Benefits Buzz

Open Enrollment: What’s Changing in 2020?

To prepare for open enrollment, group health plan sponsors should be aware of the legal changes affecting the design and administration of their plans for plan years beginning on or after Jan. 1, 2020. Employers should review their plan documents to confirm that they include these required changes.

In addition, any changes to a health plan’s benefits for the 2020 plan year should be communicated to plan participants through an updated summary plan description (SPD) or a summary of material modifications (SMM).

Health plan sponsors should also confirm that their open enrollment materials contain certain required participant notices, when applicable—for example, the summary of benefits and coverage (SBC). There are also some participant notices that must be provided annually or upon initial enrollment.

Important Notices

  • Annual CHIP notice
  • Medicare Part D creditable coverage notice
  • Notice of grandfathered status (if applicable)
  • Annual notice regarding coverage requirements for mastectomy-related benefits (WHCRA notice)

Don’t wait any longer to review your plans. Contact The Unland Companies for a full list of 2020 plan changes and requirements.

Hospitals to Publish Retail Prices Under a New Proposed Rule

In July, the Centers for Medicare and Medicaid (CMS) proposed rules that would require all Medicare-participating hospitals to post their negotiated prices for standard health care services.

The proposed rule is intended to increase pricing transparency and help consumers understand the charges they may incur before receiving care.

These are just proposed rules at the moment, which means no changes will be made effective until the rules are finalized. The agency is currently asking for comments on the proposed rule. The deadline for submitting comments is Sept. 27, 2019.

We will continue to monitor and keep you updated on these developments.

Can Health Insurance Rebates Affect Workers’ Comp Premiums?

Since 2012, the Affordable Care Act (ACA) has required insurers with a certain medical loss ratio (MLR) to issue a rebate to employers. Depending on the way the rebates are distributed, you may end up paying more for your workers’ compensation insurance.

Medical Loss Ratio

The MLR provision of the ACA states that insurers must spend a proportion of premium revenues on clinical services and improvements to the quality of care, or pay rebates to their customers. It is a basic financial measurement that the ACA uses to encourage health insurers to provide value to their customers.

The rebates can be issued in a few ways, some of which include:

  • Passing along MLR rebates directly to employees
  • Applying the rebates to future premiums
  • Applying the rebates to benefit enhancements

Impact on Your Payroll

When employers pass any portion of the rebates along to employees, the rebates must be counted as payroll for the purposes of workers’ compensation. This rule only applies if the rebate is coming through the employer and not directly from the insurance provider. The rule also applies regardless of whether the rebate distribution is taxable or nontaxable.

For many employers, the amount of money paid out in rebates will not significantly impact payroll due to rebates. Your workers’ compensation insurance premium is calculated based on your payroll, so if that increases, your premium likely will, too.

Here are a few more points to remember when issuing the rebates:

  • High-dollar rebates may be rare, but you should still be aware of their increased impact on your premium if you receive them.
  • Ensure that any information that is pertinent to your insurance coverages is up-to-date and thorough. Per the National Council on Compensation Insurance (NCCI), “an employer is required to keep records of information needed to compute [its] premium. In addition, the employer must provide records to the carrier, when requested, for the purpose of auditing the employer’s workers’ compensation policy.”

The relationship between the ACA and workers’ compensation is more complex than ever and still evolving. The Unland Companies can help you determine how to handle your health insurance rebates and keep you in the know with new information.

The ACA Remains in Place After Being Struck Down by a Federal Court

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OVERVIEW

On Dec. 14, 2018, a federal judge ruled in Texas v. United States that the entire Affordable Care Act (ACA) is invalid due to the elimination of the individual mandate penalty in 2019. The decision was not stayed, but the WhiteHouse announced that the ACA will remain in place pending appeal.

This lawsuit was filed by 20 states as a result of the 2017 tax reform law that eliminates the individual mandate penalty. In 2012, the U.S. Supreme Court upheld the ACA on the basis that the individual mandate is a valid tax. With the penalty’s elimination, the court in this case ruled that the ACA is no longer valid under the U.S. Constitution.

ACTION STEPS

This ruling is expected to be appealed and will likely be taken up by the Supreme Court. As a result, a final decision is not expected to be made until that time. The federal judge’s ruling left many questions as to the current state of the ACA; however, the White House announced that the ACA will remain in place pending appeal.

Background

The ACA imposes an “individual mandate” beginning in 2014, which requires most individuals to obtain acceptable health insurance coverage for themselves and their family members or pay a penalty. In 2011, a number of lawsuits were filed challenging the constitutionality of this individual mandate provision.

In 2012, the U.S. Supreme Court upheld the constitutionality of the ACA in its entirety, ruling that Congress acted within its constitutional authority when enacting the individual mandate. The Court agreed that, while Congress could not use its power to regulate commerce between states to require individuals to buy health insurance, it could impose a tax penalty using its tax power for individuals who refuse to buy health insurance.

