Benefits Changes

Look Backward to Plan Forward | North Carolina Employee Benefits

We have entered Open Enrollment season and that means you and everyone in your office are probably reading through enrollment guides and trying to decipher it all. As you begin your research into which plan to choose or even how much to contribute to your Health Savings Account (HSA), consider evaluating how you used your health plan last year. Looking backward can actually help you plan forward and make the most of your health care dollars for the coming year.

Forbes magazine gives the advice, “Think of Open Enrollment as your time to revisit your benefits to make sure you are taking full advantage of them.” First, look at how often you used health care services this year. Did you go to the doctor a lot? Did you begin a new prescription drug regimen? What procedures did you have done and what are their likelihood of needing to be done again this year? As you evaluate how you used your dollars last year, you can predict how your dollars may be spent next year and choose a plan that accommodates your spending.

Second, don’t assume your insurance coverage will be the same year after year. Your company may change providers or even what services they will cover with the same provider. You may also have better coverage on services and procedures that were previously not eligible for you. If you have choices on which plan to enroll in, make sure you are comparing each plan’s costs for premiums, deductibles, copays, and coinsurance for next year. Don’t make the mistake of choosing a plan based on how it was written in years prior.

Third, make sure you are taking full advantage of your company’s services. For instance, their preventative health benefits. Do they offer discounted gym memberships? What about weight-loss counseling services or surgery? How frequently can you visit the dentist for cleanings or the optometrist? Make sure you know what is covered and that you are using the services provided for you. Check to see if your company gives discounts on health insurance premiums for completing health surveys or wellness programs—even for wearing fitness trackers! Don’t leave money on the table by not being educated on what is offer

Finally, look at your company’s policy choices for life insurance. Taking out a personal life insurance policy can be very costly but ones offered through your office are much more reasonable. Why? You reap the cost benefit of being a part of a group life policy. Again, look at how your family is expected to change this year—are you getting married or having a baby, or even going through a divorce? Consider changing your life insurance coverage to account for these life changes. Forbes says that “people entering or exiting your life is typically a good indicator that you may want to revisit your existing benefits.”

As you make choices for yourself and/or your family this Open Enrollment season, be sure to look at ALL the options available to you. Do your research. Take the time to understand your options—your HR department may even have a tool available to help you estimate the best health care plan for you and your dependents. And remember, looking backward on your past habits and expenses can be an important tool to help you plan forward for next year.

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Gupton on the Role of an Employee Benefits Broker in the Opioid Crisis

Gupton’s work on the opioid crisis continues to get attention. October 9th, Employee Benefit Advisor Magazine published an article on Gupton’s motivators, statistics, current pushes, and ideas on how an employee benefit consultant can impact the opioid crisis.

Ask the Experts: Distributing ERISA Notices Electronically | North Carolina Employee Benefits

Question: Our company is getting ready for open enrollment. Can we distribute ERISA notices electronically instead of printing and delivering hard copies?

Answer: Yes, electronic delivery complies with ERISA’s disclosure rules – but certain conditions must be met.

First, whether delivered in hard copy or electronic media, ERISA requires preparing and furnishing materials “in a manner consistent with applicable style, format, and content requirements.” It is a good idea to test electronic documents to make sure the formatting and style are correct.

Secondly, materials must be furnished using “measures reasonably calculated to ensure actual receipt.” For instance, if using a traditional delivery method, such as first-class mail, be sure to follow up on any undelivered/returned mail.

For electronic delivery, the compliance rules work differently depending on whether the recipients have regular access to the employer’s electronic information system:

  • Regular access means the recipients use the system, such as the employer’s email system or intranet, as an integral part of their regular job duties. This may include employees who work from home or who are traveling. However, simply having access to a kiosk in a workplace common area does not qualify as having regular access.

  • Without regular access means all other recipients. This may include employees on leave as well as non-employees such as COBRA participants, retirees, and alternate payees. For this group, electronic delivery does not comply with ERISA unless the recipient first affirmatively consents to receive the material electronically, provides an electronic address, and reasonably demonstrates their ability to access the material in electronic form. Since the process to secure consent is fairly cumbersome, most employers choose to distribute materials to this group using traditional hard-copy methods instead of electronic delivery.

Both groups of recipients must be notified of their rights to receive paper copies of the documents (at no charge), and reasonable and appropriate steps must be taken to safeguard confidentiality of personal information related to benefits. A best practice is for employers to ensure return-receipt or notice of undelivered mail features are enabled. Employers may conduct periodic reviews or surveys to confirm receipt as well.

Just emailing documents or posting them on the company’s intranet or benefit administration portal is not enough. Each time an electronic document is furnished, a notice (electronic or paper) must be provided to each recipient describing the significance of the document.

Originally published by www.thinkhr.com

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Medicare Part D Notices Due Oct. 15 | North Carolina Benefit Advisors

Are you an employer that offers or provides group health coverage to your workers? Does your health plan cover outpatient prescription drugs — either as a medical claim or through a card system? If so, be sure to distribute your plan’s Medicare Part D notice before October 15.

Purpose

Medicare began offering “Part D” plans — optional prescription drug benefit plans sold by private insurance companies and HMOs — to Medicare beneficiaries many years ago. People may enroll in a Part D plan when they first become eligible for Medicare.

If they wait too long, a late enrollment penalty amount is permanently added to the Part D plan premium cost when they do enroll. There is an exception, though, for individuals who are covered under an employer’s group health plan that provides creditable coverage. (“Creditable” means that the group plan’s drug benefits are actuarially equivalent or better than the benefits required in a Part D plan.) In that case, the individual can delay enrolling for a Part D plan while he or she remains covered under the employer’s creditable plan. Medicare will waive the late enrollment premium penalty for individuals who enroll in a Part D plan after their initial eligibility date if they were covered by an employer’s creditable plan. To avoid the late enrollment penalty, there cannot be a gap longer than 62 days between the creditable group plan and the Part D plan.

To help Medicare-eligible plan participants make informed decisions about whether and when to enroll in a Part D drug plan, they need to know if their employer’s group health plan provides creditable or noncreditable prescription drug coverage. That is the purpose of the federal requirement for employers to provide an annual notice (Employer’s Medicare Part D Notice) to all Medicare-eligible employees and spouses.

