Innovative Benefit Planning Blog

The Innovative Award Goes To…

Posted On: March 2, 2012 | Categorized as: Company News, Employee Benefits

Innovative would like to congratulate UBA partner firm principal, Paul Bogumill of Mountain West Benefits in Helena, Montana, for receiving the Innovative Award at the annual Pharmacy Benefit Management Institute conference in Phoenix, Arizona. Paul was the brainchild behind the development of a new, innovative pharmacy benefit called URx.  At the time of development, Paul was running the Montana University System and was president of a “think-tank” in Montana dedicated to health care and self-funded health plans, specifically focused on best-in-class management of these health plans. If you would like to learn more about this exciting new cost saving pharmacy benefit, please contact Dan Foley at 856-786-4300 ext. 312.


Posted On: March 1, 2012 | Categorized as: Company News, Employee Benefits, Health Care Reform

The ACA provision on automatic enrollment requires certain large employers (those with more than 200 full-time employees) to automatically enroll new full-time employees in one of the employer's health benefit plans (subject to any legally permissible waiting period), and to continue the enrollment of current employees in a health benefit plan.  It further requires notice and an opt-out opportunity for employees who have been automatically enrolled. The Department of Labor had previously indicated that it intended to issue regulations on the automatic enrollment rules before 2014.  In what will likely come as welcome relief to many large employers, Notice 2012-17 indicates that, in order to ensure coordinated guidance and a smooth implementation process, the DOL has concluded that regulations implementing the ACA's automatic enrollment provisions will not be ready to take effect by 2014.  Until such regulations are finalized, employers are not required to comply with these automatic enrollment provisions.


Posted On: February 27, 2012 | Categorized as: Company News, Employee Benefits

Click Here to Participate in the 2012 Survey and Receive a Detailed Benchmarking Analysis The 2011 survey gathered results from 16,421 health plans from 10,744 employers -- making it the largest benchmarking survey of employer-sponsored health care plans in the country.  The results provided critical national and regional benchmarks that enabled companies to compare their plans alongside those of peers and competitors.   While past surveys have primarily targeted large employers, the focus of the UBA survey is to report results that are applicable to the small and mid-size companies who represent the overwhelming majority of the nation's employers. With employer health plan information reported for over 3,100 cities from 48 states and the District of Columbia, differences in plan design and plan costs between various regions and industry groups become apparent.  All survey responses are confidential and reported only as aggregate benchmarks. We encourage that you take advantage of this…

The Innovative Way!

Posted On: February 22, 2012 | Categorized as: Company News, Employee Benefits

Great job by Innovative’s Jeannine Bandiera, who found a way to make a member’s medication affordable!  Recently one of our members was made aware of a tier change for the medication that she needs to treat her condition.  The insurance carrier moved the medication to the Specialty Drug list from the Third Tier Formulary list, making the medication unaffordable to the member at $250 per month.  After contacting the insurance carrier, who said there wasn’t anything they could do, Jeannine decided to contact the manufacturer, Glaxo, Smith & Kline directly.  Jeannine discovered that Glaxo Smith & Kline has a co-pay assistance program that bases the cost of the medication on means. For this member the drug cost was reduced to $75, a savings of $175 monthly.  Way to go Jeannine, that’s the Innovative way! There are similar programs offered by other manufacturers as well.  If you would like to learn…

Milliman Study Highlights the Impact of Medical Loss Ratio Rules on HSAs

Posted On: February 21, 2012 | Categorized as: Company News, Health Care Reform

A new report by Milliman Inc. says that high-deductible health plans, including those with health savings accounts (HSAs), will likely be more adversely impacted by the medical loss ratio requirements under PPACA than other types of comprehensive medical plans.  Consumers who rely on HSA-qualified plans to finance their health care may experience greater costs in their current health plans and may eventually have to find more expensive replacement coverage. The primary issues of concern for high-deductible plans are that: -The medical loss ratio formula doesn't take into account contributions to HSAs.  Many high-deductible health plans are accompanied by an HSA, which covers much of the first-dollar costs before the plan's deductible is reached. HSA contributions are currently not reflected in the medical loss ratio calculations. -High-deductible health plans may not be able to raise rates fast enough to keep up with rising costs.  High-deductible health plans will require larger annual…