However, a 2017 tax reform bill, called the Tax Cuts and Jobs Act, reduced the ACA’s individual mandate penalty to zero, effective beginning in 2019. As a result, beginning in 2019, individuals will no longer be penalized for failing to obtain acceptable health insurance coverage.

Texas v. United States

Following the tax reform law’s enactment, 20 Republican-controlled states filed a lawsuit again challenging the ACA’s constitutionality. The plaintiffs, first, argued that the individual mandate can no longer be considered a valid tax, since there will no longer be any revenue generated by the provision.

In addition, in its 2012 ruling, the Supreme Court indicated(and both parties agreed) that the individual mandate is an essential element of the ACA, and that the remainder of the law could not stand without it. As a result, the plaintiffs argued that the elimination of the individual mandate penalty rendered the remainder of the ACA unconstitutional.

The U.S. Justice Department chose not to fully defend the ACA in court and, instead, 16 Democratic-controlled states intervened to defend the law.

Federal Court Ruling

In his ruling, Judge Reed O’Connor ultimately agreed with the plaintiffs, determining that the individual mandate can no longer be considered a valid exercise of Congressional tax power. According to the court,“[u]nder the law as it now stands, the individual mandate no longer ‘triggers a tax’ beginning in 2019.” As a result, the court ruled that “the individual mandate, unmoored from a tax, is unconstitutional.”

Because the court determined that the individual mandate is no longer valid, it now had to determine whether the provision is “severable” from the remainder of the law (meaning whether other portions of the ACA can remain in place or whether the entire law is invalid without the individual mandate).

In determining whether the remainder of the law could stand without the individual mandate, the court pointed out that “Congress stated three separate times that the individual mandate is essential to the ACA … [and that] the absence of the individual mandate would ‘undercut’ its’ regulation of the health insurance market.’ Thirteen different times, Congress explained how the individual mandate stood as the keystone of the ACA … [and,] ‘together with the other provisions’ [the individual mandate] allowed the ACA to function as Congress intended.” As a result, the court determined that the individual mandate could not be severed, making the ACA invalid in its entirety.

Impact of the Federal Court Ruling

Judge O’Conner’s ruling left many questions as to the current state of the ACA, because it did not order for anything to be done or stay the ruling pending appeal. However, this ruling is expected to be appealed, and the White House announced that the ACA will remain in place until a final decision is made. Many industry experts anticipate that the Supreme Court will likely take up the case, which means that a final decision will not be made until that time.

While these appeals are pending, all existing ACA provisionswill continue to be applicable and enforced. Although the individual mandatepenalty will be reduced to zero beginning in 2019, employers and individualsmust continue to comply with all other applicable ACA requirements. This rulingdoes not impact the 2019 Exchange enrollment, the ACA’s employer shared responsibility(pay or play) penalties and related reporting requirements, or any otherapplicable ACA requirement.

© 2018 Zywave, Inc.

FITNESS FIRST: WALKING

2 people walking on a path in the middle of a forest

If you are looking for an easy and inexpensive way to stay healthy or lose weight, you need nothing more than your own two feet. Walking is an ideal form of exercise—it’s free, and you can do it almost anytime and anywhere. Walking is also a great way to maintain a healthy weight or to shed those extra pounds.

The First Step: Good Shoes

Whether you walk outdoors, on a treadmill or at the local mall, you will want to invest in a good pair of walking shoes. Walking shoes are designed to give you the flexibility, support and proper push off needed for walking. Everyone’s feet are different, but look for shoes that are light, flexible and immediately feel comfortable. Walking shoes should not require a “breaking in” period.

Setting the Pace

You can walk to maintain your health or as part of a weight-loss program. To get moving, experts advise beginners to start with a 15- or 30-minute walk daily, adding five or 10 minutes to the walking session time per week. More specifically:

1.) To maintain your health, walk 30 minutes a day most days of the week at a “talking” pace, which means you are able to carry on a conversation comfortably while walking.

2.) If you are walking for weight loss, walk 45 to 60 minutes a day at a medium to fast pace. In addition, do not skip more than two days per week.

3.) For aerobic and cardiovascular fitness, walk 20 minutes at a very fast pace (you should be breathing hard), three to four days a week.

After walking, gentle stretching can help keep your muscles from being sore. It is also wise to warm up before walking fast or going a long distance.

Cautions

Make sure to be safe while walking outside:

1.) Always walk on sidewalks (or on the left side of the street facing traffic if there are no sidewalks).

2.) Be aware of traffic.

3.) Carry identification and your cellphone in case of emergencies.

4.) In the evening hours, wear reflective gear and/or carry a flashlight in front of you.

Going the Distance

Once you get started, you will want to stay motivated. Consider finding a walking friend, joining a walking club or registering for a challenging walking event. Remember that you will not notice immediate physical changes to your body, but by adding walking and a healthy diet to your daily routine, it won’t be long before you look and feel better.

Note: Before beginning any walking program, consider discussing your exercise plans with your doctor, particularly if you have health issues such as diabetes.