NEW – AHP, Catholic Business Owners Healthcare Relief

Catholic Business Owners

The NEW AHP regulations created to fit President Trump’s Executive Order make it possible to create a Catholic Buying Trust. This provides owners a way to control what they pay for in healthcare.

This is the biggest news in benefits since ERISA. Small business owners can keep their firmly held beliefs (respect for all Human life), follow their conscience, offer the Dignity of the Human Person in their Healthcare plan, and own the ability to choose how to lower cost. Perfect! Continue reading “NEW – AHP, Catholic Business Owners Healthcare Relief”

President Trump ACA Order

What does undoing ACA look like with this Order? Here’s the first stab at it from President Trumps first days Executive Order. In a word, he loosened the expenses tied to ACA. He then encourages Federal regulators to provide flexibility to the States plus encouraging interstate commerce.

I’m not alone in my view, but many of us have been saying ACA is too broad to be undone with the stroke of a single pen. What President Trump has done is given instruction for the regulators to make the changes needed. He’s given them a very broad framework to work within, but it’s not a roll-back because that’s not possible. Continue reading “President Trump ACA Order”

A Real Life Story of Accepting ACA Changes for a Small Business; Part II

Part II – a Small Business Looking to Do Better

The story starts with a business who engaged us for our Decoder because they asked the simple question, “we know it’s different than it use to be, and we perceive we could do better but we don’t know how to make the right decision.” In the first post, a couple days ago, you learned about the background a little bit. Feel free to review that post below.

Today, we’ll begin to cover details about who is being covered and who is not. It’s very common to have employers who cover individuals that should not be covered. Would you be surprised to know that employers have been known to cover deceased employees, or family members? When we visit with employers we never expect problems but we’re never surprised to find them either.

Job One, Research

Our first job is to research the details about all those covered and all those who are, or were, working for a company. We ask for lists that would show us this information. For instance, tax statements that provide lists of employees and payroll reports that show hours worked plus HR rosters of employees and former employees and other data. The research starts almost immediately and it usually entails asking questions about documentation that’s available that an insurance company would ask to prove the status of an employee or dependent. Identifying problems can be as easy as doing this research.

Our research immediately draws our attention to questions about a former board president who is still covered. In asking questions, it’s obvious there is no current relationship with the former executive. They had been involved and were made promises by the company. As we discuss this with current ownership, no one wants to address the issue with the board or the former executive. We helped solve the problem by including a proper commentary about the liability to both parties for covering someone who should not be covered.

But the former executive had an agreement?

Insurance companies can audit large claims any time, that’s in the small print. If they audit a claim on a former executive, like in our story, and they discover this person is covered it would be bad for both the employer and former employee. Coverage for groups means employees of the group must be covered and individuals who are not employees can not be covered. This is why it’s called group coverage.

So what actually would happen?

If an audit were to occur by the insurance company they would deny the claim of the former employee stating they’re not an employee of the company and not eligible for “group” coverage.  This is bad because the former employee and covered individual could use promises by the government to impose upon the employer the need to pay the claim. To keep the story simple, I’ve eliminated all the details and possibilities for how this could happen. The point is, there’s a chance the employer would be stuck paying the claims of the employee without insurance coverage. This is bad for everyone.

When we arrived the former employee had been on the plan more than 10 years. Why this had been left to linger is anyone’s guess.

What was the outcome?

The employer and former employee understood the risk to both employer and former employee. We introduced an agent who could help with individual coverage. We directed them to seek individual coverage immediately. This was completed within a week. As a note about how this worked, ACA makes transition from group to individual possible because it eliminated pre-existing conditions and medical underwriting. In the old days, these two rules made doing what we did much more difficult.

This small adjustment to the rules gave us the understanding to help the employer. Because the Decoder puts all of these facts in writing, it made it much easier for the employer to make the change with confidence. They just had to see it in writing and be able to show the former employee as well. This is the purpose of the Decoder.

If you enjoyed the story, or learned something from it, please let me know in the comment below. Do you have your own insurance story?

See All Your ACA Options With Your Eyes Open.

A Real Life Story of Accepting ACA Changes for a Small Business

The ACA landscape is “shifting sands,” a phrase we coined a couple years ago as we started designing the “BenStaff ACA Decoder“. I’d expect by now everyone understands ACA like we do. Sadly, this is a long way from true. We’re troubled that so few owners are taking advantage of options but then, there is so much “shifting sands” no one who does this part time should be expected to “get it” fast. There is a thread of continuous change, consider this example; the government just announced that open enrollment that ended 2/15 is open still through 4/15. You can still enroll so don’t miss out. See my post, or talk to one of the agents we like to make sure you don’t miss this NEW open enrollment.

Today begins a Story

ACA has changed the world of benefits. We're using our Decoder everyday to help employers meet the challenge.
ACA has changed the world of benefits. We’re using our Decoder everyday to help employers meet the challenge.

Today, I wanted to begin telling a real life story about a family and small business. Of course, names have been changed to protect the innocent (a bit of a Dragnet reference). The reason for it to be a multi-part story, is to allow me to keep tackling the days work. If you follow the story you will learn what’s really happening in the employee benefit world and how it affects you, or could affect you.

It would take too long to write the entire story in one sitting and likely, you wouldn’t have time to read it. If I understand my audience, your interests are different than your neighbor (in viewing anyway). My interest in telling this story is the circumstances cover most every variation for you. Undoubtedly, in this story, there’s something in it for everyone. Owners will appreciate it and also will their HR and Finance staff plus any employee of any employer plus individuals looking for coverage. This story is about any typical business trying under the new law to provide coverage. It should help us collectively understand what ACA means in many different ways.

Part I – a Small Business Looking to Do Better

The story starts with a business who engaged us for our Decoder because they asked the simple question, “we know it’s different than it use to be, and we perceive we could do better but we don’t know how to make the right decision.” This is the question that we answer most of the time. So, here’s a brief background for the story. This is an employer with 18 employees many of whom are part time. We agreed to complete an ACA Decoder for them. We delivered the Decoder to the owners (2 of them) and started the conversation about which of the 3 options was best for them to pursue.

No two employers are the same and no two employers can solve the problems the same. No matter the employer size there are issues employers are facing. There are more than 20 options available to employers. And most employers are facing today’s rate increases with the same tools and intellect as they did last year, or the year before that and this is not serving them well. It’s why no matter your best efforts, you will find employers who use the Decoder do so with added confidence. As you will see with the story as it unfolds over the next few days.

This employer had an agent who was capable by any measure but not attentive to the employers needs. Of course, we established a connection with the current agent by encouraging them to participate with the completion of the Decoder. They objected to the idea and explained they would not be participating. This is so unfortunate, why would an agent not want to work with BenStaff or me to help a customer make a better decision and implement change? This kind of reception by the agent community really doesn’t make sense but we offered introductions to local agents who we knew who would work with us to develop the Decoder. The new agent worked with us to develop options, added a new customer and delivered the services I told the customer they should expect.

Too bad for the old agent but as you will see, the story ends happily every after in the end, you will see how we helped the employer navigate the ACA shifting sands by digging in and getting it done.

I’ll post Part II in the next day or so. Stay tuned.