Help Your Employees Understand the Individual Mandate

individual mandate imagesWith all of the Patient Protection and Affordable Care Act (PPACA) regulations, the last thing employers want to do is worry about requirements that don’t apply.  One particular regulation that doesn’t necessarily concern employers is the individual responsibility requirement (also know as the individual mandate). 

And although the employer shared responsibility requirements have been delayed to 2015, the individual responsibility requirement is still scheduled to take effect in 2014. Under the individual mandate, most people residing in the U.S. will be required to have minimum essential coverage, or they will have to pay a penalty. Many individuals will be eligible for financial assistance, through premium tax credits (also known as premium subsidies), to help them purchase coverage if they buy coverage through the health insurance marketplace (also known as the exchange). 

Employers are not required to educate their employees about their individual responsibilities under PPACA, but providing information on this component of the law is just another way to help your employees understand all facets of health care reform.

United Benefit Advisors has developed a summary of individual mandate requirements that employers may find useful. The summary includes:

  • General information on the individual responsibility requirement;
  • Eligibility requirements for premium subsidies; and
  • Penalty exemptions.

To view this summary, click here.

Real Health Care Reform

89468436Holly Parsons
VP Marketing & Business Development
The Wilson Agency

We spend so much time worrying about how heath care reform will affect our business, which provisions apply and when, how much it will cost, and on and on, that I wanted to take a moment and write about what real health care reform is all about.

I recently attended a business luncheon where the keynote speaker was the CEO of a large regional hospital.  At one point he asked the audience to hold up their hands if they could answer in the affirmative all of the following points:

  1. Exercise at least 20 minutes three times per week
  2. Don’t smoke
  3. Eat multiple portions of fruits and vegetables
  4. Wear seatbelts in a car
  5. Are at a normal Body Mass Index (BMI)

Setting aside genetics, people who practice these behaviors will generally use less health care.  Less health care usage will lead to lower health insurance premiums, among other positive benefits.  Unfortunately, only about 30 percent of us could admit that we practice these elements of healthy behavior.  As sad as this percentage is, the speaker informed us that it’s actually much better than the national average of only three percent.

But, consistently practicing healthy behaviors can be challenging, especially in our culture.  Exercising takes time, sometimes money and knowledge of the best methods and techniques. Quitting smoking is one of the most difficult things a person can do, or so I’ve heard.  Very few of us get enough fruits and vegetables.  If you ever eat out, you can see this in our culture through abundant fast food options, limited offerings of vegetables, and plates filled primarily with white starch or cholesterol-laden meat.  All of this leads to a BMI that is less than optimal.

If we want our health insurance costs to be lower, if we want to pay less at the doctor’s office, if we want to keep the government out of our business decisions, if we want to stop subsidizing other people’s health care, then we must begin the process ourselves.  Address your own unhealthy habits.  If you already have healthy habits, encourage others to do the same.  Turn off the TV and take a walk after dinner.  Learn a recipe that incorporates vegetables.  Educate yourself about weight loss or exercise.  Find restaurants that provide a good selection of healthy alternatives to high starch, high fat, and high sugared foods.  Demand that healthier food be served at conferences and business meetings.  By all means, stop smoking

Change can be hard.  For some people, it can be overwhelming to alter habits that have developed over a lifetime or longer and therefore they never try, or quit soon after they start.  But, start we must.  And continue to start, over and over until we experience the progress we need to see: lower blood pressure, normal BMIs, less medication, fewer doctor visits and sick days. 

The real health care reform isn’t going to be found through Congress, your health plan or your doctor.  Real health care reform begins and ends with you.  What will you do today to start?

The Principal 10 Best

Encourage your best clients to enter The Principal 10 Best. This prestigious national program recognizes growing companies that excel in innovation, corporate culture and providing their employees financial security. Entries are due by Aug. 30, 2013.

UBA News in the News

istockphoto newsAs the complexities of the Patient Protection and Affordable Care Act (PPACA) continue to challenge business owners and HR professionals, UBA continues to lead the industry by sharing proprietary research and analysis, often utilized by journalists and media outlets looking to help employers and consumers navigate the increasingly complex world of insurance benefits.

UBA recently launched an online News Center, intended to provide a one-stop solution for media looking for resources on health insurance and employee benefits, health care reform and business compliance information. In the first part of 2013, we have already seen significant increases in media requests, having served as a source to leading publications such as The New York Times, Money Magazine, Business Insurance, Consumer Reports, HR Executive Magazine, Employee Benefit News, and dozens more.

The News Center includes press releases, expert bios, previous media coverage, a list of popular topics requested and various ways to connect to UBA, as well as links to valuable resources, such as whitepapers and UBA’s popular PPACA Resource Center.

