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NYS Pushes Back Association Plans and Short Term Medical

NYS Pushes Back Association Plans and Short Term Medical

NYS Pushes Back Association Plans and Short Term Medical

NYS is pushing back on Association Health  Plans (AHP) In reaction to President Trump’s Executive Order of Association Health Plans expansion.  The President expanded the role of association plans earlier this week rule to makes it easier for small businesses and trade groups to band together to purchase health coverage outside of Obamacare’s insurance markets.

These regulations provide an additional basis for a group or association of employers to be treated as an “employer.  New York’s top insurance official said the Trump administration’s final rule making it easier to form association health plans will not hamper the state’s ability to continue regulating the health insurance industry.  Other states like Massachusettes have have also pushed back over Association Plans. “Yesterday’s announcement by the Trump Administration to dramatically expand the footprint of Association Health Plans will invite fraud, mismanagement, and deception – and, as we’ve made clear, will do nothing to help ease the real health care challenges facing Americans,” Healey and Underwood said in a joint statement. “We believe the rule, as proposed, is unlawful and would lead to fewer critical consumer health protections.”

One program getting attention are inpexpesivive but limited short-term health insurance plans.  According to yesterdays NYS DFS annoncment, however, New York regardless of federal actions will prohibit these plans as consumer protection.  Current federal rules only permit short-term plans — which are exempted from certain health benefits coverage requirements, such as chronic pre-existing conditions — to last up to three months, but the Trump administration wants to expand that up to 364 days. “Such ‘limited health’ plans, whether limited to less than three months or one year, are not short-term at all, but rather an end-run around requirements applicable to individual or group hospital, surgical or medical expense coverage and are prohibited under New York State law,” DFS wrote in a circular letter to insurers.

Summary of Trump’s Association Health Plans Expansion

 Purpose of Association. Employers may band together in an association for the purpose of obtaining health coverage.  However, the association also “must have at least one substantial business purpose unrelated to offering and  providing health coverage or other employee benefits to its employer members and their employees.”  The DOL clarifies in its safe harbor that a “substantial business purpose is considered to exist if the group or association would be a  viable entity in the absence of sponsoring an employee benefit plan.” 

 Commonality of Interest. Employers in the association can either (1) be from the same trade, industry, line of business, or profession; or (2) all have a principal place of business in a State (or portion of a State, such as a city or  county) or in the same metropolitan area (even if the metropolitan area spans more than one State, like New York, Washington, D.C., or Kansas City

 Structure and Control. There must be a formal organizational structure with a governing body and by-laws or similar formalities, to control the association, including the establishment and maintenance of the group health plan.   The  control can be direct or indirect through the regular election of directors, officers, or other similar representatives; however control must be present both  in form and in substance. Ultimately, the functions and activities of the group or association are controlled by its employer members, and the group’s or association’s employer members that participate in the group health plan  control the plan, by determining contributions, plan designs, and benefits. 

Eligibility. Only employees and former employees of association members (and  their eligible family members) may participate in the association health plan.  In other words, it cannot be an insurance exchange for any interested party. 

Regulations

FAQs

News Release

We will closely monitor this as awell as all Health Care Reform developments. Sign up for our premium newsletter below.  Learn how our Agency is helping buinsesses thrive in today’s economy.  Check out PEO Case Studies here and learn how they can apply to you. Please contact us at info@medicalsolutionscorp.com or (855) 667-4621. 

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New Jersey Enacts Individual Health Mandate

New Jersey Enacts Individual Health Mandate

New Jersey Enacts Individual Health Mandate

A new law entitled the “New Jersey Health Insurance Market Preservation Act” was signed by Governor Phil Murphy on May 30, 2018 to reestablish the recently repealed “shared responsibility tax”. The law, which will take effect on January 1, 2019, will require every New Jersey resident to obtain health insurance with minimum essential coverage or pay a fee, essentially adopting the rules of the ACA.

This legislation will directly impact residents of NJ and indirectly affect employers with employees residing in the state.NJ Enacts Individual Mandate

State Individual Mandate

The New Jersey Health Insurance Market Preservation Act will require all New Jersey residents to have Minimum EssentialCoverage (MEC) beginning January 1, 2019, or pay a penalty.

In light of Federal repeal on Dec 29, 2017, Tax Reform Bill Includes Repeal of Individual Mandate Beginning in 2019,  NJ’s mandate is scheduled to take effect on January 1, 2019, making NJ the second state, after Massachusetts, to enactan individual mandate. The mandate includes an annual penalty of 2.5% of a household’s income or $695 per adultand $347 per child – whichever is higher. The maximum penalty is based on household income and will not exceed theaverage yearly premium of a bronze plan.If it’s based on a per-person charge, the maximum household penalty will be $2,085.

A “hardship exemption” will be available for individuals who cannot afford coverage, determined by the State Treasurer. NJ expects to collect between $90 million and $100 million in penalties. This money, along with additional federal funding, willbe used on a reinsurance program, which Murphy also signed into law.

Employer Action

While these bills do not directly affect employer sponsored plans, the individual mandate requirement for NJ residents will likely require education for employees. As residents in NJ will now be required to obtain health overage to avoid a state income tax penalty, employers may see an increase in plan enrollment. Unlike Massachusetts which requires specific coverage components, the NJ law only requires that coverage be MEC. Thus, most traditional employer-sponsored group health plans should meet this definition. However, coverage for only dental benefits, certain medical indemnity policies and vision benefits are likely not sufficient for purposes of avoiding the state tax. For now, employers with employees who reside in New Jersey may wish to educate employees at Open Enrollment that by January 1, 2019 health coverage will be required for NJ residents to avoid a penalty.  

Conclusion

New Jersey lawmakers feared the repeal would drive healthier people out of the marketplace causing premiums to spike. They believe this law is pertinent to stabilize the marketplace, keep people insured, and prevent a death spiral of the individual market.

Resource:Obamacare Indivudal Mandate  &  Individual Mandate ACA Flow Chart   and  https://www.healthcare.gov/fees/fee-for-not-being-covered/

Learn how our Agency is helping buinsesses thrive in today’s economy.  Check out PEO Case Studies here and learn how they can apply to you. Please contact us at info@medicalsolutionscorp.com or (855)667-4621. 
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NYS 2019 Rate Requests

NYS 2019 Rate Requests

NYS 2019 Rate Requests

Last Friday, June 1, 2018, the NYS 2019 Rate Requests filings were released. Great news for SMB!  The total weighted average increases were a modest 7.5%  small groups but  24% for the individual market.  This early filing request deadline request requirement is not an Obamacare requirement.  As per NY State Law carriers are required to send out notices of rate increase filings to groups and subscribers.

These are simply requests and the state’s Department of Financial Services has authority to modify the final rates. But they are the first indication of what New Yorkers can expect when shopping for health insurance on the individual marketplace at the end of this year. The news comes as insurance companies across the country brace consumers for another year of large rate hikes, owing in part to the composition of the individual market, and in part to the uncertainty over the future of the law under the Trump administration.

Background:

By contrast last year’s  NYS 2018 Rate Request early filing request were higher at 11.5% small group but much lower  16.6% for individuals. The NYS final August 2018 rate approval are expected to be lower.  For example, the final filing rates were aproved  NYS 2018 Final Rates at 9.3% small group and 13.9% for individuals. Incidentally, the NYS 2017 Rates final rates were 8.3% small group and 12.3% for individuals.  Using these past figures one projects a 2019 Final Rates of 6.5% small groups and 19% individuals.

With only 3 months of mature claims in 2018 to work of off Insurance Actuaries have little experience to predict accurate projections. Simply put the less credible information presented to actuarial the higher the uncertainty and higher than the expected rate increase.  The national rate trend, however, has been much higher than in past years due to higher health care costs and the loss of Federal reinsurance fund known as risk reinsurance corridor.

Summary of 2019 Requested Rate Actions

Individuals:

 

Individual rates are expected to be higher than the small group market. The national rate trend, however, has been much higher than in past years due to higher health care costs  Like other states throughout the nation, the 2019 rate of increase for individuals in New York is higher than in past years partly due to the termination of the federal reinsurance program.  The loss of the program’s aka federal risk reinsurance corridor funds accounts for 5.5 percent of the rate increase.

The single biggest justification offered by insurers for the requested increases is the recent repeal of the individual mandate penalty –Tax Reform Bill Includes Repeal of Individual Mandate Beginning in 2019. The individual mandate, a key component of the Affordable Care Act, helped mitigate against dramatic price increases by ensuring healthier insurance pools.  Insurers have attributed approximately half of their requested rate increases to the risks they see resulting from its repeal.  Without the federal action, the average requested rate increase  would be  12.1%.  As DFS reviews all of the submissions, we will continue to ensure that any rate increases are fully and actuarially justified by appropriate medical cost increases and are not inadequate, excessive or unfairly discriminatory, in accordance with New York law.

Small Groups:

Most encouraging to see the average rate requests for the small group market reflect the increased stability of that market in New York State. The combination of 2-50 and 51-100 market underscores the stability for msall bsuinesses under 50 employees.  Prior to the NYS regulatory combination, the 2-50 market was running an average 12-13% trend.

The Obamacare  health insurance tax, aka The HIT, is responsible for approximately  2.5%.  Whiel the HIT moratorium was approved it had indeed come back last year. The total projection is $14 Billion.  Notably, Empire Blue Cross has filed a modest 6% increase as their portfoliio is running stable. Additionaly, Oscar’s inbdustry low 3% filing is practially at break-even considering the HIT.

THE THREE R – RISK CORRIDOR, RISK ADJUSTMENT & REINSURANCE designed to mitigate the adverse selection and risk selection. The problem, according to many insurance companies, is that the formula is flawed, and CareConnect executives have consistently complained that they are at an unfair disadvantage. The Cuomo administration has taken steps to ameliorate some of those problems, giving the DFS the authority to essentially overrule the federal numbers.  In its first-quarter financial report, executives made clear that the risk adjustment penalty was a threat to its business.

Company Name2019 Requested Rate Change
Aetna Life16.2%
CDPHP6.7%
CDPHP UBI6.1%
Crystal Run Health Insurance Company11.5%
Crystal Run Health Plan, LLC12.5%
Emblem12.0%
Empire Healthchoice Assurance6.0%
EmpireHealthchoice HMO5.2%
Excellus*3.8%
Healthfirst Health Plan, Inc.21.0%
Healthfirst Insurance Company, Inc.7.0%
Healthnow New York-0.1%
IHBC*3.8%
MetroPlus*4.7%
MVP Health Plan7.0%
MVP Health Service Corp*10.3%
Oscar3.0%
Oxford Health Insurance Inc*8.3%
UnitedHealthcare Ins Company of New York7.2%
Weighted average:7.5%

Conclusion

Defined Contribution Choice:  Instead, the correct approach for a small business in keeping with simplicity is a defined contribution model using a Private Exchange.  This is a true defined contribution empowering employees with the choice of leading insurers offering paperless technologies integrating HRIS/Benefits/Payroll.  Both employee and employers still gain tax advantage benefits under the business.  Also, the benefits, rates and network size are superior under a group plan as THE RISK OUTLINED ABOVE ARE HIGHER FOR INDIVIDUAL MARKETS THAN SMALL GROUP PLANS.

