What is MEC and What Does it Cover?

What is MEC?

Understanding minimum essential coverage (MEC) can be complicated when comparing MEC to Minimum value, essential health benefits, and actuarial value. Let’s start by answering what is MEC and what does it cover? MEC is a plan that meets the Affordable Care Act requirement for getting health coverage. Some of these programs under MEC include marketplace plans, job-based plans, Medicare, and Medicaid.

So what is the difference between MEC and minimum value?

Minimum value is a higher threshold than MEC. Minimum value is when a plan pays 60% of the actuarial value of allowed benefits under the plan. If a large employer offers benefits and meet MEC requirements, but they do not meet the minimum value they meet the ACA employer requirements. 

What about MEC and Essential health benefits?

Essential health benefits are the core benefits that “qualified health plans” must cover. MEC also has a lower threshold than Essential Health Benefits. If a group health plan doesn’t provide all the benefits under the essential health benefits, the coverage will likely meet MEC, so companies will be ACA compliant.

Why is it important to understand the differences? 

Each of these coverage specifications are important to ensuring large employers provide proper coverage to their employees. As an employer, you must understand your legal liability in providing benefits, as well as understanding what coverage you need to be offering your employees to give them the best options and ensure compliance with the ACA.

At SBMA, all of our plans are compliant with MEC regulations to ensure your employees have coverage for whatever comes your way. Want more information? Visit our site to understand your coverage options better.

What is MEC and what does it cover?

When is it safe to go back to a doctor’s office?

When is it safe to go back to a doctor's office?

Hospitals and doctor’s offices seem like the worst place to be during a pandemic. Many medical offices, hospitals, and surgeons canceled non-emergency procedures to accommodate the influx of coronavirus cases. Knowing that the numbers of cases are still high, it may be anxiety-inducing to go back to the doctor for your normal check-up. Businesses have started to reopen, and doctors have started to schedule more non-emergency procedures. Is it safe to go back to the doctor’s office? 

The pressure for hospitals and doctors offices to re-open is great even while patients are wary to return. The financial implications of reopening serve as incentives for some medical offices to reopen, as the pandemic has caused the hospital industry to lose about $50 billion per month. Elective procedures are the lifeblood of hospitals, financially;  without them, hospitals have struggled. 

While doctor’s offices are seen as a place of healing and safety, in the current climate it may be difficult to choose to go back.  Telemedicine offers a solution for those who are worried about seeing their doctor in person. Telemedicine offers a solution for non-emergency care front eh safety and convenience of your own home while still ensuring that your symptoms are reviewed and a medical professional is monitoring your case. 

Health care providers are taking care to keep their patients safe. These precautions include: 

  • COVID-19 screening questionnaires
  • No-touch thermometer temperature check for employees and patients. 
  • Required face masks
  • Implementing social distancing measures in populated areas
  • Employees are tested regularly
  • Patients may be tested a few days before their procedure

While health care providers are covering a lot of bases, there are a few things you can do to keep yourself as safe as possible. Including:

  • Take your temperature before you go to your appointment
  • Wash your hands before you leave the house and sanitize regularly
  • Wear a mask and gloves if you feel it’s necessary
  • Avoid touching your face, especially areas like your nose, eyes, and mouth
  • Show up on time, not before to avoid overcrowding in the waiting room
  • Try to stay away from touching surfaces
  • Practice proper social distancing measures

While you begin to navigate returning to in-person patient care, consider your options and take the proper precautions. 

If you can utilize Virtual Health/ telemedicine, now is the time to use this service.  While telemedicine can’t replace all in-person appointments, it can replace regular checkups, virus check-ins, cold and flu-like symptoms and rashes, and many other non-life-threatening cases.  For those who still feel the need to go into the MD’s office: if you take the proper precautions when you are in-person you can navigate this new normal and stay safe!

return to the doctor's office

How to attract the best employees: Voluntary benefits.

Attract the best employees with voluntary benefits

Looking for ways to attract the best employees in a market where thousands of employees have been laid off? Offering voluntary benefits adds a level of insurance coverage that many workers have not previously had access to. Benefits beyond the traditional 401(k) and health insurance are vital to attracting the right talent for your business. 

What exactly are voluntary benefits?

