All Savers Alternate Funding Monthly Welcome Webinars

UnitedHealthcare’s All Savers Alternate Funding New Business groups are invited to join a monthly Welcome Webinar that is designed to help groups understand and get the most out of their plan. The webinar will cover the information a group receives at the start of their policy.

Welcome Webinar Schedule
December 12, 2018
January 16, 2019

Helpful materials to have available during the meeting include:

  • Employer Guide including eligibility changes
  • Administrative Services Agreement
  • Excess Loss Policy
  • Taxes and Fees
  • Wellness Capability Overview which includes information on Rally, HealthiestYou and UnitedHealthcare Motion

IMPORTANT UPDATE: National General Short-Term Products in OH to Activate TOMORROW

National General will open their Ohio plans for quoting and enrollment effective tomorrow, November 28, after temporarily suspending all sales of short-term medical plans.

Reminder: Short-term sales in Kentucky are still temporarily suspended as National General is required to refile their short-term plans and rates with the Kentucky Department of Insurance. This change does not impact current customers or sales submitted prior to November 13, 2018.

You are still able to quote and enroll all other National General products in Ohio, Kentucky, Indiana, and other states.

Please contact Geoff Beglen with any questions or additional information about short-term sales carrier options in Ohio and Kentucky.

Geoff Beglen | 513-629-9358 | gbeglen@crnstone.com

Aetna Updates on January New Business Deadlines, Billing Timelines, and Reporting Notices

December and January Deadlines

The deadline for Aetna December sales notices is right around the corner. Make sure you get your notices in for December 1 effective dates by Tuesday, November 27th. Also, today is the last day to submit sales notices early and earn an administrative fee credit for your clients. You must also submit all required documents by Monday, November 26th in order for your clients to qualify for the credit. Click here for a flyer with more details on the administrative fee credit program and deadlines.

Below are the regular submission deadlines for December and January effective dates:

Effective Date Sales Notice Submitted All Required Documents Submitted
December 1 11/27/2018 11/30/2018
January 1 12/27/2018 12/31/2018

Billing

On the 25th of each month, Aenta posts monthly AFA invoices on Springboard Marketplace. Aenta emails invoices directly to those who do not use Springboard. The invoice is based on how many employees are enrolled for coverage on the 17th of that month. On the second business day of the following month, Aetna will pull funds from your account.

The first month’s bill may follow a different timeline if Aetna installs a group after the 19th of the month before their effective date. In this scenario, Aetna will pull eligibility on the first day of the month of their effective date and five days later post your invoice on Springboard. Aetna will pull funds by the 15th of the month. If they install a group after the effective date, they will not pull funds the first month. Instead, they will pull funds for two months of coverage on the second business day of the next month. For renewals, they will pull funds at their renewal and the next month’s invoice will include any changes that occurred after the 20th of the month.

*If group is not installed by the effective date, the customer will receive a bill for 2 months of coverage at once.

NY HCRA Notices

AFA customers may have recently received a communication from the New York State Office of Pool Administration regarding their NY HCRA filing eligibility. Please note, that there is no action needed. As the third party administrator, Aetna files NY HCRA forms on behalf of their Small Group AFA customers and determine whether that filing is annual or monthly.

Ohio Farm Bureau Health Benefits Plan Update for January 1, 2019 and Later Enrollments

JANUARY 1 DEADLINES

The following dates and deadlines pertain to enrollment for January 1, 2018:

December 10, 2018- Last day to request a January 1, 2019 quote (or re-quote) for any group.

December 17, 2018- Last day to bind coverage for January 1, 2019

Any group making a request after these dates will be able to receive a quote or join the plan on February 1, 2019 but will not have the option to be quoted or enroll for January 1, 2019.

Please share with your clients that due to the high end of year enrollment volume the delivery of paperwork such as employee ID cards may take longer than is normal. Those needing help accessing their benefits can contact Medical Mutual at 800-382-5729.

December 19, 2018- Please have all renewal confirmations and paperwork to Cornerstone no later than December 19, 2018 to allow for processing time in order to meet the Ohio Farm Bureau December 21, 2018 submission deadline.

MANDATORY ELECTRONIC BILLING

Any group sold after January 1, 2019 with ten (10) or fewer employees enrolling is required to sign up for ACH* payments. Groups in this size category will no longer have the option to pay their monthly premium equivalent rate by check.

Any group that is delinquent more than once in a six (6) month period will also be required to sign up for ACH payments as a condition of reinstatement.

These requirements will ensure that every group is able to participate in the Ohio Farm Bureau Health Benefits Plan without administrative difficulties.

ACH (Automated Clearinghouse also known as EFT or Electronic Funds Transfer) allows a group to provide payment details once and have funds debited from their bank account automatically each month to pay for their coverage.


Questions? Get in touch with us by phone or email!

The Importance of Wrap Documents

Jennifer Agnello

Jennifer Agnello | President

Are you looking to provide even more value for your group clients?

