Pardon the Interruption…
…But it’s time for a promotional break! This is an important one, because if you’re in the healthcare consulting industry or certain categories of benefits fulfillment, we just might have the lifeline you’ve been waiting for. Here goes!
We’ve said it before, and we’ll say it again: GM&A is happy to partner with other entities. Who are they? They’re benefits providers, facilitators, brokers and consultants of all types.
When we say “partner,” here’s what that means: On the front end, any partner of ours can sell its services to an employer or other large group. On the back end, we will provide the service. We’ll do the audits, we’ll worry about all the compliance and we’ll process the employee claims as they come in. We’ll even handle the Affordable Care Act regulations – a big plus in the new world of healthcare. In addition to working with brokers and consultants, we are also ready and able to help with vision benefits, pharmaceuticals and other fulfillment needs.
After attending the Dallas Fort Worth Business Group on Health (DFWBGH) last week and meeting so many potential partners at the 11th Annual Benefits & Wellness Forum, we know there is a gaping hole that only we can fill. If you are a broker, consultant or other firm that is in need of back end fulfillment, we’re the ones to call for turnkey, full service direct contracting. This is the future of healthcare service, and we know how to provide it.
GM&A had a drawing for two Apple Watches at the DFWBGH Forum and we would like to congratulate our two winners, Margret Wise from The City of Fort Worth, and Kristen Ramirez from Holmes Murphey! GM&A also would like to wish everyone Happy Holidays and a Prosperious Happy New Year!
To learn more, contact Hurb Vandenhoogen, GM&A Vice President of Corporate Accounts, at (858) 775-9170.
Another week, another news report to dismay healthcare consumers – this time, federal employees. The Washington Post reports that in 2016, enrollee premiums for federal workers and retirees will rise by 7.4 percent on average, and overall premiums will increase by an average of 6.4 percent. If those seem like small figures, think about it this way: That is the largest increase since 2011. Wow!
Fortunately, the government still pays about 70 percent of the total premium for its employees (even more for U.S. Postal Service workers, though not postal retirees). Regardless, a 7.4 premium increase is no small change. Here’s how it breaks down: Non-postal employees will pay an average of $89.59 per year more for Self Only coverage, $203.40 more per year for Family Coverage and $192.71 more for Self Plus One. For employees who switch to the Self Plus One program, their premiums will only rise by 4.9 percent – a somewhat more manageable figure. Self Plus One, however, is exclusively for earners who only need coverage for themselves and one family member (i.e. a spouse or one child).
The good news is that federal employees have a chance to turn this around for themselves. Open enrollment season for federal workers starts November 9 and continues through December 14; throughout that time, they can change plans or levels of enrollment for the following year. That means it’s the only opportunity they have to look at other plans in search of lower costs, or to switch from a family coverage plan to a Self Plus One program.
It’s important to recognize that within the averages listed above, there is a great deal of variation among health plans. For federal government employees, there are about 250 participating plans total, with each state having its own selection of plans from that pool. Rather than combing through the fine print themselves, federal personnel departments can take advantage of a direct contracting plan that utilizes the most affordable premiums on the market. If you are a federal personnel manager, a GM&A healthcare consultant will be glad to tell you more during a complimentary health plan consultation.
As we have explained before, the ACA imposes a “Cadillac tax” intended to supplement benefits for the uninsured. The idea is that by forcing employers to pay a 40% excise tax on the cost of any premium health plans they may offer employees, the ACA can be funded by employers who “can afford” to help pay for it.
Is it fair? Definitely not. And with the 2016 open enrollment season starting on November 1, this is the time for employers to make the changes they need to make in order to circumvent the Cadillac tax. In fact, GM&A is among those healthcare consultants who believe this may be employers’ last chance to make the changes that are necessary if they want to avoid this penalty.
Why is that? Because although the Cadillac tax technically stays latent until 2018, it can take years to make the required changes on the employer’s part. Adjustments to the company health plan have to be made in small increments, so as not to alarm employees. Remember, maintaining consistency in your company health plan is important for employee retention – so in order to get ready for the Cadillac tax implementation of 2018, those changes have to start now.
