Current Healthcare News

• Religious Freedom Protection and Civil Union Act / June 1, 2011

  Signed by Governor Quinn on January 31, 2011, the Religious Freedom Protection and Civil Union Act (Public Act 96-1513, the "Civil Union Law") will allow both same-sex and different-sex couples to enter into a civil union with all of the obligations, protections, and legal rights that Illinois provides to married heterosexual couples.   The Civil Union Law becomes effective on June 1, 2011. Click here for more information on the law or contact your BSG representative.

   

• Medicare Part B - Revised Model Creditable and Non-Creditable Coverage Notices / May 20, 2011

  CMS recently posted on its website revised model creditable and non-creditable coverage notices. These new notices must be provided to Medicare Part D eligible individuals on or after April 1, 2011. The changes in the notices reflect the change in the Medicare Part D annual coordinated election period from its prior November 15 - December 31 timeframe to its new October 15 - December 7 timeframe.
  
  This change in the election period was made under health care reform and reflects recently issued regulations. The change applies beginning with plan year 2012-i.e., beginning with the 2011 election period.
  
  These revised model creditable and non-creditable coverage notices replace the model notices that were posted in 2009.
  
  
   

• President Signs 1099 Repeal Into Law / April 15, 2011

  President Obama signed legislation Thursday, April 14 repealing the expanded 1099 reporting requirements in the health care reform law and Small Business Jobs Act.
  
  Congress succeeded in repealing the 1099 requirements earlier this month after numerous votes on competing versions of the legislation. The widely unpopular rules would have required businesses to report any purchases of goods or services of more than $600 a year from another vendor to the IRS on a Form 1099-MISC.
  
  “This is a big win for small businesses,” wrote SBA Administrator Karen Mills in a blog post. “The SBA and President Obama supported repealing this provision, which would have required businesses to send 1099 forms for all purchases of goods and services over $600 annually. With this bipartisan effort, we have removed a requirement that would have been an undue barrier to small business growth. The many benefits of the health reform law for small businesses remain in place. These tools are already helping small business owners find more affordable and accessible coverage for themselves and their employees.”
  
  House Ways and Means Committee Chairman Dave Camp, R-Mich., praised the repeal. “After nearly a year-long battle to repeal the onerous 1099 provisions enacted by Democrats, I am pleased the President has now signed their repeal into law,” he said. “On the eve of Tax Day, small businesses can finally breathe a huge sigh of relief that one of the many burdens the Democrats’ health care law would have placed on them has been repealed. Instead, small businesses can focus more of their energies and resources on creating jobs, not filling out yet another form for the IRS.”
  
  — Written by Michael Cohn.  Cohn writes for Accounting Today, a SourceMedia publication.
  

• Healthcare Spending Addressed In Long-Term Deficit Reduction Plans / April 15, 2011

  In a speech Wednesday, President Barack Obama unveiled his deficit reduction plan, which included several measures that seek to address health care spending. According to a White House fact sheet, the President's plan will build on policies put in place by the Affordable Care Act (ACA) and would save an additional $340 billion by 2021, $480 billion by 2023 and at least an additional $1 trillion in the subsequent decade.
  
  The House Budget Committee released the GOP deficit reduction proposal last week, which President Obama has said he will oppose. Both the President's and GOP’s proposals have indicated that their deficit reduction plans include Medicare and Medicaid spending cuts.
   

• Federal Budget Deal Targets ACA Measures / April 15, 2011

  Late last Friday night, a bipartisan budget agreement was reached to avoid a federal government shutdown. The agreement is now known as H.R. 1473. If H.R. 1473 becomes law, it would continue to fund the federal government through the end of the fiscal year (Sept. 20, 2011), and according to the latest Congressional Budget Office's estimate, would cut between 20 to 25 billion dollars in spending over the next 10 years.
  The package went to Congress for passage this week as H.R. 1473. The bill was passed by both the House of Representatives and Senate yesterday. It now goes to the White House for the President's signature.
  
  The budget agreement contains several provisions that would affect the ACA. Most notably, H.R. 1473 would:
  
  1. Eliminate ACA's Free Choice Voucher program
  H.R. 1473 repeals the health benefits exchange-related Free Choice Voucher program that would have allowed employers to provide vouchers for eligible employees to use in purchasing health insurance coverage on a health exchange beginning in 2014. They are different from the premium tax credits and cost-sharing subsidies that will be provided by the federal government to individuals purchasing health insurance coverage on a health exchange.
  
