FLU SHOTS – covered in full by health insurance policies!

Download (PDF, 780KB)

Posted on by Melanie Epstein in Insurance Basics Leave a comment

CareFirst Rebates – Do you know what to do with it?

CareFirst has started sending out the rebate checks that are required under the provisions of the Affordable Care Act.  If they don’t spend a certain amount of every claims dollar (either  $0.80 or $0.85) on actual claims, they must rebate premiums.  The rebates are calculated by jurisdiction, group size and product.    If you receive a rebate, do you know the rules surrounding distribution?  Here is some guidance:

Download (PDF, 420KB)

Posted on by Melanie Epstein in CareFirst, Health Care Reform Leave a comment

2018 HSA Limits- Increased contribution limits for all!

Here are the updated HSA Limits for 2018 as set by the IRS.

Download (PDF, 138KB)

Posted on by Melanie Epstein in Health Savings Accounts, Uncategorized Leave a comment

Dependent Care Flexible Spending Accounts – Overview – Great tax savings for child care expenses!

Download (PDF, 433KB)

Posted on by Melanie Epstein in Flexible Spending Accounts Leave a comment

Corporate Coverage Compliance Bulletin – New York Paid Family Leave

Download (PDF, 546KB)

Posted on by Melanie Epstein in Compliance, Uncategorized Leave a comment

New CareFirst Benefit – Introducing Video Visits!

New Benefit – CareFirst Video Visits!

CareFirst has just introduced Video Visits, a new benefit immediately available to all of their group and individual(except those enrolled in a Medicare plan**) members.    CareFirst has partnered with American Well to offer this new telemedicine service that provides 24 hour access to a board certified doctor when your primary care provider is not available.

If you are traveling or you wake up sick in the middle of the night, Video Visits can be an alternative to the Emergency Room as you can consult with a doctor day or night from your smartphone, tablet or computer.

Video Visit allows you to connect with a doctor whenever or wherever you want without an appointment!   The service is great for Bronchitis, Fever, Vomiting, Cough/Sore throat, Pinkeye, Diarrhea, Sinus infection, Cold/Flu or Headaches.

The cost for the visit is the same as your Primary Care Physician copay for a sick visit.    If your plan has a deductible, the visit will cost no more than $60 and will apply to your deductible.

Video Visit can be accessed from the CareFirst member website at www.carefirst.com/needcare.  You can also download the CareFirst Video Visit app (iTunes and Android) to see a doctor on your smartphone or tablet.

Before the first visit, you will need to register for an account. Upon successful registration, you will receive a welcome email with instructions on how to schedule a visit.

Let us know what your experience is like when you use Video Visits.

*American Well is an independent company that provides Video Visit services.  The doctors accessed via Video Visit are independent providers making their own medical determinations and are not employed by CareFirst.  CareFirst does not direct the action of participating providers or provide medical advice.

**Video Visit is not a covered benefit for consumer direct members enrolled in over 65 products.  However they can access the service and pay the full $60 copay.

Posted on by Melanie Epstein in CareFirst Leave a comment

Understanding your deductible

Most health plans today have a deductible.   A deductible is the dollar amount of your covered claims you are responsible for before your insurance will start to pay. Deductibles can operate differently from carrier to carrier and from plan to plan.    To help you understand your deductible, find out the answers to the following questions

What time period is my deductible calculated on? Some deductibles are tracked on a calendar year basis while others are tracked based on a plan year basis.  For example, if your health plan’s renewal date is April of each year with a plan year deductible, your deductible runs from April 1 to March 31 of each year.  Maryland small group plans run on a plan year basis while individual policies run on a calendar year basis.  This is especially important if you are a new employee to a plan with a plan year deductible.  If you are a new employee and your effective date is June 1, your deductible would start then.  If the plan year is September 1, your deductible would start over just three months later in September.  If you have purchased a Maryland individual policy with an effective date of August 1, your deductible would start then and restart January 1

How are the deductibles on family policies tracked?  Some plans require the entire family deductible to be met before claims are paid.  This is common for health savings account plans (H S A).  An example of this is if a plan has a $1500 individual deductible and a $3000 family deductible, for families, the full $3000 must be met before any claims are paid.  The $3000 can come from one family member or a combination of all family member claims.  Because of this, in a family of two purchasing a policy, we suggest that the policies are purchased separately so that the deductible can be tracked separately.

In other plans, one family member cannot contribute more than the individual deductible.  Some carriers call this an “embedded” or “stacked” deductible.  In our previous example, this would mean that if one family member reached the individual $1500 in claims, the insurance company would start to cover that family member’s claims.  This is a good feature for a family where there is one family member who incurs most of the claims.

