum plan is designed for people who want broad access and can pay a higher premium to obtain it. The bottom line is choice. We are aiming to give people enough choices to select the right health plan for their needs.”
The Blues intend to offer a total of 41 options for coverage, pending regulatory approval. The products will not be available to Michigan consumers until Nov. 15, when the federally run Health Insurance Marketplace begins taking applications for open enrollment. Products will be available through independent Blue-certified insurance agents and also directly through BCBSM and BCN.
BCBSM’s offerings in all 83 counties throughout Michigan provide affordable choices for all residents, both on and off the Marketplace. The following represent estimated average prices for BCBSM and BCN individual plans intended to be offered on and off the Health Insurance Marketplace. All prices are pending regulatory approval. The prices shown are without the federal subsidy that some individuals may qualify for, which in turn would lower their costs.
Monthly Estimated Premium Range for BCBSM and BCN’s Individual ACA-Qualified Health Plans Products pending regulatory approval; pricing does not reflect subsidies
Notes
1.Prices listed are estimates pending HHS approval of a statewide average of individual plan premiums for non-smokers and do not reflect the impact of federal subsidies
2.Plans listed are across all legal entities and delivery systems
3.Not all plans are available in every county
4.Plans listed include Multi-State Plans in Silver and Gold
5.* Denotes BCN plan. Please see product availability map for product availability.
6.Blue Cross Blue Shield of Michigan has entered into an agreement with CMS to provide health insurance coverage through Qualified Health Plans on the Health Insurance Marketplace
Blue Cross Blue Shield of Michigan, a nonprofit mutual insurance company, is an independent licensee of the Blue Cross and Blue Shield Association. BCBSM provides and administers health benefits to more than 4.4 million members residing in Michigan in addition to employees of Michigan-headquartered companies who reside outside the state. For more company information, visit bcbsm.com and MiBluesPerspectives.com.
https://mb-wp-uploads.s3.us-east-1.amazonaws.com/2024/04/MichBusiness-logo.png00michbusinesshttps://mb-wp-uploads.s3.us-east-1.amazonaws.com/2024/04/MichBusiness-logo.pngmichbusiness2014-07-23 16:00:302015-10-08 00:00:00Blue Cross Blue Shield of Michigan and Blue Care Network Intend to Double Health Plan Product Offerings For the 2015 Individual Market
On June 25, 2014, the Department of Health and Human Services, the Department of Labor, and the Department of Treasury (collectively, the “Departments”) jointly issued Final Regulations clarifying the maximum allowed length of a “reasonable and bona fide employment-based orientation period” and the relationship between the orientation period and the 90-day waiting period allowed by the Final Regulations issued in February 2014. These new Final Regulations are scheduled to apply for plan years beginning on or after January 2015.
Final Regulations issued earlier in February 2014 stipulated that group health plans may not impose any waiting period exceeding 90 calendar days, including weekends and holidays. A waiting period is a period of time that must elapse before coverage becomes effective for an employee, or dependent, who is otherwise eligible to enroll under a group plan’s terms.
The Departments acknowledged that the use of orientation periods, trial periods, or probationary periods is common. The practice allows employers and newly hired employees to evaluate the employment relationship and determine whether it is satisfactory for both parties before commencing the 90-day waiting period to begin coverage. The new Final Regulations state that such orientation periods may not exceed one month.
If an employer imposes an orientation period, the 90-day waiting period begins the first calendar day after the orientation period. For the purposes of the orientation period, a month is measured by adding one calendar month from the employee’s start date in a position eligible for coverage and subtracting one calendar day. For example, if an employee is hired on January 5, the final day of the orientation period must be no later than February 4. If there is no corresponding calendar date in the month following the employee’s start date, the employee’s last permitted orientation date is the last date of the calendar month following the employee’s start date in the position eligible for coverage. For example, if the employee’s start date is January 30, the last permitted day of the orientation period is February 28 (or February 29 if it is a leap year).
https://mb-wp-uploads.s3.us-east-1.amazonaws.com/2024/04/MichBusiness-logo.png00michbusinesshttps://mb-wp-uploads.s3.us-east-1.amazonaws.com/2024/04/MichBusiness-logo.pngmichbusiness2014-07-22 16:00:552015-10-08 00:00:00New Final Regulations Issued Regarding the 90-Day Waiting Period and Orientation Periods
Aflac’s recent Workforces Report for Brokers recently divulged that nearly 50 percent of brokers are considering leaving the industry, due largely to a landscape vastly changed by PPACA. Employee health benefits have become an increasingly complex industry in the past four years — which is precisely the reason that a solid broker workforce is more needed than ever. When it comes to reporting requirements, your employer clients need advice on everything from W-2 reporting to treatment of self-insured plans to reporting around minimum essential coverage. Here, you’ll find answers.
https://mb-wp-uploads.s3.us-east-1.amazonaws.com/2024/04/MichBusiness-logo.png00michbusinesshttps://mb-wp-uploads.s3.us-east-1.amazonaws.com/2024/04/MichBusiness-logo.pngmichbusiness2014-07-22 16:00:452015-10-08 00:00:0027 PPACA Reporting Obligations Employers Need To Know
Last year, in United States v. Windsor, the Supreme Court struck down section 3 of the Defense of Marriage Act (DOMA) as unconstitutional. President Obama said: This ruling is a victory for couples who have long fought for equal treatment under the law, for children whose parents’ marriages will now be recognized, rightly, as legitimate; for families that, at long last, will get the respect and protection they deserve; and for friends and supporters who have wanted nothing more than to see their loved ones treated fairly and have worked hard to persuade their nation to change for the better.
