brittany, Author at Decisely

Humana sponsors new ‘Top Docs’ – which addresses MAG’s health insurance plan

The latest edition of the Medical Association of Georgia’s (MAG) ‘Top Docs’ show is sponsored by Humana® – which provides health insurance for more than 13 million Americans – and it addresses the new MAG Healthcare Solutions Plan, which is already delivering significant savings on health insurance for eligible MAG member practices. It features Mike Ganoni, who is the channel development lead for association business at Humana®, and Tyler Davis, REBC®, RHU®, ChHC®, who is a senior account executive with Decisely Insurance Services, which administers the MAG plan.

https://www.facebook.com/MAG1849/videos/703790813807048/

Association Health Plans Offer Comprehensive Coverage; At Least 30 States Want AHPs Operating In Their State

For over a year, the Coalition to Protect and Promote Association Health Plans (AHPs) has been working tirelessly to correct-the-record. Contrary to what critics are saying, AHPs are not an “end-run around” the Affordable Care Act (ACA). Quite the opposite. AHPs are currently offering better coverage than ACA-compliant “small group” and “individual” market plans. How do they do that?

AHPs are voluntarily covering all ten of the ACA’s “essential health benefits” (EHBs), including pediatric services. AHPs also cover pediatric dental and vision services either through their AHP insurance contract or through a stand-alone product.

In addition, AHPs offer broader “health care provider networks” relative to many existing ACA small group and individual market plans, and they are priced at an “actuarially fair premium” for both young and old AHP participants. Doing so encourages more young and healthy individuals to enroll in AHP health coverage, which in turn benefits older and less healthy AHP participants by increasing the size of, and balancing out, the risk pool.

AHPs are also subject to specific rules that prevent them from discriminating against individuals/employees based on a health condition. Most importantly, AHPs are prohibited from denying people coverage if they have a pre-existing condition.

To date, at least 30 States have signaled that they want to allow AHPs to (1) cover small employers in the same industry, (2) cover small employers in different industries, and (3) cover self-employed individuals with no employees.

This is compared to the 11 States and the District of Columbia (DC) that have filed a lawsuit to invalidate the Department of Labor’s (DOL’s) final AHP regulations (issued on June 21, 2018). These 11 States and DC already prohibit certain types of AHPs from operating in their State, including AHPs that cover small employers in the same industry.

The bottom-line is this: AHPs that cover small employers in the same industry currently provide comprehensive coverage to tens of thousands of employees. States should issue formal guidance clarifying that these types of AHPs can operate in their State, and further clarify that AHPs will be regulated like “large employer plans.” This will help more employees of small employers access quality and affordable health coverage through an AHP.

Today, roughly 30,000 individuals living in States like Alabama, Arizona, Florida, Georgia, Michigan, Missouri, Minnesota, Nebraska, Nevada, Oklahoma, Tennessee, Texas, West Virginia, and Wisconsin are covered by AHPs that allow employers in different industries and self-employed individuals with no employees to participate.

If the Circuit Court of Appeals for the District of Columbia invalidates the DOL’s final AHP regulations governing these types of AHPs, employees of small employers and self-employed individuals with no employees – who live outside of the 11 States and DC – will face a choice: (1) they will experience a 10-percent to 30-percent premium increase (depending on the savings under their existing AHP) or (2) they will go without coverage. These are outcomes no State or court of law should want.

The Coalition to Protect and Promote Association Health Plans is currently comprised of 33 like-minded organizations that believe employees of small employers and self-employed individuals deserve quality and affordable health coverage with strong consumer protections. Member organizations include: American Bankers Association; American Composites Manufacturers Association; American Farm Bureau Federation; American Society of Association Executives; American Society of Travel Advisors; American Veterinary Medical Association; Associated Employers Benefit & Trust; Association of Web-Based Health Insurance Brokers; Decisely Insurance Services; Financial Services Institute; Food Marketing Institute; Foundation for Government Accountability; Global Cold Chain Alliance; Humana; Indiana Credit Union League; International Franchise Association; International Sign Association; iPSE-U.S.; Manufacturer & Business Association; Marsh McLennan; Mercer; Michigan Business and Professional Association; Michigan Dental Association; National Apartment Association; National Association of Mortgage Brokers; National Association of REALTORS^®; NFIB; National Marine Manufacturers Association; Small Business Association of Michigan; The Association of Independent Workers; TranscendAHP; Transportation Intermediaries Association; Vimly Benefit Solutions.