Voluntary benefit plans are offered through the employer, but are paid, either partially or solely, by the employees. These benefits are typically paid through payroll deductions. Some of these plans offer group rates that employees cannot typically get on their own.

Why do employees look for employers who offer voluntary benefits?

  • It gives employees the choice: Allowing employees to choose the voluntary benefits they need gives your employees higher satisfaction and engagement with your business.
  • It meets the needs of various types of employees: Voluntary benefits cater to various generational, cultural, and economic differences among employees. It can be a challenge to meet the needs of a diverse workforce with a benefits plan that has only one option.
  • It ensures employees are financially stable: Voluntary benefit plans can protect employees financial wellbeing, and give them a sense of security in case something goes wrong. This makes them better, more engaged employees.

Not only do voluntary benefits help your existing employees, but also your future employees. When you offer competitive voluntary benefit packages to your workforce, great talent will be more likely to join your team. 

At SBMA, our benefit plan offers voluntary benefits that most employees will need. Your employees are the backbone of your business, so treat them right! Our plans can be modified to include dental, vision, life, hospital indemnity, accident, and critical illness coverage. Contact us today to see how voluntary benefits packages can improve your company’s ability to attract and retain the best employees.

how can voluntary benefits help you attract and retain employees

Are You Liable for Shared Responsibility Payments?

are you liable for shared responsibility payments?

With all the recent changes to employment due to the global pandemic, navigating ACA compliance can be challenging. ACA noncompliance may lead to shared responsibility payments. Businesses with 50 or more full-time employees must offer affordable, minimum essential health coverage. 

How can your business avoid tax penalties from the IRS? 

The first step to avoid potential shared responsibility payments is to make sure your business stays compliant with the ACA shared responsibility requirement. While this may seem simple, there are few distinctions to be aware of, including determining full-time employment status and full-time equivalents, and identifying the minimum value requirements. 

If employers do not cover at least 95% of full-time employees and their dependents, the employer will be subject to a shared responsibility payment. 

If a full-time employee receives a premium tax credit because they were not offered coverage, the coverage was not affordable, or the minimum value was not provided, the employer may also be subject to a shared responsibility payment. 

Once you have identified how to stay compliant with the ACA shared responsibility requirements, ensure your reporting is accurate and timely. 

Applicable Large Employers (employers with 50 or more employees) are required to file information returns with the IRS, Forms 1094-C and 1095-C. These forms will inform the IRS of the employers that owe shared responsibility payments.

To mitigate the risk of receiving a letter from the IRS for shared responsibility payments, employers should carefully review and complete the forms above. 

If you do receive a shared responsibility payment letter from the IRS, the employer has 30 days to respond. If you do need more time to gather your information, the IRS may be able to extend the 30 days deadline. Either way be sure to respond or ask for an extension as quickly as possible.

If you are required to pay a shared responsibility payment be sure to consult a lawyer to ensure your reporting is accurate. At SBMA, we want to ensure you remain compliant with all ACA requirements. If you receive a letter from the IRS in 1094/1095 filing that we completed, we will refile your forms, free of charge. 

Contact us today to learn more.

shared responsbility payments

Can a Doctor Really Diagnose Over Zoom?

Is zooming your doctor the new normal?

Imagine you’re in quarantine, beginning to feel early symptoms that align with Coronavirus, yet to keep others safe you feel you need to stay home. The symptoms begin to worsen, but you still don’t want to risk others safety by leaving the house. How can you ensure you will be okay without leaving the house? Telehealth services might be your saving grace. This begs the question, can a doctor really diagnose over Zoom?

The American Medical Association is working to maximize telemedicine service options in order to revolutionize healthcare– especially because COVID-19 is highly contagious. Not only does telemedicine help keep potential Coronavirus carriers quarantined, but it also helps those who have had non-urgent medical care postponed due to the pandemic. 

These services can be extremely beneficial for those who still need to go to work, or those who have to take care of their children at home. With children home from school, it can be more challenging to leave them home with a sitter, so what does that mean if you have to go to the doctor? Well, you can just hop on a Zoom call during their nap and get the same results as going to the doctor!

So how exactly does telemedicine work?

Drs. Francavilla Brown and Boyd told AMA that telemedicine “is easier than people think it is to incorporate into a practice.” 

