The IRS recently announced in Notice 2018-85 that the adjusted applicable amount for the Patient-Centered Outcomes Research (PCOR) Fees is $2.45 for policy or plan years ending on or after October 1, 2018, and before October 1, 2019.
The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule that advocates for additional oversight to protect both the issuer and consumer. The rule, called the “Patient Protection and Affordable Care Act (PPACA): Exchange Program Integrity”, would safeguard taxpayer dollars by ensuring that people are accurately determined eligible for premium subsidies they receive through the Exchange.
On Monday, November 12 (day of observation) Cornerstone will once again pay special tribute to the men and women who so bravely devoted their time to serve in the armed forces. November 11th is a day dedicated to those individuals and a time for us to recognize their sacrifices. In honor of Veterans Day, please take some time to remember that it is because of our veterans that we all enjoy the freedom to express ourselves and the unlimited opportunities for which this country stands. Please pause to recall the sacrifices that our Soldiers, Sailors, Airmen, Marines, and Coast Guardsmen have and will continue to make, serving our Nation where and whenever they have been called. Their service deserves acknowledgement. These courageous and brave individuals have forgone family life, private sector careers, and for many, sacrificed their lives, willingly taking on the greatest responsibility of upholding our freedom. They have voluntarily joined the ranks of America’s Armed Forces, fully aware of their obligations as citizens and the risks they are taking to stand for what our country believes in and founded upon.
Through their courageous and unquestioned sacrifices, they have secured for millions the blessings of freedom, democracy, and unmatched opportunity that we enjoy in the United States today.
Please take the time to PERSONALLY thank these special folks and those who are a part of your lives. They deserve our respect and recognition.
We have chosen to give our Cornerstone Veterans ½ day off on Monday November 12th to show our appreciation corporately.
Thank you to our employees, Eric Pouncy Sr. and Hal Demmerle, as well as our families for making this sacrifice. We are grateful to you for allowing us to continue to live in a thriving, peaceful, FREE country.
Have a safe Veterans Day, and as always, God bless the United States of America.
The Trump Administration and the United States Department of Labor (DOL) announced new rules for Association Health Plans (AHP). The new rules allow insurance carriers to expand access to the market for fully insured plans beginning September 1, 2018, and on January 1, 2019, for self-funded plans.
What are AHPs?
AHPs are group health plans that employer groups and associations offer to provide health coverage for employees. These plans exist today, and existing plans may continue after the new rule takes effect. The new AHP rule brings additional plans into the market, allowing more small businesses and sole proprietors to join together to create an AHP by either purchasing large group or self-insuring coverage. Business owners with no employees and small businesses that have employees will have access to these plans, and AHPs will now be able to cross state lines. Many AHPs will most likely choose to self-insure, which further reduces regulatory burden since self-insured plans are not subject to state insurance regulations.
A small group is defined in Ohio as having less than 50 employees. Local business groups and industry groups nationally will be able to band together, which will allow the insurance risk to be spread out over a larger group. Spreading out the risk over larger pools gives small businesses access to health coverage at a lower premium, which was only afforded to large groups in the past.
Large group plan underwriting guidelines are much less restrictive than the small group and individual plan rules. Less restrictive coverage would likely attract healthier people and the combination of reduced benefits, healthier enrollment, and administrative costs being spread across a larger group would generally result in lower premiums for an AHP. AHPs as a large group will have better leverage to negotiate premiums as compared to small group and individuals that are set by the insurance industry.
AHP rules available to small groups:
- For the sole purpose of obtaining health insurance
- Same geographically located industry and businesses
- Members of chambers of commerce and nationally affiliated trade industry groups
- Sole proprietors and non-employer firms
The new rule would give small businesses access to coverage as an alternative to the ACA market.
Number of Businesses and Associations
According to the 2016 U.S. Census Bureau’s Annual Survey of Entrepreneurs, there were 5.6 million employer firms. Employer firms with less than 20 employees made up five million firms and there were 24.8 million non-employer firms. The number of non-employer firms added to the firms with less than 20 employees equals nearly 30 million firms.
