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How your business is impacted by new ACA reporting requirements

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/

Employer Mandate Delayed

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

My Little Health Experiment

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!

Whistle While You Work

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.

Things Happen

You know the saying, “When there’s a rhyme, there’s a rhythm”?  As humans, we do certain things by nature.  Have you realized that you didn’t think about it when you were tying your shoes this morning?  You probably wondered how you got to work today since the route is so familiar.

There are other things we do naturally like, finding the right car insurance when you purchase a new vehicle, reviewing your homeowners’ policy when you move or purchase a new home.  We take care of our goods, but what many professionals forget about is the protection of their lives.  Are you a mother, father, or a key person in a business?  Do you have outstanding debts and things you want to ensure are paid off?  What would happen to all of your “things” if something happened to you on your way home from work today?  Would your kids or family members have to pay off the rest of your mortgage?  Would your kids be able to afford college?  Who will take over that car payment?

Life can happen faster than you can blink.  Some good, some bad.  Yet, as much as we can plan, we never know what tomorrow can really bring us… so how do we, well, plan for the unknown.  Unless you’re Evil Knievel, we take steps on the daily to improve our odds of success.   You wear a life vest on a sea-doo, you lock your door when you go to sleep at night, and we wear seatbelts to protect us all when life happens.  That’s why there’s life insurance, to help protect our families and financial futures without being a detriment.

September 2013 is Life Insurance Awareness Month.  Take this month to review your family and financial situation, sit down with a professional and learn about all of your options.  There are many different types of life insurance.  What you will find is protecting your family can be a lot simpler and affordable than you think!  It just might be worth your time.


Call us today 1 (888) 839-2147 or visit our website at https://www.montageinsurance.com to learn more about how  Montage Insurance Solutions can help you find the right plan at the right price to protect you, your family and your most prized assets.

Don’t Forget to Take Your Vitamin…Sea??

Aloha!

It may be no secret to you that I love the beach! You know better than anyone that when we are there we both just feel better, don’t you agree? So, you might be wondering what it is exactly that makes us both so happy by the beach. Maybe it’s the fun we have when we are there, or the company that is with us, or the sun, or maybe all of the above.  But the truth is the ocean is not just good for lifting our mood, but it also contains many healing properties as well. I am begging you.. before the summer is totally over, take me down to the sea at least once. If you don’t have access to the beach, try the tips below at home to give my body the healing sea boost I crave!

Adventure awaits!

I Love you,

Your Body

HEALTH TIP OF THE DAY: THE SEA REALLY CAN CURE YOU

People usually feel much happier, relaxed, and healthy when they are by the sea, but why? We may have all heard over time the “healing benefits” of the sea. But what exactly does it heal? And what parts of the ocean are really good for us? Research shows that the ocean helps heal us and benefits us in a multitude of ways. Here are just a few facts of what the ocean can do for us health wise:

-Research shows that the sound of the waves alter wave patterns in the brain resulting in a calmer state and reducing stress

-The minerals in the ocean’s water help with many skin issues such as acne, rosacea, ezema, and other skin conditions. Studies also suggest that these minerals even help to balance depression.

-Iodine, a mineral found in ocean water, boosts thyroid function and improves the immune system.

-Waves crashing on the shore release negative ions which helps to counter act the free radicals in the air. This allows us to have better mental concentration and boosst our immune systems too.

-Swimming in ocean water helps improve blood circulation to our vital organs.

– Studies show that the minerals in the sea air not only decrease stress but the salt also helps to maintain serotonin, tryptamine, and melatonin levels in your brain which of course are our ‘feel good’ brain chemicals that help ward of depression and sadness.

If you can’t make it down to the water’s edge to get some of these amazing benefits you can also take some wonderful supplements from the sea to improve health or bring the ocean into your home.

– Take Spirulina :  This nutrient rich blue-green algae is a one of the most nutritious superfoods on the planet. It is packed with phytonutrients  such as carotenoids, antioxidants,  and minerals such as iron, calcium, magnesium, and zinc. It is a great source of vegetarian and vegan protein. It helps to boost the immune system, increase brain and cardiovascular function, and is easily digestible. I take Spirulina every day in my healthy greens.

– Kelp: Increasing sea kelp in your diet can help to stimulate thyroid function as well as provide a healthy mineral rich alternative to sodium in cooking. It is packed with immune boosting iodine and  there are many other health benefits to taking kelp which you can read about them here.

