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Healthcare Reform

The Patient Protection and Affordable Care Act (PPACA) is the most important legislation to pass in the history of our industry and has changed the world of health insurance forever. For the better part of half a decade, our brokers and staff have studied the law and kept up to date on its changes. Perhaps one of the most important aspects of our jobs is to make sure our clients understand every detail of the law and how it affects their businesses and employees. From small to large groups, and from fully insured to self-funded programs, each is different and needs to be understood on its own. We educate not only the business client but every single employee on their payroll, ensuring everyone understands how this law will affect them and their future healthcare needs.


This legislation is so massive that it comprises more than 20,000 pages, so far, and keeps growing as the law gets implemented and changed. It’s unique to you, we get that, and that’s why the best way for you as our client to get the information you need, is to just ask us because we know. So email or call us and we can schedule a time to sit down over a coffee and get you the answers to your questions.


Non Discrimination – Can an employer still have different contributions for employees, or classes of employees? Or different plans such as a management carve-out arrangement? What if the plan is self-funded versus fully insured? Large group versus small groups? We have these answers…



Reporting Requirements – This is a crucial component of the PPACA and starts in 2014. Basically every employer will have to provide the IRS and/or their employees with crucial data on the plans, enrollments, contributions, and other relevant data. Are you prepared?


Employer Mandate – The employer mandate applies on January 1, 2015 to any group with more than 100 full time employees and requires the employer to not only offer coverage but coverage that is affordable and coverage that pays for approximately 60% of covered expenses. Groups with 51-99 full time employees must comply by January 1, 2016. We have the tools to calculate whether a group is considered large or not and the timeframe a group can use to determine this important number. Whether grandfathered or not, the mandate applies. We can help…


FTE Calculation – In order to determine whether the employer mandate applies, or what type of reporting is required by your company, a calculation needs to be made of the number of full time equivalent (FTE) employees you have on payroll over a certain time period. This is a crucial calculation as it will have a direct and significant effect on what your benefits strategy is as a company. We provide this to our client on an ongoing basis. Please use our FTE Calculation spreadsheet to help with the calculation.


Are You A Small Business Under 50 Employees? – A company with fewer than 50 FTE’s is considered a small business under health care reform, and therefore the employer mandate does not apply to them. However, several other key healthcare reform provisions do, such as the requirement of essential health benefits (EHB), waiting periods, SBC delivery, and contribution strategies. We can help…


Summary of Benefits and Coverage (SBC) – A requirement of the Affordable Care Act is that every plan member receive a summary of their benefits in an easy to read format, even COBRA participants. Whether your plan is fully insured or self-funded, and regardless of size, an SBC must be sent to every member enrolling or re-enrolling at the beginning of the annual open enrollment period (not the date the plan year starts) and within 7 days for any eligible new hires or special enrollees. We supply the SBC’s for you, so all you have to do is send them via email.


ERISA Compliance - ERISA compliance is now one of the most critical areas for concern due to the PPACA and the recent aggressive auditing by the DOL/IRS. We help our clients with the communication, forms, storage, and record keeping to avoid audits and fines. For example, the Summary Plan Document (SPD) from the carrier does not have all the ERISA language required to make the benefit plan compliant, and never has, so we develop and design a WRAP Document that pulls all the ERISA requirements together for all benefits and shields the employer from large fines and excise taxes. This document as well as the Summary of Material Modification (SMM) and the Summary Annual Report (for groups over 100 employees) are also required and must be distributed to employees. The risk of not being compliant has increased dramatically with the increase in audits (a focus of the PPACA in 2015) so this is a critical area employers need to address right away.

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