Gallen Insurance is ready to help with Pennie Open Enrollment. Don’t struggle to enroll on your own, contact us today for assistance!
State-run health insurance exchange “Pennie” makes its debut today!!
Pennsylvania residents will use Pennie (instead of HealthCare.gov) to enroll in coverage for 2021 once open enrollment starts on November 1, 2020 and will continue through January 15, 2021, giving Pennsylvania residents an additional month to sign up for coverage.
What is Pennie?
Pennie is Pennsylvania’s official destination for shopping for quality health insurance plans and accessing financial assistance, if eligible.
What is open enrollment?
Open enrollment is November 1, 2020, to January 15, 2021. During this time period, anyone living legally in Pennsylvania can apply for health insurance through Pennie. Individuals with qualifying life events can enroll at any time of the year.
Pennie, the new Pennsylvania state based health insurance exchange will be used for Open Enrollment starting on November 1st.
Visit our website for the most up to date information about Pennie:
Are you currently insured with an ACA or Obamacare plan?
PA will be launching Pennie, a state based exchange for open enrollment starting November 1st.
Check our Pennie!
Pennie – Pennsylvania State-Run Health Insurance Exchange makes its debut
Pennie – Pennsylvania State-Run Health Insurance Exchange makes its debut in time for open enrollment on November 1, 2020.
Pennsylvania residents will use Pennie – Pennsylvania State-Run Health Insurance Exchange (instead of HealthCare.gov) to enroll in coverage for 2021 once open enrollment starts on November 1, 2020 and will continue through January 15, 2021, giving Pennsylvania residents an additional month to sign up for coverage.
Our very own Mike Fields took the time to write up an article for our upcoming October Enews about the new state based exchange.
Learn more about Pennie, open enrollment, how to set up or access your account, and where to learn more about financial assistance and who qualifies.
We also cover what you need to gather before starting enrollment, key dates to remember, and of course, Gallen Insurance is here to help you enroll!
Visit our new page about Pennie – Pennsylvania State-Run Health Insurance Exchange to take a look at his insights.
Or reach out to Mike, Jay or Brin in our Health & Life Department by calling 610-777-4123 or email Mike directly at mfields@galleninsurance.com
As we learn more, we will keep you posted!
The CARES Act: Health and benefit implications
The CARES Act brings changes to employee benefits and employer-sponsored group health plans in response to the COVID-19 pandemic.
Read about the changes here: https://files.constantcontact.com/aeb7619c001/ae35c626-1fec-4d9e-8e2f-8fef0c0a4b24.pdf
Feeling overwhelmed with all the options for Medicare Supplemental Insurance?
Gallen Insurance can help.
In 2018, over 2 million Pennsylvania residents were enrolled in Medicare. Gallen Insurance has a variety of Medicare coverage options available and we have helped many people select the best Medicare Supplemental Insurance for their needs with our no-cost, free medicare insurance consultations!
Find the best Medigap plans for you and your budget!
Are you turning 65? Do you have a question on Medicare, Medicare Part D or a Medicare Supplement?
Are you receiving a tremendous amount of information in the mail?
You should take advantage of our experience to help you make an informed decision on the following:
- Medicare Supplement
- Medicare Part D Prescription Plans
- Long Term Care Plans
- Final Expense
… and more!
Call Jay, a fellow senior who wants to help on his direct line at 610-898-6515 or call our main office line at 610-777-4123, contact us online or view our medicare information.
If you don’t have health insurance or want to change your plan, open enrollment this year started on November 1, 2019 and runs through December 15, 2019.
Medicare open enrollment starts on October 15th and ends December 7th.
Our in house Medicare Specialist, Jay Mahoney, offers information about the various plans here:
Do you have questions on Medicare or Medicare Supplements? Are you receiving a tremendous amount of information in the mail?
You should take advantage of our experience to make an informed decision on the following:
- Medicare Supplements
- Medicare Part D Prescription Plans
- Long Term Care Plans
- Final Expense
… and more!
Call Jay, a fellow senior who wants to help!
610-898-6515
Have you decided on a health insurance plan for the next year? If you do not update your Marketplace application and enroll in a plan before December 15, you will be automatically re-enrolled in a 2019 Marketplace plan.
A premium tax credit can drastically lower the cost of health insurance premiums.
Depending on household income, you may be eligible for a premium tax credit. These can drastically lower the cost of health insurance premiums.
To find out if you qualify, please contact a benefits representative at Gallen Insurance.
Reach out to Mike, Jay or Brin in our Health & Life Department by calling 610-777-4123
Get a Head Start on 2019’s Individual Health Insurance Open Enrollment
Like last year’s Open Enrollment Period, the 2019 Open Enrollment Period to sign up for individual health insurance will last less than two months—45 days to be exact. This Open Enrollment Period will run between November 1, 2018, and December 15, 2018.
The first day that coverage begins is often called the effective date. In Pennsylvania, the Open Enrollment deadline (December 15) matches up with an effective date of January 1. This means that, as long as you enroll by the final deadline, your 2019 coverage will begin on the first day of the year.