How do you do it? You mean, how do you start implementing changes now in the 2016 open enrollment season? First, recognize that the Cadillac tax will be imposed on health plan premiums that exceed $10,200 for single coverage and $27,500 for family coverage. This means you will want to slowly lower employee contributions and premiums, while still attempting to provide your employees with coverage that is parallel to what is currently offered. Does that sound like something you can do?
It might not – but when we introduce you to direct contracting, that’s exactly what GM&A can help you with. By negotiating directly with providers and hospitals, we create a customized health plan network for our employer clients; the result is lower premiums for the employer and consistently good benefits for employees.
The great thing about open enrollment is that it offers employers a clean slate when they need it. This is the time when enrollees have an opportunity to seek out plans with lower costs, and we can help them do it. Remember, though: The open enrollment period is November 1 to January 31. After that, employers are stuck with their current plans for another year. That’s why the early part of open enrollment is the time to start learning about your options; contact GM&A for a complimentary health plan consultation.
Getting Affordable Mental Health Coverage for Employees
Every employer is asked the question at some point: “Does our company plan cover mental health treatment?” If you’re an employer that hasn’t been asked this yet, you will be – so before you get caught in the headlights without a good answer, here’s what you need to know.
Providing affordable mental health coverage is the law, but only if physical health coverage is also provided (which it will be now, thanks to the Affordable Care Act). Many Americans do not realize that there was a law passed in 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (more commonly known as the “mental health parity law”).
The mental health parity law requires employers who provide health insurance to also cover services for mental health, behavioral health and substance-use disorders – and, it requires that coverage to be comparable to the physical health coverage provided in the plan. How do we know most Americans aren’t familiar with this law? Because the American Psychological Association reports that more than 90 percent of Americans don’t know about it.
Here’s a practical application of the mental health parity law. Say an employer-sponsored healthcare plan includes a $20 copay for office visits to a medical doctor. Under that plan, it would be unacceptable for visits to a mental health professional to require a $40 copay – because that is twice the cost. It’s not on par with the other copay (hence the term “parity”).
Additionally, the law has significantly reduced – maybe even eliminated – annual limits on the number of mental health visits allowed each year. However, employers should note that insurance companies are still allowed to impose limits on visits deemed not “medically necessary.” That’s something to keep in mind.
Because of the mental health parity law, employers need to be connected to a healthcare system that makes it easy to cover mental health treatment. Direct contracting can provide a way to do that, because it involves negotiating the lowest rates directly with providers. GM&A can do this with mental health providers the same way we do with medical service providers. Contact us today to learn more.
As the Affordable Care Act (ACA) becomes the new normal in healthcare, many employers are forgetting about the flood of penalties that may come their way over the next few years if they fall short on ACA compliance. And even those who are aware of the compliance issues they face may not be doing enough.
Some employers, understanding that ACA compliance is here to stay, are taking advantage of compliance firms and they are wise to do so. However, some ACA compliance solutions merely track and report employee health plan claims – firms that fail to handle exchange appeals, provide audit representation or deliver any of the other important services that are now necessary in the post-ACA era. Tracking and reporting are good, but those services should be the tip of the iceberg. They help employers avoid tax penalties, sure – but there’s a lot more to ACA compliance than that.
To start, ACA compliance requires accuracy. Employers, ask yourself: Does your ACA compliance solution address the following problems?
- Controlled group/common ownership
- High variable hour workforce
- Multiple payroll systems with varying data points
If they don’t, the reality is that the work they are doing on your behalf may not be accurate – and that means you may not be avoiding penalties at all. The fact is, the IRS is budgeted to hire almost 500 new full-time employees in 2016 to fulfill the “new audit requirements related to the shared employer responsibility payment.” In other words, they will be auditing companies and are already making plans to do so. Perhaps more alarmingly, the Congressional Budget Office projects that the federal government will generate $9 billion in ACA compliance penalties from employers alone in 2016.
So when you are searching for an ACA compliance solution, make sure you look beyond the slick website and promises of monthly reports. You need a compliance firm that has experience in all aspects of employer health plan maintenance, both before and after the ACA. Compliance requires knowledge, and GM&A has it. To learn more, contact us today!