Obamacare Update - Group Plans

Health Care Reform Updates

IRS Releases Final 2016 1094-B and 1095-B Forms & Instructions

Every person that provides minimum essential coverage to an individual during a calendar year must file an information return reporting the coverage. Filers will use Form 1094-B (transmittal) to submit Forms 1095-B (returns). 

Employers (including government employers) subject to the employer shared responsibility provisions sponsoring self-insured group health plans generally will report information about the coverage in Part III of Form 1095-C instead of on Form 1095-B. 

However, employers that offer employer-sponsored self-insured health coverage to non-employees who enroll in the coverage may use Form 1095-B, rather than Form 1095-C, Part III, to report coverage for those individuals and other family members.

In general, employers with 50 or more full-time employees (including full-time equivalent employees) during the prior calendar year are subject to the employer shared responsibility provisions. 

See the Instructions for Forms 1094-C and 1095-C for more information about who must file Forms 1094-C and 1095-C and for more information about reporting coverage for non-employees. 

Small employers that aren't subject to the employer shared responsibility provisions sponsoring self-insured group health plans will use Forms 1094-B and 1095-B to report information about covered individuals. 

2016 Forms and Instructions

The following forms and instructions are now available for calendar year 2016 reporting:

• Form 1094-B (transmittal)
• Form 1095-B  
• 2016 Instructions for Forms 1094-B and 1095-B

For more information, call our office at 423-292-4142 or if you are in Johnson City, Kingsport, or Bristol, just swing by for help.  

4451 North Roan Street, Johnson City, TN 37615 - In Boones Creek across from Ingles

Blue Cross to Stop Paying Brokers

When the Marketplace opened, I said that brokers like Veritas Risk Management would only get paid for 3-5 more years....Looks like I was right...

With the many carriers exiting the individual health insurance market in Tennessee and leaving Blue Cross as the only option for many, Blue Cross, who anticipates losing almost $500,000,000 since they began selling Affordable Care Act Plans, has taken the step I expected them to take.  They will not be paying brokers commission on any new policies written pushing brokers out of the picture, although Navigators will continue to get paid (click here for more on that).  If you look at the rules involved in the Affordable Care Act, you could see the writing on the wall so this is not surprising.

We entered into this market with this in mind in an effort to stand in the gap where few ventured, to help you, our friends in Johnson City, Kingsport, Bristol and the rest of the great state of Tennessee, understand and navigate through the crazy new laws in hopes that we would be able to build stronger relationships and build trust that you might allow us to serve any of your other insurance needs such as Business, Auto, Life, Home, Workers' Compensation and Employee Benefits.  

So here are the details...

1- Blue Cross will only be offering polices to people who live in 5 of the 8 regions.  They will not offer coverage to the Knoxville, Nashville, or Memphis regions.  So if you live in my region, you will be able to stay with Blue Cross.

2- They will only offer 4 plans total so you will not have much to choose from.

3- If you are getting tax credits right now, you should be OK but if you are not.... look out...

4- From the wording of Blue Cross' statements, unless there are more backstops that are put in place by the federal government (this means more federal money to keep it afloat) they may completely exit the market.  Check out my video about why the rates are going up - https://www.youtube.com/watch?v=Jds_HaOSs6o - this is not unexpected.

For more information, you can go to the Blue Cross website -

http://www.bcbst.com/why-bcbst/about-us/news-center/2017ACAplans.page

We will do our best to continue to keep you up to date on the changes going on with the Affordable Care Act and feel free to contact us if you have any questions - 423-292-4142 or Help@VeritasRM.com

Need Help with Health Insurance? Brokers to Stop Being Paid - Federal Government to Continue to Pay Navigators

Many insurance carriers announced last year that they would not pay Individual Health Insurance Brokers commission for policies issued after Open Enrollment ended.   Now, Blue Cross has just announced that they will not be paying brokers for any new policies effective January 1, 2017 or later.  However, you, the tax payers, will continue to pay Navigators, Certified Application Counselors, and Non-Navigator Assisters to assist.

You are probably asking, "What are Navigators, Certified Application Counselors, and Non-Navigator Assisters?"  When the Affordable Care Act started the Health Insurance Marketplace it created new positions- Navigators, Certified Application Counselors, and Non-Navigator Assisters- the act created a system where organizations and individuals would go through some courses and then apply for Federal grant money to open up as Navigators, Certified Application Counselors, and Non-Navigator Assisters.  They would usually get up front money to get started then they in some cases got paid per person they help.  The thing to note is that since they are paid by grant money set up by the Affordable Care Act through the Federal government, it did not impact Health Insurance Carriers and allowed them to keep more of the money rather than having to pay us as brokers out of their premium collections.  This also helped in calculating their Medical Loss Ratio.  For more info on that see my other blog post- (http://veritasrm.blogspot.com/2016/09/need-help-with-health-insurance-brokers.html).
One major thing to note here....
Almost none of these people are licensed insurance agents.  They dont have to pass any insurance tests, just a short Centers for Medicare & Medicaid Services training.  In addition, there were issues back in 2013 because many of them did not have any background checks performed and were dealing with personal information and it was creating some problems.