Although PA has not started yet, it could come soon.
NJ is our closest neighbor considering their own state health laws.
ACA Complexity to Grow as States Develop Their Own Healthcare Solutions
Starting in April, 2018 ALL enrolled Medicare recipients will receive new ID cards like the one shown here.
The new cards will be printed without using insured’s Social Security numbers for security reasons.
*Important notes:
- the NEW card will NOT replace their healthcare plan card.
- the new Medicare number on the card will be needed anytime they join, leave or switch to a new plan.
- the NEW card may be needed to obtain hospital services.
- the OLD card can be destroyed when the NEW card is received.
Let’s Talk
Our very own Jay Mahoney, CBC, Benefits Manager wants to help breakdown any confusion or misunderstanding in regards to the types of health insurance.
Read more in our recent news article:
https://files.constantcontact.com/aeb7619c001/cac74e13-759c-4729-8bcc-f5bc2c4a9030.pdf
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http://www.readingeagle.com/life/article/two-women-who-survived-heart-attacks-have-started-a-support-group#.WnmPpHJJGN0.facebook
Take a minute to review the common warning signs for a heart attack or stroke. Also remember, there are uncommon signs as well…so if you or a loved one is experiencing unusual symptoms, please play it safe!!
Congress Passed the Tax Reform Bill which includes changes on the horizon for Health Insurance.
Among the changes, employers will especially see updates on:
- Medical Expense Deduction – increase to expenses in excess of 10%
- Employee Benefit – transportation benefits, Employer tax credit for FMLA
- Individual Mandate – penalty reduction
For full details, see this article:
http://files.constantcontact.com/aeb7619c001/7334d6f6-d70d-4be8-b9fc-c738741e1676.pdf
We have mentioned this here before, but it is certainly important enough to repeat: Governor Wolf’s policy mandates that 3D mammograms must be provided to women in PA by their insurance with NO cost sharing. Read more:
October is now Pinktober
Breast Cancer Awareness Month
Breast cancer is the second most common type of cancer in women. About 1 in 8 women born today in the United States will get breast cancer at some point.
The good news is that most women can survive breast cancer if it’s found and treated early. A mammogram – the screening test for breast cancer – can help find breast cancer early when it’s easier to treat.
National Breast Cancer Awareness Month is a chance to raise awareness about the importance of early detection. Make a difference! Spread the word about mammograms and encourage communities, organizations, families, and individuals to get involved.
PA is heading in the right direction during PINKtober, Breast Cancer Awareness month, with Governor Wolf’s policy mandating that PA women must be provided with 3D mammograms under their insurance coverage with no cost sharing.
Our agency does NOT forget about you! Jay Mahoney, from our Health & Life department, continues to fight for your rights in hopes to see the House Bill 15853 pass to protect you and your family members from balance billing.
House Bill 15853 would also require insurance and health care providers to settle billing disputes.
Read more here:
Gallen Insurance is proud to announce that Brin Bossler has joined the team to further develop and support their ever growing Benefit department. Brin Bossler readily joins Gallen Insurance bringing a wealth of experience and knowledge within the industry. He started his insurance industry career over 30 years ago, after graduating from Alvernia University.
He has worked for both the insurance carriers and the brokerage agency insurance business in Central and Southeast Pennsylvania.
Since 1997, he has concentrated his work with Employee Benefits for health, dental, vision, life, and disability plans.
Over the last 14 years, as an Employee Benefits Consultant, his efforts are fully devoted to activities with the brokerage of employee benefit plans and administrative services.
He has attained the Certified Benefits Consultant designation.
His deep understanding of the benefits business and strong carrier relationships helps him as a broker, work together with you to evaluate the various carriers’ coverage alternatives and discuss ideas to find the best strategies for your needs of your company sponsored plan.
He enjoys watching sports, playing golf, running and skiing. He is a lifetime resident of Berks County and is married and has a daughter.
Please join us in welcoming Brin Brossler to our team!!
Gallen Celebrates 60 Years
A look back over the past 60 years…way back to when Joe Gallen, Sr. opened the doors!!
More to come, but please join us in celebrating our 60 years!!
We will be holding an open house at our agency in late September to thank you all, our loyal customers, as we know we would not be here without you!
Gallen Insurance was recently named in the top 50 businesses of Berks County by the Greater Reading Economic Partnership.
Watch Judy Schwenk, Theresa Miller and Gallen Insurance’s Jay Mahoney testify at a PA Department of Insurance hearing from 10/1/15
BALANCE BILLING PUBLIC HEARING – OCTOBER 1, 2015
On Oct. 1, 2015, Commissioner Miller and the Insurance Department held a hearing at the State Museum in Harrisburg to address the issue of surprise balance billing in Pennsylvania. Balance billing occurs when a consumer, after receiving a service from a health care provider that is in-network for the consumer’s health insurance, receives a bill for all or a portion of the care. This can occur despite the consumer researching all available channels to ensure the health care providers and facilities they use are in-network because these providers may contract with out-of-network doctors for additional services. For more information, view the post-hearing press release.
