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R&R Insurance Blog

ACA Impact: Prepare for Cost Shifting in the Worker’s Compensation System

Posted by Scott Shaver

Business OwnerQuite often, I’ll get questions from employers wondering what impact the ACA will have on worker’s compensation. A recent study by the Worker’s Compensation Research Institute (WCRI) helps shed some light on what employers can expect. It’s not encouraging news.


According to the recent WCRI study, hundreds of millions of dollars in insurance claims nationally could shift from health insurers to worker’s compensation carriers.


The concept is simple. The Affordable Care Act encourages health providers to form Accountable Care Organizations that shift payment from a traditional fee-for-service model to capitated or pre-paid health insurance. As you know through experience, most worker’s compensation treatment is based on fee-for-service.


The study suggests that providers may, in some cases, have a financial incentive to categorize an injury as being work-related. In States like Wisconsin and Pennsylvania where a large percentage of workers are enrolled in capitated health plans, this case shifting could be significant.


For more information on the report, click here.


If you would like assistance with evaluating your current worker’s compensation policies and procedures to see if there are ways to strength your program, please contact me.

Topics: Workers Compensation, Health Reform, Workers comensation, Business Insurance, healthcare reform, ACA

Buyer Beware: Review Your Enrollment from Healthcare.gov

Posted by Pete Frittitta

Email_verificationBy now, the deadline for registering for individual health insurance on healthcare.gov has come and gone. However the Wisconsin Office of the Commissioner of Insurance (OCI) is warning consumers to verify the status of their health insurance. The OCI has received numerous reports of consumers enrolled in incorrect plans. Much of the confusion is coming from a technical problem dealing with the zip code: either the pulled premium rate was for the wrong area or some insurers didn’t even have plans for listed zip code. In the most extreme cases, consumers are left without coverage but may not have been informed.

What to do? Be proactive and verify your coverage:

  • Confirm you have received your enrollment materials
  • If you have NOT received your enrollment materials within the expected time frame, check the status with your agent or insurance company
  • Verify payment has been received by the insurance company
  • Review policy documents that deductibles and co-pays match what you were expecting
  • See discrepancies? Contact your insurance company immediately

Wisconsin residents, still have questions about your individual health insurance? Contact Donna Wahl.

Topics: ObamaCare, Health Reform, Healthcare.gove, Individual Health Insurance, double check

Self-Insurance Guide for Self Insuring Your Health Insurance

Posted by Resource Center

CTA-Self-Insurance-Guide-1With the onset of The Affordable Care Act (PPACA), many small employers will see their costs rise, despite successful efforts to encourage healthy habits and smart consumer choices - just another reason why smaller employers are taking matters into their own hands and self-funding. (Actually the healthier your employees, the better off your plan will be if you self-insure...here's why.)

At R&R Insurance, we get weekly inquiries about self-funding or self-insuring health insurance for their employees. This is a very hot topic right now, and we are here to help. This Self-Insurance Guide covers the basics of self insuring your company's health insurance. Download your Self-Insurance Guide here.

Recent articles about self-funding:

3 Guidelines driving small employers to self-funding
Health Benefits Continue to Be Key for Employers Despite Obamacare
How to Get, or Keep, Health Insurance if You Are Self Employed
Self-Insurance is a Loophole for Small Businesses

R&R is well versed in the self funded options available to small groups and has first hand experience transitioning small employers to partially self funded and self funded options. For more information about self funding your health insurance, contact a knowledgebroker today!

Topics: Employee Benefits, Health Reform, Business Insurance, Self Funded Health Insurance, WellCompForLife

Individual Marketplace Exchange: 41% Rate Increase for 40 Year Olds In Milwaukee

Posted by Jane Shevey

Steth_MoneyWith the onset of Obamacare and the need for individuals to make decisions about their own health insurance purchases, I thought it appropriate to share the information we received from the Wisconsin Office of the Commisstioner of Insurance, (OCI).

Taken directly from the press release dated September 3, 2013:
The Wisconsin Office of Commissioner of Insurance (OCI) has completed its initial analysis of rate filings in the individual market.

View Percent Increase Chart published by the OCI.

"While the exchange in Wisconsin will be run by the federal government, insurers wanting to offer coverage in the exchange had to file their rates with OCI. With our review of the exchange rate filings completed, we have attempted to compare what Wisconsin consumers are paying today to what plans will cost post 2014 under the new federal health law," stated Commissioner Nickel. "The truth is that comparisons are difficult because rates are going to vary based on age and where you live."

