ARC Updates Archives - ARC Benefit Solutions

Take Advantage of Zywave’s Online Human Resources Library

November 13, 2024/in ARC Updates, Employee Benefits/by ARC Benefit Solutions

Clients of ARC Benefit Solutions with group medical coverage have access to the Zywave online Human Resources library. If you are an office administrator, company executive, owner, or other administrator wearing multiple hats at your company, a resource like Zywave is beneficial on staying up-to-date with different legal requirements and industry standards relating to employee benefits, human resources, and federal and state regulations and changes.

Zywave houses thousands of articles, reference materials, member communications, forms, templates, and additional resources that pertain to various human resources, laws by state, employee benefits administration such as 401(k)s, and other administrative topics. These articles and reference materials are vetted and maintained by lawyers, human resources professionals, and other industry professionals to ensure that the information is current and accurate. The information contained in Zywave can help you stay current on state and federal regulatory changes and research difficult or complex laws or legal situations associated with running your business.

There are also many useful tools built into Zywave. Below is a list of some of the applications that are at your disposal:

Content Library with federal and state-specific resources
Human Resource tools, such as:
- Custom Job Description Builder
- Employee Cost Calculator
- Enrollment Booklet Builder
- HR Self-Assessment Tool
- In-Person Interview Question Builder
- Performance Review Builder
- Salary Benchmarking Tool
- Total Compensation Statement Builder
Compliance Applications:
- Federal Poster Advisor
- FMLA Advisor
- Multi-State Laws Comparison Tool

As a client of ARC, you can access Zywave at no charge. If you have questions or issues with accessing Zywave, or if you haven’t logged into Zywave before, please contact your ARC Benefit Solutions representative for assistance and additional information.

Key Takeaways From the DOL’s Employee Benefits Report

November 13, 2024/in ARC Updates, Employee Benefits/by ARC Benefit Solutions

The U.S. Department of Labor’s (DOL) Bureau of Labor Statistics (BLS) recently published a report examining employee benefits in the country. The estimates in the report are from the BLS’ National Compensation Survey, which measures costs and trends related to employer-provided benefits.

The survey represents more than 146 million civilian workers in private industry and state and local government. This article summarizes the main points of the DOL’s Employee Benefits in the United States release.

Medical Care Benefits for Civilian Workers

The survey provides estimates on the percentage of workers with access to and participating in employer-provided health care benefits as of March 2024, as well as estimates for medical care premiums. The statistics for private industry and state and local government were published separately and then combined to measure the civilian economy, as follows.

While 89% of full-time civilian workers had access to medical care benefits, just 26% of part-time workers did. The take-up rate was 66% for full-time workers and 46% for part-time workers. For private industry workers enrolled in medical plans with single coverage, the employer share of premiums was 80%, and the employee share was 20%. For family coverage, employers paid 68% of premiums for private industry workers, with employees covering 32% of premiums.

Participating state and local government workers with single coverage had 86% of premiums covered by employers and 14% by employees. Employers paid 71% of premiums for family coverage, with employees covering 29% of such plans.

Wages for Civilian Workers

The median hourly wage for civilian workers was $25, with

$24 for private industry workers and $33.16 for state and local government workers. Industry research suggests that employers will continue increasing wages to keep up with inflation and remain competitive in the labor market.

Benefits for Private Industry Workers

Most civilian workers (more than 126 million) surveyed work in the private industry. The following figures represent how many of those workers had access to certain employee benefits as of March 2024:

Medical care benefits: 72%
Dental benefits: 43%
Vision benefits: 28%
Retirement benefits: 72%
Paid sick leave: 79%
Paid holidays: 81%
Paid personal leave (leave used for reasons important to the individual employee but not otherwise provided by other forms of leave, such as sick leave, vacations and holidays): 49%

On average, small organizations (those with one to 99 employees) offered 10 annual paid vacation days for workers after one year of employment, 14 days after five years, 16 days after 10 years and 17 days after 20 years. Large organizations (those with 500 or more employees) offered, on average, 14 annual paid vacation days after one year of employment, 18 days after five years, 21 days after 10 years and 24 days after 20 years.