An Insurance Department panel of Commissioner Teresa Miller, Executive Deputy Commissioner Seth Mendelson, and Chief of Staff Jessica Altman heard testimony from approximately 20 speakers, including consumers, consumer advocates, industry stakeholders, and Senator Judy Schwank, among others. Interested parties that could not attend the event were invited to submit testimony. Submitted testimony is available below, or you may also re-watch the hearing in its entirety.
Transcription:
Urgent Care Clinics Could Be the Cost Effective Alternative to Traditional Emergency Room Visits
Medical issues can be overwhelming. You’re not a medical expert. You know there’s an issue. You know you need professional medical attention, and you know you need it ASAP.
But then there’s the ominous cloud of astronomical deductibles, co-pays and medical bills. Of unforeseen expenses and the danger of stepping out of your standard budget and spending limit.
You’ve accounted for miscellaneous expenses. But who can account for medical expenses?
The Good News
The good news is there are plenty of medical issues and incidents that can – and often should – be diverted to lower-cost Urgent Care clinics in your local area.
Even as you shouldn’t take chances with severe or life-threatening complications, you have more options than you think.
Urgent Care centers offer treatments for routine issues and less serious conditions that are just as comprehensive as those employed in an ER – but they’re usually much less expensive.
Cut Costs Considerably
If you lack insurance coverage, it’s worth noting that out-of-pocket expenses at an Urgent Care center are often relatively minor. The cost of an immediate visit to your local Urgent Care clinic can be hundreds – even thousands – of dollars less than a visit to a trauma center or traditional emergency room.
If you do have coverage, your insurance company usually diverts a portion of the higher cost of emergency treatment by passing it off in your co-pay or deductible, leaving you with a considerably higher bill.
Let’s say your plan covers a trip to Urgent Care but calls for a $20 copay. That same medical plan may very well demand upwards of $100 to be treated in the emergency room. This applies to co-insurance percentages too.
Medical Treatment at an Urgent Care center is almost always less expensive – far less expensive – than at a Trauma Center or Emergency Room, regardless of plan coverage.
Urgent or Emergency?
Urgent Care clinics can effectively treat injuries that require stitches, numerous routine illnesses and various infections, bites, fevers, lacerations, pains, aches, and many others.
Certain issues, however, do call for emergency room treatment. Things like cardiac arrest, head traumas that cause loss of consciousness, symptoms of serious or chronic illnesses, or anything else that could lead directly to loss of life.
Emergency Rooms are open 24/7, which is hugely convenient. But Urgent Care clinics are almost always open long after the close of regular business hours, as well as on weekends.
Don’t Waste Any Time
Emergency Rooms follow standard hospital Triage procedures – which means they attend to your emergency according to its severity.
If you’re suffering from something relatively minor – you may end up waiting behind other patients with more serious or complicated issues to see a physician or an assistant.
Urgent Care services are often delivered as immediately as a practitioner or provider becomes available – getting you back out into your day without significant time lost.
So save your money and your time – consider visiting an Urgent Care center for routine medical treatment.
We know it’s difficult to maneuver all the guidelines and regulations associated with COBRA. So we’ve decided to put together a list of Do’s and Don’ts.
But first – and for the sake of clarity – let’s cover the basics:
What Is COBRA, And Who Is It For?
COBRA offers health coverage to individuals and families in need. COBRA itself – or the “Consolidated Omnibus Budget Reconciliation Act of 1985” – was originally passed in the wake of the economic recession of the early 1980s. Workers’ lives were suddenly tossed into upheaval. They lost their jobs – and with their jobs, their employer-sponsored health coverage.
If workers (or their loved ones) qualify for COBRA, they’re entitled to continued health benefits. Certain qualifying events – like job loss (voluntary or involuntary), significant scheduling changes (moving from full-time to part-time), workplace transitions, and family events like death or divorce – make COBRA benefits accessible to individuals and families.
So What, Exactly, Are You Supposed To Do?
As an employer you’re responsible for making employees aware of COBRA and all of its limitations. If you’re noncompliant with COBRA – even unintentionally – you’re in danger of facing legal and financial penalties.
Inform
You’re required to provide written notification to your employees (and their families) of COBRA’s guidelines and limitations. It’s called a “notification of rights”, and it has to be given:
- At the start date of the health coverage term
- In the health benefit plan summary
- Whenever a COBRA-qualifying event occurs
A Little More About the “COBRA Notification of Rights”
Let’s explain the Notification of Rights a little more clearly.
COBRA states that you must notify your employees and their dependents of COBRA’s provisions within 90 days of the beginning of plan coverage. Should an employee that’s already enrolled in a health plan add a dependent – that dependent must also be informed within 90 days of the beginning of plan coverage. The “Notification of Rights” has to be mailed directly.
Document, Document, Document
In addition to providing a notification of rights, you’ve got to maintain written documentation illustrating your company’s compliance with all of COBRA’s laws and guidelines.
So What Shouldn’t You Do?
