Free Preventative Care Under Medicare

Starting January 1, 2011, co-payments and deductibles can no longer be charged for preventive care medical services.

This reform will enable more senior citizens to get regular check-ups to help detect potential health problems. When people with heart disease, cancer, and diabetes are diagnosed earlier, faster treatment can aid in the prevention of long-term complications of treatable diseases which not only cost more in consumer dollars, but cost people their lives.

Medicare Part D “Donut Hole”

In 2010, Medicare recipients will only get a $250 rebate for prescription drugs. However, beginning in 2011, seniors on Medicare will get a 50 percent discount on brand-name drugs while in the “Donut Hole,” a gap in the Medicare Part D prescription drug coverage plan. Medicare Part D currently covers up to $2,700 per year in prescription drug payments then stops paying for medications until costs exceed $6,100. This means Medicare Part D coverage recipients are responsible for paying all their own drug costs between $2,700 and $6,100. This gap in coverage will be eliminated completely by 2020.

Insurance Company Financial Accountability

Good-bye insurance industry executive greed. Beginning on January 1, 2011, insurance companies that provide individual and small group policies will be required to spend 80 percent of their premium dollars on medical services. Previously, insurance companies could pocket high profits without being accountable for the level of services provided to their insureds, the number of rescinded (retroactively canceled) insurance policies to avoid paying and claims, and salaries that made Wall Street fat cats look poor.

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Good Afternoon Everyone:

As you know, when something interesting passes by my desk, I like to use my blast e-mail system to get the information out to all of you as soon as possible…this is such a piece. On December 17, 2010, President Obama signed into law the Tax Relief, Unemployment Insurance Reauthorization, and Job Creation Act of 2010. Click Here for the memo that provides some bullet point explanations of the highlights of the law.

Click here for more information

Happy Reading!
Kindest Regards,
John Tranchida
Van Dyk Financial Services

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Good Afternoon Everyone:

Finally, on December 2nd 2010, the Federal Government released the forms to claim the small business health care tax credit for the 2010 tax year. The release includes a one page form and instructions small employers can use to claim the credit.  Quite honestly, most of you will not qualify for the credit, which should surprise nobody.  While you should go through the forms, here is an abridged version of your ability to qualify or not.

All three of the following criteria must be met in order to qualify:

1)    The employer must cover at least 50% of the health care costs for workers based on the employee only (single) rate.
2)    The employer must have no more than the equivalent of 25 full time workers (not counting owners or family members).
3)    Employees’ average annual wages (not counting owners or family members) must be below $50,000.

If you meet the above three qualifications:

The maximum credit is worth up to 35% of the company’s premium costs in 2010 (25% for tax-exempt employers).  That rate will increase to 50% on January 1st, 2014.  Here’s the kicker…even if you meet the above 3 requirements, the credit is gradually phased out for employers with average wages between $25,000 and $50,000 and also for employers with the equivalent of between 10 and 25 full time workers.

This information is only intended as a high level guide and is not to be relied upon as actuarial, tax or legal advise.  You should seek advice from an accountant and attorney to determine how the credit may affect your specific situation.

Below is a copy of the press release.

Forms to Claim Small Business Health Care Tax Credit Are Now Available

Included in the Affordable Care Act enacted in March, the small business health care tax credit is designed to encourage both small businesses and small tax-exempt organizations to offer health insurance coverage to their employees for the first time or maintain coverage they already have.

The new guidance addresses small business questions about which firms qualify for the credit by clarifying that a broad range of employers meet the eligibility requirements, including religious institutions that provide coverage through denominational organizations, small employers that cover their workers through insured multiemployer health and welfare plans, and employers that subsidize their employees’ health care costs through a broad range of contribution arrangements.

In general, the credit is available to small employers that pay at least half of the premiums for single health insurance coverage for their employees. It is specifically targeted to help small businesses and tax-exempt organizations that primarily employ moderate- and lower-income workers.

New Form 8941, Credit for Small Employer Health Insurance Premiums, and newly revised Form 990-T are now available on IRS.gov. The IRS also posted on its website the instructions to Form 8941 and Notice 2010-82 , both of which are designed to help small employers correctly figure and claim the credit.

