March 2020 - ARC Benefit Solutions

PCORI Fees: Are They Back Again?

March 31, 2020/in Compliance, Employee Benefits/by ARC Benefit Solutions

A Patient-Centered Outcomes Research Institute (PCORI) fee is imposed by the Affordable Care Act (ACA) on certain health insurance policies and self-funded plans to help fund the Patient-Centered Outcomes Research Institute, which is a non-profit institute organized to fund research into the comparative effectiveness of medical treatments and services.

The IRS treats the fee as an excise tax and is a requirement for self-funded and fully insured customers. For fully insured plans, the insurance carrier pays the PCORI fees. If the plan is self-insured, however, the plan sponsor or employer would pay the fees directly to the IRS along with the filing of the Form 720 for reporting.

Under the ACA, the PCORI fees were scheduled to end in 2019; however, they have been extended through the signing of the Further Consolidated Appropriation Act of 2020 (the “Act”) by President Trump on December 20, 2019. The reinstatement of the PCORI fees extends to 2029, covering plan years ending on or before September 30, 2029. The last payment for calendar year plans will be July 31, 2029.

The PCORI fee is determined by calculating the average number of covered lives for the plan year multiplied by the applicable dollar amount. The fee is paid annually to the IRS using Form 720 (Quarterly Federal Excise Tax Return).

PLAN/POLICY YEAR END DATE	FILE NO LATER DATE	APPLICABLE RATE
January 2018 – September 2018	7/31/19	$2.39
October 2018 – December 2018	7/31/19	$2.45
January 2019 – September 2019	7/31/20	$2.45

A plan sponsor has three methods that they can use to calculate their average number of covered lives. Only one method can be used during that plan year to determine the average total number of covered lives.

Actual Count Method. Calculating the total number of lives covered for each day of the plan year and dividing it by the number of days in the plan year.
Snapshot Method. Adding the total number of lives covered on a date during the first, second, and third month in each quarter, or an equal number of dates for each quarter, and dividing the total by the number of dates on which a count was made.
Form 5500 Method. Based on the number of participants reported on the Form 5500.

For additional information about calculating and paying the PCORI fees, please visit the IRS website at https://www.irs.gov/newsroom/patient-centered-outcomes-research-institute-fee.

What is Telemedicine and How Can I Use It?

March 31, 2020/in Employee Benefits, Individual/Family, Medicare/by ARC Benefit Solutions

Telemedicine is a cost-effective and accessible option that involves electronic communication and software to provide clinical services to patients without an in-person visit. Many people opt for telemedicine because it can be done from the comfort of your own home or anywhere else like work, vacation, the park, etc. You do not have to bring yourself or your children in contact with illnesses that you may encounter at the doctor’s office.

Moreover, every physician you see using telemedicine communications will be considered in network no matter where you are. Physicians can prescribe certain medications through telemedicine, including medications for allergies, arthritic pain, asthma, bronchitis, colds and flu, diarrhea, infections, and insect bites. Regardless of location, your telemedicine doctor will be able to find the closest in-network pharmacy for you to pick up your medications.

Depending on the carrier, how telemedicine operates can vary. In most cases, you log into your carrier’s website, enter your member identification number, and answer any questions that your doctor may need to provide a diagnosis. Using your insurance carrier’s telemedicine services, you are able to speak with a physician in real time from one computer screen to another through a HIPAA compliant video conferencing tool. Most telemedicine options also allow you to take pictures so the doctors can review your case.

It is important to note that telemedicine is not an appropriate communication channel for all cases and conditions. Your physician will make a judgement call on the communication that will be most effective for you and your situation. The cost of using telemedicine services will, depending on your carrier, often match what you would pay as copay for a normal doctor’s visit on your plan. If you have a Health Savings Account (HSA), the cost will be a lot less in most cases because there is set copay (which goes toward your deductible) for the visit.

Telemedicine might be a good option for you as we navigate the COVID-19 orders for social distancing. Contact your ARC representative today to learn more about your telemedicine options and how you can use it to your advantage.

What is an Employee Assistance Program (EAP)?

