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ACA ‘repeal and replace’ plans in motion for 2017: What should HR do?

ACA’s replacement may soon by on the way according to this article by Lauren Stead

Republican House and Senate leaders have been energized by the election of a president likely to accept a proposal to repeal Obamacare. As a result, they’re preparing to dismantle the Affordable Care Act (ACA) within the first 100 days of Donald Trump’s first term.

Reports coming out of Capitol Hill indicate that the repeal measures GOP congressional leaders are planning to introduce would most likely be modeled after a 2015 repeal bill that was vetoed by President Obama. In addition, Senate leaders are thinking of using a process called reconciliation, which would allow budget bills to pass with a simple majority vote and bypass any filibuster attempts from Democrats.

Republicans are looking to pass repeal measures as Trump transitions into office, but delay the effective date of the repeal for two to three years.

GOP leaders are hoping the delay of the full rollback of Obamacare would sway enough Democrats to vote for the repeal and avoid a protracted legislative process.

The delay would also buy Republican lawmakers time to come up with a plan to replace the ACA so some 20 million Americans who purchased insurance on Obamacare’s exchanges don’t lose their health insurance seemingly overnight — while still fulfilling the promises of the Trump campaign to take down the existing law.

Republicans have released few details on what exactly their replacement plan may look like, but Trump said he wants it to save some of the more popular parts of the ACA — like guaranteed coverage for individuals with pre-existing conditions and the ability for children to stay on their parents’ insurance policies until they are 26 years of age.

What does this mean for employers?

Employers, meanwhile, are left wondering: What do — and what can — we do with our company sponsored plans now?

The answer: Stay the course. Even if a repeal bill is passed the second Trump takes office, it’s unlikely to change anything in the near future.

For at least a little while, it looks like larger companies (those with 50+ employees) will still be subject to the employer mandate/shared-responsibility non-compliance penalties if they drop coverage — or even drop benefits limits significantly — for full-time equivalent employees (those working 30+ hours per week on average). The GOP hasn’t released any specific timelines.

That means large employers still have to work on complying with the ACA’s reporting requirements, for at least the 2016 plan year (for which reporting will be due in 2017).

Obamacare compliance should still be at the forefront of every employers’ actions, as it’s unlikely the feds will waive non-compliance penalties just because companies are banking on a future repeal.

See the original article Here.

Source:

Stead L.(2016 December 7). ACA ‘repeal and replace’ plans in motion for 2017: what should HR do?[Web blog post]. Retrieved from address http://www.hrmorning.com/aca-repeal-and-replace-plans-in-motion-for-2017-what-should-hr-do/

UBA Special Report: 2016 Trends in Employer Wellness Programs

Great article from our partner, United Benefit Advisors (UBA) by Jason Reeves

The latest round of regulations in the area of wellness (what employers can and can’t do) is proving to be a hotly contested topic. Employers are eager to offer incentives as a way to both encourage wellness and also lower health care costs. However, employee privacy is on the line, and some argue, at risk. Even though many employers may never see the data collected, there is a philosophical debate brewing about what should – or should not – be permitted.

According to UBA’s new free special report, “2016 Trends in Employer Wellness Programs,” 67.7 percent of employers who offer wellness programs have incentives built into the program, an increase of 8.5 percent from four years ago. Major lawsuits are pending against employers with particularly robust wellness programs and the regulatory environment is becoming increasingly restrictive. As a result, employers are continuing to pursue wellness programs, but they are being very cautious with program design, avoiding implementing high penalty and incentive programs.

Incentives are the most prevalent in the Central U.S. (76.1 percent), among employers with 500 to 999 employees (83.2 percent), and in the finance, insurance, and real estate industries (74.7 percent). Last year, employers in the Southeast were the regional leaders in wellness incentives (75.9 percent), growing 24 percent since 2012. But this year, prevalence of incentives dropped more than 17 percent in just one year, perhaps indicating regional caution amid the uncertain regulatory environment. The West offers the fewest incentives, with only 48.3 percent of their plans having rewards.

Across all employers, slightly more (45.4 percent) prefer wellness incentives in the form of cash toward premiums, 401(k)s, flexible spending accounts (FSAs), etc., versus health club dues and gift cards (40 percent). But among larger employers (500 to 1,000+ employees) cash incentives are more heavily preferred (63.2 percent) over gift certificates and health club dues (33.7 percent). Conversely, smaller employers (1 to 99 employees) prefer health club-related incentives (nearly 40 percent) versus cash (25 percent).

The smallest employers (fewer than 25 employees) have seen significant shifts in wellness incentive design over time. Prior to 2016, health club incentives were on the decline and cash incentives had been increasing 80 percent since 2012. But 2016 shows a dramatic pendulum shift from 36 percent of plans featuring cash incentives in 2015, to only 16.2 percent of plans offering this design in 2016.

Also, dramatically shifting away from cash incentives are construction, agriculture, mining, and transportation employers (going from 63.8 percent in 2015 to 48.4 percent in 2016). The finance, insurance, and real estate industries offer the most health club-related incentives (50.0 percent).