"With that said, from our analysis, it appears premiums will increase for most consumers. And, while there is no question that some consumers will have subsidies and may not pay these higher rates," Commissioner Nickel continued, "someone will pay for the increased premiums whether it is the consumer or the federal government."

Wisconsin Health Exchanges Offer Slim Pickins

How to Get, or Keep, Health Insurance if You Are Self Employed

5 Mistakes to Avoid When Buying Individual Health Insurance

7 Tips on How To Pick The Best Individual Health Insurance Coverage

Wisconsin residents: for more information about Obamacare, PPACA or individual health insurance, please contact knowledgebroker Jane Shevey.

Join our group on LinkedIn: Obamacare: Strategies for Business to Survive. We welcome you to join in the conversation with our LinkedIn group dedicated to discussions for business owners on Obamacare: Strategies for Business To Survive. Read articles, download documents, join the conversation, and add your expertise!

Topics: ObamaCare, Health Reform, Wisconsin Health Exchanges, Voluntary Benefits, Commissioner Nickel, Wisconsin Office of Commissioner of Insurance (OCI, Jane Shevey, Individual Health Insurance, PPACA, Individual Marketplace Exchange

Health Benefits Continue to Be Key for Employers Despite Obamacare

Posted by Jane Shevey

Emp Benefits Policy82% of mid-to-large size employers surveyed in a recent Towers Watson survey will continue to view health care benefits as a key element of their employee’s compensation in 2014. Despite the impending Obamacare mandates and ACA excise tax - known as the Cadillac Tax - employers continue to value health insurance benefits.

As employers move forward they will be looking to keep their plans affordable and viable - maintaining a sustainable plan amidst cost increases (5.2% increase projected for 2014). Full article on Towers Watson survey results.

Wisconsin based employers are considering a self-funding approach or adding additional voluntary benefits such as dental, vision, life insurance and disability insurance to offset any changes they may be implementing.

We've always known that offering quality health insurance coverage is a critical part of remaining competitive in today's talent marketplace. This news is just a reiteration of what I am seeing on the street when I talk to my customers and prospects. Smart, educated decisions moving forward will help curtail any pain PPACA might inflict.

For Wisconsin employers interested in self funding options or voluntary benefits for their plans, please contact me.

Topics: ObamaCare, Employee Benefits, Health Reform, Voluntary Benefits, Towers Watson, Jane Shevey, ACA excise tax, Self Funded Health Insurance, PPACA, ACA, cadillac tax

Form 720: New HRA Research Fee

Posted by the knowledge brokers

Form 720The IRS has issued a revised Form 720 (Quarterly Federal Excise Tax) that now includes a section for reporting the Patient-Centered Outcomes Research Institute (PCORI) research fees, also called the Comparative Effectiveness Research (CER) fees. The PCORI fee is listed in Part II of the form, IRS No. 133.

The first due date of these research fees (for some employers) was July 31, 2013.

The Affordable Care Act (ACA) includes a "research fee" that plan sponsors, including HRA plan sponsors, must pay on an annual basis. The research fee is referred to as the Patient-Centered Outcomes Research Institute (PCORI), or Comparative Effectiveness Research (CER) fee.

The ACA imposes this fee on insured plans and self-insured health plans, including HRAs. The research fee is temporary; it applies to plan years ending on or after October 1, 2012 and before October 1, 2019.

Applicable employers are required to report and pay the PCORI research fees annually via Form 720, due by July 31 of each year.

For more information about self-funding your health insurance plan, health care reform or basic employee benefits questions, contact knowledgebroker Les Kitzman.

Topics: Health Reform, PCORI, Self Funded Health Insurance, Form 720, ACA, CER

Wisconsin Health Exchanges Offer Slim Pickins

Posted by Pete Frittitta

Slim PickinsThe first cut of the Wisconsin Health Insurance exchange markets have been announced and it looks like slim pickins! Wisconsin's "big 3" (United Healthcare, Humana and Anthem) are not participating in the small group exchanges.

Also, keep in mind that for Wisconsin’s Exchange, we have 16 different rating regions and carriers can file for just specific ones. Carriers have until 9/15/13 to sign contracts/pull out.

Wisconsin Exchange Carriers for Individual and small group markets.

Any way you look at it - this is slim pickins for Wisconsin businesses. There are other options for avoiding the exchanges and the "taxes". More about self funding your health insurance.

