News Archives - SBMA Benefits

Unlocking Cost Savings and Optimizing Employee Benefits with the MEC Savings Calculator

September 3, 2023/in News

As a Qualified Applicable Large Employer (ALE), navigating the complex world of employee benefits while maintaining financial stability is a top priority. Offering robust benefits packages, including Minimum Essential Coverage (MEC) plans, is crucial to attracting and retaining a talented workforce.

In this blog, we introduce a powerful tool tailored to ALEs – MEC savings calculator – designed to simplify decision-making and help you optimize your employee benefits strategy.

Understanding the ALE Perspective on Employee Benefits

ALEs face a unique set of challenges when it comes to providing employee benefits that comply with the Affordable Care Act (ACA) while managing costs effectively. Striking the right balance between comprehensive coverage and affordability requires informed decision-making backed by data-driven insights.

Introducing the MEC Savings Calculator: A Customized Solution for ALEs

The MEC Savings Calculator, offered by SBMA Benefits, is a user-friendly tool designed to address the specific needs of ALEs. This calculator empowers you to make well-informed decisions by analyzing the potential savings and advantages of incorporating MEC plans into your benefits offering.

How the MEC Savings Calculator Works for ALEs

Tailored Analysis: The MEC Savings Calculator takes into account your company’s unique number of full-time employees.

Comprehensive Reports: The calculator generates detailed reports illustrating potential cost savings, helping you visualize the financial benefits of adopting MEC plans.

ACA Compliance: The calculator ensures that your benefits strategy aligns with ACA requirements, mitigating the risk of penalties while providing essential coverage to your employees.

Benefits of Utilizing the MEC Savings Calculator

Informed Decision-Making: The MEC Savings Calculator empowers you to make educated choices by presenting clear data on potential cost savings and benefits.

Financial Optimization: Gain insights into how MEC plans can help you reduce benefits-related expenses, contributing to your company’s financial well-being.

Employee Satisfaction: Offering MEC plans can enhance employee satisfaction by providing a basic level of coverage that meets ACA standards, promoting a healthier and happier workforce.

Compliance Confidence: Ensure your benefits strategy aligns with ACA regulations, minimizing compliance-related risks and potential penalties.

Let’s Crunch the Numbers: Real-World Savings Scenarios

If your ALE has 100 employees, your savings of annual mec vs penalties is: $203,066.39

If your ALE has 150 employees, your savings of annual mec vs penalties is: $348, 113. 81

If your ALE has 200 employees, your savings of annual mec vs penalties is: $493,161.23

If your ALE has 500 employees, your savings of annual mec vs penalties is: $1,363,445.75

Visualize the potential savings firsthand by plugging your organization’s numbers into the MEC Savings Calculator:

Final Notes

For ALEs, providing comprehensive employee benefits while managing costs can be a challenging task. The MEC Savings Calculator offers a tailored solution that streamlines decision-making, providing you with the necessary insights to optimize your benefits strategy. By leveraging this tool, you can enhance employee satisfaction, achieve financial stability, and navigate the complex landscape of employee benefits with confidence.

Ready to unlock significant savings and improve your benefits offering? Explore the MEC Savings Calculator from SBMA Benefits today and take a proactive step toward a stronger, more cost-effective employee benefits strategy. Your organization’s financial health and employee well-being are just a click away.

Any Questions?

We are in the business of providing healthcare to everyday people, ensuring peace of mind through trust and transparency.

Our customer service is what sets us apart. We work when you work. Our carrier partners have given us exclusive offerings to complement our medical plans, giving you the best possible price. Our speed of implementation and innovative approach to benefit coverage is second to none.

Learn more about us and our services, here.

Fully Insured vs. Level Funded Plans: A Guide for Qualified ALEs

August 27, 2023/in News

As a Qualified Applicable Large Employer (ALE), choosing the right employee health insurance plan is crucial for your organization’s financial health and employee satisfaction. Two popular options for providing healthcare coverage to your employees are Fully Insured Plans and Level Funded Plans. In this comprehensive guide, we will delve into the differences, advantages, and considerations of both options to help you make an informed decision for your company’s healthcare benefits.

Understanding Fully Insured Plans: Exploring Benefits and Limitations

Fully Insured Plans are a type of employee health insurance where employers pay fixed premiums to an insurance carrier. In return, the carrier assumes the responsibility for covering employees’ healthcare costs, transferring the financial risk from the employer to the insurer.

Advantages of Fully Insured Plans

Cost Predictability: Fixed premiums allow accurate budgeting for healthcare expenses without unexpected fluctuations. Employers can plan their finances more effectively, knowing the exact cost of providing health insurance.

Simplified Administration: Insurance carriers handle plan administration, including claims processing and customer service, reducing administrative burden for employers. This allows HR teams to focus on other strategic initiatives.

Regulatory Compliance: Fully Insured Plans often come with pre-packaged ACA-mandated benefits, ensuring compliance with regulatory requirements. This helps employers avoid penalties and stay in line with federal healthcare laws.

Limitations of Fully Insured Plans

Limited Customization: Employers have less flexibility to tailor the plan to their workforce’s specific needs. The insurance carrier offers pre-determined benefit packages, which may not align perfectly with the preferences of your employees.

Cost Control: Employers may have less control over healthcare premiums as the insurer assumes financial risk. Premium increases may occur, leading to higher costs for employers without additional benefits.

Understanding these aspects of Fully Insured Plans is crucial for employers in making informed decisions while choosing the most suitable health insurance option for their workforce.

Unveiling Level Funded Plans: A Hybrid Approach to Employee Health Insurance

Level Funded Plans represent a unique approach to employee health insurance, combining elements of self-insurance and traditional insurance. In this arrangement, employers pay fixed monthly premiums to a third-party administrator (TPA), which holds the funds in a claims account. The TPA then uses these funds to cover employees’ healthcare expenses. If claims are lower than expected, the surplus is often returned to the employer at the end of the year, making it a potentially cost-saving option.

Advantages of Level Funded Plans

Cost Savings: Level Funded Plans offer potential cost savings compared to Fully Insured Plans. Unused claims funds may be returned to the employer, reducing overall healthcare expenses. This can be particularly beneficial for organizations with healthier employee populations.

