Group Health Blog

Obamacare

  • Plans simplified – in many ways, the new metal tiers to which all plans must be designed makes comparison of benefits somewhat easier. All plans must fit in Platinum, Gold, Silver or Bronze tiers.  I won’t go into how this is determined, but suffice it to say this was new to carriers in the last couple years and some are still grappling with it.  The fallout is that some plans designed to fit in these tiers have been determined to ...

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Compliance

  • If it weren’t for the fact that IRS and DOL are way more likely to knock on your door now than ever before, we might not even be concerned about all the hoops the multiple government agencies have us jumping through. Following is a partial list of documents that should be provided all your employees:
    • Summary of benefits and coverages (SBC)
    • Evidence of coverage (EOC)
    • Summary of plan descriptions (SPD) and wrap documents
    • Marketplace notice (Covered California information)
    • Women’s rights / Children’s rights
    • Acknowledgement of having ...

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Enterprise

Business tools

  • In my Convene Forum a couple years ago, we were introduced to a process intended to turn a difficult confrontation into a more structured and profitable engagement. Face it, there is no avoiding confrontations, whether with your partner, employee or spouse.  So make it profitable!  Here are the steps toward that end:
    • Let the other party know that you are “for them”. Unless you simply want to terminate the relationship, make sure you explain this engagement is to work things ...

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Industry News

  • Health care costs continue to rise – is this the “affordable care” we were promised? I don’t believe we have really seen the full impact of Obamacare in our health premiums yet – and they won’t be coming down.  Virtually no one has seen premiums drop without an equal reduction in benefits.  First, the only “affordability” anyone is experiencing are those in low income brackets that are getting premiums subsidized by the feds.  Second, all the additional mandated benefits & ...

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Obamacare (ACA) Implementation

2014 relief – Late last year, legislation was passed that lightened the load a little for the insurance industry so we didn’t have to deal with as massive change as we might have. There was “grandfathering”, “grandmothering” along with most clients having their plans comply with ACA. Who knows what this year will look like, but we were thankful for some respite. We will keep you informed as this year rolls out.

State Exchanges – Many state exchanges ...

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Compliance

COBRA / Cal COBRA – you, as an employer, must determine whether you must comply with Federal COBRA or California Cal COBRA legislation the beginning of each calendar year.  It boils down to whether you had 20 full time (or full time equivalents) 50% of the working days in 2014.  Complying with the wrong law provides no safety from VERY LARGE liabilities.  If you have any questions about your status, PLEASE contact us to discuss this immediately. 

Cal COBRA compliance ...

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Enterprise

2 Second Lean – We have begun an initiative adopted by Toyota decades ago. Large manufacturing companies spent hundreds of millions on “Lean” systems studies, training and implementation. That has trickled down to small enterprise and found champions that are adopting the simplest forms of implementation. One such champion, Paul Akers, President of FastCap, has written a book “2 Second Lean”, actually offering tours of his facility in the Northwest. Some business owners in Convene business ...

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Industry

New, New waiting period – The changes just keep coming at you! Recent legislation was passed that allows employers to have as long as a 90 day waiting period for eligibility of new employees as of January 1, 2015. You may recall in 2014 the ACA mandated no more than a 60 day waiting period. As most carriers make coverage effective the first of the month following, this meant the first of the month following 30 days. The new ...

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Industry News

New waiting period – We want to remind you that at the 2014 renewal of your group plan the new law mandates your employees be eligible the first of the month following 30 days of full time employment (30+ hours a week). For some employers with high turnover, this could be a real burden, not just financially but also administratively. Please don’t shoot the messenger! We recommend having any other ancillary coverage (dental, life, LTD, etc.) be changed to ...

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California Prop 45

Picture yourself having been told that you have a limit on how much of your revenue can be spent on overhead. To make matters worse, another, new limit will be placed on how much you can charge for your product/service. You would have to reduce what you are offering to your customers, right? Welcome to the health insurance business! Obamacare placed a ceiling on overhead for insurance companies. California’s Prop 45 would put the insurance ...

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