Loss of an employer-provided health insurance plan can be concerning, but programs do exist to help you stay insured. A federal law called the Consolidated Omnibus Budget Reconciliation Act, or COBRA, created the opportunity for those who would otherwise lose an employer-provided plan to stay on the plan for a certain length of time. Likewise, the state of California instituted its own, separate but similar, COBRA law. Here’s what you need to know about both programs.
Both COBRA programs help individuals and/or families maintain health insurance coverage during a time that they would otherwise lose access to their employer-provided plan. Examples of these situations include layoffs, divorce, reduction in work hours, medical leave, death, and more.
If one of these “qualifying events” occurs, the employee or his/her dependents can apply for COBRA coverage to remain on their plan. They must opt in within 60 days, and send the first premium payment within another 45 days.
Federal COBRA allows you to remain on the health insurance plan for 18 months, or 36 months for dependents. This law only applies to those who were employed by a company with more than 20 employees. Each worker’s dependents are also eligible for COBRA if a qualifying event occurs.
Cal-COBRA, on the other hand, extends the provisions offered under the federal law. Cal-COBRA allows coverage for workers (or their dependents) employed by companies with 2 to 19 employees. Plus, the coverage can be maintained by the former employee for 36 months.
Those who are coming to the end of their 18-month federal coverage period can then apply for Cal-COBRA in order to retain healthcare coverage for another 18 months. The employer must be located in California, and employ 2-19 people for at least half of the year.
COBRA coverage is not always right for every person in every situation. If you face job loss or another qualifying event, contact us to discuss COBRA as well as your other options. We can help you decide if federal and/or California COBRA coverage is right for you, and what to do next.
Each year, prior to Medicare’s Annual Election Period, employers must send notices of creditable coverage to all employees over age 65 (or any other employee or dependent otherwise eligible for Medicare).
What is creditable coverage? If a health insurance plan (in this case, a group policy) is expected to pay, on average, as much as a standard Medicare Part D policy, that is called “creditable coverage”. It means that the prescription drug benefits of a healthcare plan is at least equivalent in coverage to what Medicare Part D plans would offer.
What must the notice of creditable coverage communicate? Prior to October 15 each year, employers must supply written notice to all
- Medicare-eligible employees
- COBRA-covered individuals
- retirees covered by the group health plan
- and all dependents of these employees or former employees
The notice simply certifies that the prescription drug plan offered by the group health plan qualifies as “creditable coverage” for the purposes of being equivalent with Medicare Part D.
Why does creditable coverage matter? The Medicare Modernization Act imposes a late enrollment penalty on individuals who do not maintain prescription drug coverage for 63 days or longer, following their initial date of Medicare eligibility. The notice serves to inform individuals that their group health plan does provide this coverage. Otherwise, if they are not maintaining coverage they should consider enrolling in Medicare Part D promptly, in order to avoid a penalty later.
How does Medicare know whether an individual has maintained creditable coverage? The law also requires employers to file an online disclosure to certify the creditable coverage status of their group health plan. This disclosure should be filed no later than 60 days from the beginning of the plan’s contract year, within 30 days of termination of a prescription drug plan, or within 30 days of any change to the status of creditable coverage.
Again, notices of creditable coverage must be sent to all affected employees and former employees by October 15. Medicare must also be notified of your plan’s creditable coverage status. Contact us with any questions regarding these notices, so that we can assist you in properly complying with the law.
Who could have predicted the changes 2020 has brought? Remote working, or working from home, was rising in popularity prior to this year. Even still, no one expected the swift and dramatic rise of remote work at the level we’re currently experiencing.
Because this change has happened so suddenly, many businesses found themselves somewhat unprepared for the transition. Institute these safe practices, and pass them along to your employees to help things run more smoothly.
Ensure that each device is protected. Employees should use a device dedicated to work; sharing with family members should be strongly discouraged. Remind them to install security updates when prompted, and to protect devices with passwords.
Use safe WiFi connections. Working from home sometimes also means working from hotels, cafes, other locations. Remind your employees that public WiFi connections are not secure, and can put your data and business operations at risk. As for home WiFi, make sure everyone is using a strong password and secure firewall.
Adopt a VPN. Institute a Virtual Private Network for company use, and make sure to update settings and limitations regularly.