MEDIA CONTACT: Chris Vest, ASAE, 202.626.2798, cvest@asaecenter.org

Decisely is proud to be named Best for the World: Workers by our partners at B Lab in recognition of our employee-friendly practices, job flexibility, and fair-chance hiring policies. This accomplishment solidifies what we already knew; Decisely is a great place to work.

“Bringing our vision to life starts with our team,” said Kevin Dunn, Decisely CEO. “We believe that great client service originates with happy, engaged employees. Our employee owners make our company better because everyone has a stake in the company’s success. We are proud and excited to see Decisely being recognized for our culture.”

Best For The World recognition is administered by B Lab, the global nonprofit that certifies and supports Certified B Corporations, which are for-profit companies dedicated to using business as a force for good. Today there are 3,000 Certified B Corporations across 64 countries and 150 industries, unified by one common goal, to redefine success in business by meeting the highest standards of verified social and environmental performance, public transparency, and legal accountability to balance profit and purpose.

The 2019 Best for The World honorees are determined based on the verified B Impact Assessments of Certified B Corporations. The full lists are available on https://bcorporation.net/.

For more information, see the original article here.

In March, the U.S. District Court for the District of Columbia found in favor of the state of New York (and 11 other participating states), who sued the Department of Labor over portions of the new association health plan regulations issued in 2018.

The ruling struck down two of the 2018 expansions to existing AHP regulations: formation of geography-based programs for non-same trade businesses and participation in AHPs by sole proprietor-based businesses. The ruling also essentially affirmed old rules for same trade or business and those without sole proprietors.

The lawsuit specifically called out the Trump administration’s stated desire to unravel the Affordable Care Act and ties the 2018 AHP rule to these efforts. It expressed concern that small group employees and individuals will be left unprotected if AHP collective sourcing migrates them to the large group market, because they will not have the benefits of the small group and individual market protections. The lawsuit’s concerns revolved around possible reduction of ACA policy-related benefits, cherry picking underwriting and advantageous pricing of the healthiest groups, eliminating pre-existing conditions, and lower coverage per dollar spent.

The lawsuit, however, actually affirms that traditional AHPs are valid by stating that federal courts for decades have interpreted that phrase to cover only associations whose members share a true commonality of interest, or close nexus, with one another.

Does this new ruling impact current AHPs?

Traditional AHPs remain viable under long-standing ERISA law and interpretations. This includes plans for employers with two or more W-2 employees in the same trade or business to come together for medical insurance sourcing purposes. Practically, this means trade associations of businesses in the same industry, collections of common franchisees, or franchisees of different brands in the same trade or business (like quick service restaurants) are still able to form AHPs.

Traditional association health plans are allowed under existing ERISA law and are not impacted by this ruling. Many in-progress AHP franchise and association partnerships are built upon this traditional AHP framework.

In spite of the DOL ruling last year, most AHP solutions are still based upon the four standard requirements of creating and administering AHPs:

Must be related trade or business. Partner with associations and franchises that meet the same trade or business criteria, franchises of common brands or different franchise brands in the same trade or business (ex. Various restaurant brands, or cleaning services brands).
Delivering medical and other benefits for traditional common-law employers and their W-2 employees. When there is clear regulatory and carrier support for including sole proprietors and 1099s at the state level, there may be limited opportunity for now.
AHPs created for a primary purpose other than sourcing medical Insurance. Full recruit to retire solutions for businesses for association members, can help fulfill this association AHP requirement.
For well-governed, independent AHPs. An AHP must be governed by members, for members; it cannot be broker or insurer owned or managed.

Successful AHPs and program solutions will likely be fully insured medical insurance solutions complying with ACA and state-level requirements for essential coverages, to meet the demands of ACA qualified products under existing law. Many state regulators are still leery of self-funded AHPs, and each state has different requirements for approving self-funded programs.

The AHP is still important for small business

Small businesses and individual franchises generally do not qualify for large group plans with lower rates, or expanded coverage for both medical or non-medical benefits. This dramatically impacts 6 million small businesses employing 60 million (40% of the U.S. workforce). Nationally, only 53% of small businesses offer health and other benefits to employees.