March 31, 2020/in Employee Benefits, Health and Wellness/by ARC Benefit Solutions

An Employee Assistance Program (EAP) is an employer paid, work-based program that provides confidential and free assessments, short-term counseling, referrals, and follow-up services to employees who have work related personal or financial concerns.

EAPs address a complex and broad body of issues affecting mental and emotional well-being, such as stress, alcohol and other substance abuse, family problems, grief, and psychological disorders. EAP counselors also work in an advice-giving role with supervisors and managers to address employee and organizational challenges and needs. Many EAPs are instrumental in helping organizations prevent and cope with workplace violence, trauma, and other emergency response situations.

These services are available from a variety of different providers and the cost is determined by the amount of employees at a specific workplace or by employee per month. If you are interested in offering an EAP to your employees, contact your ARC representative to learn about your options.

Determining Medicare Creditable Coverage

March 31, 2020/in Compliance, Employee Benefits, Medicare/by ARC Benefit Solutions

What is Medicare creditable coverage and why does it affect me as an employer?

As part of the Medicare Modernization Act of 2003, the Medicare Part D prescription drug program was created. The law requires that each employer offering prescription drug benefits as part of their employee benefit plan must notify any Medicare-eligible participant and the federal government if the coverage offered is at least as good as the standard Medicare prescription drug plan. If the benefit the employer offers is at least that valuable, the plan is deemed “creditable.” Notification to these participants is critical as that same law created a “late enrollment penalty” for those who did not have creditable coverage for 63 days or longer prior to their initial enrollment period for their Medicare prescription drug benefit. This will help those affected determine whether or not to stay on the employer plan or enroll in a Medicare Part D drug plan.

So as an employer, what do I need to do?

Every employer who offers a plan covering prescription drugs must file their status (creditable or non-creditable) to the Centers for Medicare and Medicaid Services (CMS) each year no later than 60 days after the start of their plan year. For example, the majority of health plans renew on January 1 of each year, which means they will need to file by March 1. To notify CMS of the plan’s status, the plan sponsor/employer needs to complete this form by entering their contact information and the federal tax identification number and completing the certification. The process is quite simple. Employers are also responsible for notifying each plan option’s credibility status (note: many plans have more than one health plan option) to all active employees, plan participants, and any covered retirees that may be Medicare eligible. Keep in mind, Medicare does not always apply to those 65 years or older. There are other extenuating circumstances why someone may be eligible for Medicare and since you may not be aware of any that qualify for other reasons, it is best to send the announcement to all covered persons. This notice must be delivered prior to October 15 each year, so that any person who wishes to enroll for Medicare may do so during that calendar year’s Medicare open enrollment period. Many employers tend to include the creditable status in their open enrollment packets or to new hires as they come on board. The point is, make sure all participants receive the information no later than October 15.

How will I know if our plan is creditable or non-creditable?

If your group plan is fully insured, the insurance carrier will be able to verify if the drug benefit is or is not creditable. Since every carrier is different in the handling of these notices, your agent should assist you as plan status may change each year even if there have been no changes to benefits. Employers may also check plans status by using guidance from CMS or an independent actuary can be hired to value the benefits appropriately.

What if my plan is not deemed creditable? Are there penalties?

There is no requirement that employers offer creditable coverage and no penalty exists today if they do not. You are only required to a) notify the government annually and b) notify all active employee plan participants and covered retirees that could be Medicare eligible. We recommend that new hires (as they come onboard) are also made aware of the current plan’s Medicare creditable status. Medicare-eligible beneficiaries will be able to decide if they would like to enroll in a higher value Medicare Part D plan if the employer plan is indeed determined non-creditable.

How can I get assistance throughout this process to make sure I stay compliant?

At ARC Benefit Solutions we know that this may be a complex and intimidating task for employers who are busy running their businesses. Our licensed advisors are equipped with the knowledge and resources you need to keep your employees informed and keep your business compliant. If you have questions about creditable coverage or questions about any other compliance issues, please contact your ARC representative today.