Southeast employers, on the other hand, are shifting away from health club-related incentives to cash toward premiums, 401(k)s, and FSAs with nearly a 60 percent increase in this type of incentive (going from 47.1 percent to 74.7 percent over four years).

Offering paid time off (PTO), historically a seldom-offered wellness incentive, is becoming rarer with 4.5 percent of employers offering this incentive, nearly a 20 percent decrease from four years ago. The majority of these PTO-based wellness incentives are seen in the Southeast U.S. (13.1 percent – a nearly 50 percent increase from 2015) and within the finance, insurance, and real estate industries (10.6 percent).

Employers are beginning to use the regulations proposed by the Equal Employment Opportunity Commission (EEOC) as their guidelines for program development, and the wellness guide provided by the Patient Protection and Affordable Care Act (ACA) have re-empowered employers to implement premium differentials for wellness participation and cessation of tobacco use. However, many are likely wary of the EEOC’s new guidance regarding wellness programs that include health risk assessments, biometric screenings, and medical exams. How those regulations influence plan design remains to be seen.

Read our breaking news about UBA’s new wellness special report.

Download our free (no form!) special report, “2016 Trends in Employer Wellness Programs,” for more information on regional, industry and group size based trends surrounding prevalence of wellness programs, carrier vs. independent providers, and wellness program components.

For complete findings within the 2016 UBA Health Plan Survey, download UBA’s 2016 Health Plan Survey Executive Summary.

For comprehensive information on designing wellness programs that create lasting change, download UBA’s whitepaper: “Wellness Programs — Good for You & Good for Your Organization”.

To understand legal requirements for wellness programs, request UBA’s ACA Advisor, “Understanding Wellness Programs and Their Legal Requirements,” which reviews the five most critical questions that wellness program sponsors should ask and work through to determine the obligations of their wellness program under the ACA, HIPAA, ADA, GINA, and ERISA, as well as considerations for wellness programs that involve tobacco use in any way.

See the original article Here.

Source:

Reeves J.(2016 November 18). UBA special report: 2016 trends employer wellness programs[Web blog post]. Retrieved from address http://blog.ubabenefits.com/uba-special-report-2016-trends-in-employer-wellness-programs

3 ways to help employees with retirement planning

by Marlene Satter

Lack of confidence, lack of knowledge and lack of money all plague workers trying to save for retirement, leaving them working longer than they planned and saving considerably less than they need.

But a series of surveys from TIAA has identified three ways that plan sponsors can help to improve retirement outcomes for their employees.

Employees want income for life, for instance, with 49 percent saying that their retirement plan’s top goal should be providing guaranteed monthly income in retirement.

And although it’s something they badly want, 41 percent are unsure if their current plan has that as an option.

1. Employees need help figuring how much retirement income they’ll need and how to translate savings into income – Plan sponsors can help with this, said the data, by helping employees be realistic about how much income they’ll need in retirement—something few have figured out.

While 63 percent of Americans who are not retired estimate that they’ll need less than 75 percent of their current income to live comfortably, most experts recommend replacing 70–100 percent of current income in retirement.

Compounding the situation is the fact that 53 percent of employees haven’t even figured out how to translate their savings into income—while 41 percent of people who haven’t yet retired are saving less (many considerably less) than the 10–15 percent of income experts recommend.

Lifetime income options such as annuities are one way to guarantee income replacement during retirement, but most people are unaware of them or of how they work. Just 10 percent of Americans have annuities, so for the other 90 percent, they’re not an option.

2. Employees are interested in receiving financial advice – Sponsors can also offer financial advice as part of a benefits package.

While 61 percent of those who have received advice feel confident about their financial situation, just 37 percent of people who haven’t feel that way.

But the cost—or perceived cost—of seeking advice is putting them off, as is distrust of advisors in general.

Although 71 percent of Americans say they’re interested in receiving advice, more than half haven’t.

For instance, 35 percent of Americans who have not worked with a professional financial advisor say they don’t think they have enough money to justify a meeting; 51 percent say they don’t have enough money to invest (49 percent believe they need more than $50,000 in savings to get an advisor to talk with them), while 45 percent have concerns about cost and affordability.

And 34 percent don’t know whom they can trust.

3. Employees can use tools and resources early and in all stages of retirement planning – Last but not least, the study found that getting involved early in the planning process can make a difference.

Sponsors who introduce resources for all stages of the financial planning process, with customizable planning tools and tailored support based on employees’ life stages, can help employees consider what they need to do to prepare for retirement, even if that day is years away.

Such tools can make it easier for employees to evaluate their personal risk tolerance, asset allocation and the current status of Social Security and Medicare to help them better envision their future retirement and the steps they can take to make sure that their retirement is successful

See the original article Here.

Source:

Satter M.(2016 December 8). 3 ways to help employees with retirement planning[Web blog post]. Retrieved from address http://www.benefitspro.com/2016/12/08/3-ways-to-help-employees-with-retirement-planning?ref=hp-news

9 reasons why retirement may go extinct

Worried about your future retirement? Check out this great read by Marlene Satter

Retirement as we know it may be set to disappear, as younger people look for ways to finance surviving into old age.

But extinction? Surely not.

However, according to the Merrill Edge Report 2016, that might just be in the offing, as workers change how they plan and save for retirement and how they intend to pay for it.