Consider two-factor authentication. Your cloud system and any other processes should be protected with two-factor authentication, for optimal protection against data theft or loss.
Create a protocol guide. Update your old security protocol, or adopt a new guide, to clearly communicate your expectations to employees. Focus on the expected response in the event of device loss or theft, and for suspected or known security breaches. Each employee should know how to immediately proceed if one of these events occurs.
The above procedures can help protect your business from unwanted virtual viruses and more… But what about real-world viruses and other health risks? Check with your healthcare plan administrator about telemedicine (virtual healthcare appointments). This type of healthcare is not only time-saving; receiving healthcare from home can shelter us all from the inherent risks of waiting rooms.
If these benefits are available under your plan, communicate that information directly to employees. Review sick leave procedures and determine how you will handle telemedicine appointments as time away from “the office”. Working from home is still work, and together we can adopt procedures to keep each other safer at this time.
Telemedicine sounds like a new thing, but the origins of “remote” healthcare lie all the way back in the 1950s. Many decades ago, patients learned that they didn’t always need to visit their physician in person when a simple phone call would suffice.
Today, telemedicine is supported by high-speed internet access, allowing us to attend face-to-face virtual “visits” with our healthcare providers. And in the time of Covid-19 and shelter-in-place orders, many insurance carriers are now covering telemedicine appointments.
Telemedicine actually encompasses three areas of patient care:
- Interactive care allows patients and healthcare providers to “meet” virtually to discuss symptoms and other concerns
- Remote patient monitoring allows providers to collect data on patients remotely, such as blood sugar levels, blood pressure, and more
- Store and forward is a method of sharing a patient’s healthcare information with other providers and specialists (with the patient’s permission, of course)
While telemedicine does include all of these areas of practice, most of us associate the term with virtual medical appointments conducted via video call. These interactive care appointments can benefit the patient in a number of ways, including:
- No need to travel to an appointment; the visit can be conducted from home or anywhere else the patient is located
- No worries about obtaining childcare or juggling schedules in order to attend appointments
- Fewer hours missed from work and/or school
- Limiting exposure to other illnesses in hospitals or medical offices
- Quicker access to care
- Affordability of care; telemedicine appointments are often priced much lower than in-office consultations
- Covered by many health insurance plans
- Reimbursed by Medicare and Medicaid/Medi-Cal in many situations
Of course, telemedicine appointments should not be used for emergency situations. Patients should always call 911 or proceed to an emergency room if they suspect heart attack or stroke, have sustained a serious injury, or otherwise need immediate lifesaving care. But for routine care, minor illnesses and injuries, mental health treatment, and many other non-emergency situations, telemedicine provides safe and quality healthcare at greater convenience to the consumer.
Even better, the monetary savings help us all by helping to lower the cost of healthcare. Ask your healthcare provider if they offer telemedicine appointments, and familiarize yourself with the process so that you know what to do next time you need healthcare services.
From school openings to job security, to personal budgets and safety, we all have plenty to worry about right now. Luckily, your health insurance premium might not be one of them. Many health insurance providers have announced that they will be offering a variety of solutions to help consumers make their regular health insurance premium payments.
The pandemic situation has created a curious combination of events in these past few months. Due to fears of coronavirus, and shutdowns in many areas, the numbers of elective procedures and office visits at this time have sharply declined. With consumers avoiding both doctor appointments and emergency rooms, healthcare providers have reported a 30 percent drop in inpatient care, a 25 percent drop in outpatient care, and a 35 percent drop in physician services.
Naturally, such an enormous drop in healthcare services has equalled a decline in health insurance claims. Many of the major health insurance providers will be extending that savings to their customers, which can be great news if you’re worried about making premium payments right now or in the near future.
Depending upon your carrier, you might be able to take advantage of these provisions:
- A credit for premiums paid in previous months
- A discount on upcoming premiums due
- An extended grace period for making premium payments
- Suspension of out-of-pocket charges on some healthcare services
Look for a notice from your health insurance provider, or you can call them directly to discover what help they might be offering to their customers. Alternately, feel free to call us and we’ll assist you in locating answers.
