Affordable Care Act

September 10, 2015
ACA employer reporting requirements

Assuming Your Small Business is Free From Affordable Care Act Requirements? Think Again!

Let’s say you own a business with over 50, but under 100 employees, and you offer an affordable group health insurance plan. You’re clear from any responsibilities under the Affordable Care Act, right? Think again. Starting January 1, 2016, you will be subject to the same reporting requirements employers of over 100 people are currently managing. What do the ACA reporting requirements mean for your business? With the adoption of the ACA came additional paperwork that is tied to payroll reporting requirements. Now, employers have to send information to the Internal Revenue Service about their employee group health benefits, and they have to provide the value of that program to their employees. Formulas for determining full-time employee status have also changed and can have a great effect on determining accountability under the ACA. The penalties for miscommunicating this information are substantial, making it important that your Human Resources Administrator fully understand the complexities of these new reporting requirements. (Click here to learn more about the penalty structure that will affect businesses with 50+ employees 1/1/16). There is no need to figure out this new world all on your own! Wharton Insurance and Financial Services has many options to help ensure all of your bases are covered. We can guide you through the decisions surrounding offering affordable group health care coverage. We can help your employees find individual coverage if you want to disband your program. And, we can provide resources for managing the new intricacies of being an employer under the ACA. Send us an email, or give us a call at 317.663.4138 for more information.
August 19, 2015
healthcare deadlines

Healthcare Deadlines Important to Your Business & Family Are Approaching

Healthcare-related deadlines important to your business and your family are approaching: Mid-September: Group health insurance renewal letters will be sent out to businesses in mid-September. We are expecting an average rate increase of 15% this year, so do not wait until then to prepare. The WIFS Team can help you strategize on the best course of action to manage your increased costs. We have options for you. October 15-December 7: Medicare open enrollment affords policy holders the opportunity to make changes to their Advantage Plan or Supplemental policies. If your health or prescriptions have changed over the last year, or you feel you are paying more than you should, the WIFS Team can help you find the best plan for your current situation. December 1: For organizations that have legacy health plans, December 1 is the final renewal date for those policies. The ACA requires business interested in staying out of the community marketplace to keep their current plan with no changes. Policies that renew this year will be in affect until October 1, 2016 only, so plan for an earlier renewal process in 2016! January 1: Businesses with 51 or more employees will be subject to payroll reporting requirements that kicked in for 100+ employers earlier this year. Click here to read more about these new requirements. Organizations with 2-50 employees are still not subject to these regulations. Questions about how these deadlines affect your business and family? Send us an email or give us a call at 317.663.4138 to set an appointment. We’d be happy to help.
July 29, 2015
Affordable Care Act info

BAGI Member Sessions: The Affordable Care Act and Your Business

The Affordable Care Act has changed the health insurance and human resources landscape. As a business owner, what can you do to stay ahead of it? Join your fellow BAGI members as Scott Wharton of Wharton Insurance & Financial Services presents valuable information on the changes your business faces within group health insurance. Thursday, August 6th 9-10:30am or 2-3:30pm BAGI Offices 1011 Dr. Martin Luther King Jr. St. Indianapolis, IN 46202 Topics Will Include: Expected changes to the 2016 BAGI/IBA Group Health Insurance Program Shorter renewal periods forcing quicker action The activation of additional rules within the ACA How to manage the expected average double digit rate increases In addition, Kelly Cathcart from ADP will present information on HR Compliance/ Employee Related Responsibilities required under the ACA. Members must register for a session at BAGI.com.
July 7, 2015
Affordable Care Act

