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Entries in ACA (5)

Tuesday
Sep032013

Understanding Health Care Exchanges Made Easy 

Hospital: © Matthew Cole/Shutterstock.com, question background: © grmarc/Shutterstock.com, top woman, wounded man, umbrella, question man, calendar men, mechanic, doctor and patient shaking hands: © The Last Word/Shutterstock.com, sun: © P.Piboon/Shutterstock.com, precious metals: © PILart/Shutterstock.com, map: © maraga/Shutterstock.com, computer: © gameanna/Shutterstock.com, internet background: © notkoo/Shutterstock.com, U.S. map: © alicedaniel/Shutterstock.com, shopping cart: © Mathee saengkaew/Shutterstock.com

Thanks to Damion Hendricks, Susan Lidika and our friends at Bankrate.com for this easy to understand infographic about how the new state Health Insurance Marketplaces will operate starting October 1st, 2013.

Under the PPACA, Patient Protection and Affordable Care Act, every American is required to obtain insurance coverage or face a penality beginning in 2014.

Monday
Jul082013

PEO Broker Blog Stirs Lively Linkedin Discussion

 

PEOs, The PPACA and Health Care Reform Debated

Our previous blog post on Healthcare Reform and Professional Employer Organizatiions started a lively discussion after we distributed the article to various LinkedIn discussion groups. More than 30 individuals added their comments in the Healthcare Exchange Linkedn discussion group The subject attracted a wide range of opinions from a diverse group of health insurance brokers, HR professionals, and small business owners.

Whose Employees Are They?

Aaron Hoffman Vice President, RSS Insurance Services in Denver, Colorado asked • Bruce- I have a question for you as a PEO. Are the FTE calculations based on the employees reported under the PEO’s UITR or the employees managed by the specific worksite employer?

Jeffrey Buchanan a broker with West Callaway Stotka, Inc. in Pleasant Hill, California agreed • Great question—sort of a double edge sword. If the employees are common law employees of the employer (the business) then the FTE count lies with the business. If the PEO is the common law employer, I believe the PEO has the FTE count to deal with. So if it’s the business whi is the common law employer and the business has 45 FTE’s the business can avoid the shared responsibility payment. If the PEO is held to be the common law employer (must offer coverage), the PEO will have to have a plan in place. Will they, the PEO mandate the business pay for coverage? Small employer may be better off not in the PEO? I really don’t know? The regs are vauge. Any thoughts?

Eric Kane Account Executive at Cool Insuring Agency Inc. in Albany, New York  added • The proposed regulations do not address how the pay or play provisions apply to PEOs. The general rule is that leased employees are not considered employees of the service recipent for purposes of ACA”s pay or play provisions, it is still unclear as to how this applies to PEOs. There is some indication that the pay or play provisions will attach at the client level, thus making the client company the “employer” for this purpose. However, until guidance is issued on the pay or play rules with respect to PEOs, these organizations should use the common law standard to determine whether an employement relationship exists.

Margie Brownlee, RHU, REBC  Account Mgr at OMS Staff Solutions, LLC in Lakeland, Florida followed up • Hi Eric, I am looking at Federal Register Vol 78 page 221 “As noted in Notice 2011-36, section 414(n), which treats leased employees (as defined in section 414(n)(2) as employees of the service recipient for various purposes, does not cross-reference section 4980H (and is not cross-referenced by section 4980H) and accordingly does not apply for section4980H purposes. I am taking this to mean that leased employees are not tied to Section 4980H. The employment relationship may apply to some aspects but not to 4980H. Guess we will have to wait for further clarification as it involves PEOs.

Our Response  @Eric @Margie @Jeff - Great points, and I agree with your observations and interpretations. My understanding is that credit will be applied at the client level. The standard is whoever exercises “care and control” of the “recipient” worksite co-employer.

The IRS is aware of the PEO reporting issue and the need for clarity. They are in the process of implementing guidelines, updating forms, and will be focusing on compliance, not only for the purpose of applying Small Business Health Insurance Credits but for reporting and collecting unemployment taxes as well.
 

http://www.treasury.gov/tigta/auditreports/2011reports/201140103fr.html

PEO Master Group Medical Plans

Armand Smith, CIC Insurance and Employee Benefits Broker Chicago, Illinois stated • I have worked for a couple of PEOs and both of them their plans rates blew up because eventually the claims were more than they could handle and the good groups moved on.

Michael Schunk, CEBS President of Employee Benfits Advisors, LLC in Fort Lauderdale, Florida agreed • Armand, good point. - I’ve seen PEOs place groups in a preferred rating tier simply to write the business. Then at renewal the group gets a huge rate hike. Bottom line is the People with integrity will do the right thing, regardless of whether they are an insurance agent or a PEO salesman.