Customization: Employers have more flexibility to tailor plan design and benefits to meet the specific needs of their workforce. This customization can lead to higher employee satisfaction and better alignment with your company’s unique culture and values.

Risks and Considerations of Level Funded Plans

Financial Risk: Although Level Funded Plans provide cost-saving potential, they also carry a higher level of financial risk compared to Fully Insured Plans. Employers are responsible for any claims exceeding the funds in the claims account. It is essential to assess your company’s financial stability and risk tolerance before opting for self-insurance.

Cash Flow Management: Employers must ensure they have sufficient cash flow to cover unexpected high claim costs since they are responsible for funding the claims account. Planning for potential fluctuations in claim expenses is critical to avoiding cash flow issues.

Key Differences: Fully Insured vs. Level Funded Plans

To better understand the distinctions between Fully Insured and Level Funded Plans, let’s explore their key differences in several areas:

Premiums and Payments

Fully Insured Plans: Fixed premiums are paid to the insurance carrier, and the insurer assumes the financial risk. Premiums may be subject to annual adjustments based on claims experience and other factors.

Level Funded Plans: Fixed premiums are paid to a third-party administrator, with the employer assuming the financial risk for claims. The TPA holds the claims funds and manages the claims payment process.

Financial Risk

Fully Insured Plans: The insurance carrier bears the financial risk of employees’ healthcare expenses. Employers pay fixed premiums and have no direct financial responsibility for claims costs.

Level Funded Plans: Employers partially self-insure by funding the claims account, assuming a portion of the financial risk. Stop-loss insurance may be used to limit financial exposure for high claim costs.

Regulatory Compliance

Fully Insured Plans: Often come with pre-packaged ACA-mandated benefits, ensuring compliance with federal regulations. Insurance carriers handle compliance-related administrative tasks.

Level Funded Plans: Allow more customization, but employers must ensure they comply with applicable federal and state regulations. HR teams and TPAs share the responsibility of compliance-related tasks.

Understanding these distinctions empowers employers to make well-informed decisions about employee health coverage, considering cost, risk, and regulatory requirements. By choosing the most suitable plan, employers can provide their workforce with comprehensive healthcare while optimizing budget allocation.

Plan Flexibility and Customization: Tailoring Benefits to Meet Your Employees’ Needs

Fully Insured Plans: Fully Insured Plans typically come with standardized benefit packages provided by the insurance carrier. While this offers simplicity and convenience, it may limit the ability to tailor the plan to the specific needs of your employees. Employers have less control over plan design, benefit levels, and cost-sharing arrangements.

Level Funded Plans: One of the primary advantages of Level Funded Plans is the increased flexibility and customization they offer. With Level Funded Plans, employers can work closely with the third-party administrator (TPA) to design a plan that aligns with their employees’ unique healthcare needs. This flexibility extends to benefit design, network selection, and even wellness programs. By having more control over plan features, employers can cater to the preferences of their workforce, leading to higher employee satisfaction and engagement.

Any Questions?

We are in the business of providing healthcare to everyday people, ensuring peace of mind through trust and transparency.

The Unwinding of the Medicaid Continuous Enrollment Provision: What You Need to Know

August 20, 2023/in News

The unwinding of the Medicaid continuous enrollment provision marks a significant change in the Medicaid landscape in the United States. As states regain the ability to initiate disenrollments, it is important to understand the key aspects of this process. From potential coverage losses to addressing eligibility and awareness issues, various factors play a crucial role in navigating the unwinding of the continuous enrollment provision.

By exploring these nine key things to know, we can better comprehend the unwinding of the Medicaid continuous enrollment provision and work towards maintaining accessible and equitable healthcare coverage for all individuals.

Unwinding Process

The unwinding of the Medicaid continuous enrollment provision began on March 31, 2023, allowing states to resume Medicaid disenrollments. This marked a significant shift in the Medicaid enrollment process, as states regained the ability to initiate disenrollments.

However, it is important to note that states must adhere to specific rules to qualify for the phased reduction in enhanced federal Medicaid matching funds. These rules include not restricting eligibility standards, methodologies, and procedures, as well as refraining from increasing premiums as required under the FFCRA. By following these guidelines, states can ensure a smooth transition during the unwinding process.

Potential Coverage Losses

Estimates suggest that between 8 million and 24 million individuals may be disenrolled during the 12-month unwinding period, leading to a potential decline in enrollment between 8% and 28%. The scope of potential coverage losses highlights the significant impact of the unwinding of the continuous enrollment provision. Approximately 17 million people could lose their Medicaid coverage if enrollment decreases by 18%. These figures underscore the need to closely monitor the unwinding process and implement strategies to mitigate coverage losses.

Eligibility and Awareness

Many individuals who may be disenrolled during the unwinding period are still eligible for Medicaid. Survey findings indicate that a significant number of enrollees are unaware of the need to renew their coverage. This lack of awareness poses a challenge as eligible individuals may unintentionally lose their Medicaid coverage.

Enrollees report no change in income or circumstances that would make them ineligible for Medicaid, highlighting the potential disconnect between their eligibility and their knowledge of the unwinding process. It is crucial to address this gap in awareness and ensure that eligible individuals are well-informed about the renewal requirements to retain their coverage.

Disenrollment Risks

Certain groups that experienced substantial growth under the continuous enrollment provision, such as ACA expansion adults, other adults, and children, are expected to witness the largest declines in enrollment. These groups, which have benefited significantly from the continuous enrollment provision, are now at risk of losing their Medicaid coverage.

It is important to address the disenrollment risks faced by these vulnerable populations and implement targeted strategies to assist eligible individuals in retaining coverage. Conducting outreach programs, providing education, and offering enrollment assistance will be crucial in ensuring that those who remain eligible for Medicaid can navigate the unwinding process and retain their coverage.

Engaging Community Health Centers and Assister Programs

Community health centers and assister programs are crucial stakeholders in supporting Medicaid enrollees throughout the unwinding process. These organizations can provide valuable information and assistance to enrollees, helping them navigate the renewal process and understand their coverage options.

