Employee Benefits
A Look at the Affordable Care Act: Common Acronyms
Author RankinJ
Each month Neace Lukens will discuss a different aspect of the Affordable Care Act. Stay tuned for more updates on the second Thursday of each month. Click here for more Affordable Care Act blogs.
The Affordable Care Act has brought about sweeping changes to the health care industry, and in turn, how organizations handle the administration of their employee benefits and insurance. Reading about the Affordable Care Act might instead leave you scratching your head—use this guide to help decode some of the confusing acronyms you may come across:
• CHIP (The Children’s Health Insurance Program): This program provides health insurance to low-income children who do not qualify for Medicaid, but are unable to afford private health insurance. In some states, this may cover pregnant women also.
• EBSA (Employee Benefits Security Administration): This is a division of the Department of Labor responsible for compliance assistance concerning benefit plans.
• EPO Plan (Exclusive Provider Organization Plan): A managed care plan that only covers services in the plan’s network of doctors, specialists or hospitals (except in emergencies).
• ERRP (Early Retiree Reinsurance Program): Created under health care reform to provide coverage to early retirees.
• FLSA (Federal Fair Labor Standards Act): Amended by PPACA to incorporate health care reform-specific revisions.
• HCERA (Health Care and Education Reconciliation Act): Enacted on March 30, 2010 to amend and supplement PPACA.
• IRO (Independent Review Organization): An organization that performs independent external reviews of adverse benefit determinations.
• MLR (Medical Loss Ratio): Refers to the claims costs and amounts expended on health care quality improvement as a percent of total premiums. This ratio excludes taxes, fees, risk adjustments, risk corridors and reinsurance.
• PCE (Pre-existing Condition Exclusion): A plan provision imposing an exclusion of benefits due to a pre-existing condition.
• PCIP (Pre-Existing Condition Insurance Plan): A temporary high-risk insurance pool to provide coverage to eligible individuals until 2014.
• PPACA (Patient Protection and Affordable Care Act): The primary health care reform law enacted on March 23, 2010.
• QHP (Qualified Health Plan): A certified health plan that provides an essential health benefits package. A QHP is offered by a licensed health insurer.
• SHOP Exchange (Small Business Health Options Program): A program that each health insurance exchange must create to assist eligible small employers when enrolling their employees in qualified health plans offered in the small-group market.
Are you able to keep all these acronyms straight? Check back on the second Thursday of each month as we discuss the Affordable Care Act and what it means to you. For questions about the Affordable Care Act, contact a Neace Lukens representative.
This post is not intended to be exhaustive, nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.
*Information from Zywave
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A Look at the 11th Annual Conference on Health and Productivity
Author campbellm
Attendees at last week’s 11th Annual Conference on Health and Productivity in Indianapolis took an in-depth look at how to address the escalating costs of health care and workers’ compensation costs. Nationally-renowned experts presented on topics including resolving different types of pain without drugs or surgery, treatments for mental and emotional disorders and how to create a culture of health. Each session offered a different “prescription” to the escalating costs of health care and workers’ compensation. In addition to a full schedule of innovative sessions, conference attendees were able to network and visit with exhibitors throughout the day.
Thank you for joining Neace Lukens at the 11th Annual Conference on Health and Productivity. To learn more about how Neace Lukens can help your organization develop strategies for promoting healthful living and work productivity, please visit Neace Lukens Health & Productivity Management. To learn more about upcoming Health and Productivity conferences in Newburgh, Ind., Lexington, Ky., or Louisville, Ky., please visit Neace Lukens Events.
A Look at the Affordable Care Act: Changes to Health Accounts
Author RankinJ
Each month Neace Lukens will discuss a different aspect of the Affordable Care Act. Stay tuned for more updates on the second Thursday of each month. Click here for more Affordable Care Act blogs.
Together, the Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 make significant changes to health flexible spending accounts, health reimbursement arrangements and health savings accounts. These changes are:
• Reimbursement permitted only for medicine or drugs with a prescription (excluding insulin)
• Limited contributions to health FSAs, up to $2,500 a year, subject to cost-of-living increases
• Increased tax penalties for withdrawals from HSAs and Archer medical saving accounts not used for medical expenses
Read on to learn more about each of these changes in greater detail:
Limits on Reimbursement for Over-the-Counter Medications
The medications categorized as “qualified medical expenses” have been redefined by the healthcare reform laws for the purposes of reimbursement from FSAs and HRAs and for distributions from Archer MSAs and HSAs. The new definition of a “qualified medical expense” is now consistent with the definition used for the itemized tax deduction. Under this new definition, medicine and drugs eligible for reimbursements include only medicines that are a prescribed drug (does not take into account if the drug is available without a prescription or not) or is insulin.