So make sure not to forget to take your Vitamin Sea so you can also be sea cured.

Check out more from Brittney at www.brittneykara.wordpress.com!

Generation GMO – Our Future of Genetically Modified Humans

In the olden days, an up and coming generation would look proudly to the generation before them for support, wisdom, and reassurance that they could make their mark on the world. Children could look up to our political leaders and dream about making a difference one day by following their examples. As a mother of two young daughters I want only the best for my kids, of course, and I dream of them having a fulfilling and amazing future. However, being a parent is one of the hardest, scariest things on earth, because at some point you know that you will lose control of your kids. All you can do is just pray that you have done all that you could to help them grow into extraordinary human beings.

Today however, not only do parents have to worry about all the things you normally worry about as a parent, but we must also be constantly on guard to make sure our children are not being poisoned by Genetically Modified Foods (GMO’s). Not to mention, the plethora of other deadly chemicals and toxins that are bombarding all of us daily. Today, parents must face a very different battle then ever before. We face our greatest challenge yet, fighting against a food system that is literally killing us silently.

The truth is, most foods today are not safe for human consumption. These foods, or ‘food type products’, are extremely detrimental to the growing minds and bodies of our youngsters. As it stands now, the United States is one of the only developed nations in the world that does not require labeling on GMO foods.  This is because the companies that produce and distribute these products are American made companies. These giant Agrotech companies, not only run our food system, but they have a major grip on our political system as well. The way our food system is designed right now, our children and future generations, will have a bleak chance at a healthy, disease, and illness free life. That is, if, we let these corporations have their way. While every generation gets a nickname from the Baby Boomers to Generation X, I would now like to introduce you to, what I call, Generation GMO.

So what does it mean to be apart of Generation GMO? It means that you are one of the millions of children that are being pumped full of artificial and toxic ingredients daily, without any scientific documentation showing that it will not affect your brain development, social skills, metabolic processes, or who you may have the ability to become in the future. From baby formulas, to snacks, to our fruits, vegetables, and meats, our bodies are constantly exposed to genetically modified ingredients that are silently wreaking havoc on our health. From the cradle to the grave, the food industry is laughing all the way to the bank.

I believe this is the number one health issue in the United States right now. I also believe that it should be the first priority of politicians to solve this issue and change the way our foods are being made to protect our children. Food has become poison, and that my friends is a tragedy. Think about this, if we don’t have our children’s health and mental acuity to run our country when we are all gone, then what do we as a nation have to give the world? Will the United States literally eat themselves to death? These questions may sound harsh to you, but the truth of the matter is, we don’t really know the long term affects of eating these foods. I don’t think any of us are prepared to grasp how badly it might be in the future. Unless, we fight for change in the food industry now.

In our current reality parents are secretly lied to about the ingredients in the foods and beverages their children consume daily. Worse yet, most American parents are not even fully aware of the dire situation of our food industry. Nor are they aware of the incredible risk their kids are in everyday when they sit down at the dinner table to eat. If our kids are being poisoned how could this not be the most important topic around? Why is this not on the front page of every major newspaper and magazine? Why aren’t our TV’s flooded with adds about how to protect our families? The answer to all of these questions plain and simple is, greed. Money is the reason, and money rules the world. This issue is, in my opinion, is the most serious and important public health issue ever in our history. Sadly, this problem is rarely ever addressed in the mainstream media, so the mass population continue to be blinded to the reality of what we are doing to our children’s futures every time we sit down to eat.

As a parent, it is my top purpose and priority to protect my kids, and to educated other parents about how something as innocent as the foods we eat, could be silently killing us and turning us into Genetically Modified Humans. You may be thinking this sounds pretty out there, but the closer you look into the food industry the more you will understand what I am talking about.  Genetically Modified foods are foods that are created from seeds that have been altered in a lab. These companies will take the DNA of some other species, plant, or bacteria, and actually put it into the DNA of say a tomato plant or even a fish, like salmon. This is done to ‘supposedly’ help more food grow with less waste, less water, and produce a more sustainable plant. However, what these companies don’t want you to know is that none of that is really true. Also, these Genetically Modified foods and seeds have not been tested to see if they are even safe for human consumption. So not only are these companies messing with our natural food supply, but they are also not even concerned with the safety or efficacy of their products. When independent parties have done testing with GMO foods such as corn on laboratory rats the results were frightening. The test animals would develop cancerous tumors, brain delays, allergies, and digestive issues.