Millennials in particular represent a shift in attitude that includes very unretirement-like plans, although GenXers too are struggling with ways to pay their way through their golden years.

That’s tough, considering that most Americans neither know nor correctly estimate how much money they might need to keep the wolf from the door during retirement—or even to retire at all.

Here’s a look at 9 reasons why retirement as we know it today might be a terminal case—unless things change drastically, and soon.

9. Ignorance.

Most Americans have no idea how much they might need to retire, which leaves them behind the eight ball when trying to figure out when or whether they can afford to do so.

Of course, it’s hardly surprising, considering how many are members of the “sandwich generation,” who find themselves caring for elderly parents while at the same time raising kids, or even trying to put those kids through college.

With soaring medical costs on one end and soaring student debt on the other, not to mention parents supporting adult children who have come home to roost, it’s hard to figure out how much they’ll need to meet all their obligations, much less try to save some of an already-stretched income to cover retirement savings as well.

8. Poor calculations.

We already know most workers don’t know how much they’ll need in retirement—but it’s not just a matter of ignorance. They don’t know how to figure it out, either.

More than half—56 percent—figure they’ll be able to get by during retirement on a million dollars or less, while 9 percent overall think up to $100,000 will see them through.

And 19 percent just flat-out say they don’t know how much they’ll need.

Considering that health care costs alone can cost them a quarter of a mil during retirement, the optimists who think they can get by on $100,000 or less and even those who figure $100,000–$500,000 will do the job are way too optimistic—particularly since saving for medical costs isn’t one of their top priorities.

7. Despair.

It’s pretty hard to get motivated about something if you think it’s not achievable—and that discourages a lot of people from saving for retirement.

Those who have a “magic number” that they think will see them through retirement aren’t all that optimistic about being able to achieve that level of savings, with 40 percent of nonretired workers saying that reaching their magic number by retirement will either be “difficult” or “virtually unattainable.”

6. Luck.

When you don’t believe you can do it on your own, what else is left? Sheer dumb luck, to quote Professor Minerva McGonagall at Hogwarts after Harry and Ron defeated the troll.

Only instead of magic wands, 17 percent of would-be retirees are sadly (and amazingly) counting on winning the lottery to get them to their goal.

5. The gig economy.

Retirement? What retirement? Millennials in particular think they’ll need side jobs in the gig economy to keep them from the cat food brigade.

In addition, exactly half of younger millennials aged 18–24 believe they need to take on a side job to reach their retirement goals, compared with only 25 percent of all respondents. They don’t believe that just one job will cut it any more.

4. Attitude adjustment.

While 83 percent of current retirees are not currently working or never have during their golden years, the majority (83 percent) of millennials plan to work in retirement—whether for income, to keep busy or to pursue a passion.

The rise of the “gig economy” has created an environment where temporary positions and short-term projects are more prevalent and employee benefits such as retirement plans are less certain. This may be why more millennials (15 percent) are likely to rank an employer’s retirement plan as the most important factor when taking a new job compared with GenXers (5 percent) and baby boomers (5 percent).

Older generations had unions to negotiate benefits for them. Millennials might realize they have to do it all themselves, but they aren’t negotiating for salaries high enough to allow them to save.

And union benefits or not, 64 percent of boomers, 79 percent of Gen Xers and even 17 percent of currently retired workers plan to work in retirement.

3. A failure to communicate.

Lack of communications is probably not surprising, since most people won’t talk about savings anyway.

Fifty-four percent of respondents say that the only person they feel comfortable discussing their current retirement savings with is their spouse or partner. Only 36 percent would discuss the subject with family, and only 22 percent would talk with friends about it.

And as for coworkers? Just 6 percent would talk about retirement savings with colleagues—although more communication on the topic no doubt could provide quite an education on both sides of the discussion.

2. Misplaced confidence.

They won’t talk about it, but they think they do better than others at saving for retirement. How might that be, when they don’t know what others are doing about retirement?

Forty-three percent of workers say they are better at saving than their friends, while 28 percent believe they’re doing better at it than coworkers; 27 percent think they’re doing better than their spouse or partner, 27 percent say they’re doing better than their parents and 24 percent say they’re beating out their siblings.

All without talking about it.

1. DIY.

They’re struggling to figure out how much they need, many won’t talk about retirement savings even with those closest to them and they’re anticipating working into retirement—but millennials in particular are taking a more hands-on approach to their investments.

Doing it oneself could actually be a good thing, since it could mean the 70 percent of millennials, 72 percent of GenXers and 57 percent of boomers who are taking the reins into their own hands better understand what they’re investing in and how they need to structure their portfolios.

However, doing it oneself without sufficient understanding—and millennials in particular are also most likely to describe their investment personality as “DIY,” with 32 percent making their own rules when it comes to investments, compared to 19 percent of all respondents—can be a problem.

After all, as the saying goes, “A little knowledge is a dangerous thing.”

See the original article Here.