To be clear: These trends affect a small subset of the insurance market—non-group plans that cover less than 2 percent of the population. Many qualify for tax credits that lower their net costs and reduce or eliminate the impact of year-to-year rate increases.However, non-group customers with incomes above 400% of the poverty level ($48,560 for a single adult) get no subsidy—and feel the full brunt of any hikes.

Resource

  • You may view the NYS 2019 Rate Requests DFS press release, which includes a recap of the increases requested and approved bclicking here.
  • For a custom analysis detailing YOUR upcoming 2018-2019 renewal please contact our team at Millennium Medical Solutions Corp  (855)667-4621.  We work in coordination with Navigators to assist with Medicaid, CHIP Child Health Plus, Family Health Plus and Medicare Dual Eligibles.   We have Spanish, Russian, and Hebrew speakers available.  Quotes can also be viewed on our site.
  •  See Health Reform Resource

*These averages may change based on DFS’s review of the rate applications.** Empire submitted a filing that DFS is evaluating.

Learn how a Private Exchange and our PEO Partnership can help your group please contact us at info@medicalsolutionscorp.com or (855)667-4621.

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No More Surprises – NJ Surprise Medical Bill Law

No More Surprises – NJ Surprise Medical Bill Law

No More Surprises – NJ Surprise Medical Bill Law

New Jersey Governor Phil Murphy (D) signs law to take in effect within 3 months that will reduce Surprise Out-Of-Network Medical Bills.This is well needed and in-step with NYS law passed 3 years ago – No More Surprises – NY Surprise Medical Bill Law.

The reform is designed to protect patients, businesses, and others who pay for medical care from the high-cost bills associated with emergency or unintentional care from doctors or other providers who are not part of their insurance network. The law requires greater disclosure from both insurance companies and providers — so patients are clear on what their plan covers — ensures patients aren’t responsible for excess costs, and establishes an arbitration process to resolve payment disputes between providers and insurers, a mechanism intended to better control costs.

The Problem. This has been a pattern in recent years and posted in Out of Control Out of Network Charges (March 2012).  According to an investigation report commissioned by Governor Cuomo recognizing the unexpected out-of-network claim problem.  Officials say that this is now  “an overwhelming amount of consumer complaints.”   Some examples cited in the report An Unwelcome Surprise – “a neurosurgeon charged $159,000 for an emergency procedure for which Medicare would have paid only $8,493.”  Another example: ” a consumer went to an in-network hospital for gallbladder surgery with a participating surgeon. The consumer was not informed that a non-participating anesthesiologist would be used, and was stuck with a $1,800 bill. Providers are not currently required to disclose before they provide services whether they are in-network.” The average out-of-network radiology bill was 33 times what Medicare pays, officials say.

The blog post goes on to say “Today, 90% of SMB members have in network only benefits but the few remaining consumers are paying for eroding out of network benefits with little transparencies and necessary protection from new out of network billing practices.  The NY Dept of Financial services  is calling for providers in non-emergency situations to disclose whether or not all services are in-network, what out-of-network charges will be and how much insurers will cover.”

The Solution:  The The out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act requires greater disclosure from both insurance companies and providers — so patients are clear on what their plan covers — ensures patients aren’t responsible for excess costs, and establishes an arbitration process to resolve payment disputes between providers and insurers, a mechanism intended to better control costs.  The law sets a timeline and other parameters for negotiations between the payer and the provider and, if they can’t resolve the issue, requires the state to hire an independent expert to decide between the final offers presented by both sides. While earlier drafts of the bill included a range of factors for the arbitrator to consider in making this decision — including the doctor’s experience, the patient’s condition, and certain payment benchmarks — these details were eliminated entirely in the final version.

NJ becomes the 7th State to enact such consumer protection.  The other states include California, Connecticut, Florida, Illinois, Maryland and New York.

Learn how a Private Exchange and our PEO Partnership can help your group please contact us – info@medicalsolutionscorp.com or (855)667-4621.

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NYS Passes Sexual Harassment law

NYS Passes Sexual Harassment law

NYS Passes Sexual Harassment law

NYS passed the law in April 2018 which contains assortment of provisions aimed at preventing sexual harassment as well as the  silencing of victims.The law goes into effect October 9, 2018.  Additionally, on May 9th, Mayor DiBlasio also signed the STOP SEXUAL HARASSMENT in NYC ACT. 


Policy and Training

The new law requires all employers to adopt and distribute a sexual harassment prevention policy and provide interactive sexual harassment prevention training to all employees. 

The state will be developing a model policy and a model training, so employers will not need to create their own. They will, however, need to administer both the policy and the interactive training. We will provide additional information in our clients HR Support Center Portal as well as via newsletter  as it becomes availabl and released by the state. 

Employers do have the option of creating their own policy and training program, so long as it meets the requirements set by the state.

No Mandatory Arbitration or Confidential Settlements

The new law bans contract provisions that require arbitration for claims of sexual harassment. Any such provision in a contract entered into after July 11, 2018, will be null and void. The rest of the contract will remain enforceable, assuming it was drafted correctly. However, this provision of the new law may be unenforceable under the Federal Arbitration Act. Until this question is resolved, we encourage employers to operate as if contract clauses that require arbitration of sexual harassment claims will not hold up in court or to consult with legal counsel before continuing to use them.

Confidential settlement agreements with respect to claims of sexual harassment are also prohibited by the new law, unless a confidential agreement is the preference of the person who brought the claim. If the claimant does not want confidentiality, employers will not be able to include language that prevents the disclosure of the underlying facts and circumstances of the claim when it involves sexual harassment. This provision of the new law also takes effect July 11, 2018.


Protections for Non-Employees

In addition to the requirements and prohibitions above, the law also gives non-employees—such as vendors, contractors, and consultants—the ability to file a complaint with the Division of Human Rights if they feel they have been sexually harassed in an employer’s workplace. This expansion of the current law has already taken effect.

Employers Next Steps

New York employers can take several steps to prepare for the new requirements created by the Budget.

  1. Employers, initially, should evaluate existing sexual harassment prevention policies and education regarding non-employees in the workforce, including independent contractors.
  2. Employers should review existing sexual harassment policies and training programs for compliance with the Budget’s minimum standards, and revise them accordingly if necessary.
  3. New York employers should review standard settlement and arbitration agreements in connection with sexual harassment complaints, and revise them in light of the Budget’s requirements.

More information:   NYS Sexual Harassment Employer Law Policy and Training

Learn how our Agency is helping buinsesses thrive in today’s economy.  Check out PEO Case Studies here and learn how they can apply to you. Please contact us at info@medicalsolutionscorp.com or (855)667-4621. 
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Breaking: Trump Announces New Rx Program

Breaking: Trump Announces New Rx Program

Breaking: Trump Announces New Rx Program

President Trump announced earlier today a new pharmacy cost reduction program, “American Patients First”.  The program aims to provide new tools to Medicare to negotiate lower prices, stop limiting pharmacists from helping patients save money and speed up approval of over-the-counter medicines so that fewer will require prescriptions.

The plan has 4 components:

  • Increasing competition.
  • Easing negotiation.
  • Creating incentives to lower prices.
  • Lowering out-of-pocket spending on drugs.

“American Patients First” calls for reforms in Medicare Part D to allow plan sponsors to negotiate lower prices for high-cost drugs, including negotiation tools that may be available to private payers. The administration also plans to address incentives in Part D to push drug companies to lower prices.The plan includes a five-part plan to restructure the Part D program to reduce drug costs. The budget includes proposals to cap spending in Medicare Part B and move Part B coverage into Part D to facilitate better negotiation.

The Food and Drug Administration will begin acting quickly to bring more generics and biosimilars to the market to address competition issues, for example.

Another area of particular focus is using a US large buying group much as other countries have been doing traditionally.  The U.S. pays for 70% of the profits of branded drugs among 35 leading countries because many have government-run health systems that pay one price for drugs, senior administration officials said.  According to Trump the U.S. is essentially subsidizing the R&D costs for other countries.

Last Sundays 60 Minutes segement on how the Town of Rockford, Illinois can NOT meet its budgetery obligations due to crushing PBM influenced pricing.  Example:  In 2001 an infant drug cost  $40/vile and now

$40,000/vile.

The Dept of Health and Human Services  reiterated the agency’s focus on price transparency and said that was another crucial element of the drug pricing plan. The FDA, for example, is going to immediately begin

to examine ways to push drug companies to disclose prices in their advertising.Long awaited and a welcomed consumer  policy.

Survey Shows 94% of PEOs Expect an Increase in Employees

Survey Shows 94% of PEOs Expect an Increase in Employees

Survey Shows 94% of PEOs Expect an Increase in Employees

Businessman pressing a People concept button.

 Professional Employer Organizations (PEO)  growth doesn’t appear to be slowing down. Earlier this year, NAPEO released the results from there 2017 Q3 Industry Pulse Survey. The findings showed that PEOs are continuing to grow, and at an impressive pace. In the report, 72% of PEOs reported revenue growth in Q3 of 2017, compared to Q3 of 2016.

With all that is happening with employment laws, healthcare and health insurance, and other areas of HR that impact small and medium-sized businesses (SMBs), it is easy to see why PEOs and other HR outsourcing options are seeing, in many cases, rapid industry growth.

Now, NAPEOs latest Quarterly Pulse Survey, which compared the 4th quarter of 2017 to the 4th quarter of 2016, shows that PEO growth is still occurring, and will almost certainly continue in 2018 and beyond.

DATA FROM THE 2017 Q4 NAPEO PULSE SURVEY

The NAPEO Quarterly Pulse Survey – Q4 2017 was conducted in early 2018, and was taken by 32 PEO executives.

The first result from the survey looked at PEO revenue. 71.9% of PEO executives said their organization’s revenue increased in Q4 of 2017, compared to Q4 of 2016.

Broken down further, 50% said that revenue increased somewhat, and 21.9% said revenue increased significantly.

Next, the survey showed that PEOs experienced an increase in the average annual wage per worksite employee (WSE), with 65.5% of executives responding.

NAPEO’s findings also revealed that 66% of PEOs saw an increase in gross profit. Of this 66%, 43.3% said gross profit increased somewhat, while 23.3% said it increased significantly.

OPERATING INCOME, NUMBER OF CLIENTS, AND WSE PROJECTION DATA

The next group of results from the survey uncovered data around operating income, the number of clients, and worksite employee projection information.

First, the report showed that 65.7% of PEO executives reported an increase in operating income in the 4th quarter of 2017, compared to the 4th quarter of 2016. The 65.7% can be broken down further, with 43.8% saying that operating income increased somewhat, and 21.9% increasing significantly.

Next, 59.4% of PEOs said that the number of clients increased, while 31.3% said that the number of clients stayed about the same. Of the 59.4%, 50% said that clients increased somewhat, and 9.4% said clients increased significantly.

Lastly, the survey asked PEO executives about worksite employee (WSE) projections over the next 12 months.