Employer Requirements

Federal law requires all employers that offer group health coverage including any outpatient prescription drug benefits to provide an annual notice to plan participants.

The notice requirement applies regardless of the employer’s size or whether the group plan is insured or self-funded:

  • Determine whether your group health plan’s prescription drug coverage is creditable or noncreditable for the upcoming year (2019). If your plan is insured, the carrier/HMO will confirm creditable or noncreditable status. Keep a copy of the written confirmation for your records. For self-funded plans, the plan actuary will determine the plan’s status using guidance provided by the Centers for Medicare and Medicaid Services (CMS).

  • Distribute a Notice of Creditable Coverage or a Notice of Noncreditable Coverage, as applicable, to all group health plan participants who are or may become eligible for Medicare in the next year. “Participants” include covered employees and retirees (and spouses) and COBRA enrollees. Employers often do not know whether a particular participant may be eligible for Medicare due to age or disability. For convenience, many employers decide to distribute their notice to all participants regardless of Medicare status.

  • Notices must be distributed at least annually before October 15. Medicare holds its Part D enrollment period each year from October 15 to December 7, which is why it is important for group health plan participants to receive their employer’s notice before October 15.

  • Notices also may be required after October 15 for new enrollees and/or if the plan’s creditable versus noncreditable status changes.

Preparing the Notice(s)

Model notices are available on the CMS website. Start with the model notice and then fill in the blanks and variable items as needed for each group health plan. There are two versions: Notice of Creditable Coverage or Notice of Noncreditable Coverage and each is available in English and Spanish:

Employers who offer multiple group health plan options, such as PPOs, HDHPs, and HMOs, may use one notice if all options are creditable (or all are noncreditable). In this case, it is advisable to list the names of the various plan options so it is clear for the reader. Conversely, employers that offer a creditable plan and a noncreditable plan, such as a creditable HMO and a noncreditable HDHP, will need to prepare separate notices for the different plan participants.

Distributing the Notice(s)

You may distribute the notice by first-class mail to the employee’s home or work address. A separate notice for the employee’s spouse or family members is not required unless the employer has information that they live at different addresses.

The notice is intended to be a stand-alone document. It may be distributed at the same time as other plan materials, but it should be a separate document. If the notice is incorporated with other material (such as stapled items or in a booklet format), the notice must appear in 14-point font, be bolded, offset, or boxed, and placed on the first page. Alternatively, in this case, you can put a reference (in 14-point font, either bolded, offset, or boxed) on the first page telling the reader where to find the notice within the material. Here is suggested text from the CMS for the first page:

“If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a federal law gives you more choices about your prescription drug coverage. Please see page XX for more details.”

Email distribution is allowed but only for employees who have regular access to email as an integral part of their job duties. Employees also must have access to a printer, be notified that a hard copy of the notice is available at no cost upon request, and be informed that they are responsible for sharing the notice with any Medicare-eligible family members who are enrolled in the employer’s group plan.

CMS Disclosure Requirement

Separate from the participant notice requirement, employers also must disclose to the CMS whether their group health plan provides creditable or noncreditable coverage. The plan sponsor (employer) must submit its annual disclosure to CMS within 60 days of the start of the plan year. For instance, for calendar-year group health plans, the employer must comply with this disclosure requirement by March 1.

Disclosure to CMS also is required within 30 days of termination of the prescription drug coverage or within 30 days of a change in the plan’s status as creditable coverage or noncreditable coverage.

The CMS online tool is the only method allowed for completing the required disclosure. From this link, follow the prompts to respond to a series of questions regarding the plan. The link is the same regardless of whether the employer’s plan provides creditable or noncreditable coverage. The entire process usually takes only 5 or 10 minutes to complete.

Originally published by www.thinkhr.com

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Ask the Experts: FSA Limits | North Carolina Employee Benefits

Question: Our company offers flexible spending accounts (FSAs) for health care and dependent daycare. Our plan limits are the maximum amounts allowed by federal law. Will the IRS increase the limits for 2019? We hold open enrollment in November for employees to make their FSA elections for the following year.

Answer: The maximum annual limits for Dependent Care FSAs and Health Care FSAs are set forth under § 129 and § 125, respectively, of the Internal Revenue Code.

The § 129 (Dependent Care) limits do not change from year to year. They are currently $5,000, or $2,500 if married and filing separately, and they apply on a calendar-year basis. To change them would require a change in law, which is unlikely in the current Congress.

On the other hand, the maximum limit for elective contributions to a Health Care FSA (HFSA) may change from year to year depending on inflation. The limit applies on a plan-year basis and the HFSA limit for a 12-month plan year beginning in 2018 is $2,650. The limit is one of over 50 different tax provisions that is subject to annual cost-of-living or inflation adjustments. Each fall, the IRS announces any changes for the following year. The announcement usually is released in mid-October, which should give employers time to prepare 2019 enrollment materials.

Based on estimated inflation, it appears the HFSA limit will increase from $2,650 for plan years beginning in 2018 to $2,700 for plan years beginning in 2019. The increase will not be official, however, until the IRS announcement is released.

Originally published by www.thinkhr.com

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Look Backward to Plan Forward | North Carolina Employee Benefits

We have entered Open Enrollment season and that means you and everyone in your office are probably reading through enrollment guides and trying to decipher it all. As you begin your research into which plan to choose or even how much to contribute to your Health Savings Account (HSA), consider evaluating how you used your health plan last year. Looking backward can actually help you plan forward and make the most of your health care dollars for the coming year.

Check out these four things to look at as you go into Open Enrollment season!

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Is Your Health Plan Affordable for 2019? | North Carolina Benefit Advisors

The Affordable Care Act’s employer shared responsibility provision — often called the employer mandate or “play or pay” — requires large employers to offer health coverage to their full-time employees or face a potential penalty. (Employers with fewer than 50 full-time and full-time-equivalent employees are exempt.) Large employers can avoid the risk of any play or pay penalties by offering all full-time employees at least one group health plan option that meets two standards: It provides minimum value and it is affordable.

Minimum value means the plan’s share of total allowed costs is at least 60 percent and the plan provides substantial coverage of physician services and inpatient hospital services.