HHS Releases Guidance Related to Annual Dollar Limit Waivers

Posted On: February 21, 2012 | Categorized as: Company News, Employee Benefits

On Feb. 13, 2012, the Department of Health and Human Services (HHS) stated a health insurance issuer that has received a waiver of the annual dollar limit requirements pursuant to Section 2711 of the Public Health Service Act for a group health insurance product can sell that product to a self-insured grandfathered group health plan that has itself been granted a waiver and wishes to switch from being a self-insured plan to a fully insured plan, as long as the following criteria are satisfied: 1. In all cases, the plan sponsor must have been offering group health coverage to its employees before Sept. 23, 2010, for which it obtained from HHS a waiver of the annual limits requirement; 2. The issuer from which the group health plan is now obtaining the insured policy must have obtained a waiver from HHS for the newly purchased policy;--- 3. The annual limits of…

Agencies Finalize Guidance On Summary Of Benefits And Coverage

Posted On: February 15, 2012 | Categorized as: Company News, Health Care Reform

As explained in our August 2011 article, the health care reforms enacted in March of 2010 will require employer health plans to provide a uniform "summary of benefits and coverage" (SBC) to all plan participants and beneficiaries.  The agencies charged with implementing this requirement have now finalized the regulations they proposed in August of 2011.  The final regulations ease certain of the more onerous requirements, and they also grant a six-month delay in the statutory effective date. Compliance Deadlines As enacted, this SBC requirement was to apply as of March 23, 2012.  This recent guidance allows compliance to be deferred until the first open enrollment period beginning on or after September 23, 2012.  For participants who are not a part of the open enrollment process (such as new hires or special enrollees), the compliance deadline is the first day of the first plan year beginning on or after September 23,…

DOL, HHS and Treasury Issue Technical Release on Automatic Enrollment, Waiting Periods and Employer Shared Responsibility

Posted On: February 12, 2012 | Categorized as: Company News, Health Care Reform

The Employee Benefits Security Administration (EBSA) has issued Technical Release 2012-01, which provides information on questions from employers and other stakeholders regarding the provisions of the Patient Protection and Affordable Care Act (PPACA) governing automatic enrollment, employer shared responsibility, and the 90-day limitation on waiting periods.  These provisions are scheduled to become effective in 2014.  Also outlined in the release are various approaches that the three regulatory agencies (Departments of Labor, Treasury and Health and Human Services) are considering proposing in future regulations or other guidance. The full release can be found at  Comments are requested by April 9, 2012, may be submitted anonymously, and will be shared by the Departments.

HHS Provides Illustrative Information Regarding Benchmarks for Essential Health Benefits

Posted On: February 12, 2012 | Categorized as: Company News, Employee Benefits, Health Care Reform

The Department of Health and Human Services (HHS) provided illustrative information to complement its Dec. 16, 2011, bulletin on essential health benefits (EHB) under the Patient Protection and Affordable Care Act.  The information provides the names of the three largest products in the small group market in each state ranked by enrollment, as well as a list of the top three nationally available Federal Employee Health Benefit Program plans based on enrollment. In an earlier bulletin released Dec. 16, 2011, HHS described the approach it intends to pursue in rulemaking to define these essential health benefits.  Under that approach, states would be able to select an existing health plan to set as a benchmark for the items and services included in the package. The options would be: one of the three largest small group plans in the state; one of the three largest state employee health plans; one of the…

Agencies Release PPACA Final Rule, Guidance and Templates for Summary of Benefits and Coverage (SBC) and Uniform Glossary of Terms

Posted On: February 12, 2012 | Categorized as: Company News, Health Care Reform

The Departments of Labor, Treasury and Health and Human Services have released final regulations under the Patient Protection and Affordable Care Act (PPACA) that require health insurers and group health plans to provide concise and comprehensible information about health plan benefits and coverage to those with private health coverage.  Under the rule, health insurers must provide consumers with clear, consistent and comparable summary information about their health plan benefits and coverage. The new explanations will be available beginning, or soon after, Sept. 23, 2012. Specifically, these rules will ensure consumers have access to two key documents that will help them understand and evaluate their health insurance choices:  a short, easy-to-understand Summary of Benefits and Coverage (SBC); and, a uniform glossary of terms commonly used in health insurance coverage. All health plans and insurers will provide an SBC to shoppers and enrollees at important points in the enrollment process, such as upon application…

Innovative’s Mark Sulpizio Goes To The Harvard Club

Posted On: February 10, 2012 | Categorized as: Company News, Retirement Plans

On Wednesday, February 8, 2012 our own Mark Sulpizio attended Federated Investors' Retirement Security Symposium at The Harvard Club of New York City. This special event was by invitation only and featured The Honorable Bradford P. Campbell as the Key Note Speaker. Mr. Campbell formerly served as the Assistant Secretary of Labor for Employee Benefits, the head of the Employee Benefits Security Administration (EBSA). He is a nationally recognized figure in employer-sponsored retirement plans. The symposium focused on changing the role of the Financial Advisor as it relates to investment committee best practices, fiduciary status and its implications, and prudent investing in turbulent markets.