  Proponents of the Free Choice Vouchers believe that the vouchers provide eligible employees with more choice and flexibility, increase competition, and reduce costs. Opponents believe they are too costly for employers, especially those that offer both low-cost and high-cost coverage, or employ large numbers of younger employees who do not make large salaries. They also say the vouchers have the ability to create adverse selection, which could increase employer costs.
  
  2. Reduce $2.2 billion in funding for ACA's CO-OP Program

  The Consumer Operated and Oriented Plan (CO-OP) program of the ACA directs the federal government to support the creation (through issuance of federal loans and grants) of member-owned, nonprofit insurers (CO-OPs) that will offer qualified health plans on the exchanges and possibly in the off-exchange individual and small group markets. Some $2.2 billion of the $6 billion in appropriated budget for the (CO-OP) will be permanently cut.
  
  3. Require auditing, reporting on various aspects and effects of ACA
  
  H.R. 1473 directs the General Accounting Office, the federal government's "watchdog" over how taxpayer money is spent, to issue a report on ACA implementation; to perform an audit of requests for essential health benefit annual limit waivers; and to audit the comparative effectiveness research funding (comparing the effectiveness of different treatments for the same illness).
  In addition, the bill directs the Chief Actuary of CMS to conduct an actuarial analysis of projected premium impacts as a result of a number of the ACA provisions, including guaranteed issue, guaranteed renewability, and community rating.
   

• Employee Notification - Affordable Care Act / September 13, 2010

  Group Plan Administrators - Your health plan renewal includes changes required by the Patient Protection and Affordable Care Act effective for plan years on or after September 23, 2010.   Click here to read more.

• Illinois Pre-Existing Condition Insurance Plan (IPXP) / August 31, 2010

  The federal health reform law, known as the "Affordable Care Act", establishes a federally funded temporary high risk pool to provide affordable health insurance coverage to people who have been denied insurance because of pre-existing conditions.  The Illinois Pre-Existing Condition Plan (IPXP) will be a transitional insurance program for uninsured Illinois residents.

  IPXP - Frequently Asked Questions
  Premium Rate Table Instructions

• Rules Released on External Appeal Process / August 23, 2010

  The Obama Administration is announcing both new regulations to empower consumers to appeal decisions made by their health plans or insurance companies and the availability of resources that will be used to help give consumers more control of their health care decisions. These provisionsof the Affordable Care Act will help support and protect consumers and help end some of the worst insurance abuses.

  The new appeals regulations were issued by the Departments of Health and Human Services (HHS), Labor, and the Treasury.  Consumers in new health plans in every State will have the right to appeal decisions, including claims denials and rescissions, made by their health plans.  This includes the right to appeal decisions made by a health plan through the plan's internal process and, for the first time, the right to appeal decisions made by a health plan to an outside, independent decision-maker, no matter what state a patient lives in or what type of health coverage they have.

  For more information about the new appeals regulation or Consumer Assistance Grants program, click here. 

• New Employer Form W-2 Health Insurance Reporting Requirements / July 30, 2010

  The Patient Protection and Affordable Care Act (PPACA) adds a new reporting requirement aimed at improving health care transparency and cost awareness by requiring employers to report the value of employees’ health benefits on Form W-2s. 

  Click here to view full document

   

   

• Required First Dollar Coverage for Preventive Services / July 19, 2010

  The Patient Protection and Affordable Care Act (PPACA), as modified by the Health Care and Education Reconciliation Act of 2010 (HCERA) (collectively the “Act”), requires all group health plans to comply with certain mandates, although some of these mandates only apply to non-grandfathered plans. This issue focuses on the Act’s requirement that all non-grandfathered plans provide first dollar coverage for preventive services. Recently released interim final rules clarify the meaning of “preventive services” and provide other information important to sponsors of non-grandfathered plans.
  
  First Dollar Coverage for In-Network Preventive Services
  
  The interim final rules require non-grandfathered group health plans to provide first dollar coverage for certain in-network preventive services. This means plans must cover and pay all costs of those in-network preventive services with no additional cost to the participant (i.e., no cost-sharing, copayment or coinsurance). Specifically, the rules require coverage for four categories of preventive services:

  • Services rated “A” or “B” by the U.S. Preventive Services Task Force (USPSTF)1
  • Immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention
  • Preventive care and screenings for children as recommended by the Health Resources and Services Administration
  • Preventive care and screenings for women as recommended by the Health Resources and Services Administration
    
    
    The recommendations of these groups cover pages of preventive services, including such services as mammograms, colonoscopies, cancer screenings, blood pressure tests, counseling to quit smoking, health checkups, and immunizations for children. Click here for a complete list of services.
     