So what does this mean for you? Health FSAs and HRAs will not reimburse the cost of over-the-counter medications that do not have a prescription. Distributions from Archer MSAs and HSAs used to purchase over-the-counter medicine without a prescription will be taxable and subject to penalties. Keep in mind that amounts paid for over-the-counter medicines with a prescription still qualify as medical expenses.
Limits on Health Flexible Spending Account Contributions
Starting in 2013, heath FSAs offered through a cafeteria plan will limit the amount of salary reduction contributions that employees can make. For plan years, employees may now elect to contribute up to $2,500 a year to a health FSA. This amount will go up to reflect cost-of-living increases in future years.
Increased Tax on Withdrawals from Health Savings Accounts and Archer MSAs
The healthcare reform law increases the additional tax on any HSA distributions before age 65 from 10 to 20 percent for distributions that aren’t used for qualified medical expenses. The additional tax for any Archer MSA distributions not used for qualified medical expenses increases from 15 to 20 percent. Remember, only your withdrawals used to pay for qualified medical expenses are tax-free. If you use funds from your HSA or Archer MSA for other purposes, your funds will be taxable and subject to penalties.
What do you think about the changes to health accounts? Check back on the second Thursday of each month as we discuss the Affordable Care Act and what it means to you. For questions about the Affordable Care Act, contact a Neace Lukens representative.
This post is not intended to be exhaustive, nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.
*Information from Zywave
A Look at the Affordable Care Act: Exchanges
Author RankinJ
*Each month Neace Lukens will discuss a different aspect of the Affordable Care Act. Stay tuned for more updates on the second Thursday of each month.
Exchanges are a vital piece of Affordable Care Act legislation and, in just a few short months, will change the landscape of how your healthcare insurance coverage could be offered. Healthcare exchanges can provide increased purchasing power for individuals and small business by pooling many insurance buyers together. Read on to learn more about healthcare exchanges and tips for how you can navigate them.
What is an Exchange?
An Exchange creates a competitive marketplace where individuals and small businesses alike can compare prices and shop around to purchase private health insurance coverage. Additionally, insurers must be prepared to comply with a new set of market reforms associated with the Exchanges. Exchanges are scheduled to become operational by Jan. 1, 2014, with an enrollment period on track to begin on Oct. 1, 2013.
When it comes to implementing Exchanges, states have three options:
• Establish its own state-based Exchange
The deadline for states intending to pursue a state-based Exchange has now passed. States were required to submit a declaration letter and an Exchange outline to the Department of Health and Human Services (HHS) for approval. States offering state-based Exchanges include: California, Hawaii, Oregon, Washington, Nevada, Idaho, Utah, Colorado, New Mexico, Minnesota, Kentucky, Maryland, the District of Columbia, New York, Connecticut, Rhode Island, Vermont and Massachusetts.*
• Have the Department of Health and Human Services operate a federally facilitated Exchange (FFE)
HHS will operate federally facilitated Exchanges in each state that did not move forward with implementing its own Exchange or partnering with HHS. HSS will work with these states to preserve the traditional responsibilities of state insurance departments when creating the FFEs. FEEs will be funded through monthly user fees, a proposed 3.5 percent of the premium, although this is subject to change. These states include: Montana, Wyoming, Arizona, Alaska, Texas, Oklahoma, Kansas, Nebraska, South Dakota, North Dakota, Wisconsin, Missouri, Louisiana, Indiana, Ohio, Pennsylvania, New Jersey, Virginia, North Carolina, South Carolina, Tennessee, Mississippi, Alabama, Georgia and Florida.*
• Partner with HHS so that some FFE operations can be performed on the state level
The deadline for states intending to pursue a state partnership has now passed. States were required to submit a declaration letter and an Exchange outline to HHS for approval. These states include: Iowa, Illinois, Arkansas, Michigan, West Virginia, Delaware and New Hampshire.*
How will Exchanges impact me?