Community health centers and assister programs can assist individuals in updating their contact information, completing the necessary documentation, and transitioning to alternative coverage options if they are no longer eligible for Medicaid. Their involvement is essential in ensuring that individuals receive the necessary support and guidance during this transitional phase.

Timely Data and Reporting

States are required to provide baseline data and monthly reports to monitor the unwinding process effectively. These reports serve as essential tools for tracking various metrics related to renewals, disenrollments, and pending renewals. By analyzing this data, states can gain valuable insights into the progress of the unwinding process and identify any potential challenges or disparities. Timely and accurate reporting enables policymakers and stakeholders to make informed decisions and develop targeted interventions to address emerging issues.

State Approaches

States have adopted different strategies for handling the unwinding process, reflecting the diverse landscape of Medicaid programs across the country. The variation in disenrollment rates among states that have already resumed disenrollments highlights the importance of understanding and analyzing state-specific approaches.

Monthly reports provide a comprehensive overview of state efforts and enable policymakers to evaluate the impact of different strategies. By studying these variations, states can learn from one another’s experiences and identify best practices to optimize their own unwinding processes.

Addressing Operational Challenges

The unwinding of the continuous enrollment provision presents operational challenges for states, including staffing shortages and outdated systems. To address these challenges, CMS has provided temporary waivers that allow states to simplify the renewal process for select enrollees.

These waivers offer flexibility in streamlining administrative tasks, reducing bureaucratic hurdles, and minimizing procedural terminations. By leveraging these waivers, states can optimize their operational processes and ensure a more efficient unwinding process.

Increase in Uninsured Individuals

The termination of the continuous enrollment provision raises concerns about an increase in the uninsured population. Efforts should focus on simplifying the transition to alternative coverage options and reducing barriers that may prevent individuals from accessing healthcare. It is crucial to implement strategies that facilitate smooth transitions for individuals who are no longer eligible for Medicaid, ensuring they have access to other sources of coverage, such as ACA marketplaces or other programs.

By addressing the potential increase in uninsured individuals, policymakers can work towards maintaining affordable and accessible healthcare for all.

Final Notes

The unwinding of the Medicaid continuous enrollment provision brings significant changes to Medicaid enrollment and coverage. It is crucial for states to address potential coverage losses, support eligible individuals in maintaining their healthcare coverage, and ensure a smooth transition for those no longer eligible. Partnering with community health centers, and assister programs, along with timely data and reporting, are essential for effective monitoring of the unwinding process. Ultimately, the goal is to mitigate the increase in uninsured individuals by simplifying transitions and ensuring equitable access to healthcare for all.

Any Questions?

We are in the business of providing healthcare to everyday people, ensuring peace of mind through trust and transparency.

Learn more about us and our services, here.

Maintaining ACA Compliance in 2023: Your Questions Answered

July 16, 2023/in News

Complying with the Affordable Care Act (ACA) can be a complex task for employers, especially with changing regulations and reporting requirements. It is crucial for organization leaders to stay informed about the latest developments and strategize to ensure ACA reporting and compliance. Even employers who have met ACA requirements without penalties or notices should pay attention to the evolving landscape. In this blog post, we will provide an overview of recent changes in ACA enforcement and explore the importance of developing a comprehensive plan for ACA reporting and compliance.

What is the ACA?

The Affordable Care Act, enacted in 2010, is a comprehensive healthcare reform law that introduced various regulations and requirements for employers. One significant aspect of the ACA is its mandate for businesses with more than 50 full-time employees to provide affordable healthcare options to their qualifying employees. Affordable coverage, as defined by the ACA, means that the cost of healthcare coverage must not exceed a certain percentage of an employee’s annual salary. Employers are obligated to report their healthcare coverage offerings to demonstrate compliance with ACA requirements.

What are the changes to the ACA?

The ACA has undergone several changes in terms of compliance and reporting requirements. Notably, there has been a heightened emphasis on enforcement due to increased funding for the Internal Revenue Service (IRS) through the 2022 Inflation Reduction Act. This additional funding, amounting to $80 billion, represents a significant budget increase of approximately 60% for the IRS. As a result, the IRS now possesses enhanced capabilities to enforce ACA requirements compared to previous years.

Furthermore, the IRS is also playing catch-up in enforcing ACA compliance due to circumstances like the COVID-19 pandemic. Recent treasury reports have revealed that the IRS issued only a fraction of the potential notices in previous years. Therefore, employers should not assume that they are fully compliant simply because they have not received any notices thus far. It is crucial for employers to conduct a thorough analysis of their systems, offerings, and data to ensure they understand which employees may qualify for subsidized coverage.

Additionally, the Treasury Department and the IRS have eliminated the provision of good-faith relief from penalties for companies that made efforts to comply with ACA requirements but experienced inaccuracies or omissions in their ACA reporting. As a result, employers will be held fully accountable for complying with ACA requirements.

Do I need a 1095-C to stay in ACA compliance?

Yes, if you are classified as an applicable large employer (ALE), you must file Forms 1094-C and 1095-C to meet ACA reporting requirements. These forms provide crucial information about the coverage options you offered to your employees and the cost of the lowest available premiums throughout the year. It is essential to file these forms accurately and on time to demonstrate compliance. The deadline for filing with the IRS is March 31, and you must furnish the forms to your full-time employees by January 31. It’s worth noting that the deadline for furnishing forms to employees has been extended permanently. However, regardless of the deadline extension, it remains critical to file Forms 1094-C and 1095-C on time to avoid penalties.

Late filings are subject to a tiered penalty structure.

The first tier, from April 1st through April 30th, incurs a penalty of $50 per form for any late or corrected forms filed during that timeframe. The second penalty tier runs from May 1st to August 1st, where the penalty increases to $110 per form for filings during that period. After August 2nd, late forms will be assessed a penalty fee of $280 per form. Therefore, there is a strong incentive to file the required forms early and accurately to mitigate the risk of penalties.

How do I stay in compliance with ACA requirements?

To effectively navigate ACA compliance and reduce the risk of penalties, it is crucial to develop a comprehensive ACA strategy that allows you to take control of your compliance efforts. One fundamental step is to ensure that you offer healthcare benefits to at least 95% of your full-time employees. This involves identifying which employees qualify for coverage and ensuring that they receive the appropriate benefit offerings promptly and accurately.