Our Response • @Michael @ Armand @Dave- You seem shocked that some PEOs and PEO clients may have experienced higher claims than expected. That is what happens when underwriting small group health insurance. Are you telling us that carriers never “lowball” rates to gain market share, then increase rates 40% or 50% at renewal? PEOs to not operate in a vacuum. The are subject to the same market conditions as the carriers, who for the most part, dictate underwriting guidelines and pricing to the PEOs.

Our job, as consultants is knowing which markets can provide our clients with the most favorable rates based on census, underwriting, and your client’s plan preferences.

Gary Whiddon Principal at Digital Benefit Advisors, Los angeles, California wanted to know • Do PEO’s have to adhere to the 85% MedicAl Loss Ratio while small groups insurers require only a 80%?

Our Response @Gary - PEOs are not insurance companies. Less than 10% of the over 700 PEOs operating in the US offer a “master group health insurance policy”. Most of these health plans are available from the larger national and regional PEO’s. They are usually fully insured plans from carries like Aetna, Humana, and the Blues. The larger PEOs work with brokers like Aon and Marsh. Most smaller PEOs provide coverage written in the standard markets using either an in-house agency or a broker relationship.

http://news.regence.com/article_display.cfm?article_id=4755

It is the carriers who must satisfy the MLR rules, not the PEO.

The PEOs handle all of the enrollment, on-boarding, benefits administration, and client support services internally or through established 3rd party relationships. Plan designs, markets, networks, pricing, choice, quality and level of service will vary by PEO.

We wish to thank everyone for their participation in the Linkedin discussion  group. We welcome your questions, comments and contributions. Please submit any questions and comments you may have about The Patient Protection and Afforadable Care Act or Obamacare and how a professional employer organization can help you. We will attempt to address and clarify any issues or concerns you have about co-employment administration, employee leasing, HR outsourcing and professional employer organizations.

 

 

Wednesday
Jun262013

PEOs Help With Health Care Reform and the ACA.

Affordable Care Creates Demand for HR Outsourcing & PEOs

There is no question that  the (PPACA) Patient Protection and Affordable Care Act and Healthcare Reform has created the greatest opportunity for the PEO industry in decades. Employee leasing companies, HR outsourcing firms, benefits administration and health insurance enrollment specialists are ramping up to assist small and mid sized business owners and non profit organizations with implementing the Affordable Care Act, and complying with all the new rules and regulations.

Costs - Credits - Penalties - New Reporting For All

The complexities and costs associated with the Patient Protection and Affordable Care Act can be too overwhelming for the average small and mid-sized companies. Under health care reform, all group health plans are required to provide a minimum level of coverage for medical expenses. This could mean higher premiums for plans providing richer coverage than before. Limited benefit and high deductible health plans will not qualify under the PPACA.

Small business owners, described as 25 employees or less, can qualify for a premium tax credit. The credits are calculated based on the number of employees, average wage base, and the premiums paid by the employer to cover their staff and workers. Low wage paying employers with 15 employees or less, can expect to qualify for a credit of up to 50% of their premiums.

See Tax Credits - Do We Qualify?

The Affordable Care Act requires employers with 50 full-time employees or more (based on 30 hours per week and over) to provide affordable health insurance coverage for their employees or pay a $2,000 penalty per full time employee, excluding the first 30. This is often referred to as “play or pay” by individuals and representatives of the health insurance industry. Businesses and organizations who employ workers at the legal threshold should make certain they are in compliance at all times. The law requires a formula that measures the hours of full and part time workers to determine the total number of full time equivalent workers that an organization employs.

Larger employers must make certain that low wage employees do not contribute more than 9.5% of their earnings for their coverage. In addition to testing for full time workers,there are additional considerations for seasonal and short term workers. This can making testing especially complicated for construction, farming, health care, hotels and restaurants, landscaping, maintenance, schools, and the staffing industry. Under the PPACA, the IRS has instituted new regulations for reporting employer paid contributions for health insurance benefits that affects companies of all sizes.

PEOs - Health Reform’s Best Kept Secret

Employee leasing, personnel management, and Professional Employer Organizations are uniquely qualified to provide the solution. PEO’s provide companies with a comprehensive integrated solution that entails the administration and processing of payroll, they calculate and submit payroll taxes accurately and on time, and submit all payroll reports with the required information to your local, state and federal agencies making certain that your organization is in full compliance.

     “The PEO Industry is in the best position to tackle all the complexities of administering and complying with the Affordable Care Act and Health Care Reform.”