If you’re interested in pursuing healthcare options offered through an exchange, you’ll need to meet the following criteria:
• Be a citizen, national or non-citizen lawfully present in the U.S., and is reasonably expected to remain so for the entire period for which enrollment is sought
• Not incarcerated
• Resides in the state covered by the exchange
Each Exchange will determine whether you meet the eligibility criteria for enrollment. If eligible, you will receive written notice. Exchanges will have an initial open enrollment period, an annual open enrollment period and also special enrollment periods at certain times.
Individuals can only enroll in a qualified health plan through an Exchange during permitted enrollment periods. The initial enrollment period is anticipated to run from Oct. 1, 2013 – March 31, 2014. The annual enrollment period for 2015 and following years will begin Oct. 15 and extend through Dec. 7 of the preceding calendar year. In 2013, Exchanges must provide advance written notice to each enrollee about annual open enrollment in September.
Beginning in 2014, the ACA requires most individuals to maintain acceptable health coverage, or they will be subject to a financial penalty. This penalty is expected to be $95 per person in 2014, and will increase each year.
How will Exchanges impact my business?
Small businesses are able to purchase healthcare insurance through an Exchange. States can choose their own definition of a “small business,” initially setting the size of the small group market at either one to 50 or one to 100 employees. In 2015, employers with 100 or fewer employees can participate in a Small Business Health Options Program, or SHOP. Beginning in 2017, states may also allow employers of any size to purchase coverage through the Exchange.
What do you think about the new healthcare Exchanges? Check back on the second Thursday of each month as we discuss the Affordable Care Act and what it means to you. For questions about the Affordable Care Act, contact a Neace Lukens representative.
As part of Neace Lukens’ commitment to educating our clients on Affordable Care Act changes, we offer monthly webinars through Proskauer law firm to provide insight. Click here to watch the latest webinar for tips on navigating Affordable Care Act fees, penalties and taxes.
This post is not intended to be exhaustive, nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.
*State exchange information from InsuranceJournal.com.
Two Neace Lukens Agents Named 2013 Risk & Insurance Power Broker Winners!
Author SchaeferL
Todd Hester and Bill Sullivan are 2013 Power Brokers
Todd Hester and Bill Sullivan have been named 2013 Power Brokers by Risk & Insurance magazine in the employee benefits category. Power Broker winners are selected based on their dedication to clients, and willingness to go the extra mile to provide a service to clients. Todd and Bill’s clients were each faced with obstacles that they were able to overcome, with help from Todd and Bill.
Todd Hester is an employee benefits specialist in the Neace Lukens Bowling Green, Ky. office. Todd received his Power Broker award for his work with a Toyota plant in Kentucky that was looking at mass layoffs when the global automotive supply chain was disrupted due to the tsunami that struck Japan in March 2011. Todd’s diligence helped the plant save jobs by cutting costs from the plant’s health care program by moving to a high-deductible health savings account and an increased focus on employee wellness. Over the past year, the plant’s loss ratio has plummeted from 110 percent to 72 percent.
Bill Sullivan is managing director of the Neace Lukens Columbus, Ohio office. Bill received his Power Broker award for his work with Big Sandy Superstore, an organization that was facing a 32 percent increase in its health care premiums. Bill worked with the carrier to create a high deductible plan that moved single deductibles up to $25,000 and family deductibles up to $50,000. The plan was supported by the creation of a captive that was used to cover the expenses the company was incurring by contributing to an employee health fund. To date, Bill has saved Big Sandy Superstore more than $700,000 and has introduced a wellness initiative that is running at a flat claim cost basis.
Todd and Bill are two of the twelve agents recognized for the 2013 Power Broker Award in the employee benefits category in Risk & Insurance magazine. Congratulations to Todd and Bill on this achievement!
Small Changes to Eating Habits Can Save You Money in Health Care Costs
Author RankinJ
Developing healthy habits for life requires time, dedication and practice. It’s easy to get caught up focusing on the fitness side of health, with exercise programs and gyms sprinkled throughout many towns and cities. However, getting healthy takes more than exercise alone. Weaving healthy eating patterns into your diet can improve your quality of life and cut your health care expenses – now and in the future.