Affordable means the employee’s required contribution (payroll deduction) for self-only coverage, if elected, does not exceed a certain percentage of the employee’s household income. The affordability percentage changes slightly each year based on the law’s indexing rule. For 2018, the percentage is 9.56 percent. For 2019, however, the percentage increases to 9.86 percent.

Although the change is minor, it means that employers may increase their plan’s employee-only contribution rate and still meet the affordability standard next year.

Determining Affordability

The first step in determining whether a group health plan option is affordable is to define the employee’s “income.” Employers do not know their workers’ total household income, so the play or pay rules offer employers three optional safe harbor methods to define income using information known to the employer. Employers may use any of the safe harbor methods. They also may use different methods for different classes (such as one method for hourly employees and another method for salaried employees), provided that the chosen method is applied uniformly to all employees in the class.

The three IRS safe harbor methods are:

1. Federal Poverty Line (FPL)

The FPL method is the easiest of the three methods. Multiply the mainland FPL amount for a single-member household by the affordability percentage, then divide by 12. As long as the self-only contribution rate does not exceed the resulting amount, the plan’s coverage is deemed affordable. For instance:

  • 2018: ($12,060 x 9.56%)/12 = $96.08 per month

  • 2019: ($12,140 x 9.86%)/12 = $99.75 per month

The FPL chart is updated every year in late January. For 2019 calendar-year health plans, the employer needs to refer to the current FPL amount ($12,140) since the new FPL amount will not be available until after the plan year starts. If the health plan year starts February 1, 2018 or later, however, the employer may refer to the new FPL amount which likely will be a little higher.

2. Rate of Pay

This is the most convenient method to define income when applied to hourly employees. Multiply the employee’s hourly rate of pay times 130 hours per month (regardless of how many hours he or she actually works), then multiply by the affordability percentage. As long as the self-only contribution rate does not exceed the resulting amount, the plan’s coverage is deemed affordable. For instance:

  • 2018: ($11* x 130) x 9.56% = $136.70 per month

  • 2019: ($11* x 130) x 9.86% = $140.99 per month

* Replace $11 with the hourly employee’s rate of pay.

For salaried employees, the rate of pay method is somewhat complicated so employers generally avoid using this method for non-hourly employees.

3. W-2

The W-2 method requires using current W-2 wages instead of looking back at the prior year. W-2 wages means the amount that will be reported in Box 1 of Form W-2. Pretax contributions, such as § 125 plan contributions and 401(k) or 403(b) plan deferrals, are not included in Box 1, so using the W-2 safe harbor method may understate the employee’s actual income. Coverage will be deemed affordable if, for each month of the plan year, the self-only contribution does not exceed the Box 1 amount multiplied by the affordability percentage.

Summary

Large employers can avoid the risk of potential penalties under the ACA’s play or pay rules by ensuring that they offer full-time employees at least one minimum value plan option that also is affordable. Affordable means the employee’s contribution to elect self-only coverage would not exceed a certain percentage of the employee’s income.

The percentage used to determine affordability changes from year to year is based on the law’s indexing formula. For 2018 plan years, the affordability percentage is 9.56 percent, but it increases to 9.86 percent for 2019 plan years. Employers and their advisors will want to keep this information in mind as they finalize their group health plan offerings and employee contribution rates for 2019.

Originally published www.thinkhr.com

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Preparation Aids Prevention | North Carolina Benefit Advisors

Incidences of workplace violence are becoming more common and are all over the news. It’s not just high-profile headline cases that are a concern—it’s happening on a smaller scale in all kinds of businesses. Threats to workplaces can take many forms, from cyberbullying and workplace harassment to physical altercations and targeted violence.

The Occupational Safety and Health Administration (OSHA) estimates that every year nearly 2 million U.S. workers are victims of workplace violence, with a total economic cost of more than $55 billion. According to the most recent National Census of Fatal Occupational Injuries, violence in the workplace increased 23 percent between 2015 and 2016 to become the second-most common category of workplace fatalities, behind transportation incidents.

Assessing elements of risk that may trigger violence, along with developing a prevention plan, is critical.

While a bill has been recently introduced in Congress relating to workplace violence in the healthcare industry, and some states address workplace violence in their safety regulations, there are no specific OSHA standards for workplace violence at the federal level outside of the OSHA General Duty Clause. This clause requires employers to provide their employees with a place of employment that is “free from recognized hazards that are causing or are likely to cause death or serious harm.”

If your clients experience acts of workplace violence or become aware of threats, intimidation, or other indicators suggesting that the potential for violence in the workplace exists, OSHA and state programs would expect them to implement a workplace violence prevention program combined with controls and training.

The good news is, you can help arm your clients with strategies for reducing the risk of workplace violence this summer.

Prevention is key

Assessing elements of risk that may trigger violence, along with developing a prevention plan, is critical. This starts with a complete evaluation of the organization’s strengths, weaknesses, opportunities, and threats as they relate to the types of risks the organization might face. A review of the company’s strategic objectives and deliverables, the resources available to employees to accomplish these deliverables, and the physical layout of the facility are important elements to include in this evaluation.

Workplace violence preparation and prevention strategies

Hire right. Your clients’ businesses may be at risk due to the actions of their employees. Advise them to make good hiring decisions by clearly defining job requirements and thoroughly evaluating applicants. They should look carefully at resumes and job applications, probe gaps in applicants’ work histories, and verify education and work experience. Encourage them to conduct reference and background checks and be consistent with all applicants throughout the hiring process. That way, they can potentially avoid bad hires or negligent hiring claims.

Set clear expectations. When employees know what is expected of them, including behaviors important to the organization and performance standards, and those expectations are consistently enforced, they may experience less work-related stress and anxiety that can lead to hostility and violent outbursts.

Nurture an inclusive company culture. Studies show that in companies where employees feel like they are a part of the business and understand how their work contributes to the organization’s success, employees are more engaged and have more trust in their leaders and co-workers. Encourage your clients to focus on an inclusive culture built on strong values and it might result in fewer accidents, less absenteeism, and reduced risk for EPLI claims or workplace violence incidents.