Benefits for State and Local Government Workers

Of the civilian workers surveyed, nearly 20 million worked in state and local government. The following figures represent how many of those workers had access to certain employee benefits as of March 2024:

Medical care benefits: 89%
Dental benefits: 60%
Vision benefits: 39%
Retirement benefits: 92%
Paid sick leave: 92%
Paid holidays: 68%
Paid personal leave: 62%

Conclusion

While the best methods for implementing benefits vary by industry, workplace size and location, being aware of current benefits trends can guide organizations as they strategize and take action. Recognizing trends and take-up rates can help employers respond with meaningful benefits to help keep their workforces healthier and happier.

Employers should continue to monitor benefits trends, employee utilization and spending. Contact your ARC representative for more resources.

Common Mid-Year Qualifying Events and Employee Considerations

November 13, 2024/in ARC Updates, Employee Benefits, Legislation, Open Enrollment/by ARC Benefit Solutions

Employers offering fringe benefits under a cafeteria plan (also known as a Section 125 plan), must follow IRS rules about when benefits can be adjusted outside the annual open enrollment period. Most insurers offering group coverage only allow mid-year changes for these rules under the IRS. Employers don’t have to allow all mid-year election changes, only those allowed under the Health Insurance Portability and Accountability Act (HIPAA) special enrollment rights. This article reviews some items to understand about mid-year qualifying events.

What Is a Mid-Year Qualifying Event?

A mid-year qualifying event is a specific life change that allows a member to alter plan elections outside the group’s open enrollment period. Usually, elections for benefits like health insurance, dental coverage and flexible spending accounts (FSAs) are locked in for the entire plan year once open enrollment ends. However, the IRS recognizes that certain events may necessitate adjustments to your benefits.

When a mid-year qualifying event occurs, employees may be able to adjust benefit elections to suit their new circumstances. This flexibility ensures that benefits continue to align with their needs.

Common Mid-Year Qualifying Events

The IRS identifies the following “change in status” events that enable you to make alterations to your benefit elections during the plan year:

Change in employee’s legal marital status (e.g., marriage, legal separation, divorce/annulment or death of a spouse)
Change in number of dependents (e.g., birth, death or adoption of a child)
Change in employment status (e.g., starting or losing a job, working at a different site or transitioning from part time to full time or vice versa)
Change in dependent status (e.g., when a child reaches the age limit for dependent coverage)
Change in place of residence (e.g., if your family moves to a new location that affects your eligibility for a health maintenance organization plan)

Additionally, employees may be allowed to adjust benefits if there are changes in cost or coverage for their plan’s qualified benefits. Other mid-year qualifying events that may prompt changes include court orders (such as those requiring the addition of a dependent to a health insurance plan), qualifying events under the COBRA, HIPAA special enrollment rights, gaining eligibility for Medicare or Medicaid, Family and Medical Leave Act leave, and Health Insurance Exchange enrollment.

Qualifying Events may allow the employee to do the following:

Add or remove dependents
Enroll in or drop coverage
Change plan options
Adjust coverage levels

While the group health plan must follow IRS rules for mid-year election changes, an employer might set stricter limits on when employees can adjust benefits. If the plan allows mid-year changes, make sure you understand which qualifying events are covered and know that these changes might be more restrictive depending on the plan’s specifics. It’s also important to note that some mid-year changes apply only to certain benefits like health FSAs, and not all IRS-approved changes are available across all benefits.

There is also a strict deadline for changes to be submitted to an insurer. Most only allow 30 days from the date of the qualifying event to modify elections.

SPECIAL NOTICE: Regarding Mid-Year Qualifying Events for Employers

Many medical carriers are now requiring proof of qualifying events in order to make changes. If you update eligibility online, be prepared to upload relevant proof of the life event or the carrier may not approve the requested change. Carriers that require this now are: MMO, UHC, Paramount, and Aetna.

Speak with your ARC client advisor to learn more about qualifying events. We have a flyer that can be posted in a breakroom, used as a payroll stuffer, or included in open enrollment materials.

Here is What You Need to Know About 2025 Open Enrollment and Annual Enrollment

September 27, 2024/in ARC Updates, Individual/Family, Medicare, Open Enrollment/by ARC Benefit Solutions

Oops, you blinked and it’s already September, which means the 2025 Open Enrollment and Annual Enrollment Periods are looming. If you don’t already know, Open Enrollment and Annual Enrollment is a window of time during the year where you can sign up for health insurance, adjust your current plan, or cancel your plan.