Making small changes to your diet is a big step toward both physical and financial health. Here are some easy ways to improve your diet and keep more money in your pocket:
- Eat breakfast
Jump-start your day with a piece of fruit and a high-fiber grain, like cereal or toast, within the first two hours of waking up to curb binge eating throughout the day. Breakfast eaters consume more healthy nutrients and less fat and cholesterol than non-breakfast eaters, which can reduce the risk of heart disease. - Cook at home
Home-cooked meals usually have fewer calories and are served in more reasonable portions. As a bonus, home-cooked meals also cost less than a typical restaurant meal. - Say no to sodas
Sugary drinks, including sports drinks, are high in calories. Replace one sugary drink per day with a glass of water to save money and cut back on sugar and calorie intake. - Limit condiments
Toppings, like salad dressings, cheese and cheese sauces, tartar sauce, gravy, butter and guacamole can add excess fat and calories to seemingly healthy foods. Limit your use of these “extras” to reduce fat and calorie intake.
These small steps can go a long way toward creating healthy habits, and can save you money on your health care costs. Neace Lukens offers wellness programs for every organization to promote healthful living and work productivity. To learn more about wellness in the workplace, or to contact an agent, visit Neace Lukens Employee Benefits.
Todd Hester Selected as a Finalist in the 2012 Transition Awards Program
Author RankinJ
Neace Lukens employee benefits specialist Todd Hester was recently named a finalist in the 2012 Vision Benefits Broker of the Year Award by Transitions Optical, Inc. Todd was selected for the award based on his unique approach in discussions with HR clients to integrate the preventative aspect of medical benefits with preventative care for employees’ eyes.
Nominees for the Transition Awards Program were evaluated on the following criteria:
- Promotion of vision benefits: positioning vision benefits as an integral part of the overall health benefits offering
- Promotion of vision wear: highlighting the vision wear elements of vision coverage to customers and recommending vision plans that include photochromatic lenses
- Education: educating about the importance of quality eye care and eyewear and promoting healthy sight and the connection between the eye and overall health
- Sales: leading their respective market in the Blue View Vision promotion and sales
Neace Lukens works with carrier Anthem Blue View Vision/Anthem Blue Cross and Blue Shield and Transitions to offer a vision plan that fully covers Transition lenses for children and provides them at a discounted rate for adults. To learn more or contact an agent, visit Neace Lukens Employee Benefits.
Congratulations to Todd on this achievement!
What Neace Lukens Can do for You: Employee Benefits
Author RankinJ
An effective employee benefits program goes beyond the one-size-fits all solution. The right employee benefits program for your organization should represent your company’s goals, support your company’s culture and provide tangible benefits to your employees. The right benefits program should be the perfect fit for your organization to keep your current employees happy, healthy and productive, and to attract quality employees in the future.
Our group of passionate employee benefits professionals work with large and small organizations to design benefits programs that are completely tailored to each organization – ensuring that it’s the perfect fit. We start by working with you to develop strategic objectives together, then analyze the impact of your current programs and work with you to develop a customized program based on our analysis and your company goals. Whether it’s medical, dental, vision, or ancillary benefits, Neace Lukens works with carriers to find the right program for you. Once your organization selects its benefits plan, our custom corporate communication services can work with you to make sure employees understand each and every one of their benefit options.
Offering a comprehensive, personalized employee benefits insurance program is essential for ensuring the health and success of your employees – both now and into the future. What do you think is the most important part of your employee benefits program? To learn more or to contact an agent, visit Neace Lukens Employee Benefits.
A Look at the Affordable Care Act: 2013 Reforms
Author RankinJ
*Each month Neace Lukens will discuss a different aspect of the Affordable Care Act. Stay tuned for more updates on the second Thursday of each month. 
When the health care reform bill, or Affordable Care Act, was signed into law by President Barack Obama in 2010, extensive changes to the U.S. health care system were not far behind. These reforms are intended to reduce the uninsured population and decrease health care costs. Significant changes to health plan administration, and fees and taxes are coming in 2013, and will impact both employers and individuals. Here’s what you can expect from Affordable Care Act reforms in 2013:
Changes to Health Plan Administration:
- Administrative Simplification
In 2013, health plans must adopt and use uniform standards and operating rules for the electronic exchange of health information. This step will reduce both paperwork and administrative burdens and costs. - Limiting Health Flexible Savings Account Contributions
The Affordable Care Act limits the amount of salary reduction contributions to health FSAs to $2,500 per year for plans beginning after Dec. 31, 2012. - Employee Notice of Exchanges
Employers must provide a notice to employees regarding the availability of the health care reform insurance exchanges. The Department of Labor expects that the timing for distribution of notices will be the late summer or fall of 2013, which will coordinate with the open enrollment period for Exchanges. - HIPAA Certification
Employers with group health plans must certify that their plans comply with certain HIPAA rules on electronic transactions by Dec. 31, 2013.
