E to E...by Employers for Employers E to E provides information from a business perspective that will educate regional employers about significant healthcare issues to help them make decisions benefiting their organizations and employees.

 Sponsored by Northern Illinois Health Plan

October 2015 Issue


Open Communication Key to a Good Open Enrollment Period

Minor Changes for HSA, HDHP Limits in 2016

Making Sense of the ACA Reporting Rules

A Reminder About the Transitional Reinsurance Fee

What's Your (ACA) Number?

Help With Healthcare Basics

Quick Poll – Review

October Quick Poll – Vote

Contact Information


Open Communication Key to a Good Open Enrollment Period

You've done the difficult work of choosing and negotiating the best benefit package for your employees, and now it's time to talk about it. Open Enrollment is more than "sign up for insurance" time – it's a chance to tell your employees they are a valued, important part of your company and that you’re proud to invest in them and their future.

You might be surprised at how employees like to get their benefits information: In a recent national survey, employees rated paper resources like brochures as useful as online resources, and more than half of the respondents reported they also liked the opportunity to talk with a benefits expert about their choices. In other words, those handouts do get read!

When you're putting together your open enrollment communication strategy, remember these tips from Employee Benefit News:

  • Stay on message, and communicate early and often. The key messages your employees will be interested in include plan changes, new choices, important dates and deadlines, employer and employee costs, eligibility, and resources for employees.
  • Explain the value of the benefits and services you offer. Healthcare benefits aren’t there "just in case you get sick," they are designed to help keep you and your family healthy! Remind employees to take advantage of preventive benefits.
  • Make the communications meaningful. Explain your employees’ benefits from a "life change" standpoint – "Did you get married this year? Are you getting ready for a baby? Are you looking to prepare for retirement?" And, even if it's "bad news," focus on the details that are critical to your employees – Are costs going up this year? Will deductibles or co-pays be higher?
  • Technology can help. Many employees – especially younger workers – appreciate being able to research, select, and enroll in company benefits online. If possible, provide resources online as well as on paper, so employees can talk over their choices with a spouse or partner before making their final decisions.

It can be overwhelming. Be prepared for employees to ask questions, and don't assume they'll read every email or plan brochure they get. Have an easy-to-understand reference guide such as a Frequently Asked Questions (FAQ) document available, and ask for feedback.


ACA – Important dates for 2016 enrollment, Healthcare.gov

Are employers offering the open enrollment tools their employees want?, Benefitnews, September 29, 2015

Tips for sharing bad news with employees, EBN, July 24, 2015

Minor Changes for HSA, HDHP Limits in 2016

The Internal Revenue Service (IRS) has adjusted some of the limits for health savings accounts (HSAs) and high-deductible health plans (HDHPs) for 2016 to keep pace with inflation.

The family HSA contribution limit has been raised $100 to the 2016 limit of $6,750. The individual HSA contribution limit remains unchanged at $3,350.

There are no changes to the limits for HSA catch-up contributions for those age 55 and older: That limit remains at $1,000.

The HDHP minimum deductible remains unchanged for 2016, as well, at $1,300 for individuals and $2,600 for family plans.

The HDHP maximum out-of-pocket expense limit, which includes deductibles, co-payments and other amounts, but not premiums, has been raised this year. Individual plans are capped at $6,550, an increase of $100 from 2015. Family plans max out at $13,100, up $200 from 2015.

Another notable change for 2016 affects HSA-qualified plans that utilize an aggregate family deductible and out-of-pocket maximum when more than one person is covered by the plan. Beginning in 2016, these plans must embed an individual out-of-pocket maximum not in excess of the plan’s out-of-pocket limit for single coverage. It’s a somewhat confusing provision: If one person in the family meets the single/individual out-of-pocket level of expenses, the expenses for that individual will be covered at 100%. The rest of the family must meet the remaining amount of the family out-of-pocket maximum before their expenses are covered at 100%.


IRS releases HSA Limits for 2016, Cornerstone Blog, September 17, 2015

This is how to make the most of your health benefits, Blomberg Business, September 25, 2015

Under the ACA, can I still have an individual HDHP and an HSA?, healthinsurance.org, October 3, 2015

Making Sense of the ACA Reporting Rules

The IRS has issued the forms and instructions for employers to use in reporting healthcare coverage offered to employees in 2015 – and they’re as simple and easy-to-use as usual. Following is a breakdown of the major details, courtesy of hrmorning.com

Who has to report: The requirements apply to "applicable large employers" (ALE) who employ 50 or more full-time or full-time equivalent employees, as well as anyone who provides minimum essential health coverage under the law to an individual. (So it would also apply to a very small self-insured employer.)

The four forms essential to this requirement are:

  • Form 1094-B – Transmittal of Health Coverage Information Returns
  • Form 1094-C – Transmittal of Employer Health Insurance Offer and Health Coverage Returns
  • Form 1095-B – Health Coverage
  • Form 1095-C – Employer Provided Health Insurance Offer and Coverage Insurance

If your company qualifies as an ALE, you will be required to file a Form 1095-C for each full-time employee regardless of whether he or she is participating in your health plan. ALEs with self-insured plans must complete a Form 1095-C for each non-full-time employee enrolled in the self-insured health plan. (There’s no need to file a Form 1095-C for non-full-time employees who aren’t enrolled in your plan.)

Insurance companies must file Form 1095-B and Form 1094-B to report individuals covered by insured employer-sponsored group health plans.

Small, self-insured employers must file Form 1095-B and 1094-B to report employees and their family members who have coverage under the self-insured plan.

