The Affordable Care Act (ACA) has created a few new reporting requirements, and many employers have questions. They want to know what reporting they need to do, when it has to be done and whether fees are involved.

“Companies need to be sure their team understands what is required to satisfy these new ACA regulations,” says Tobias Kennedy, executive vice president at Montage Insurance Solutions.
Smart Business spoke with Kennedy so he could clear up the overwhelming amount of disparate information on ACA reporting and its related fees.

What are Patient Centered Outcomes Research Institute fees?

Patient Centered Outcomes Research Institute fees are also known as PCOR, PICORI, PCORI or CERF fees. This is a relatively small fee that fully insured companies don’t need to worry about — their carrier handles it automatically. But companies who are self-funded and companies who have a Health Reimbursement Account (HRA) are responsible for it themselves.

If your company is self-funded, has an HRA or is unsure, ask your broker, other consultant or CPA about the second quarter Form 720, which is due by July 31.
Depending on the plan anniversary, the fee is either $1 per year per covered life or $2 per year per covered life with most companies using a ‘snapshot average’ method of calculating the figure of lives covered in the fee — although there are a few different safe harbors.

How does the reinsurance fee work?
The reinsurance fee is also calculated off of the number of covered lives but at a substantially higher amount.

The fee for 2014 was $63 per year per covered life and can be paid in two installments. The first installment of $52.50 was already due by Jan. 15, 2015, and the second installment of $10.50 per covered life will be due no later than Nov. 15, 2015.

The 2015 fee will be $44 and can be paid at once, of course, or you also can pay it in two installments of $33 and $11 respectively.
The proposed amount for 2016 is $27 per member per year.

The calculation for the number of covered lives has to be submitted to the Department of Health and Human Services. Similar to the PCOR fees, fully insured groups will have this done for them by their carriers, whereas self-funded companies need to take action.

Also, similar to the PCOR fees, there are a few different safe harbors. Companies will want to work with their consultants to correctly apply for the one they deem most suitable.
Within 30 days of submitting the count to the department, companies will be notified of the amount they owe, and that payment will be due back within 30 days of the company’s receipt of notice.

What do employers need to know about Forms 6055 and 6056?

Forms 6055 and 6056 are also new reporting measures. The first time this comes into play is in 2016 for the 2015 health plan year, so companies have a little more time on this.
Form 6055 is to be used by insurance carriers and self-funded companies to report all of the people they cover. It deals with the individual mandate. Basically, it is a resource for the government to double check that people who claim to have satisfied the individual mandate are indeed covered.

Form 6056 is a report where companies list the employees that are offered coverage to help the government track subsidies. This is required by all applicable large employers — fully insured or self-funded — because subsidies are only available to people not otherwise offered affordable coverage. Form 6056 also helps to track those who might be applying for subsidies but who are actually ineligible because of their employer’s offering.

Human resources is at the heart of the company, touching all employees and helping spread the message of the C-suite. However, many times these employees are the last to know about upcoming business changes, instead of the first.

Smart Business spoke with Danone Simpson, CEO of Montage Insurance Solutions about business change and HR’s role in shepherding it along successfully.

Why is HR the last to know about business change?

By working with many human resource leaders, I have often found their common statement is that they are ‘the last to know.’ They are the last to know when change is coming, whether that’s layoffs, mergers, acquisitions, financial difficulties and/or business decisions that can alter a company’s culture.

To begin with the end goal in mind is noble and important along with the understanding that ‘the most well-designed departmental communication program will not tear down silos unless the people who created those silos want them torn down,’ Patrick Lencioni says in his book, ‘The Advantage: Why Organizational Health Trumps Everything Else In Business.’

The well-developed HR professional understands this, because they are the change agent. Along with ensuring compliance measures are met, employee management and communication is critical.

What’s one of the biggest problems with change management?

Often the C-suite of small and midsize companies creates the plan, and then hands it off to HR to implement. Some even give it to supervisors who discuss it with staff members — a handoff that may have started above the C-suite level.

Lencioni, however, states that the success of top-down communication starts with building a cohesive leadership team and creating clarity. ‘Without these,’ he says, ‘no amount of communication is going to be effective.’