A Navigator is an individual or organization that's trained and able to help consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including completing eligibility and enrollment forms. These individuals and organizations are required to be unbiased. Their services are free to consumers.

A Certified Application Counselor is an individual (affiliated with a designated organization) who is trained and able to help consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including helping them complete eligibility and enrollment forms. Their services are free to consumers.

A few things to mention about Navigators, Certified Application Counselors, and Assisters-

1- They are paid by the tax payers and not the insurance carriers.  With the passing of the Affordable Care Act, in very basic terms, insurance carriers were only allowed to keep 15-20% of the premiums for profit and overhead.  In the late 1990's we were making 10-15% commission on individual health insurance policies.  Once this law was passed, carriers had to cut commissions drastically since these commissions had to be included in the 15-20% overhead.  If they had more than that, they had to give money back to the policy holders.  

2- Navigators are required to be impartial up to and including not being able to recommend a plan for someone according to the training I have had to do through the Centers for Medicare & Medicaid Services.  This means that they really only help people get online and enter information in on the applications, but if someone asks what plan would be best for them, they are prohibited from making a statement.  According to other documents, Navigators will be able to help people choose a plan but the way I read it, Certified Application Counselor will be the ones that will help people pick a plan.  

3- In 2018, Navigators will be required to give some service after enrollment.... a novel concept.... but will they get paid more for doing so?

On a search of Johnson City, TN, there were 19 Navigators, Certified Application Counselors, and Assisters and 127 Brokers with 25 miles.  I can tell you that for the past 3 years, we have been absolutely slammed trying to help people.  It will be interesting to see how much of an increase there will be in the number of Navigators, Certified Application Counselors, and Assisters in the next year.

Andrew Darlington

Veritas Risk Management - Home, Business, Auto, Life, Work Comp, Employee Benefits, and anything else that ends in insurance....

Yahoo Hacked and 4 Steps You Can Take to Protect Yourself

500 Million User Accounts Hacked in Yahoo Breach

On Sept. 22, 2016, Yahoo Inc. confirmed that 500 million email accounts had been compromised in a 2014 hack—making it one of the largest cyber security breaches ever recorded. Personal information including  names, email addresses, phone numbers, dates of birth, encrypted passwords, and unencrypted security questions and answers were stolen in the breach. Initial reports show no evidence that payment card or bank data was lost.

Click here for the rest of the article and the 4 Steps You Can Take to Protect Yourself

https://drive.google.com/file/d/0B7zFS9NbfwdXUml6Y255cjBFSjQ/view?usp=sharing

Warning if you own an older building...

Whether or not you own an entire apartment building or just one condo, it is important to be aware of your unique exposures to risks. Even if it was not built in the 1900s, you have to keep in mind that building and safety policies are constantly changing in Tennessee and most likely in your local county. Often times we are not aware of the changes until we are forced to face them ourselves. Your condo or apartment may be fine the way it is now but, if it is damaged or destroyed and you are forced to repair or rebuild it, you may begin to face rules and regulations that you never imagined. Due to new laws passed since your building was built, you may be required to provide another exit from your basement apartment, install a sprinkler system, or provide handicap accessible entrances such as an elevator or ramps. These can be expensive improvements and if you do not take them into account when purchasing protection, your may face an uncovered loss and not be able to rebuild. Your insurance provider should give you enough to restore the building to its current condition, but it may not provide you with the funds you need to meet new requirements in the area when rebuilding. Call us today at (423) 292-4142 to make sure that your investment is properly protected.

https://www.youtube.com/embed/piYDXyWLaRU

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Andrew Darlington has been a licensed insurance agent since 1997 and formed Veritas Risk Management in 2009. He has earned his Accredited Adviser in Insurance, Certified Insurance Consultant, Certified Builders Insurance Agent, and Certified Risk Manager designations. He is a graduate of King College and lives in Johnson City with his wife and children.  He may be contacted at 423-292-4142 or Help@VeritasRM.com.​

Affordable Care Act Section 1557

Update on Changes to Coverage of Gender Reassignment Surgery and Related Services

Section 1557 of the Affordable Care Act (ACA) prohibits a covered entity from discriminating in its health programs or activities on the basis of an individual's sex, as well as other factors. Most of the state BlueCross program like Blue Cross of Tennessee, Humana, United, Aetna, Anthem and almost every carrier out there is a covered entity, and subject to the prohibitions contained in 1557, as long as they receive federal financial assistance through Marketplace and/or Medicare Advantage health plans.