Establish emergency preparedness plans. Advise your clients to develop emergency plans covering human-caused emergencies such as crime and violence, as well as hazards caused by natural disasters, outbreaks of disease, and accidents.

Establish safe reporting systems. Recommend that clients establish more than one method for employees to report any type of threat or issue that makes them feel unsafe in the workplace. These systems should include clear communication to employees that everyone is responsible for workplace safety, and there will be no retaliation for reporting safety concerns.

Provide workplace wellness programs. Some safety experts suggest that companies that demonstrate their commitment to their employees’ wellbeing through comprehensive wellness programs may reduce the risk of workplace violence. The rationale is that these programs help to defuse employee stress, anxiety, and unhealthy personal behaviors that can lead to violence.

Train, train, train. Every member of the team should be trained to know what to do in each type of emergency. In the case of workplace violence prevention, encourage your clients to train employees who have contact with the public about how to defuse potentially violent situations and protect themselves. Designate management team members to receive additional training to recognize the signs of employee distress — such as physical exhaustion, missing work commitments, more time out of the office, violent outbursts, isolating themselves from co-workers, or talking about hurting themselves or others — with the proper procedures for handling those situations. Well-trained team members who react quickly can save lives.

With the proper planning, systems, communications, and training, your clients can be better prepared to prevent or lessen the threats of workplace violence.

Originally published by www.thinkhr.com

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10 Stories That Caught Our Eye in June 2018 | North Carolina Benefit Advisors

Just Don’t Ask

Job candidates are covered by the Civil Rights Act prohibiting discrimination, and most interviewers know what kinds of direct questions to avoid. But what seems like a friendly conversation-starter could be an unwitting violation of the act. Read five questions you should never ask.

Read more on Namely.

Trust in Design

Office design is known to have an impact on employee productivity and satisfaction. At the heart of this is trust – trust that staff will choose to use the facility in the most effective way rather than be chained to their desks. And when trust rises, engagement follows.

Read more on Entrepreneur.

Pride Without Pandering

June was Pride Month, and corporations everywhere joined in the celebration. Some, although well-meaning, missed the mark. Seven LGBTQ executives explain how employers can embrace inclusion and celebrate diversity without coming across as pandering.

Read more on Fast Company.

Dad Days

Reddit cofounder Alexis Ohanian was a proponent of paternity leave and planned to lead by example by using his company’s benefit. However, he didn’t fully appreciate its importance until his daughter was born and he used the time off to slow down and take stock of his priorities.

Read more on CNN.

Culture Still Eats Strategy

Strategy is essential, but if a company doesn’t have a good culture, it won’t matter. Once you understand what culture is and isn’t, you can work toward developing a strong one, starting with defining the qualities you value in your employees.

Read more on Forbes.

Buy in Bulk

A rule released by the U.S. Department of Labor on June 19 loosens restrictions on association health plans, paving the way for more small businesses to band together to buy health coverage. That is, if it stands up to legal challenges, state laws, and the realities of the insurance marketplace.

Read more on Kaiser Health News.

The Family Friendly Workplace

Work-life balance can be especially challenging for parents. Both mothers and fathers lament not having enough time for their children. Get 10 creative ways you can make your workplace better for working parents.

Read more on Employee Benefit News.

Remote Control

The remote workforce continues to grow, but 57 percent of companies still lack a remote work policy. These companies may be missing out on attracting and retaining top talent. There’s no one-size-fits-all solution, with numerous factors to consider in crafting one.

Read more on HR Dive.

What Makes a Great Workplace

Inc. magazine surveyed thousands of employees to measure what employer qualities lead to high levels of employee engagement and sentiment, taking into account elements of corporate culture. See which of 45 perks and benefits employees value most.

Read more on Inc.

Run, Hide, Fight

Law enforcement officials stress the need for employers to conduct active shooter training to protect their employees and customers in the event of a violent incident. In addition to training, find out other ways to mitigate the risk a shooter or potential shooter holds.

Read more on Business Insurance.

Originally published by www.thinkhr.com

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The News about Association Health Plans | North Carolina Employee Benefit Advisors

On June 19, 2018, the U.S. Department of Labor released its Final Rule regarding Association Health Plans (AHPs). AHPs are not new, but they have not been widely available in the past and, in some cases, they have not been successful. The Final Rule is designed to make AHPs available to a greater number of small businesses as an alternative to standard ACA-compliant small group insurance policies.

This article answers common questions about AHPs under the current rules (which groups can continue to use) and the new rules.

Is group medical insurance the same for small and large employers?

Yes and no. Federal law imposes certain basic requirements on all group medical plans, regardless of the employer’s size. For instance, plans cannot exclude pre-existing conditions nor impose annual or lifetime dollar limits on basic benefits. If the plan is insured, it also is subject to the insurance laws of the state in which the policy is issued.

Small group policies, which are sold to employers with up to 50 or 100 employees, depending on the state, are subject to additional requirements. These policies must cover 10 categories of essential health benefits (EHBs), including hospitalization, maternity care, mental health and substance abuse treatment, and prescription drugs. (Some states allow certain grandfathered or grandmothered policy exceptions.) For most small employers, their options for group medical insurance are limited to small group policies that comply with the full scope of ACA requirements. On the other hand, the policies are subject to guaranteed issue and adjusted community rating rules, so carriers cannot refuse to insure a small employer nor use any past claims experience in setting rates.

Large group policies, which can only be sold to groups with at least 50 or 100 employees, depending on the state, are not required to cover all EHBs. Carriers have more flexibility in designing coverage options and developing premium rates in the large group market. This means larger employers have more options to choose from and may be able to purchase coverage at a lower cost than would apply to a small group policy. Note, however, that there is no guaranteed issue protection, so carriers can accept or reject each employer’s application or use the employer’s past claims experience in setting rates.

Lastly, self-funded plans are subject to the ACA and other federal laws, but generally are exempt from state laws. They typically are not feasible for small employers, however, due to the financial risk of uninsured programs.

What is an Association Health Plan (AHP)?

