October 2016 Print


NAHU's "Live from NAHU" with Janet Trautwein available online.

NAHU CEO Janet Trautwein presented the latest installment of the Live from NAHU! webinar series with timely updates on where healthcare and health insurance stand during the 2016 elections. This webinar reviewed the healthcare proposals of Donald Trump and Hillary Clinton and their respective party platforms, the potential for these to be enacted into law, what’s at stake in the congressional elections, and what we can expect from the remaining days of the 114th Congress.

If you weren’t able to watch it live or through one of our numerous chapter-sponsored events, you can now view it online.

NAHU Submits Comments on Payment Parameters Rule

On Thursday, NAHU sent a letter to the Department of Health and Human Services (HHS) on the proposed Notice of Benefit and Payment Parameters for 2018 regulation. The 294-page proposed regulation, a version of which is released towards the end of each year, serves as an omnibus policy document covering a wide-range of health insurance market topics. Among other concerns, our comments specifically addressed the ongoing issues of insurers reducing or eliminating broker commissions during the plan year. Read more here.

NAHU Submits Comments on Employer Reporting

On Monday, NAHU sent a letter to the IRS on the proposed rule, “Information Reporting of Catastrophic Health Coverage and Other Issues under Section 6055.” Our letter addressed required reporting, truncated taxpayer identification numbers (TINs), plans for which reporting is not required, the solicitation process for TINs, and employer TIN-solicitation requirements regarding section 6056. Our comments were comprised in consultation with a wide scope of member brokers and consultants who assist employers with information reporting nationwide. Read more here.

3 things NAHU told the IRS about ACA premium tax credits

The National Association of Health Underwriters has tried to show Affordable Care Actprogram managers that it can take a practical, apolitical approach to thinking about ACA issues.

Janet Stokes Trautwein, NAHU's executive vice president and chief executive officer, says she and colleagues at NAHU talked to many agents and brokers about the draft regulations.

For a look at just a little of what she wrote in her comment letter, read more here

NAHU Adopts Position Paper Opposing the Public Option

The NAHU Board of Trustees voted to adopt a position paper outlining our opposition to a public health insurance plan, also known as a “public option.” Policymakers are currently considering proposals to implement public plans that would provide coverage to Americans through state or federal marketplaces that would compete alongside private insurance plans. NAHU has been a leading opponent of the public option since 2008, is deeply concerned about the damaging impact that a public option could have on private-market coverage, and will continue to strongly oppose any efforts to implement a national public health insurance plan. Read more here.

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Industry News

2016 Employer Health Plan Trends

In their 2016 Health and Well-being Touchstone Survey, PricewaterhouseCoopers (PwC) received detailed responses from more than 1,100 employers in 37 industries across the country. The report provided summary data on medical, prescription drug, and dental plan designs, as well as work-life, wellness, and disease management programs, overall costs, and more.

Learn how to reduce company health care costs and improve employee health. Read the full article here.

5 Ways to Prepare Now for a Smooth Open Enrollment

The busiest and most stressful time of the year for HR and benefits professionals is fast approaching. Although it can be daunting, benefits consultants Rosemary Hughes and Suzannah Gill offer tips on how to make the process successful.

View these tips here.

Upcoming Deadlines for Employers

October 15 – Medicare Part D notice – Date by which plan sponsors must send Medicare Part D notices to Medicare-eligible participants, informing them whether employer-sponsored prescription drug coverage is creditable or non-creditable.

October 15 - Medicare Annual Open Enrollment begins and runs through December 7th for January 1 effective dates.

October 17, 2016 - Just as with retirement plans, if the health plan is on a calendar year and your client filed an extension request on or before July 31, 2016, they must file the 2015 Form 5500 for a calendar year plan by this date.

October 30 – Plan sponsors of self-funded group health plans and/or IRC 125 plans may wish to have nondiscrimination testing done, so plan sponsor can make adjustments (if needed) before year-end.  (not a required date)

November 1 – Open enrollment begins in the Health Insurance Marketplaces (Exchanges).  Eligible individuals can enroll or renew enrollment for 2017, and some may qualify for subsidies.  Open enrollment period is November 1, 2016 – January 31, 2017.

November 1 - if the plan's open enrollment is approaching, the Plan Administrator should fix the starting and ending dates for open enrollment, and then prepare and distribute enrollment materials such as the Summary of Benefits and Coverage.