“Most studies with GM foods indicate that they may cause hepatic, pancreatic, renal, and reproductive effects and may alter haematological [blood], biochemical, and immunologic parameters, the significance of which remains to be solved with chronic toxicity studies.”
– Dona A, Arvanitoyannis IS. Health risks of genetically modified foods. Crit Rev Food Sci Nutr. 2009; 49: 164–175

Scary isn’t it? When you take a look at what has happened to the health of individuals all across this nation since these foods have been introduced into the market, you can’t help but see the direct line pointing straight to our foods. We have seen a rise in all of the health issues mentioned above and then some! The rise in childhood developmental issues as well as cancers has skyrocketed in the last two decades. More and more we are seeing children developing serious health and mental issues, and this is becoming the norm. The scariest and saddest part to me is that most people aren’t questioning our food sources as a possible issue, solely because the education about these issues is not mainstream.

Large food corporations pay millions of dollars to promote deceptive advertising that lures children and parents to buy their products. These products contain deadly, brain altering, and even DNA damaging chemicals and ingredients that are promoted as ‘child friendly’, and even sometimes as ‘health’ foods. Many parents are starting to wake up to this reality, but sadly, many are still in the dark.   Even when parents start to question ingredients in certain foods, these companies will often come out with a backlash campaign that is designed to fool the public back into thinking their product really is safe. For example, a few years ago the devastating effects of High Fructose Corn Syrup were starting to circulate among parents of young children and people were getting upset.  So, the company that makes this product started to put out TV and print ads of a young child asking if this product was safe, and their parent gently telling them that it was totally natural and actually good for them to consume! These adds then reassured many parents that the previous information about this toxic product must have been false, and that it was ok to keep feeding it to their kids. When I saw these ads I was so upset.  I made it my mission over the next few months to talk to as many parents as I could about why, this ad was a straight up lie, and why they should never let their kids eat this artificial sweetener.

There is lots of conflicting information out there about the state of GM foods and if it is really safe. So, let’s get the facts straight right now about GMO’s.  GMO’s have not been tested for human safety. We know that in lab rats GMO consumption is linked to allergies, cancerous tumors, heart issues, and even death.  We know that GMO’s do not solve world hunger, as their makers have advertised. We know that most developed nations in the world do not approve of GMOs and have banned their sale and import.  We know that GM foods lack nutritional value. We know that parents don’t even know when they are feeding their children GMO’s since the U.S. does not require these ingredients to be labeled. We know that kids of all ages are experiencing more and more health issues everyday.  And we know that eating fresh healthy foods is our God Given Right. My question to you today is why are we letting this happen to us?

Americans are amazingly brilliant and our future generations deserve so much more than what this system is serving them. I know that together we can change Generation GMO, to Generation Non-GMO: the generation that fought for their health, and got it back. I encourage you to join this crusade of education and empowerment, so together we can save our children and our future. I see the future of our nation with bright, healthy, creative children flourishing.  What do you see?

Disability Insurance Awareness Month

Did you know that May was Disability Insurance Awareness Month?

Think about your most important asset.  Many people might say their car or their home.  These are material things.  But think about how you acquire those materials.  You achieve this by earning an income.  Your most important asset is actually your ability to earn an income, because without an income, you cannot fund the acquisition of those materials.

Did you know that 3 out of 5 people will become sick or injured at some point in their lives and will not be able to work for a period of time?  Just like your other insurance, why not transfer the risk to someone else?

Offering a disability plan through your employee benefits package is just as significant, if not more than, as offering life insurance.  We have home and auto insurance, why not “paycheck” insurance?  Some people say they can rely on Social Security. Yet, Social Security only covers a TOTAL disability, thus no benefits are payable for a partial disability.  Additionally, if you have a disability and are able to adjust to another career, you will not qualify for Social Security benefits.   Another common excuse is the saying, “I can use my emergency fund.”  The use of an emergency fund can keep you afloat for a few months (3-6); however, prolonged disabilities can deplete your savings very quickly.

Many employers have assessed adding an employer paid disability plan to their benefits portfolio and realized the importance of this benefit to their employees.  Disability plans are exceptionally customizable to fit within any company budget.