Every CEO could agree they have had plans thwarted due to breakdowns in the message — either it was not clear enough or the subculture of important departments did not accept the change because they were not a part of it.

How can the C-suite ensure the message is clear?

Lencioni shares his philosophy of the thematic goal. He recommends ‘every organization that wants to create a sense of alignment and focus must have a single top priority within a given period of time.’

This tight focus should be scheduled for three months to one year. Then, the leadership team has clarity around how to spend its time, energy and resources. ‘The thematic goal must become the responsibility of the leadership team,’ Lencioni says.

Where does HR fit into this focused way of doing business and making changes?

HR is the heartbeat of the company.

At a recent HR organization meeting with roundtable discussions, one person stated, ‘I need advice on how to help my CEO, and other executives, understand I can’t be the last to know about layoffs and other decisions that impact employees.’

Another HR executive/consultant shared how she found the same thing in her startup company, so she asked the leadership team to agree to read one article per week, or month, that she would send them. They agreed, and she sent an article about poor employment decisions similar to ones her leaders handed down to her. It was results based, stating facts of court cases and liability payouts for poor decisions. Another article was on employee engagement or team building exercises to help promote better communications down to the trenches. Her method worked, and now she is on the executive team.

Anita Gorino, owner of Creative Resources, says of HR executives, ‘First of all, don’t be the police. Ask good questions of your executives and then come up with a few key ideas that may lead to a deeper brainstorming session. Be a part of the strategy. Don’t find one million ways why new plans and ideas will not work.’

HR executives are needed to help create and implement employee management strategies, beginning with the ‘why.’ No longer can they be the last to know.

The 2015 Affordable Care Act transitional guidance — in laymen’s terms

“As we head into 2015, I’m encountering several employer groups who are coming to me to make sure they know what needs to be done to stay compliant with the latest Affordable Care Act regulations,” says Tobias Kennedy, executive vice president at Montage Insurance Solutions.

Let’s assume you already know the broad strokes of the legislation. You understand the Employer Shared Responsibility (ESR) provision, which says if you add the total of your full-time employees plus your full-time equivalent employees and that equals 50 or more, you need to offer insurance — good insurance that doesn’t make your employees pay too much for coverage.

Your biggest questions now may concern clarifying some of the transitional pieces of the legislation.

Smart Business spoke with Kennedy to get a high-level look at the employer who is trying to pin down his or her needs for the rest of 2014 and the beginning of 2015.

What’s the first step to understanding transitional relief?

The transitional relief you get depends on your employee size, so it’s important to calculate that correctly. If you are unsure, there are good resources available, but you basically average the month-by-month totals for your full-time employees and add your full-time equivalents.

The good news is that 2014 has some ‘one time only’ relief where you can pick any continuous six months for the determination. In other words, you can do the calculation based on data from January through June, and take the remaining few months of 2014 to plan for what you need to do next year.

Once you’ve calculated your size, what are the rules?

If you have less than 50 employees, don’t worry at all — the ESR provision doesn’t apply to you.

If you have 100 or more employees, the rules begin for you in 2015, so be sure you’re offering affordable coverage. If you are offering coverage to at least 70 percent of your eligible employees, you’ll be considered compliant for 2015.

What about employers with between 50 and 99 employees?

This is really the most complex piece of the transitional guidance. Basically, if you meet a few conditions, you don’t have to worry about the ESR provision until your first renewal in 2016. Those conditions are related to your workforce size and benefits.

If you can check off each of the bullet points below, and you’re in this size range, you can hold off on being ESR compliance until your 2016 plan renewal:

• You did not reduce workforce just to qualify. You can reduce workforce for other reasons, but you need to be able to justify the reduction.
• You keep your in-force coverage the same or similar to what you had on Feb. 9, 2014, the day before they released this news. By ‘the same or similar’ they mean that when you look at the employee only tier of your benefits on Feb. 9, 2014, you either cover the same percentage of the cost or cover 95 percent of the same dollar amount. You can change the benefits themselves, such as co-pays, deductibles, carrier, etc. The government just wants you to keep the premium split in line and be sure that if any changes are made, the new plans are still above a 60 percent actuarial value.