Source:

Satter M. (2016 December 7). 9 reasons why retirement may go extinct[Web blog post]. Retrieved from address http://www.benefitspro.com/2016/12/07/9-reasons-why-retirement-may-go-extinct?ref=mostpopular&page_all=1

Long-Term Care Insurance: Employee Education Makes the Difference

Looking to educate your employees about long-term insurance? Check out this article from our partner, United Benefit Advisors (UBA) by Megan Ellis

Most Partners of United Benefit Advisors (UBA) and their clients have benefits enrollment down pat. They know what to communicate to employees, and when. Employees, too, are usually familiar with the process. For example, they know what to expect when they start comparing their medical plan options to their 401(k) contributions. But not all benefits are created equally. Some require more communication, understanding, and detail. Long-term care insurance (LTCi) is one of those products. More than any other benefit, it calls for well-thought-out employee education.

LTCi education is critical to employees for the following reasons:

Underwriting concessions are available for a limited time only and an employee’s health determines approval. Employers are able to offer LTCi with reduced underwriting, but the employees can only take advantage of this offer during initial enrollment. It will not be available at any other time – including during future open-enrollment periods – so it’s essential that employees understand the advantages of this benefit at a time when they will receive their best opportunity for approval.
LTCi isn’t just another voluntary benefit, it’s an important component of any employee’s retirement plan. Long-term care can be a huge financial burden for many Americans. Those who buy LTCi are doing so to protect their savings and assets down the road. As a result, LTCi becomes a critical aspect of an overall retirement plan. Employees will want guidance on which coverage options best suit their financial needs.
LTCi is often a one-time purchase and employees may face closed plans and rate increases.Unlike other benefits where providers may change from year-to-year, the majority of LTCi purchasers will hold on to their original plan for life. As the market evolves and carriers develop new products, an employer may be administering multiple LTCi programs to employees. Employees will be curious how their plan stacks up – especially if they have a plan with MetLife, John Hancock, Prudential, or CNA since those carriers no longer offer new LTCi plans. Employees may also be impacted by rate increases with these carriers and will need education-based support on what decisions to make regarding their increased premium. Helping employees compare programs will allow them to make an informed decision about their plan.
What Employees Need to Know

Employees need focused time, separate from other benefits education, to learn about LTCi. It is important to communicate with them, both in writings and through in-person or Web meetings, so that they can learn:

What long-term care is, how likely it is they will need it, how it’s delivered, and the costs associated with it
What LTCi covers and how it differs from other benefits
The risks associated with not having LTCi
Myths about long-term care coverage (for example, that it’s only needed by the elderly or that it only covers nursing home care)
An overview of options and an understanding of all possible solutions for long-term care
Tax incentives available for LTCi
The right time to buy LTCi and the risks associated with waiting
Decision-making tools to help select the best coverage levels for their needs
We’ve had a great reception from UBA Partners and clients who are interested in LTCi for their employees. One of the primary themes we continue to hear is that LTCi is on the to-do list for many brokers and employers. When employees have all of this information laid out in an accessible, easy-to-understand way, they will be able to make informed decisions about this valuable benefit.

See the original article Here.

Source:

Ellis M.(2016 December 1). Long-term care insurance: employee education makes a difference[Web blog post]. Retrieved from address http://blog.ubabenefits.com/long-term-care-insurance-employee-education-makes-the-difference?utm_source=hs_email&utm_medium=email&utm_content=38533673&_hsenc=p2ANqtz-8W78pwQxczRAb1y67e7xD3jwPtkqR_X_o-sRGKiRohYRvmaOZZsxXNMDj0hNN899cMderNq8-4LjAd4tt_AsuPVW_1AA&_hsmi=38533673

2016 Election Results: The Potential Impact on Health and Welfare Benefits

If you missed our partner,United Benefit Advisors (UBA) checkout this article by Les McPhearson

Following the November 2016 election, Donald Trump (R) will be sworn in as the next President of the United States on January 20, 2017. The Republicans will also have the majority in the Senate (51 Republican, 47 Democrat) and in the House of Representatives (238 Republicans, 191 Democrat). As a result, the political atmosphere is favorable for the Trump Administration to begin implementing its healthcare policy objectives. Representative Paul Ryan (R-Wis.) will likely remain the Speaker of the House. Known as an individual who is experienced in policy, it is expected that the Republican House will work to pass legislation that follows the health care policies in Speaker Ryan’s “A Better Way” proposals. The success of any of these proposals remains to be seen.

Employers should be aware of the main tenets of President-elect Trump’s proposals, as well as the policies outlined in Speaker Ryan’s white paper. These proposals are likely to have an impact on employer sponsored health and welfare benefits. Repeal of the Patient Protection and Affordable Care Act (ACA) and capping the employer-sponsored insurance (ESI) exclusion for individuals would have a significant effect on employer sponsored group health plans.