Additionally, it is advisable to proactively work with ACA experts who possess in-depth knowledge and understanding of the ACA regulations. These experts can provide guidance and support in navigating the complexities of ACA compliance, leveraging technology to gather insights from your data and identify any potential risks within your organization.

Another important aspect of staying in compliance with ACA requirements is documenting your benefits offers and relevant data throughout the year. By establishing robust documentation processes and keeping track of your decisions, you can piece together a comprehensive picture of your compliance efforts. This documentation can be invaluable if you face any IRS inquiries in the future, as it will help you provide a clear and accurate account of your compliance measures.

Furthermore, filing ACA reports on time is crucial for maintaining compliance. By adhering to the filing deadlines, you minimize the risk of penalties. It is important to note that late or incorrect filings are subject to penalties under a tiered structure. Therefore, it is in your best interest to file early and accurately to avoid unnecessary financial burdens.

Final Notes

Maintaining ACA compliance and meeting reporting requirements can be overwhelming, but it is essential for employers to navigate the complexities of the ACA. By developing a comprehensive ACA strategy, documenting practices, and seeking expert guidance, organizations can minimize risks, avoid penalties, and showcase best practices in employee benefits. Stay informed and proactive to ensure ACA compliance and reporting success.

Still Have Questions?

We serve employers who want to offer their employees affordable benefits. We simplify the complexity of providing those benefits and ensure compliance with the Affordable Care Act. We provide affordable benefits for the everyday person. We are different because of our personal service, speed of implementation, and innovative approach to providing benefits coverage.

Learn more about us and our services, here.

What is the Difference Between Fully Insured and Self-Insured Health Plans?

June 23, 2023/in News

In today’s complex healthcare landscape, having access to adequate health insurance coverage is of utmost importance. Health insurance provides individuals and families with financial protection against the high costs of medical care, ensuring that necessary treatments, medications, and healthcare services are accessible when needed. It offers a sense of security and peace of mind, safeguarding individuals from potential financial burdens that can arise from unexpected medical expenses.

Overview of the Two Primary Types of Health Plans: Fully Insured and Self-insured

When it comes to health insurance options, there are two primary types: fully insured and self-insured health plans. Understanding the differences between these two options is crucial for individuals, employers, and organizations seeking the most suitable coverage for their needs. Fully insured and self-insured plans differ in terms of how the plans are structured, who assumes the financial risk, and the level of control employers have over the plan design and administration.

Fully Insured Health Plans:

Fully insured health plans are the more traditional and common type of health insurance arrangement. In this model, employers contract with an insurance company or carrier to provide healthcare coverage to their employees and dependents. The insurance company assumes the financial risk associated with providing coverage, including paying claims and managing the plan’s administrative functions.

Under a fully insured plan, the employer pays a fixed premium to the insurance company based on factors such as the size of the group, location, and the health profile of the employees. Premiums are usually paid on a monthly or annual basis, providing employers with predictability in their healthcare costs. The insurance company sets the premium rates and determines the coverage options and benefit levels.

One advantage of fully insured plans is the stability they offer in terms of cost. Employers know in advance what their premium costs will be, which aids in budgeting and financial planning. However, this stability comes at the expense of flexibility and control over plan design. Insurance companies may impose certain limitations and restrictions on coverage, such as pre-authorization requirements for specific medical procedures or limitations on access to certain specialists or healthcare providers.

Self-Insured Health Plans:

Self-insured health plans, also known as self-funded plans, take a different approach. In this model, employers assume the financial risk for providing healthcare coverage to their employees. Rather than paying premiums to an insurance company, employers set aside funds to cover the cost of claims and other administrative expenses. Employers may choose to work with a third-party administrator (TPA) to handle claims processing and other administrative functions.

One of the primary advantages of self-insured plans is the potential for cost savings. Since employers assume the financial risk, they can potentially save money if the actual claims experience is lower than anticipated. Additionally, self-insured plans provide employers with greater flexibility and control over plan design. They can customize the plan to meet the specific needs of their workforce, implement wellness programs, and have direct access to claims and utilization data.

However, self-insured plans also come with risks. If claims exceed the anticipated amount, employers may face significant financial burdens. To mitigate this risk, employers often purchase stop-loss insurance, which provides protection against catastrophic claims expenses.

Main Differences Between Fully Insured and Self – Insured Health Plans

Overall, the main differences between fully insured and self-insured health plans can be summarized as follows:

Financial Risk: In fully insured plans, the insurance company assumes the financial risk associated with providing coverage, while in self-insured plans, employers take on the financial risk themselves.

Premiums: In fully insured plans, employers pay fixed premiums to the insurance company, whereas in self-insured plans, employers set aside funds to cover the cost of claims and administrative expenses.

Plan Design and Control: Fully insured plans offer less flexibility and control over plan design since insurance companies determine coverage options and benefit levels. Self-insured plans provide greater customization and control over plan design, allowing employers to tailor the plan to meet the specific needs of their workforce.

Cost Considerations: Fully insured plans provide stability and predictability in costs, as employers know in advance what their premium costs will be. Self-insured plans offer potential cost savings if claims experience is lower than expected, but employers bear the risk of higher-than-anticipated claims expenses.

Limitations and Restrictions: Fully insured plans may come with limitations and restrictions imposed by the insurance company, such as pre-authorization requirements or limitations on provider networks. Self-insured plans offer more flexibility in provider choices and plan customization, depending on the employer’s preferences and needs.

Administrative Responsibilities: In fully insured plans, the insurance company handles claims processing and plan administration. In self-insured plans, employers may choose to work with a third-party administrator (TPA) to handle administrative functions.

Understanding these distinctions is crucial for individuals and employers in choosing the most suitable health insurance option. Fully insured plans offer stability and simplicity but come with limited control. Self-insured plans provide flexibility and potential cost savings but require careful risk management and administrative oversight. Employers should evaluate their specific needs, resources, and risk tolerance to determine the best approach to healthcare coverage for their organization.