The President instructed the Cabinet to review all relevant federal statutes to ensure the decision, including its implications for federal benefits and programs, is implemented.
In light of this directive and to ensure all families will have the flexibility to deal with serious medical and family situations without fearing the threat of job loss, we are moving to update the regulatory definition of spouse under the Family and Medical Leave Act (FMLA), which entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons.
We are publishing a Notice of Proposed Rulemaking (NPRM) to amend the regulatory definition of spouse under the FMLA so that eligible employees in legal same-sex marriages will be able to take FMLA leave to care for their spouse or family member, regardless of where they live. This will ensure that the FMLA will now be applied to all families equally, giving spouses in same-sex marriages the same ability as all spouses to fully exercise their rights and responsibilities to their family.
What is the Family and Medical Leave Act (FMLA)
The FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons. Eligible employees may take up to 12 workweeks of FMLA leave in a 12-month period:
*for the birth of the employee’s child and for newborn care;
*for the placement of a child with the employee for adoption or foster care;
*to care for the employee’s spouse, parent, son, or daughter with a serious health condition; or
*when the employee is unable to perform the functions of his or her job due to the employee’s own serious health condition.
The FMLA also includes certain military family leave provisions:
*Military Caregiver Leave: Entitles eligible employees who are the spouse, son, daughter, parent, or next of kin of a covered servicemember (current member or veteran of the National Guard, Reserves, or Regular Armed Forces) with a serious injury or illness incurred in the line of duty to take up to 26 workweeks of unpaid, job-protected leave during a single 12-month period to care for their family member.
*Qualifying Exigency Leave: Entitles eligible employees to take up to 12 workweeks of unpaid, job-protected leave in a 12-month period for a “qualifying exigency” related to the foreign deployment of the employee’s spouse, son, daughter, or parent.
Major features of the NPRM
*The Department is proposing to move from a “state of residence” rule to a rule based on where the marriage was entered into (sometimes referred to as “place of celebration”). The NPRM proposes to change the regulatory definition of spouse in 29 CFR §§ 825.102 and 825.122(b) to look to the law of the place in which the marriage was entered into, as opposed to the law of the State in which the employee resides. A place of celebration rule would allow all legally married couples, whether opposite-sex or same-sex, or married under common law, to have consistent federal family leave rights regardless of where they live.
*The proposed definition of spouse expressly references the inclusion of same-sex marriages in addition to common law marriages, and will encompass same-sex marriages entered into abroad that could have been entered into in at least one State.
What impact would this definitional change have on FMLA leave usage?
*The proposed definitional change would mean that eligible employees, regardless of where they live, would be able to:
**Take FMLA leave to care for their same-sex spouse with a serious health condition;
**Take qualifying exigency leave due to their same-sex spouse’s covered military service; or
**Take military caregiver leave for their same-sex spouse.
*The proposed change would entitle eligible employees to take FMLA leave to care for their stepchild (child of employee’s same-sex spouse) even if the in loco parentis requirement of providing day-to-day care or financial support for the child is not met.
The Department has consistently recognized the eligibility of same-sex partners, whether married or not, to take leave to care for a partner’s child provided that they meet the in loco parentis requirement of providing day-to-day care or financial support for the child. For more information on FMLA leave on the basis of an in loco parentis relationship, see Fact Sheet #28B at www.dol.gov/whd/regs/compliance/whdfs28B.htm.)
*The proposed change would also entitle eligible employees to take FMLA leave to care for their stepparent (same-sex spouse of the employee’s parent), even though the stepparent never stood in loco parentis to the employee.
The Department encourages interested parties to submit comments on this proposal. The full text of the NPRM, as well as information on the deadline for submitting comments and the procedures for submitting comments can be found at www.dol.gov/whd/fmla/nprm-spouse.
For additional information on the FMLA, please visit www.dol.gov/whd/fmla.
For More Information:
If you have any comments or questions regarding any of the above information, please do not hesitate to call me at (708) 717-9638 or e-mail me at larry@larrygrudzien.com
Thank-You, Larry Grudzien – Attorney-At-Law
https://mb-wp-uploads.s3.us-east-1.amazonaws.com/2024/04/MichBusiness-logo.png00michbusinesshttps://mb-wp-uploads.s3.us-east-1.amazonaws.com/2024/04/MichBusiness-logo.pngmichbusiness2014-07-22 16:00:402015-10-08 00:00:00DOL – Amends the Definition of a Spouse Under FMLA
By Larry Grudzien
By Avik Roy
DETROIT, June 10, 2014 – Blue Cross Blue Shield of Michigan intends to more than double its product offerings in the 2015 individual market this November. Blue Cross and its HMO subsidiary, Blue Care Network, filed 41 total product options with the Department of Insurance and Financial Services (DIFS) on Sunday, with the intent to offer these plan options to Michigan consumers during the 2015 open enrollment period that begins Nov. 15, 2014. The new products and their prices require regulatory approval – and the products cannot be sold to consumers until Nov. 15.
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