The Office of Civil Rights (OCR) recently expanded the prohibition on the basis of sex to include sex stereotyping and gender identity. The updated rule states:

· Members may not be denied coverage, or have coverage limited, based on their sex, including their gender identity.

· Members may not be limited or denied sex-specific health care only because the person seeking such services identifies as another gender.

· Categorical exclusions of coverage for all health services related to gender transition are inherently discriminatory.


While this rule became effective July 18, 2016, required changes to health insurance or group health plan benefit designs (e.g., cost sharing, covered benefits, or benefit limitations or restrictions) may be made on the first day of the first plan year beginning on or after January 1, 2017.

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Grace & Peace,
Andrew Darlington CRM, CIC, CBIA, AAI

***Typed qith tumbs or used voice to text soplease forgive the gramatical errora.***

Veritas Risk Management & Insurance Services
PO Box 4539 Johnson City, TN 37602
Phone- (423)292-4142

Insurers cannot deny or limit coverage based on among other things gender identity...

As I mentioned on my Facebook Live video Tuesday, we received a notice from Blue Cross Blue Shield of Tennessee letting us know about the changes that they will be required to make due to the Affordable Care Act and its rulings.

With the final regulations coming on May 18, 2016 carriers are now stating the things they must do to comply with the law.  The changes to their specific policies must be in place by January 1, 2017 when all the individual policies in Tennessee (and the whole US) renew.  Blue Cross already did this for large groups in 2016.  This is one of the many things that Blue Cross Blue Shield of Tennessee will have to do...

• Specific Requirements for Health-Related Insurance and Coverage

In administering or insuring a plan, a covered entity cannot discriminate on the basis of race, color, national origin, sex, age, or disability.  This includes the designing and marketing of benefit plans.  In addition, covered entities cannot deny or limit coverage based on the gender identity of an individual, if the service or coverage is appropriate, such as for a transgendered individual.  Covered entities cannot have blanket coverage exclusions for all services related to gender transition.

One interesting note on this....one of the things that the Affordable Care Act was supposed to do was to create competition by bringing more carriers to the market thus driving down the price.  As it stands right now, Blue Cross will probably be the only market available for individual health insurance in Washington County, Sullivan County, Johnson County, Unicoi County, Greene County, and Hawkins County.  The insurance department in Tennessee basically said that they feared that if they did not give Blue Cross their desired increase, the health insurance market may have collapsed.  I guess it is not working quite as well as hoped!

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From Blue Cross.....

Health Care Reform Update – Week of September 12, 2016

This week's edition includes information about:

• ACA Section 1557: Nondiscrimination in Health Programs and Activities

ACA Section 1557: Nondiscrimination in Health Programs and Activities

The Affordable Care Act (ACA),[1] specifically section 1557, prohibits a covered entity from discriminating in its health programs or activities on the basis of race, color, national origin, sex, age, and disability.  Final regulations were issued on May 18, 2016 implementing this section of the ACA.

Entities that receive federal financial assistance (FFA) are considered covered entities. BlueCross is a covered entity – and subject to the prohibitions contained in 1557 – because we receive FFA through our Marketplace and Medicare Advantage health plans.  Entities other than insurance companies may be covered entities subject to this rule, including hospitals, doctor’s offices, skilled nursing facilities, and others.  For issuers that are covered entities, this rule applies to all of the entity’s operations, and not only the program or activity that receives the financial assistance.

Highlights of Requirements for Covered Entities

The final rule imposes many requirements on covered entities.  Some of these requirements existed for covered entities under other civil rights laws and some are new.  Here are some highlights:[2]

• Nondiscrimination Notice and Taglines

A nondiscrimination notice and non-English taglines in at least 15 languages must be included in significant publications and communications, in physical locations, and on the home page of the covered entity’s website.

• Effective Communication for Persons with Limited English Proficiency (LEP) and Disabilities

Covered entities must take reasonable steps to effectively communicate with persons with LEP and disabilities.  This includes offering services such as oral translations and aids such as large print documents.  A covered entity’s website must also be accessible by persons with disabilities who use assistive technologies.