By now most of you are familiar with a Summary Plan Description (SPD) issued for your clients’ medical plan. The SPD is one of the most important documents participants are entitled to automatically receive. This document must be provided and maintained by the plan administrator (typically the employer) and should be distributed automatically to all plan participants no later than 30 days after a written request. It outlines specific details of the health plan, such as a description of the employee benefits that are covered through the plan, participation rules, annual limits, election procedures, eligibility, employer contributions, and the plan year. It also summarizes claim filing procedures and plan sponsorship and administration.

Herein lies the issue. The Employee Retirement Income Security Act (ERISA) requires that the majority of health plans hold a Summary Plan Description. Only three exemptions exist in this ERISA regulation: 1) Indian Tribal Governments, 2) Church Plans, and 3) Governmental Entities subject to the Public Health Service Act. Chances are that the majority of your clients must comply.

Since ERISA not only applies to the medical insurance plan but to surgical, hospital, accident, HRA, FSA, dental, Rx, vision, life and AD&D, disability plans, and many voluntary plans, the health plan SPD does not cover all ERISA requirements for these additional benefits often written through various insurance companies. A written contract of insurance with an insurance company does not normally contain all of the rules required by ERISA and therefore is not a plan document. Estimates from the Department of Labor (who hold authority over employers offering these group benefit plans) show that three out of four plans audited have an ERISA violation. 70 percent of those audits result in monetary fines, many of which are significant, up to $110 per day, per affected individual for failure to comply.

Because most SPDs do not fully comply with ERISA, a wrap SPD is necessary. It is designed to “wrap” around all existing certificates of insurance and benefit plan booklets for each fully insured or self-funded plan and provides the information necessary to comply with ERISA’s reporting and disclosure requirements, HIPAA, and other federal laws. The wrap supplements the SPD with any additional ERISA required documentation, while also combining multiple benefits into a single plan for filing purposes. When a wrap document is used, the insurance policy or contract remains part of the plan document.

Therefore, the wrap and the insurance policy or contract together comprise the complete plan document and consequently meet the requirements of an ERISA plan document.

Various sources are available to prepare these wrap documents with prices ranging from $600 to $1,500. Contact your Cornerstone representative for more information.

If your clients do not currently have a wrap document in place, you have a chance to provide real value by keeping them compliant. Contact us today! Your E & O carrier will appreciate it!

Updates from Dental Care Plus: Shelf Rates, Sales Incentives, and More

Deadline for 1/1 Business

To ensure that member ID cards for January 1, 2019, groups are in the mail by January 1, Dental Care Plus Group (DCPG) must be in receipt of the group’s complete sold case submission, including employee enrollment forms or enrollment spreadsheet, by Friday, December 7, 2018.

Sales Incentive for 25+ Members

​Any DCPG group dental sale with 25 or more members will earn you a Visa gift card. DCPG has extended this program to include January 1, 2019, effective dates.

  • 25–50 members = $50
  • 51–99 members = $100
  • 100–249 members = $250
  • 250+ members = $500

Click here to learn more.

 

2019 Shelf Rates

Dental shelf rates:

Cincinnati/Northern Kentucky HMO
*NEW* Cincinnati/Northern Kentucky PPO
Ohio PPO
Kentucky PPO
Indiana PPO
Tennessee PPO

Vision shelf rates:

Ohio
Kentucky, Indiana and Tennessee

Ohio Essential Health Benefit (EHB) compliant rates:

Ohio PPO EHB (not available in Hamilton, Butler, Clermont and Warren counties)

Ohio HMO EHB

 

Qualification Period for Overrides

Starting this year, DCPG’s override compensation program will be calculated from February to January. So overrides will be effective from February 1, 2018, through January 1, 2019, on new sales and retention. Overrides will be payable in April of 2019.

What are Association Health Plans?

Gregg Amato

Gregg Amato | Director of Employee Benefits (Cleveland)

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

Summary

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.

Anthem Commission Increase!

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.

Medical Mutual Redefines SuperMed Service Area

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:

 Accredo Health  LabCorp
 Apria Healthcare  Lincare
 Coram Healthcare  The Little Clinic
 Davita  Quest
 Fresenius Medical Care  St. Elizabeth Healthcare (Kentucky only)
 Hanger  Tri-Health (all locations)

 

For more information, contact your Cornerstone representative.

Trump Administration Unveils Proposed Rule on HRA Flexibility

The Trump Administration recently unveiled a proposal that “expands the usability” of tax-free health reimbursement arrangements (HRAs) in direct response to President Trump’s executive order “Promoting Healthcare Choice and Competition Across the United States.” Under the proposed rule, small business would be allowed to use HRA funds to provide offsets for premiums purchased by their employees in the individual market.

Critics of the proposal, however, contend that this could allow employers to push higher-risk employees away from company-sponsored coverage and into individual coverage offered through the Affordable Care Act’s Marketplaces. The Administration says the proposed rule “includes certain safeguards to mitigate the risk that health-based discrimination could increase adverse selection in the individual market.”

Resources

7 Points for Employers to Know About Proposed HRA Regulations

Proposed Rule on HRA Flexibility Improves an Important Health Coverage Tool for Small Businesses

Trump Administration Proposal Expands Access to HRAs