Group insurance covers the employees of an employer (or an employee organization such as a labor union). An AHP, as the name implies, covers the members of an association. Unrelated employers can obtain coverage for their employees through an AHP provided the employers form a bona fide association. Traditionally, this has meant that the employers had to have a “commonality of interest” and their primary interest had to be something other than an interest in providing benefits. For this reason, AHPs generally have been limited to associations formed by employers in the same trade, industry, or profession.

The Final Rule makes AHPs available to a wider range of businesses by expanding the meaning of “commonality of interest.” Once the Final Rule takes effect, an association may be formed by employers that are:

  • In the same trade, industry, or profession, regardless of location; or
  • In the same principal place of business; i.e., in the same state or in the same multi-state metropolitan area.

Under the new rules, the employer’s primary interest in associating may be benefits coverage, although they still will need to have at least one other substantial business purpose other than benefits. This is a key difference from the current rules.

When does the new Final Rule take effect?

The Final Rule expanding the definition of an association for purposes of an AHP will take effect on staggered dates:

  • For fully insured AHPs: September 1, 2018
  • For self-funded AHPs:
    • If in existence on or before June 19, 2018: January 1, 2019
    • If created after June 19, 2018: April 1, 2019

As noted, the new rules do not replace existing rules. Employers and associations may continue to follow the existing rules (which generally limit AHPs to employers in the same trade, industry, or profession). The new rules merely expand the opportunities for AHPs, such as making them available to employers in the same state or metropolitan area even if they are in different industries.

Are AHPs limited to employers with employees? What about sole proprietors?

Currently, sole proprietors, such as mom-and-pop shops without any W-2 employees, purchase medical insurance in the individual market. Individual policies often cost more than group policies or AHPs. The new rules will expand the availability of AHPs to include sole proprietors who work a minimum number of hours (so-called working owners).

What about state laws? Will AHPs be available nationwide?

Insurance products, including AHPs, are regulated by state law. Under both the existing and new rules, AHPs are multiple employer welfare arrangements (MEWAs). State laws on MEWAs are quite complicated. In some states, MEWAs are prohibited. In others, insured MEWAs are allowed but self-funded plans are prohibited. The laws vary from state to state, so different carriers will make different decisions about whether they want to design and market AHPs in various jurisdictions around the country.

A number of states are very concerned about AHPs and may prohibit them in their states or impose strict requirements to ensure they will provide reliable and effective coverage. Other states will view AHPs as cost-effective alternatives to ACA-compliant policies for small employers and look to encourage their expansion.

What’s next?

There is no clear answer to what’s next. Over the coming months, carriers across the country likely will review the reasons they have or have not offered AHPs in the past, and whether they want to consider new approaches in the future. Along with economic and market issues to consider, carriers also must consider the state insurance laws in different jurisdictions. At the same time, many state legislatures and insurance commissioners will be reviewing their existing rules and whether they want to promote or expand the availability of AHPs in their area.

Oh … and the lawsuits. Yes, that also is what’s next. As of this writing, attorneys general in different states are planning to join together in challenging the federal government’s Final Rule on AHPs. Their stated concern is that effective regulation is required to ensure that plans provide adequate coverage.

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6 Questions on Dependent Care Spending Accounts | North Carolina Employee Benefits

School’s out! Summer is here, and it’s the time of year when working parents have questions about using their Dependent Care Spending Accounts (DCSAs). Are summer camp expenses eligible? What about day versus overnight camps? Employers and benefit advisors want to be ready with answers about this valuable benefit program.

The following are the top summertime questions about DCSAs and reimbursable expenses:

1. What are the basic rules for reimbursable expenses?

Dependent care expenses, such as babysitting and daycare center costs, must be work-related to qualify for reimbursement. Work-related means the expenses are for the care of the employee’s child under age 13 to allow the employee to work. If the employee is married and filing jointly, the employee’s spouse also must be gainfully employed or looking for work (unless disabled or a full-time student).

In some cases, expenses to care for a disabled dependent, regardless of age, may be reimbursable. This article focuses on expenses for children under 13 since those are by far the most common type of DCSA reimbursement.

2. One of our employees and his family are taking a two-week vacation this summer, but his children’s daycare center will charge its regular fee. Are the expenses reimbursable even if the employee and spouse are off work?

Yes. In most cases, expenses are not eligible unless the dependent care services are necessary for the parents to work, but some exceptions apply. The IRS rules for DCSAs provide that expenses during short, temporary absences are eligible if the employee has to pay the child’s care provider. Absences of up to two weeks are automatically considered short, temporary absences. Depending on the circumstances, longer absences also may qualify.

3. During the school year, our employee uses her DCSA for her 10-year old’s after-school daycare center expenses. This summer, the child’s daycare will be provided by her 20-year old sister. If the older daughter bills for her services, are the costs eligible for reimbursement?

The answer depends on whether the employee or spouse can claim the older daughter as a tax dependent. If the older daughter can be claimed as a dependent, whether or not the employee actually claims her, she is not a qualifying dependent care provider under the DCSA rules.

If the older daughter cannot be claimed as a tax dependent, her charges for providing care are eligible expenses. The specific rule is that a child of the employee, whom the employee cannot claim as a dependent, may be a qualifying provider if the child is age 19 or older by the end of the year.

Note that the employee’s spouse or the child’s parent is never a qualifying provider.

4. One of our employees has to pay an application fee and deposit before her child starts attending a daycare center this summer. Are those expenses eligible for reimbursement?

Prepaid expenses are eligible for DCSA reimbursement, provided the costs are required in order for the child to receive care. In this case, after the daycare center begins providing care, the employee can be reimbursed for the application fee and deposit she paid. On the other hand, if the employee cancels and her child does not attend, then the application fee and deposit are not eligible expenses.

5. An employee will pay day camp expenses for his 8-year-old son and overnight camp expenses for his 12-year-old daughter this summer. Are both types of expenses eligible for reimbursement?

The day camp expenses generally are reimbursable. Expenses for overnight camp, however, are not eligible since overnight care is not work-related.

Under the IRS rules for DCSAs, expenses for food, lodging, clothing, education, and entertainment are not reimbursable. If, however, such expenses are small, incidental expenses that cannot be separated from the cost of caring for the child, they may be included for reimbursement. For instance, the day camp may include lunch, snacks, and some sports activities in its basic fee, which would be eligible for reimbursement.