• Specific Requirements for Health-Related Insurance and Coverage

In administering or insuring a plan, a covered entity cannot discriminate on the basis of race, color, national origin, sex, age, or disability.  This includes the designing and marketing of benefit plans.  In addition, covered entities cannot deny or limit coverage based on the gender identity of an individual, if the service or coverage is appropriate, such as for a transgendered individual.  Covered entities cannot have blanket coverage exclusions for all services related to gender transition.

Effective Dates

Generally, the rule was effective on July 18, 2016.  However, the rule allows the notice and tagline requirements to be implemented by Oct. 17, 2016.  To the extent that health plans must be changed to conform to the rules, the rule permits benefit changes to be implemented on the first day of the plan or policy year beginning on or after Jan. 1, 2017.

What is BlueCross Doing?

BlueCross is currently implementing this rule and working in good faith to satisfy its requirements.  As a covered entity, the requirements apply to our operations, including operations related to the administration of a self-funded plan.

Beginning in October, significant publications and communications will include our nondiscrimination notice and taglines.  Because BlueCross has to comply with other regulations that require taglines, we have decided to include 20 non-English language taglines in our significant communications.

In addition, BlueCross is making some changes to our insured medical plans.  In 2016, we removed the blanket exclusion of gender reassignment surgery and related services for our large group plans.  We’ll be removing the same exclusion for individual policies and small groups for policy and plan years beginning in 2017.

For self-funded plans, BlueCross will be removing the blanket exclusion for plan years beginning Oct. 1, 2016 or later. If a self-funded plan doesn’t want to remove the blanket exclusion, it must contact its BlueCross sales or account executive. Self-funded groups with October, November or December 2016 renewals may contact their BlueCross sales or account executive to direct that the exclusion remain until the first day of their 2017 plan year.

Self-funded plans are ultimately responsible for complying with the ACA and should consult with their legal counsel as to their status as a covered entity and possible risks if they decide to continue excluding gender reassignment surgery and related services.  If a self-funded plan determines that any aspect of its benefit design is discriminatory, the plan should contact its BlueCross sales or account executive to initiate changes. BlueCross will administer the plan as the employer and/or plan sponsor directs.

For groups with the exclusion removed, gender reassignment surgery and related services will be a covered benefit subject to BlueCross medical policy.

Please contact your BlueCross field agency support team member, sales executive, or account executive for more information.

BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association.

[1] The Patient Protection and Affordable Care Act, Public Law 111-148, was enacted on March 23, 2010. The Health Care and Education Reconciliation Act, Public Law 111-152, was enacted on March 30, 2010. They are collectively known as the Affordable Care Act.

[2] This is a high-level summary of a portion of the provisions of the final rule and is not a comprehensive list.

Blue Cross Blue Shield Double Billing

​Blue Cross Blue Shield of Tennessee had a system error and auto drafted some people for their September and October premiums this month.

At this time, they are trying to determine if they are going to just credit them for next month or give a refund.

We will keep you up to date as we find out more but you can also call customer service at (800) 725-6849.​

Blue Cross Double Billing

Blue Cross Blue Shield of Tennessee had a system error and auto drafted some people for their September and October premiums this month.

At this time, they are trying to determine if they are going to just credit them for next month or give a refund.

We will keep you up to date as we find out more but you can also call customer service at (800) 725-6849.

Click Here if you would like to receive Veritas Verbum- our monthly newsletter and trivia contest

2017 Medicare Drug Cost Sharing Numbers

The portion you pay for your drugs will be going up again in 2017... shocking I know!  For all of you in Tennessee and Virginia, here is the comparison between 2016 and 2017.  If you have questions, feel free to swing by our Johnson City office.  We would love to talk to you!

September is Life Insurance Awareness Month. Is your family protected?

September is Life Insurance Awareness Month (LIAM). This industry-wide campaign from the LIFE Foundation is aimed at educating Americans about the importance of life insurance and helping them get the coverage they need.

Each year, the nonprofit Life Happens chooses a spokesperson for LIAM. In addition to having star power, the spokesperson also has personal reasons for promoting life insurance.

This year's spokesperson is professional stock car racing driver, model and advertising spokeswoman Danica Patrick. Danica has a very personal story about why life insurance is something she would never think of going without. Watch the video below to learn about it and to see why she is encouraging the 100 million Americans without life insurance to consider purchasing it.

https://players.brightcove.net/4486098250001/NyAfjYkdl_default/index.html?videoId=4924793818001

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If you think you might need life insurance (or think you don't have enough) to protect your loved ones, contact your local insurance professionals at Veritas Risk Management! We can help you find affordable coverage that gives you protection and peace of mind.