Join our group on LinkedIn: Obamacare: Strategies for Business to Survive. We welcome you to join in the conversation with our LinkedIn group dedicated to discussions for business owners on Obamacare: Strategies for Business To Survive. Read articles, download documents, join the conversation, and add your expertise!

Learn how Voluntary Benefits are impacting small businesses and their ability to attract and retain employees during this time of benefit change.

Topics: Employee Benefits, Health Reform, Business Insurance, Individual Health Insurance

4 Potential Effects of The Obamacare ACA Employer Mandate Delay

Posted by Resource Center

ACA_Employer_Mandate_DelaysA major provision of the Healthcare law that would require employers to provide health insurance for their workers has been delayed until 2015. The part that is delayed: the requirement that businesses with more than 50 employees provide health insurance to their workers or pay a penalty. Businesses with more than 50 employees would have paid a fee of $2,000 per uninsured employees after the first 30 employees. The Congressional Budget Office expected those penalties to bring in $4 billion in 2014. Employer Mandate Penalties Delayed Until 2015 - legislative brief.

Jackson Hewitt Tax Service pointed out 4 potential effects of Tuesday’s announcement delaying the implementation of the Affordable Care Act's employer mandate:

  1. Fewer employers may cut employee hours in 2014. This one-year respite may make employers (e.g., restaurant and retail establishments) less likely to reduce employee hours below 30 hours per week (so as to classify such employees as part-time for section 4980H penalty calculations).
  2. Many families with children will have an unexpected benefit. For employers who offer employee but not dependent coverage, this one-year delay may also cause employers to postpone any offer of coverage to dependents. This may have a positive effect on such families for two reasons. First, children without an offer of employer-sponsored coverage may be eligible for the Children's Health Insurance Program (CHIP) if they meet the state-specific income and other eligibility requirements. Second, children without an offer of employer coverage may be eligible for the new premium assistance tax credits in 2014 even if their incomes are above the state-specific CHIP limit. Indeed, employers may be more likely to cooperate with enrollment efforts to get uninsured employees and their uninsured dependents covered under various ACA programs because they know with certainty that they will not face a penalty in 2014.
  3. States may face less pressure from business interests to expand Medicaid. Jackson Hewitt had released a report earlier this year estimating that American employers would incur $876 million to $1.3 billion in penalties in 22 states that were refusing to expand their Medicaid programs as contemplated under the ACA. Today's decision effectively removes that penalty liability for 2014. However, employers will continue to face such penalties in 2015 and thereafter in states that do not expand their Medicaid programs.
  4. The Treasury action today addresses anxiety among employers about the lack of final regulations from the IRS. While many employers with large part-time and seasonal employees embraced the flexibility afforded to them by the IRS's proposed approach, they voiced increasingly loud concerns that the IRS had yet to finalize this approach in a final rule. Indeed, the IRS has not publicly pledged to finalize these proposed rules before the major provisions of the ACA take effect in 2014. In an unexpected development late Tuesday, though, the Treasury Department effectively moots this issue for 2014.

Other key parts of the law, including the health exchanges where individuals can buy insurance, are on schedule. The exchanges will open on Oct. 1, wrote Valerie Jarrett, a senior adviser to President Obama, in a White House blog released Tuesday.

The delay also does not change the individual mandate, which requires most Americans to purchase insurance. Some consumers may receive subsidies to help them pay for the insurance depending on their incomes.

The government still encourages businesses to voluntarily begin reporting in 2014 so they will be ready for 2015. The administration is strongly encouraging employers to maintain or expand health coverage during the 2014 transition period.

Various parts of the law have taken effect since its passage in 2010, including allowing children up to age 26 to remain on their parents' insurance plans and discounts for prescription drugs for Medicare patients. More young Americans have health insurance than before the law, because of that change, and the discounts have saved Medicare recipients billions of dollars.