Perhaps the most promising and impressive statistic found in the quarterly survey, almost 94% expect WSEs to increase. Here is the full breakdown:

  • 71% expect EE to increase somewhat
  • 22.6% expect EE to increase significantly
  • 3.2% expect EE to stay about the same
  • 3.2% expect EE to decrease somewhat

With PEOs seeing an increase in revenue throughout 2017, and executives overwhelmingly expecting EE  to increase over the next 12 months, revenue outlooks for the rest of 2018 and into 2019 look extremely promising throughout the PEO industry.

PROFESSIONAL EMPLOYER ORGANIZATIONS CONTINUE TO THRIVE

Much like the last few Quarterly Pulse Surveys from NAPEO, the 2017 Q4 survey shows that despite all of the uncertainty and complexity with various areas of HR, PEOs continue to grow.

Regarding the survey, Pat Cleary, President & CEO of NAPEO, said, “This is just the latest example that more and more business owners are realizing the true value of using a PEO. Surveys and studies consistently show that using a PEO is good for a business and its employees. PEOs provide a real benefit to businesses by providing HR services and solutions that they would otherwise be unable to afford.”

Some additional findings from the survey include:

  • Average annual wage per WSE increased somewhat
  • Average number of WSEs per client company stayed about the same
  • Number of internal employees (including salespeople) stayed about the same
  • Number of Worker’s Compensation claims reported to carrier stayed about the same

The survey also revealed that the average PEO has 19 worksite employees per client.

What’s the difference between co-employment and employee leasing? PEO and Employee Leasing. What’s the Difference.

Learn how a PEO can help grow your business.  Check out PEO Case Studies here and learn how they can apply to you.

Click below for a free PEO assessment. Our PEO Quoting Tool ensures that we have first-hand insight as to what the small business owner needs to be successful.

2018 Annual Benefit Plans Maximums

2018 Annual Benefit Plans Maximums

2018 Annual Benefit Plans Maximums

If you would like a printable version of this guide, please email info@medicalsolutionscorp.com and we will gladly forward one to you.

Pension Contribution & Benefit Limits

2017 Limit

2018 Limit

Section 401(k), 403(b), or 457(b) annual deferral$18,000$18,500
SIMPLE plan annual deferral$12,500$12,500
Section 415 maximums
Annual benefit from defined
benefit plan
$215,000$220,000
Annual additions to defined contribution plan$54,000 $55,000
Maximum IRA contribution$5,500 $5,500
Catch-up contribution limits
Retirement plan$6,000$6,000
SIMPLE plan$3,000$3,000
IRA$1,000$1,000
Compensation Amounts
Annual compensation limit$270,000$275,000
Grandfathered governmental plan participants$400,000$405,000
Highly compensated employees
any employee*$120,000**$120,000**
5 percent ownerno minimumno minimum
*   Employer may elect to limit to top-paid 20%** Due to the look-back rule, applies in determining HCEs during following year
Key employees
officer$175,000$175,000
1 percent owner$150,000$150,000
5 percent ownerno minimumno minimum
Small Employer Health Insurance Credit Average Wage Phase-Out$26,200$26,600
 

 

Social Security/Medicare

2017 Limit

2018 Limit

OASDI taxable wage base$127,200$128,400
OASDI tax rate – employer6.2%6.2%
OASDI tax rate – employee6.2%6.2%
Medicare tax rate – employer1.45%1.45%
Medicare tax rate – employee1.45%>1.45%>
Maximum income without reducing Social Security retirement benefits
SSRA* or overno limitno limit
year individual attains SSRA*$44,880/yr.^$45,360/yr.^
under SSRA*$16,920/yr.$17,040/yr.
Employer must withhold additional 0.9% from compensation in excess of $200,000*   Social Security Retirement Age (age at which an individual may receive an unreduced monthly benefit)

^  No limit on earnings beginning the month an individual attains SSRA

 

 

Health Plan Limits

Maximum Health FSA
employee deferral$2,600$2,650
carryover$500$500
Maximum HSA contribution
individual$3,400$3,450
family$6,750$6,850
catch-up$1,000$1,000
Minimum HDHP deductible
individual$1,300$1,350
family$2,600$2,700
Maximum HDHP out-of-pocket
individual$6,550$6,650
family$13,100$13,300
Maximum out-of-pocket (non-grandfathered plans)
individual$7,150$7,350
family$14,300$14,700
Transitional Reinsurance Fee (per person)Only paid through the 2016 plan year.

 

Note: The information and materials herein are provided for general information purposes only and have been taken from sources believed to be reliable, but there is no guarantee as to its accuracy. 

Learn More About your 2018 Options

Contact Us Now    Learn how our Agency is helping buinsesses thrive in today’s economy. Please contact us at info@medicalsolutionscorp.com or (855)667-4621. 

Like this blog article? You might also like our full HSA 2018 Limits page.

 

Handling Snow Days and Employee Pay

Handling Snow Days and Employee Pay

Handling Snow Days and Employee Pay 

Spring started yesterday but Old Man Winter did NOT get the Memo.  So what to do if it snows and employees are unable to get to work?

IF YOU CLOSE YOUR BUSINESS

 

If your company decides to stay open during bad weather, it’s important to understand some of the risks you face.  According to a Connecticut Business and Industry Association survey of 430 member-companies, the most common practice when “bad weather forces a closing” is to pay hourly employees only for the hours actually worked. “This was true for a majority of both small employers (25 to 249 employees) and large employers (more than 250 employees),” according to the survey.

EXEMPT EMPLOYEES

Exempt employees should be paid if a business is closed due to inclement weather- they should receive their weekly salary for this time. However, an employer can take these days out of the personal days, vacation time, or paid time off. As an employer, it is respectful and in some places required to alert employees that it will come out of their personal time. If it one full week of closure, employees do not need to be paid for that time. However, if work is done during any of the time the business is closed, employees need to be compensated.

If your company chooses to use accrued time to pay employees, but an employee does not have any paid time off accrued, you still must pay the employee their full wage. In some cases they will need to examine contracts to ensure that there are no limits to how much time can be taken away. However, if vacation or PTO is notoffered to employees in general, exempt employee should still be paid.

NON-EXEMPT EMPLOYEES

For non-exempt employees they do not need to be paid for hours they do not work. However, a company may give them the option to elect to use their paid time off or vacation time. When it comes to non-exempt employees who are paid a fix weekly salary for fluctuating hours they must be paid for the week if they work for at least three hours.

Local State Policies on Sending Employees Home

Like above, if an exempt employee goes to work, they must be paid for the entire day. However, non-exempt employees do not necessarily have to be paid for the time they do no work. Some states have reporting time pay- which means that they need to be paid for a certain number of hours regardless of whether or not they worked.

  • CONNECTICUT – This law only applies to four industries: beauty shop, mercantile trades, and laundry/cleaning/dyeing operations, all must be paid for a minimum of four hours and in the hotel and restaurant industry a minimum of two hours. It can be waived if the scheduled shift is less than four hours.
  • NEW YORK – Regardless if there is work to be done, if an employee shows up they must be paid for at least four hours of work, unless the scheduled shift is less than four hours in which case they must be paid for the full amount of time. This does not apply to: employees who are on call or live on the employers’ premises, building service industries, administrative, executive, profession, outside sales, farm laborers, taxicab drivers, babysitters, companions, golf caddies, staff counselors, and booth renters (those who rent space in a beauty shop).

EMPLOYEES WHO CAN’T MAKE IT TO WORK

If your business chooses to open but an employee cannot make it to work exempt employees can lose time out of their personal or vacation time. If no time has been saved or it has all been exhausted an employer may deduct funds from pay, only if the employee misses a full day of work.

TELECOMMUTING

If you allow employees to work from home, or expect them to work from home in the event of inclement weather they must be paid. Exempt employees should be paid for the day, or week, whichever is applicable. If an exempt employee is expected to any work whatsoever from home, or another location they must be paid for that time- even if it is beyond a week that the company is closed. As always, non-exempt employees should be paid for the hours they work.

If you are an employer it is important to recognize that snow days are an opportunity for you to support employees, especially those who have children or commute more than an hour away. If our HR Partners have written your employee handbook, office closings and delays are already addressed but it is important to use your best judgement a communicate with your employees early enough to give them time to make arrangements depending on their situation.

Click here to schedule a 1 on 1 compliance consultation.

Case Study: Law Firm and PEO Solution

Case Study: Law Firm and PEO Solution

Case Study: Law Firm and PEO Solution

Professional Services: New York Law Firm’s Benefit Benchmark Study Reveals Gap In Offerings

A law firm with a benefit offering below the New York law firm benchmark, no HR person on staff, no formal recruitment strategy and no employee development plan was struggling to attract top lawyers and paralegals, and to keep top producers. This was affecting their stability, employee morale, and ultimately, their bottom line. After losing one of their highest billing attorneys and a key associate to a larger firm with more robust benefit offerings, they realized they needed to make an immediate and drastic change to recruit and retain quality employees.

SOLUTION

Our PEO partner immediately assigned a seasoned Human Resources Manager with vast experience working with law firms to help, and conducted a market analysis of other firms in the area. After establishing a benchmark, the PEO developed an innovative employee benefits program that rivals top law firms in the area. Our PEO partner then devised a recruitment and retention strategy designed to reposition the firm in the marketplace.

RESULT

The firm now offers benefits and employee development that are on par with their top competitors. They have a clear plan on how to increase employee satisfaction and retain quality people while attracting top new talent. Their turnover has reduced significantly, and employees shared positive feedback during and after their benefit enrollment meetings via employee satisfaction and engagement surveys. Leadership can now focus on clients and on growing the firm.

Click below for a free PEO assessment. Our PEO Quoting Tool ensures that we have first-hand insight as to what the small business owner needs to be successful.

Contact Us Now    Learn how our Agency is helping buinsesses thrive in today’s economy. Please contact us at info@medicalsolutionscorp.com or (855)667-4621. 

PEO: Co-Employment

Why We Love PEO This Valentine’s Day

Why We Love PEO This Valentine’s Day

Why We Love PEO This Valentine’s Day

We already love Professional Employer Organziation (PEO)– our clinets do too.  Today we’re counting down our top 5 reasons why we love PEO:   Top 5 Reasons Why We Love PEO

1.National Capabilities: It ensures your compliance with local and federal laws, even if your business has locations in different states. Access to a national provider healthcare plan, not single state carriers

2. Laibility Protections:  Some liability moves to the PEO service instead of your company. 

3. It saves you money on HR staff.  Being part of a PEO gives you a clear cut idea of what your costs are going to be year in and year out. The PEOs work tirelessly to keep their insurance renewals down, so their clients won’t leave. Every year they work with the insurance carriers to introduce new plans and ways to reduce the costs of insurance to their clients. This gives you the ability to forecast and know precisely what your costs will be.

4.  Technologies:  Online HR resources for self service issues  Ability for employees to make personal changes on their own, online. Ability to track PTO (paid-time off).

 5. One Vendor: It streamlines HR tasks like payroll, taxes, employee benefits, worker’s compensation, 401K and HR administartive tasks. 

Our PEO Quoting Tool ensures that we have first-hand insight as to what the small business owner needs to be successful. Click below for quote.