What if there is no room in the budget for an employer to add a disability plan?  There is still an alternative!  Similar to voluntary life insurance, voluntary disability plans are available and since it is voluntary, there is no financial impact to you as the employer!  Employees can have disability premiums automatically deducted from their paychecks.

Establishing a comprehensive benefits program is not easy and worksite benefits seem to always get overlooked in the mix.  After your annual benefits review,  crunching numbers for your medical, dental, vision plans… there simply isn’t any more time nor energy for you to think about disability plans and any other voluntary offerings.!

In lieu of introducing everything at the same time, there is an advantage and strategy in splitting the presentation of your benefit programs.  For example, think about reviewing and offering your voluntary benefits during the middle of your benefits plan year.  That way, your employees’ attention will be on these great benefits instead of the increases they are receiving on their core benefits.

From an Employee Education and Enrollment Education Survey, done by Unum in January 2012, employees who receive quality benefits education report greater satisfaction as well.  In this survey, employees have found that their employer values their work, the employer cares about the employees’ wellbeing and employees start to say that it would take a lot for them to look for another employer.

Call or e-mail us to learn more about how a comprehensive worksite benefit strategy can complement your employee benefits offerings!
1 (888) 839-2147
[email protected]

How employers should treat new hires under the PPACA’s employer shared responsibility rule

Under the Patient Protection and Accountable Care Act (PPACA), large employers may know that to avoid penalties, they need to offer coverage that is affordable and qualified to full-time staff. But how do you treat a new hire to fold him or her into full-time staff so the employer shared responsibility rule can be applied?

Smart Business spoke with Tobias Kennedy, vice president of Sales and Service at Montage Insurance Solutions, about how to handle new hires, in the final of a three-part series on the employer shared responsibility provision.

When must health coverage be offered to new hires?

Per the PPACA, new hires must be offered coverage within 90 days if you reasonably expect the person to be full time. However, if, at the time of hire, you cannot reasonably predict whether the person will be full or part time, you can submit the employee to a similar set of measurement/stability periods as the full-time ongoing staff. (For more information on ongoing staff measurement/stability periods, see the second article in this series.) The term ‘standard measurement’ was created to distinguish ongoing staff from what you can use for new hires, which is called an initial measurement period.

How does the initial measurement period work?

Like the standard measurement, the initial measurement period must be continuous months of between three and 12 months. Also, you have an administration period and an associated stability period where, as long as the person remains employed, you treat him or her according to the results of the hourly average from the measurement period.

What administration period rules need to be satisfied for new hires?

First, the period is no longer than 90 days — same as for ongoing staff. However, there is a caveat that the 90 days actually starts counting upon date of hire, keeps counting until you start your initial measurement period, where it pauses, and begins counting again for the period from the close of the measurement period through to the start of coverage. This is pertinent if you don’t measure from date of hire, such as beginning to measure the first of the month following date of hire, so some days between hire date and measurement beginning are deducted from the total 90-day allotment.

Also, the administration period when added to the initial measurement period cannot exceed the first of the month following 30 days of an employee’s anniversary. The longest an employee can possibly go from date of hire to coverage effective is 13 months and some change.

How does the stability period operate for new hires?

Like the ongoing staff, if a 12-month measurement period is chosen, then a 12-month stability period must be chosen. So, if an employee were hired on May 15, 2014, the employer would use a 12-month initial measurement period beginning the first of the month following date of hire, June 1, 2014, to May 31, 2015. Because the employee’s anniversary is May 15, 2015, the first of the month following 30 days of that is July 1, and the employer’s only option for administration is the month of June. If the new hire was deemed full time, he or she is offered coverage for a 12-month stability period beginning July 1, 2015, through June 30, 2016.

So, in this example, what happens with the employee on June 30, 2016?

The employee’s timeline runs from May 15, 2014, to June 30, 2016, so there is enough time for him or her to have eclipsed whatever time frame the employer uses as the standard measurement period for ongoing staff. If this new hire worked for an employer who measures ongoing employees from Nov. 1 to Oct. 31 every year, what happens to benefits on June 30 would be contingent upon the average hours worked from Nov. 1, 2014, to Oct. 31, 2015.

If the employee were full time during this time frame, the benefits would continue to the end of the year, per a 2016 stability period associated with that standard measurement period. If the employee was not full time in the standard measurement period but was during his or her initial measurement, benefits will continue through to June 30, 2016. And if the employee was not full time in either measurement period, benefits don’t have to be offered through the end of 2016.