Small businesses can claim the credit for 2010 through 2013 and for any two years after that. For tax years 2010 to 2013, the maximum credit is 35 percent of premiums paid by eligible small businesses and 25 percent of premiums paid by eligible tax-exempt organizations. Beginning in 2014, the maximum tax credit will increase to 50 percent of premiums paid by eligible small business employers and 35 percent of premiums paid by eligible 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 or more FTEs or that pay average wages of $50,000 or more per year. Because the eligibility rules are based in part on the number of FTEs, not the number of employees, employers that use part-time workers may qualify even if they employ more than 25 individuals.

Eligible small businesses will first use Form 8941 to figure the credit and then include the amount of the credit as part of the general business credit on its income tax return.

Tax-exempt organizations will first use Form 8941 to figure their refundable credit, and then claim the credit on Line 44f of Form 990-T. Though primarily filed by those organizations liable for the tax on unrelated business income, Form 990-T will also be used by any eligible tax-exempt organization to claim the credit, regardless of whether they are subject to this tax.

More information about the credit, including a step-by-step guide to claiming the credit and answers to frequently asked questions, is available on the Affordable Care Act page on IRS.gov.

Kindest Regards,

John Tranchida

Van Dyk Financial Services
500 Barnegat Blvd N Suite 300
Barnegat, NJ 08005
609-597-3240 phone
609-597-1458 fax

www.vandykfinancial.com

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Given the scope of this landmark legislation, this short summary is by no means a comprehensive review of the new law. As your tax professionals at CB&H continue to study the legislation, we will continue to keep you informed and up-to-date regarding how the Health Care Act will affect you and your business.

The Health Care Act requires all individuals not covered by Medicaid or Medicare to obtain minimum essential coverage or pay a penalty (unless they are exempt from the individual responsibility mandate). Low-income individuals and some middle-income families are eligible for credits or vouchers to aid in the cost of obtaining coverage.

The Act also encourages employers to provide qualifying coverage by both penalizing large businesses that lack qualifying coverage and promoting contributions from small businesses to employee premiums. Employers that currently offer qualified coverage can continue to offer that same coverage under a grandfather provision.

The Health Care Act is offset chiefly by three measures:

• An increase in Medicare payroll taxes for individuals with earned income over $200,000, $250,000 for families (effective 2013)
• A 40-percent nondeductible excise tax on coverage plans above a high-dollar threshold (effective 2018)
• New fees and taxes on several health care-related industries (some effective starting in 2010)

The IRS will have oversight responsibility for these measures, in addition to several smaller revenue-raising efforts. To allow ample time for both taxpayers and the IRS to prepare for these sweeping changes, many measures include delayed start dates and/or phase-in provisions over the next four years. Click here to download a quick reference timeline that outlines the start dates related to these provisions.

Small Businesses

The Health Care Act defines a small business as one with 25 or fewer employees and average annual wages of $50,000 or less. Small businesses that meet these qualifications are eligible for a tax credit designed to offset some of the cost of the employer contribution toward the employee’s health insurance premium.

From 2010 to 2013, prior to the availability of state-run insurance exchanges, this credit will apply for up to 35 percent of the employer contribution to premiums. After the exchanges come into effect, that credit will equal up to 50 percent of the contribution for two years. Employers with 10 or fewer employees and average annual wages of less than $25,000 (indexed for inflation) will be eligible for the full credit.

Small businesses with 100 or fewer employees will be able to pool funds and distribute risk through state-based web portals. These Small Business Health Options Program (SHOP) Exchanges should give small businesses greater leverage when negotiating with insurance providers.

New Fees for Certain Health Care Companies

Under the Health Care Act, health insurance providers, pharmaceutical companies, and other health care-related businesses are liable for new, nondeductible annual fees according to market share. Certain delays exist in some instances, such as a 2011 onset date for brand name pharmaceuticals and a 2014 start date for health insurance providers.

Medical device companies. The Health Care Act adds a 2.3-percent excise tax on medical device sales starting in 2013. Frequently purchased items, such as eyeglasses and hearing aids, are exempt from the new tax.

Indoor tanning services. Starting July 1, 2010, the Health Care Act levies a 10-percent tax on indoor tanning services.