PEO: Co-Employment

 

Small, Midsize Businesses Hold Key to Growth

Small, Midsize Businesses Hold Key to Growth

Small, Midsize Businesses Hold Key to Growth

By Thomas J. Donahue, President and CEO, U.S. Chamber of Commerce Sept 25 ,2017

Small, Midsize Businesses Hold Key to Growth  The U.S. economy grew at a rate of 3% last quarter, the fastest pace in more than two years and a welcome sign of momentum following a sluggish recovery. What do we need to do to ensure this progress continues? For one thing, we need to listen to America’s small and midsize business leaders. These economic playmakers often get drowned out in our modern political discourse, but the U.S. Chamber of Commerce is working to make sure their voices are heard—because our country depends on them.

We’ll never kick our economy into high gear if we don’t understand the concerns and goals of the business leaders who are on the ground working to expand their companies every day. In debates over tax reform, health care, regulations, and more, input from these Americans holds the key to boosting the entire country. After all, two-thirds of new private sector jobs come from our 30 million small and midsize businesses. When we respond appropriately to their frustrations, we end up helping our workers and communities too.

The Chamber conducts surveys of small and midsize businesses every quarter, and we use the results to keep our government in tune with our economy. We also host events such as our recent National Small Business Summit in Washington, D.C., and our Small Business Series of events across the country. Our priority with these is t

o listen and then amplify what we hear.

In the case of our most recent surveys, about 60% of small business leaders in the second-quarter had a positive outlook for their companies and the environment in which they operate. Our third-quarter survey of midmarket business owners, released last week, was slightly less encouraging. These leaders are still optimistic, yet their outlook had dimmed from the previous quarter, partly due to a lack of progress on policy reform in Washington.

These business leaders are eager to hold government accountable. At our recent Small Business Summit, for example, we gave attendees the opportunity to engage directly with members of Congress—and the response was overwhelming. About 200 business owners stormed Capitol Hill to talk tax reform and other issues.

With the third-quarter ending this Saturday, we’ll soon get another official reading on America’s economic performance. The Chamber hopes to see continued momentum with another strong quarter. But regardless of the result, it is clear that small and midsize businesses are ready for real action on vital issues like tax reform and infrastructure. Government leaders would do well to listen up—and get moving.

Contact Us Now    Learn how our Agency is helping buinsesses thrive in today’s economy. Please contact us at info@medicalsolutionscorp.com or (855)667-4621. 


Learn how SMB are accelerating growth using our PEO Partnerships exclusives:

PEO: Co-Employment

$700 Million for Struggling Brooklyn Hospitals

$700 Million for Struggling Brooklyn Hospitals

$700 Million for Struggling Brooklyn Hospitals

Brookdale Hospital Kings County and Interfaith get $700 Million

Gov. Andrew Cuomo announced Wednesday that One Brooklyn Health — a conglomeration of Interfaith Medical Center, Kingsbrook Jewish Medical Center and Brookdale Medical Center — will receive a substantial share of the $700 million that the administration has held for more than two years with the promise that it would one day be used to transform health care in central Brooklyn.

Why it matters: 

Brookdale alone has cost $100-$150M annually. The state spends $250 million a year keeping the lights on in these hospitals. That’s tax money that could be spent on anything else if the state can somehow figure out how to make these three hospitals more financially sound.

With state and federal reforms they are exposed. Adapting to a reimbursement landscape in which payment is increasingly linked to performance has become a fail. Ironically, the very reason for this fail is that the State links performance with Medicaid funding.

In other words if you are a hospital already in need of a lifeline Medicaid was paying you ‘X,’ now the managed Medicaid people come and say we are going to pay you $2000 less per discharge. The new reimbursement shift to pay per performance vs a fee for service reimbursements consistent with Obamacare. Its designed to reward value over volume with financial incentives to keep patients healthy through preventive care and early disease detection rather than running up expenditures.

The downward spiral continues as Medicaid Patients are likely to select a more prestigious hospital whenever possible. See how your Hospital ranks here. 40 percent of Brookdale Hospital patients indicating that they would definitely recommend the hospital. Wyckoff Heights and Interfaith also scored poorly – less than 50 percent of their patients reported that ‘they would definitely recommend the hospital. Sadly, with such low scores a State spending strategy alone has not solved the problem in the past nor likely in the future.

Cadillac Tax Delayed Two Years

Cadillac Tax Delayed Two Years

Obamacare tax delayed

Cadillac Tax Delayed Two Years

We received the following communique from the Council of Insurance Agents & Brokers (CIAB)  a delay in the Cadillac Tax for two years as a result of the passage earlier today in the US Senate of the continuing resolution (CR) to fund government until February 8th

Implementation of the Cadillac Tax on health insurance plans will be delayed by two years, from 2020 to 2022, as part of a deal reached in Congress today to fund the government through February 8.

Repealing the Cadillac Tax is a top legislative priority for The Council and we’re pleased to see the two year delay included in this agreement. The agreement will also delay the medical device tax for two years and the health insurance tax for one year.

The Cadillac Tax imposes an annual 40 percent excise tax on plans with annual premiums exceeding $10,800 for individuals or $29,500 for a family. The Council strongly advocates for legislation that exclusively repeals the Cadillac Tax as championed by Senators Dean Heller (R-NV) and Martin Heinrich (D-NM), and Representatives Mike Kelly (R-PA) and Joe Courtney (D-CT).

The major hurdle to the effort continues to be the $87 billion cost associated with the bill, a figure with which The Council and our allies take issue. We will continue to work with our Congressional allies to see a full repeal of the tax.

Contact Us Now    Learn how our Agency is helping buinsesses thrive in today’s economy. Please contact us at info@medicalsolutionscorp.com or (855)667-4621. 

2018 Compliance Calendar

2018 Compliance Calendar

2018 Compliance Calendar

2018 Important Dates

2018 Compliance Calendar. The following are important compliance due dates and reminders for 2018. The laws and due dates apply based on the number of employees, whether or not someone does business with the federal government, and on benefits offered. Other state-by-state laws may also apply.

Date Compliance Issue Employer Action
 1/1/2018 Social Security Taxable Limit Increases The maximum amount of earnings subject to the Social Security tax (taxable maximum) has been increased for 2018 from $127,200 to $128,400.

 

 1/31/2018 Forms W-2 and 1099 due Employers must provide all employees copies of Form W-2 reporting earnings and taxes for 2017 by January 31, 2018. When applicable, employers must provide Forms 1099 to contractors who earned more than $600 in business-related payments in 2017.

 

2/1/2018 Post OSHA Form 300A 

Employers with more than 10 employees who are not in exempted low-risk industries must post Form 300A, the annual summary of job-related injuries and illnesses, in a workplace common area from February 1 through April 30, 2018. If there were no recordable injuries or illnesses, applicable companies must still post the form with zeroes on the appropriate lines.

 2/28/2018 or  4/2/2018 ACA Forms 1094 and 1095 

Applicable Large Employers must submit Forms 1094 and 1095 to the IRS by February 28, 2018 if submitting paper forms or April 2, 2018 if submitting electronically.

 3/2/2018 1095-C/B Form 

The IRS recently announced they were extending the ACA reporting requirement deadlines for Forms 1095 C/B to employees for all Applicable Large Employers (ALEs) and anyone offering a self-funded plan from Jan. 31 to March 2, 2018. No further extensions will be permitted beyond this revised deadline.

 3/31/2018
(extended from 9/30/2017
 EEO-1 Report 

Organizations with 100+ employees and organizations with federal government contracts of $50,000 or more and 50+ employees are to submit the 2018 EEO-1 report by March 31, 2018.

 04/30/18 Form 941 

Deadline to file Form 941, employer’s quarterly tax return. Subsequent quarter deadlines are 7/31/2018, and 10/31/2018.

 4/30/2018
(if on a calendar plan year)
 Summary Plan Description (SPD) 

Employers who offer a health insurance plan must provide SPD’s to all participants within 120 days after a new plan is adopted. SPDs must also be provided to new participants no later than 90 days after the person first becomes covered under the plan.

 7/1/2018 OSHA Form 300 A Accident Summary Posting 

 

Employers with at least 250 employees (including part-time, seasonal, or temporary workers) in industries covered by the recordkeeping regulation must submit information from their 2017 Form 300A by July 1, 2018. Employers with at least 20 employees but fewer than 250 in certain identified high-hazard industries must submit information from their 2017 Form, 300, and 301 by July 1, 2018.

 7/31/2018 PCORI Fee Due 

July 31, 2018 is the annual deadline for payment of the Patient Centered Outcomes Research Institute fee (PCORI fee). The amount of the PCORI fee is equal to the average number of lives covered during the policy year or plan year multiplied by the applicable dollar amount for the year.

 7/31/2018 (if on a calendar plan year) Form 5500 

Group plans with 100 or more participants must file Form 5500 annually, by the last day of the 7th month following the end of the plan year. Outside of a few exceptions, all group health and retirement plans subject to ERISA are required to file a form 5500 when they have 100+ participants.  If an extension is obtained forms are due by October, 15, 2018.

 9/30/2018 VETS-4212 Report 

Government contractors must submit a VETS-4212 Report no later than September 30.

 10/15/2018 Medicare Part D Notice 

Employers are to provide notice to all Part D eligible individuals, or those about to become eligible, prior to October 15 of each year who is covered by an employer health plan with outpatient prescription drug coverage, regardless of whether the employer coverage is primary or secondary to Medicare. The notice must be provided to all Part D eligible individuals, whether covered as active employees, retirees, COBRA recipients, disabled individuals, or as dependents. Plan participants are Part D eligible if they are 65 or more years old, three months before turning age 65, and/or if they are disabled.

Note: If you provided participants with the all-in-one Employee Notification service provided by HR Service, Inc. this notice was included.

 12/31/2018(if on a calendar plan year)125 Premium Only Plans (POP) & Flexible Spending Account (FSA) non-discrimination testing 

Employers who offer either a 125 POP or Flexible Spending Account must conduct Nondiscrimination testing as of the last day of their plan year to ensure that benefits are available to all eligible employees under the same terms. A good practice is to test the plan after open enrollment is complete and again at the end of the plan year. Early testing allows for modifications in plan design should discrimination testing result in a fail.

 

 12/31/2018 HIPAA Certification Part 2 

Health plans must certify that its data and information systems are in compliance with applicable standards and operating rules for:

  • health claims or equivalent encounter information
  • enrollment and disenrollment in a health plan
  • health plan premium payments
  • referral certification and authorization
  • health claims attachments

 

Note: The information and materials herein are provided for general information purposes only and have been taken from sources believed to be reliable, but there is no guarantee as to its accuracy. 

Contact Us Now    Learn how our Agency is helping buinsesses thrive in today’s economy. Please contact us at info@medicalsolutionscorp.com or (855)667-4621. 

Top 10 Questions to Ask Your Benefits Broker

Top 10 Questions to Ask Your Benefits Broker

Top 10 Questions to Ask Your Benefits Broker

Top 10 Questions to Ask Your Benefits Broker  

Benefits Broker Checklist

Are you asking the right questions? Yes, your Broker was referreered by family or friend. You may have met him at golf outing or an event. With rapidly changing laws and markets it maybe a good idea to refer back to this checklist.