With Open Enrollment on the horizon, now is a good time to review your current health insurance plan and make any changes needed. Here are some reminders and tips to help make your enrollment season smooth and constructive:

Know Your Dates (Trust Us, They’re Important)

Open Enrollment Period (individual and family health insurance): November 1 to December 15, 2024

Please note: December 15 is the last day to enroll in or change plans for coverage starting January 1, 2025. For plans that do not start January 1, Open Enrollment ends on January 15, 2025.

Annual Enrollment Period (Medicare): October 15 to December 7, 2024

If you miss the Open Enrollment window, you may need to wait until the next Open Enrollment Period to make changes, or there are additional opportunities throughout the year to update your plan called Special Enrollment Periods (SEPs). However, an SEP is only triggered by particular qualifying life events, including marriage, divorce, loss of coverage, changes in household, a child’s birth or adoption, etc. Generally, you are given 60 days prior to the event and/or 60 days from the day of the event to enroll into a new plan and that new plan will start the first of the following month in which you apply. Contact your ARC client advisor if you think you may qualify for an SEP.

Take Inventory of Your Current Situation

At this time, it’s important to review any changes from throughout the year, including your household income, medications, doctors, facilities, etc., and communicate those changes with your client advisor because they may affect the efficacy of your plan for your current situation or your qualifications for subsidies. If you are currently on a plan with subsidies, a change in household income could significantly impact your monthly premium for 2025. Using current information ensures you aren’t receiving too much or too little in federal assistance with your Marketplace plan.

“What if I’m happy with my current plan and don’t need to make any changes?” Great! Depending upon the plan you are on, your renewal may be automatic. You may receive the Annual Notice of Change from your health insurance carrier that details the plan premium and coverage for the 2025 plan year.

What You Can Expect from ARC Benefit Solutions

If you’re looking for health insurance coverage (for yourself, your family, your employees, etc.) and you don’t know where to start, give us a call! Our licensed health insurance agents are armed with the knowledge needed to find you a plan that works for budget and your situation. Our goal is to help simplify the process for you.

For our current clients…

As we do each year, we will be sending out annual renewal letters in mid-September with instructions on filling out your annual renewal form, either digitally or by using the paper form we include with your letter. We will include a QR code in the letter if you prefer to fill out the form digitally.

If you are interested in reviewing your coverage or shopping for a new plan, be sure to submit your annual renewal form and schedule an appointment with your client advisor as soon as possible!

As you can probably imagine, Open Enrollment is our busiest time of the year, so appointment times fill up fast!

As always, ARC’s client advisors are available to help you sort through your options and walk you through your health insurance plan so you can take full advantage of your benefits. Contact us today with any questions or if you’d like to get set up with a health insurance plan.

Seven Advantages of Offering Basic Life Insurance to Your Employees

September 26, 2024/in ARC Updates, Employee Benefits, Life Insurance/by ARC Benefit Solutions

When tragedy strikes a member of an employer’s workforce, it is unsettling for everyone and can cast a dark cloud over the workplace.

Life insurance is a popular employee benefit that is advantageous for both the employee and the employer. Here are a few ways that life insurance can benefit employers:

Basic life insurance can offer piece of mind for the burial of the employee at a minimum, if not other expenses that will help the family during a tough transition.
Employers not offering a life insurance benefit may be a drawback to those employees who are considering getting a policy.
Employers may feel obligated to help with funeral expenses or compensation when an employee’s family lacks the resources or a long-time or key employee passes. In addition, other employees may pressure their employers to offer financial assistance to the family in these cases.
Life insurance often includes Employee Assistance Programs (EAP) that can help surviving employees, their coworkers, and the family of the deceased employee cope with their loss. If the loss occurred in the workplace, many EAPs offer in-person grief counseling with employees for an additional fee.
Unlike medical insurance, life insurance can be “classed” so that only certain employees receive the benefit to keep costs and administrative work to a minimum. However, it’s important to note that the rates will lower as the number of covered employees increases.
Smaller companies are often limited on employer paid life insurance to $25,000 or $50,000 depending on the carrier. The benefit is guaranteed issue, which means that any eligible employee can obtain the coverage regardless of medical fitness.TIP: If you want to provide more coverage that’s guaranteed issue, you can purchase voluntary life insurance for employees such as executives, owners, managers, or those who have worked for the company for a longer period of time. This can usually double the benefit.
Life insurance is relatively inexpensive for the value of the benefit.