Changes to Fees and Taxes:
- Eliminating Deduction for Medicare Part D Subsidy
Employers that receive the Medicare Part D retiree drug subsidy may currently take a tax deduction for their prescription drug costs and costs attributable to the subsidy. The deduction for the retiree drug subsidy will be eliminated in 2013. - Increased Threshold for Medical Expense Deductions
The Affordable Care Act increases the income threshold for claiming the itemized deduction for medical expenses from 7.5 percent of income to 10 percent. Individuals over 65 would be able to claim the itemized deduction for medical expenses at 7.5 percent of adjusted grown income through 2016. - Additional Medicare Tax for High Wage Workers
The Affordable Care act increases the Medicare hospital insurance tax rate by 0.9 percent on wages greater than $200,000 for an individual or $250,000 for a married couple filing jointly. The tax is also expanded to include a 3.8 percent tax on net investment income in the case of taxpayers earning more than $200,000, or $250,000 for a joint return. - Medical Device Excise Tax
The Affordable Care Act establishes a 2.3 percent excise tax on the first sale for use of a medical devise. Eye glasses, contact lenses, hearing aids and any type of a devise that is generally purchased by the public at retail for individual use are exempted from the tax. - CER Fees
For plan years ending on and after Oct. 1, 2012 and before Oct. 1, 2019, self-insured plans and issuers must pay fees per covered life. The initial fee is $1 per covered life, increasing to $4 per covered life for plan years ending on or after Oct. 1, 2013. This will be adjusted annually for later plan years. The first possible payments are due on July 31, 2013.
What do you think about the changes to health care in 2013? Check back on the second Thursday of each month as we discuss the Affordable Care Act and what it means to you. For questions about the Affordable Care Act, contact a Neace Lukens representative.
This post is not intended to be exhaustive, nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.
American Heart Month: Reduce Your Risk of Heart Disease
Author RankinJ
February is American Heart Month, and a great time to think about how your habits could be affecting the health of your heart. Heart disease is the leading cause of death in the United States, according to the Centers for Disease Control and Prevention, with one of every three deaths caused by heart disease and stroke. Heart disease is an umbrella term that covers many types of heart and blood vessel diseases, including cardiovascular disease, coronary artery disease, infections and more.
Here are a few ways to keep your heart healthy and reduce your risk of heart disease:
- Eat smart
Heart healthy meals consisting of fresh fruits and vegetables can keep your heart strong. The CDC recommends choosing foods that are low in saturated fat, trans fat and cholesterol and high in fiber to help prevent high blood cholesterol. Along with increasing the number of fresh fruits and vegetables in your diet, limiting your sodium intake can help lower your blood pressure. - Break a sweat
The CDC suggests at least 30 minutes of exercise most days of the week for adults to keep your body at a healthy weight. Regular exercise can keep your heart fit by lowering cholesterol levels and blood pressure. Exercise can make it easier to maintain a healthy body weight and reduce your risk of heart disease. - Know your numbers
Learn to understand your blood pressure reading and what the numbers really mean. Blood pressure readings are made up of two numbers, a systolic number and a diastolic number. According to the American Heart Association, systolic is the top number of the ratio and should be a higher number. Systolic measures the pressure in the arteries when the heart beats. Diastolic is the bottom number of the ratio and should be the lower of the two numbers. Diastolic measures the pressure in the arteries between heartbeats. A solid understanding of your current blood pressure reading compared to where you should be helps monitor for signs of heart disease.
These tips can reduce your risk of heart disease and keep your health expenses down. The CDC reported that cardiovascular disease cost the nation more than $444 billion in health care expenses and lost productivity in 2010. Looking to promote healthy living at your workplace? Visit the Neace Lukens website to learn more about our Health and Productivity Management solutions.