Each employee must get a copy of the applicable form 1095 or a substitute statement by February 1, 2016. (The usual deadline, January 31, falls on a Sunday this year, so we’ve been given an extra day.) Employers must file these forms for 2015 by Feb. 29, 2016. Employers filing electronically have until March 31, 2016 to file the forms, and any employer filing at least 250 forms MUST file electronically. Failing to provide these forms in a timely manner to the IRS or employees can result in fines of $250 per return.

There are four steps involved in filing electronically:

  1. Naming your responsible official(s) and IRS contacts – Register here. All companies that plan to e-file must put at least one responsible official and two contacts on their applications.
  2. Obtaining a Transmitter Control Code (TCC) – after you have registered, you can apply for a TCC through the IRS e-services portal. The link will be mailed to you.
  3. Test filing – you're encouraged to complete a communication test using the IRS' Affordable Care Act Assurance Testing System, and
  4. Actual filing – using the IRS' Affordable Care Act Information Returns Program, also known as AIR.


ACA reporting rules: A plain-English breakdown, HR Morning, September 18, 2015

IRS releases forms, instructions for 2016 reporting of health-care coverage under ACA, Blomberg BNA, September 24, 2015

The very hard facts: 2015 reporting requirements under the Affordable Care Act ("ACA"), Lexology, September 29, 2015

You saw this coming: New ACA forms and instructions from the IRS, HR Morning, September 25, 2015

A Reminder About the Transitional Reinsurance Fee

The Nov. 16, 2015 deadline is approaching for reporting the number of covered lives in your company’s health plan to the Department of Health and Human Services. The reporting is part of the ACA Transitional Reinsurance Program, which provides payments to health insurance issues that cover high-risk individuals to more evenly spread the financial risk of issuers.

The fee will be assessed on health insurance issuers and plan sponsors of self-funded health plans in 2014, 2015, and 2016 years and is deductible as an ordinary and necessary business expense.

The fee for the 2015 benefit year is equal to $44 per covered life per year, and is expected to raise about $8 billion in revenue. The 2016 fee is expected to be $27 per covered life per year to raise approximately $5 billion in revenue. After 2016, the fee will expire and no longer be applicable.

The 2015 ACA Transitional Reinsurance Program Annual Enrollment and Contributions Submission form is available at www.pay.gov. You will be informed of the fee due and payable will be reported to you by Dec. 15, 2015.

As with 2014, you have two options to make the payment. The first option splits the fee into two parts — $33 per covered life, payable no later than Jan. 15, 2016 to cover reinsurance payments and administrative expenses. The second portion of the fee, $11 per covered life, will be due no later than Nov. 15, 2016. This part of the fee covers Treasury’s administrative costs associated with the Early Retiree Reinsurance Program.

The second payment option is to pay the full fee, $44 per covered life, by Jan. 15, 2016.

Please contact NIHP if you need assistance with filing and making this payment.


Health plan check-up: Prepping for 2016, Human Resource Executive Online, September 24, 2016

Reminder! Transitional Reinsurance Fee – Year 2, WSB, October 2, 2014

Transitional reinsurance fee deadlines approaching, SHRM, October 1, 2015

What's Your (ACA) Number?

How many full-time employees does your company have? Though that might seem like a simple question, the answer in terms of the Affordable Care Act might be different than you think, and that number is the key to a number of important upcoming reporting deadlines.

Under ACA rules, an employee is generally considered full-time if he or she is reasonably expected to work on average about 30 hours a week (130 hours a month).

Under the new ACA rules, variable hour and seasonal employees may also be considered full-time. An employee is a variable-hour employee if his or her weekly schedule fluctuates above and below 30 hours, and it can’t be immediately determined if that number averages out to 30 hours.

The IRS has proposed a safe harbor method for employers to determine each employee’s full-time status by counting hours using a look-back/stability period. For more on this method, read: "4 keys to calculating full-time employees under Affordable Care Act, HR Benefits Alert, September 16, 2015"

An employee is considered seasonal if he or she works no more than 120 days during the year. Seasonal workers don’t count against the 50 full-time employee threshold for providing coverage.

Your health plan may require an amendment, summary plan description update and employee communications to bring it into compliance with the employer mandate. Look for any changes that need to be made now.


The ACA: Know your number, EBN, September 25, 2015

4 keys to calculating full-time employees under Affordable Care Act, HR Benefits Alert, September 16, 2015

Help With Healthcare Basics

Several new smartphone apps can help your employees with the basics of good healthcare:

GoodRX – is free and provides instant access to the lowest prices for prescription drugs at more than 75,000 pharmacies, along with coupons and savings tips.

iTriage – is a free app that helps your employees locate medical answers, care options, and securely maintain your health information.

Do you have a healthcare-specific app you'd like to recommend to our readers? Let us know!

A Quick Review of Last Issue's "Quick Poll"

In the July 2015 issue of E to E we asked readers, "Will the Supreme Court ruling on marriage equality cause you to make any changes in your healthcare benefits?" Specific survey results are noted in the chart, below.

July Quick-Poll Summary

October Quick Poll – Vote

Do you know your ACA number?
(Click a response to vote. Answers are strictly anonymous.)

Then, visit the NIHP website to view this issue's quick poll results.

For more information contact us at:
(800) 723-0202 or NIHPCustomerService@nihp.com

Northern Illinois Health Plan

773 W. Lincoln Blvd., Suite 402, Freeport, IL 61032

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