As the News Center is updated, new features and information will be added to showcase UBA’s extensive research and analysis tools, highlighting expertise of staff as well as our network of 2,200 experienced benefits professionals representing more than 36,000 employers.

Journalists are encouraged to subscribe to News Center updates via RSS, and can request further information by contacting Bill Olson, Chief Marketing Officer, at

A PPACA To-Do List

Checklist imageThomas Jefferson said it best: “Never put off tomorrow what you can do today.” And when it comes to the Patient Protection and Affordable Care Act, this lesson couldn’t ring more true. It’s easy to keep pushing compliance off to a more convenient time, but there are requirements that take effect later this year which demand preparation. The recent PPACA delays, while helpful in some ways, have erroneously caused many to think they can take a sigh of relief for a year.

But oftentimes the reasons for procrastination have to do with not knowing where to start. PPACA requirements are also affected by employer size, which adds further confusion.

The best approach for big projects, such as PPACA compliance, is to have a to-do checklist, especially in our environment where even something as seemingly simple as determining how many employees you have is almost incomprehensible! United Benefit Advisors has developed a PPACA Readiness Checklist that helps employers prepare for upcoming regulations. “Preparing for PPACA – A Readiness Checklist” outlines seven significant requirements, which include:

  1. All plans that ended between Oct. 1, 2012 and Dec. 31, 2012 must pay the PCORI fee by July 31, 2013.
  2. All employers covered by the Fair Labor Standards Act (FLSA) must provide a notice about the new health insurance marketplace (also called the affordable care exchange) by Oct. 1, 2013.
  3. If coverage is offered, regardless of the employer’s size, as of the start of the 2014 plan year, the plan must be updated to include several items.
  4. If the plan is not a calendar year plan, the employer should decide whether it will allow employees to make mid-year election changes to move from the plan to the exchange/marketplace, and/or to allow employees who previously declined coverage to enroll as of Jan. 1, 2014. (The IRS recently delayed the individual shared responsibility requirement for individuals who are eligible for coverage under an employer-provided, non-calendar year group health plan to the start of the 2014 plan year, so obtaining coverage by Jan. 1, 2014 is not as urgent as previously thought.)
  5. Although the employer shared responsibility/play or pay requirement has been delayed to 2015, employers should take advantage of this extra time to consider their options. Employers with 50 or more full-time or full-time equivalent employees are considered “large” and will need to offer coverage or pay penalties.
  6. If the employer is large enough that the shared responsibility requirements will apply in 2015, the employer needs to decide how it will determine which of its employees are “full-time” under PPACA. An employee is considered “full-time” if he or she works an average of 30 or more hours per week.
  7. If the employer is large enough for employer shared responsibility requirements to apply, the employer needs to decide whether it will offer coverage to its full-time employees, or pay penalties instead.

To view all the details in the guide, click here.

Smoking Attestation is on the Honor System, Like Income Reporting

By Mick Constantinou, Advisor, Employee Benefits
Connelly, Carlisle, Fields, & Nichols, A UBA Partner FirmNo Smoking image

Provisions under the Affordable Care Act allow health insurers to charge smokers 50 percent higher premiums than nonsmokers for new individual policies sold beginning in 2014.  The question now is whether the final ruling on the tobacco surcharge will have the teeth necessary to promote healthier lifestyles.

In terms of the exchange application process, applicants will only need to attest whether they are or are not a smoker without further verification.  Additionally, the final rules prevent insurers from rescinding a policy or denying coverage because someone was not “honest” about whether they are a smoker or not.  Insurers can only charge “dishonest” policyholders for any surcharge amount that should have been paid that year.

Consumer advocates weighed in on the implementation of a tobacco surcharge and indicated that charging smokers more for health insurance was counterproductive for a variety of reasons:

  • Smokers disproportionately have lower incomes, so a premium surcharge would hit them especially hard. Tax credits to help pay for health insurance cannot be used for the tobacco surcharge.  The additional cost would discourage smokers from buying health insurance.
  • The health law requires many plans to cover FDA-approved smoking cessation services as a preventive care benefit.  According to advocates, charging more means fewer smokers would be able to take advantage of the tools and services to help them quit.

In response to consumer advocates, final rules also give states the option to reduce or eliminate the variation in rates (i.e. the tobacco surcharge).  Six states and the District of Columbia have opted not to charge smokers more, according to the Department of Health and Human Services.  A few other states have limited the premium differential to less than 50 percent.

While the teeth around the tobacco surcharge may not be immediate, if the reporting verification process and systems catch up with the implementation of the exchanges, dishonestly with self reporting income and tobacco usage will have financial bites.