Assuming you can check these boxes, it’s business as usual until your 2016 plan renewal without fear of penalties levied from the ESR compliance.

Insights Business Insurance is brought to you by Montage Insurance Solutions

http://www.sbnonline.com/article/2015-affordable-care-act-transitional-guidance-laymens-terms/

CEOs, CFOs and COOs all require specific things from their HR department.

The CEO develops the mission, vision and direction of the company, fine-tuning the key words that express “why” you do what you do and for whom, and then where you are going as a company.

CFOs then have to budget and balance the dreams, and COOs create action plans with every department.

So while the C-suite is busy creating their 20 Mile Marches, per Jim Collins in his book “Great by Choice,” how does all of this truly get to the most important person in the company — the employee?

You don’t want CEOs just espousing this message from their office without ensuring the employees are a part of the planning, whether that’s in an intimate forum for a smaller office or throughout the world for large companies.

Beyond the C-suite, the answer is one of the most important departments — HR, the heart of the company.

Smart Business spoke with Danone Simpson, CEO of Montage Insurance Solutions, about getting your team involved in company planning and ensuring they understand and are committed to the plan, via HR.

Why is employee buy-in important?

Every employee has to understand the mission, purpose and values of the company. They have to want to be a part of the journey.

Zappos.com Inc. CEO Tony Hsieh identifies employees who are not on the same track with his mission and literally pays them to quit. Now, others have joined in such as Jeff Bezos, CEO of Amazon, who offers $2,000 to any new employee that wants to leave, and up to $5,000 for more veteran employees who would prefer to seek employment elsewhere, according to a Huffington Post article.

Even here at Montage Insurance Solutions, employees know that we want to retain people who want to be a part of the team, and they should feel free to move on if that is where they feel they’d be more successful.

Companies today cannot afford to have employees who don’t care or show up just for the paycheck.

So, is creating the right culture the key?

Hsieh understood culture was where he had to start and created an internationally recognized three-day culture boot camp to train other CEOs how he did it. When Zappos was first started, it sounded strange to think of women buying shoes online. Yet today he not only proved the naysayers wrong, he built a profoundly successful business.

In 2011, Jamie Naughton, Zappos’ speaker of the house, spoke at the Pepperdine University Graziadio School of Business and Management, where she shared the Zappos value proposition that, “Zappos is committed to WOWing every customer.” At that time they had over 10 million customers to wow.

Naughton clearly understood what Hsieh needed, and she became the courier of that message. She spoke at universities and HR organizations worldwide, ultimately becoming the company’s chief culture ambassador. This is what CEOs, presidents and business owners want and need.

How do you recommend HR help spread the culture?

The HR team should begin with this end in mind and hold no hostages — either the employee joins in or doesn’t.

HR executives who partner with their C-suite are the ones that work to ensure the company’s mission and vision are communicated consistently, from the first interview and continuing often thereafter.

It takes first wanting to be a part of that culture yourself, and then spreading it like wildfire. A company can be dry without a cohesive culture. It takes both ingredients, vision and culture, to create a company that can make a difference in this world — and is on the lips of its employees and customers.

Insights Business Insurance is brought to you by Montage Insurance Solutions

http://www.sbnonline.com/article/spread-culture-c-suite-needs-hr/

The process used for the selection of key positions is likely to impact the organization’s goals and objectives. The costs associated with an ineffective process not only result in increased expenses, but can also damage company culture. The loss of members who don’t fit consume time and money in terms of search, training, development, and disruption to the system.  In addition, an inappropriate set of hires can lead the organization in a direction different than that which it had intended.

Consider your process—you probably gather a set of applications/resumes, find a way to sort out candidates, narrow the pool to 3-5 individuals, invite them for interviews, and then select the person who best meets the criteria.  Although this approach appears to be the standard method, there is no guarantee of success. A question to reflect—“are you pleased with the process you are using?”   The purpose of this article is to propose a more sophisticated method for assessing the extent to which candidates are right for the company from a cultural perspective.

My guess is that during the selection process, at least one-member of the decision team asks whether a job candidate is a cultural fit for the organization. The effectiveness of this approach depends on whether the decision maker(s) has a clear sense of their own company culture along with being able to decipher the style of the candidate. In most cases the decision is based on gut feel rather than an objective measure.