Trump Policy Proposals

President-elect Trump’s policy initiatives have seven main components:

Repeal the ACA. President-elect Trump has vowed to completely repeal the ACA as his first order of Presidential business.
Allow health insurance to be purchased across state lines.
Allow individuals to fully deduct health insurance premium payments from their tax returns.
Allow individuals to use health savings accounts (HSAs) in a more robust way than regulation currently allows. President-elect Trump’s proposal specifically mentions allowing HSAs to be part of an individual’s estate and allowing HSA funds to be spent by any member of the account owner’s family.
Require price transparency from all healthcare providers.
Block-grant Medicaid to the states. This would remove federal provisions on how Medicaid dollars can and should be spent by the states.
Remove barriers to entry into the free market for the pharmaceutical industry. This includes allowing American consumers access to imported drugs.
President-elect Trump’s proposal also notes that his immigration reform proposals would assist in lowering healthcare costs, due to the current amount of spending on healthcare for illegal immigrants. His proposal also states that the mental health programs and institutions in the United States are in need of reform, and that by providing more jobs to Americans we will reduce the reliance of Medicaid and the Children’s Health Insurance Program (CHIP).

Speaker Ryan’s “A Better Way” Proposal

In June 2016, Speaker Ryan released a series of white papers on national issues under the banner “A Better Way.” With Republican control of the House and Senate, it would be plausible that elected officials will begin working to implement some, if not all, of the ideas proposed. The core tenants of Speaker Ryan’s proposal are:

Repeal the ACA in full.
Expand consumer choice through consumer-directed health care. Speaker Ryan’s proposal includes specific means for this expansion, namely by allowing spouses to make catch-up contributions to HSA accounts, allow qualified medical expenses incurred up to 60 days prior to the HSA-qualified coverage began to be reimbursed, set the maximum contribution of HSA accounts at the maximum combined and allowed annual high deductible health plan (HDHP) deductible and out-of-pocket expenses limits, and expand HSA access for groups such as those with TRICARE coverage. The proposal also recommends allowing individuals to use employer provided health reimbursement account (HRA) funds to purchase individual coverage.
Support portable coverage. Speaker Ryan supports access to financial support for an insurance plan chosen by an individual through an advanceable, refundable tax credit for individuals and families, available at the beginning of every month and adjusted for age. The credit would be available to those without job-based coverage, Medicare, or Medicaid. It would be large enough to purchase a pre-ACA insurance policy. If the individual selected a plan that cost less than the financial support, the difference would be deposited into an “HSA-like” account and used toward other health care expenses.
Cap the employer-sponsored insurance (ESI) exclusion for individuals. Speaker Ryan’s proposal argues that the ESI exclusion raises premiums for employer-based coverage by 10 to 15 percent and holds down wages as workers substitute tax-free benefits for taxable income. Employee contributions to HSAs would not count toward the cost of coverage on the ESI cap.
Allow health insurance to be purchased across state lines.
Allow small businesses to band together an offer “association health plans” or AHPs. This would allow alumni organizations, trade associations, and other groups to pool together and improve bargaining power.
Preserve employer wellness programs. Speaker Ryan’s proposal would limit the Equal Employment Opportunity Commission (EEOC) oversight over wellness programs by finding that voluntary wellness programs do not violate the Americans with Disabilities Act of 1990 (ADA) and the collection of information would not violate the Genetic Information Nondiscrimination Act of 2008 (GINA).
Ensure self-insured employer sponsored group health coverage has robust access to stop-loss coverage by ensuring stop-loss coverage is not classified as group health insurance. This provision would also remove the ACA’s Cadillac tax.
Enact medical liability reform by implementing caps on non-economic damages in medical malpractice lawsuits and limiting contingency fees charged by plaintiff’s attorneys.
Address competition in insurance markets by charging the Government Accountability Office (GAO) to study the advantages and disadvantages of removing the limited McCarran-Ferguson antitrust exemption for health insurance carriers to increase competition and lower prices. The exemption allows insurers to pool historic loss information so they can project future losses and jointly develop policy.
Provide for patient protections by continuing pre-existing condition protections, allow dependents to stay on their parents’ plans until age 26, continue the prohibitions on rescissions of coverage, allow cost limitations on older Americans’ plans to be based on a five to one ratio (currently the ratio is three to one under the ACA), provide for state innovation grants, and dedicate funding to high risk pools.
Speaker Ryan’s white paper also addresses more robust protection of life by enforcing the Hyde Amendment (which prohibits federal taxpayer dollars from being used to pay for abortion or abortion coverage) and improved conscience protections for health care providers by enacting and expanding theWeldon Amendment.

Speaker Ryan also proposes other initiatives including robust Medicaid reforms, strengthening Medicare Advantage, repealing the Independent Payment Advisory Board (IPAB) that was once referred to as “death panels,” combine Medicare Part A and Part B, repealing the ban on physician-owned hospitals, and repealing the “Bay State Boondoggle.”

Process of Repeal

Generally speaking, the process of repealing a law is the same as creating a law. A repeal can be a simple repeal, or legislators can try to pass legislation to repeal and replace. Bills can begin in the House of Representatives, and if passed by the House, they are referred to the Senate. If it passes the Senate, it is sent to the President for signature or veto. Bills that begin in the Senate and pass the Senate are sent to the House of Representatives, which can pass (and if they wish, amend) the bill. If the Senate agrees with the bill as it is received from the House, or after conference with the House regarding amendments, they enroll the bill and it is sent to the White House for signature or veto.