Still Have Questions?

Learn more about us and our services, here.

Reducing Healthcare Costs for Qualified Large Employers

June 15, 2023/in News

The Gold Standard in Low Cost, High-Care, and Easy-to-Administer Healthcare Plans

As a business owner of a Qualified Large Employer (ALE), managing healthcare costs while providing ACA compliant benefits to your employees can be a daunting task. With rising healthcare costs and the ongoing pandemic, finding effective solutions to mitigate expenses has become even more crucial. This is where SBMA comes in. We offer a low-cost, high-care, and easy-to-administer healthcare option that positions itself as the gold standard in healthcare plans.

Self-Funded Healthcare Plans: Mitigating Risks, Reducing Costs

SBMA’s self-funded healthcare plans operate on a risk basis, ensuring that clients receive the best possible care at the lowest cost. By choosing a self-funded plan, qualified large employers have more control over their healthcare expenses. If claims volume exceeds the fund, the client assumes the risk. However, SBMA supports its clients by reducing its administrative fee to cover the claims and then gradually recoups the accommodation in subsequent years. This approach provides financial flexibility and helps mitigate the impact of high claims on employers’ budgets.

No Increase in Administrative Rates: Commitment to Affordability

At SBMA, we understand the importance of affordability when it comes to healthcare plans for qualified large employers. We stand by our promise of not increasing administrative rates, ensuring that our clients can rely on stable and predictable costs. Our goal is to offer high-quality care at an affordable price, providing peace of mind to business owners while ensuring their employees receive the benefits they deserve.

Captive Healthcare Plans: Shared Coverage, Lower Fees

In addition to our self-funded plans, SBMA offers captive healthcare plans. These plans leverage a cooperative structure where each company in the #1 position covers their own claims, while the others provide backup coverage. By strategically pooling resources and mitigating losses, captive plans help keep fees low and reduce exposure risk for qualified large employers. This approach enables businesses to share the burden of healthcare costs, leading to more manageable expenses for all participants.

ASO & Standard Groups: Flexible Options for Different Needs

SBMA provides ASO (Administrative Services Only) and Standard group options to cater to diverse employer requirements. With ASO, you have the flexibility of a pay-as-you-go basis, where you absorb exposure for claims, while SBMA creates reserves to cover any deficits. We have recently transitioned to the SBMA captive, which pays the claims and further reduces exposure risk. The ASO and Standard group options ensure that qualified large employers have tailored solutions that align with their specific financial and administrative needs.

The SBMA Captive: The Gold Standard in Healthcare Plans

Our SBMA captive represents the gold standard in healthcare plans for qualified large employers. Operating on a self-funded basis, it allows clients to handle their claims first, empowering them with greater control over their healthcare expenses. The captive serves as the second position, stepping in to cover deficits if the client goes into the red. With stable administrative rates and a gradual collection of any deficits over the current and subsequent years, the SBMA captive ensures financial sustainability while maintaining the quality of care provided to employees.

What Makes SBMA Benefits Different?

Our customer service is what sets us apart. We work when you work. Our carrier partners have given us exclusive offerings to complement our medical plans, giving you the best possible price. Our quick execution and advanced approach to benefit coverage is second to none.

How SBMA Supports the Onboarding and Offboarding Processes

At SBMA, we support businesses beyond providing affordable minimum essential coverage (MEC). We are proud to support the employee onboarding process so your human resources (HR) teams have more time to focus on the daily tasks that keep your business running.

This is why we offer a complete insurance solution that covers:

Implementation
Enrollment
Administration, and
Reporting

Our benefits professionals are fully equipped to support onboarding and offboarding procedures to eliminate the hassle for businesses.

How? Using our benefits portal.

Our Benefits Portal

Employee benefits administration can be a pain for any HR department. At SBMA, we aim to simplify the process by giving you access to everything you need in one place.

Our one-stop-shop portal is proprietary and unlike any other. Our portal grants you access to all of the tools necessary to support a new hire (from beginning to end).

We eliminate the headache of unnecessary paperwork with benefits management portal access. You can:

Make plan changes
Order ID cards
Check a claim status online
Track onboarding and offboarding
And more

Resources are only a click away.

Besides creating a seamless onboarding process with our all-in-one portal, we also provide video tutorials for our partners. These resources provide instructions that assist navigation through the portal.

Read on to view our enrollment portal walkthrough.

How to Decrease Stress in the Workplace (and Increase Productivity!)

April 17, 2023/in News

Stress is a common issue that affects the mental and physical health of employees, ultimately impacting their productivity and job performance. As a result, it is crucial for employers to prioritize stress management in the workplace.

In this blog, we will discuss the negative impact of stress on employee health and the benefits of reducing workplace stress. Additionally, we will provide some tips and strategies to help decrease stress in the workplace. By implementing these strategies and offering support to employees, companies can improve employee satisfaction, productivity, and ultimately, their bottom line.

The Impact of Stress on Employee Health

Stress can have both physical and mental health consequences on employees. The prolonged effects of stress can lead to a range of health problems such as heart disease, high blood pressure, digestive issues, headaches, and weakened immune systems. Mental health issues such as anxiety and depression can also arise as a result of prolonged exposure to stress. If left unaddressed, these health consequences can have a significant impact on employees’ well-being, job performance, and overall quality of life.

Employees who are experiencing high levels of stress are also more likely to take time off work, leading to increased absenteeism and decreased productivity. It is essential for employers to prioritize stress management in the workplace to prevent these negative health consequences and their associated costs.

How to Decrease Stress in the Workplace

Encourage Breaks:

Encouraging breaks can take on many forms. It could be as simple as reminding employees to take a 10-15 minute break every few hours to stretch their legs and clear their minds. Employers could also provide a designated break area that is separate from workstations, where employees can relax and socialize with coworkers. Additionally, employers can create policies that encourage regular breaks throughout the day, making it a part of the company culture to prioritize mental and physical health.

Offer Wellness Programs:

When implementing wellness programs, it’s important to consider employees’ diverse interests and needs. Employers could provide yoga classes or guided meditation sessions for employees to help them destress during the workday. Wellness challenges can also be a fun way to encourage employees to get active and take breaks throughout the day. Consider offering incentives or prizes for employees who participate and meet specific goals. These programs can not only reduce stress, but also create a sense of community and camaraderie among employees.