Employers have made some pretty significant mistakes in handling their own COBRA administration. Here are some of the most common mistakes and misappropriations:
What They Failed To Do
- Give a notification of rights to their employees
- Offer an “election notice” to qualified or prospective dependents
- Offer open enrollment
- Recognize an event that qualified an employee for COBRA benefits
- Document properly or consistently
- Collect a premium
- Understand the requirements of Medicare
What They Shouldn’t Have Done
- Provided employees with coverage that wasn’t required
- Provided plan coverage for longer than was necessary
- Incorrectly managed plan timeframes for COBRA coverage
- Misworded Rights-notices poorly, so as not to meet Department of Labor standards
- Over-paid invoices
There’s Just No Way Around It – COBRA Administration is a Complex Business
COBRA management is a difficult – and often confusing – endeavor. You don’t have to exhaust yourself with checking and re-checking guidelines, measuring compliance against COBRA regulations, or any of the other red-tape protocols associated with COBRA administration.
Talk to COBRAGuard. We’ll handle it for you. Call us at 610.777.4123 or email Mike Fields today.
Get the lowest costs while maintaining benefits!
Get the Lowest Cost
The Premium Saver is a group supplemental insurance plan that helps reduce the cost of group medical coverage. The strategy is simple: Find an affordable High Deductible Major Medical Plan, then add our Premium Saver plan to fill the deductible and cost sharing holes.
Whether you select your plan from a commercial insurance carrier or self-insure your High Deductible Major Medical, you can add the Premium Saver to deliver benefits as good or better than Silver, Gold or Platinum plans for a much lower cost.
Maintains Benefits
NO GAPS in coverage: The Premium Saver covers the same expenses as the underlying High Deductible Major Medical with the exception of charges for professional fees in a doctor’s office (or outpatient medical clinic) or for outpatient prescription drugs. Additional coverage for professional fees and outpatient prescription drugs is available by rider in some states.
Custom Design
This plan allows the employer to choose the Premium Saver deductible that best achieves the group’s needs. Groups like unions or municipalities can select rich plans with deductibles as low as $250, while groups that need a lower cost can select higher deductible plans.
Claims process is simple
The employee just hands their insurance card to the provider. The provider can file the claim electronically or manually. The Premium Saver pays off of the underlying major medical plan’s EOB and it pays directly to the provider. When the insured goes in-network they always receive the carrier’s in-network discounts.
How the Premium Saver works with High Deductible Major Medical plans
The example below shows a 68 person broadcasting company that currently offers their employees a $2,000 deductible BC/BS plan. At renewal, the group received a 19% increase, raising their $400,000 annual premium to $477,980.76. To save the employer premium and maintain benefits, the broker recommended changing to an affordable High Deductible Major Medical, then adding our group supplemental insurance plan to fill the deductible and cost sharing holes.
The Result? A guaranteed annual savings of over $50,000. The employer saved money. The employees maintained the same deductible. And the agent earned commission on both plans — the major medical and the Premium Saver.
For more information contact:
Mike Fields
610-898-6532
mfields@galleninsurance.com
2237 Lancaster Pike
Shillington, PA 19607
On February 20, the Centers for Medicare & Medicaid Services (CMS) announced a Special Enrollment Period (SEP) for individuals and families who did not have health insurance coverage in 2014 and are subject to the fee or “shared responsibility payment” when they file their 2014 taxes in states which use the Federally-facilitated Marketplaces (FFM).
CMS will provide consumers an opportunity to purchase health insurance coverage beginning on March 15, 2015 and ending on April 30, 2015. This Special Enrollment Period is for on-exchange business only and all applications must go through the Marketplace.
We’re Here To Help
We here at Gallen Insurance can assist people with obtaining health insurance, regardless of whether it’s on the Marketplace or not. We’ve heard many times that they think the Marketplace and private agencies are mutually exclusive when it comes to buying health insurance.
If you didn’t have health insurance last year for a period of time and don’t have it now, you can STILL obtain health insurance even though open enrollment has ended. However, the window is small and it will end April 30th, 2015.
You can also note that the Special Enrollment Period (SEP) is still available to anyone based on such factors as:
Qualifying Life Events
- Marriage
- Domestic partnership
- Birth, adoption
- Loss of minimum essential coverage (i.e. if you had coverage through an employer and they dropped group coverage)
- A permanent move to a new area that offers different health plan options
- Change in income, household or other status that affects eligibility for Advance Premium Tax Credits (APTC) or Cost-Sharing Reductions (CSR)
- And more! Please refer to the attached CPA SEP form for a complete list
For more information call Mike Fields at 610-898-6532.
If you haven’t already signed up for Health Insurance or are uninsured, don’t be left standing out in the cold with a bad cough and no coverage. Open enrollment begins November 15th, 2014 and will run throughFebruary 15th, 2015. Of course, some of you can still apply for insurance outside of the open enrollment period if you qualify for the special enrollment period based on a qualifying life event .We understand how daunting a task these things can be sometimes, so we have customer representatives here at Gallen who are waiting to help you with enrollment. Call us at (610) 777-4123.