6. An employee’s children go to private year-round schools. He pays tuition for one child’s grade school and fees for the other child’s nursery school. Are both types of expenses eligible for reimbursement?

Educational expenses are not reimbursable, unless the educational services are merely incidental as part of a child care service. Expenses to attend kindergarten or a higher grade are educational, so the older child’s school fees are not eligible for DCSA reimbursement. (Expenses for before- or after-school care, however, may qualify as reimbursable expenses.)

On the other hand, expenses for a child in nursery school, preschool, or a similar program for children below the level of kindergarten are expenses for care. Such expenses are not considered educational even though the nursery school may include some educational activities.

Originally published by www.thinkhr.com

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Benefits of an Annual Exam | North Carolina Employee Benefits

Becoming a well-informed patient who follows through on going to their annual exam, as well as follows the advice given to them from their physician after asking good questions, will not only save your budget, but it can save your life!

Check out this short video so you too, can be a well informed patient!

 

Discount Drug Programs | North Carolina Benefit Advisors

Did you know that you can save time and money on your prescription drugs by simply signing up for a discount card online? With savings as much as 80% off, these discount cards keep your health care costs down even when the prices of prescriptions are sharply rising.  At no cost to the patient, discount drug programs negotiate the price of medicines with pharmacies and then pass the savings on to the consumer.  These programs give subscribers a personalized discount card to be used at any pharmacy. While the discount card cannot be used in conjunction with health insurance, the consumer may see that the cost of their medicine is actually LESS with the card than it is with their insurance.

Another benefit to the consumer is that these programs will publish at which pharmacy you can find your medicine. This is especially helpful to the person who has specialty drug prescriptions. For example, Rebekah is prescribed a specialty drug for pain and neuropathy due to Multiple Sclerosis. This drug is not commonly stocked in pharmacies and so many times, she has had to wait for them to order it. By using the discount drug program, Rebekah is able to see which pharmacies have her medicine in stock and the estimated price.

So where do you start? Here are a few discount drug programs to investigate costs and providers for your prescriptions:

·      Provides free drug cards to reduce the out-of-pocket cost of prescription drugs.

·      Click on your state and the site will redirect you to your corresponding prescription assistance program.

·      Compares prices and discounts at thousands of pharmacies.

·      Receive coupons via phone, email, or text to print or present for discounts.

·      Free drug card to present at pharmacy for cost savings on prescriptions.

·      Earn rewards each time you use their card—similar to credit card rewards. Each fill is 500 points and when you reach 5,000 points, you earn a gift card to various retailers.

Being a savvy consumer can save you money! Shop around to find the best cost for your prescription drugs and save time by locating the pharmacy that has your meds in stock. Discount drug programs are a great resource so do your research and find one that fits your needs.

 

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Disability Insurance and why you need it! | North Carolina Employee Benefits

“Your most valued asset isn’t your house, car, or retirement account. It’s the ability to make a living.”

No one foresees needing disability benefits.  But, should a problem arise, the educated and informed employee can plan for the future by purchasing disability insurance to help cover expenses when needed.

When you ask people what is the number one reason disability insurance is needed, most will answer that it is for workplace related injuries. However, the leading causes of long-term absences are back injuries, cancer, and heart disease and most of them are NOT work related.   In addition, the average duration of absences due to disability is 34 months.  So how do you prepare for an unplanned absence from work as a result of an injury or illness? Disability insurance is a great option.

Disability insurance is categorized into two main types.

Short Term Disability covers 40-60% of the employee’s base salary and can last for a few weeks to a few months to a year. There is typically a short waiting period before benefits begin after the report of disability.  This plan is generally sponsored by the employer.

Long Term Disability covers 50-70% of the employee’s base salary and the benefits end when the disability ends or after a pre-set length of time depending on the policy. The wait period for benefits is longer—typically 90 days from onset of disability.  This plan kicks in after the short-term coverage is exhausted. The individual purchases this plan to prevent a loss of coverage after short-term disability benefits are exhausted.

While the benefits of these disability plans are not a total replacement of salary, they are designed for the employee to maintain their current standard of living while recovering from the injury or illness. This also allows the individual to pay regular expenses during this time.

There are many ways to enroll in a disability insurance plan. Often times your employer will offer long-term and short-term coverage as part of a benefits package. Supplemental coverage can also be purchased.  Talk with your company’s HR department for more information on how to enroll in these plans.  Individuals who are interested in purchasing supplemental coverage can also contact outside insurance brokers or even check with any professional organizations to which they belong (such as the American Medical Association for medical professionals) as many times they offer insurance coverage to members.

As you begin planning for your future, make sure you research the types of coverage available and different avenues through which to purchase this coverage. For more information on disability and the workplace, check out:

·      Americans with Disabilities Act

·      The National Organization on Disability

·      Council for Disability Awareness

·      Social Security Administration

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Federal Employment Law Update – January 2018 | North Carolina Employee Benefits

WHD Revises Test for Unpaid Internships

On January 5, 2018, the U.S. Department of Labor’s Wage and Hour Division (WHD) released a Field Assistance Bulletin (FAB No. 2018-2) establishing that the primary beneficiary test, rather than the six-point test, will determine whether interns at for-profit employers are employees under the federal Fair Labor Standards Act (FLSA).

The primary beneficiary test requires an examination of the economic reality of the intern-employer relationship to determine which party is the primary beneficiary of the relationship. The following seven factors are part of this test:

  1. The extent to which the intern and the employer clearly understand that there is no expectation of compensation. Any promise of compensation, express or implied, suggests that the intern is an employee — and vice versa.
  2. The extent to which the internship provides training that would be similar to that which would be given in an educational environment, including the clinical and other hands-on training provided by educational institutions.
  3. The extent to which the internship is tied to the intern’s formal education program by integrated coursework or the receipt of academic credit.
  4. The extent to which the internship accommodates the intern’s academic commitments by corresponding to the academic calendar.
  5. The extent to which the internship’s duration is limited to the period in which the internship provides the intern with beneficial learning.
  6. The extent to which the intern’s work complements, rather than displaces, the work of paid employees while providing significant educational benefits to the intern.
  7. The extent to which the intern and the employer understand that the internship is conducted without entitlement to a paid job after the internship.