Consolidated Health Care Reform Resources on one site! Health Care Reform Resources

Join the discussion on LinkedIn: Obamacare: Strategies for Business to Survive

Related Articles: Health Care Reform


Topics: Employee Benefits, Health Reform, Healthcare law, Treasury delay, Obamacare Delay, ACA delay, Jackson Hewitt Tax Service, Employer Mandate delay, Affordable Care Act Delay

14 Affordable Care Act Requirements Taking Effect in 2014

Posted by Pete Frittitta

2014 calendarThere's a lot to keep track of over the next six months, so let's get right to the list. Here are 15 Affordable Care Act requirements that will become effective on Jan. 1, 2014:

1. State Health Insurance Exchanges
Each state must establish a health insurance exchange (or HHS will do so) for use by the uninsured and small employers with 100 or fewer employees (states may set the cap at 50 employees). The exchanges will offer fully insured insurance contracts that provide essential health benefits at differing levels of coverage (bronze, silver, gold, and platinum). Employees of small employers who offer health insurance coverage through an exchange may pay their employee premiums for such coverage on a pre-tax basis through the employer’s cafeteria plan.

2. State Health Insurance Exchange Tax Subsidies
Individuals who do not have affordable minimum essential coverage from their employer will be eligible for tax credit subsidies for their health insurance purchase on a state exchange if their income is below 400 percent of federal poverty level. (In 2013 the federal poverty level for a household of 1 in the 48 contiguous states is $11,490, therefore 400% of that would be $45,960.

3. Individual Mandate Tax Penalty
Individuals are required to obtain minimum essential health coverage for themselves and their dependents or pay a monthly penalty tax for each month without coverage. The monthly penalty tax is one-twelfth of the greater of the dollar penalty or gross income penalty amounts. The dollar penalty is an amount per individual of:

    • $95 for 2014 (capped at $285 per family
    • $325 for 2015 (capped at $975 per family)
    • $695 for 2016 (capped at $2085 per family)
      These dollar penalties will be indexed for inflation starting in 2017.

The gross income penalty is a percentage of household income in excess of a specified filing threshold of:

    • 1 percent for 2014
    • 2 percent for 2015
    • 2.5 percent for 2016 and later years
      In no event will the maximum penalty amount exceed the national average premium for bronze-level exchange plans for families of the same size. Minimum essential coverage includes Medicare, Medicaid, CHIP, TRICARE, individual insurance, grandfathered plans, and eligible employer-sponsored plans. Workers compensation and limited-scope dental or vision benefits are not considered minimum essential health coverage.

4. Automatic Enrollment
Employers with more than 200 employees who maintain one or more health plans must automatically enroll new full-time employees in a health plan. The employer must give affected employees notice of this automatic enrollment procedure and an opportunity to opt out. State wage withholding laws are preempted to the extent that they prevent an employer from instituting this automatic enrollment program. The final effective date will be established by DOL regulations.

5. Pre-Existing Condition Exclusion Practices Eliminated
Pre-existing condition exclusions no longer will be allowed in group health plans or individual insurance policies, not even the limited exclusions previously allowed under HIPAA. This also applies to grandfathered plans.

6. Ninety-Day Maximum Waiting Period
Group health plans and health insurance issuers may not impose waiting periods of more than ninety days before coverage becomes effective. This also applies to grandfathered plans.

7. Cost-Sharing Limits
Group health plans, including grandfathered plans, may not impose cost-sharing amounts (i.e., copays or deductibles) that are more than the maximum allowed for high-deductible health plans (currently these limits are $5,000 for an individual and $10,000 for a family coverage). After 2014, these amounts will be adjusted for health insurance premium inflation.

8. Annual or Lifetime Limits
Group health plans, including grandfathered plans, may no longer include more than restricted annual or any lifetime dollar limits on essential health benefits for participants. Limits will possibly exist in and after 2014 for non-essential benefits.

9. Wellness Program Health Plan Discount
The maximum premium discount an employer can offer under its health plan for participation in a wellness program is 30 percent. (It is possible that this could increase this maximum discount to 50 percent in the future.)

10. Coverage for Those in Clinical Trials
Insurers and health plans, unless grandfathered, may not discriminate against an individual for participating in a clinical trial. If a plan covers a qualified individual, it may not deny or impose additional conditions for participation in a clinical trial.

11. Employer Minimum Essential Coverage Reporting
All employers providing minimum essential coverage must file information with the IRS and plan participants.

12. Large Employer Health Information Reporting
Large employers and employers with at least 50 full-time equivalent employees must submit annual health insurance coverage returns to the FTEs and the IRS. The returns must certify whether the employer offers health care insurance to its employees and, if so, describe the details regarding plan participation, applicable waiting periods, coverage availability, the lowest cost premium option under the plan in each enrollment category, and other information.