An alternative is to start with a framework that objectively assesses organizational culture to determine the key ingredients of the culture that lead to success (or identify what’s lacking in the culture that keeps the organization from being successful).  Once clarity is reached regarding the key cultural components either present or desired the first piece of the selection puzzle is in place. The next step requires the design of a survey an applicant would complete that mirrors the organization’s most significant cultural components. Using this model can provide a more advanced means of selection.

The initial step is to determine the organization’s culture. The 7-dimensions of the Integrated Cultural Framework (ICF) offers a useful model to measure corporate culture (See endnote citation).  The 35-item ICF survey is designed to assess the following set of cultural components:

Ability to Influence: The extent to which organization members have an opportunity to influence decisions

Comfort with Ambiguity: The extent to which the members of the organization for comfortable with uncertainty and risk taking

Achievement Orientation: The extent to which members are assertive, goal directed and achievement oriented.

Individualism vs. Collectivism: The extent to which individual versus group loyalty exists

Egalitarianism: The extent to which equal opportunity exists for advancement

Time Orientation: The extent to which the organization’s goals/mission is focused on values from the past, present or future.

Space Orientation: The extent to which physical layout of the organization is public, private or a mix of both.

It is important to recognize that “right/wrong, good/bad” are not appropriate in assessing culture.  The focus should be what is.  That is, there isn’t a one-best culture. Each organization, based on its goals, mission and vision, is likely to identify a culture unique to its objectives.  Therefore, the results of the ICF survey provides a “picture” of the organization’s culture from the perspective of the members who complete the questionnaire.  To absorb a deeper understanding, however, it is necessary to interview a cross-section of the respondents.  Doing so allows a more substantive recognition of the underlying elements of the 7-dimensions.

It is likely that 3-5 of the ICF dimensions will “jump out” as most significant in terms of describing critical aspects of the culture.  Using these elements the organization can prepare a short questionnaire to be given to job candidates.  The purpose of the questionnaire is to measure the extent to which the candidate fits the critical elements identified in the ICF analysis. For example, if Ability of Influence is identified as an important part of the culture, then in the job candidate survey and interview the focus would be on evaluating the extent to which the candidate is comfortable and capable of taking on a decision making role. It is recommended, however, that the candidate survey be validated by current organization members before using it with prospective employees. That is, asking the organization’s strong performers to complete the job candidate survey will allow the organization to revise the measure where needed before including it in the selection process.

The advantage of incorporating a more rigorous method of selection, particularly one that focuses on organizational culture, is that it will likely result in not only a more effective, less costly process, but it may offer an effective way of ensuring cultural sustainability.

Citation Endnote:
Mark Mallinger, “Recognizing Organizational Culture in Managing Change,” Graziadio Business Review. 2009 (co-authors D. Goodwin & T. Ohara)

There are a few new reporting requirements the Affordable Care Act (ACA) has created, but with the overwhelming amount of disparate information on the topic, many employers still have more questions than answers.

They want to know which are necessary for them, when the reporting is to be done and whether or not there are fees involved.

“Companies need to be sure their team understands what is required to satisfy these new ACA regulations,” says Tobias Kennedy, executive vice president, Montage Insurance Solutions.

Smart Business spoke with Kennedy about a few of the key points of the ACA from a reporting standpoint.

What do employers need to understand about the Patient Centered Outcomes Research Institute fees?

Patient Centered Outcomes Research Institute fees are also known as PCOR, PICORI, PCORI or CERF fees. This is a relatively small fee that fully insured companies can be assured their carrier handles automatically. However, companies who are self-funded and have a health reimbursement arrangement (HRA) are responsible for this fee.

If your company is self-funded and has an HRA, or if you are unsure if this applies to you, ask your broker or work with a CPA to ask about the second quarter Form 720, which is due by July 31. Depending on the plan anniversary, the fee is either $1 per year per covered life or $2 per year per covered life with most companies using a ‘snapshot average’ method of calculating the figure of lives covered in the fee — although there are a few different safe harbors.

How is the reinsurance fee being handled under the ACA?