What the U.S. Supreme Court’s ACA Decision Means for Your Business

The highly anticipated U.S. Supreme Court decision on the Affordable Care Act created certainty around the law. The issue under question was one of financing, regarding the 36 states that have opted to forgo setting up their own state health insurance exchanges and using the federal exchanges. The ruling clarifies that the residents of those states are entitled to take advantage of the available premium tax credit if they qualify. The subsidy structure already in place was affirmed, therefore the law has not changed, but the future has become clearer. Within a day or two of the Supreme Court’s ACA decision, Aetna announced its plans to purchase Humana for $37 billion. Centene announced it is buying HealthNet, and Aetna and Cigna are in merger-related talks. It seems evident that in the wake of the Supreme Court decision comes consolidation. The health insurance marketplace is shrinking to fewer providers, leaving less choice for individuals and organizations. The industry is lining up toward a two-tiered system: programs with funding coming from the Federal government and programs for those fortunate to have a job that offers group health benefits. The private sector will have a role in this new world, but it will change. As an employer, what does this changing landscape mean to you? According to a recent New York Times article, health care insurance providers will be seeking a double-digit rate increase for 2016, possibly between 20% and 40%. Federal mandates requiring companies who employ 50 or more full-time workers to provide group health insurance will kick in January 1, 2016. These mandates and associated penalties are already in affect for 100+ employers. Fortunately, we have group health insurance benefit options for you: 1) Join the BAGI Group Health Insurance Program The BAGI program takes advantage of the power of pooling resources. Joining together the employees of other BAGI builder members allows an even spread of risk, less rate volatility, and a potentially more affordable option to the double-digit rate increases we expect for 2016. As the sole administrator of the program, Wharton Insurance is in a unique position to help you take advantage of this option. Click here for more information on the BAGI program. 2) Continue with Your Current Group Health Benefits Plan As long as you do not make any changes to your current plans, the federal government is allowing a “Transition” renewal year in which employers can keep their current group health insurance plan. Electing this course of action means accepting your provider’s rate increase. A knowledgeable insurance broker can help guide you through your options, helping you weigh the pros and cons of keeping your plan. 3) Eliminate Your Group Health Benefits If you employ under 50 full-time workers, you can elect to not offer group health insurance benefits and send your employees to the marketplace. Individuals must have insurance or be subject to a penalty, so many employers who take this option often gross up employees wages to help offset the costs of health insurance. […]
February 18, 2015
ACA employer reporting requirements

Managing the New Affordable Care Act Employer Reporting Requirements

As of January 1st, 2015, businesses with 100+ full-time employees must be in compliance with the Affordable Care Act mandate to provide affordable employee health benefits or be subject to penalties. (Click here to read our blog post about what this change means for your business.) Along with the benefits mandate came a whole new layer of employer reporting requirements. The costs of non-compliance are now stiff, making it worthwhile to find a viable option to fulfill your obligations under the law. Human Resources Administration is becoming more complex and expensive to mismanage. Beyond the ACA, it seems the world of human resources is getting more and more complex, and expensive to mishandle. The reporting requirements for employers are also becoming more intricate. With the adoption of the ACA came additional paperwork that is tied to current payroll reporting requirements: employers may now have to report the value of employee health benefits on the employee’s W-2. With the cost of miscommunicating this information becoming more substantial, it is important that your HR Administrator fully understand the complexities of this new structure. PEOs Offer Employer Solutions As the HR landscape changes, how are you as a business owner meant to keep up? One way to insure that you are following the law is to contract with a Professional Employer Organization, or PEO. These entities offer employers a way to outsource their human resources needs, including payroll, employee benefits, and workers’ compensation insurance. PEOs are experts in their field. They allow the reporting process to be consolidated into one place, alleviating employers of the stress of trying to understand and abide by the new laws. Wharton Insurance & Financial Services has partnered with Worksmart, a local PEO with a 17 year history of satisfied clients. When you enter into a co-employment relationship with Worksmart, they become the employer of record for tax and insurance purposes while you retain the management of your employees’ overall work. Worksmart manages your payroll reporting requirements, which with the ACA is now tied to your health insurance obligations. As a co-employer with the expertise in dealing with HR administration on a daily basis, partnering with Worksmart provides a layer of protection from potential compliance and reporting issues. PEOs serve as a smart choice for one-stop shopping for your compliance reporting needs. For more information on how to manage the new Affordable Care Act employer reporting requirements using Worksmart, send us an email, or give us a call at 317.663.4138.
January 16, 2015