With technological advancements typically come progress and challenges. Physicians who have tried implementing telemedicine have identified these challenges, and have come up with a few solutions. 

One challenge is patients may not have a good signal to support their doctor’s visit. Trouble with a weak signal may make the appointment longer, or impossible for someone who really needs it. Another challenge physicians have identified is booking appointments to be a televisit for doctor’s offices. The patient must call into the office to ensure their appointment is virtual. 

While telehealth services may not be the best option for detecting major issues, it has been great for reassessing and monitoring patients who have known problems. It can also be used to adjust medications, answer questions, and share information. Patients in areas where medical resources are limited also benefit greatly from these services. 

These services also help people avoid unnecessary hospital visits, which helps to give advice at a distance, save time, and reduce costs for both patients and doctors. Not only will it help avoid hospital visits when they aren’t necessary, but it will also give patients in the hospital the ability to discharge sooner by monitoring their vitals with telemedicine.

Zooming your doctor may begin to become the new normal in a post-COVID world. At SBMA, we offer telemedicine services at competitive prices. Contact us to learn more about how our benefit plans with telemedicine services today!

Can a doctor really diagnose over zoom?

Employee Retention is More than Just Health Care

Keeping employees engaged and excited about work can be a difficult task for some employers. There are a few things you can do as a leader within your organization to foster employee happiness. One of the main ways is to offer voluntary benefits. Employees are looking for insurance when they are looking for a company that will serve them, but they also require additional benefits, and other creative approaches to benefits. In the article below, you will see the best ways to keep employees engaged and excited about work, and how important it is to offer more than just health insurance. At SBMA, we have insurance options that include vision, dental, and other voluntary benefits. Check out our plan options here!

The Best Ways to Keep Employees Engaged and Excited About Work

Attract ENGAGE Retain. 

An engaged workforce is a productive workforce. 

But you can’t force someone to be engaged. 

Once you’ve got a candidate through the hiring, onboarding and training process, you really want to retain them.  But what about two years in, five years in.  What do you do as a company to re-engage and thereby retain your staff?

People are engaged when they feel they make a difference.  People are engaged when they feel appreciated.  People are engaged when they feel a sense of purpose.  People are engaged when they feel aligned with the company’s values.

So, here are 6 ways to align yourself as a company for the best possible chance of engaging, inspiring, and thereby retaining your workers. 

  1. Benefits aren’t just a 401K: While health insurance is the #1 benefit employees look for, there are many other ways to keep employees feeling valued that are outside the traditional, raise, increase in benefits routes. Flexibility around work-life balance rates more highly among millennials than even health insurance in a study conducted in 2017 by Forbes magazine.  Bringing yoga into the workplace is another way to engage your teams in physical and emotional self-care right there on the job.  Don’t think of it as losing an hour of productivity, you’re not!  You’re donating an unproductive hour to the cause of engagement. Stress is the #1 reason people leave jobs.  So OHHHMMMMMM.
  2. Share your passion: If you’re passionate about running, donate 5% of your profits to a charity that uses running programs to get homeless people back on their feet.  If your passion is the environment, commit to a 100% plastic waste-free catering service… Whatever drives you will inspire others.  Sharing your passion with the team makes everyone clear that the CEO and owner cares deeply just like them.
  3. Get goofy: Not the dog that owns a dog… Get silly, be willing to be wrong.  Allow the company to see your human side. If that means outtakes and blooper reels go out on social media, do that.  If it means sharing that your dog died and you’re feeling really low… that’s vulnerability and as goofy as it may sound.  There’s tremendous strength in vulnerability (Brene Brown)
  4. Raise the bar: Raise up the mid-level managers in your company by bringing in training for them.  There are grants companies can apply for that pay for training effectively making that training free on the front end and so very profitable when your managers become leaders.
  5. Bang a gong: Employee of the month? Employee Spotlight, an actual gong for sales that close? There are so many ways to praise publicly (and reprimand in private).  These principles set out years ago by the likes of Ken Blanchard hold true to this day.  People want to be recognized for what they do well.  So give ‘em a hand.
  6. Ensure role alignment: Identify your company culture.  Hone in on it like a laser and protect it like it’s a crystal figurine your granny asked you to hold.  When you’re certain about your culture you can hire to align with it.  When you hire people who are aligned with the culture and get them in the right role, you’ll retain those people throughout their job lifecycle.