DOL Finalizes, Delays 401(k) Fee Disclosure Rules

Posted On: February 10, 2012 | Categorized as: Company News, Retirement Plans

After months of delay, the Department of Labor (DOL) has just released final regulations under Section 408(b)(2) of ERISA, requiring retirement plan service providers to disclose information about their services and fees to plan sponsors.  In doing so, the DOL delayed the effective date of those rules and made minor modifications to them.  The final regulations defer the compliance date from April 1 to July 1, 2012.  As a consequence, plan sponsors will also have more time to comply with the related participant-level fee disclosure rules. In an attempt to arm plan fiduciaries with additional information about the increasingly complex services provided by retirement plan vendors (such as record keepers, third-party administrators, and brokers) and the fees charged for those services, the Section 408(b)(2) regulations impose specific disclosure requirements on those providers.  Under ERISA, fiduciaries must ensure that these arrangements are reasonable, and that only reasonable compensation is paid for…

2012 Fiscal Year Plans Must Adhere to FSA $2,500 Limit

Posted On: February 3, 2012 | Categorized as: Company News, Employee Benefits, Health Care Reform

Though not the norm, some Cafeteria Plans (Section 125 plans) are not calendar year plans but instead are fiscal year plans (e.g. February 1-January 31).  Be careful if this applies to you because if your fiscal year plans include Health Care Spending Accounts (HCSA), then as the plan sponsor, you must institute the $2,500 pre-tax contribution account maximum beginning with the first day of the 2012 fiscal year. The Patient Protection and Affordable Care Act (PPACA) Section 9005 provides the following:  “ if a benefit is provided under a cafeteria plan through employer contributions to a health flexible spending arrangement, such benefit shall not be treated as a qualified benefit unless the cafeteria plan provides that an employee may not elect for any taxable year to have salary reduction contributions in excess of $2,500 made to such arrangement, for any taxable year beginning after December 31, 2012”.  The potential trap…

HHS Secretary Announces One-Year Delay for Nonprofits with Religious Beliefs in Complying with No-Cost Women’s Preventive Services

Posted On: January 24, 2012 | Categorized as: Company News, Employee Benefits, Health Care Reform

After receiving comments on the interim final rule requiring most health insurance plans to cover preventive services for women including recommended contraceptive services without copays, coinsurance or deductibles, Health and Human Services (HHS) Secretary Kathleen Sebelius announced that nonprofit employers who, based on religious beliefs, do not currently provide contraceptive coverage, will be given an additional year, until Aug. 1, 2013, to comply with the new law. HHS also released an amendment to the prevention regulation that allows religious institutions that offer insurance to their employees the choice of whether or not to cover contraception services.  This regulation is modeled on the most common accommodation for churches available in the majority of the 28 states that already require insurance companies to cover contraception.  The full text can be found at: HHS welcomes comment on this policy; comments are due on or before Sept. 30, 2012. For more information on…

IRS Releases 2011 Form 8941 and Instructions for Claiming

Posted On: January 24, 2012 | Categorized as: Company News, Employee Benefits

The IRS has released the 2011 version of Form 8941, which is used by eligible small employers to calculate their health care tax credit.  Once calculated, the tax credit is claimed as a general business credit on Form 3800 (or by tax-exempt small employers as a refundable credit on Form 990-T).  As background, employers with fewer than 25 employees and average annual wages of less than $50,000 per employee that offer health insurance coverage under a qualifying arrangement may qualify for a tax credit of up to 35 percent of the non-elective contributions they make toward premium cost.  A qualifying arrangement is generally one under which the employer contributes a uniform percentage of at least 50 percent of the premium cost for employees. Form 8941 has been shortened for 2011 to remove the reporting of carry-forwards, carry-backs, and passive activity limitations for this credit, which are now reported on Form…