To ensure that your broker is the right fit for your company, ask prospective brokers these 10 questions:

  1. What is their method for controlling healthcare costs? The ideal broker will give his or her professional advice to your management and HR teams in order to create a strategy that will work for years. Using data analytics and benchmarking they will be able to show you where your premium falls in comparison to companies similar to yours. Additionally, they will negotiate with carriers to get you the best rate and suggest alternative options for funding your benefits.
  2. What services should I expect? It is important to understand the scope of services that your benefits broker can provide. First, you need to determine what is most important to your company’s needs, then you can discuss what services you will need from your broker in order to have a well-run benefits plan.
  1. Do they have solid references and industry experience? A reliable benefits broker will be able to provide you with references in similar industries and demographics to yours. This guarantees your benefits broker is focused on the specific types of products your employees need.
  1. How will they support your company and your employees? Providing ongoing employee support for benefits-related issues and questions beyond enrollment is important. The best brokers are the ones who are invested in your employees and want them to completely understand their benefit options. You will want to hire a benefits broker who will host informational sessions and schedule employee meetings in order to meet this goal.
  1. What kind of online enrollment and other tools do they offer? Model brokers offer a fully-integrated solution shaped to fit your needs. These brokers will ensure that the technology is equipped to solve your problems. Many brokers offer enterprise class HRMS and Open Enrollment solutions.
  2. How do they plan on handling the renewal process? Typically, the renewal process starts a minimum of 45 to 60 days prior to the renewal date. However, you want a broker who will be proactively working on your plan year-round. This gives both parties involved plenty of time to review the data, gather competitive quotes, and make the right decision. Your broker should negotiate your renewal rate each year and be able to suggest products that would be appealing to your employees.
  1. How do they ensure that their clients are kept in compliance, and what resources do they offer? A good broker takes compliance to the next level. They will supply you with all of the tools and information you need in order to make informed decisions. In addition to communicating compliance information and providing technology to manage compliance issues, their services should include a dedicated contact, representative, or call center that you can use for questions or concerns.
  1. How much support will they offer your HR department? The ideal broker will act as a trusted partner who works strategically with HR, supplying the vital tools for success. Tools such as online enrollment, HRIS software, and human resource outsourcing services. You want your broker to be a total solution provider for your organization.
  1. Will you have a dedicated account manager? As an employer, you want your broker to be accessible in case you ever need them. A dedicated account manager is someone who will always be available to help you if you have a question about your plan or are having trouble making a claim. This contact can help you resolve any issues and answer questions.
  1. How will they determine the best coverage for you? Your employees’ insurance and benefit needs will change over time due to both internal and external causes and changes, so your benefits broker should not only demonstrate the experience to create initial packages, but continue to monitor employee and business needs based on the financial information you provide.

Insurance and benefits offerings are the second largest employee expense outside of payroll. And who is responsible for it all? Your benefits broker. Insurance programs can directly impact employee turnover, retention numbers, workplace productivity, job offer acceptance rates, and candidate quality. With the ability to affect your organization at a very large scale, it is important to have a broker who outperforms the rest. Analyzing these ten critical questions in relation to your organization’s needs will help you make a more informed decision about your benefits broker. If your broker is incapable of answering these questions then odds are you should reconsider.

 

Contact Us Now    Learn how our Agency is helping buinsesses thrive in today’s economy.Please contact our payroll and reimbursement team on your HR/Payroll/Compliance needs at Millennium Medical Solutions Corp at info@medicalsolutionscorp.com or (855)667-4621 for immediate answers.

4 New Years Resolution Tips

4 New Years Resolution Tips

4 Tips in keeping New years resolution

4 New Years Resolution Tips   

(Courtesy Cleveland Clinic)

Starting the New Year can be a perfect opportunity to change something about your life or behavior or do something you have always wanted to do. 4 New Years Resolution Tips. Here are a few examples of popular health related resolutions:

  • Lose weight
  • Get fit
  • Eat more healthily
  • Start a new sport
  • Run a marathon

Many people start strong in January, but by the time summer comes around resolutions are often long forgotten. Here are four tips to help you set and stay on track with your goals in the year ahead.

1. Choose your goals wisely

Your chances of success are much greater if you channel all of your energy into changing just one thing. Your resolution should be something reasonably achievable but also not a quick or easy fix. For example, rather than aiming to cut out all refined sugar in your diet, try cutting back gradually, or find healthier alternatives to your favorite snacks. Avoid setting any overly ambitious goals as this will just discourage you and may encourage unhealthy practices. If you are taking up a new sport, sudden over-exertion can cause discomfort and lead to excessive muscle ache in the following days, which could cause you to give up all together. Try to build up slowly and work on making your new regime a sustainable lifestyle change.

2. Tell people or find a buddy

Telling your family and friends about your goal means you are more likely to get support and want to avoid failure. You may find that someone else has the same resolution as you – this can keep you motivated and you can resolve to take the first steps of your lifestyle changes together, such as joining a group exercise class. You are more likely to push on through the more difficult days when you have a supporting partner.

3. Have a plan and track your progress

Break your end goal into a series of steps; focus on creating sub-goals that are measurable and time based. If you are taking up a new sport, start small and build up at regular intervals. If you are jogging, challenge yourself to run five minutes longer each week until you reach your distance goal. Once you have accomplished this, you can work on improving your timing, or even set a new, bigger distance goal. This can also help you monitor your progress and give you a periodic sense of accomplishment, which can give you the motivation to work towards your next milestone.

4. Don’t get disheartened, remind yourself of the benefits

Remember, setbacks are inevitable. Don’t be too hard on yourself and give yourself enough time to recover from momentary setbacks before working towards your next milestone. If you are trying to shed some weight for example, try to weigh yourself no more than once a week. If you have lapsed from your healthy diet or skipped a gym class, you may think the increase on the scales the next day is a direct result of that. However, it’s normal for weight to fluctuate on a daily basis for reasons beyond lifestyle. By limiting how often you check your progress, you can get a more accurate view of how effective your new, healthier lifestyle is progressing.

If your progress is slow, and you are feeling demotivated, it may help to remind yourself of the benefits associated with achieving your goals. Try creating a checklist of how life will be better once you obtain your aim.

HAPPY 2018!  Wishing everyne good health and prosperity for the year to come. 

Empire Strikes Back – 2018 Plans

Empire Strikes Back – 2018 Plans

Empire Strikes Back – 2018 Plans

Empire Blue Cross 2018

Empire Blue Cross Blue Shield recently announced  their re-entry back into the New York small group market for 2017. A legendary broad networked PPO is welcome news especially in the NY small group market of 1-100 employees.  Recently, the broad national networks have  diminished to only 2 national health insurers, Aetna and Oxford.  As a result of Empire Blue Cross participation in the BlueCard PPO program members enjoy unparalleled national access network to 96% of hospitals and 93% of doctors across the country. This national program will be on 18 of 28 plans below.

Network Overview

3 distinct networks:

PPO Network Savings

PPO Network Savings

  1.  PPO/EPO Network – traditional non-gatekeeper large network of approximately 85,384 physicians, 160 facilities and the BlueCard PPO
  2. Blue Priority Network – hybrid of broad PPO/EPO 160 facilities  and similar Pathway’s 65,796 physicians network.
  3. Pathway Network –  HMO value based narrower gatekeeper referral network of 109 facilities and 60,535 physicians. Limited to 28 NYS Counties.

Additional Features:

  •   Telemedicine will be available on all products
  •   Vision –  Limited adult vision will be available on all products at no additional cost.empires-whole-health-connection
  •   Pharmacy – All plans use their large BCBS formulary Except the HMOs, and the Silver and Bronze Blue Priority Plans. They will be utilizing what they call the Select Formulary.
  •  Clinical Programshealth coaching/advocacy, disease management, behavioral health, maternity and Gaps in Care
  •  Online Resources – wellness coaching, discounts, health assessments and The Weight Center.
  •   Healthy Support – Wellness program offers easy ways to earn up to $900 per member, per year.  Gym Reimbursement  $400 single/$600 couple, $100 Wellness + Flu Shot, Online Wellness toolkit, up to $150 and $50 Tobacco-free certification online.

 

DOCTOR SEARCH:  Click Here 

BENEFITS SUMMARY:  Empire Blue Cross 2018 Top Plans 

Small Group Rates: 2018 EMPIRE BLUE CROSS Plan Grid

Drug Formulary: Click Here

Blue Priority  FAQ: Click Here 

Pathway FAQ: Click Here

Ask us about Empire’s flexible low participation voluntary group dental, vision,  disability and life insurance plans. Stay proactive and contact us today for a customized consult on how your organization can prepare  ahead  for ACA, Benefits, Payroll and HR  @ (855) 667-4621 or info@medicalsolutionscorp.com.

empire-voluntary-ancillary-dental-whole-life


 

 Contact Us Now    Learn how our Agency is helping buinsesses thrive in today’s economy. Please contact us at info@medicalsolutionscorp.com or (855)667-4621. 
Tax Reform Bill Includes Repeal of Individual Mandate Beginning in 2019

Tax Reform Bill Includes Repeal of Individual Mandate Beginning in 2019

Tax Reform Bill Includes Repeal of Individual Mandate Beginning in 2019

On Dec. 20, Congress passed the Tax Cuts and Jobs Act, which makes significant changes to individual and corporate provisions of the U.S. tax code, including a reduction in the corporate tax rate to 21%, down from 35%, beginning in 2018. The bill includes permanent effective repeal of the Affordable Care Act (ACA) individual mandate, requiring individuals to purchase and maintain health coverage, by zeroing out the penalty beginning in 2019. For 2018, most individuals are still required to maintain coverage or pay a penalty when they file their 2018 federal income tax return.

The bill was negotiated by a conference committee comprised of representatives from both the Senate and House after each chamber passed their own versions of tax reform. The final bill was passed 51-48 by the Senate and 224-201 by the House before being sent to the President. President Trump is expected to sign the bill into law soon.

The bill also changes how certain tax thresholds will be indexed for inflation. Affected provisions, including the ACA “Cadillac” Tax (scheduled to take effect in 2020), will now be indexed to the Chained Consumer Price Index (CPI) instead of the regular CPI (the previous metric). That change makes it likely that more employer-sponsored plans would trigger the Cadillac tax sooner.

We will keep our clients advised of timely developments of the Tax Cuts and Jobs Act as it relates to employee beneifts. For now, though, it appears that the biggest impactsthe next couple years are likely to be with respect to the individual mandate repeal and the Cadillac Tax changes.

RESOURCE

 

What You Need to Know about Medicare 2018 Infographic

What You Need to Know about Medicare 2018 Infographic

What You Need to Know about Medicare 2018 Infographic

Infographic Medicare 2017 Open EnrollmentThis timely infographic walks seniors through the differences between traditional Medicare and Medicare Advantage vs. Supplement Plans + a helpful plain english glossary.

Open Enrollment ends Dec 7, 2017 for Jan 1, 2018 effective date. Enroll by phone advatange at (855) 667-4621.

2018 Medicare Open Enrollement is Here

We are certified and appointed to sell senior plans from Empire Blue Cross, AARP United Healthcare, Humana and Aetna to help people in New York currently enrolled in Medicare or those who are aging in to Medicare (turning 65) with a wide variety of options. Some of these are Medicare Advantage (HMO, PPO), supplement plans and Part “D” prescription plans (PDP,s).