Foster a Positive Work Environment:

Creating a positive work environment involves more than just providing free snacks or hosting occasional team-building activities. Employers can promote open communication and constructive feedback to help employees feel valued and supported. Recognizing and rewarding employees’ hard work can go a long way in creating a positive work culture. Additionally, providing opportunities for professional development, such as training or conferences, can show employees that they are valued and help reduce stress by boosting their confidence and job satisfaction.

Reduce Workload:

To reduce stress caused by heavy workloads, employers can evaluate workload distribution and make adjustments as needed. This may involve delegating tasks to other team members, providing additional support or resources, or prioritizing projects to help employees better manage their time. Employers should also ensure that employees have access to the necessary tools and resources to complete their work efficiently and effectively.

Provide Mental Health Support:

Mental health support can come in many forms, including counseling services or employee assistance programs. Employers should ensure that employees are aware of the resources available to them and encourage them to seek help if needed. Additionally, employers can create a supportive work culture by openly discussing mental health and promoting mental wellness. This can help reduce the stigma surrounding mental health and make it easier for employees to seek support when they need it.

Benefits of Reducing Workplace Stress

Reducing workplace stress has a number of benefits that can positively impact both employees and employers. One key benefit is increased productivity. According to a study conducted by the American Psychological Association, workers who experience less stress are more engaged and productive at work. In addition to productivity, reducing workplace stress can also improve employee satisfaction and retention.

Employees who feel less stressed are more likely to feel satisfied with their jobs and stay with their current employer. Finally, reducing workplace stress can lead to lower healthcare costs. A study published in the Journal of Occupational and Environmental Medicine found that workplace stress was associated with higher healthcare costs and increased absenteeism. By reducing stress, companies can potentially save money on healthcare expenses and increase their bottom line.

The Role of Health Insurance in Stress Management

Health insurance plays a crucial role in supporting employees’ efforts to manage stress. Companies can offer their employees access to mental health services and wellness programs, both of which can be helpful in managing stress. For instance, employees can access counseling and therapy sessions through their health insurance plan.

Many health insurance plans also offer wellness programs that include stress management techniques like meditation, yoga, or exercise classes. Additionally, affordable health insurance can help alleviate financial stress for employees by providing access to affordable medical care and prescription drugs. By providing employees with the tools they need to manage stress, health insurance can help increase employee productivity and reduce absenteeism.

In Summary

Benefits and incentives are some of the best ways to show your appreciation for your employees. Offering competitive benefits and showing employees you care will increase employee morale and satisfaction as well as reduce within your company. Contact us for more information on benefits for your employees.

ACA Reporting Deadlines and Compliance Requirements in 2023

March 19, 2023/in ACA Compliance, News

The Affordable Care Act (ACA) has been in effect for over a decade, but its reporting and compliance requirements continue to evolve. In 2023, businesses and employers will face several ACA reporting deadlines and compliance requirements that they must adhere to in order to avoid penalties and maintain compliance with the law.

These requirements include providing healthcare coverage to employees, filing information returns with the IRS, and furnishing statements to individuals. It is essential for employers to understand these requirements and stay up to date with any changes or updates to ensure that they are meeting their obligations under the ACA.

What Are the ACA Reporting Deadlines at the Beginning of 2023 to Report on the 2022 Calendar Year?

New regulations have been finalized by the IRS, which stipulate that Applicable Large Employers (ALEs) must provide their employees with the Forms 1095-C on or before March 2, 2023. Additionally, ALEs are required to file Form 1094-C and provide copies of Forms 1095-C to the IRS by March 31, 2023 if they choose to file electronically.

Employers who must file fewer than 250 returns are permitted to file on paper, but must do so no later than February 28, 2023. It is important for ALEs to meet these deadlines to ensure compliance with the Affordable Care Act (ACA) reporting requirements and avoid potential penalties.

ACA Reporting: Overview

The Affordable Care Act (ACA) mandates that Applicable Large Employers (ALEs) report whether they provided full-time employees with affordable, minimum essential coverage (MEC) that meets minimum value requirements. For employers with self-insured plans, regardless of their size, reporting must also include months of coverage for all individuals enrolled.

The reporting requirements for ALEs, regardless of their funding arrangement, are fulfilled through IRS Forms 1094-C and 1095-C. This overview highlights the essential elements of ACA reporting for ALEs.

ACA Reporting Deadlines for ALEs

The IRS has recently made changes to the ACA reporting deadlines for Applicable Large Employers (ALEs) by finalizing new regulations that make the automatic 30-day extension permanent. This extension, which was previously available to employers who needed extra time to furnish Form 1095-C to individuals, will now be available for all future years of ACA reporting.

The ACA reporting deadlines for ALEs will now be as follows:

Form 1095-C: Deadline to Furnish to Individuals

Standard Due Date: January 31

Automatically Extended Due Date: March 2

(Leap Year Due Date: March 1)

Form 1094-C (+Copies of Form 1095-C):

Deadline to File with IRS by Paper

Standard Due Date: February 28

Form 1094-C (+Copies of Form 1095-C):

Deadline to File with IRS Electronically (Required for 250 or More Returns)

Standard Due Date: March 31

If the due date falls on a weekend or a legal holiday, the deadline is extended to the next business day. These deadlines apply to all ALEs regardless of their plan year.

The IRS has also proposed regulations that would reduce the required electronic filing threshold to employers filing just 10 or more returns. That reduced 10-return electronic filing threshold has not been finalized and therefore is not currently being enforced.

ACA Reporting: Fully Insured vs. Self-Insured Plans

The ACA reporting requirements for Applicable Large Employers (ALEs) differ based on whether their medical plan is fully insured or self-insured. Level funded plans are considered self-insured for reporting purposes as they are not fully insured. ALEs with fully insured medical plans are not required to report under §6055 in Part III of Form 1095-C. Their only reporting responsibility is under §6056, which covers Parts I and II of Form 1095-C as well as the full Form 1094-C.