Samsung Issues Worldwide Recall of Note 7

Click here to get all the information...

https://drive.google.com/open?id=0B7zFS9NbfwdXNHBOSlo1c285TmM

Obamacare Update

A couple of very interesting things came out on the 29th about the 2018 Health Insurance Policy Requirements...

First, looks like rates are going to be increasing and probably a lot especially for kids aged 15-20) - Child Age Rating: We propose updates to the child age rating structure to better reflect the health risk of children and to provide a more gradual transition when individuals move from age 20 to 21. Specifically, we propose one age band for individuals age 0 through 14, and then single-year age bands for individuals age 15 through 20, effective for plan years or policy years beginning on or after January 1, 2018. We also propose child rating factors that, overall, are higher than the current child factor and more accurately reflect health care costs for children.

Second, the deductibles and out of pocket limits are going up.... shocking!  Annual Limitation on Cost Sharing: The maximum annual limitation on cost sharing is the product of the dollar limit for calendar year 2014 ($6,350 for self-only coverage) and the premium adjustment percentage for 2018, rounded down to the next lower $50. We are proposing a maximum annual limitation on cost sharing for 2018 of $7,350 for individual coverage and $14,700 for family coverage. 

Third, the fee that the Marketplace charges customers, yes, insurance companies have to pay a percentage of their premiums to the Marketplace for each client that they have, is staying the same.  For people in TN and other states that dont have a State Marketplace, it is 3.5%.  Here is the kicker, they are asking how much funding should be used to "ensure robust enrollment in the Marketplace."  Why do they have to do that when they have no competition and it is compulsory?  FFM User Fee for 2018: We propose to charge a Federally-facilitated Marketplaces (FFM) user fee rate of 3.5% of premium for the 2018 benefit year. This user fee rate is the same as the rate for each year from 2014 through 2017 benefit years. We propose to charge issuers operating in a State-based Marketplace on the Federal platform (SBM-FP) a user fee rate of 3% of premium for the 2018 benefit year. We also seek comment on how much user fee funding to devote to outreach and education to help ensure robust enrollment in the Marketplace.

#Obamacare #HealthInsurance #ACA

Top 4 changes to pay or play for 2016 for business owners

Transition Relief Expiration, Penalty Increases Among Notable Items

As employers continue to receive Health Insurance Marketplace notices and file appeals based on the 2015 pay or play compliance season, it is never too early for applicable large employers (ALEs)—generally those with 50 or more full-time employees, including full-time equivalent employees (FTEs), in the preceding calendar year—to begin preparing for the 2016 compliance season. With the end of the 2016 calendar year quickly approaching, employers should take a moment to review the pay or play provisions that have changed for 2016.

Transition Relief Expiration, Penalty Increases Among Notable Items

As employers continue to receive Health Insurance Marketplace notices and file appeals based on the 2015 pay or play compliance season, it is never too early for applicable large employers (ALEs)—generally those with 50 or more full-time employees, including full-time equivalent employees (FTEs), in the preceding calendar year—to begin preparing for the 2016 compliance season. With the end of the 2016 calendar year quickly approaching, employers should take a moment to review the pay or play provisions that have changed for 2016.

Top 4 Changes for 2016

1- Transition Relief Expired: The transition relief which delayed compliance with the pay or play requirements for ALEs with 50 to 99 full-time employees (including FTEs) in 2015 is now expired for employers with calendar year health plans. For ALEs with non-calendar year health plans, this transition relief, along with the transition relief for dependent coverage, continues to apply for any calendar month during the 2015 plan year that falls in 2016.

2- New Affordability Threshold: If an employee's share of the premium for employer-provided coverage in 2016 would cost the employee more than 9.66% (formerly 9.56%) of his or her annual household income, the coverage is considered unaffordable to that employee. Employers offering unaffordable coverage may be subject to a pay or play penalty.

3- Coverage Thresholds Increased: For 2016, ALEs will now be liable for a penalty if they:

• Do not offer health coverage or offer coverage to fewer than 95% (formerly 70%) of their full-time employees (and their dependents), and at least one full-time employee receives a premium tax credit; or
• Offer health coverage to at least 95% (formerly 70%) of their full-time employees (and their dependents), but at least one full-time employee receives a premium tax credit.

4- Increased Noncompliance Penalties: For 2016, the general annual penalty for ALEs that do not offer coverage or offer coverage to fewer than 95% of their full-time employees (and their dependents) is $2,160 (formerly $2,080) per full-time employee, minus up to 30 full-time employees. For ALEs offering coverage to at least 95% of their full-time employees (and their dependents), the general annual penalty is $3,240 (formerly $3,120) per full-time employee that receives a premium tax credit.