There are also some special enrollment periods (SEP) available to individuals under certain conditions. The Annual Enrollment Period (AEP) for Medicare is October 15 to December 7 this year. Those currently on Medicare can shop around and switch their plans at this time. The initial enrollment period (IEP) of 7 months. This is from 3 months prior to your 65th birthday, the month of your birthday and the 3 months following your birth month.
It is wise to contact an expert to help you find the coverage that best suits you during these enrollment periods. You can call or email us at any time for comprehensive, “no pressure” advise.

Resource:

Download a Copy of 2017 Medicare and You.

2013 Medicare Costs

Medicare Supplement Plans

Medicare Advantage 

Getting Extra Help with Medicare Expenses

Medicare FAQ

Dates to Remember

October 1

You can start getting plan information for 2018 premiums and benefits.

October 15 — December 7

This is the Annual Election Period (AEP). During this time, you can make changes to your existing Medicare health or prescription drug plan or select a new plan for 2018.

January 1 — February 14

This is the Medicare Advantage Disenrollment Period. During this time, you can prospectively disenroll from your Medicare Advantage (MA) plan and return to Original Medicare.

If you are turning 65:

– If you aren’t getting Social Security (for instance, because you are still working), you will need to sign up for Medicare benefits. You should contact Social Security three months before you turn age 65.
– You can enroll in a Medicare plan starting three months before the month of your 65th birthday, the month of your birthday, and for up to three months after your 65th birthday, for a total period of seven months.

 Contact Us Now    Learn how our Agency is helping buinsesses thrive in today’s economy. Please contact us at info@medicalsolutionscorp.com or (855)667-4621. 
 
2018 Individual Marketplace Guidance

2018 Individual Marketplace Guidance

2018 Individual Marketplace Guidance

2018 Individual Marketplace Guidance

Health and Human Services had released earlier this year the final version of its 2018 Individual Marketplace Guidance.  Under the Affordable Care Act (ACA) this is issued annually. While the guidance is mostly related to the individual marketplace it does, however, include several items relevant to employers and group health plans.

Example:

  • Annual limits for cost sharing (out-of-pocket limits)
  • Marketplace eligibility notifications to employers
  • Marketplace annual open enrollment period
  • Small Business Health Options (SHOP) Exchange

Nov 2017 – How to Select a Broker on NYS of Health marketplace. 2018 Individual Health Insurance Market Open Nov 1 - Dec 15

Nov 2017- 2018 Individual Marketplace Guidance. 

Nov 2017- Indiviudal Enrollement  on Oscar or UnitedHealthcare Essential Plan.

Nov 2017 – Emnployer Reporting 2017 Updated 1094 & 1095 Now Available


On Exchange Maximum Household Income for Subsidy

Your decision on which will depend on your Household Income and the number of people in your household applying for coverage. In the chart below, if your HOUSEHOLD income (include all members or your tax household regardless of if they are applying for coverage or not) is below the limit shown based on the number in your household applying for coverage, then it is better for you to apply via your state marketplace such as the NY State of Health.

# of Household Members Applying for Coverage Maximum Household Income for Subsidy
1$48,240
2$64,960
3$81,680
4$98,400
Each Add’l. Household Member$16,720

MEDICAID EXPANSION: For those with incomes less than 200% of the Federal Poverty level you should also enroll via NYSOH as you might qualify for the United Healthcare Essential Plan.

ENROLLING ON NY STATE OF HEALTH

To enroll via NYSOH and have us as your broker use this link for instructions. How to Select a Broker on NYS of Health marketplace. 

Alternatively, If you earn too much to qualify for a subsidy we will enroll you OFF EXCHANGE. The application forms can be found using the Oscar link above. Download the FULL ENROLLMENT KIT and complete the necessary forms to send to us for processing.

2018 NY State of Health Open Enrollment Runs from 11/1/17 – 1/31/18. Special enrollment period runs throughout the rest of the year for qualifying events.

ANNUAL LIMITS FOR COST SHARING:

The annual out of pocket limits for plan years beginning on or after January 1, 2018 are $7,350 for individual coverage and $14,700 for family coverage.  These cost sharing limits apply to in-network essential health benefits offered under non-grandfathered health plans, both fully and self-insured.  Annual deductibles, in-network co-insurance and other types of in-network cost sharing accumulate toward the out-of-pocket limit, including prescription drug copayments.  Not included are premium payments, out-of-network cost sharing and spending on non-essential health benefits.

MARKETPLACE ELIGIBILITY NOTIFICATIONS TO EMPLOYERS:

Beginning in 2017, the Marketplace will notify an employer as soon as possible when one of its employee’s first enrolls in subsidized Marketplace coverage.  Since some employers may be liable for a penalty under the ACA’s employer mandate when an employee qualifies for a subsidized Marketplace coverage, this change to a more proactive notification process will hopefully provide employers with the opportunity to work with CMS in cases where an improper subsidy has been provided.

MARKETPLACE ANNUAL OPEN ENROLLMENT PERIOD:

Open Enrollment in the Health Insurance Marketplace, Healthcare.gov, for 2018 will take place from November 1, 2017 through January 31, 2018.

SMALL BUSINESS HEALTH OPTIONS (SHOP) EXCHANGE:

Beginning in 2017, small employers electing coverage in the SHOP Exchange will have the option of “vertical choice,” offering plans across all metal levels (platinum, gold, silver and bronze) from one insurer. States who opt out of the vertical choice option will continue to offer employers the choice of selecting health plans that are available at one single metal level of coverage.

Stay proactive and contact us today for a custmozied consult on how your organization can prepare  ahead  for ACA, Benefits, Payroll and HR  @ (855) 667-4621 or info@medicalsolutionscorp.com.

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6 Changes to 2018 Individual Health Insurance Open Enrollment Period

6 Changes to 2018 Individual Health Insurance Open Enrollment Period

6 Changes to 2018 Individual Health Insurance Open Enrollment Period

HealthCare.com Offers Insight on 6  Changes to 2018 Individual Health Insurance Open Enrollment Period. The health insurance Open Enrollment Period for 2018 opens Nov 1st and now lasts only 45 days. HealthCare.com provides insight on the abbreviated timeline and other notable changes to watch out for.

2018 Individual Marketplace Guidance:

HHS released final 2018 Notice of Benefit. Contact us today at (855) 667-4621 or info@medicalsolutionscorp.com.


6 Changes to 2018 Individual Health Insurance Open Enrollment Period

MIAMI and NEW YORK, Oct. 27, 2017 /PRNewswire/ — Despite efforts from the federal government to reform the Affordable Care Act, the 2018 health insurance Open Enrollment Period – the time when Americans can change Obamacare health insurance plans or a join a new plan for the upcoming year – will still begin on November 1, 2017. But this has left most Americans confused about how this year’s open enrollment differs from the previous three.

2018 Individual Health Insurance Market Open Nov 1 - Dec 15

Unlike previous Open Enrollment Periods, which each occurred over a 90-day window, this year’s open enrollment will last just 45 days – starting on November 1 and lasting until December 15. The shortened timeframe means Americans will have less time to make decisions about their healthcare. While some U.S. states have extended the enrollment periodfor their individual state exchanges (notably, California and New York), most states will follow the condensed 45-day enrollment window.

There are several major changes to the open enrollment process in addition to the condensed 45-day enrollment window. It’s likely that many consumers will be caught off-guard, as these changes to open enrollment have not been well publicized. HealthCare.com cofounder and CEO, Howard Yeh, explains how these open enrollment changes may affect consumers and the coverage options available to them.

1. Changes to Re-Enrollment:

“In previous enrollment periods, people were provided with several government notices to compare their current plan with other healthcare plans on the Marketplace. This year, it’s unclear whether consumers will be provided those notices. That’s why it’s important to shop around for a different health insurance plan during open enrollment. If consumers don’t compare their plan options, they run the risk of being re-enrolled in the same plan. This is the case even after the enrollment period has already passed. If their current plan’s monthly premium is set to increase, they may get stuck with a plan that doesn’t fit their needs, or is otherwise unaffordable.”

2. The End of Subsidies Towards Cost-Sharing Reductions:

“The Trump administration has decided to stop financing cost-sharing reduction (CSR) subsidies to insurance companies. Most insurers predicted this in fact.  The prices for Silver plans (the only plans for which these cost-sharing reductions were made available). This means higher insurance premiums and out-of-pocket costs for some. This also means, though, that people in some areas of the country may encounter Gold and Platinum plans that cost just as much or even less than Silver plans.”

3. Fewer Insurers, Fewer Options:

“Several insurers have filled in the gaps left by the exit of major insurance companies like Aetna and Anthem from the Marketplace. While this ensures that consumers across the country have healthcare options available to them.  In reality, the options are significantly slimmer than those in previous years. In many areas of the country, only one ACA health plan option will be available to consumers. Most plans are costlier that may be prohibitive for many.”

4. Higher Costs Overall:

“Costs for ACA plans overall will be higher compared to previous years – with insurers charging, on average, 20% more on premiums. These costs have outpaced income growth. Leading to a unique affordability gap – where people make too much to qualify for Obamacare tax credits, but make too little to actually afford a Bronze plan. Under the law, those unable to afford a Bronze plan are exempt from paying the penalty for not having health insurance, “Marketplace affordability exemption”). This year, we expect more than 1.5 million people to qualify for that exemption – a significant increase from the 600,000 two years ago.”

5. Less Government Assistance:

“The federal government has also slashed funding for different initiatives intended to encourage and support people enrolling in Marketplace coverage. Notably, there will be less help available from ‘navigators’ and government spending on Obamacare outreach and advertising is now virtually nonexistent. This means it’s up to consumers to actively seek out help when signing up – and it’s up to nonprofit organizations and private companies to step up and make sure consumers get the information they need.”

6. Decrease in Participation Due to Rise of Alternatives to Traditional Health Insurance:

“Motivated by increasing costs and limited options, more consumers are moving towards alternatives to ACA health insurance. Relatively unknown healthcare options, like association plans and faith-based healthcare, are becoming more popular. And people may start using short-term health insurance plans – which typically serve as temporary coverage solutions. They may reult in full-time replacements to traditional coverage, especially due to the President’s executive order. The short term plans may now last up to a year (compared to the previous limit of three months).”

Approximately 20 million people will shop for health insurance during this Open Enrollment Period. HealthCare.gov a top destination for consumers looking to shop around for the best-priced plan on Marketplace health insuranc.  Additonaly, alternatives to ACA coverage (like short-term health insurance plans) are included.

RELATED LINKS: For important updates throughout open enrollment, follow us medicalsolutionscorp.com on Facebook, Twitter, or visit our call us  855-667-4621 for more customized information.

 

 

NYS DFS Announces CareConnect Exit

NYS DFS Announces CareConnect Exit

NYS DFS Announces CareConnect Exit

Join us for Oct 25th Webinar.

We have been informed that the NY DFS has recently approved the following measures in the process of CareConnect exiting the market:
  • For individuals the market exit date is 12/31/2017.
  • For Small Group the market exit date is 11/30/2017.

All groups renewing starting 12/1/17 will no longer be accepted.  Currently active group business will end on the last day of their policy year (For example, a 9/1/17 effective will remain in force until 8/31/18).

