CalCPA ProtectPlus

The Group Insurance Trust operates the CalCPA-endorsed health and welfare plans, including CPA ProtectPlus medical plans, Delta Dental and Vision Service Plans. The Trust is governed by 12 trustees, and each year four are elected for three-year terms.

In order to ensure that the Trust continues to be governed by dedicated, knowledgeable members, it is expanding its pool of qualified future trustee candidates. Several appointed committee member positions are available to CalCPA members who are currently participating in a ProtectPlus medical plan. Due to the complicated nature of the Trust, ideal candidates are from firms with 15 or more employees, who can be reasonably expected to remain in active practice and serve the Trust for many years. Candidates are appointed for a two-year term and may be reappointed for a second two-year term. Appointed committee members sit on committees of the Board and attend four committee meetings and one board meeting per year. Appointed committee members are eligible for the same level of employer reimbursement compensation as trustees, and all out-of-pocket expenses are reimbursed.

If you are interested in applying, please send your resume with a cover letter of introduction to: Ron Lang, CEO, The Group Insurance Trust, 1800 Gateway Drive, San Mateo, CA 94404.

Banyan Administrators have been providing us with beneficial information about several different aspects of the Health Care Reform and how it affects us. Over the next months and years, employers will be faced with numerous changes, many of which require regulatory clarification. Banyan will continue to keep us up to date and on target with decisions that affect our plans.  Over this past week, Banyan has provided answers to many questions regarding how the Health Care Reform Cadillac Tax will affect you. We are sure you will find the following information from Banyan Administrators valuable. This article is part 2 of 2. If you missed last week’s article, click here.

Health Care Reform Cadillac Tax

What You Need to Know Now About: The Cadillac Tax

Another component of the Patient Protection and Affordable Care Act (PPACA) commonly referred to as the Health Care Reform Act is a tax on benefit-rich or “gold-plated” insurance plans. This tax is often referred to as “The Cadillac Tax” and, although it is not scheduled to go into effect until 2018 and may see several revisions in design before then, some plan sponsors are beginning to develop strategies to address it.

1.  I sponsor a grandfathered health plan. Am I subject to The Cadillac Tax?

Yes. The Cadillac Tax is applicable to both grandfathered and non-grandfathered health plans. 

2.  Are there any exceptions for certain groups of employees such as collectively bargained union groups?

During initial debate about implementing The Cadillac Tax for 2013, there was debate about excluding federal employees and union groups from the provision; however that was abandoned when the implementation of the tax was delayed to 2018. At this time, union groups will also be subject to the tax in 2018.

There are some adjustments to the current 2018 Annual Value Amounts for certain groups. For example, insurance plans that have an above average population of older workers or female workers may have higher 2018 Annual Value Amounts based on a still to be determined formula. The reasoning is that the higher cost to insure these groups is due to risk factors and not to benefit-rich plan designs.

This line of reasoning is also responsible for higher 2018 Annual Value Amounts for retirees and workers in high-risk professions (firefighters, coal miners, etc.). The amounts for these professions are set at $11,850 for an individual and $30,950 for a family plan. 

3.  How many plan sponsors might be subject to The Cadillac Tax?

Initially, when the tax was scheduled to go into effect in 2013 the CBO estimated that by 2016 19% of all workers would be subject to The Cadillac Tax.

With the delayed implementation date of 2018, several studies and estimates have been performed and assuming just an average annual trend of 8%, the projection is in the range of 40%-60% of all plan sponsors will trigger The Cadillac Tax. Of course, all these projections assume the plan sponsor does not make any significant plan design changes like increased deductibles and other employee out-of-pocket costs and that the details of The Cadillac Tax as currently constituted for 2018 remain unchanged. (continue reading…)

The following information is from www.healthcare.gov:

Under the Affordable Care Act, you and your family may be eligible for some important preventive services —which can help you avoid illness and improve your health—at no additional cost to you.

What This Means for You:

If your plan is subject to these new requirements, you would not have to pay a copayment, co-insurance, or any deductible to receive preventive health services, such as recommended screenings, vaccinations, and counseling.

For example, depending on your age, you may have free access to such preventive services as:

• Blood pressure, diabetes, and cholesterol tests;
• Many cancer screenings, including mammograms and colonoscopies;
• Counseling from your health care provider on such topics as quitting smoking, losing weight, eating healthfully, treating depression, and reducing alcohol use;
• Routine vaccinations against diseases such as measles, polio, or meningitis;
• Flu and pneumonia shots;
• Counseling, screening, and vaccines to ensure healthy pregnancies;
• Regular well-baby and well-child visits, from birth to age 21. (continue reading…)

The following information is from the United States Department of Labor’s web site. Since this COBRA article (or booklet, as the article refers to it) from dol.gov has an abundance of information, we will break the article up into sections over the next several weeks. We hope that you find the information valuable.

An Employee’s Guide to Health Benefits Under COBRA – The Consolidated Omnibus Budget Reconciliation Act

Note: This publication contains information about the COBRA premium reduction provisions of the American Recovery and Reinvestment Act of 2009 (ARRA). This publication has not been updated for recent amendments made to ARRA. For updated information on ARRA and its amendments, please see the COBRA Premium Reduction Fact Sheet.

Your COBRA Rights and Responsibilities:
Notice and Election Procedures

Under COBRA, group health plans must provide covered employees and their families with certain notices explaining their COBRA rights. They must also have rules for how COBRA continuation coverage is offered, how qualified beneficiaries may elect continuation coverage, and when it can be terminated.