According to the WHD, under the primary beneficiary test, no one factor is dispositive and every factor is not required to be fulfilled to conclude that the intern is not an employee entitled to the minimum wage. The primary beneficiary test is a distinct shift in analysis because per the six-part test every intern and trainee would be an employee under the FLSA unless his or her job satisfied each of six independent criteria. Courts have held that the primary beneficiary test is an inherently “flexible” test and whether an intern or trainee is an employee under the FLSA necessarily depends on the unique circumstances of each case.

The WHD announced it will conform to the federal court of appeals’ determinations and use the same court-adopted test to determine whether interns or students are employees under the FLSA.

Read the field bulletin

Increased Penalties for Federal Violations

On January 2, 2018, the U.S. Department of Labor (DOL) announced in the Federal Register that penalties for violations of the following federal laws have increased for 2018:

  • Black Lung Benefits Act.
  • Contract Work Hours and Safety Standards Act.
  • Employee Polygraph Protection Act.
  • Employee Retirement Income Security Act.
  • Fair Labor Standards Act (child labor and home worker).
  • Family and Medical Leave Act.
  • Immigration and Nationality Act.
  • Longshore and Harbor Workers’ Compensation Act.
  • Migrant and Seasonal Agricultural Worker Protection Act.
  • Occupational Safety and Health Act.
  • Walsh-Healey Public Contracts Act.

These increases are due to the requirements of the Inflation Adjustment Act, which requires the DOL to annually adjust its civil money penalty levels for inflation by no later than January 15.

These increased rates are effective January 2, 2018.

Read the Federal Register

OSHA Penalties Increased

On January 2, 2018, the U.S. Department of Labor announced in the Federal Register that Occupational Safety and Health Administration (OSHA) penalties will increase for 2018 as follows:

  • Other-than-Serious: $12,934
  • Serious: $12,934
  • Repeat: $129,336
  • Willful: $129,336
  • Posting Requirement Violation: $12,934
  • Failure to Abate: $12,934

These increases apply to states with federal OSHA programs; rates for states with OSHA-approved State Plans will increase to these amounts as well; State Plans are required to increase their penalties in alignment with OSHA’s to maintain at least as effective penalty levels.

These new penalty increases are effective as of January 2, 2018 and apply to any citations issued on that day and thereafter.

Read the Federal Register

Agencies Release Advance Copies of Form 5500 for Filing in 2018

The Employee Benefits Security Administration (EBSA) the Internal Revenue Service (IRS), and the Pension Benefit Guaranty Corporation (PBGC) released the advance informational copies of the 2017 Form 5500 and related instructions. For small employee benefit plan reports, advance short form copies of 2017 Form 5500-Short Form (SF) and 2017 Instructions for Form 5500-SF were also released with supplemental materials including schedules and attachments.

Read about and download the Form 5500 Series

 

Originally published by www.thinkhr.com

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Oral Health = Overall Health

Have you heard the saying “the eyes are the window to your soul”? Well, did you know that your mouth is the window into what is going on with the rest of your body? Poor dental health contributes to major systemic health problems. Conversely, good dental hygiene can help improve your overall health.  As a bonus, maintaining good oral health can even REDUCE your healthcare costs!

Researchers have shown us that there is a close-knit relationship between oral health and overall wellness. With over 500 types of bacteria in your mouth, it’s no surprise that when even one of those types of bacteria enter your bloodstream that a problem can arise in your body. Oral bacteria can contribute to:

1.     Endocarditis---This infection of the inner lining of the heart can be caused by bacteria that started in your mouth.

2.     Cardiovascular Disease---Heart disease as well as clogged arteries and even stroke can be traced back to oral bacteria.

3.     Low birth weight---Poor oral health has been linked to premature birth and low birth weight of newborns.

The healthcare costs for the diseases and conditions, like the ones listed above, can be in the tens of thousands of dollars. Untreated oral diseases can result in the need for costly emergency room visits, hospital stays, and medications, not to mention loss of work time. The pain and discomfort from infected teeth and gums can lead to poor productivity in the workplace, and even loss of income. Children with poor oral health miss school, are more prone to illness, and may require a parent to stay home from work to care for them and take them to costly dental appointments.

So, how do you prevent this nightmare of pain, disease, and increased healthcare costs? It’s simple! By following through with your routine yearly dental check ups and daily preventative care you will give your body a big boost in its general health. Check out these tips for a healthy mouth:

·       Maintain a regular brushing/flossing routine---Brush and floss teeth twice daily to remove food and plaque from your teeth, and in between your teeth where bacteria thrive.

·       Use the right toothbrush---When your bristles are mashed and bent, you aren’t using the best instrument for cleaning your teeth. Make sure to buy a new toothbrush every three months. If you have braces, get a toothbrush that can easily clean around the brackets on your teeth.

·       Visit your dentist---Depending on your healthcare plan, visit your dentist for a check-up at least once a year. He/she will be able to look into that window to your body and keep your mouth clear of bacteria. Your dentist will also be able to alert you to problems they see as a possible warning sign to other health issues, like diabetes, that have a major impact on your overall health and healthcare costs.

·       Eat a healthy diet---Staying away from sugary foods and drinks will prevent cavities and tooth decay from the acids produced when bacteria in your mouth comes in contact with sugar. Starches have a similar effect. Eating healthy will reduce your out of pocket costs of fillings, having decayed teeth pulled, and will keep you from the increased health costs of diabetes, obesity-related diseases, and other chronic conditions.

There’s truth in the saying “take care of your teeth and they will take care of you”.  By instilling some of the these tips for a healthier mouth, not only will your gums and teeth be thanking you, but you may just be adding years to your life.  

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Tax Reform: What It Means for Employee Benefit Plans

December 18th, 2017

Late Friday, the public got its first look at the Tax Cuts and Jobs Act. The 500-plus page bill is the product of separate House and Senate bills that were reconciled in conference. Congressional Republicans appear to have sufficient votes to pass the reconciled bill in both chambers and deliver it to President Trump’s desk this week.