Intentional culture takes time and effort to build and only a small amount of neglect to destroy.  On that happy note, we’ll say, Happy retaining!

Encouraging and engaging employees can make a huge impact on your company’s culture. If you feel your company could use some adjustments to your current company culture, Culture Works can help!

Vision and Dental Add Value for Employees

How Can Vision and Dental Add Value for Your Employees?

Voluntary benefit plans are an important part of employee insurance opportunities. Among these voluntary benefits, vision and dental insurance are an important part of employees voluntary benefit plans. How can vision and dental plans add value to your employees’ wellbeing? Here are a few ways:

Vision:

  • Vision exams identify future problems: They can detect things like eyestrain, diabetes, and even high blood pressure. They can also identify common eye issues and diseases.
  • Cost savings: According to the National Alliance for Eye and Vision Research eye disease, vision loss, and eye disorders cost the U.S Economy $68 billion per year.
  • Increase productivity: The vision council reported that eye care delivers $7,800 in more productivity per employee.

Dental:

  • Dentists can identify disease: Dentists have the ability to identify over 120 diseases. This can help your employee long-term health with potential early detection
  • Young employees likely don’t have dental coverage: The American Dental Association states that millennials have untreated tooth decay. The main reasons for this issue are cost convenience and confusion surrounding dental care.
  • Those with dental coverage are more likely to use it: As more people offer dental insurance the number of adults who miss work for oral health-related issues dropped 7%.

At SBMA, we provide voluntary benefits that employees love. To learn more about our voluntary benefit programs, contact us today!

How vision and dental add value to your employees (1).png

Virtual Health is Saving Lives During Coronavirus

How Virtual Health Services are Saving Lives During the Coronavirus Crisis

With the outbreak of COVID-19 healthcare workers and providers have had to come up with better ways to diagnose and treat patients. The number of patients who need to be seen for health issues both related to and peripheral to the coronavirus has put a strain on our hospitals.  It is in this environment that Telemedicine has found its spotlight. Telemedicine or Virtual Health Care is the practice of performing virtual appointments and check-ups for patients. Especially now, this keeps both patients and healthcare workers safe while continuing to provide care for those in need. This is only the beginning of how virtual health is saving lives during the Coronavirus pandemic.

Virtual healthcare has slowly been taking hold as more and more of the norm in recent years. The cost savings alone make virtual care the right choice for many doctors, hospitals, and patients.  $7 billion of physicians’ time can be saved by switching in-person visits to virtual appointments.

These days, in quarantine, many people need the ability to have their doctor’s appointments at home. Even during the best of times, for many, the convenience is key to successful follow up appointments and check-ins.  Telemedicine allows for a safe environment to ask questions, get simple diagnoses and to get prescriptions from your doctor while remaining at home.  

Doctors around the country have implemented telemedicine and online appointments to help keep all patients safe from COVID-19. Patients with a smartphone or computer can visit a provider in a secure network. Dr. Chris Davis, Medical Director for UCHealth’s Virtual Urgent Care says, “COVID-19 is quite infectious, so if you can stay home and get medical advice, that gives you two advantages. First, if you’re sick, you’re not going to be bringing your illness into a doctor’s office or a hospital. Second, you won’t be exposed to other patients.”

These changes to what we have thought of as normal healthcare have given people affordable, manageable options to care for themselves and others throughout this uncertain time. As we work to navigate COVID-19, the best thing we can do is keep ourselves and others safe from harm by ensuring we do everything we can to stop the spread.

How Does the FFCRA Affect My Employee’s Coverage?

The Families First Coronavirus Response Act is an Act of Congress meant to respond to the economic impacts of the ongoing 2019–20 coronavirus pandemic. The act will provide funding for free coronavirus testing, 14-day paid leave for American workers affected by the pandemic, and increased funding for food stamps. So, how does the FFCRA affect my employee’s coverage?

As the effects of Coronavirus continue to unfold, we have seen many changes to how companies have to adjust their benefits. Here are some strategies that employers can utilize to prepare for the changes:

Employer-provided health coverage: The Families First Coronavirus Response Act ensures that group health plans cover COVID-19 screenings without cost-sharing. The law, however,  does not require coverage for treatment without cost-sharing; treatment costs will be based on the terms of the benefits plan.

