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Posts by bahim


Know Your Open Enrollment Period

Know Your Open Enrollment Period


Posted By on Sep 12, 2019

For those who need to enroll in a new healthcare plan, or change from one plan to another, Open Enrollment is the time to complete those tasks. More to the point, unless special circumstances apply, you can only enroll in a plan or make changes during this time. Therefore it is extremely important to anticipate your Open Enrollment period, and be ready to complete the process during that window of time. But wait! You might have noticed that there is more than one Open Enrollment period for health insurance. You will need to understand which enrollment window applies to your situation, and then complete the correct steps to select a health insurance plan. Individual Open Enrollment. This enrollment period applies to the general health insurance marketplace for individuals – that is, people who are not covered by health insurance through their employers. In California you will complete your enrollment through Covered California, either online, over the phone, or with assistance from an independent health insurance broker. This year, Open Enrollment for individuals runs from November 1 to December 15, 2019. Coverage under your new plan will begin on January 1, 2020. Group Open Enrollment. Your initial enrollment period for group health insurance will occur at the time you become employed and eligible for that company’s healthcare plan. From that point on, Group Open Enrollment occurs annually upon the anniversary of the company’s enrollment in the plan. So, for example, if an employer originally enrolled in a group policy on October 1, 2015, their Open Enrollment period will occur on the first of October every year thereafter. When you experience a change in your circumstances, allowing for a change to your plan (you get married or have a baby, for example), you can make that alteration to your plan at the time it occurs. Contact your human resources department for more information on your group health insurance plan, or to make necessary changes to that policy. Special Open Enrollment for Small Groups. The Affordable Care Act acknowledged that many smaller employers might want to offer a group health insurance plan, but do not meet standard employer contribution or employee participation ratios. For those cases, the Special Open Enrollment for Small Groups window exists, and will run from November 15 to December 15. Eligible small groups will receive coverage beginning January 1. In the context of small group health insurance, an employer cannot require employees to enroll unless they cover 100 percent of the employee’s premiums. Have more questions about Open Enrollment? Give us a call, and we will help you determine what you need to do...

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Do You Have a Federal COBRA Game Plan?

Do You Have a Federal COBRA Game Plan?


Posted By on Aug 12, 2019

In the event that one of your employees is no longer employed by you, federal law might require that they are allowed to temporarily continue their health insurance plan. The Consolidated Omnibus Budget Reconciliation Act, or COBRA, asserts that former workers and their dependents are entitled to maintain group health insurance coverage for a period of time after their eligibility ends, if one of the following conditions apply: Job loss, whether voluntary or involuntary (except in cases of gross misconduct) Work hours are reduced and the employee otherwise loses eligibility for benefits A dependent is divorced or legally separated from an employee The employee becomes eligible for Medicare An employee’s child loses their dependent status An employee dies (in this case COBRA applies to their dependents) Are you required to provide COBRA health insurance coverage? COBRA applies to private-sector employers, with twenty or more full-time employees (or full-time equivalents) in 50 percent of the calendar year, who provide group health insurance benefits. However, COBRA coverage might not apply to all of your employees. You don’t have to provide COBRA to: Employees who haven’t worked for you long enough to be eligible for group health insurance benefits Those who declined to participate in a group benefits plan Those who are enrolled in Medicare Even smaller employers should be aware of COBRA requirements. Your company could grow in the near future. Even if you employ just under 20 workers, become familiar with COBRA so that you can comply with the law when the time comes. Employees must be notified. COBRA also requires that you notify workers of their COBRA rights within 90 days of their eligibility for your group plan. You must also notify them of COBRA eligibility within 14 days of a qualifying event (as listed above). The former employee, or dependent, has 60 days to opt into COBRA coverage. COBRA applies to all health plans. If a former employee (or dependent) elects COBRA coverage, it must apply to all plans in which they were formally enrolled. Examples include medical flexible spending accounts, dental plans, vision plans, or drug plans. COBRA is subject to certain time limits. For employees, COBRA coverage lasts up to 18 months. For dependents, coverage under COBRA can extend to 36 months after the qualifying event. Other rules apply in cases of disability. Who pays for COBRA? The employer can require that the former employee or dependent pays 100 percent of the cost of coverage under the group plan. Premiums cannot exceed the full cost of coverage plus two percent for administrative expenses. Noncompliance can cost you. Failure to comply with COBRA requirements can result in...