Health Insurance Status Reflected on 2014 Tax Forms

Your 2014 tax form is going to look at little different this year. The penalties for not having health care coverage set under the Patient Protection and Affordable Care Act (PPACA), or Obamacare, have kicked in. On line 61 of Form 1040 will ask you if you had health insurance coverage in 2014. If you did not, you may be subject to a penalty. 2014 Penalty structure: Individuals: $95 per person or 1% of household income, which ever is greater, up to a family cap. For families with children under age 18, the penalty is $47.50 per child, up to $285 total per family. The penalties increase in 2015 to 2% of household income or $325 per person.  2016 penalties will be $625 per person (half for children) or 2.5% of income. Family caps will also be in place. However, it is unclear how many American will actually have to pay the penalty. Click here to read an article by Maggie Mahar outlining the complexities around these calculations. If you were without health coverage or signed up for a PPACA plan, you may want to discuss your tax implications with your accountant.
January 14, 2015
affordable care act penalties

1/1/15: Big Penalties Kick in for Employers Ignoring The Affordable Care Act

After years of delays, the Affordable Care Act’s employer mandate to provide employee affordable health care coverage has kicked in. As of January 1, 2015, employers with 100+ full time* employees must be in compliance or they will be subject to penalties. For organizations with 50+ employees, these penalties will apply in 2016. So what do the mandates mean to you? If you have been postponing complying with the ACA, now is the time. The Kaiser Family Foundation has put together a flow chart outlining the penalty structure. We have also provided an explanation below: The penalties for ignoring the law are levied for each month you are out of compliance and are based on two situations: Situation 1) Do you offer health insurance to your employees?** If not, and  just one of them receives a subsidy (premium tax credit) within the marketplace, you will be subject to a penalty. Situation 2) If you do offer health insurance, is it affordable? Your plan must meet the standards of affordability*** or you will be penalized. If you are not complying under Situation #1, the formula to calculate penalty levels for each month you are not offering a plan is as follows: Situation #1: Not Offering Group Health Insurance Plan Formula: $2,084 Divided by 12, times the # of full time employees – 80. Example: 150 full time employees ($2,084 /12) * (150 -80) = 173.67 x 70= $12,157 per month For Situation #2, the formula is as follows: Situation #2: Group Health Insurance Plan is Not Affordable Formula: $3,126 Divided by # of employees receiving credit or subsidy (up to 80), times 12 Example: 150 full-time employees, 50% receiving ACA subsidy (35) ($3,126/ 12) *35 = $260.5 x 35= $9,117.5 per month For Situation 2, there is a set maximum penalty that increases is 2016. It is now expensive to ignore the employer mandates under the Affordable Care Act. In both examples, once you get the fixed cost of the penalty established, the formula is not going to fluctuate greatly. However next year the percentage increases in health care premiums will be applied to the penalty levels. Therefore, your penalties will grow as premium costs grow. Until you offer a plan, your expenses are going to continue to rise. For employers with 100+ full time employees, the sooner you get into compliance, the lower your penalty costs. And if you employ 50+, it is smart to prepare for 2016, when your mandates will kick in. For more information on how to avoid the ACA penalties, send us an email, or give us a call at 317.663.4138. *Under the ACA, a full-time employee is defined as working an average of 30 hours per week, or at least 130 hours in a month. **You are not penalized for not offering spousal coverage, but you must offer coverage for your employee’s children under 26 years of age. *** What does Affordable mean? Under the ACA, affordable health insurance plans must: a) cover at least […]
October 22, 2014
employee health insurance

Facing a Large Rate Increase on Your Employee Health Insurance Plan?