13. Medicaid Expansion
The U.S. Supreme Court in effect ruled that the requirement for states to offer Medicaid benefits to all persons with incomes at or below 133 percent of the federal poverty level is optional with each state. States that participate in the expansion will receive full reimbursement of their additional Medicaid costs from the federal government until 2017. At that time, reimbursement will gradually decline to 90 percent of extra costs in 2020 and thereafter.

14. Health Insurance Nondiscrimination Requirements
Code Section 105(h) currently taxes the benefits received by highly compensated employees (HCEs) under discriminatory self-funded health plans. PPACA has extended these nondiscrimination rules to insured plans. Employers with discriminatory insured arrangements will need to consider changing them. Grandfathered plans are exempt from this rule. This new requirement was originally intended to be effective for plan years beginning on or after September 23, 2010. The effective date was postponed in 2010 until IRS publishes a notice, which has not yet been issued. The provision may not be effective in 2014 but it most likely will be.

Topics: Employee Benefits, Health Reform, Business Insurance

How to Get, or Keep, Health Insurance if You Are Self Employed

Posted by Resource Center

LadyComputerIf you're starting your own business - Good for you! It's a big leap of faith and can often times be a big hit on your pocket book. If you're leaving a full-time employer to make this move, chances are you are also walking away from your health insurance coverage - or some form of it anyway. For those that have health insurance currently, but are making the move, here are some suggestions that will help you either find health insurance or try to extend what you've got for the first year or so.

How to Get or Keep Health Insurance if You Are Self Employed

  1. Enroll on spouse's plan
    If you have an insured spouse that has health insurance, this is probably your most affordable option. On average, workers pay $4,129 toward their annual health insurance premiums. This averages to $344 a month. You'll be hard pressed to find individual health insurance for that price. (Younger workers are taking a huge increase with reform, and older workers, well, they are more risky - so your age may not get you a better price in the new age of reform).
  2. COBRA Extension
    Under the COBRA (Consolidated Omnibus Budget Reconciliation Act), employers are required by federal law to offer COBRA extensions for health and dental coverage up to 18 months for you an your dependents when you leave your job. Drawback: It's really expensive. If you have planning time before you leave, consider dropping to the lowest cost plan your company offers - when the enrollment period allows. This will at least get you a lower monthly COBRA payment.
  3. Purchase your own policy
    Be leery of websites that offer you dozens of quotes for affordable health care insurance. Sure you'll get some numbers - sometimes too many numbers. But once they have your information, you'll be hounded by a plethora of independent insurance agents all clambering for the same piece of business - yours! Health insurance rates are set by the federal government - so no one company is going to be different than the other - the real difference is service from an independent agent. An independent agent can provide free quotes and handle all of the shopping for some of the best choices and value in health care coverage. An independent agent knows the marketplace, knows the product, knows the carriers and most of all will get to know you and your needs, and protect you - that's their job. See 5 Mistakes to Avoid When Buying Individual Health Insurance and 7 tips on How To Pick The Best Individual Health Insurance Coverage.
  4. Join a professional organization that offers a health insurance benefit
    Some professional and trade associations offer health insurance with group coverage rates. If you are over 55, consider AARP.org. The National Association for the Self Employed offers insurance plans as well. Chambers of commerce or business alliances can often have a consortium offering for health care insurance too - check with your local chamber of commerce for their options.
  5. Opt to hire one person - making your own small group
    Because individual insurance is fairly expensive, some self employed people have opted to hire an additional employee to qualify them as a small business. Most independent agents like R&R Insurance can offer group premiums with 2 or more employees - this could make a significant difference in your monthly cost.
  6. Stay employed
    Probably the least desirable for someone with an entrepreneurial spirit, but the suggestion to stay employed is worth mentioning. Stay employed either with your current company or with a company that offers health insurance coverage for the minimum number of hours a week - most often times its 30 hours a week. This keeps your pocket book in line, continues coverage for your family and gives you more time to chase your dream - although a little more slowly.

For more information on insurance for self employed individuals please visit our website. R&R Insurance Services is an independent insurance agency serving all of Wisconsin. We offer businesses and families access to affordable insurance coverage with excellent 24/7 service. For more information on individual health care plans contact knowledgebroker Donna Wahl.

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Topics: Employee Benefits, Health Reform, National Association for the Self Employed, aarp.org, Business Insurance, self employed health care insurance, health care insurance for self employed, Self Funded Health Insurance, Individual Health Insurance, COBRA, Get or Keep Health Insurance, donna wahl