It’s important to note that if an employee was not full time during the initial measurement but was full time during the standard measurement, you will need to add him or her to the benefits. So, in the running example, if an employee didn’t qualify based on June 1, 2014, to May 31, 2015, hours worked, but you re-measure according to your ongoing rules and find the person was full time during the Nov. 1, 2014, to Oct. 31, 2015 period, then the 12-month new hire stability period of not having benefits is clipped short. It’s replaced by the guarantee of benefits for the full 2016 plan year with an effective date of coverage of Jan. 1, 2016.

This can be complicated, but you should be fine as long as you work with a good consultant and utilize the tools your payroll vendor provides.

Tobias Kennedy is vice president of Sales and Service at Montage Insurance Solutions. Reach him at 1 (888) 839-2147 or [email protected].

Insights Business Insurance is brought to you by Montage Insurance Solutions

http://www.sbnonline.com/2013/05/how-employers-should-treat-new-hires-under-the-ppacas-employer-shared-responsibility-rule/?full=1&sectionid=business-insurance-insights&edition=los-angeles-editions

How to understand health care reform’s Employer Shared Responsibility

The Patient Protection and Affordable Care Act (PPACA) is full of employer mandates, but the most prominent and pressing for employers is the Shared Responsibility provision where large employers need to offer affordable coverage.

“The Employer Shared Responsibility part of PPACA is one of the most onerous and complex parts of the legislation, with employers needing as much guidance as possible,” says Tobias Kennedy, vice president of Sales and Service at Montage Insurance Solutions.
Smart Business spoke with Kennedy for an overview of the provision, as there are several intricacies that can confuse one from gaining a broad, basic knowledge on the topic.

How do you know if you’re a large employer?
Generally speaking, a large employer has 50 full-time equivalent employees. It’s important to note the word equivalent, because when the legislation defines 50 employees it is actually counting full-time workers plus full-time equivalent employees. As an example, if you have 45 full timers, and you also have a few people doing part-time work, the reform bill would have you add up all of those hours worked by the part-time people and figure out how many full-time equivalents that equates to.
The penalty for not offering coverage at all is basically $2,000 per year, per person, minus the first 30, applying only to full timers.

What does affordable coverage mean?
Talking high-level affordable coverage would ask an employer to evaluate two things. For any person where you are in violation of either of these two things, the employer is fined $3,000 annually.
• Does the plan have an actuarial value of at least 60 percent? To figure this you have several options, but the easiest is to use the calculator provided by the Department of Health and Human Services. (URL where it can be downloaded can be a link on the page: http://cciio.cms.gov/resources/regulations/index.html#pm)
• Are the employee’s premiums affordable? This is asking for the employee-only portion of your cheapest — above 60 percent, of course — plan not to exceed 9.5 percent of an employee’s income. Income can be calculated a few ways, but the easiest is probably using the wages inserted in the most recent W-2.

Who are employers supposed to cover?
Any employee who works an average of 30 hours or more per week is considered full time, and therefore needs to be offered affordable coverage to avoid fines. If you do not know whether certain employees average more than 30 hours because of varying hours, busy seasons, etc., employers can use a measurement safe harbor.
It can be complicated, but generally speaking, if an employer choses to, the legislation allows for a measurement period. During the measurement period, you look at the employee’s hours and average it out over time. How long the measurement period lasts is up to the employer, but needs to be between three to 12 months.

Once the measurement period ends, an employer must enter a stability period. During the stability period, an employer treats all ongoing employees according to the results of the measurement period. In other words, regardless of hours worked during the stability period, if an employee was full time during the measurement period, you have to offer coverage for the stability period. And, regardless of hours worked during the stability period if an employee averaged below 30 hours per week during the measurement period, the employer does not have to offer insurance.

The measurement/stability period is quite complicated with very particular time frames; the option to implement an administration period; different treatment for new hires versus ongoing employees; rules to transition employees from new hires to ongoing; and a host of other technicalities that truly require the assistance of a trained PPACA professional.
As with all parts of the health care reform bill, consult your professionals for help in the details of this and other provisions.

Tobias Kennedy is vice president of Sales and Service at Montage Insurance Solutions. Reach him at 1 (888) 839-2147 or [email protected].

http://www.sbnonline.com/2013/02/how-to-understand-health-care-reforms-employer-shared-responsibility/?full=1&sectionid=business-insurance-insights&edition=los-angeles-editions