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Now that the federal Individual Mandate requirement for health insurance has loosened – since setting the penalty at 0 dollars, the law is effectively nullified – individual states are now passing their own mandate laws. With passage of the Minimum Essential Coverage Individual Mandate, California is poised to join those ranks. Effective January 1, 2020, the mandate requires all Californian residents (along with spouses and dependents) to enroll in a qualified insurance plan for each month of the year. Those who fail to maintain health insurance coverage will be subject to a Shared Responsibility Penalty , to be determined and collected by the Franchise Tax Board. Some exceptions to the law do apply, according to financial hardship and religious belief as dictated by Covered California. Currently, 93 percent of the state’s population is covered by a health insurance plan. New affordability provisions within the law aim to close that gap, so that the state can achieve 100 percent coverage. Currently, individuals and families with incomes between 100 and 400 percent of the federal poverty level can obtain government subsidies to make health insurance premiums more affordable. The new law will expand that bracket up to 600 percent, so that more Californians can obtain coverage. The new legislation also raised Medi-Cal’s age cut-off for undocumented residents, from 18 to 26. In the wake of the new law, we can expect to see a ripple effect upon other policies regarding health insurance. For example, the legislation also calls for additional reporting requirements under Internal Revenue Code 6055. “Applicable entities”,such as health insurance companies and companies which provide health insurance coverage, will be required to provide proof of coverage to the Franchise Tax Board each year. Penalties will be imposed upon companies that fail to complete their filings. We will keep you updated on these changes as they occur. In the meantime, please don’t hesitate to contact us if you have questions about the new health insurance mandate law. We can assist both individuals and employers to ensure that you’re in compliance with the...

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We tend to think of Medicare as “healthcare for retirees”, due to the fact that we become eligible for coverage when we turn 65. But in reality, plenty of people are still working at age 65, and the trend toward later retirement is expected to continue (and even become more common). So, if you’re still working and are covered by a group healthcare plan when you reach your 65’th birthday, you might be wondering what you’re supposed to do about Medicare. Yes, you still need to enroll. When you turn 65, enroll in Medicare regardless of your employment situation. Assuming that you or your spouse have worked at least ten years, and paid taxes into Medicare, you are eligible for premium-free coverage under Medicare Part A. You might also want to enroll in Medicare Part B, or in Part D (prescription drug coverage). Yes, you can have Medicare along with your other health insurance plan. If you already have health insurance coverage, you can still enroll in Medicare at 65. If your employer is a smaller company, Medicare will become your primary coverage and your group health plan will be secondary. In this case you definitely want Medicare Parts A and B, because it will be your primary coverage. If you work for a large employer, that health insurance plan will remain primary, with Medicare serving as secondary coverage. Either way, having group health insurance along with your Medicare could mean lower out-of-pocket costs for you. You can delay Part B and Part D enrollment, if you prefer. Normally, failing to promptly enroll in Part B or D coverage at age 65 can result in paying a penalty when you finally do enroll. However, if you’re still working and are covered by your employer’s plan, you can delay this enrollment with a confirmation of creditable coverage from your employer. This way you can avoid the late enrollment penalties when you do enroll in those plans later. You are responsible for remembering the deadline. You can enroll in Medicare beginning three months before your birth month, or for three months afterward. This is called your Initial Enrollment Period (IEP). Medicare will not remind you of your IEP unless you’re receiving Social Security or Railroad Retirement Board benefits, so mark this date on your calendar. If you have questions about Medicare plans, or how enrollment works when you’re not yet retired, please give us a call. We can offer more detailed advice once we discuss your...

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A quality group health insurance plan is the backbone of your employee benefit package. But even the most comprehensive plans have their limits, and therefore your employees might experience some gaps between the coverage they need and the coverage they have. In particular, health insurance plans rarely cover vision exams, glasses, or contact lenses. The good news is that you can offer your employees a vision insurance plan as an added, voluntary benefit. They can opt in at no added cost to you (if you set it up that way), but will appreciate the opportunity to obtain quality vision care at group rates. Why Do Employees Choose Vision Insurance? For most of your employees, their benefits package isn’t just about their needs. Their families depend upon these insurance options, too. Vision insurance can cover the entire family, allowing for annual vision checks, and glasses or contact lenses when needed. While health insurance plans generally cover eye exams for children under age 19, spouses are not included, nor are children over 19 who are still utilizing a parent’s policy. Children under age 19 typically have an exam and glasses covered, but you can’t go to just any eye doctor, you must stick to a specific list of providers. Also, considering the amount of “screen time” most of us are getting these days, we all stand a greater chance of needing vision assistance at some point. Even those who have always enjoyed 20/20 vision might find that as they get older, reading glasses become necessary. A Complement to Health Insurance. Eye exams can detect more than just vision problems. Often, the first signs of many health problems are noticed by an optometrist or opthamologist. These can include diabetes, brain tumors, high blood pressure, high cholesterol, and more. And of course, certain degenerative eye disorders like glaucoma and macular degeneration are first detected by a vision screening. When caught early, treatment can save the patient’s sight or at least slow the progression of the disease. Increased Workplace Safety. Vision impacts job performance, too. As an employer, you are likely aware of the various liability issues that can exist in the workplace. Regular vision screenings not only keep employees healthy and happy; they could increase productivity and reduce the risk of accidents as well. Vision insurance offers a valuable voluntary benefit at a comparatively low price. Give us a call to learn more about adding vision insurance to your menu of...

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