In addition to the 30 million or so small business employees that do not have access to employer-sponsored or co-funded medical insurance, those that do traditionally pay more per employee than large employers and adhere to stricter employee participation requirements. Additionally, small-group insurance providers of medical and other benefits often offer narrower coverage than those large companies can source and offer to their employees. Large companies have the advantage of employing HR and benefits professionals specifically to navigate the complicated waters of benefits sourcing and delivery.

Surveys conducted by Decisely across more than 25 different association and franchise organizations, representing more than 90,000 employees, clearly reinforce small business interest in complete benefits program solutions on a collective basis.

The key finding is that small businesses need to find solutions to address both the lack of plan benefit affordability and healthcare access.

Out of more than 1,000 small employers surveyed, the majority said they did not offer benefits because of cost, complexity and administration. To small businesses, benefits are often complicated, confusing and expensive.

AHPs are a proven method of improving the health of small businesses and their employees. For one of our AHP clients, more than 35% of franchise members were able to secure employer-sponsored benefits for the first time. Among the owners who already offered benefits, average savings on medical insurance alone was more than 20% (more than $1,100 per employee), addressing concerns of affordability. A full 36% of these employers broadened benefits offered to employees, adding benefits such as dental, vision, life and disability.

The potential of AHPs will still be a game-changer in terms of potential savings and efficiencies for small businesses and millions of employees. Appropriately defined associations, franchisors and their small businesses capitalizing on opportunity can do so with careful planning for creation and administration of their AHPs.

Chris Duncan is chief operating officer of Decisely Insurance Services.

Originally published at Employee Benefit News on June 16, 2019.

by Carlos Garcia, Founder & CEO of Finhabits

Americans are not saving enough for retirement and relying on social security will not be enough to provide for a comfortable future. States are chiming with legislation that compels businesses to offer retirement benefits to their employees. California, Oregon and Illinois are leading the charge with their programs and 11 others, including New York, Connecticut and Maryland have plans under way.

As a business owner, you want to take care of the people who work hard at making your business succeed. But figuring out how to offer a retirement savings benefit that makes sense for you and your staff members is not for the faint of heart. In fact, when the Pew Research Center conducted a survey on this topic, they found that the main reason employers were not offering retirement benefits was that they were deterred by the cost and time involved.

So whether you have to comply with a state mandate or just believe that it’s good for your business, here are a couple of things you should consider as you dive in:

A 401(k) isn’t a one-size-fits all solution.

When most employers think of providing a retirement benefits they start looking into 401(k) plans. But that’s not the only option to consider. Did you know that as a business you can choose to offer an IRA-based retirement benefit to your staff? And that you can offer it alongside an existing 401(k) plan? It’s not an either/or scenario when it comes to offering work-based retirement savings. Both options can complement each other and be a great solution for many workplaces.

So if you run a business that has a diverse workforce, including part-time and contract workers, you might want to consider providing an IRA-based retirement savings option. The fees are lower than the typical 401(k), you don’t need to have a plan sponsor, and when your employee leaves, you don’t carry the burden of their account maintenance costs. To find out more, check out our IRA offering from Finhabits™.

Work is the best place to get in the habit of saving for retirement.

If you’re not saving for retirement through a workplace benefit then you’re likely not saving for retirement at all. In fact, research shows that people are 10 to 15 times more likely to save for retirement if they are offered an option through work.

That’s great news for employees who already have access to their company’s 401(k). But for people who work for smaller businesses (especially those with under 100 employees) accessing a retirement plan through work is just not an option.

Financial experts and policymakers are recognizing this problem and have determined that mandated state programs are the way to address this. As each state is rolling out their plan, keep updated on what your state expects of you in your role in solving this societal challenge.

To ensure participation, make it easy to enroll and contribute regularly.

These days anyone can start saving and investing in mere minutes with a mobile app. So why not look for the same feature in whatever retirement solution you offer?

Thanks to mobile-based financial apps like Finhabits, it is easier than ever for businesses of all sizes to offer retirement options. And your staff will really appreciate being able to easily control their contributions and manage their accounts through their phones.

Be prepared for what’s coming by knowing your options.

In an effort to close the retirement gap for hard-working Americans, states have put their best foot forward in implementing state-mandated retirement programs. While they are designing their programs to get workers to start saving for retirement, they don’t necessarily offer a solution that makes sense for every business.