In January of 2015 The Power of Associations states, “In 2013, there were 66,985,501 organizations on file with the IRS. This subsection includes chambers of commerce and the majority of the trade associations and professional societies operating in the United States today. Associations are found in every state and territory in the country.”
Considering the number of small firms along with the number of associations that exist in the U.S., the expansion of AHPs has the potential to impact a large number of people.
New Rules/Pre-Existing Conditions
The Affordable Care Act (ACA) requires AHPs that sell health insurance plans to small employers and individuals and small employers must meet the same standards that the ACA applied to these respective markets. The ACA outlined certain essential benefits that have to be included in health insurance plans, including preventive care, ambulatory services, emergency services, hospitalization, mental health services, maternity care, prescription drugs, rehabilitation, laboratory services, and pediatric care. AHPs are exempt from these regulations and may not cover some of these services.
AHP new rules:
- Do not have to include the ACA’s 10 essential health benefits for plans in the individual and small group market, businesses with fewer than 50 employees
- Allows different premium rates based on age, gender, and location; charges can vary by industry
- Does not allow discrimination based on health status
- Cannot deny coverage or charge more because of pre-existing
- Cannot cancel coverage due to an employee’s illness
- Can vary charges, higher rates for high-risk industries compared to low-risk industries
- Allows dependents on the plan until they reach age 26
- Cannot charge older applicants more than three times as much as younger applicants
- Must cover at least 60 percent of average medical costs
- Subject to the ACA’s risk adjustment program for small group and individual plans
- Sole proprietors and non-employee firms can get coverage for their family
- Does not change or affect any existing association health plans
- Requires AHP to elect a governing body
- Effective dates for the new rule are September 1, 2018, for fully insured association plans and January 1, 2019, for self-funded association plans
Providing health insurance as a small business owner can be costly when balancing between growing their business and attracting new talent. The new rules and expansion of AHPs provide small businesses with the opportunity to offer health insurance at lower premiums, giving them the same kind of flexibility that large companies have when selecting a health insurance plan. AHPs can lower health insurance premiums because they are exempt from covering the 10 essential health benefits required by the ACA and the law allows for more flexibility in the way AHP premiums are set. Even though AHPs will most likely have lower premiums, it is important to remember the benefits plan options may not be the same as those in other more expensive health plans. With many small businesses facing rising premiums, having access to a more affordable coverage alternative in AHPs is a viable solution
It is important to research and understand the options before purchasing any health insurance plan, including an AHP. Even though the selection process can be time consuming, the investment is worthwhile to ensure the right health insurance plan is placed. Working with an experienced health insurance broker or consultant can be beneficial, saving both time and money when navigating the selection process.
If you need additional information about AHPs, the experts at Cornerstone can help. We have extensive experience working with AHPs and with understanding the positive impact of the new rules. Please ask your local Cornerstone representative about the available AHP plans offered through our contracted health insurance carriers.
Molina Healthcare is excited to announce an agent bonus for NEW 2019 members!
- Bonus payment will pay out in May 2019 to your agency.
- Bonus amounts are paid only when the enrollment tier threshold is met (no prorating).
- Example: Enroll 50 members = $1,000, enroll 49 members = $500
- Bonus amounts must be earned by each agent individually. New enrollments by an agent will not be added to enrollments by a different agent for purposes of meeting the enrollment tier.
- One-time payment (not per member per month, PMPM).
- The above table outlines the enrollment tiers for new 2019 members and the bonus amount that you will earn.
- One-time payment will be made determined by the total amount of qualifying policies and the single tier that corresponds.
Program Terms and Conditions:
- NEW MEMBERSHIP ONLY.
- Members must effectuate January 1, 2019.
- Members MUST remain enrolled with Molina through March 31, 2019.