Although Republicans hold the majority in the Senate, they do not have enough party votes to allow them to overcome a potential filibuster. A filibuster is when debate over a proposed piece of legislation is extended, allowing a delay or completely preventing the legislation from coming to a vote. Filibusters can continue until “three-fifths of the Senators duly chosen and sworn” close the debate by invoking cloture, or a parliamentary procedure that brings a debate to an end. Three-fifths of the Senate is 60 votes.

There is potential to dismantle the ACA by using a budget tool known as reconciliation, which cannot be filibustered. If Congress can draft a reconciliation bill that meets the complex requirements of our budget rules, it would only need a simple majority of the Senate (51 votes) to pass.

Neither President-elect Trump nor Speaker Ryan has given any indication as to whether a full repeal, or a repeal and replace, would be their preferred method of action.

The viability of any of these initiatives remains to be seen, but with a Republican President and a Republican-controlled House and Senate, if lawmakers are able to reach agreeable terms across the executive and legislative branches, some level of change is to be expected.

See the original article Here.

Source:

McPhearson L.(2016 November 14). 2016 election results: the potential impact on health and welfare benefits [Web blog post]. Retrieved from address http://blog.ubabenefits.com/2016-election-results-the-potential-impact-on-health-and-welfare-benefits

Employer FYI: Individual Mandate Requirements and Proposed Regulations

ACA mandates and regulations have you worried? Read this interesting article from our partner, United Benefit Advisors (UBA) by Danielle Capilla

Though employers are not required to educate employees about their individual responsibilities under the Patient Protection and Affordable Care Act (ACA), it is helpful to know about the individual mandate.

The individual responsibility requirement (also known as the individual mandate) became effective for most people as of January 1, 2014. Under the individual mandate, most people residing in the U.S. are required to have minimum essential coverage or they must pay a penalty. Many individuals will be eligible for financial assistance through premium tax credits (also known as premium subsidies) to help them purchase coverage if they buy coverage through the health insurance Marketplace (also known as the Exchange).

For 2014, the penalty for an adult was the greater of $95 or 1 percent of household income above the tax filing threshold. For 2015, the penalty was the greater of $325 or 2 percent of income above the tax filing threshold. For 2016, the penalty is the greater of $695 or 2.5 percent of income above the tax filing threshold.

The penalty for a child under age 18 is 50 percent of the adult penalty. The maximum penalty per family is three times the individual penalty. The penalty is calculated and paid as part of the employee’s federal income tax filing.

A person must have “minimum essential coverage” to avoid a penalty. Minimum essential coverage is basic medical coverage and may be provided through an employer, Medicare, Medicaid, CHIP, TRICARE, some VA programs, or an individual policy (through or outside the Marketplace). Acceptable employer coverage includes both insured and self-funded PPO, HMO, HDHP and fee-for-service plans, as well as grandfathered coverage, COBRA, retiree medical, and health reimbursement arrangements (HRAs). It does not matter whether the coverage is provided directly by the employer or through another party, such as a multiemployer plan, a collectively bargained plan, a PEO, or a staffing agency.

While most people must obtain coverage or pay penalties, individuals will not be penalized if they do not obtain coverage and:

They do not have access to affordable coverage (cost exceeds 8 percent of modified adjusted gross household income)
Their household income is below the tax filing threshold
They meet hardship criteria (such as recent bankruptcy, homelessness, unreimbursed expenses from natural disasters)
Their period without coverage is less than three consecutive months
They live outside the U.S. long enough to qualify for the foreign earned income exclusion
They reside in a U.S. territory for at least 183 days during the year
They are a member of a Native American Tribe
They belong to a religious group that objects to having insurance, including Medicare and Social Security, on religious grounds (for example, the Amish)
They belong to a health sharing ministry that has been in existence since 1999
They are incarcerated (unless awaiting trial or sentencing)
They are illegal aliens
If the person has access to employer-provided coverage as either the employee or an eligible dependent, affordability of the employer-provided coverage is the only factor considered for purposes of the individual mandate.

For the employee, coverage is unaffordable (so no penalty applies for failure to have coverage) if the cost of single coverage is more than 8 percent of household income.
For a dependent, coverage is unaffordable (so no penalty applies for failure to have coverage) if the cost of the least expensive employer-provided dependent coverage is more than 8 percent of household income.
If the employee and spouse both have access to coverage through their own employer, the cost for each person’s coverage is based on the cost of their own single coverage, but the totals are then combined to see if the total cost exceeds 8 percent of household income.
See the original article Here.

Source:

Capilla, D. (2016 November 9). Employer FYI: individual mandate requirements and proposed regulations [Web blog post]. Retrieved from address http://blog.ubabenefits.com/employer-fyi-individual-mandate-requirements-and-proposed-regulations

Health insurers willing to give up a key ACA provision

Great article about new changes to the ACA from BenefitsPro by Zachary Tracer

U.S. health insurers signaled Tuesday that they’re willing to give up a cornerstone provision of Obamacare that requires all Americans to have insurance, replacing it with a different set of incentives less loathed by Republicans who have promised to repeal the law.

Known as the “individual mandate,” the rule was a major priority for the insurance industry when the Affordable Care Act was legislated, and also became a focal point of opposition for Republicans.

