In response to the current conditions surrounding the COVID-19 pandemic, IRS Notice 2020-18 postpones the April 15, 2020 due date for filing federal income tax returns, deferring payments to July 15, 2020. The IRS has added information regarding this notice under “Filing and Payment Deadlines Questions and Answers” which addresses contribution extensions for those in Health Savings Account plans.
The $2.2 trillion Coronavirus Aid, Relief, and Economic Security Act (CARES) was signed into law on March 27, 2020 with the purpose of helping employees out with benefit-related items during the COVID-19 crisis. The CARES Act repeals the Affordable Care Act’s exclusion of over-the-counter (OTC) medications from the definition of “qualified medical expenses”. The bill is over 880 pages long, but to review the new rules regarding OTC provisions, see Sec. 3702 of the CARES Act.
Exciting news: Chuck Gielow received the CalCPA Distinguished Service Award! Here at CalCPA Health, CalCPA member firms have access to quality health insurance and benefit products. Chuck is one of CalCPA Health’s first Board members and was the Board Chair from 2013-2018. He is a huge advocate for CalCPA members and deserves this special recognition!
Thank you, Chuck, for all that you have contributed to the CPA profession and to CalCPA Health!
The new California Law, SB 1375, was signed by Governor Brown on September 22, 2018 and will affect many small firm’s group health insurance. SB 1375 changes the Health Insurance Code to reclassify certain small employer groups as individuals. The affected firms will have to obtain individual health insurance in 2019, rather than the small employer group plans they currently have. Individual health insurance is typically more expensive with less provider network and benefit plan choices than small group plan offerings.
Fortunately, for CalCPA members and their firms, CalCPA Health received certain exemptions from SB 1375, which generally allows us to treat the affected firms as groups, and not as individuals. Commercial carriers (Blue Shield, UnitedHealthcare, Anthem, etc.,) must comply with the new regulations and reclassify these groups as individuals.
SB 1375 defines groups that consist entirely of owners/partners, and/or W-2 employees that are spouses of owner/partners, as not eligible for group health coverage. Even though these entities may be classified as employer/employees by other regulations, (e.g. Workers’ Comp, payroll tax, etc.,) SB 1375 specifically states they do not qualify for group health coverage and may only purchase individual plans.
Anthem is taking action to help people affected by the wildfires in Lake, Mariposa, Mendocino, Napa, Riverside and Shasta counties by revising medical and pharmacy guidelines that will help ensure members can continue care and access needed prescription medications. The items pertaining to pharmacy apply to Anthem’s relationship with Express Scripts. It’s important that our members know what Anthem is doing for our members in the above mentioned areas during this critical time.
For impacted members, Anthem is:
- Relaxing time limits for prior authorization, pre-certification and referral requirements – there will be no late penalties.
- Suspending early refill limits for prescriptions.
- Allowing replacement of medical equipment or supplies.
- Extending filing deadlines for claims.
These medical and pharmacy guidelines are effective from July 26, 2018 until August 25, 2018, unless further extended.
For additional questions, members should call the phone number on the back of their membership card as associates are standing by to help.
Applies to all small employer plans in California
Two years ago the Affordable Care Act’s mandated premium rating method went into effect for small employers (under 50 employees). As of January 1, 2016, all small employers in California (under 100 employees) must be rated according to the ACA rating method. This ACA mandate applies to all insurance carriers and all groups under 100 employees in California.
- Group and individual employee premium rates may be significantly changing due to ACA’s mandated method of calculating premiums – not due to the base cost of medical insurance.
- The largest premium increases/decreases tend to be:
- Younger employees (increase) / older employees (decrease)
- Family size: one child (decrease); two or more children (increase)
- Families with children over age 21 (large increase)
- Spouse’s age higher than the employee (increase); lower than employee (decrease)
- Employees over age 65 with Medicare secondary rates (increase); Medicare primary (decrease)
- Employees in certain mandated “rating areas” (increase or decrease)
Premium Rating Rule Changes Explained
The premiums calculated under the ACA and legacy (grandmother or large group) methods can have great differences. Premium rate differences between the methods may be driven by any combination of the four rating variants detailed below.
- Age Rating. The ACA mandates that each age has its own specific rate and also mandates the relative premium cost between each age rate. This means that each employee has a birthday increase at the start of every plan year as compared to the legacy method which only had age increases when employees crossed an age band threshold (20-29; 30-40, etc.).Compared to the legacy rating method this mandate increases rates for younger people and lowers rates for the older ages. This can result in rates doubling in the younger ages. Many parents are shocked to learn that the ACA mandates a 57.5% premium increase when their 20 year old dependent child turns 21. This is true for all insurance companies.
- Family Rating. ACA mandates that each member of a family is individually age-rated and then summed to an employee total. The legacy method had four rating tiers: employee only; employee+spouse; employee+children; and family. The legacy employee+children and family rating did not consider how many or how old the enrolled children were. Under the ACA mandate, the eldest three children under age 21 in each family are age rated in addition to any dependent children age 21 and older. Families with two or more children, and older children, can see significant premium increases under the ACA method. The legacy method did not consider the spouse’s age. Employee+spouse and family categories can experience sharp differences under the ACA method if the spouse is significantly older or younger than the employee.
- Medicare Secondary. Under the legacy rating method employees over age 65 employed by groups with fewer than 20 employees were rated below larger firms because their coverage was secondary to Medicare. ACA’s age rating rules eliminate Medicare secondary rates so all 65+’s are rated the same, which causes the legacy secondary employees to have significant premium increases.
- Rating Areas. The legacy rating method had nine (9) rating areas in California. California has mandated 19 rating areas under ACA rating rules. The state did not subdivide the 9 into 19 but redrew many of the boundaries. This can create significant premium variances for certain employees that were previously in a relatively lower/higher rating area and have been assigned to relatively higher/lower premium area.
Premiums can increase or decrease, on specific employees, on dependents and on the group in aggregate. In many instances the ACA premium increases tend to affect dependent/spouse costs. Firms typically contribute relatively less towards dependent premiums which transfers much of the increase to the employee. For analyzing premium changes, firms should calculate the amount the premium increase effects their employer contribution versus the employee’s contribution. The ACA rating method can cause disruption in the employer and employee contributions based on the change to the ACA age rates. This may require companies to restructure their employer contributions to mitigate large variations in employer or employee contributions for employee only coverage.
To mitigate the rise in premiums the law has brought about since the implementation of ACA, there has been a trend of employees migrating to lower benefit (higher deductible) plans. Migrating to lower premium plans is a tactic being used by many employers and employees.
Employees with children age 21+ may look to enrolling them in a lower benefit plan in the individual market. The individual market has limited plan choices and provider networks, but these trade-offs may yield a lower premium.
If you have any ACA related questions, please email firstname.lastname@example.org.
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