This is all great news, but we do want to caution you about one potential problem: Considering that preventive care accounts for many of the healthcare services postponed at this time, some of those avoiding doctor visits might be at increased risk of chronic health problems in the future. Stay in touch with your doctor, and discuss with them alternate means of accessing care. They will advise you of which preventive tests or procedures are most important, considering your personal risk factors, and help you make a plan to catch up on preventive care.
This month, we wanted to reach out to all of our business clients. How are you holding up during these challenging times? Is there anything we can do for you?
Just a few reminders…
Have you applied for the Paycheck Protection Program yet? Or, do you anticipate applying in the near future?
Funded through the Small Business Association, the Paycheck Protection Program provides businesses with a loan to cover eight weeks’ worth of payroll and other expenses. The goal is to help your business remain viable during our current economic climate, and of course, to help your employees keep their own bills paid.
You can obtain a loan in the amount of 2.5 times your average monthly expenses, or $10 million, whichever is less.
If you follow guidelines correctly, 100 percent of your loan could be forgiven (you won’t have to pay it back)
You can qualify for Paycheck Protection if your business employs 500 or fewer workers, and you can demonstrate that the coronavirus pandemic has negatively impacted you economically.
As you might expect, numerous rules and regulations apply to both qualification for the program, and in order to have your loan forgiven. Since this is quite a chunk of change, you will want to follow those guidelines to the letter.
You can also apply for an Economic Injury Disaster Loan, for up to $10,000. This loan can also be forgiven in certain situations. And yes, you can apply for both programs, but you cannot use money from both programs toward the same purpose.
If you have questions about HR and Benefits during this ongoing situation, give us a call. We can help you identify solutions to the unique problems your business is facing.
Remember, we’re here for you! Sticking together makes us all stronger – so let us know if you need help with anything at this time.
Employees might decline enrollment in their company’s small group health insurance policy for any number of reasons, but what happens if they later change their minds? Fortunately, the law does provide for a Special Enrollment Period under those circumstances. That’s good news, because under California law we all must enroll in a health insurance policy or face a penalty at tax time next year. That requirement began on January 1 of this year.
For many reasons, a worker might change their mind after once declining coverage. In most cases, such as loss of coverage under another plan, or due to marriage or addition of a new child, they have 30 days to request enrollment in the small group plan. However, if the lost coverage was CHIP or Medi-Cal, a 60-day enrollment period will apply.
Currently, anyone who previously denied coverage for any reason can now enroll in a healthcare plan. You do not need to experience a qualifying life event in order to take advantage of this opportunity. However, the time to enroll does differ from one carrier to the next, so we advise acting now in order to have access to as many options as possible.
Coverage will be equivalent to other enrollees. Special enrollees in small group plans must be offered the same benefits as those who signed up during the original enrollment period. They cannot be charged more than those who enrolled when first eligible.
Benefits cannot be denied on the basis of a preexisting condition. The Affordable Care Act protects potential enrollees from being denied healthcare coverage on the basis of a condition which was present prior to enrollment.
Enrollees cannot be asked to complete a physical or submit a health history before joining the small group plan. A general questionnaire may be used, provided it does not request genetic information and is not used to deny, restrict, or delay benefits.
A group health plan cannot charge an individual more than any other similarly situated individual, based on any health factor.
Contact us to learn more about small group health coverage, and we can help you determine whether a Special Enrollment period applies to your situation.
Historically, employees of small businesses have enjoyed few options with regard to retirement planning. With only four out of ten small businesses offering any sort of retirement benefit, many Californians faced challenges with regard to their financial futures. Looking toward the future, and envisioning millions of citizens retiring at barely above the poverty line, lawmakers stepped in to create a state-operated retirement system.
CalSavers is now open for enrollment, with small businesses employing five or more workers required to enroll. Enrollment deadlines are staggered over the next two years, with the end goal of enrolling seven million Californians into a retirement savings plan (unless they take steps to opt out).
The set-up is relatively simple: CalSavers will provide an IRA (Individual Retirement Account) and eligible employees of participating businesses will be automatically enrolled at a 5 percent contribution rate. A one percent automatic escalation will apply, up to an 8 percent contribution rate. Accounts stay with employees even if they change jobs.
Business owners, also, can enroll in CalSavers if they are also employees of their businesses. Those who are not employees of their businesses can participate, but must make contributions from their bank accounts rather than payroll deductions. Self-employed workers are also eligible to join the program via the same process.