In a position paper released Tuesday — the first since President-elect Donald Trump’s victory — health insurers laid out changes they’d be willing to accept.

“Replacing the individual mandate with strong, effective incentives, such as late enrollment penalties and waiting periods, can help expand coverage and lower costs for everyone,” AHIP said.

That also includes openness to Republican ideas such as an expanded role for health-savings accounts and using so-called high-risk pools to cover sick people.

In return, insurers are asking Republicans to create strong incentives to buy insurance, and to ensure the government continues to make good on payments it owes insurers under the ACA. The paper was released by America’s Health Insurance Plans, or AHIP, the main lobby for the industry.

“Millions of Americans depend on their current care and coverage,” AHIP said in the document outlining its positions. The group called on lawmakers to “ensure that people’s coverage — and lives — are not disrupted.”

Republican replacement

Now that they’re set to gain control of the White House, Republican lawmakers are working to define their vision for replacing the law after years of attempts to repeal it. Obamacare brought insurance coverage to about 20 million people via an expansion of Medicaid and new insurance markets, and repealing the law without a replacement would leave those individuals without coverage.

Trump has said that repealing and then replacing the law will be one of his first priorities. Republicans in Congress, however, have signaled that they’ll need time to write a replacement — potentially via a years-long delay between passing a repeal and implementing it — to craft a replacement.

And AHIP on Thursday said insurers will need at least 18 months to create new products and get them approved by state regulators, if Republicans change the market. It could take even more time to educate consumers and change state laws, AHIP said.

“It’s taken six years to get where we are now and to demonstrate the failure of Obamacare, so it’s going to take us a little while to fix it,” said Senator John Cornyn of Texas, a member of the Republican leadership in the chamber.

Medicaid changes

Republicans may also make substantial changes to Medicaid, by turning the joint state-federal program into one where the U.S. sends “block grants” to the states, which exert more control. Vice President-elect Mike Pence said on CNN Tuesday that the Trump administration will “develop a plan to block-grant Medicaid back to the states” so they can reform the program. Some Medicaid programs are administered in part by private insurers.

AHIP said any such plans should ensure that payments are adequate to meet the health needs of individuals in Medicaid coverage. And they should ensure that when enrollment increases in an economic downturn, funds are available to help states deal with the increased demand, AHIP said.

AHIP is open to working with Congress on replacement plans for the ACA, said Kristine Grow, a spokeswoman for the lobby group. The document is the first detailed look at AHIP’s priorities.

Big insurers like UnitedHealth Group Inc. and Aetna Inc. are already scaling back from the ACA’s markets, because they’re losing money. At the same time, remaining insurers are boosting premiums by more than 20 percent on average for next year.

Trump’s election increased the level of uncertainty in the market, and a repeal bill without something to replace the law could destabilize it further. To shore up insurance markets, AHIP says lawmakers should fund a program, known as reinsurance, designed to help insurers with high costs, through the end of 2018, and avoid cutting off cost-sharing subsidies for low-income individuals.

See the original article Here.

Source:

Tracer Z.(2016 December 7). Health insurers willing to give up a key ACA provision[Web blog post]. Retrieved from address http://www.benefitspro.com/2016/12/07/health-insurers-willing-to-give-up-a-key-aca-provi?ref=mostpopular&page_all=1

DOJ to appeal overtime ruling

Great article from BenefitsPro by Jack Craver

The Obama administration is not giving up on its overtime rule just yet.

The Department of Justice is appealing an injunction placed on the rule by a federal judge, which prevented the rule from going into effect on Dec. 1, as planned. The injunction came in response to a suit challenging the rule by 21 states, led by Texas and Nevada.

“That injunction was granted to some large businesses and Republican governors who had colluded to try to disrupt the implementation of this rule,” says White House spokesman Josh Earnest, according to NPR. “And essentially continue to take advantage of more than 4 million of the hardest-working Americans.”

Judge Amos Mazzant of the U.S District Court for the Eastern District of Texas ordered an injunction after deciding that the challenge to the rule was likely to succeed in a trial.

The Department of Labor exceeded its authority by raising the salary threshold for a worker to be exempt from mandatory overtime pay from $23,660 to $47,476, Mazzant writes.

The ruling suggested that federal overtime law only allows the agency to determine overtime eligibility based on job duties, not salary, Mazzant writes. The ruling thus casts into doubt the existing salary threshold as well.

If the legal battle drags on, it is unlikely that the incoming Trump administration will continue fighting on behalf of the rule in court. In the one instance in which the president-elect commented on the issue during the campaign, he said that he would like to see an exemption from the rule for small businesses.

If Trump did reverse course on the issue, it would be a great disappointment to the Republican attorneys general who brought the suit. In a statement following the announcement of the injunction, Texas Attorney General Ken Paxton, who led the suit, said that the new rule “hurts American workers.”

Congressional Republicans also denounced the rule when the Obama administration announced the final version in May. House Speaker Paul Ryan called it “an absolute disaster.”

See the original article Here.