What types of claims are subject to the deductible?  Affordable Care Act plans include preventive care as a covered in full benefit and not subject to the deducible.  Other than the preventive care, plan designs are unique.  Some plans impose the deductible for mainly hospital based services only.   These type of plans generally require just a copay for a visit to the primary care doctor or the specialist.   The copay you pay would not credit your deductible.  Other plans require that all services are subject to the deductible.  This is common in the HSA plan designs.  Check your benefit chart carefully which will show you what services are subject to the deductible.

Is there a separate deductible for prescriptions?  Some plans have a separate deductible for prescription claims and medical claims.   HSA plans have a combined medical and pharmacy deductible.  This is called an “integrated” plan.  In plans that have a separate pharmacy deductible, the pharmacy deductible is tracked per person in the family and may or may not have a family maximum.

Does my “out of pocket” maximum include the deductible?  The out of pocket maximum is the most you have to pay out of your pocket in the year before the insurance picks up 100% of your claims.   Most plans include the deductible amount in the presentation of their out of pocket number.  Some plans however, present the out of pocket maximum in addition to the deductible

Is there a separate  or combined deductible for in and out of network claims and do they count towards each other? For plans that have out of network benefits most have separate in and out of network deductibles which do not count towards each other.   It’s like having two separate health plans.


Posted on by Melanie Epstein in Insurance Basics Leave a comment

IRS Extends Deadline for Section 6055 and 6056 Reporting

On December 28, 2015, the IRS granted an extension to employers and insurers for the Affordable Care Act reporting required under Sections 6055 and Sections 6056.  Section 6055 reporting is for insurers and self- insured groups that do not meet the 50 lives Applicable Large Employer(ALE) definition.  Section 6056 is for employers meeting the ALE definition.  The extensions are as follows:

1095-C – form distributed to employee extended 2 months from January 31, 2016 to March 31, 2016

1094-C – paper form filed with the IRS extended 3 months from February 29, 2016 to May 31, 2016

1094-C  – electronic filing with the IRS extended 3 months from March 31, 2016 to June 30, 2016

Click here for the full 2014-6 release by the IRS.

Posted on by Melanie Epstein in Health Care Reform Leave a comment

2016 HSA contributions

Now that 2016 has begun, check your current payroll contributions into your HSA(health savings accounts). The maximum for individuals is $3350 which is no change from 2015.  The maximums for families is $6750 which is an increase of $100 from 2015.  If you are 55 or older at the end of 2016, you are eligible for the catch up provision which allows you to contribute an additional $1000.  If you and your spouse are both 55 or older, you can each take advantage of the extra $1000 but you would each have to have your own HSA account.

Posted on by Melanie Epstein in Health Savings Accounts Leave a comment

Does your business qualify for the Small Business Health Care Tax Credit?

One of the provisions of the Affordable Care Act (ACA) is the Small Business Health Care Tax Credit.    This tax credit has been available to small businesses since 2010 when the ACA was originally passed.  The current eligibility parameters are:

  1. Businesses including tax-exempt organizations that employ no more than 25 full-time equivalent employees.   Business owners and shareholders and their family members are not considered employees.
  2. Average annual wages (excluding business owners and shareholders and their family members) do not exceed $50,800(as adjusted for inflation).
  3. Business pays at least 50% of the employee’s individual health insurance premium
  4. As of June 1, 2014, the group health plan must be purchased through the SHOP which is the small business health insurance marketplace.  Corporate Coverage is an authorized broker and can help you secure coverage through the SHOP marketplace.
  5. 75% of eligible employees must participate in the plan.  Eligible employees are those that work more than 30 hours per week.   Employees who have other employer sponsored or government sponsored coverage can be excluded from the participation count.  Participation requirements are waived during annual SHOP open enrollment periods.  The first open enrollment period is for applications received between May 15, 2014 and June 15, 2104.
  6. The maximum tax credit is  50%(35% for tax-exempt employers)of the premiums that are paid by the employer not to exceed the average premiums for the small group market in the employers rating area as reported by the Department of Health and Human Services.  The credit is reduced as the employer size increases and the average wages increase.  The largest tax credit would be for an employer with less than 10 employees with average wages of $25,000 or less.
  7. Beginning in 2014, the tax credit is available for two consecutive years.  It is filed on tax form 8941.

Click here for a link to the IRS website that provides the details on this available credit and consult with your accountant.   To assist you in determining your eligibility, two calculators are available:

  1. Click here for the calculator that helps you determine the number of full/time employees/equivalents.
  2. Click here for the calculator that will estimate your tax credit.


If you will be taking advantage of the tax credit, please advise us during our renewal meeting so that we can provide you with the applicable SHOP plans.

Posted on by Melanie Epstein in Health Care Reform Leave a comment