Stress-Busting Tips While Social Distancing

March 31, 2020/in Health and Wellness/by ARC Benefit Solutions

Stress can cause you to feel frustrated and irritable and not addressing it can cause deterioration in your mental health. Especially now, it’s important to practice stress-relieving relaxation techniques that keep you grounded. Here are some tips for keeping your stress levels at bay:

Exercise. There’s a reason exercise is consistently listed as a solution to common health problems—because it works. According to Harvard Health Publishing, “The mental benefits of aerobic exercise have a neurochemical basis. Exercise reduces levels of the body’s stress hormones, such as adrenaline and cortisol. It also stimulates the production of endorphins, chemicals in the brain that are the body’s natural painkillers and mood elevators.” The American Heart Association (AHA) recommends at least 150 minutes of moderate aerobic activity every week, as well as at least two sessions of muscle-strengthening activities. Be sure to speak with your doctor before starting any new exercise routines.
Get some fresh air. Especially now when we’re all doing our part to social distance and reduce the spread of COVID-19, it’s important to take intermittent breaks and get outside. A quick walk at a local park or a stroll around your neighborhood is enough to improve your mood and help you relax.
Practice mindfulness. Right now, it’s easy to get sucked into questions of “what if”. Take the time to combat the negativity and anchor yourself in the present moment using journaling, meditation, yoga, deep breathing, or anything else that helps ground you when your brain feels chaotic.
Connect with others. With social distancing, it is important to connect with your family and friends on a regular basis. According to Mayo Clinic, “Social contact is a good stress reliever because it can offer distraction, provide support, and help you tolerate life’s up and downs.” In today’s world, there are a number of options to reconnect with your loved ones digitally. Some common resources include Google Hangouts, Skype, Zoom, and FaceTime.

Resources:

Exercise as Stress Relief (Healthline)

Exercising to Relax (Harvard Health Publishing)

16 Simple Ways to Relieve Stress and Anxiety (Healthline)

Coronavirus Update: ARC Mandatory Remote Work Policy

March 17, 2020/in ARC Updates/by ARC Benefit Solutions

As the Coronavirus (COVID-19) situation continues to develop, our first priority is the safety and health of our employees and our clients. In an attempt to flatten the curve and reduce the spread of the virus, ARC has issued a mandatory remote work policy until May 1, 2020, or until we are confident that the threat has diminished.

We have been preparing for this situation and our expectation is to have minimal disruption in the support that we provide to you, our clients. Our team is properly equipped to manage the business at hand remotely.

For everyone’s safety, our offices will be closed to outside visitors and all employees at this time. We are also restricting in-person interactions and opting for interaction via phone or webinar until further notice.

We will continue to monitor the situation and act in accordance with the Centers for Disease Control, World Health Organization, and any state and federal guidelines to update our approach and planning.

Thank you for your continued business and understanding while we take the steps needed to keep all of us and our loved ones safe and healthy.

Please use your normal channels of communication to contact us with any questions or concerns you may have.

How to Update Your Income for ACA Plans to Qualify for Subsidies

March 17, 2020/in Individual/Family/by ARC Benefit Solutions

If your income has changed as a result of the coronavirus (COVID-19) pandemic, and you are covered by an ACA on-exchange health insurance plan, you may qualify for additional subsidies. Please update your application in accordance with any income or household changes as soon as possible to find out if you are eligible for savings.

You can update your income information by logging in to your Healthcare.gov account and clicking on “Report a Life Change”.

If your income estimate increases or you lost a household member, you may qualify for less savings than you are receiving now. If you don’t report the change, you may have to pay money back when you file your federal tax return.

On the other hand, if your income estimate goes down, you may qualify for more savings, which could lower what you pay in monthly premiums. You may also qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).

Contact your ARC representative with any questions.

Exploring Cost-Effective Health Insurance Options: What is Medicaid?

March 17, 2020/in Individual/Family/by ARC Benefit Solutions

As costs continue to rise in the individual health insurance world, consumers are continually looking for alternative cost-effective options. This is especially true for people who do not qualify for a monthly tax credit because their income is too high and those who are ineligible for underwriting with a short-term plan. But what about those who are on the other end of the spectrum and have income that is too low to qualify for a tax credit? Medicaid is an option worth exploring for those who are eligible for low-cost (and sometimes free) health care.