If you are interested in offering life insurance to your employees, contact your ARC client advisor to review your options.

Why You Need Travel Medical Insurance

July 30, 2024/in ARC Updates, Individual/Family/by ARC Benefit Solutions

Did you know that your current health insurance coverage may not cover health care in another country? How can you ensure that your honeymoon in Greece won’t cost more than you can afford due to unforeseen medical bills?

There are a few measures that you can put in place to ensure your trip runs as smooth as possible, even in the event of a medical emergency. Travel insurance, including trip cancellation insurance, travel health insurance, and medical evacuation insurance all in one, will provide coverage for unpredictable events that may impact your financial security.

Travel health insurance, in particular, is highly recommended for jet setters to provide financial security in the event of sickness or accidents overseas. Whether you’re an adrenaline junkie, someone with a pre-existing condition, or looking to travel abroad for extended trips, travel health insurance can help you in the event of unexpected accident or illness. Here’s why you should consider adding travel medical insurance to your trip plans:

Travel health insurance provides up to $1 million worth of coverage for emergency medical services outside of the U.S.

Outside of the U.S., your current health insurance plan may only cover up to a certain limit (or it may not cover anything at all). A travel health insurance plan is a stop-gap measure to help you manage the costs of health emergencies, especially if you have a pre-existing condition. Your policy may cover the following:

Ambulance service
Doctor and hospital bills
Emergency medical expenses (e.g., imaging)
Emergency dental expenses
Prescription medications.

The cost of travel health insurance is often budget friendly.

The cost of your policy will depend on a few factors, including the country your traveling to, your age, your state of residence, and the amount of coverage provided. According to data from Squaremouth, “you can expect to pay between 5 to 10% of their insured trip costs on a travel insurance policy.”

If you’re hopping on a plane and vacationing outside of the U.S., be sure to speak with your client advisor about travel health insurance and medical evacuation insurance. Contact your ARC client advisor today and they can help you review your current coverage to determine if a travel health insurance plan may be beneficial.

Resources

Travel Insurance (Centers for Disease Control and Prevention)

Travel Medical Insurance: Emergency Coverage While You Travel Internationally (NerdWallet)

How Much Does Travel Insurance Cost in 2024? (SquareMouth)

GUIDE: What to Expect When Shopping for Group Health Insurance Coverage

July 23, 2024/in ARC Updates, Employee Benefits, Open Enrollment/by ARC Benefit Solutions

When looking for a suitable benefits package, your client advisor works through an exhaustive checklist of considerations and requirements to ensure the plan you choose is optimal for your business, your employees, and their families. There are compliance regulations, carrier requirements, geographic restrictions, and more to consider when choosing a group health plan.

Whether you are shopping for group benefits for the first time or you are conducting your annual benefit review, here’s an overview of the most important details your advisor considers as well as some frequently asked questions we receive from our clients.

What are some considerations to keep in mind when choosing a plan?

The state you’re in geographically. For fully insured plans, the state a group is headquartered in generally drives what products are available. For example, groups with fewer than five employee lives in Ohio have more options than groups with fewer than five in Kentucky. It’s also a challenge if your company is headquartered in one state but all your employees live in another or if there are “pockets” of employees in other areas or states.

Believe it or not, it also matters what part of the state you’re in. There are regional players that can come into play along with “rating areas” that dictate costs in various parts of the state based on access to care and its cost.

Your group’s health. If there are serious, ongoing conditions in your covered population, the cost of those are factored into most options, except for Affordable Care Act (ACA) plans. This is called medical underwriting.

ACA plans are for groups with fewer than 50 employees (full-time plus part-time) and are guaranteed issue, which means that they are not medically underwritten so employer groups can purchase these plans regardless of health status. In some states, ACA options are predominantly all that are available.

Medical underwriting emerged in some states as a way for healthier groups to save premiums by banding together. Sponsored by Chambers or by trade associations, Multiple Employer Welfare Arrangements (MEWAs) have become fairly common in many states. For example, Ohio has four major MEWAs and counting, Indiana has several, and Kentucky has one.