The WIFS Team has been preparing for the release of group health insurance policy renewals rates over the past year. Since the passage of the Affordable Care Act, we have gained a lot of experience guiding our clients through the changing employee benefits landscape. Our clients look to us for expertise in managing the challenges presented by large rate increases. It is during these times of upheaval that they are fortunate to have an experienced insurance broker on their side. Facing a large rate increase on your employee health insurance plan? There are options: 1) Stay with your current plan. The benefit of accepting the rate increase with no changes to your plan is that your policy is not subject to community rating* for 2015. If you have a healthy workforce, staying out of the general pool will most likely save you money. Altering the percentages paid by employees can help your company’s bottom line manage the rate increases. 2) Partner with a PEO. Professional Employer Organizations offer access to employee benefits programs similar to large companies, providing you with protection from large jumps in premiums as well as a wide variety of plans. WIFS is the Indiana Broker of Record for Indianapolis-based Worksmart Systems, placing us in a unique position to offer you this creative solution. 3) Access an Association Program. Many industry associations offer private group health insurance plans. Locally, the Builder’s Association of Greater Indianapolis (BAGI) has partnered with the WIFS Team to offer a cost-effective, fully-insured insurance plan. Members in good standing may take advantage of the benefits of this plan, such as staying out of the community-based rating model. 4) Drop your employee health insurance benefits. In some rare cases employers are facing such large jumps in their health insurance premiums that they are eliminating their plans altogether. In this case, we can help create a plan to supplement the employees’ costs for individual plans on the federal exchange. The days of price shopping for insurance brokers are gone. Today, you need a broker with solutions. The WIFS Team works with clients every day to find creative solutions for their group health insurance issues. We can help you too. Send us an email, or give us a call at 317.663.4138 for more information. *Community rating refers to the manner in which health risks are managed. In this model, the lower costs of covering healthy employees are balanced by the higher costs of covering unhealthy employees. The risks associated with each are leveled over the entire coverage base, and charged to all.
October 8, 2014
Employee Benefits from Wharton Insurance

Avoid the Suck: Why Are YOU Spending Time on Employee Health Benefits?

Most likely you chose to be in your business because you are an expert at what you do. Your customers value that expertise, and spending your time building on that value is what allows your business to grow. So why spend your valuable time figuring out the ever-changing world of employee health benefits? Save time and money by bringing in experts like us to guide you and your employees through the entire process. Why use an employee benefits expert? Knowledge: Employee benefits and insurance is our world. Why should you take the time to sift through all of the choices? Over the past 25 years we have built relationships with carriers that allow us to provide the best options for your business. We have the expertise to help you balance budget with benefits, providing you with a plan you can be comfortable offering. Process: With the Affordable Care Act came mandates, for individuals as well as businesses. We understand these requirements, and ensure that all of your bases are covered. For example, part of our process is to create a concise spreadsheet of the elements of your plan. Not only does this allow you and your employees to understand the coverage, it fulfills the ACA mandate to provide a Summary of Benefits & Coverage. We see it as our job to make offering employee benefits a high-quality, affordable and easily manageable process. Simplification: Health insurance plans are complex. Covered expenses, deductibles, co-pays, maximum out-of-pocket expenses, available networks…the list of particulars goes on and on. We know how to minimize the complexities by creating clear, plain-English tools for you and your employees. We prepare an employee packet, outlining the elements of your plan and addressing items that worry employees most. We also hold yearly meetings with your employees to explain the plan and to answer questions. Finally, we are always just a phone call or email away to address individual concerns. Guidance: Even within one health insurance plan, employees can be faced with many choices about their health care. We offer individualized advice for your employees, helping them find the lowest-cost, highest care options within their plan. If available, we can advise them on HSA strategies. We answer questions like how to handle chronic disease considerations, or how to access widely available interest-free credit programs. Complete Service: Employee benefits go beyond group health insurance. As industry experts, we can help you manage all of your human resources administration needs. Short- and long-term disability insurance, COBRA, dental and supplemental insurance, life insurance, workers’ compensation and HR admin services – we can do it all, and keep you compliant. You wear a lot of hats as a business leader, but there are times when it makes sense to hand one off to an expert you trust. The WIFSInc Team is ready to use our experience, knowledge and tools to successfully guide you through the complexities of employee health benefits. Give us a call at 317.663.4138 or send us an email to set an […]
October 3, 2014
Health care deadines

Do You Know Your Health Insurance Deadlines?