A reinsurance fee is also calculated off of the number of covered lives, but it is a substantially higher amount. The fee for 2014 is $63 per year per covered life with 2015 and 2016 fees not announced yet, other than to say they ‘will decrease.’ The calculation for the number of covered lives is due by Nov. 15 and is submitted to the Department of Health and Human Services (HHS).

Similar to the PCOR fees, fully insured groups will have this done for them by their carriers, whereas self-funded companies will need to take action. Also, similar to the PCOR fees, there are a few different safe harbors and companies will want to work with their consultants to correctly apply whichever they deem most suitable.

Within 30 days of submitting the count to HHS, companies will be notified of the amount they owe, and that payment will be due back within 30 days of the company’s receipt of notice.

What about Forms 6055 and 6056?

Forms 6055 and 6056 are simply reporting measures and do not levy fees. The first time this comes into play is in 2016 for the 2015, so companies have a little more time on this than the PCOR/reinsurance fees.

The 6055 is where insurance carriers and self-funded companies report all of the people they cover, and it deals with the individual mandate. Basically, it is a resource for the government to double-check that people who claim to have an insurance policy — and thus to have satisfied the individual mandate — are indeed covered.

The 6056 is a report where companies list out all of the employees they offer coverage to, which helps the government with the subsidies. This is required by all applicable large employers — fully insured or self-funded. Because subsidies are only available to people not otherwise offered affordable coverage, this helps the exchange track people that might be applying for subsidies but who are actually ineligible because of their employer’s offering.

Remember if you need any additional help or have any questions about ACA reporting requirements, don’t hesitate to contact your health care reform experts.

Insights Business Insurance is brought to you by Montage Insurance Solutions

http://www.sbnonline.com/article/business-impacted-new-aca-reporting-requirements/

Stick with Montage for further developments, but to sum up, the Employer Shared Responsibility provision appears to be delayed entirely for employers of 50-99 until 2016, while there is only a minimal change for employers larger than 100.   For employers larger than 100, during the 2015 year, you will satisfy the requirement by offering coverage to at least 70% of your qualified employees–this is down from a 95% requirement.

As you know, you can always count on Montage for the latest news on the PPACA.  We strive to be on the forefront of your reliable sources.  We will dissect the exact changes for you in a longer article, but in the interim, we wanted to give you an overview.  The Obama Administration has announced that it will alter the Employer Shared Responsibility provision by phasing in the penalty assessed on large employers who are not offering coverage.

Initially, the ACA employer penalty was set to come alongside the individual mandate on 1-1-2014.  However, after realizing the reporting structures may not be fully in place, the Administration announced in early July of 2013 that employers who do not offer insurance will not face the penalty for the 2014 year.  However, consistent with the legislation, employers who employ an average of at least 50 full time employees (or FTEs) were going to still need to offer qualifying coverage or face a penalty beginning 1-1-2015.

Well, the due date to get coverage or face a fine has changed again.  For employers with 100 or more employees, there is no change, at least as of now, to the looming penalty start date, which remains 1-1-2015.  However, for those employers who qualify as a “large employer” under the wording in the bill, but average less than 100 employees, the fine is delayed until 2016.

For a couple of additional references, see:
http://money.cnn.com/2014/02/10/news/economy/obamacare-employer/ 
http://www.latimes.com/nation/politics/politicsnow/la-pn-obama-delay-healthcare-mandate-20140210,0,5381642.story#axzz2sxcCd9s0

Ever wonder why and how you can possibly take so many vitamins or what you have to do now to stay healthy?  I mean, every time you turn on the TV or read an article, someone from somewhere is telling you of a new “special” pill out there, or the next “miracle” drug that will change your life.  OR in order to stay healthy you have to take 20 different vitamins.  It can be overwhelming to the point of asking yourself, “Why bother?”  If you have been thinking this, you are not alone.

This takes me back to when I was younger, and my mom would always remind me to take my vitamins. Well I didn’t mind too much, but I had to take those chewable Flintstones vitamins.  I can’t say that I enjoyed artificial fruit flavors mixed with vitamins. I ate well as a child, but never fully acknowledged what healthy eating was or what healthy habits were.  I just ate what I liked, and luckily for my parents, it was usually good for me.  Eventually the time came, and I was able to take my first adult capsule. Let’s just say that didn’t last long. The vitamins were huge, and I decided that it was back to the chewable Flintstones vitamins for me.  And this was where my dislike for vitamins came in and anything that sounded good for you.