With recent announcement “CareConnect Withdraws from NYS Market” a Healthfirst addition to the NY Small Business market is especially important.  In many instances the Healthfirst plans have a more robust network than CareConnect for NYC and LI.  Namely, they have the same hospitals North Shore LIJ(Northwell), Maimonides, but additionally key hospitals such as Mt. Sinai, NYU, Lenox Hill + urgent cares such as CityMD and GO-Health.  Rates are approximately $100/month higher for singles for example than CareConnect and would not be an automatic decision to move to Healthfirst.

DOCTOR SEARCH: Click Here

HEALTHFIRST HOSPITAL NETWORK 2017

HEALTHFIRST BENEFITS SUMMARY

DEC 2017 HEALTHFIRST PRO EPO PLANS

JAN 2018 HEALTHFIRST PRO EPO PLANS

 RSVP a FREE web-meeting below.



Learn how a Healthfirst EPO on your very own Private Exchange can help your group.Please contact us at info@medicalsolutionscorp.com or (855)667-4621. 

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NEW 2018 Healthfirst for NY Small Business

Healthfirst has released affordable new 2018 plans for NY small businesses and not a moment too soon.  With the recent exit of popular CareConnect of NY the market is starving for an affordable option.

About HealthFirst

Healthfirst had entered the small business market Jan 1, 2017. Healthfirst is a provider-sponsored health insurance company that serves more than 1.2 million members in downstate New York and Nassau county. Healthfirst offers top-quality Medicaid, Medicare Advantage, Child Health Plus, and Managed Long Term Care plans. Healthfirst Leaf Qualified Health Plans and the Healthfirst Essential Plan are offered on NY State of Health, The Official Health Plan Marketplace. Healthfirst offers Healthfirst Pro and Pro Plus, Exclusive Provider Organization (EPO) plans for small-business owners and their employees, and Healthfirst Total, an EPO for individuals.

The Healthfirst options include four Pro EPO plans with comprehensive benefits and pediatric dental and vision coverage that span all the metal tiers (Bronze, Silver, Gold, and Platinum). With Healthfirst plans, employees will have access to key features, including preventive and wellness visits (including annual checkups, vaccinations, and mammograms); a multilin

gual member services team; access to telemedicine via Teladoc; a robust choice of in-network doctors, specialists, hospitals, and urgent care centers; behavioral health and substance abuse services; coverage for acupuncture visits; and a user-friendly member portal that enables members to proactively manage their care.

Value

Healthifrst’s new January 2018 rates are in fact virtually the same as 4thQ 2017. Example, a single rate is approximately $2-$3 higher. Today’s largest networks with popular in-network only GOLD  are priced at  $857/single monthly. By comparison the Healthfirst Gold plan is $717 annualy or 15% less expensive.  For platinum the price gap jumps are even higher – $1050/single vs $850/single.

  •  Members have access to a broad network of providers and dozens of industry-leading hospitals.
  • Community locations throughout New York City, Long Island and parts of Westchester.
  •  Dental and vision coverage, 24/7 telemedicine access, acupuncture, exercise reward programs.

All Metal Levels will be included for all size groups including 1-99 market.  Referral’s are not needed to vsisit a Specialist MD but one must select a Primary Care Physician on the enrollment form.

NEW 2018 Healthfirst for NY Small Business

NEW 2018 Healthfirst for NY Small Business

NEW 2018 Healthfirst for NY Small Business

Healthfirst has released affordable new 2018 plans for NY small businesses and not a moment too soon.  With the recent exit of popular CareConnect of NY the market is starving for an affordable option.

About HealthFirst

Healthfirst had entered the small business market Jan 1, 2017. Healthfirst is a provider-sponsored health insurance company that serves more than 1.2 million members in downstate New York and Nassau county. Healthfirst offers top-quality Medicaid, Medicare Advantage, Child Health Plus, and Managed Long Term Care plans. Healthfirst Leaf Qualified Health Plans and the Healthfirst Essential Plan are offered on NY State of Health, The Official Health Plan Marketplace. Healthfirst offers Healthfirst Pro and Pro Plus, Exclusive Provider Organization (EPO) plans for small-business owners and their employees, and Healthfirst Total, an EPO for individuals.

The Healthfirst options include four Pro EPO plans with comprehensive benefits and pediatric dental and vision coverage that span all the metal tiers (Bronze, Silver, Gold, and Platinum). With Healthfirst plans, employees will have access to key features, including preventive and wellness visits (including annual checkups, vaccinations, and mammograms); a multilin

gual member services team; access to telemedicine via Teladoc; a robust choice of in-network doctors, specialists, hospitals, and urgent care centers; behavioral health and substance abuse services; coverage for acupuncture visits; and a user-friendly member portal that enables members to proactively manage their care.

Value

Healthifrst’s new January 2018 rates are in fact virtually the same as 4thQ 2017. Example, a single rate is approximately $2-$3 higher. Today’s largest networks with popular in-network only GOLD  are priced at  $857/single monthly. By comparison the Healthfirst Gold plan is $717 annualy or 15% less expensive.  For platinum the price gap jumps are even higher – $1050/single vs $850/single.

  •  Members have access to a broad network of providers and dozens of industry-leading hospitals.
  • Community locations throughout New York City, Long Island and parts of Westchester.
  •  Dental and vision coverage, 24/7 telemedicine access, acupuncture, exercise reward programs.

All Metal Levels will be included for all size groups including 1-99 market.  Referral’s are not needed to vsisit a Specialist MD but one must select a Primary Care Physician on the enrollment form.

Attention CareConnect Clients:

Join us for Oct 25th Webinar.

We have been informed that the NY DFS has recently approved the following measures in the process of CareConnect exiting the market:
  • For individuals the market exit date is 12/31/2017.
  • For Small Group the market exit date is 11/30/2017.

All groups renewing starting 12/1/17 will no longer be accepted.  Currently active group business will end on the last day of their policy year (For example, a 9/1/17 effective will remain in force until 8/31/18).

With recent announcement “CareConnect Withdraws from NYS Market” a Healthfirst addition to the NY Small Business market is especially important.  In many instances the Healthfirst plans have a more robust network than CareConnect for NYC and LI.  Namely, they have the same hospitals North Shore LIJ(Northwell), Maimonides, but additionally key hospitals such as Mt. Sinai, NYU, Lenox Hill + urgent cares such as CityMD and GO-Health.  Rates are approximately $100/month higher for singles for example than CareConnect and would not be an automatic decision to move to Healthfirst.


DOCTOR SEARCH: Click Here

HEALTHFIRST HOSPITAL NETWORK 2018

HEALTHFIRST BENEFITS SUMMARY

2018 3Q HEALTHFIRST PRO EPO PLANS


Learn how a Healthfirst on your very own Private Exchange can help your group. Please contact us at info@medicalsolutionscorp.com or (855)667-4621. 

Newsletter Sign Up Now

Healthpass Adds HealthFirst

Healthpass Adds HealthFirst

Healthpass Adds HealthFirst 

HealthPass New York, a private health insurance exchange for small businesses, announces that it will offer Healthfirst insurance plans to small business employers in the metropolitan New York City area. Healthfirst, a provider-sponsored health plan serving more than 1.2 million members in New York City and on Long Island, offers small employer group EPO plans to fit the needs of hardworking New Yorkers.

HealthPass will offer Healthfirst Pro EPO plans to eligible employers that employ between one to 100 employees. These plans are available to small businesses with employees who live, work, or reside in New York City and Nassau County. Eligible employers and their employees can begin enrolling in the Healthfirst plans now for coverage that would take effect as early as December 1, 2017.

The Healthfirst options include four Pro EPO plans with comprehensive benefits and pediatric dental and vision coverage that span all the metal tiers (Bronze, Silver, Gold, and Platinum). With Healthfirst plans, employees will have access to key features, including preventive and wellness visits (including annual checkups, vaccinations, and mammograms); a multilingual member services team; access to telemedicine via Teladoc; a robust choice of in-network doctors, specialists, hospitals, and urgent care centers; behavioral health and substance abuse services; coverage for acupuncture visits; and a user-friendly member portal that enables members to proactively manage their care.

About HealthFirst

Healthfirst had entered the small business market Jan 1, 2017. Healthfirst is a provider-sponsored health insurance company that serves more than 1.2 million members in downstate New York and Nassau county. Healthfirst offers top-quality Medicaid, Medicare Advantage, Child Health Plus, and Managed Long Term Care plans. Healthfirst Leaf Qualified Health Plans and the Healthfirst Essential Plan are offered on NY State of Health, The Official Health Plan Marketplace. Healthfirst offers Healthfirst Pro and Pro Plus, Exclusive Provider Organization (EPO) plans for small-business owners and their employees, and Healthfirst Total, an EPO for individuals.

Attention CareConnect Clients:

With recent announcement “CareConnect Withdraws from NYS Market” a Healthfirst addition is especially important.  In many instances the Healthfirst plans have a more robust network than CareConnect for NYC and LI.  Namely, they have the same hospitals North Shore LIJ(Northwell), Maimonides, but additionally key hospitals such as Mt. Sinai, NYU, Lenox Hill + urgent cares such as CityMD and GO-Health.  Rates are approximately $100/month higher for singles for example than CareConnect and would not be an automatic decision to move to Healthfirst.

Next Step:

Please register for Oct 25, 2017 1:00PM Webinar or set up a one on one online meeting here.

NYS PFL Paid Family Leave Checklist

NYS PFL Paid Family Leave Checklist

NYS PFL Paid Family Leave Checklist

Starting January 1, 2018, New York State will require all ALL PRIVATE EMPLOYERS with one or more employees to obtain insurance under their disability insurance. Designed to provide financial stability for state residents through major life changes, the new policy will provide guaranteed paid leave for families in three life circumstances including:
  • Care for a covered family member when the family member has a serious health condition;
  • Bond with his or her child the first year of birth or adoption; or
  • Spending time with a family member being called to active military service

        Plan for Staffing

If you have one or more employees who may use Paid Family Leave in 2018, you need to have the right staff in place to cover their workload while they’re out. There are many ways to make sure you’re covered during an employee’s PFL, but they all start with a plan of action.

Start now by making sure you have cross-training plans in place. And if necessary, consider starting a relationship with a short-term staffing company to see you through the employee’s absence. You’ll also want to create a guide or process for tracking eligibility requirements and requests for PFL, so you can ensure the proper level of benefits and leave time are implemented.

  Get Payroll in Order

New York State Paid Family Leave will be financed through employee payroll deductions, so now is the time to start having a conversation with your payroll provider. Whether your payroll is handled in-house or by a third-party payroll processor, this team can help you get ahead of any process changes necessary to prepare for the implementation of PFL on January 1, 2018.

 Double-Check Insurance

Have a conversation with your insurance broker or agent to ensure that both of you know what’s coming down the pike and what needs to be done about it. This is also a good time to confirm that your current statutory disability (DBL) carrier will remain in the PFL/DBL market. In addition, you should make sure your company is fully compliant with today’s DBL requirements.

