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Benefits

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How Employers Should Handle MLR Rebates

The Affordable Care Act's medical loss ratio (MLR) rules require group health insurance issuers to provide rebates if their MLR—the amount of health insurance premiums spent on health care and activities to improve health care quality—falls short of the applicable standard during a reporting year. Each year's rebates are issued to plan sponsors by September 30 of the following year and have three months to distribute the rebate to eligible plan enrollees. Employer Distribution The MLR rules provide that issuers must pay any rebates owed to persons covered under a group health plan to the policyholder, who is then responsible for distributing...

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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...

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Employers Are Expected to Spend More on Health Care and Wellness in the Next Year

According to Optum’s Wellness in the Workplace study, more than 80% of employers plan to spend more on health care and wellness in the next year than in previous years. Health Care Spending The cost of providing employer-sponsored health care has been steadily increasing over the years. According to the Kaiser Family Foundation, the average health insurance premium for family coverage was $19,616 in 2018, with employers paying 71% of that cost. Premiums are expected to continue to increase, which means employer health care spending will increase too. Wellness Spending To mitigate rising health care costs, improve attraction and retention, and increase employee well-being,...

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Reminder: Medicare Part D Notices Are Due Before Oct. 15

Requirement Applies to Employers that Offer Prescription Drug Coverage Employers who sponsor group health plans that offer prescription drug coverage to Medicare-eligible individuals must provide a Medicare Part D Creditable or Non-Creditable Coverage Notice to those individuals before October 15. These notices inform Medicare-eligible individuals whether the plan’s prescription drug coverage is expected to pay, on average, as much as the standard Medicare prescription drug coverage (meaning it is "creditable”). For more information on this notice requirement, including links to downloadable model notices, click here. ...

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IRS Confirms ACA Pay or Play Penalties Still Apply – See Q&A including payment info

No Waiver or Transition Relief is Currently Available Recently, the Internal Revenue Service released an information letter regarding the Affordable Care Act's employer shared responsibility (pay or play) penalties. The information letter is intended to clarify the applicability of the penalties in light of President Trump's 2017 executive order broadly directing federal agencies to waive, delay or grant exemptions from ACA requirements that may impose a financial burden. The information letter: Confirms that the ACA's pay or play penalties continue to apply to applicable large employers (ALEs) that fail to offer affordable, minimum value health coverage to their full-time employees (and dependents). ...

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Open Enrollment Season – A Checklist for Employers

Here at SIMA we offer a comprehensive set of tools and support materials to ensure your employees remain engaged, educated, and, most of all, enrolled in a plan that helps them make better decisions for a healthy physical and financial future. Here are just a few things to do before, during, and after the enrollment period. Pre-Enrollment:  4-10 weeks before Open Enrollment Plan kickoff event around enrollment Send a letter, email, or text message about upcoming enrollment period Print flyers or order materials to hand out at enrollment event Open Enrollment:  1-2 weeks before and during Open Enrollment Send reminders about...

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HSA and Retirement: How to Use Your Health Savings Account

When you get ready to retire, there’s a good chance one of your biggest expenses will be health care. Luckily, there are tools you can use to help make the most of your money. If you qualify, you might be able to use a health savings account (HSA) as a sort of “retirement account” to help you continue to grow your wealth. “An HSA isn’t actually a retirement account; it’s completely different,” said Tom Vipond, emerging products consultant at TD Ameritrade. “However, it is a tax-advantaged savings account that can be used as part of your retirement strategy.” Here’s what you need...

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Medicare Part D – Creditable Coverage Disclosure Notice to Individuals

Employers must send Medicare Part D Creditable Coverage Disclosure Notices to individuals each year by October 14th and at additional specified times during the year. All employers that provide prescription drug coverage to individuals who are eligible for Medicare Part D are required to notify those individuals whether or not the coverage that is provided is creditable, as part of the Medicare Part D creditable coverage requirements. Notices must be provided to Medicare-eligible active working individuals and their dependents, Medicare-eligible COBRA individuals and their dependents, Medicare-eligible disabled individuals covered under the prescription drug plan, and any retirees and their dependents who...

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