Be ready for a big shock from Healthcare Deformity

As the realities of ACA become clear, the impact on employers will be staggering in two ways:

Increase cost of premiums.  There is nothing in ACA that helps to reduce the overall cost to employers or to employees.  In fact, we believe that employee-only premium will be an average of $600 per month with dramatic increases to young and healthy individuals.  The least expensive option available under ACA is the Bronze plan, which could be $20,000 per year for a family.

Daunting record keeping. An employer with over 50 FTEs will be required to monitor which employees are eligible to participate in the health insurance offering.  Aggregating all hours worked to calculate FTEs (full time equivalents) and establishing a look-back period for the monitoring of the same will require the need to be able to get data from your HRMS system for documenting this process.

More good news for small companies
Even though a company with less than 50 FTEs is exempted from the law, all companies regardless of size will be subject to the premium increases due to mandated plan designs of ACA.  And don't think you can escape being a plan sponsor if you decide one of the exchanges is right for you.  Securing health insurance through an exchange creates a whole new set of requirements for plan documents and disclosures.

Yet to be determined
ACA will evolve over the next year even more.  There are about 1800 rules yet-to-be-written by more government appointees.  So, hold on to your belt and tie your shoes tight!

What do I need to do if we offer a health insurance plan?

Does this sound like you?

My company has grown over the years with a number of employees. To help keep employees happy and attract the right kind of new employees, my company provides health insurance for everyone.  

We have worked with an agent for a long time who shops our health insurance plan every year.  The agent provides some services to us and works gives us quotes from different health insurance providers. Does my agent do these things? 

Use this checklist to make sure you are doing what you need to do.

             

Plan administrative tasks	Who is performing task?	Who has liability?
Monitor when a new employee becomes eligible to participate in the plan?
Conduct new hire health plan orientation and educate new hires on the basics of the plan selected?
Secure the benefit election forms?
Answer questions from employees or their covered dependents about the benefits?
Assist the covered employees and their dependents with benefit/coverage problems?
Help employees understand the Explanation of Benefits (EOB) or other communications or questions they may receive from the carrier?
Assist employees with locating network providers?
Assist employees with accessing medical websites?
Order ID cards if employee misplaces them?
Communicate and/or provide election information to payroll so the proper payroll deductions can be made?
Update the deductions if rates for the plan are based on age when an employee falls into a new rate band and the premium increases?
Review the accuracy of the bills from the insurance company every month?
Add and delete employees from the insurance provider bill?
Pay the invoice from the insurance company?
Audit payroll reports to make sure the proper deductions are being taken from the employees’ pay?
Administer the HSA and/or FSA accounts and make fund transfers to the employees’ accounts?
Update the Summary Plan Description annually and completing the IRS 5500 form?
Send out the required ERISA and state notifications to plan participants?
Manage the open enrollment process?
Perform COBRA administration (if applicable) or prepare & send State continuation of coverage notices to the ex-employee?
Protect employees’ rights under the Privacy Act and HIPAA?
Prepares a standard plan document for all coverage (this is not the insurance contract)
Works with outside legal to help be compliant
Segment health insurance records and keep in secure location
Trustee on the plan and what does it mean to be a plan trustee
Protects employee confidentiality under “need to know” principals
Employee benefit E & O coverage and cost