All states have level-funded options available. Level-funded products are designed to give employer groups the benefits and advantages of self-funding, while limiting the disadvantages by offering a “pre-packaged” hybrid of self-insurance for small employers (down to five enrolled locally).

Group size. Options for quoting vary based on the average total number of employees (ATNE) for the prior calendar year, which includes full-time and part-time employees. This is how most carriers determine the quoting process and the products available.

- Quote processes. Group size (ATNE) will also determine the process we follow for obtaining quotes and what information must be provided. Some carriers have been able to embrace census-only quoting, which uses a large database of claims history and algorithms to determine future costs with only basic information about a group. We call this census quoting. Census quoting generally requires the name, ZIP code, date of birth, gender, and coverage type for every member enrolling. This is often only available to groups of 10 or more enrolling. ACA quotes are also done with a member census for groups of two or more.
- Products available. If you’re a group made up of either a husband and wife, sole proprietor, solely covering family members, or, owner-only coverage, this can limit your options. We have to ask a lot of nosy questions to figure out what you can be offered.
- Participation. ACA rules require that, if you offer coverage as an employer, you have to offer it to all full-time, eligible employees working 30 hours or more. There are a handful of exceptions. We attempt to confirm this up front whenever possible. You might feel the questions are intrusive when you just want a quote; however, if possible, we try to determine up front if the option we present is even available to you.

How does medical underwriting work?

If the group is unsure of their population’s overall health or if they know they have a healthy group, your client advisor will need to get applications from all full-time employees so that they can present the group to underwriting to determine if the group is an acceptable risk for the carrier. If the group is not healthy or is declined by the carrier, don’t worry, we still have options.

How do we collect the applications?

We use a data collection site called FormFire. FormFire has each employee create their own account and then it will ask them a series of questions to set their account up and determine if they want to be included in the group quote or if they are waiving coverage. All full-time eligible employees complete the FormFire application. Once the entire group is complete, you just let your client advisor know and we will then send the requests for quotes to all appropriate carriers.

How long will it take to get quotes back?

Every carrier is different, and the time frame is different depending on the time of year you are looking for coverage. During the last three months of each year, it takes the longest to get quotes back as January 1 is the most common date for plans to start and carriers receive a lot more requests. Generally, we can start collecting medical applications as early as September for January 1 effective dates.

Once your quotes come back from the carriers, your client advisor will review each option for the best offers to review with you with a recommendation for what they feel will best fit your group. However, the decision is always yours. If you are able to decide on your plan within 30 days of its effective date, the client advisor will have enough time to conduct employee meetings and preparation of employee materials. For January 1 dates, we like to have decisions around Thanksgiving. If you decide later than that, you run the risk of having a longer “blackout period” where you’re waiting for benefits to be loaded.

From start to finish, we like to have at least 45 to 60 days to get a quote for you and set up your group with a new carrier or work with you on a renewal. If we are looking during the fourth quarter, it is best to start at least 60 to 90 days prior to when you want you plan to be effective.

Group health insurance can be complicated and overwhelming, but your client advisor is there to help take the administrative load off of your plate. After all, you have a business to run.

If you’re interested in finding a health insurance plan for your group or if you’re considering a change, contact ARC Benefit Solutions today!

Join Us for a LIVE Medicare 101 Presentation! Register Today!

June 18, 2024/in ARC Updates, Medicare/by ARC Benefit Solutions

Join licensed sales agent Bram Binsky and our friends from Medical Mutual of Ohio to learn about the basics of Medicare, review your plan options, and get the guidance you need so you can feel more confident in choosing a Medicare plan. You’ll get answers to questions like:

What is included in Original Medicare?
When should I enroll?
What are my other coverage options?
Is prescription drug coverage included?
What are Medicare Star ratings?
Why are Star ratings important?

There will be two more opportunities throughout the summer to join us and we will be giving away a $15 gift card at each event!*

Please note: You do not have to be a Medical Mutual customer in order to join us! All are welcome!

Reserve your spot for any of the days by clicking the “register” button below!

Location: Hilliard Public Library (Hilliard Room)

4500 Hickory Chase Way

Hilliard, Ohio 43026

Date: Monday July 15

Time: 5:00 to 6:00 pm

Register

Date: Thursday August 1

Time: 1:00 to 2:00 pm

Register

*Eligible for a free drawing, gift, or prizes with no obligation to enroll.