• Affordable Care Act - Model Notices / June 29, 2010

  As part of the Affordable Care Act, the Department of Labor’s Employee Benefits Security Administration has posted the following three model notices that must be distributed to employees by the first day of the first plan year after September 23, 2010.
  
  Patient Protection
  Lifetime Limit No Longer Applies and Enrollment Opportunity
  Opportunity to Enroll in Connection with Extension of Dependent
   

• Grandfathered Plan Requirements / June 22, 2010

  New Healthcare Reform law establishes that individual and group plans that were in place on March 23, 2010 will not have to comply with all of the new law's insurance market provisions.  No new policies sold after March 23, 2010 will be considered grandfathered.  Need more details?  Click here to read more from our friends at the National Association of Health Underwriters.

• Scammers Use Promise of Medicare Rebate Checks to Steal Personal Information / June 11, 2010

  The Kaiser Family Foundation reported in its Health News that the Illinois Attorney General is warning that scammers are trying to trick Medicare-eligible seniors into revealing personal information in order to get a rebate check. "The first $250 rebate checks are being mailed this week to seniors in Medicare's drug coverage gap, known as the 'doughnut hole.'" The checks are being sent out automatically, so any request for information is a con (6/10).
  
  "Federal officials say they're already hearing reports that scam artists have called seniors and other Medicare beneficiaries, telling them they need to provide personal information to get the checks — including Medicare, Social Security or bank account numbers," the Chicago Sun-Times reports. "Not true. Seniors don't need to provide any personal information. The checks are being mailed automatically to eligible Medicare recipients" (Thomas and Knowles, 6/10).
  
  For the full story, click here.

• IRS Gives Guidance on Small Business Tax Credit / May 17, 2010

  The Internal Revenue Service issued new guidance to make it easier for small businesses to determine whether they are eligible for the new health care tax credit under the Affordable Care Act and how large a credit they will receive. The guidance makes clear that small businesses receiving state health care tax credits may still qualify for the full federal tax credit. Additionally, the guidance allows small businesses to receive the credit not only for regular health insurance but also for add-on dental and vision coverage.
  
  In general, the credit is available to small employers that pay at least half the cost of single coverage for their employees in 2010. The credit is specifically targeted to help small businesses and tax-exempt organizations that primarily employ moderate- and lower-income workers.
  For tax years 2010 to 2013, the maximum credit is 35 percent of premiums paid by eligible small business employers and 25 percent of premiums paid by eligible employers that are tax-exempt organizations. The maximum credit goes to smaller employers -- those with 10 or fewer full-time equivalent (FTE) employees -- paying annual average wages of $25,000 or less. The credit is completely phased out for employers that have 25 FTEs or more or that pay average wages of $50,000 per year or more. Because the eligibility rules are based in part on the number of FTEs, not the number of employees, businesses that use part-time help may qualify even if they employ more than 25 individuals.
  
  Eligible small businesses can claim the credit as part of the general business credit starting with the 2010 income tax return they file in 2011. For tax-exempt organizations, the IRS will provide further information on how to claim the credit.
  
  For a copy of Notice 2010-44, go to:
  http://www.irs.gov/pub/irs-drop/n-10-44.pdf
  
  For a copy of the step-by-step guide, go to:
  http://www.irs.gov/pub/irs-utl/3_simple_steps.pdf
  
  For a copy of the answers to frequently asked questions, go to:
  http://www.irs.gov/newsroom/article/0,,id=220839,00.html
  
  All are found on the Affordable Care Act page:
  http://www.irs.gov/newsroom/article/0,,id=220809,00.html
   

• Young Adults and the Affordable Care Act: Protecting Young Adults and Eliminating Burdens on Families and Businesses / May 10, 2010

  The United States Department of Labor just released:   The Affordable Care Act allows young adults to stay on their parents' health care plan until age 26. Before the President signed this landmark Act into law, many health plans and issuers could and did in fact remove young adults from their parents' policies because of their age, leaving many college graduates and others with no insurance. This helps to explain problems like:

  read more

• Impact of Healthcare Reform on Dental Benefits / May 3, 2010

  Since the Patient Protection and Affordable Care Act was signed into law, those throughout the health care system, as well as the media, have been primarily focused on the near-term impact that reform will have on individual and group medical benefits. What hasn't received as much coverage is how dental benefits will ultimately be impacted by the new reform law.
   

  Read more

• COBRA Premium Reduction / April 16, 2010

  FACT SHEET:  (U.S. Department of Labor)  The American Recovery and Reinvestment Act of 2009 (ARRA), as amended, provides for premium reductions for health benefits under the Consolidated Omnibus Budget Reconcilation Act of 1985, commonly called COBRA.  The premium assistance is also available for continuation coverage under certain State laws.  "Assistance Eligible Individuals" pay only 35% of their COBRA premiums; the remaining 65% is reimbursed to the coverage provider through a tax credit. 