As I got older, I remembered this experience and never paid too much attention to the whole concept of taking my vitamins. Recently, I’ve had to change my tune a bit. Through the various articles that I read every day and research I do for Montage’s Wellness Newsletters, I have learned that there are SEVERAL health benefits to taking vitamins, and treating my body well.  So I started slowly with my self-improvement and vitamin intake. First came the vitamin D, and then came the vitamin B, and then Fish Oil, and then vitamin K, and so on. Then I added essential oils in the mix for better sleep and stress relief.   After months of taking my vitamins and using the oils, I continually felt great. My immune system had “strengthened” and I had more energy.  The research that I have done on wellness has not just led me to the benefits of vitamins, but also various wellness techniques, exercises, remedies such as essential oils and more. I stared to create healthier options and choices for myself.

And after the last few years of intense research, my knowledge was put to the test last night. I was making stuffed jalapeno poppers, and realized I had forgotten to wear gloves before taking out all the seeds. Oh, I was in for it! The heat burn on my finger was so bad, it hurt for several hours. I tried dipping it in milk, running cold water on it, icing it, and nothing worked. Once I got home, I noticed my lavender oil I had bought for stress relief next to my bed.  I remembered through research that lavender had a healing effect for skin rashes, and similar issues. Well, it was worth a shot. I put a little lavender oil on my finger, and within seconds the burning was gone! I was beyond excited for trying this new remedy.

It was at that moment that it hit me.  I have been slowly but surely on this path to improving my healthy habits.  From not taking vitamins, to now taking vitamins regularly, I made the decisions on my own to take better care of myself. I did it when the time was right, and did what I wanted to do.  It became second nature and I strongly believe it can for you as well.  Study up and you’ll see.  I have increased my knowledge of wellness and maintain the skills to help heal and cure the most common issues.  I’m not an expert, but I’m no longer a skeptic.  I do think that there are gimmicks out there, and people who just want to sell you another product. But I also believe that there are many things that are really there to help us. For the skeptics out there, I’m hoping that everyone takes an opportunity to step out of their comfort zone, and try something new.  I encourage all of you to try a wellness tip that we post on our Facebook, or put in our newsletters. They’ve helped me!  They may help you too!

Exercise – the forgotten ally

With all the rustle and bustle we go through on a day to day basis; you wake up, go to work, come home, go to bed, just to wake up the next morning and do it all over again.

“Where’s my “ME” time?” you might be asking yourself.  “I’m so tired these days,” we start to tell ourselves.

What is simple to forget and sometimes understand is that exercising can do more than just be an obligation that takes up a block of time in your schedule.  Its stress relieving, fever reducing, multi-faceted span of minutes that can be fun, variable and most definitely beneficial.

A Few Ideas:
Depending on your distance to work, how hard would it be to take your bike to work? That doesn’t mean every day, but maybe you start off with one day a week, then two, then three.
Work at home? Not a problem!  If you are working from home, you can take breaks when you need to and use these breaks to your advantage.  Even if it’s at night when you’re watching your favorite episodes of ‘Friends’ or ‘Homeland’, think about moving the coffee table to the side and doing some core building, abdominal workouts and even pushups.  What you might find is that if you’re that engaged in the show, you’ll be breaking a sweat no problem.

How long is your lunch break?  Grab a coworker or two and take a walk around the block.  Even walking at a pace of 1 mile an hour has its benefits such as improving blood sugar levels and increasing your metabolic state.  You don’t even have to sweat!

Are you in front of the computer screen all day at your desk?  Stay true to those breaks and use them!  Think about setting an alarm that goes off every hour reminding you to stand up and walk around.  Walk around the office, take a breath of fresh air outside and stretch.  A 15-minute walk can change your day.

These are just a few of the thousands of ideas you can do to get yourself moving, increase circulation and help you thinking clearly.  Any bit of exercising helps your fatigue levels too!  Those who exercise have much more energy in the day than those who don’t.