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…
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…
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…
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,…
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,…
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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…
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…
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…
New Figure Marks Decrease from 2019 Under the employer shared responsibility (“pay or play”) provisions of the Affordable Care Act, 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…