14 facts about the Health Insurance Marketplace
The Health Insurance Marketplace makes it easier to find quality, affordable coverage. Millions of Americans have already gotten coverage, many for the first time.
Here are 14 things you should know about the Marketplace:
- No matter what state you live in, you can use the Marketplace. Some states operate their own Marketplace, and in other states the Marketplace is run by the federal government. You can sign up for 2015 Marketplace coverage as soon as November 15, 2014.
- Health insurance plans offered through the Marketplace are run by private companies.
- Every health plan in the Marketplace offers the same set of essential health benefits, including doctor visits, preventive care, hospitalization, prescriptions, and more.
- You can compare your options in the Marketplace and see what your premium, deductibles, and out-of-pocket costs will be before you make a decision to enroll.
- After you fill out a Marketplace application you’ll learn if you’re eligible for lower costs on your monthly premiums. Most people who apply for health coverage through the Marketplace will qualify for some kind of savings.
- You can apply for Medicaid or the Children’s Health Insurance Program (CHIP) through the Marketplace any time of year. These programs provide free or low-cost coverage to millions of Americans with limited incomes, disabilities, and certain family situations.
- If you qualify for a Special Enrollment Period, you may apply for health coverage through the Marketplace outside the Open Enrollment Period.
- Insurance plans offered through the Marketplace can’t deny you coverage because of pre-existing conditions like cancer or diabetes, and they can’t charge women and men different premiums.
- In the Marketplace, you generally can get dental coverage as part of a health plan or by itself through a separate, stand-alone dental plan.
- You must report certain qualifying life changes to the Marketplace, such as if you get married or divorced, have a child or adopt a child, or have a change in your income. After you report life changes to the Marketplace, you’ll get a new eligibility notice that will explain if you qualify for a Special Enrollment Period and lower costs.
- Members of federally recognized tribes and Alaska Natives can enroll in Marketplace coverage any time of year, and they can change plans as often as once a month.
- If you have an income-generating business with no employees, you’re considered self-employed and can get coverage through the Marketplace.
- Even if you have access to a student health plan, you can choose to buy a health plan through the Marketplace instead. You may qualify for lower costs based on your income.
- If you don’t agree with a decision the Health Insurance Marketplace makes, like whether you’re eligible to buy a plan or whether you’re eligible for lower costs based on your income, you may be able to appeal the decision.
For more information or questions about the Open Enrollment Period or the Affordable Care Act, please contact:
Mike Fields
2237 Lancaster Pike
PO Box 100
Shillington, PA 19607
Direct: 610-898-6532
With all the changes in the healthcare laws today, business owners may be confused about the circumstances in which they need to offer health insurance to their employees. You may know that full-time employees are required to be provided with healthcare for companies with more than 50 full-time employees but it becomes a little more complicated when you’re talking about temporary employees such as interns.
Beginning in 2015, the Affordable Care Act (ACA) will require large employers to offer healthcare coverage for full time employees or risk paying a penalty. According to the Employer Shared Responsibility provision of the ACA, employers with 100 or more full-time employees need to offer healthcare coverage for 70% of their full-time employees in 2015. This will increase to 95% for 2016. This employer mandate is based on full-time equivalent employees, not just full-time employees. A full-time employee is one who works 30 hours per week, on average, or 130 hours per calendar month. When calculating hours for the purpose of full-time employment status, an employer must consider hours for which an employee is paid or entitled to payment. Hours entitled to payment would include paid time off, such as vacation or a paid leave of absence.
Unpaid interns, even if working full time hours, are not considered full-time employees, therefore not eligible for health insurance coverage. However, paid interns require a closer examination to determine eligibility. If a paid intern works 30 hours or more, he/she must be offered health insurance to avoid a penalty. However if the full-time paid intern can be classified as a seasonal worker, that is, working 6 months or less at approximately the same time each year, the employer does not need to offer health insurance coverage.
All these changes and requirements may be difficult to keep up with but you’re friendly neighborhood Gallen Insurance agent is here to help you navigate the changing waters of American healthcare requirements. For more information on the Affordable Care Act and Healthcare Insurance, please contact:
Mike Fields
2237 Lancaster Pike
PO Box 100
Shillington, PA 19607
Direct: 610-898-6532
Fine for Paying Employees Health Care Premiums?
Did you know you can be fined up to $36,500 for paying your employees health care premiums? According to the ACA guidelines, employers are not allowed to pay for their employees’ individual health plans.
While you may think you’re doing your employees a favor, if a small business drops their health coverage and their employees pick up individual policies to cover their families, the company cannot directly pay their health premiums. The owner can, however, raise the wages of the employees to compensate for this. But the employer cannot simply write a check to the insurance companies on behalf of their employees.
The IRS issued an FAQ addressing the potential consequences of an arrangement where an employer reimburses employees for the purchase of individual health insurance premiums on a tax-favored basis (referred to as an “employer payment plan”).
For this purpose, individual health insurance premiums includes individual coverage purchased either inside or outside of the Health Insurance Marketplace.