New health care therapies. The Act also provides a two-year temporary tax credit for investments in therapeutic discovery projects. This credit is effective for tax years beginning in 2009 and 2010.

Additional Revenue Provisions

The Act includes additional provisions that are projected to raise $28.1 billion through 2020:

Biofuel credit. As of January 1, 2010, cellulosic biofuel sales of the “black liquor” by-product no longer qualify for the biofuel tax credit. Intended to reward taxpayers for the use of alternative fuels, some legislators have targeted abuse of this particular credit category. Though unrelated to health care matters, this measure is expected to raise $23.6 billion of the $28.1 billion cited above.

Information reporting. Businesses that pay $600 or more annually to property and service providers (including corporations) must file an informational return with each provider and the IRS.

Economic substance doctrine. The basis for a transaction’s economic substance now exists only if a taxpayer both changed their economic position in a meaningful way and had substantial non-federal income tax purpose for engaging in the transaction. This change in definition is immediate and could lead to penalties of 20 or 40 percent depending on the transaction and disclosure requirements.

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The small employer health insurance tax credit guidelines, given in IRS Notice 2010-44, include examples that can help employers and their benefits advisors determine whether the employers are eligible for the tax break, and exactly how much of the new federal health insurance tax credit the employers can claim.

The IRS first began publishing information about how it will implement the small group health insurance tax credit here.

Calculating exactly how small an employer is for tax credit purposes will depend partly on the definition of “full-time equivalent” employee, officials write in the notice.

“In general, employees who perform services for the employer during the taxable year are taken into account in determining the employer’s FTEs, average wages, and premiums paid,” officials write.

But “partners in a business and certain owners are not taken into account as employees,” officials write. “Specifically, sole proprietors, partners in a partnership, shareholders owning more than 2% of an S corporation.

Owners and partners need not count family members or other dependents who are members of their households as employees when they are trying to qualify for the tax credit.

Season workers count toward the FTE total only if they work for an employer on more than 120 days during the taxable year.

IRS officials devote another section to computing workers’ hours.

The IRS issued the notice to implement a new tax law, Section 45R of the Internal Revenue Code, which was added by Section 1421 of the new Patient Protection and Affordable Care Act.

PPACA and a companion act, the Health Care and Education Reconciliation Act, are part of what federal agencies have dubbed the Affordable Care Act.

This year, the new ACA small business tax break will offer small employers a tax credit equal to at least half the cost of single coverage, if the employees earn average wages of less than $50,000 per year.

The tax credit is not available to ordinary government employers, but it is available to small businesses, small tax-exempt employers, and government-affiliated tax-exempt employers that can be described as section 501(c) organizations.

“For tax years 2010 to 2013, the maximum credit is 35% of premiums paid by eligible small business employers and 25% of premiums paid by eligible employers that are tax-exempt organizations,” officials write in a summary of the notice.

Employers with 10 or fewer FTE employees that pay annual average wages of $25,000 or less can qualify for the maximum credit.

Employers with 10 to 25 FTE employees that pay annual wages of $50,000 or less can qualify for a smaller tax credit.

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What the legislation aims to accomplish

The law builds upon the employer-based health insurance model that covers 83 percent of Americans today by adding coverage for 30 million uninsured individuals. This will be accomplished by providing financial help through subsidies or tax credits for low-income individuals and small businesses, and by expanding Medicaid. The Congressional Budget Office said that, as a result of the law, 94 percent of Americans will have access to health care.

The legislation also includes a range of measures to improve the quality of care and lower cost; we believe that much work remains to be done to improve the quality of care and to lower the cost of medical care.

Overall, the legislation includes these key provisions:

• Requires most U.S. citizens and legal residents to have health insurance
• Creates state-based American Health Benefit Exchanges through which individuals will be able to purchase health insurance
• Requires individuals who do not purchase insurance to pay penalties
• Creates separate exchanges through which small businesses can purchase coverage and receive tax credits
• Generally requires employers to pay penalties for not providing coverage or for having employees who receive tax credits through an exchange
• Imposes various new regulations on group plans and in the individual market
• Expands Medicaid in order to cover another 15 million people.