Notice Procedures

Summary Plan Description

The COBRA rights provided under the plan must be described in the plan’s summary plan description (SPD). The SPD is a written document that gives important information about the plan, including what benefits are available under the plan, the rights of participants and beneficiaries under the plan, and how the plan works. ERISA requires group health plans to give you an SPD within 90 days after you first become a participant in a plan (or within 120 days after the plan is first subject to the reporting and disclosure provisions of ERISA). In addition, if there are material changes to the plan, the plan must give you a summary of material modifications (SMM) not later than 210 days after the end of the plan year in which the changes become effective; if the change is a material reduction in covered services or benefits, the SMM must be furnished not later than 60 days after the reduction is adopted. A participant or beneficiary covered under the plan may request a copy of the SPD and any SMMs (as well as any other plan documents), which must be provided within 30 days of a written request.

COBRA General Notice

Group health plans must give each employee and each spouse who becomes covered under the plan a general notice describing COBRA rights. The general notice must be provided within the first 90 days of coverage. Group health plans can satisfy this requirement by giving you the plan’s SPD within this time period, as long as it contains the general notice information. The general notice should contain the information that you need to know in order to protect your COBRA rights when you first become covered under the plan, including the name of the plan and someone you can contact for more information, a general description of the continuation coverage provided under the plan, and an explanation of any notices you must give the plan to protect your COBRA rights. (continue reading…)

The following information is from the United States Department of Labor’s web site. Since this COBRA article (or booklet, as the article refers to it) from dol.gov has an abundance of information, we will break the article up into sections over the next several weeks. We hope that you find the information valuable.

An Employee’s Guide to Health Benefits Under COBRA – The Consolidated Omnibus Budget Reconciliation Act

Note: This publication contains information about the COBRA premium reduction provisions of the American Recovery and Reinvestment Act of 2009 (ARRA). This publication has not been updated for recent amendments made to ARRA. For updated information on ARRA and its amendments, please see the COBRA Premium Reduction Fact Sheet.

Who Is Entitled to Continuation Coverage?

There are three basic requirements that must be met in order for you to be entitled to elect COBRA continuation coverage:

• Your group health plan must be covered by COBRA;
• A qualifying event must occur; and
• You must be a qualified beneficiary for that event.

Plan Coverage

COBRA covers group health plans sponsored by an employer (private-sector or state/local government) that employed at least 20 employees on more than 50 percent of its typical business days in the previous calendar year. Both full- and part-time employees are counted to determine whether a plan is subject to COBRA. Each part-time employee counts as a fraction of a full-time employee, with the fraction equal to the number of hours that the part-time employee worked divided by the hours an employee must work to be considered full time. (continue reading…)

The Group Insurance Trust of the California Society of CPAs is pleased to announce that it has selected a new administrator for the CalCPA ProtectPlus programs. Effective later this fall, program administrator responsibilities will transition from Seabury and Smith Insurance Program Management to Banyan Administrators, LLC. Banyan is a firm with extensive experience in administering multiple employer health plan arrangements.

What’s Next?

• Additional Web Features on CPAProtectPlus.com
• Brainshark Multimedia Online Presentation
• Detailed Administrative Guide Released
• Annual Enrollment Communications

The Trust is committed to continually improving the ProtectPlus member experience and the quality of the CalCPA ProtectPlus programs. The administrator transition will allow ProtectPlus program members to take advantage of a host of new and enhanced services, including:

• Simplified enrollment processes
• Improved program invoice design
• Enhanced communication capabilities – new web features; dynamic, multi-media presentations
• Streamlined administration leveraging web-based technology
• Online HR and Benefits reference materials

ProtectPlus Members
Your Annual Enrollment materials will be mailed to you on November 2, 2009 and will include new plan contact information.

In an effort to reduce Medicare costs, Congress passed the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) on December 29, 2007. Because Medicare has been unable to identify primary payers consistently, Section 111 of the new Act (MMSEA) imposes mandatory reporting requirements for fully insured and self-funded group health plans.

These requirements impose an obligation on primary payers to identify claimants entitled to Medicare and to report those claims to Medicare electronically.

As of July 1, 2009. Health plans are required to report specific member eligibility data for members who meet certain age or disability criteria. The reporting rules apply to covered individuals age 45 and older for groups with 20 or more full or part-time active employees. (continue reading…)

It’s as easy as 1,2,3.

1. Provide a written request including; the employee’s name, the plan(s) from which the employee should be terminated, the reason why, and the effective date.
2. Sign, date and include your title.
3. Fax your written request to Seabury & Smith @ 800-682-8787

(Originally published by Anthem Blue Cross April 24,2009)

The new CalCOBRA legislation, California Assembly Bill 23, is expected to be signed by the Governor by the end of this week. This bill will align the current CalCOBRA legislation with the Federal Subsidy as defined by ARRA (American Recovery and Reinvestment Act). The following are high-level details you should be aware of:

• This bill states that health plans and health insurers have 14 days from the date of enactment to provide proper notification to those individuals who may qualify for the Cal-COBRA subsidy. The Department of Labor (“DOL”) has agreed that the timeliness within which the state mini-COBRA programs must comply is to be determined by the states themselves. The DOL held a call with the California Department of Insurance (“CDI”) and the Department of Managed Health Care (“DMHC”) to assure this is understood by all three regulators.
• The mailing will go out to all individuals who had a qualifying event between Sept. 1, 2008, to the present, regardless of whether or not they had already elected CalCOBRA.
• The bill (AB23) currently states that California residents who were involuntarily terminated from their jobs between Sept. 1, 2008, and the present will qualify for the Cal-COBRA special election period.
• There is a notice letter being developed by Anthem in conjunction with the California Association of Health Plans (“CAHP”) and other health plans in this state. Once finalized, this notice will be deemed approved by both the CDI and DMHC. Anthem will send the notice as soon as possible following the enactment of AB 23.
• Once the bill is finalized and signed into law, Anthem will share a more detailed summary of the specific provisions of this law.

To continue reading “In the Interim“