  Read more

• FREE Healthcare Reform Webinar! / April 15, 2010

  Attention business owners and executives!  Do not miss this FREE informational (previously recorded) webinar; it’s your chance to learn more about the key elements of healthcare reform and how it will affect your business.
  
  Larry Grudzien, Attorney at Law, gave a thorough presentation on April 15, 2010.  Click here to register for a link to this interesting webinar.  Larry has over 28 years of experience; he practices exclusively in the field of employee benefits including experience in qualified plans, health and welfare, fringe benefits and executive compensation areas. Larry brings insight to business owners on the specific effects healthcare reform may have on their business.

  Learn more about:

  • The overall $940 billion plan is projected to extend insurance coverage to roughly 32 million additional Americans.
  • All individuals not covered by Medicaid or Medicare are required to obtain health care coverage or pay a penalty.
  • Larger employers must offer health care insurance for employees or pay a tax penalty (to the tune of $2,000 per full-time employee, excluding the first 30 employees)
  • There will be a new health insurance exchange for uninsured and small businesses
  • Medicaid will be expanded to 16 million people Insurance companies can no longer deny coverage for pre-existing conditions
  • Young adults will be able to stay on their parent’s plan until age 26
  • Insurance companies cannot place a lifetime cap on health care benefits

  If you have any additional questions about this webinar or the registration process, please contact Yana Kaykov at 630.371.6212.
   

• A Timeline of When Health Care Reform May Affect You / March 23, 2010

  (CNN) -- President Obama signed sweeping health care reform into law this week.  The Senate must now pass a package of changes that will reconcile the differences between Senate and House bills.   If those changes are worked out, here is how health care reforms will affect you:

  Within the first year

  read more

• Will You Be Penalized in Taxes as Part of the New Law? / March 24, 2010

  Tax season is here! This is a friendly reminder that employees who added dependents under the Illinois Public Act 95-0958 (that went into effect on June 1, 2009) may incur additional taxable income. As you may know, only certain dependents may qualify to receive employer-provided health coverage on a tax-free basis. If coverage is provided to a dependent who does not meet the IRS definition of a “qualified tax dependent” (per Sections 152 and 105(b) of the Internal Revenue Code), federal income and payroll tax consequences will result. In addition to post-tax payroll deduction, the employee will incur additional taxable income.
  
  If you find yourself in this situation, the amount of income on which the tax is calculated is determined by the fair market value of the employer-provided health benefits for the non-tax qualified dependents. This income will be subject to income withholding and payroll taxes such as Social Security and Medicare. Also mentionable: health care expenses for non-tax dependents are not reimbursable under a health care flexible spending account.
  
  Please remember to consult with your accountant, as soon as possible, if you may be in the aforementioned situation.
   

• Obama Signs Stopgap COBRA Subsidy Extension / March 3, 2010

  WASHINGTON-President Obama Tuesday night signed into law legislation that provides a stopgap, 31-day extension of federal subsidies of COBRA health care premiums.
  
  The measure was approved earlier Tuesday by the Senate on a 78-19 vote, while the House cleared it last week.
  Under H.R. 4691, the 65%, 15-month premium subsidy for laid-off workers is extended to those involuntarily terminated from March 1 through March 31.
  
  Without the extension, employees laid off after Feb. 28 would have been ineligible for the subsidy.  The measure also will allow employees to receive the subsidy if they first lost group coverage due to a reduction in hours and then were terminated after enactment of the legislation, if certain conditions are met.
  
  Meanwhile, the Senate Wednesday will continue consideration of legislation, H.R. 4213, that would extend the premium subsidy to employees laid off through Dec. 31, 2010.
   

• Go Red for Women This February / February 10, 2010

  The American Heart Association is offering a free 12 week makeover program (Better U) that can change your life. The program features an online nutrition and fitness program. Each week focuses on a different area and provides step-by-step guidance. Click here for more information.

• New COBRA Subsidy Extension Notices Available / January 14, 2010

  ARRA, as amended by the Department of Defense Appropriation Act, 2010 (2010 DOD Act), mandates that plans notify certain current and former participants and beneficiaries about the premium reduction.

  The Department created model notices to help plans and individuals comply with these requirements. Each model notice is designed for a particular group of qualified beneficiaries and contains information to help satisfy ARRA's notice provisions, including those added by the 2010 DOD Act.

  read more ...