In contrast, enrolled employees and their dependents’ coverage information for a fully insured plan is reported by the insurance carrier on Form 1095-B, and the carrier is solely responsible for furnishing and filing the Form 1095-B coverage information and soliciting any missing dependent SSNs. ALEs with self-insured medical plans are subject to §6055 reporting and must complete Part III, in addition to Parts I and II, of Form 1095-C.

The following overview addresses ACA reporting obligations by employer size and funding arrangement:

ALE Sponsoring a Self-Insured Medical Plan (Including Level Funded)

IRC §6055 and §6056 Reporting

Completed via Forms 1094-C and 1095-C.
Employer must complete Part III of the Form 1095-C (“Covered Individuals”) for enrolled individuals.
If the employer sponsors both self-insured and fully insured medical plan options, the employer completes Part III only for individuals enrolled in the self-insured medical plan.

Important Note: “Level funded” plans are considered self-insured for these purposes.

ALE Sponsoring a Fully Insured Medical Plan

IRC §6056 Reporting Only

Completed via Forms 1094-C and 1095-C.
Employer does not complete Part III of the Form 1095-C (“Covered Individuals”).
Insurance carrier completes coverage information on separate Form 1095-B.

Non-ALE Sponsoring a Self-Insured Medical Plan (Including Level Funded)

IRC §6055 Reporting Only

Completed via Forms 1094-B and 1095-B.
Employer does not complete Forms 1094-C and 1095-C (because not subject to the employer mandate).
Employer information listed in Part III (“Issuer or Other Coverage Provider”) of the 1095-B.
Employer does not complete Part II (“Information About Certain Employer-Sponsored Coverage”) of the Form 1095-B.

Important Note: “Level funded” plans are considered self-insured for these purposes.

Non-ALE Sponsoring a Fully Insured Medical Plan

No ACA Reporting!

ACA Reporting: Controlled Groups

For an ALE that falls under the ACA employer mandate and has multiple corporate entities in a controlled group, each subsidiary or related entity in the controlled group must file a separate Form 1094-C. Each entity, also known as an Applicable Large Employer Member (ALEM), must file their own report.

Aggregated ALE Groups have additional ACA reporting obligations:

Form 1094-C for each ALEM must contain the following:

Part II, Line 21: Each ALEM must answer “Yes” to the question “Is ALE Member a member of an Aggregated ALE Group?”
Part III, Column (d): The “Aggregated Group Indicator” box will be checked for each month in which the controlled group existed.
Part IV: The “Other ALE Members of Aggregated ALE Group” section will be completed listing the names of the other related entities in the controlled group (the other ALEMs) and their EINs.

Forms 1095-C from each ALEM must contain the following:

The full-time employees of each EIN (i.e., each ALEM) must receive a Form 1095-C with that ALEM’s corporate name and EIN.
If an employee works for more than one ALEM in the Aggregated ALE Group in any calendar month, the ALEM for whom the employee worked the most hours of service in that calendar month is responsible for the employee’s Form 1095-C ACA reporting for that month.

It is important to note that Aggregated ALE Groups must comply with all ACA reporting requirements and that failure to do so could result in penalties.

ACA Reporting: COBRA Guidelines

Employers with fully insured plans only need to address additional COBRA-related ACA reporting requirements in the event of an employee’s qualifying event being a loss of coverage due to a reduction in hours. The appropriate coding in such a case depends on whether the employee has elected COBRA and whether the employee was in employee-only or family coverage.

Apart from the above requirements, self-insured plans (including level funded plans) must report coverage information completed in Part III for all months of active or COBRA coverage.

Part II of Form 1095-C for COBRA participants who were a full-time employee for at least one month in the year will be completed similarly for both self-insured and fully insured plans. For individuals who were enrolled in COBRA under a self-insured plan for at least one month in the reporting year but whose active coverage terminated in a previous year, the Part II coding will indicate that the individual was not an employee for any month of the year (Code “1G” in Line 14 for all 12 months).

Note: additional rules apply when the spouse or dependent elects COBRA separately from the employee.

Still Have Questions?

The best way for employers to remain compliant with healthcare laws is to consult with a team of professionals. Our team at SBMA understands the ACA and can help you stay up-to-date on any changes to the law.

Common Health Insurance Terms to Help You Understand Your Plan

March 12, 2023/in News

If you’re considering purchasing health insurance, you may feel overwhelmed by the variety of terminology associated with it. From coinsurance to deductibles, there are numerous health insurance terms you should know before you enroll. But don’t worry; we’ve got you covered. We have translated some of the confusing terminologies around health insurance into plain English to help you better understand your health insurance coverage.

Let’s dive in.

Coinsurance

Coinsurance is a health insurance term that refers to the percentage of the cost of a healthcare service that you are responsible for paying after you have met your health insurance plan’s deductible.

For example, if your healthcare bill is $1,000 and you have already met your deductible, and your coinsurance is 20%, you will be responsible for paying $200 (20% of $1,000), while your insurance company will pay the remaining $800. Coinsurance is one of the ways in which health insurance companies share the cost of healthcare services with their policyholders.

Copay

Copay refers to a fixed amount of money that you may need to pay out-of-pocket for a covered healthcare service or supply. For example, your health plan may require a $20 copay for an office visit or a $10 copay for a generic prescription. After you pay the copay, your health insurance plan will cover the remaining cost of the healthcare service or supply.

Copays are a way for health insurance companies to share the cost of healthcare services with their policyholders. Copay amounts may vary depending on the type of healthcare service or supply, and the specifics of your health insurance plan.

Deductible

A deductible is the amount of money that you need to pay out-of-pocket for healthcare services before your insurance plan starts covering those services. For example, if your plan has a $1,000 deductible, you will need to pay the first $1,000 of healthcare services you receive during the year before your plan starts contributing to the cost of covered services. Once you’ve met your deductible, your insurance plan will begin to share the cost of healthcare services with you. The amount of the deductible can vary depending on the specifics of your insurance plan and is an important factor to consider when choosing a plan, as it can significantly impact your out-of-pocket costs for healthcare.