Immediate implications of reform

While the majority of the provisions go into effect in 2014, there are a number of provisions that take effect in 2010. Here’s an overview of the provisions that become effective this year:

Immediately/at enactment

• Grandfathering – Plans and individuals that “renew” their coverage are exempt from any provisions of the law. These “grandfathered plans” must comply, however, with the following provisions of the law: extend dependent coverage through age 26, prohibit rescissions, eliminate waiting periods greater than 90 days, and eliminate pre-existing condition exclusions for children
• Small employer tax credits – provides premium subsidies for small groups with 25 or fewer employees and average salaries of $50K or less. The IRS has begun mailing out millions of postcards to small employers encouraging them to try to qualify. Click here to read more about the small employer tax credits.

Less than six months

• High-risk pool program – establish a temporary national high-risk pool for individuals with pre-existing medical conditions. (effective 90 days post enactment through January 1, 2014)
• Temporary reinsurance for employer retirees – Creates a temporary reinsurance for employers providing health insurance coverage to retirees over 55 who are not eligible for Medicare (effective 90 days post enactment through January 1, 2014)

Six months (plan year)

• No lifetime limits – Eliminates all lifetime limits on the dollar value of coverage (effective six months post enactment)
• Restrictions on rescissions – Prohibits insurers from rescinding coverage except in the cases of fraud (effective six months post enactment)
• No pre-existing conditions for children – Eliminate pre-existing condition exclusions for children under 19 (effective six months post enactment)
• Dependent age 26 – Extends dependent coverage to age 26 (effective six months post enactment)
• Preventive care with no cost sharing – Eliminates cost-sharing for certain preventive services (effective January 1, 2011)
• Appeals process – Individuals have access to an internal and external appeals process to appeal decisions by their health insurance plan

AmeriHealth will continue to participate and remain engaged in the national discussion about health care reform in order to best serve our members and customers. We will also work closely with all of our stakeholders as we implement the law and prepare for the changes ahead. You should urge your customers to speak with their legal counsel for specific guidance about the law.

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The new guidance is timely, given the efforts of the Secretary of Health and Human Services to encourage insurers to offer this coverage earlier than required by the law.  Key issues addressed by the guidance include:

Effective Date – The effective date is the first plan year beginning on or after September 23, 2010;

Eligible Dependent – Once the new rules become effective for a plan, the only restriction on dependent eligibility for a child of a participant (if the plan covers dependents) will be the age 26 cutoff – a plan will not be able to exclude otherwise eligible dependents based on:

• living apart from the participant,
• financial independence or employment,
• marriage (although the dependent’s spouse and children do not have to be offered coverage),
• student status, or
• the availability of other coverage from their job (except for grandfathered plans);

Type of Dependent Coverage Can’t Vary by Age – An employer will not be allowed to require different levels of coverage for dependents based on age (except on and after age 26, if the employer extends such coverage). This will prevent employers from attempting to avoid extending coverage by providing lesser coverage for adult dependents.

Cost of Coverage – Employers will have to bear the same share of the cost for the extended coverage that they do for coverage of younger dependents. This appears to mean, for instance, that if the employee is already paying a family rate because of younger children, the extension of coverage to the adult dependent would not increase the employee’s premium. Similarly, if the adult dependent is the only child and there are premium tiers for employee, employee plus one and family, the employee would be charged the premium for the applicable tier that results from the continued coverage of the adult dependent or the new tier, if any, based on the addition of the adult dependent if currently aged out. This will prevent employers from attempting to avoid extending coverage by imposing additional premiums for adult dependents.

Grandfathered Plans – The adult children provisions apply with respect to grandfathered coverage only if such adult child is not eligible to enroll in another group health plan other than a group health plan of a parent. So, if a child under the age of 26 is not eligible for his own employer’s coverage and both parents have separate plans that offer dependent coverage, neither parent’s plan can deny coverage.

Special Enrollment for Currently Aged Out Dependents – An adult dependent who is under the age of 26 as of the date these new rules become effective for a plan and is not covered by the plan as of that date, will have to be given a 30 day period to enroll beginning on the compliance effective date. This special enrollment right will require that a notice be provided to the dependent explaining the enrollment right and will allow the coverage to be retroactive to the beginning of the election period.

