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Benefits

OPEN ENROLLMENT 2020: SIMA’s plans for a safe & seamless open enrollment period for our clients

2020 has certainly presented more than its share of challenges. Here at SIMA, with gratitude to our dedicated employees and exceptional technology team, we haven’t missed a beat. But, things do look a little different and will continue to do so for some time. And that includes during your company’s open enrollment period. Here's how SIMA will manage Open Enrollment 2020: Enrollment meetings, presentations and employee education will take place online. We are confident that SIMA’s electronic open enrollment system will make this change to a virtual format a seamless one. SIMA is equipped with an electronic benefits administration system that provides online access...

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Court Upholds Expansion of Short-term, Limited-duration Insurance

2018 Final Rule Allows Policies Lasting up to 12 Months On July 17, 2020, a federal appeals court upheld a 2018 final rule expanding short-term, limited-duration insurance (STLDI) for purposes of the Affordable Care Act (ACA). The final rule: Provides a maximum coverage period for STLDI of up to 12 months; and Allows STLDI to continue for up to 36 months in total, taking into account renewals or extensions. The plaintiffs in this case argued that extending the duration of STLDI is inconsistent with HIPAA’s plain text and an unreasonable interpretation in light of the ACA’s structure and purpose. However, the Court of Appeals...

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ACA Affordability Contribution Rate Set at 9.83% for 2021

New Figure Marks Slight Increase from 2020 Under the Affordable Care Act’s employer shared responsibility (pay or play) rules, applicable large employers—generally those who have 50 or more full-time employees (including full-time equivalent employees)—may be subject to a penalty if they do not offer affordable health insurance coverage that provides minimum value to their full-time employees and their dependents. For plan years beginning in 2021, the Internal Revenue Service has announced that coverage will generally be considered affordable if the employee's required contribution for the lowest-cost self-only health plan offered is 9.83% or less of his or her household income for the taxable year....

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Trump Signs Executive Orders to Lower Drug Prices

Series of Four Executive Orders Issued On July 24, 2020, President Donald Trump issued the following series of executive orders in an effort to lower drug prices: Executive Order on Lowering Prices for Patients by Eliminating Kickbacks to Middlemen: directs federally qualified health centers to pass along massive discounts on insulin and epinephrine received from drug companies to certain low-income Americans. Executive Order on Increasing Drug Importation to Lower Prices for American Patients: intended to allow state plans for safe importation of certain drugs, authorize the re-importation of insulin products made in the United States, and create a pathway for widespread...

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ACA Pay or Play Penalties Increase in 2021

The Adjusted Penalty Amounts for 2021 are $2,700 and $4,060 Under the Affordable Care Act’s employer shared responsibility (pay or play) rules, applicable large employers—generally those who have 50 or more full-time employees (including full-time equivalent employees)—may be subject to a penalty if they do not offer affordable coverage that provides minimum value to their full-time employees and their dependent children. Two separate penalties can apply under the employer shared responsibility rules—the Section 4980H(a) penalty and the Section 4980H(b) penalty. The Section 4980H(a) penalty can apply when an ALE does not offer coverage to “substantially all” full-time employees (and dependents). The annual...

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EMPLOYER RESOURCE: 8 Tips for a Successful Open Enrollment During COVID-19

The coronavirus (COVID-19) pandemic has highlighted the importance of health care benefits. Its impact has led to many elective procedures being delayed, and 2021 may look different than previous years. Given the impact of the coronavirus pandemic, many enrollees are increasingly conscious of having appropriate health care coverage. The effects of the pandemic have also impacted open enrollment this year—with many employees feeling confused, anxious or stressed about making the right choices. Generally, many employees complete open enrollment rather quickly—but with the added pressures this year, employees are encouraged to spend the time needed to make enrollment choices confidently.  8 Tips...

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The New Normal: How COVID-19 Has Reshaped the Workplace

This video series explores the lasting effects the coronavirus pandemic has had on workplaces across the country. This video can help employers identify ways to keep operations running smoothly after reopening their businesses. [video width="1920" height="1080" mp4="https://simafinancialgroup.com/wp-content/uploads/2020/08/NewNormal_COVID19-Reshaping-Workplace.mp4"][/video]...

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Employers Have Flexibility with Contraceptive Coverage Plan Designs

In July, the U.S. Supreme Court upheld expanded exemptions to the ACA’s contraceptive mandate. Under these exemptions, plan sponsors that object to providing contraceptive coverage based on sincerely held religious beliefs or moral convictions will not be penalized for failing to include contraceptive coverage in the plan’s benefits. The ACA requires non-grandfathered health plans to cover certain women’s preventive health services without cost sharing, including all FDA-approved contraceptives. Religious exemptions apply to certain churches, houses of worship, and other church-affiliated institutions, which allows them to choose not to contract, arrange, pay or refer for any contraceptive coverage. In its 7:2 decision, the...

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Supreme Court to Hear Arguments in Lawsuit Challenging ACA’s Constitutionality This Fall

This fall, the U.S. Supreme Court is expected to hear oral arguments in Texas v. Azar, the lawsuit arguing that the Affordable Care Act (ACA) is unconstitutional. In June 2020, President Donald Trump’s administration asked the Supreme Court to strike down the entire ACA due to the elimination of the individual mandate penalty. The administration’s argument hinges on Congress’ decision in 2017 to reduce the individual mandate penalty to zero. According to the White House, removing that provision invalidated the entire law. If the remaining provisions of the ACA  are upheld without the individual mandate penalty, then little will change from the current...

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Post-coronavirus Return-to-Work Plans and EAPs

The coronavirus (COVID-19) pandemic has changed employees’ daily lives and routines, and even as businesses reopen, many employees are feeling the effects of the pandemic. As businesses reopen, employers must consider how the COVID-19 pandemic has affected employees, which in turn will affect their post-coronavirus return to work. As employees return to work, many are experiencing financial hardship, balancing new caregiving responsibilities, managing concerns over their physical well-being, and maintaining their mental well-being and health. During these uncertain times, employees are understandably experiencing significant stress, which can lead to lower productivity and morale, and increase their risk for health conditions, absenteeism...

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