November 7 – Date by which group health plans WERE going to be required to use unique Health Plan Identifiers (HPIDs) in specified HIPAA standard transactions.  However, on October 31, 2014, HHS indefinitely delayed enforcement until further notice, and there has been no further notice at this time.  So the November 7, 2016 HPID requirement will NOT apply.

November 15 – Second portion of 2015 transitional reinsurance fee (TRF) is due, for self-funded health plans that submitted enrollment data to Pay.gov last year and paid only the first payment as of January 16, 2016. The second portion is $11.00 per enrollee.  The first portion was $33.00 per enrollee.  Total TRF for 2015 was $44 per enrollee.

November 15 – For 2016 transitional reinsurance fee (TRF) calculation, deadline by which self-funded health plans must submit enrollment data to Pay.gov and schedule payment(s) to be made in 2017.  The 2016 TRF is $27 per enrollee, which can be paid either in one installment due by January 16, 2017, or in two installments, with $21.60 per enrollee due by January 16, 2017, and $5.40 per enrollee due by November 15, 2017.  For transitional reinsurance payments for 2016, see https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/The-Transitional-Reinsurance-Program/2016-Benefit-Year-Page.html .

December 7 -Medicare Annual Open Enrollment ends.

December 15 – Date by which SARs (Summary Annual Reports)  – Plan administrator must distribute SARs to plan participants, if 5500 was filed October 15 (on extension).

December 15  Date by which individuals must enroll in Marketplace/Exchange coverage for it to be effective January 1, 2017.

December 29  – Date by which ERISA plan sponsors who received MLR rebates on September 30 must pay the appropriate rebate amount to participants or for benefit improvements if the rebate is in part “plan assets,” or employer must establish a trust to hold the rebate as plan assets.

December 31  Date by which employers who sponsor self-funded plans must make second request for Social Security numbers of enrolled dependents, if they made the initial request in 2015, and if they want to be able to show they made a “reasonable effort” to obtain Social Security numbers, so they will not be subject to penalties for failure to report a Social Security number.  Per IRS Notice 2015-68.

December 29  – Date by which ERISA plan sponsors who received MLR rebates on September 30 must pay the appropriate rebate amount to participants or for benefit improvements if the rebate is in part “plan assets,” or employer must establish a trust to hold the rebate as plan assets.

December 31  Date by which employers who sponsor self-funded plans must make second request for Social Security numbers of enrolled dependents, if they made the initial request in 2015, and if they want to be able to show they made a “reasonable effort” to obtain Social Security numbers, so they will not be subject to penalties for failure to report a Social Security number.  Per IRS Notice 2015-68.

How Do Employees Make Smart Decisions in a Consumer-Driven Health Plan?

With healthcare costs rising year after year, an increasing number of employers are providing their employees with more choices when it comes to their benefits plans through consumer-driven health plans. This helps employers save money on insurance premiums, but it’s making the decision process more difficult for employees.

Read a great article regarding helping employee’s understand how to look at an insurance plan from Stephanie Ward here.

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Medicare News

Kaiser brief finds that Medicare’s EpiPen costs increased 1,151% from 2007 to 2014.

The latest example of high and rising prescription drug prices to attract significant media and public attention relates to the EpiPen, an auto-injector containing the drug epinephrine which is used to reverse the effects of severe allergic reactions. Since Mylan acquired the EpiPen from Merck in 2007, the company has increased the list price for a pack of two EpiPens nearly 550%, from $94 in January 2007 to $609 in May 2016.1 While the EpiPen can be a lifesaver for children with serious food allergies, it is also used to treat life-threatening allergic reactions experienced by the older adults and people with disabilities who are covered by Medicare. The EpiPen is covered under Medicare Part D, which provides outpatient prescription drug coverage to beneficiaries who enroll in private drug plans.

Wyden Bill Would Cap Out-of-Pocket Medicare Costs

A new bill from Sen. Ron Wyden would impose caps on out-of-pocket costs for traditional Medicare beneficiaries and expand eligibility among low-income seniors eligible for financial assistance for premiums.

The Oregon Democrat introduced the Medicare Affordability and Enrollment Act, which he says would help seniors who find their health care unaffordable. Companion legislation was also introduced in the House. Read more here.

Allow COBRA to be treated as Creditable Coverage for Medicare

On September 27, 2016, Representatives Bob Dold (R-IL-10) and Kurt Schrader (D-OR-5) introduced H.R. 6184, legislation that would allow seniors enrolled in COBRA coverage to transition to Medicare Part B without a penalty. This legislation would effectively treat COBRA as creditable coverage, the same as seniors who remain on similar employer-sponsored coverage and then enroll in Medicare. This one time Medicare special enrollment period would only apply for this scenario.