- Members must not have any data discrepancies in the 834 report.
- Members cannot be in the Grace Period on March 31, 2019.
- Bonus applies to the following Molina service states: Utah, Texas, New Mexico, Washington, Ohio, Michigan, Wisconsin, and Florida.
As a reminder, in order to write and be compensated for any Molina policy:
- You must have a current Errors and Omissions on file with us at the time you write the policy. Your name must be noted on the policy.
- You must have a current license in the state(s) you are contracted with us at the time you write the policy.
- If you are contracted with Molina to sell in the following Molina Federally Facilitated Marketplace (FFM) states: MI/OH/FL/TX/NM/UT/WI, you must have completed the Federally Facilitated Markeplace Registration and you must show up on the FFM Registration List at the time you write the policy. if you are contracted with Molina to sell in WA you must have completed the Washington Health Plan Certification at the time you write the policy.
We have just received word from National General that they are being required to refile their short term plans and rates with the Ohio Department of Insurance. Until further notice from National General, no quoting or enrollment for any short-term sales in the state of Ohio will be allowed.
You are able to still quote and enroll their other products in Ohio, or all of their products in Kentucky, Indiana, and other states.
They will be sending out further notice sometime today, but wanted to get this out to you as quickly as possible.
If you have clients needing short term in Ohio, we would recommend going with UHOne for the time being.
Geoff Beglen | 513-629-9358 | email@example.com
Social Security (SS) now requires you to open a “My Social Security” account to file an online application. Previously, you could file an application online with a special application number so you could start an application online, save it, and return later to complete it. Now you must get to the online application through your “My Social Security” account. The process is similar to credit card and bank procedures. You will log into your account with a user ID and password and then SS will send a special code to your cell or email. You need this code before completing the online application. The SS website also recognizes IP addresses, so you must start and finish the application from the same IP address. If logged on from a different IP address, you will be locked out and must restart the application.
This new process is beneficial to you! ID theft has led to more fraudulent Social Security retirement claims filed online in recent years.
So open your “My Social Security” account at www.ssa.gov and keep it up to date every six months.
Happy Thanksgiving to all!
About Dennis Heywood
Denny’s career with Social Security provides an in-depth, working knowledge of the Social Security Administration’s internal organization and processes. An expert in all phases of SSA programs: retirement, survivor, disability, and Medicare, Denny has expertise with the complex Social Security regulations based on more than 40 years of experience.
The Internal Revenue Service and Social Security Administration announced cost of living adjustments affecting dollar limitations for pension plans and other retirement-related items for tax year 2019.
The important limits are provided below:
401(k), 403(b) & 457(b) deferrals $19,000
Catch-up 401(k), 403(b) & 457(b) $6,000
415(c) Limit $56,000
Annual Compensation Limit $280,000
HCE Compensation Limit $125,000
Maximum Pension at age 62 $225,000
SIMPLE Deferrals $13,000
SIMPLE Catch-up $3,000
SEP Minimum Compensation $600
Key Employee Limit, Officer Test $180,000
IRAs for individuals age 49 & below $6,000
IRAs for individuals age 50 & above $7,000
Soc. Sec.Taxable Wage Base $132,900
Anthem commission increase! The 2019 SOCA BP/MEWA commissions increase from $22 to $26 on business with original effective dates January 1, 2019, and later. Any groups that move in January from GM to MEWA with Anthem’s push this year, will have this new SOCA BP/MEWA commission.
Starting Jan. 1, 2019, Medical Mutual is redefining their SuperMed service area. The new service area will consist of all 88 counties in Ohio, three counties in Kentucky (Boone, Kenton and Campbell), and the 12 national/ancillary providers, which include labs, medical suppliers and other providers, listed below:
|Coram Healthcare||The Little Clinic|
|Fresenius Medical Care||St. Elizabeth Healthcare (Kentucky only)|
|Hanger||Tri-Health (all locations)|
For more information, contact your Cornerstone representative.