 Housekeeping Items

Because there’s a new policy being implemented, now is also a good time to do a quick sweep of housekeeping items you may have put to the side. A few examples include the following:

  • Locate, organize, and update employee policies
  • Include PFL guidance in new employee handbooks
  • Gather PFL forms, such as the Request for Paid Family Leave form (when available)
  • Make plans to include PFL to your mandatory signage in break rooms or in another prominent location in the building

 Prepare for Employee Education

Prepare to educate employees and communicate to them the details and eligibility requirements of the new PFL benefit. Be sure to create written documentation of the new policy, including eligibility requirements, so employees have a reference in-hand when necessary.

 Ask Questions

Education is a key component to PFL compliance, so continue to ask questions as they arise.  Our Agency’s, HR providers and third-party payroll processors are there to answer your questions. The more knowledge you attain now, the more smoothly the transition to PFL compliance will go.

Next Step Toward PFL Compliance

Educating yourself now can help everyone be better prepared. Although not all of the details have been finalized yet, we hope this checklist helps you achieve an easier transition to PFL compliance when the time comes.

How to Get a Quote for Paid Family Leave Coverage?

If your New York State clients are looking for quality DBL coverage to comply with the new Paid Family Leave policy, MMS Corp. will need policy payroll information to provide an accurate quote. The payroll wage totals must include a cap adjustment for those employees that make over the statewide average weekly wage of $1,305.

For example, if the employee makes over $67,860 (SAWW $1,305 x 52 weeks), the employer must only report the wages up to that amount. The Paid Family Leave rate of 0.126% will be applied to the total adjusted wages provided by the employer to calculate the Paid Family Leave premium amount.

Learn More About the New York State Paid Family Leave Policy

Find out how you can help your New York State clients get prepared for the new Paid Family Leave Policy now by booking a training webinar.

Contact Us Now    Learn how our Agency is helping buinsesses thrive in today’s economy. Please contact us at info@medicalsolutionscorp.com or (855)667-4621. 

Love this article? You might also like our NYS PFL Paid Family Leave page.

CareConnect Withdraws from NYS Market

CareConnect Withdraws from NYS Market

CareConnect Withdraws from NYS Market

CareConnect today has announced their intent to withdraw from the NYS 2018 market. The ACA Risk Adjustment Program was penalizing CareConnect again $100 Million for 2018 after a $112 million tax in 2017.

The problems CareConnect was facing were not new and was covered in last month blog. This problem has bipartisan recognition and Cuomo Administration Asks Feds for ‘Immediate Changes’ to Risk Adjustment Program. While this tax or “risk adjustment penalty” was intended to increase competition it is blamed as the single largest bankruptcy cause for the 12 of 16  Obamacare Co-Ops such as the Health Republic of NY and for start-ups like Oscar and CareConnect.

The formula used to calculate payments in the risk-adjustment program has been criticized for unfairly favoring larger plans with more claims experience. Smaller companies that sell on the ACA’s exchanges have said they don’t have as many claims data, and therefore their membership base looks healthier than it is. In a twisted way, the young companies in need of help were actually subsidizing mature Insurers with legacy data systems.

Who is CareConnect?

CareConnect is a physician/hospital-owned Insurer by Northwell Health also formerly known as North SHore LIJ.  Careconnect manages the health of 400,000 individuals, including 125,000 customers.  Outside of the risk adjustment penalty the Insurer was managing population health and would have posted a profit.  Their past rate increases were single digits.

Sadly, this is a tremendous consumer market hit.  Their growth was predicated on delivering excellence of care while still mindful of consumer affordability, see chart below.  Not only were they on average 20-30% less expensive but their benefits were typically enhanced.  Example:  A Tradition Gold plan member would NOT have a deductible nor coinsurance for surgeries and hospital stays at a time when all competing Gold plans did.

Regrettably, no State appeal has been victorious as of yet.  With logger-head federal conflicts in Government today on repairing Obamacare flaws the victims will once again be the middle-class consumer.

See Press release:

https://www.northwell.edu/about/news/press-releases/while-preserving-its-population-health-commitment-northwell-withdraw-careconnect-nys-insurance-market

CareConnect Leaving NY Market 2018CareConnect Individual rates

Next Step:

Please sign up for the Sept 13th webinar below on CareConnect Exit & Next Steps for Your Group.

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NYS 2018 Final Rates Approved

NYS 2018 Final Rates Approved

NYS 2018 Final Rates Approved   2018 NYS healthcare_costs_scrabble_1333568743

NYS has approved  2018 Final Rates last week. Small group rates will increase 9.3% while the individual rate average increase will be 13.9%.

As per NY State Law carriers are required to send out early notices of rate request filings to groups and subscribers see original –NYS 2018 Rate Requests.  With only 3 months of mature claims, experience for 2017  health insurers’ requests are historically above average.  Ultimately the State reduces this request substantially. This year, however, NYS acknowledged that medical costs increased, citing a 7-percent average increase on the individual market and an 8.5-percent increase on the small group market. The administration also acknowledged drug prices have impacted insurers, pointing specifically to blockbuster drugs for Hepatitis C.

OTHER STATES

The national rate trend, however, has been much higher than in past years due to higher health care costs  Like other states throughout the nation, the 2017 rate of increase for individuals in New York is higher than in past years partly due to the termination of the federal reinsurance program.  The loss of the program’s a.k.a. federal risk reinsurance corridor funds account for 5.5 percent of the rate increase.

How are neighboring States doing? In NJ, not that bad.  According to a review of filings made public last week the expected rate increase will likely be half.  Example: Horizon Blue Cross Blue Shield requested a 4.8% increase on their OMINA Plans.  For CT market, on the other hand, things are much worse at least for the individual marketplace with average 25% rate increases.

While the individual mandate is still the law, Washington has made it clear that they aren’t going to enforce the mandate. That means fewer people will buy health insurance raising the prices for those who do.

 A bipartisan group of congressional representatives has discussed an agreement to extend and guarantee the payments, but it’s unclear whether they could do so by the new filing deadline of Sept. 5. A lawsuit filed by Congress against the Obama administration to challenge the payments is still pending. In addition, Trump has repeatedly threatened to withhold payments to insurers that reduce cost-sharing – deductibles, copays and coinsurance – paid by low-income customers. More than half of New Jersey’s marketplace customers receive that assistance, and without it, most would be unable to afford coverage.

Finally, a tax on health insurance premiums is due to be reinstated in 2018 after a one-year “tax holiday” approved by Congress for 2017. That contributed 2.3 percent to the rate hikes that insurers requested last year.

SMALL GROUP MARKET VS.  INDIVIDUAL MARKET

The new premium hikes ranged from as little as .8% percent for Hudson Valley’s Crystal Run Health Insurance Company to a whopping 20.4% percent increase for  Albany region’s CDHP.  Importantly, small group market is still more advantageous than individual markets unless one gets a sizable low-income tax credit.

Overall, about 350,000 individual plan consumers will be affected by the price hike, while more than a million users will be hit by higher small group fees. Last year, Blue Cross Blue Shield released a study showing Obamacare user costs were 22 percent higher than people with employer-sponsored health plans, while UnitedHealth plans to exit most Exchanges see –  Breaking: Oxford Exits Metro Indiv & Oxford Liberty HMO 2017.

The correct approach for a small business in keeping with simplicity is a Private Exchange and with our large buying group PEO partnerships. This is a true defined contribution empowering employees with a choice of leading insurers offering paperless technologies integrating HRIS/Benefits/Payroll.  Both employee and employers still gain tax advantage benefits under the business.  Also, the benefits, rates and network size are superior under a group plan as the risk are lower for small group plans than individual markets.

NYS 2018Health Insurance Rates Approved

* All amounts are rounded to the nearest 1/10.

**Indicates that the company makes products available on the “New York State of Health” marketplace.

Learn how a Private Exchange and our PEO Partnership can help your group please contact us at info@medicalsolutionscorp.com or (855)667-4621.

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Cuomo Administration Asks Feds for ‘Immediate Changes’ to Risk Adjustment Program

Cuomo Administration Asks Feds for ‘Immediate Changes’ to Risk Adjustment Program

Cuomo Administration Asks Feds for ‘Immediate Obamacare Risk Adjustment in NYSChanges’ to Risk Adjustment Program

Yesterday marked 1 the year anniversary since the above Politico article “Cuomo Administration Asks Feds for ‘Immediate Changes’ to Risk Adjustment Program” was published. Little has changed and the controversial ACA Risk Adjustment is proving to be a company killer rather than the intended savior.

What is Risk Adjustment?

Risk Adjustments is one of three Rs of ACA regulations –  Risk Adjustment, Reinsurance, and Risk Corridors – Millennium Medical Solutions Inc. Small insurers rack up large charges while Blues benefit under ACA’s risk-adjustment program – Modern Healthcare Modern Healthcare business news, research, data and events

The permanent risk-adjustment program is meant to keep ACA insurers from cherry-picking healthier plan ACA's 3 Rmembers over sicker, costlier ones. It collects payments from plans with healthier than average members and distributes that money to plans saddled with sick, high-cost members. The zero-sum program is based on a patient’s risk score, which factors in demographic information and health conditions. The CMS said 709 insurers participated in the risk-adjustment program.

The formula used to calculate payments in the risk-adjustment program has been criticized for unfairly favoring larger plans with more claims experience. Smaller companies that sell on the ACA’s exchanges have said they don’t have as much claims data, and therefore their membership base looks healthier than it is.

Several small plans and co-ops formed under the ACA have sued over the risk-adjustment formula. Evergreen Health co-op in Maryland, for instance, sued in June 2016 to block the federal government from requiring it to pay millions in risk-adjustment charges. Co-ops New Mexico Health Connections and Minuteman Health of Massachusetts filed similar suits last year.

This punishes start-up growth companies. A local example would be small group/individual market CareConnect’s $129M and Oscar’s $44M negative adjustment while United has had a windfall of nearly $330M positive adjustment.  Put another way, this is an unintended welfare program for the rich legacy Insurers paid for by the very companies needing help in the market.

Risk-adjustment transfers for individual-market plans



Risk-adjustment transfers for small-group market plans

Cuomo Adjusting to Risk Adjustment?

Since last months NYS 2018 rate filing announcement the justifiable calls from members have been “Why are my #CareConnect rates going up 19%”.  A whopping $119 Million in RISK ADJUSTMENT is owed to Center for Medicare Services.  Alarmingly, this is not a political partisan issue and all agree on the flaws and unintended consequences. CMS has acknowledged the flaws but are working with a 5 year time frame. Sadly young companies cannot afford to stay in business by then.

The unofficial 3 tests presumptions of good regulations have been missed:

  1. Regulations must be non-political
  2. Designed with excellence
  3. Executed perfectly

The good news is that CMS can change this regulation without an act of Congress. Regrettably, no State appeal has been victorious as of yet.  For Governor Cuomo’s part the majority of the policies outlined in a press release from the governor’s office do not directly address the Risk Adjustment appeal and are already state law and would do nothing to protect New Yorkers’ from the skyrocketing costs they’d likely bear if the subsidies that underpin the Affordable Care Act are reduced or repealed.

In conclusion, to the clients suffering a 19% increase for 2018 the biggest fear is not having to change companies.  The real fear, in fact, ought  still to be will that company be around next year? This regulation, ironically,only affects individuals and small busnesses.