• The notice can be given to the employee for the dependent – this will likely reduce the administrative burdens of the special enrollment process;
• Since the effective date is based on the plan year, many plans will be able to accomplish the special enrollment notice and election as part of the open enrollment process.

Note: It is unclear whether allowing retroactive coverage poses a cafeteria plan problem. To be safe, if the employer has a cafeteria plan it should provide the notice and opportunity in advance so that the election will be made prior to the effective date of coverage.

Early Coverage – At the urging of the Secretary of Health and Human Services, most of the major group health insurers are offering to extend age 26 dependent coverage to existing group policies on a limited basis before the effective date for the particular employer.  A similar acceleration is being offered under self insured arrangements administered by these carriers.

• Acceleration is Optional – In most cases, the acceleration is optional, although the opt-out may be hidden in the fine print of the insurer’s communication to the employer (in some States, the insurance regulators have agreed to mandate the acceleration for small policies – usually under 100 lives);
• Acceleration is Limited – Acceleration will generally only be offered to dependents who are currently covered and will age out after the accelerated effective date (June 1, in most cases – this is aimed at the emerging group of college students about to graduate and who would otherwise age out because of that);
• No Increase in Current Premium – Most of the insurers are offering the acceleration at no additional premium during the current policy period;
• Acceleration May Affect Claims Experience – Although the insurers are generally not “charging” for the accelerated coverage, there is no indication that the actual utilization by the newly covered adult dependents won’t be taken into account in determining a plan’s claims experience (some would point out, however, that these individuals would hit a plan’s experience under COBRA).

Taxability – Health care reform provides that health contributions and reimbursements for a child who does not turn age 27 by December 31 of a calendar year are no longer taxable to the employee for the entire calendar year, even if the child does not qualify as the employee’s tax dependent for health coverage purposes.  This means that employees whose dependents receive extended coverage under the age 26 rules will generally not have imputed income on the value of the employer paid portion of that coverage.

The IRS has already issued guidance on this issue. Notably, the nontaxability does not appear to extend to HSA distributions. Also, employers must amend their cafeteria plans by December 31, 2010.

Next Steps – Employers should review their current programs to assess the impact of the new rules.  Key considerations include:

• Acceleration – offers of accelerated coverage should be carefully reviewed with the insurer, especially in regard to the impact of negative claims experience on future rates;
• Coverage after “age out” – Most plans continue to cover aged out dependents for a specified period following the age out date –end of the calendar month, or in some cases, end of the calendar year. Plans with end of calendar year extensions should be reviewed to assess the cost impact resulting from the newly expanded coverages group; and
• Timing – If the open enrollment period is different from the plan year (e.g. policy renewal and plan year differ) the new rules may not become effective until after the next open enrollment. If an employer chooses to defer compliance until the actual effective date in this kind of situation, the special enrollment notices and election rights required for currently aged out dependents will have to be provided and administered as a separate endeavor.

We will continue to monitor developments and provide additional guidance and insights as they develop.

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As you know, I occasionally send blast e-mails to all of my group clients when any major happens in the health insurance world.  This is one such time.  While national health reform continues to mosey along without much direction, New Jersey is moving forward with its own reform plans.

Beginning September 1^st, 2010 New Jersey set forth new underwriting guidelines for the small group market.  Many carriers took this opportunity to make some additional changes in the way they do business and what plans they offer.

Below is a summary of the changes each carrier is making effective September 1^st for new business and October 1^st for renewal business.

Horizon Blue Cross Blue Shield:

• Horizon has significantly reduced their product portfolio by almost two thirds and has dramatically limited the number of prescription options offered as well.
• If you received a letter from Horizon saying that they are terminating your plan, you might have one of the options (either Health or Rx) that they will no longer offer.  If you have one of these plans, you don’t have to worry about making changes until your renewal or October 1^st, whichever is later.  Don’t worry; we will contact you in plenty of time to review the options available to you.
• You must move your plan on Anniversary, or Horizon will arbitrarily choose one for you.
• You can keep any number of “preferred plans” you may have now (many of the plans we recommend and many of you have are already “preferred”) as long as you don’t make any changes.  We have the list of “preferred plans” and will go over them with you upon renewal.
• Horizon will not offer coverage as a second carrier.  What this means is that a business can only have Horizon coverage and not a second carrier (i.e. you can’t have half of your employees with Horizon and the other half with AmeriHealth). In fact, no carrier will allow a second carrier going forward.
• Horizon will limit the number of options you can offer your employees to a maximum of 2 plans regardless of the number of employees you have.  They will allow a third option if and only if the third plan is a HSA.  In addition, these plan options can not be alike…in other words you can’t have 3 variations of HMO plans with different Rx cards.
• Horizon is talking about adding additional restrictions on the Rx options, but nothing is official yet.