If you are a business owner, eligible for Medicare, medically uninsured, or want to change your individual coverage, there are some deadlines approaching that you need to know about: Business Owners: If you offer Group Health Insurance for 2-50 employees, most policy renewals are due December 1st. Eligible for Medicare: The Medicare Annual Enrollment period is October 15th through December 7th.  Changes applied for will be effective January 1, 2015. Medically Uninsured or Looking to Change Your Insurance Plan: The Federal Health Exchange open enrollment begins November 15th and ends February 15th. Needless to say, this time of year can cause anxiety and confusion! The team at Wharton Insurance is ready to help, with options and solutions for each group facing their impending deadline. For more information, check out the links below, or contact us. Give us a call at 317.663.4138 or click here to send an email. Group Health Insurance Medicare Advantage Individual Health Benefits
August 22, 2014

Infograph: American’s Views on Health Insurance & Employment

According to results from Gallup’s July 7-10 2014 Consumption Habits survey, fewer Americans support instituting higher health insurance rates based on an individual’s lifestyle habits than they did in 2003. While the majority still support this type of rate structure, the percentage has decreased. However, when it comes to hiring discrimination, the majority of Americans do not support allowing companies to make employment decisions based on an individual’s smoking habits or weight. The Affordable Care Act allows for higher premiums for smokers, and the Gallup report does recognize that higher insurance costs are associated with smoking and being overweight. Businesses concerned with minimizing their group health coverage costs can offer wellness programs that encourage healthy lifestyles. For more information on instituting a wellness program in your organization, send us an email or give us a call at 317.663.4138. LifeHealthPro.com recently published an infograph based on results of Gallup’s survey:  
August 12, 2014
employee benefits

Providing Health Insurance Benefits to 2-50 Employees? A Deadline is Approaching!

If you have a business that offers group health benefits to 2-50 full-time employees, an important date is arriving soon. On September 1, health insurance providers will be releasing prices for December 1, 2014 policy renewals. Anthem, one of the major group benefits carrier in Indiana, expects rates to increase by 13.5%. Last year increases came in lower than expected at only 5-7%. Once we receive the renewal documents, the WIFS Team will be reaching out to our clients with final numbers. Needless to say, this rate jump may mean you will be looking for creative solutions to manage the higher costs. Fortunately, we have some options for you: Worksmart– Indiana’s fastest growing PEO solution, Worksmart Systems has a cost-effective option to providing employee benefits. Endorsed by Anthem, their self-insured group health plan allows organizations to opt-out of the community-rate model* set by the Affordable Care Act. A high–quality, self-insured, and fully funded PEO solution, Worksmart offers competitive pricing without the volatility often seen with smaller programs. As the Indiana Broker of Record for Worksmart, the WIFS Team is in the unique position to present this option for your group health benefit plan. Association Programs – WIFS has partnered with organizations like the Builder’s Association of Great Indianapolis (BAGI) to provide cost-effective private group health insurance benefits. Similar to Worksmart, these programs allow businesses to opt out of the community-based model. In this case, the association is medically underwriting the risk of the participating members. Like BAGI’s program, quality association plans are fully insured. Keep Your Current Plan – The WIFS Team is skilled in guiding business owners through the choice of managing benefit price increases. Absorbing the costs, altering the percentages paid by employees, or amending coverage are all options. However, it is important to note that choosing to amend your plan for 2014 means automatically losing Grandmother status for 2015. Keeping this status allows you to stay outside of the ACA community-rated model for 2015. Discontinue Group Health Benefits – One available option that few employers who offer group health benefits want to take is discontinuing their plans. Employees would then have to go out to the federal exchange for health coverage as Indiana does not have a state exchange. Rising costs of doing business are always a concern for business owners. Come to WIFS for personalized solutions for your company’s situation. We are experts in navigating through the options to find the most cost-efficient, high-quality coverage for your employees. For more information, send us an email, or give us a call at 317.663.4138. *Community-based model refers to the manner in which health risks are managed. In this model, the lower costs of covering healthy employees is balanced by the higher costs of covering unhealthy employees. The risks associated with each are leveled over the entire coverage base, and charged to all.  
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