For accommodation of persons with special needs call 1-833-342-5272 TTY:711 (Monday through Friday 8:30 A.M. to 5:00 P.M.)

ARC Benefit Solutions is not affiliated or endorsed by any government or the Federal Medicare Program.

IMPORTANT: Updates to Short-Term Limited Duration Insurance Coming September 2024

April 29, 2024/in ARC Updates, Individual/Family/by ARC Benefit Solutions

The Departments recently announced a change to the federal definition of Short-Term, Limited-Duration Insurance (STLDI) that imposes nationwide plan duration limits to no more than three months and the maximum coverage period to no more than four months.

STLDI policies currently in effect, or that are sold and issued before September 1, 2024, are not affected by this new rule.

If you currently have a short-term health insurance plan or were looking into a short-term plan for your family, please contact your ARC client advisor to develop a plan of action as soon as possible!

Contact your ARC client advisor with any questions.

Compliance Corner: Are Your Medical Benefits Near a Fault Line?

April 8, 2024/in ARC Updates, Compliance, Employee Benefits/by ARC Benefit Solutions

Understanding the Landscape: Classing Employees

While there was always some discouragement towards employers paying more of the cost of medical coverage for some employees and less for others in self-funded plans, the ACA put teeth into the regulations with a strong prohibition when paying more for higher paid employees versus lower paid employees. Having different tiers or classes also increases the administrative burden on the employer.

However, there is some leeway based on certain criteria:

Different companies under a holding company hiring different types of employees (e.g., if you own an engineering firm and a restaurant)*
Hourly versus salary
Geographic location*
Permanent full-time employees versus variable hour employees or part-time employees*
Seasonal employees
Tenure or length of service at the company*
Within the same company, white collar versus blue collar
Union versus non-union*
Owners versus regular employees, depending on the company type and taxation (e.g. physician-owned practices or a law firm)

*bona fide classifications

In general, employers may treat employees differently, as long as they aren’t violating any federal rules. The discrimination rules currently apply to self-insured health plans (MEWAs and level-funded plans are in this bucket) and when employees pay their health insurance premiums on a pre-tax basis.

If an employer chooses to use classes, they should be prepared to make a business case for why their approach is appropriate under the circumstances. An example of a good business case: “We experience the most turnover within the first 90 days of employment for hourly staff, so we use a 90-day waiting period for those workers to minimize administration and re-work while using a 30-day waiting period for the office staff.”

Potential Pitfalls

These types of plan designs may be considered discriminatory:

Different benefits offered to a select group of employees (e.g., very low deductible plan offered only to executives or owners);
Only a select group is eligible to participate (only offered to management or office staff);
The employer pays more or all of the cost of coverage for a select group of employees (paying 100 percent of managers, but not other employees); or
Excluding based on health status or age (e.g., requiring, pressuring, or paying for employees to move to Medicare when they become eligible).

Ground Rules

To ensure your group can pass any applicable nondiscrimination test, the best course of action is for the employer to treat all employees the same for the purposes of health plan coverage in terms of cost, eligibility rules, and types of coverage offered.

Applicable large employers (50 or more full-time equivalent employees) also have the opportunity to implement a measurement period if they have variable hour or seasonal employees to measure those employees consistently working full-time hours. Please understand that different federal rules use different counting methods to determine what is considered “seasonal” or “variable hour.”

Tread Lightly

Although fully insured plans are not subject to nondiscrimination testing, the ACA includes a requirement that non-grandfathered, fully insured health plans follow many of the same nondiscrimination rules that have historically applied only to self-insured plans under IRS Code Section 105(h). These rules have been delayed since September 2010, pending regulations from the IRS.

However, if the fully insured plan is paid for with pre-tax dollars by the employee, highly compensated employees’ health plan contributions become taxable if the plan is considered to be discriminatory.

Ground Test

It’s important to review your employee medical contributions periodically, such as at renewal time, if you’re giving an advantage to highly compensated employees over other employees on medical premiums. Your ARC client advisor can provide reference material to help you to determine if your plan meets the criteria to avoid issues as well as strategies to walk back if you find that your plan needs adjusting.

If you’d like to learn more about discrimination testing or the concepts introduced here, we have a guide available upon request. Please contact your ARC representative for more information.