Oxford

• Oxford, at this point, is not reducing their product portfolio
• Oxford will not offer coverage as a second carrier
• Oxford will allow up to 3 plan options with no limits on design or prescriptions

AmeriHealth

• AmeriHealth will not offer coverage as a second carrier
• AmeriHealth, at this point, is not limiting their product portfolio
• AmeriHealth will allow up to 4 plans but the Rx can not be the differentiator between the 4 plans allowed.

Aetna

• Aetna has limited their portfolio…although they are rarely competitive so I don’t think it matters much
• Aetna will not offer coverage as a second carrier
• Aetna, like Horizon, will offer a max of 2 medical plans and they must be different.  A third option is allowed if and only if the third option is a HSA plan.

Please remember that we will be there to help with any transition we may have to make well before your renewal.  We are ready to answer whatever questions you may have.

NEW CARRIERS IN NJ!!!!

Last but not least, there are two new carriers offering coverage in New Jersey.  Assurant Health and Trustmark are two self insured options that may or may not work for your business.  Both carriers do medical underwriting (so your health will affect rates) and are not subject to NJ mandates.  These plans may be a way to save money, or they may end up not being good options at all.  We will begin to obtain quotes from these carriers for renewals beginning with September 1st, 2010.  I’m sure no one is interested in being the proverbial “guinea pig” but it is better to know what is out there and then make an educated decision.

As always, all of our producers and I will actively seek any and all available quotes to assure that your company has the best benefits possible for the lowest possible price.

We appreciate your business and look forward to continuing to earn your trust going forward in these challenging times.

Kindest Regards,
John Tranchida

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To be a qualified small employer, (1) the company will need to have less than 25 full-time equivalent employees (FTEs) for that taxable year; (2) the average yearly income of its employees for that year has to be less than $50,000 per FTE; and (3) the company must preserve a “qualifying arrangement.”¹ A qualifying arrangement is an arrangement in which the employer pays premiums for every employee enrolled in health insurance coverage made available from the employer in an amount equal to a uniform percentage (a minimum of 50 percent) of the premium price of the policy (but see section V of this notice for transition relief for taxable years beginning in 2010 with regards to the requirements to get a qualifying arrangement).

These steps have to be followed to discover whether a company is entitled to a credit under section 45R:

1. Determine the employees that are considered for purposes of the credit
2. Determine the quantity of hours of service performed by those employees
3. Calculate how many FTEs the employer has
4. Determine the average annual wages paid per FTE
5. Determine the premiums paid by the employer which are taken into consideration for purposes of the credit. Specifically, the premiums have to be paid by an employer within a qualifying arrangement and need to be paid for health insurance that meets the needs of section 45R.

Partners in a business and certain owners aren’t taken into consideration as employees for purposes of section 45R. Specifically, sole proprietors, partners within a partnership, shareholders owning over two percent of any S corporation, and any owners in excess of five percent of other companies are not considered employees for purposes of the credit. The family of the owners and partners are not looked at as employees. For purposes of section 45R, a family member is understood to be a child (or descendant of a child); a sibling or step-sibling; a parent (or ancestor of a parent); a step-parent; a niece or nephew; an aunt or uncle; or a son-in law, daughter-in-law, father-in-law, mother-in-law, brother-in-law or sister-in-law. Finally, any person in the household of these owners and partners who qualifies as a dependent under section 152(d)(2)(H) isn’t taken into consideration as an employee for purposes of section 45R.

Season workers count toward the FTE total only if they work with a company for over 120 days throughout the taxable year.

Employers with 10 or fewer FTE employees that pay annual average wages of $25,000 or less are entitled to the maximum credit.

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