• The Importance of an Annual Exam / January 1, 2010

  Annual physical exams are a vital part of a preventative illness measure taken to ensure a long and healthy life for you and your family. Parents often make certain their children receive an annual exam, however exams become increasingly important into adulthood. Nothing can replace the importance of daily exercise, maintaining a healthy weight and not smoking, but health professionals can use an annual exam to keep abreast of signs and symptoms that could lead to a serious illness.

  read more ...

• COBRA Subsidy Extension Passed / December 16, 2009

  On December 16, 2009, the U.S. House of Representatives approved legislation extending the federal subsidy of COBRA health insurance premiums for employees who are involuntarily terminated. For beneficiaries whose nine-month COBRA premium subsidy has run out, an additional six months of subsidized coverage will be provided. This will apply to those who lose their jobs through Feb. 28, 2010.
  
  Also, the legislation will give beneficiaries whose subsidy ran out and who didn't pay the full premium a second chance to opt for coverage. For example, a beneficiary whose nine months of subsidized coverage ran out Nov. 30 and who didn't pay the regular unsubsidized December premium could pay the 35% premium share in January and receive coverage for December.
  
  Please note: Employers are required to notify current COBRA beneficiaries and future beneficiaries of the new 15-month premium subsidy.

  Benefits Solutions Group will keep its clients apprised of any changes as they occur. If you have any questions, please feel free to contact your Benefits Representative at 630-928-0500.
   

• COBRA and State Continuation Subsidies Ending / November 30, 2009

  The American Recovery and Reinvestment Act provided eligible COBRA and state continuation participants with nine months of subsidized premiums, beginning with the first wave on March 1, 2009. These first participants will be past their nine-month mark at the end of November 2009. They will then be responsible for paying 100 percent of their premiums beginning December 2009. For some, the increase will be a significant financial drain; particularly for those who have lost track of the nine-month end date. Subsequent waves of the nine-month subsidy period will expire for participants monthly from here on out.
  
  Employers and group administrators should anticipate an increase in calls from impacted participants concerned with the ability to pay the premiums and an increase in member terminations due to unpaid premiums.
  
  Employers currently receiving federal subsidy reports will continue to receive those reports as long as they have participants receiving the subsidy. The subsidy program will end on December 31, 2009, for any new applicants. This means, assuming there is no extension, the final wave of the nine-month subsidy period will end on September 30, 2010. The government, however, is currently considering an extension of the subsidy program. We will monitor this possibility and post any changes to our web site.
   

• H1N1 - How can employers prepare? / October 22, 2009

  According to the Center for Disease Control, if you do contract the H1N1 virus you may be ill for a week or longer.  If you are ill, you should stay home and keep away from others as much as possible.  Avoid travel and do not go to work or school for at least 24 hours after your fever is gone. 
  
  For more information on flu prevention, vaccination, and signs you should seek medical attention - click here.

• Changes to Dependent Coverage / June 1, 2009

  Effective June 1, 2009, there will be changes to the dependent coverage provision for health and dental plans issued in Illinois pursuant to the Illinois Public Act 95-0958.  All group health insurance policies amended, delivered, issued or renewed on and after June 1, 2009 and that provide coverage for dependents must allow for dependent coverage of eligible unmarried dependents up to age 26.  In the case of eligible unmarried dependents who have served as a member of the active or reserve components of any branch of the United States Armed Forces, up to age 30.  Based on this new law, full-time student status up to age 25 is no longer required and dependents who meet the definition of disabled will continue to be covered without the age limitation.
  
  If employees have any dependents who meet these criteria and who are not currently enrolled under their policy, they may elect to enroll the dependent during open enrollment.  Contact your Benefits Solutions Group representative or insurance company for more information.
   

• Insurance Coverage for Autism / December 12, 2008

  A new law (Public Act 95-1005) went into effect on December 12, 2008. If your insurance policy was issued or renewed after this date, the coverage for Autism may have changed in your policy. All individual and group policies as well as HMO contracts must include psychiatric, psychological, habilitative or rehabilitative and therapeutic care for those with Autism under the age of 21 up to $36,000 per year. Click here for more information about coverage, limits and your legal rights or read the full text of Public Act 95-1005.

• New Mental Health Parity Act / October 3, 2008

  On October 3, 2008 the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 went in to effect. The Act requires group health plans providing mental health and substance abuse benefits to ensure that coverage of these benefits is equal to the plans’ coverage of medical and surgical benefits. This Act substantially increased the mental health benefits protection afforded under the federal Mental Health Parity Act of 1996, which only require parity coverage for lifetime and annual dollar limits and did not apply to benefits for substance use disorders. Click here to read more details about the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. Click here for full text of Act.