“The trouble is that I don’t hear enough employee leasing companies and professional employer organizations telling the business community exactly what it is that PEOs do, how we can relieve them of problems of dealing with health care reform, and help them stay focused on running their business.”

Rod Diekema - PEO Network

Some larger professional employers offer a choice of health insurance plans that have been tested to assure compliance with the PPACA. Many PEO’s can assist larger companies with testing for determining full time equivalents and contribution strategies to attain “safe harbor” status to avoid facing a $3,000 contribution penalty, should an employee obtain coverage in the public exchange instead of opting for the company’s group health plan. 

Inspirity - Getting The Message Out

 

     “Health care reform has generated over 15,000 pages of regulations filled with increased complexities, compliance and cost for your business. You can spend the time and money to figure it out, or you can  …..”

Paul Sarvardi - CEO Inspirity

Health Care Reform Video

Complying with health care reform will affect every employer in some way. Depending on the size and structure of an organization’s workforce, the remedies and requirements may be unique to your organization, even in the same industry. This is why the administrative capabilities, benefits expertise, human resource information technology, and payroll systems of HR Outsourcing and Professional Employer Organizations can be invaluable today, and in the future.

Sunday
May262013

Health Insurance Marketplaces Are Coming - Are You Ready?

What PEOs and Small Business Owners Should Know

With 2013 almost halfway over, our attention turns to 2014, when the Affordable Care and Patient Protection Act goes into effect. The individual mandate kicks in, requiring all Americans to purchase health insurance or face a fine. Employers with 50 employees or more will also face penalties of $2,000 per employee (the first 30 employees don’t count) for not providing a minimum level of health insurance coverage.

Small business owners, or employers with less than 50 full time employees (defined as 30 hours or more) are exempt from any penalties, fines or requirements to provide coverage to their employees. To the contrary, smaller businesses (defined as 25 employees or less) are rewarded for offering coverage to their workers. In 2014, companies can receive a credit of up to 50% of their premiums. The credits are calculated on a sliding scale which favors lower wage employers with 15 employees and less.


Most small business owners in America employ less than 50 full time employees. Those companies will not be subject to most of the provisions of the Affordable Care Act. This doesn’t necessarily relieve employers from any it’s responsibilities when it comes to guiding and assisting their workforce to comply with the individual mandate. Many lower wage employees will qualify for premium support in the form of credits that will offset their cost of coverage.

According to statistics compiled by the PEO Network, www.peonetwork.com, there are over 700 employee leasing, personnel management companies, and professional employer organizations operating throughout the United States. Approximately 90% - 95% of their client companies are firms with less than 50 full time employees. Many of their clients, small business owners, will be seeking the employee benefits and health insurance expertise these companies provide. PEOs are uniquely qualified to handle the additional compliance, reporting and analysis that business executives, HR professionals and tax professionals will require.

Health insurance marketplaces, formerly referred to as exchanges are being implemented in all 50 states. Some will be operated by the states individually, like California’s health insurance exchange called “Covered California” http://www.coveredca.com. Other states, like Florida, will introduce marketplaces which will be operated by the federal government, while other states will manage marketplaces as a joint partnership.

Are you ready?

Friday
Nov092012

Health Care Reform - The New Reality for PEOs

The End of Denial for Employee Leasing and PEO Companies?

NAPEO, The National Association for Professional Employer Organizations has published on their website napeo.org an announcement entitled;

PROFESSIONAL EMPLOYER ORGANIZATIONS CONGRATULATE PRESIDENT OBAMA ON REELECTION, LOOK FORWARD TO WORKING WITH ADMINISTRATION ON HEALTHCARE.

I had to clean my glasses. This is an industry where many of it’s owners and executives, (over 98% of all employee leasing companies and PEOs are privately held) have fought health care reform every step of the way. Large contributions were made to The National Federation of Independent Business, The Chamber of Commerce, (click on this link to see the NFIB position) and a host of Republican PACs and lobbyists. We reported on their attitudes and views about Health Care Reform and the PPACA in our earlier blog post Want to Repeal Health Insurance Reform, Not Likely!!!.

NAPEO President and CEO Pat Cleary is quoted as saying “PEOs are already the go-to source for small businesses looking for help in preparing for and complying with the healthcare benefits changes brought on by reform, so we feel we have an important role to play as the implementation of the ACA proceeds” and offered its industry’s expertise as the Obama administration moves forward with implement the Patient Protection and Affordable Care Act (ACA).

Only time will tell if NAPEO, and the industry as a whole embraces Health Care Reform or not. My opinion is that the PPACA is one more reason small business owners should consider the services of proactive, qualified and responsible employee leasing companies and professional employer organizations.