Medicaid is a joint state and federal program that is administered by each state to provide health coverage to particular groups of people. Medicaid enrollment in 2018 was just under 75 million and is the largest single source of health care in the United States. Eligibility for Medicaid varies from state to state and could depend on whether or not that state expanded Medicaid after 2010 when the Affordable Care Act (ACA) created the opportunity. This eligibility is based largely on your Modified Adjusted Gross Income (MAGI) and tax household size. One of the misconceptions around Medicaid is that only those with a low income are eligible for the program. However, certain conditions or situations may make someone eligible, including those who are disabled, pregnant, blind, or in foster care.

Children make up the largest group enrolled into Medicaid. Due to a high number of eligible children, it is important for each state to provide comprehensive benefits. If a state has chosen to provide a separate Children’s Health Insurance Program (CHIP), then they must provide one of three coverage types: benchmark, benchmark-equivalent, or secretary-approved coverage. Benchmark coverage is a plan that is equal to a Federal Employee Plan, State Employee Plan, or HMO plan in that state. Benchmark-equivalent coverage has an aggregate actuarial value that is equal to or greater than the benchmark coverage types listed above. Secretary-approved coverage is approved by the Health and Human Services (HHS) secretary to be appropriate for the targeted low-income children that are under the plan. Just like the ACA, the CHIP plans are required to cover certain benefits including well-baby and well-child care, dental coverage, behavioral care, and vaccinations for free or at very low cost.

CHIP can be especially helpful to families that make too much for everyone to be put on Medicaid, but not enough to purchase private coverage. Let’s take the example of a family of three (married with one child) that makes around $42,000/year gross. They are very close to the threshold amount of being eligible. If this family applies for Medicaid, the state can place the child on a CHIP plan (denying the parents), but allow the parents to enroll in private coverage with a monthly tax credit/discount. This situation is common and is something that some people tend to shy away from. In reality, it is a win-win situation because it allows everyone in the family to receive coverage and take advantage of all possible savings. Now, this example can vary state to state as each have different requirements, but even if a family is in a situation similar to the above, it doesn’t hurt to apply and let the state make a determination. Income limits also change year to year, so just because a family/individual is found not eligible one year does not automatically count them out for the next year.

The licensed sales representatives at ARC are available to help you sort through your health insurance options. Your family may be eligible for Medicaid! Contact us today for more information.

https://www.medicaid.gov/medicaid/eligibility/index.html

https://www.medicaid.gov/chip/benefits/index.html

A Message from ARC Benefit Solutions About Coronavirus (COVID-19)

March 16, 2020/in ARC Updates, Health and Wellness/by ARC Benefit Solutions

ARC Benefit Solutions is committed to your health and well being. As news continues to spread about the coronavirus COVID-19, we want to be sure we keep our valued clients informed. Below is some information gathered from resources provided by the Centers for Disease Control and Prevention (CDC) regarding the virus and how to protect yourself, your loved ones, and others.

Many health plans are covering testing for COVID-19. Carriers are continually providing more details and updates as they come about regarding your plan and coverage in relation to COVID-19. We will be sure to continually update you as we receive more information. Contact your ARC representative with any questions.

What is coronavirus COVID-19?

According to CDC, coronavirus disease 2019 (COVID-19) is a respiratory illness that can spread from person to person. The virus that causes COVID-19 is a novel coronavirus that was first identified during an investigation into an outbreak in Wuhan, China.

What are the symptoms of COVID-19?

Patients with COVID-19 have mild to severe respiratory symptoms including fever, cough, shortness of breath, and breathing difficulties.

How is COVID-19 spread?

Human coronaviruses are usually spread between people who are in close contact with one another (within about 6 feet) through respiratory droplets produced when an infected person coughs or sneezes. It also may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

How can I protect myself and others?

People can help protect themselves from respiratory illness with everyday preventive actions including:

Avoiding close contact with people who are sick.
Avoiding touching your eyes, nose, and mouth with unwashed hands.
Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60 percent alcohol if soap and water are not available.
Stay home when you are sick.
Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

Clean and disinfect frequently touched objects and surfaces.