The FAQ follows up on earlier guidance describing these types of arrangements (Notice 2013- 54). Employer payment plans include arrangements that reimburse some or all of an employee’s individual health insurance premiums on a tax-free basis (including reimbursement through a HRA or a direct payment by the employer to an insurance company).
Under the Affordable Care Act (“ACA”), an employer payment plan is considered a group health plan subject to the market reforms, including the prohibition on annual dollar limits for essential health benefits and the requirement to provide certain preventive care without cost sharing.These arrangements cannot be integrated with individual policies to satisfy the ACA’s requirements.
Consequently, employer payment plans will not satisfy the market reforms under the ACA and employers offering such a program may be subject to a $100/day excise tax per applicable employee (which is $36,500 per year, per employee). An employer payment plan generally does not include an arrangement under which an employee may have an after-tax amount applied toward health coverage or may take that amount in cash compensation.
For more information on the Affordable Care Act or Group Health Insurance Benefits, please contact:
Mike Fields
2237 Lancaster Pike
PO Box 100
Shillington, PA 19607
Direct: 610-898-6532
Special Enrollment Opportunity
in the Federal Marketplace for COBRA Beneficiaries
Special Enrollment Opportunity in the Federal Marketplace for COBRA Beneficiaries
There has been some confusion surrounding COBRA continuation coverage rules and the Marketplace (also known as the Exchange). The issue is that once an individual elects COBRA continuation coverage, s/he cannot simply drop COBRA and enroll in a plan through the Marketplace outside of an annual enrollment period. The individual may (a) voluntarily drop COBRA but will have to wait until the next open enrollment period, or a special enrollment period, to choose coverage in the Marketplace (typically less expensive); or (b) continue to pay for COBRA until the next available enrollment period in the Marketplace if s/he wants continuous coverage. To help clarify the rules, the Department of Health and Human Services (HHS) issued guidance that creates a limited special enrollment opportunity for certain COBRA qualified beneficiaries to drop COBRA coverage and enroll, on a prospective basis, in the Federally Facilitated Marketplace (“FFM”). In general, there are two special enrollment opportunities available in the FFM to an individual eligible for COBRA outside of annual open enrollment:
- When the individual is first eligible for COBRA due to a loss of group health plan coverage; and
- Once the entire COBRA continuation of coverage period has been exhausted (end of 18/29/36 months).
HHS is concerned that former model COBRA election notices did not sufficiently address Marketplace options for persons eligible for COBRA and COBRA beneficiaries. Thus, persons eligible for COBRA and COBRA beneficiaries may have had insufficient information to understand when they can enroll in Marketplace coverage. As COBRA coverage may be more expensive than FFM coverage for some individuals, this lack of information may have created a financial hardship. As a result, HHS is providing an additional special enrollment period so that persons eligible for COBRA and COBRA beneficiaries may elect qualified health plans in the FFM as opposed to COBRA. Affected individuals have a short window (from May 2, 2014 – July 1, 2014) to drop COBRA coverage and enroll in FFM coverage. Individuals interested in pursuing this special enrollment opportunity should contact the Marketplace (1-800-318-2596).
The DOL also revised the COBRA model election and model initial notices to more clearly articulate options in the Marketplace. You can find these updated notices at http://www.dol.gov/ebsa. State Based Marketplaces It should be noted that this special enrollment opportunity only applies in the FFM. HHS encourages state-based Marketplaces to adopt similar special enrollment periods. However, it is up to each state to determine whether to extend this enrollment window. Although New York State of Health has not formally announced a similar special enrollment period, it has confirmed that it will allow for a special enrollment window through July 1, 2014 for COBRA beneficiaries. Covered California announced it will use a May 15, 2014 – July 15, 2014 special enrollment window for COBRA beneficiaries. For more information, visit http://www.coveredca.com/faqs/cobra/#c4. At this point, Connecticut has not announced a similar special enrollment period. We will keep you apprised of any further developments. Severance Arrangements Some employers have a practice of paying COBRA premiums on behalf of a former employee during a severance period (e.g., the employer pays 6 months of the former employee’s COBRA premiums). If the former employee elects COBRA under this type of arrangement, once the employer’s payment obligation ends, the individual is responsible for the entire COBRA premium and s/he would not be eligible to enroll in the Marketplace until the earlier of the Marketplace annual enrollment or the exhaustion of COBRA (unless there is a subsequent qualifying life event). Thus, structuring severance in this manner may bind the former employee to more costly COBRA coverage than what s/he could have obtained in the Marketplace had s/ he declined COBRA. Employers should consider this outcome, along with the potential for discrimination issues, when designing severance arrangements that include payment of COBRA premiums. For a copy of the HHS bulletin discussing the special enrollment period, visit this link.
For more information, please contact:
Mike Fields
2237 Lancaster Pike
PO Box 100
Shillington, PA 19607
Direct: 610-898-6532
Fax: 610-777-9957
mfields@galleninsurance.com
Pros & Cons of Employer Provided Health Insurance
In 2015, most employers will either have to provide their workers with health insurance or pay the applicable fines. The decision whether or not a company will offer employees health insurance comes with many pros and cons and is a lot more complicated than simply how it affects the bottom line.