If signed into law, the bill will make significant changes in the Internal Revenue Code with respect to corporations, businesses, and individuals. There also are a small number of provisions that will affect employee benefit plans. This article outlines the items of particular interest to employers that sponsor health and welfare benefits or retirement and savings plans.

Health and Welfare Benefits

Group health benefits, often considered the primary and most valuable benefit provided by employers, are not affected by the bill. Requirements that were added several years ago by the Affordable Care Act (ACA), including the so-called employer mandate and employer reporting requirements, will continue to apply. There also are no changes with respect to health flexible spending accounts (HFSAs), health reimbursement arrangements (HRAs), or health savings accounts (HSAs).

Current tax laws for group life and accident insurance and short- and long-term disability benefits also continue unchanged.

The original House bill would have affected the preferred tax treatment of adoption assistance benefits and educational assistance plans. The final bill, however, preserves the current treatment.

Dependent care assistance plans, including dependent FSAs, also escaped changes in the final bill. For individual income tax purposes, the federal child care tax credit will be expanded somewhat, so some employees will want to take another look at whether their employer’s FSA, or the federal credit, will offer the greater benefit.

Qualified transportation benefits, often referred to as commuter benefits, are affected by the new bill. For tax years 2018 through 2025, the bill repeals current law that allows employees to exclude bicycle commuting expenses from their gross income. Employees will continue to be able to exclude qualified parking and transit benefits from their income, but employers will lose the ability to deduct their costs for these benefits.

Retirement and Savings Programs

While early House proposals targeted retirement plan contribution limits, employer-sponsored retirement plans were generally unscathed in conference. Therefore, in 2018 employee contributions to 401(k), 403(b), most 457 plans, and the federal government’s Thrift Savings Plan remain capped at $18,500 ($24,500 for those age 50 or older). Roth and Traditional IRA limits in 2018 are capped at $5,500 ($6,500 for those age 50 or older).

The most notable change for tax favored employer-sponsored retirement plans relates to loan offsets. Under current law, if an employee receives a loan from the retirement plan and either the plan terminates or the employee terminates employment, then the employee’s obligation to repay the loan is accelerated and the employee must either repay the outstanding balance on the loan or roll the outstanding balance into another eligible retirement plan within 60 days to avoid tax liability for loan offset.

Under the bill, if the plan terminates or an employee fails to meet the repayment terms of the loan because they sever employment, then time period within which a loan offset can be rolled over tax-free to another eligible retirement plan is extended from 60 days to the employee’s due date (including extensions) for filing federal income taxes for the tax year in which the plan loan offset occurs. This provision takes effect for plan loan offset amounts treated as distributed in taxable years beginning after December 31, 2017.

Additionally, the tax plan provides more relief for employees impacted by natural disasters occurring in the 2016 or 2017 tax years. The natural disaster had to occur in an area declared as a disaster area by the president and the casualty damage (exceeding $500) must have resulted from that disaster. In such cases, employees who received a distribution from their eligible retirement plan (including a 401(k) plan, 457(b) plan or an IRA) may recontribute the funds to an eligible retirement plan to which a rollover can be made within three years after the date on which the distribution was received to avoid the money being included as income.

For this to apply to employees, employers will need to make retroactive plan amendments on or before the last day of the first plan year beginning after December 31, 2018 (December 31, 2020 for governmental plans) or a later date prescribed by the Secretary of the Treasury. The amendment is retroactively effective if it applies retroactively for the applicable period and the plan is operated in accordance with the amendment during that period. Therefore, amendments should reflect their operations during that time period. Employers are encouraged to work with employee benefits counsel to address any retroactive plan amendments.

Summary

Although early versions of tax reform bills would have affected several types of employee benefits, the final bill makes very few changes and those changes are fairly modest. Employers and their advisors will want to pay particular attention to issues affecting commuter benefits, loan provisions under 401(k) and similar plans, and tax relief for retirement/savings plan participants who were impacted by natural disasters in the past two years.

Originally published by www.thinkhr.com

 

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Fitness Incentive Program Ideas

Corporate fitness programs not only build camaraderie and morale, they can improve company bottom lines considerably. Improved worker health results in lower absenteeism, improved productivity, decreased health care costs and fewer lawsuits, according to the Wellness Council of America. Incentives and contests can help your company increase employee participation in wellness programs.

Benefits

A corporate fitness program improves employee health in several ways. Workers lose weight, reduce stress, lower blood pressure and sleep better. All of these can reduce sick days, doctor visit and workplace injuries. For example, lower-back injuries cause employees to miss 100 million work days annually, according to the Wellness Council of America. The DuPont corporation decreased disability days at its Tennessee plant by 14 percent after instituting a wellness program, saving almost $120,000 annually.

Motivation

While employee education is an important part of any corporate wellness program, a fitness incentive program motivates employees to participate. Holding a team competition or offering cash or other prizes can create a buzz throughout your workplace and get more employees participating.

Team Competitions

One way to increase fitness program participation is to create a team contest. You can draw names at random to create teams, pit management against staff, place workers from different departments on teams to create more interaction or have different offices face off against each other.

Weight-loss Challenge

Weight loss is one aspect of fitness that concerns or interests many people. Create a weight-loss challenge as either an individual contest or team competition. You can award a prize or prizes based on total number of pounds lost or percentage of individual or team weight lost.

Fitness Challenge

If you don't want to focus on weight loss only, have a broader fitness competition. Track total number of verifiable hours participants exercised during the competition period, how much each person or team lowered their cholesterol or a fitness challenge, with participants or teams competing in tests such as number of sit-ups and push-ups, minutes on a treadmill or jumping rope, timed laps swum or other measurements. Work with a fitness professional and your insurance company to create a test that is safe for all participants.

Incentives

You can use a variety of incentives to motivate employees to participate in a fitness program. You can award cash prizes, trips, gift certificates, extra vacation days or other tangible rewards. You can add prestige with winners names on plaques displayed at headquarters, a mention in the company newsletter and press releases sent to local papers. With team events, the winning team might get to name the charity that receives a donation from the company. Whenever you award prizes, make sure the rules are clear, the judging criteria are objective and that all employees are eligible -- if you set up a contest for one department or employees with more than one year's service, you may create ill will among other employees.

Originally published by www.livestrong.com

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