Under current law, seniors who are enrolled in COBRA coverage but are eligible for Medicare face financial penalties for not enrolling within the mandated timeframe. However, Medicare-eligible seniors who are enrolled in similar employer-sponsored plans are not penalized, as their coverage is considered creditable for Medicare. NAHU has long sought legislation to address this disparity for seniors enrolling in Medicare coverage. To read more and to tell your members of Congress to sign onto this bill, click here.


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HUPAC Roundup

Did you know?

HUPAC is a bi-partisan political action committee. We support Republicans, Democrats and Independents alike. It is not the party affiliation we look at but rather whether they are supporters of agents and brokers. The R or D in front of their name does not always tell the full story. There are Republicans who would like to dismantle the employer-based system for health insurance and put a lot of agents and brokers out of work and there are Democrats who support a single-payer system that would also put agents and brokers out of work. Instead we look at members of Congress and candidates who have expressed their support for private sector solutions in healthcare and co-sponsored legislation that is supportive of our legislative agenda. Help us support those who support us, contribute today!

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Nevada Health Link & Other Exchange News

NAHU Compliance Corner Blog – Employer Marketplace Appeals – The Results

At the risk of sounding like Nick Cannon on the television show  America’s Got Talent when they’re announcing performers advancing to the next round of competition, employers are beginning to see the results of appeals that they’ve filed when employees receive subsidies in the marketplace. Employers are finding some of these appeal decisions perplexing, especially when an appeal is denied. And, some employers fear that penalties will follow as a result of the lost appeal.

Read this very important article here.

Complete the FFM Exchange Certification and Register with Nevada Health Link

The Centers for Medicare and Medicaid (CMS) has opened up the broker and agent Marketplace Learning Management System (MLMS) registration and training for plan year 2017. You can access the training here: https://portal.cms.gov/wps/portal/unauthportal/home/

Once you have completed your training and have downloaded your certificate of completion, please go to https://www.nevadahealthlink.com/enrollment-partners/find-in-person-assistance-search-tool-listing-submission-form/  and enter your information if you want to be added to the In-Person Assistance Tool. Please note: only business addresses will be listed in our In-Person Assister tool. All of the information entered will be verified before publication and PO Boxes or residential addresses will not be accepted. The In-Person Assistance Tool is for consumers to find broker or agent closest to their home, for this reason we will only publish commercial locations in Nevada.  

After you have entered your contact information you will be prompted to upload your CMS certificate of completion and complete a Broker Code of Conduct Agreement. The Broker Code of Conduct was developed in accordance with 45 CFR 155.220 and must be completed online in order to be listed on the In-Person Assister tool.

Heather Korbulic Named Executive Director of Silver State Health Insurance Exchange

Carson City, Nev. – The Board of the Silver State Health Insurance Exchange, Nevada's public health insurance marketplace, has appointed Heather Korbulic as Executive Director.

Korbulic joined the Silver State Health Insurance Exchange as the Chief Operations Officer in August of 2015 after eight years with Aging and Disability Services Division where she was the State of Nevada's Long Term Care Ombudsman. Her extensive background includes the interpretation and application of State and Federal regulations, legislative testimony and advocacy, project management, research and data analysis, budget administration, complaint resolutions, quality assurance development and strategic planning. Korbulic has a Bachelor of Science from the University of Oregon and is a Certified Public Manager.

You can read the full news release here.


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2016 Election Update

The Final Presidential Debate

UNLV has been selected as the site for the final presidential debate on October 19th. The debate will take place at the Thomas & Mack Center on the UNLV campus.

Since being named the site of the final 2016 Presidential Debate, UNLV has been eagerly preparing for this historic event. From debate-related courses and lectures to hands-on learning opportunities for students of all ages.

Read more here.

NAHU, NAIFA, NIIA Candidate Meet & Greet - October 26th

NAHU, NAIFA and the Big I will be hosting a Candidate Meet and Greet for our Members and their clients on October 26th. If you are a member of NAHU, NAIFA or the Big I, please see the flyer and register online here.

We hope you register and talk to the candidates!

Early Voting Begins October 22nd

Nevadans may begin voting on October 22nd at various locations. Early voting will end on November 4th. The General Election is Tuesday, November 8th and you will need to vote in your polling location if you do not vote early.  You may find early vote locations here.

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