More IRS Guidance On W-2 Reporting of Health Coverage

Posted On: January 20, 2012 | Categorized as: Company News

Overview of Reporting Requirement Before addressing the recent guidance, it is worth noting some key points that have not changed.  For instance, this reporting requirement remains optional for 2011, but then required for 2012. Also preserved is a postponement of this requirement for "small" employers.  Any employer that is required to issue fewer than 250 W-2s for 2011 (or that would have been required to issue fewer than 250 W-2s had it not engaged an agent to handle this reporting) qualifies for this postponement.  The soonest such a small employer might be required to report the value of its employees' health coverage is January of 2014 (on the 2013 W-2). Once this reporting requirement does apply, the value of employer-sponsored health coverage is to be reported in Box 12 of the W-2, using the code "DD."  Finally, this latest Notice reemphasizes that nothing in this new reporting requirement will cause…

Do You Like To Eat Out?

Posted On: January 12, 2012 | Categorized as: Company News

Our own Terriann Procida is Chairperson for this year's Samaritan Healthcare & Hospice Gala taking place February 25th in Mt. Laurel, NJ.  As part of the fundraiser we are selling raffle tickets for $5 to win 12, $200 Gift Certificates to the following restaurants:  Amada, Brio, Caffe Aldo Lamberti, Cafe Madison, Cuba Libre, Luke Palladino's, McCormick's & Schmicks, Ponzio's, Seasons 52, Stephen Starr Restaurants, Villagio Italian Restaurant and Wolfgang Puck.  This is a great way to support a great cause so let us know how many you would like!  If you would like to donate anything for the Silent Auction at the Gala please let us know and we would be happy to come pick it up!

IRS Issues Additional Guidance on Form W-2 Health Care

Posted On: January 6, 2012 | Categorized as: Company News, Health Care Reform

The U.S. Internal Revenue Service (IRS) has issued Notice 2012-9 to provide additional guidance on the informational reporting to employees of the cost of their employer-sponsored group health plan coverage on Form W-2.  The IRS requested public comments on the W-2 reporting requirement in Notice 2011-28. Notice 2012-9 responds to these comments and amends, restates and supersedes Notice 2011-28.  Specifically, the new notice includes guidance on the W-2 reporting as it relates to small employers, flexible spending accounts, dental and vision plans, COBRA and health reimbursement arrangements. Health care cost information will have to be reported on 2012 W-2s, which will be issued in 2013. Under previous IRS guidance, smaller employers -- those that distribute fewer than 250 W-2s in 2011 -- are exempt from this requirement until at least 2014 and possibly longer. The latest guidance, released Tuesday, makes clear that employers can -- but are not required to…

Soup’s On!

Posted On: January 5, 2012 | Categorized as: Company News, Workplace Wellness

Several studies show that soup eaters end up weighing less than those who don’t eat much soup, according to Penn State nutrition professor Barbara Rolls, co-author of “Volumetrics: Feel Full on Fewer Calories.” "Incorporating soups into a weight-management plan can really help save calories," she notes. She also likes it as a snack: "When you get the munchies, it's much better to have some soup than to go to the candy machine." Soup Studies The soup effect has been demonstrated again and again over the past 30 years: • In a 1980s University of Pennsylvania study, 500 people in a weight-loss program noted each meal they ate for 10 weeks. Some were told to eat soup at least four times a week. The soup eaters ate fewer calories -- on average, 100 less per day -- and lost the most weight. • In a Baylor University College of Medicine study, Dr. John…

Final Rule for CO-OPs – Highlights

Posted On: December 19, 2011 | Categorized as: Company News, Health Care Reform

On Dec. 8, the Centers for Medicare and Medicaid Services (CMS) released the Final Rule produced by the Department of Health and Human Services (HHS) to establish the Consumer Operated and Oriented Plan (CO-OP) Program under Section 1322 of the Patient Protection and Affordable Care Act (PPACA).  The following are some of the highlights: "Substantially All" Requirement: -The Final Rule confirms that many larger employers will be able to participate in CO-OPs by permitting up to one-third of all CO-OP contracts to be purchased by such large employers.  It provides that Section 1322's requirement that "substantially all" health insurance issued by the CO-OP is placed in the individual and small group markets is satisfied where two-thirds of its contracts are in those markets.  The Final Rule confirms also that the two-thirds standard applies to all of the activities in the CO-OP, an interpretation that HHS believes properly encourages providers who…

Need a custom plan designed for your team?

Schedule a Consultation

Contact Us Now To Get Your Business Covered