The IRS states that employees who have coverage with a high-deductible health plan are able to get COVID-19 testing and treatment without additional expenses. 

Paid leave and short-term/ long-term disability coverage: Employees with less than 500 employees must provide up to 12 weeks of leave related to child care with the expansion of the Family and Medical Leave Act, and up to 80 hours of emergency paid sick leave to employees who are full-time. 

Families first does not address employees who were on disability or leave before the outbreak. 

Employer tax credits for paid leave: The FFRCA has provided multiple tax credits to aid employers as they attempt to meet the new requirements. These tax credits are equivalent to 100% of the qualifying leave wages against the employer’s portion of Social Security tax. 

Continuing health coverage during furloughs and mandated leaves of absence. During unpaid leaves of absences that are extended, like a temporary layoff of furlough, health benefits are typically halted. 

Review your insurance contracts and stop-loss policies to determine how to regard employees who lose eligibility due to an extended leave of absence.Group health brokers can help you navigate extended leave coverage for W-2 employees. 

(COBRA), where furloughed employees can choose to remain on the group health coverage the employer must collect the amount of the employees premium. If an employee is receiving payments from accrued time-off, it is possible to collect premiums from those payments. 

Employer inquiries, screenings, and disclosures for infected employees: Asking employees about their health condition is  not a HIPAA violation. Other laws, like the ADA, don’t allow confidential information to be disclosed that concerns employees. If employers screen employees onsite, test results are not associated with a health plan.

Telemedicine programs: The use of virtual medicine gives employees the ability to remain home while being cared for medically, which helps halt the spread of COVID-19.  

Employer expenses with a quarantine employee: Some expenses incurred while an employee is quarantined can be considered deductible. 

As we continue to navigate through COVID-19 we will likely see more changes to benefits that are being offered to employees. Check back for updates

Worksite Benefits Benefit Everyone

The high cost of health care and the evolution of insurance plans with high deductibles has created a market for voluntary benefits. 

Employees can choose from a number of insurance products to complement their coverage and to help achieve a greater degree of stability. Worksite Benefits (voluntary coverage) plans may be 100% paid for by employees or cost-shared with the employer. Here’s why worksite benefits benefit everyone.

Creating a more comprehensive and competitive benefits package is good for the employer as they attract better talent, good for the employee as they get improved coverage and good for the broker who is providing cost-effective solutions. In 2017 nearly half of large employers offered at least one of the three major voluntary benefits: accident, critical illness, and hospital indemnity.

Enrollment in voluntary benefits can be streamlined by offering these benefits at the time of enrollment in a MEC or other benefits plan, by ensuring ease of use in a portal or enrollment documents and by informing employees of the benefits of Worksite Benefits. .

Voluntary benefits generate commissions that can be used to fund overall benefits administration costs and project work done by TPAs that would otherwise be paid by the employer. 

SUPPORT FOR PHYSICAL AND MENTAL HEALTH AND WELLNESS

On the employer side, there has been a national push for physical and financial wellness initiatives. Employers are recognizing the increased stress their employees deal with on a day-to-day basis and are offering solutions. Stress costs American businesses more than $300 billion a year. 

PERSONAL PREFERENCE DRIVES DEMAND

Employees want to have more control when it comes to deciding which options are useful for them.

When employers offer a wide range of benefits that address physical and mental health and wellness issues, employees can adapt the package to fit their lifestyle needs. 

Employees want a benefits package that feels personalized to them, so that they feel like they An Aflac survey found that employees who were offered voluntary benefits were 19 percent more likely to be satisfied with their job – and 14 percent less likely to be job searching.

THE IMPORTANCE OF TECHNOLOGY

The wide array of technology providers offering more streamlined technology also makes voluntary benefits easier to implement for employers and brokers. Online enrollment, automated processing of administrative tasks and the ability for employees to “self-serve” all make the voluntary benefits enrollment process more attractive to employees and employers.

Voluntary benefits are only going to increase in popularity for employers and brokers of all sizes as they become more essential in the lives of employees. Isn’t it time to take a look at your benefits offerings and make sure they are competitive? Call SBMA today.