Essential Health Benefits

Let’s talk about Essential Health Benefits – a set of healthcare services that must be covered by plans in the Health Insurance Marketplace, as required by the Affordable Care Act. These benefits include emergency services, hospitalization, maternity and newborn care, mental health, prescription drugs, preventive and wellness services, pediatric services, and more.

In-Network Providers

Understanding the difference between in-network and out-of-network providers is critical. In-network providers are a group of doctors, hospitals, and other healthcare providers that your health insurance plan has partnered with to provide care to its members.

Out-of-Network Providers

When you receive healthcare services from a provider that has not partnered with your insurance plan to provide care to its members, this is known as an out-of-network provider. It’s important to note that using an out-of-network provider may result in additional costs for you, so it’s crucial to know which providers are in-network before receiving care.

Another important term to be familiar with is out-of-pocket cost, which refers to the amount you pay for health care services. This may include your deductible, coinsurance, and co-pays.

The out-of-pocket maximum is the most you’ll pay in a policy period, usually one year, before your plan starts to pay 100% of the covered Essential Health Benefits you receive. This limit must include deductibles, coinsurance, and co-payments, but typically does not count premiums toward your out-of-pocket maximum.

Monthly Premiums

Monthly premiums refer to the regular payments that an individual pays to their health insurance company in exchange for coverage. This payment can be made on a monthly, quarterly, or yearly basis depending on the insurance plan.

The amount of the premium varies based on a number of factors, such as the type of coverage, the individual’s age, location, and the level of benefits they choose. It’s important to understand the cost of the monthly premium when selecting a health insurance plan, as it can impact your budget and overall financial health.

Preventative Care

Preventive care is health care services focused on keeping you healthy before you may become sick. These include routine check-ups, patient counseling, screening tests, and immunizations. Plans must offer these services at no cost to you when the services are provided by in-network doctors. This means they can’t charge a copayment or coinsurance, even if you haven’t met your deductible for the year.

Provider

Lastly, it’s important to understand what a provider is. This refers to a person or place you go to receive health care services. Examples include doctors, hospitals, pharmacies, and more. Check with your health insurance plan to find out if a provider is in-network or out-of-network.

By familiarizing yourself with these health insurance terms, you can better understand your coverage and make an informed decision when choosing a health insurance plan.

Still Have Questions?

Learn more about us and our services, here.

What is Encompassing Health and Why Does the Government Allow it?

February 5, 2023/in News

As healthcare costs continue to rise in the US, reaching a staggering $4.1 Trillion in 2020, it’s no surprise that people are looking for ways to address the issue. But what if there was a way to address healthcare issues before they became serious problems, saving both time and money in the process? Enter preventative healthcare.

In this blog, we will discuss preventative healthcare, why it’s important and how Encompassing Health contributes to the overall well-being of individuals and communities. Let’s dive in.

Let’s Talk Preventative Healthcare: Why Is It Important?

Preventive healthcare is important because it can help to prevent or reduce the likelihood of developing health conditions or diseases in the first place. By proactively addressing potential health issues before they become serious problems, individuals can save time and money on treatment and improve their overall quality of life.

Preventive healthcare can also reduce the burden on the healthcare system by preventing the need for more costly and complex treatments down the line. In addition, preventive healthcare can help to reduce healthcare costs for both individuals and the healthcare system as a whole by addressing issues before they become more serious and costly to treat. By investing in preventative care, the government can potentially save billions of dollars each year on healthcare costs and improve the overall health of the population.

According to the CDC, chronic diseases that are avoidable through preventive care services account for 75% of the nation’s healthcare spending and lower economic output in the US by $260 billion dollars a year. This means that by introducing a preventative healthcare program, the government could potentially save billions of dollars each year.

Encompassing Health

Encompassing Health is a program that offers elective, limited health insurance benefits under Section 125 of the Internal Revenue Code. This means that the benefits provided through Encompassing Health can be paid for using pre-tax dollars, which can help offset the cost of the benefits through payroll tax savings. Essentially, this means that individuals who enroll in Encompassing Health can use pre-tax dollars to pay for their limited health insurance benefits, which can help reduce their overall tax burden.

Encompassing Health was designed with the intention of providing companies of all sizes with the best, most affordable workplace health services.

Encompassing Health is just one example of a preventative healthcare program that could help the government save money. By offering tax savings to encourage people to participate in preventative healthcare services, the government can help address healthcare issues before they become serious and costly problems.

So, Why Would the Government Allow a Program like Encompassing Health?

The answer is simple: to save money and improve the overall health of the population. If you’re interested in learning more about preventative healthcare and how it can benefit you, be sure to check out our Encompassing Health Program.

What is SBMA’s Encompassing Health?

Digital Health Portal

Provides a specialized, fully integrated technology suite, assisting employees to establish a healthy lifestyle while simultaneously improving employee productivity and reducing the need for health services by preventing health issues from arising in the first place.

Personalized Coaching

Provide employees with access to workplace certified health coaches who are personally assigned to them in order to give employees a detailed and effective regiment that will ensure their personal health.

Telemedicine

Telemedicine enables medical consultations to take place through secure, electronic communication including bi-directional video conferencing, telephone and email. This eliminates the need for traveling back and forth to a doctor’s office, and opens up availability for employees who previously may have had trouble getting in to see a doctor for check ups or test results, due to a busy at home schedule.

Behavioral Health

Behavioral clinicians provide assessment, diagnosis, consultation, and brief psychotherapy to address each employees behavioral health needs through live, interactive video conferencing.

Risk Identification

Predict and classify 35 different conditions and identify and rank the health risks of your unique environment.

Genomics Testing

Leveraging this individualistic approach with an emphasis on each employee and offer each participant an opportunity to set goals for his or her physical and mental well-being based on their genetics.

Final Thoughts

In conclusion, the high cost of healthcare in the US is a major concern for many people. However, preventative healthcare services have the potential to address a significant portion of healthcare-related issues, potentially saving the government billions of dollars each year. Encompassing Health is one example of a preventative healthcare program that could help the government save money and improve the overall health of the population. While the tax savings offered by this program may seem small compared to the potential savings, they can still be a valuable incentive for people to participate in preventative healthcare services and help address healthcare issues before they become serious and costly problems.