Source:

Craver J.(2016 December 2). DOJ to appeal overtime ruling[Web blog post]. Retrieved from address http://www.benefitspro.com/2016/12/02/doj-to-appeal-overtime-ruling

Going Where Others Fear to Tread: When COBRA and the FMLA Cross Paths

Great article from our partner, United Benefit Advisors (UBA) by Jennifer Stanley

In some of my previous blogs, the foundation of the Consolidated Omnibus Reconciliation Act of 1985 (COBRA) continuation coverage was reviewed. Now that the groundwork has been laid, it is time to tread into the territories (or laws) where employers can lose their footing. The area covered in the following is that of the intersection of COBRA and the Family and Medical Leave Act of 1993 (FMLA).

The FMLA affects COBRA continuation coverage requirements. The FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons for up to 12 weeks. The FMLA also protects employees, spouses, and dependents who are covered under a group health plan (GHP); those covered are entitled to the continuation of coverage while on leave on the same terms as if the employee was continuing to work.

Confusion may arise when FMLA and COBRA cross paths. A few problematic areas include determining when a qualifying event occurs, when calculating the maximum coverage period, and the consequences of an employee’s failure to pay their share of premiums during FMLA leave.

Qualifying Event

Typically, FMLA and COBRA intersect if an eligible employee does not return to work after exhausting his or her FMLA leave. While FMLA is not a COBRA qualifying event, a qualifying event could occur if the employee does not return to work or notifies the employer of his or her intent to not return to work at the end of the FMLA period. A qualifying event occurs if: (1) an employee or the spouse or a dependent child of the employee is covered under a GHP of the employee’s employer on the day before the first day of FMLA leave (or becomes covered during the FMLA leave); (2) the employee does not return to work at the end of the FMLA leave; and (3) the employee or the spouse or a dependent child of the employee would, in the absence of COBRA continuation coverage, lose coverage under the GHP before the end of the maximum coverage period. When it comes to the qualifying event of reduction in hours, the IRS specifically excludes FMLA leave from that category.

If the employer eliminates coverage under the GHP for the employee’s class of employees during the employee’s FMLA leave, then there is not a qualifying event. Any lapse of coverage under a GHP during FMLA leave is irrelevant in determining whether a set of circumstances constitutes a qualifying event or when a qualifying event occurs. Assuming the employer does not eliminate the GHP, the qualifying event occurs after the FMLA leave is exhausted and the employee does not return to work (or notifies the employer of the intent to not return to work).

Maximum Coverage Period

A qualifying event occurs on the last day of FMLA leave. The maximum coverage period is measured from the date of the qualifying event. If, however, coverage under the GHP is lost at a later date and the plan provides for the extension of the required periods, then the maximum coverage period is measured from the date when coverage is lost. For example, if the last day of FMLA leave is on the 21st of the month but the plan does not terminate coverage until the last day of the month, the last day of the month is the day of the qualifying event. The maximum coverage period is calculated from the last day of the month.

If state or local law requires coverage under a group health plan to be maintained during a leave of absence for a period longer than that required under FMLA (for example, 16 weeks of leave rather than for the 12 weeks required under FMLA), the longer period of time is disregarded for purposes of determining when a qualifying event occurs.

(Not) Paying Premiums

While on FMLA leave, the employee must continue to make any normal contributions to the cost of the premiums. Employers have a few options for handling payment of premiums during unpaid leave; the adopted policy should be documented in the employee handbook and discussed prior to the employee taking FMLA leave, if possible.

An employer’s trap arises if an employee does not pay his or her portion of the premium while out on unpaid FMLA leave. The employer may be tempted to discontinue coverage upon failure of the employee to pay their share. However, this is problematic if the employer cannot guarantee that the employee will be provided the same benefits on the same terms upon returning to work.

The employee’s failure to pay their share of the premiums while on FMLA leave does not create a COBRA qualifying event. Additionally, employers may not condition COBRA continuation coverage on whether the employee reimburses the employer for the premiums the employer paid while the employee was on FMLA leave. Moreover, it is not acceptable for an employer to increase the COBRA premium rate above 102 percent in order to recoup “past premiums due” when the employee was out on FMLA leave.

What happens if an employee experiences a COBRA qualifying event and elects COBRA, after which the employee takes FMLA leave, during which the employee fails to pay the COBRA premiums? Recall that the FMLA requires an employer to reinstate the employee to the same group health benefits after returning from FMLA leave. COBRA, however, is not a group health plan under FMLA. Consequently, an employee’s failure to pay COBRA premiums while on FMLA leave does allow the plan to terminate the employee’s coverage. (Remember, there may be grace periods for late payment or more generous state laws impacting the decision and time to terminate coverage. Be sure those timelines are followed and documented.)

While there is potential for the weary employer to misstep, the intersection of FMLA and COBRA can be handled, so long as it is with care and caution.

For an in-depth look at qualifying events that trigger COBRA, the ACA impact on COBRA, measurement and look-back issues, health FSA carryovers, and reporting on the coverage offered, request UBA’s ACA Advisor, “COBRA and the Affordable Care Act”.

See the original article Here.

Source:

Stanley, J. (2016 November 8). Going where others fear to tread: when COBRA and FMLA cross paths [Web blog post]. Retrieved from address http://blog.ubabenefits.com/going-where-others-fear-to-tread-when-cobra-and-the-fmla-cross-paths