Does your company plan on providing health insurance?
Yes, it does!
Employer
Employer Pros• No ACA penalties• Reduction in payroll taxes
• Tax deduction for health care contributions
• Valuable benefit for recruiting, retaining and employee morale.
• Net cost of contributing to coverage is less than the dollar amount of the contributionEmployer Cons• Additional expense for providing coverage
• Potential cost increases from year to year
• Possible in-house administrative costs
Employee
Employee Pros• Employer contributes to the cost of the plan• Employer contribution is not taxable to the employee
• Employee portion can be paid pre-tax through a cafeteria plan or deducted reducing taxable incomeEmployee Cons• Ineligible for subsidies if coverage meets requirements
No, But We Will Offer Additional Compensation
Employer
Employer Pros• Fixed contribution expense, not subject to premium increasesEmployer Cons• Increased employee compensation• Increased payroll taxes – amounts paid as compensation are subject to these taxes
• ACA penalties for companies with 50+ employees
Employee
Employee Pros• Employer helps offset insurance premiums• Increased likelihood of being eligible for subsidiesEmployee Cons• Employee responsible cost of coverage
• Employee responsible for securing and managing own plan
• Employer contribution is taxable
• Total Employee taxable income is increased
• Employee premium increases not covered by contribution
No, Definitely Not.
Employer
Employer Pros• No direct financial costEmployer Cons• Increased difficulty recruiting new employees• Increased costs associated with higher employee turnover
• Inferior workforce attributed to lack of benefits
• Negative impact on employee morale and retention
Employee
Employee Pros• Increased likelihood of being eligible for subsidiesEmployee Cons• Employee responsible entire cost of coverage• Employee responsible for securing and managing own plan
• Employee subject to penalty if insurance is not obtained
• No tax benefits
Quit Your Job with the ACA?
The Affordable Care Act, aka Obamacare, has been affording many people the opportunity to quit their jobs. Before you start calling those people lazy, let’s learn why they’re quitting their jobs and see if it’s the right option for you.
The Bad Old Days
For many people, employee sponsored health insurance was the only kind of insurance they could get. Previously, insurance companies could either deny coverage or charge astronomical prices to people with pre-existing conditions; a vague factor that could refer to anything from acne to cancer. For many that had beaten or were currently living with a pre-existing condition, leaving their job could be a death sentence. Some people were working in pain, some people were staying at a job they hated, some were simply underemployed but many were just denied the chance to live their dream because they couldn’t afford to take the risk that they would lose insurance for themselves or someone they loved.
The Freedom of Choice
As of January 1, 2014, preexisting conditions are no longer a factor in insurance costs. This is allowing many people to quit their jobs and start their own business. In fact, some 2.5 million people are expected to quit their jobs in the next 10 years because they now have the option to buy affordable, dependable health insurance. This is also creating opportunity for people to get new jobs or move up at their current companies.
What Are People Doing?
Karen Willmus is quitting her job as a 9th grade teacher so she and her daughter can start a business publishing materials for non-native English speakers and others looking to improve their literacy. She expects to work even more than she does now and hire two or three people. Her $300/mo insurance payment is less than the premiums she was paying as a teacher.
Joshua Simonson was working at a grocery store. He was being denied by insurance companies because he had previously broken 3 vertebrae in his back. Now, the young entrepreneur runs a 26-acre farm where chickens till through the flower beds and goats graze on the lawn. He has 3,000 egg-laying hens, whose eggs he and his partner will sell in the Portland metropolitan area. Soon, they’ll add pigs and raise chickens for meat.
Is Quitting Your Job an Option for You?
Everyone’s situations are different. Freelancing is a great option whether you have a lot of experience or a little. Sites like elance.com and odesk.com are great resources, especially if you’re in a creative or marketing niche. If you love to travel, books like the 4 Hour Work Week might give you some good ideas.
How Much Are the Plans?
For a single 40 year old person living in Pennsylvania making $50k/yr, plans start around $170/mo and max out around $370/mo
For a 40 year old married couple in Pennsylvania, plans start around $300/mo and max out around $700/mo.
What are the Tax Benefits?
If you’re self-employed and not eligible for an employer-sponsored health plan through your spouse’s job, you may be able to write-off your health insurance premiums. You can’t write off more in health insurance premiums than you earned, though. If you paid your health insurance premiums with your own after-tax money, they’re deductible. See more…
But before you run into your boss’ office and yell “I QUIT!!!” consult a professional and make a plan. Although this enrollment period ends on March 31, 2014, you have 7 months before the next open enrollment to plan your escape from corporate America.
Health Insurance News: ACA Deadline is Looming
Open enrollment for a qualified health plan ends March 31, 2014. Those not enrolled in a qualified health plan by that date will be subject to a penalty of $95 or 1% of modified adjusted gross income, whichever is greater. The next open enrollment period starts November 15, 2014.
