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Patient Protection & Affordable Care Act
(PPACA) While most health care reform changes aren’t effective this
year, consider the following 2010 “action items”. Ø Many carriers have implemented “early adoption” of the mandated extension of dependent
coverage to age 26. Check with your carrier(s) to see if and when this possible change applies to
your Medical plan(s). Ø Review any “dependent children” language in your Flexible Spending Account (FSA), Health
Reimbursement Arrangement (HRA), and Dental
plan documents to see if amendments are desired as a result of the extension of dependent coverage to age 26 mandate for your
Medical plan(s). Ø Review your Medical and Dental plans ERISA Summary Plan Descriptions and insurance contracts to help
verify mandated compliance deadlines and mandated changes that may be required after 2010. Ø Since most current Medical plans are “grandfathered” (not required to make some of the
mandated benefits changes), consider not making any changes to your plans that would eliminate their “grandfathered”
status. IRS guidance on allowable and non-allowable changes is forthcoming. Check your
information resources for updates. Ø If you have 25 or fewer full time employees, make sure to review rules for the 2010 Small Business
Health Care Tax Credit. You should discuss eligibility for this credit with your accounting advisor(s). Ø If your organization currently has less than 50 full time employees, review the 2014 employer tax assessments for employers
with 50 or more employees. Ø Consider contacting your elected Federal and State representatives regarding the major individual
and employer mandates scheduled for 2014. While the PPACA will likely not be repealed, modifications are
possible prior to 2014. You may want to advocate for delay (or elimination) of these mandates so that more
attention can be focused on the Cost Containment, Quality Improvement, Wellness, and Prevention features of the Act.
Information Resources
Excellus - https://www.excellusbcbs.com/wps/portal/xl/our/hpr/healthreform
Groom Law Group - http://www.groom.com/resources-signup-35.html Hodgson Russ -
http://www.groom.com/resources-signup-35.html Kaiser Family
Foundation - www.kff.org
Families USA - www.familiesusa.org Jackson Lewis -
http://www.jacksonlewis.com IRS - http://www.irs.gov/newsroom/article/0,,id=222814,00.html
Mercer - www.mercer.com/us-health-care-reform
PricewaterhouseCoopers - http://www.pwc.com/us/en/health-industries/topics/health-reform.jhtml Ø Current
Statutory NYS DBL coverage provides a maximum weekly benefit of $170 per week. Our experience shows that $170 weekly for non-occupational
disabilities does not provide enough protection for most employees. Ø Disability Insurance carriers also recognize this need, and many are offering new products that enhance the Statutory
NYS DBL coverage. Other carriers are improving rates for Group Short Term Disability Insurance which supplements
the basic NYS DBL. If you have the limited Statutory NYS DBL coverage now, we’d like to help you
review Enhanced DBL and Group Short Term Disability options. The quotation/proposal/implementation process
for these options is not difficult. Medicare Part B covers physician
services and many other “outpatient” medical expenses. Unlike Medicare Part A, Part B is not
“automatic”. The 2010 Part B monthly premium cost is $110.50 for most Medicare eligible individuals. Our clients are reporting an increasing number of problems regarding the coordination of Part B benefits
with employer-sponsored Group Medical Plans. Medicare eligible individuals are receiving claim denials
from the employer’s group insurance carrier and Medicare. Individuals are also being charged significant
“late entry” premium penalties for Part B. While most employers should not try to provide Medicare
advice, the following general points of information need to be consistently communicated
to all individuals who are eligible for Medicare benefits due to age or disability. Ø Whether working or retired,
individuals (and their spouses) may need to enroll in Part B, even if they are covered by an employer-sponsored Group Medical
Plan. Ø Individuals need to contact
both Medicare and the group insurance carrier prior to becoming eligible for Medicare to determine if they should enroll in
Part B. Ø If enrollment
in Part B is delayed or ignored; individuals can incur significant unreimbursed medical expenses and significantly increased
premiums for Part B coverage. We would be happy to discuss general Medicare Part B guidelines with you. 401(k) PLAN INVESTMENTS Most 401(k) Plans enjoyed better than average investment returns
in 2006, due to generally favorable equity markets. Now may be a good time to review your plan’s
investment options to help produce the best possible 2007 results. Retirement plan advisors often
recommend diversification as a strategy to produce consistently positive returns. Diversification requires
that plan participants understand and utilize a number of different types of equity and fixed-income investments. Following are two options that you might not yet have in your plan. Ø “Dynamic”
Lifecycle Funds/Accounts – These are normally structured as a series of related funds/accounts targeted at specific
estimated retirement dates. A professional investment manager creates unique, diversified portfolios appropriate
for each estimated retirement date. These portfolios are automatically managed to become more conservative
as the target date approaches. The manager also automatically “rebalances” these portfolios
periodically to maintain appropriate asset allocation percentages. These funds/accounts are attractive
to plan participants who want professional management at a reasonable cost. Ø
Real Estate Funds/Accounts – These can be structured as “owned” real estate funds/accounts
which emphasize longer-term holdings and lease/rental income. They can also be structured as Real Estate
Investment Trust (REIT) funds/accounts which emphasize shorter-term holdings and resale appreciation. We would be happy to discuss 401(k) Plan investment options with you. HEALTH PROMOTION Many
local employers offer various Health Promotion activities and resources for their employees. The time,
effort, and dollars devoted to Health Promotion have a positive impact on medical insurance costs, paid time off costs, and
workplace productivity. In addition to positive financial outcomes, there are positive “attitude”
outcomes for employees who appreciate these employer initiatives. While the positive outcomes take time
to develop, the long term advantages can be significant. Some
popular Health Promotion activities and resources are: Ø Worksite programs (sometimes with participation incentives) that emphasize healthy diet, healthy body weight,
physical activity, heart health, stress management, and smoking cessation Ø Quarterly newsletters that provide
Health Promotion education in an attractive, easy to read format Ø Health risk assessment tools (electronic or paper) that help employees identify their unique “lifestyle
based” health risks Ø Worksite screening of blood pressure, cholesterol, and glucose to identify health issues that employees may not
be aware of. Medical insurance carriers can provide some
activities and resources at minimal or no cost. There are also local Health Promotion management firms
that provide customized programs. Employers normally survey employees to help
identify the activities and resources that employees feel would be helpful. We would be happy to provide
a brief, sample employee survey form on request. |
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