Are all business owners required to enroll in CalSavers? No, not necessarily. Enrollment in CalSavers is required of small businesses who employ more than five workers, but only if they do not already participate in a retirement benefits program. If you have already established a qualified retirement plan for employees, or decide to establish one through another provider, you will not be required to participate in CalSavers.
Otherwise, yes, small businesses will be required to enroll in CalSavers according to the following schedule:
Businesses with 100 or more employees should enroll by June 30, 2020
Businesses with 50 or more employees should enroll by June 30, 2021
Businesses with 5 or more employees should enroll by June 30, 2022
Of course, you can enroll earlier than those dates as well. Businesses that fail to comply with the mandate can be charged a penalty of 250 dollars per employee up to 90 days after the deadline, and 500 dollars per employee after 90 days have passed without compliance.
For more information on enrolling in CalSavers, or to discuss other retirement benefit options, give us a call. We can help you understand your options and select the course of action that best suits your needs.
You may have heard the alarming news reports regarding the coronavirus outbreak in China. Although this news is concerning, mostly for those in China, arming yourself with knowledge can be the best antidote for your own worry.
What is coronavirus? Coronavirus is actually an entire class of viruses, and they’re nothing new. In fact, coronaviruses are one of the frequent culprits behind the common cold.
Concern over this particular strain of coronavirus is due to its unusual strength, and the fact that it is a strain we haven’t previously encountered before.
What are the symptoms of coronavirus? Those infected with this new strain of coronavirus present with coughing, breathing difficulties, and fever. It might appear as a bad cold at first. However, the progression of the virus into respiratory distress and pneumonia is the true risk in this situation.
What is the treatment for coronavirus? As with other viruses, antibiotics are not effective. Antiviral drugs commonly used against the flu also will not work against coronavirus.
Treatment includes admission to the hospital, fluids, rest, and support for infected lungs. Recovery mostly depends upon the patient’s immune system.
How lethal is this coronavirus? As of February 7, the infection tally has reached 31,161 inside China, with an additional 280 cases in 28 other countries. The death toll includes 636 Chinese, one death of a Hong Kong resident, and one death in the Philippines. The mortality rate of the virus stands at 2 percent.
Most of the deaths have occurred in individuals with already compromised immune systems, the elderly, and people who are otherwise in poor health already.
Health experts have suggested that many cases of coronavirus have gone undetected because symptoms were mild, and the affected individuals assumed they simply contracted a common cold. In that case, the lethality of the virus would be even lower than the estimated 2 percent.
Are we at risk of infection in the US? So far, five cases of this particular coronavirus have been diagnosed in the United States. These patients recently traveled to China or had close contact with a traveler. So far the virus seems contained to these five patients, and health officials don’t believe it was spread within their communities.
With travel to China heavily discouraged at the moment, it is unlikely that we will see a widespread outbreak of this viral strain in the US.
Billing misunderstandings are common, due to the confusing nature of medical bills in general. But if you receive a bill that seems unexpected, it’s always a good idea to investigate it before paying it. In some cases you might have been billed erroneously.
One problem that we see occasionally is a situation called “balance billing”. This practice goes against your group insurance provider’s rules, and is actually illegal.
For example, let’s say a medical practice normally charges 300 dollars for a particular service. As an in-network provider with your insurance company, they have agreed to accept a pre-negotiated amount for that service, which is always less than the “cash” price. In this example, let’s assume that the pre-negotiated amount is $200.
If this practice then sends you a bill for the remaining 100 dollars, this is called “balance billing” and it not only violates their agreement with the insurance provider, but it is also illegal. Unfortunately, that fact hasn’t completely stopped some providers from engaging in this practice.
Any time you receive an unexpected bill, you have the right to question it before paying it. In some cases the bill is simply a mistake. The first thing to do is call the physician and inquire about the charges. Most often, the billing error is not intentional and the provider will fix the issue. However, if you believe your medical provider is engaging in balance billing and they refuse to adjust the charges, the next step would be to notify your health insurance company.
Of course, you also have the right to inquire about fees and insurance payments before scheduling an appointment with any doctor or healthcare provider. If you know what to expect, it can be easier to compare services and choose a provider that is right for you.