Should I just take the penalty?
You may have heard that some business are opting to take the penalty over providing insurance because it’s actually much cheaper. That may be true but the rules aren’t the same for individuals. For most people the penalty will end up costing just as much as buying insurance, PLUS you’ll be going out of pocket for ALL of your healthcare expenses.
What is the penalty?
Those not enrolled in a qualified health plan by that date will be subject to a penalty of $95 or 1% of modified adjusted gross income, whichever is greater. The penalty in 2014 is calculated one of 2 ways. You’ll pay whichever of these amounts is higher:
- 1% of your yearly household income. (Only the amount of income above the tax filing threshold, $10,150 for an individual, is used to calculate the penalty.) The maximum penalty is the national average yearly premium for a bronze plan.
- $95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285.
So, for a single adult with an income below $19,650/yr would pay a $95 flat rate and if you make more, and have children you’re going to end up paying 1%.
What if I don’t want to use the website?
True, there has been a lot of problems with the website and it may seem confusing to some people. But the good news is, you don’t have to go through the website to get covered. Simply contact us and, at no additional cost to you, we can help get you find the best plan for you and/or your family without all the hassle.
Contact us at (610) 777-4123 to secure your health insurance policy before it’s too late.
For more information on health insurance and ACA regulations contact:
Mike Fields
Benefits Consultant
2237 Lancaster Pike
Shillington, PA 19607
ph ~ 610-898-6532
mfields@galleninsurance.com
Employers: Will You Face Penalties Under the ACA?
On February 10, 2014, the IRS released final regulations implementing the employer penalty under the Affordable Care Act (“ACA”). Since there’s just about as much disinformation out there as there is new information that you need to know in order to not be penalized. But don’t let the new changes confuse you. It really comes down to a few main points:
Which employers could face a penalty?
In a nutshell, all applicable employers (those with 50 or more full=time employees) can be penalized for:
- not providing minimum essential coverage to their full-time employees and dependents
- not providing coverage that is affordable and that provides minimum value
What constitutes a “full time employee”?
- an employee who is employed an average of at least 30 hours of service per week with an employer.
- with respect to a month with 4 weekly periods, an employee with at least 120 hours of service is an full time employee
- with respect to a month with 5 weekly periods, an employee with at least 150 hours of services is an full time employee
When is a policy considered “affordable”?
A job-based health plan is considered “affordable” if the employee’s share of premiums for the lowest cost self-only coverage that meets the minimum value standard is less than 9.5% of their family’s income.
In other words, if your share of your premiums for a plan that covers only you (the employee)–not your family–is less than 9.5% of your family’s income, the plan is considered affordable.
What is an official “offer of coverage”?
The offer can be made electronically. An employee’s election of coverage from a prior year that continues for every succeeding plan year unless the employee affirmatively elects to opt out of the plan constitutes an offer of coverage for purposes of the employer penalty provisions.
My business is exempt. Can I offer health insurance, anyway?
Offering benefits like health insurance is a great way to ensure that your business is attracting the best possible employees. Many employees would rather work for a small company, where they can have a greater impact, but are often deterred by lack of benefits that big companies offer, like health insurance, life insurance and sometimes even pet insurance. And being exempt from the group health mandate can actually put you at an advantage when shopping for employee benefits.
Companies that employ fewer than 25 full-time employees and whose average wage is less than $50,000 are eligible for tax credits, which may encourage them to offer health insurance to their workers. There are many different online calculators that small businesses can use to determine whether or not they are eligible for any tax credits (here, for example).
For more information on health insurance and ACA regulations contact:
Mike Fields
Benefits Consultant
2237 Lancaster Pike
Shillington, PA 19607
ph ~ 610-898-6532
mfields@galleninsurance.com
To the dismay of many Americans, and to the delight of many others, the Supreme Court upheld the 2010 federal health care law. In what will certainly be an oft discussed verdict for many months, if not years, the divisive ruling will have many long term effects on how you, I, and our employers go about purchasing and providing healthcare.
Though major implementations will not occur until January 1, 2014, there are a few important changes that will take effect as soon as next month.
Starting on August 1, 2012, all new health plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay, or coinsurance. Women’s preventive services – including well-woman visits, support for breastfeeding equipment, contraception, and domestic violence screening – will be covered without cost sharing.
The next major change will occur on January 1, 2013. Individual high income earners (those who make in excess of $200,000 annually) will be subject to an additional tax of 0.9%. Married couples will be subject to the same tax if their joint income is over $250,000.
Not until 2014 will perhaps the most controversial stipulation kick in – the mandatory coverage provision – which would require an individual to be covered by an acceptable insurance policy or else be subject to fines.
For more information on the 2014 provisions, feel free to check out the June 22 blog post “Will The Proposed Changes To The Health Care Law Survive The Supreme Court Decision?”
How will the new ruling effect you? Leave a question or comment below.
If you have inquiries about the Patient Protection and Affordable Care Act or would like guidance and consultation with your own health care policy, please contact Mike Fields at 610-898-6532 or mfields@galleninsurance.com