COMPLIANCE DATES APRIL 30, 2017 for new health plans on a calendar plan year: Summary Plan Description (“SPD”) Employers who offer a health insurance plan must provide SPDs to all participants within 120 days after a new plan is adopted. SPDs must also be provided to new participants no later than 90 days after the person first becomes covered under the plan. FEDERAL COMPLIANCE UPDATES NEW VERSIONS OF SBC DOCUMENTS New versions of the Summary of Benefits and Coverage (“SBC”) template, instructions, uniform glossary, and related documents are required to be used on or after April 1, 2017. Under the Affordable Care Act, group health
UPCOMING COMPLIANCE DATE REMINDERS
May 31, 2016 or June 30, 2016: Employers who were required to provide their employees with ACA forms 1095-B or 1095-C must transmit copies of each individual’s 1095-B or 1095-C along with the corresponding transmittal form (Form 1094-B or 1094-C) to the IRS by May 31, 2016 if filing by mail or by June 30, 2016 if filing electronically. (NOTE: Any employer with 250 or more forms must file electronically.) Click here for 1094-B instructions or here for 1094-C instructions. July 31, 2016 for Self-Insured Medical Plans: The annual Patient Centered Outcomes Research Institute fee (“PCORI fee”), which applies only to organizations that offered self-insured medical plans and/or self-insured Flexible Spending Account
California Paid Sick Leave (AB1522) is Effective July 1st
An employee who, on or after July 1, 2015, works in California for 30 or more days within a year from the beginning of employment, is entitled to paid sick leave. Employees, including part-time and temporary employees, will earn at least one hour of paid leave for every 30 hours worked. Accrual begins on the first day of employment or July 1, 2015, whichever is later. Exceptions: Employees covered by qualifying collective bargaining agreements, In-Home Supportive Services providers, and certain employees of air carriers are not covered by this law An employer may limit the amount of paid sick leave an employee can use in
California on Cusp of Offering Young Immigrants Health Care
In a move that adds momentum to efforts to integrate immigrants, California is on the cusp of extending state-subsidized health care coverage to children from low-income families who are in the country illegally. Democrats, immigration groups and health care advocates celebrated the announcement as both a cost-saving move and social progress for the state’s estimated 2.5 million immigrants who are in the country illegally. Critics, however, worry that the overburdened state-funded health program can’t handle another 170,000 children. Gov. Jerry Brown and legislative leaders announced a $115.4 billion budget agreement that for the first time includes state funding to cover low-income children under 19 regardless
Three Insurance Bills in California Under Review
In August, California lawmakers will discuss three important bills related to health care reform that may affect both consumers and insurers. The three bills tend to be opposed by insurers while consumers are considered to be the advocates. What are the bills? SB1176 would require insurers to record any out of pocket costs made by plan policy holders and then any expenses that go over a set limit would be reimbursed by the insurer. AB1917 is a bill that is trying to decrease the costs of specialty medications for policy holders with chronic medical conditions. This bill would also require insurers to cover Hepatitis C
Covered California Participants May Switch Plans
Recent investigations by the California Department of Managed Health went underway for Anthem Blue Cross and Blue Shield of California due to policy holders complaining they were given misleading information by the insurance giants. Policy holders argue that they were given inaccurate information regarding their benefit plans and provider networks. Anthem and Blue Shield are now facing multiple law suits from frustrated consumers. So what is California doing about this? California is “quietly” taking a stand by educating consumer’s about a provision under the Affordable Care Act that acts in their favor. The ACA states that a person can receive health coverage during an open enrollment
Complaints About Covered California Exchange
On July 8, 2014 the Sacramento Bee released a report stating that early 1800 complaints were filed regarding the Covered California exchange processes. It turns out that San Diego residents are not the only ones confused with the provider networks set up under California. Complaints Filed Entail: Health Cards and Enrollment Information Not Received (many participants on the exchange failed to receive their actually medical health insurance cards and information showing proof of their plans) Narrow Provider Networks (not enough physicians available in certain areas) Inaccurate Provider Lists (many mistakes were made when detailing which providers were covered causing patients to seek help for doctors not covered
Grandmother Bill Signed Into Effect
A big win for small business health coverage took place under the “grandmother” bill signed into effect today by Governor Jerry Brown Jr. This bill states that small business employers that have non-grandfathered health policies signed into effect before December 31, 2013 now have the option to renew their policy for another year as long as those policies are still in force as of July 7, 2014 (the day the grandmother bill took effect). This means that they will not be forced to find another health plan by the end of 2014. This bill only applies to small businesses with 50 or fewer employees. Now
Veterans Insurance Debate
Recently there has been much debate surrounding the ability for veterans to receive proper health care at Veterans Affairs hospitals and clinics. These hospitals and clinics are specially designed for military veterans and service members, Unfortunately, long wait times have prevented many service members, both past and present, from getting the medical attention they seek. According to CBS News and and a recent Veterans Affairs audit, “more than 57,000 veterans have been waiting up to three months for medical appointments.” Furthermore, 64,000 people who originally enrolled in Veterans Affairs health care coverage haven’t seen a doctor in the past ten years. This audit process and uproar
Keeping Your Employees Healthy This Flu Season
Have you ever worked at a company when flu season rolls around and the entire office gets sick? This can create huge problems for small business owners. In larger companies the effects of employee absences may be diluted. However, one sick person in a small office can cause business to be lost. As a small business owner you should have a game plan for this dreaded time of the year. This will ensure that illnesses such as the flu do not negatively impact your daily operations or bottom line. Still not convinced? A new survey of administrative personnel conducted by Staples, shows that 70% of