Knowing the essentials of your state’s plan is a good place to start. Find out which deadlines apply to your business and the program fees. Remember,you don’t have to enroll in the state’s program. States allow businesses to opt-out of their program if employers already have a retirement benefit in place such a 401(k) or an IRA.

State plans have the right intentions, but they don’t necessarily have the right solution for all businesses. Signing up for a retirement benefit now means you can even get ahead of your state’s mandate so you don’t have to worry about it later.

We are here to help you choose the right retirement solution based on your business’ specific needs. Want to learn more? Check out our Retirement Solutions

Finhabits is the first bilingual retirement savings platform focused in the 55 million U.S. workers without access to a 401(k) plan. Finhabits offers an easy to enroll IRA solution for small business employees across the US.

On March 28, 2019, the U.S. District Court for the District of Columbia found in favor of the State of New York (and 11 other participating states), who sued the Department of Labor over portions of the new Association Health Plan regulations issued in 2018. The Court’s ruling can be found at here

What does the ruling mean for those who are considering or already have an Association Health Plan?

First, and most importantly, the ruling struck down two of the new (2018) expansions to existing Association Health Plan regulations:
(1) Geography-based programs: (i.e., “Chambers of Commerce” plans) where the new AHP regulation allowed non-same trade or businesses to form AHPs within a city or state to source a single health plan, and (2) Sole Proprietor Inclusion: (employers with no employees other than the owner) participation in AHPs.

Both of these together are commonly called “New Rule” AHPs.

How does this impact Decisely Programs?

“Old Rule” AHPs remain viable under long-standing ERISA law and interpretations. This includes plans for employers with 2 or more W-2 employees in same trade or business to come together for medical insurance sourcing purposes. This ruling does not affect traditional bona fide Associations or Franchisors whose members or franchisees employ two or more W-2 employees in the same trade or business. Practically, this means AHPs for trade associations from the same industry, or collections of particular franchisees are still able to form AHPs.

“Old Rule” Association Health Plans have been around for decades, and are allowed under existing ERISA law not impacted by this ruling. It is this foundational, historical framework that the vast majority of Decisely AHP Franchise and Association partnerships rest upon.

The Decisely Program and AHP Solution for Associations and Franchises are a model of responsible “Old Rules” AHPs, and is not impacted by this ruling. Our Program’s solutions for clients is based upon the four foundational requirements of traditional AHPs:

Must Be Related Trade/Business. We partner with Associations and Franchises that meet the “same trade or business” criteria, either as a long-standing trade association of similar businesses, or franchises of common brands.
Delivering Medical and Other Benefits For Traditional Employers and their Employees. When there is clear regulatory and carrier support for including sole proprietors and 1099s, we will consider it, but only where success is certain.
Through Association AHPs created for a Primary Purpose other than sourcing Medical Insurance: Part of the answer to this point is Decisely itself. Our “Recruit to Retire” solution for businesses, as well as other employee benefits, helps fulfill this association AHP requirement.
For Well-Governed, Independent AHPs . An AHP cannot be broker or insurer owned/managed. It must be governed by members, for members; good governance and independent oversight matters.

Finally, while others may pursue self-funded or self-insured AHP medical benefits solutions, and there are appropriate places for such solutions, Decisely is focused on delivering within its AHPs and Program Solutions, fully insured medical insurance solutions (not self-funded) that comply with ACA (and State-level) requirements for essential coverages, and other ACA requirements that meet the demands of ACA qualified products under existing law.

Lawsuit Background

It’s helpful to review the background and objections to the rule in the suit.

Twelve states, led by New York, with support from Attorneys Generals in MA, DC, CA, DE, KY, MD, NJ, OR, PA, VA, and WA, filed a lawsuit in US District Court of the District of Columbia against the Department of Labor’s 2018 regulation expanding Association Health Plans (AHPs) (the “New AHP” Rule). All of the states participating were Democrat-led states. These same states (and an additional five states who did not join the litigation) submitted a joint comment letter to the DOL opposing the New AHP Rule.

The lawsuit specifically called out Trump Administration’s stated desire to unravel the ACA and ties the New AHP Rule as another effort by the Administration’s to dismantle ACA. “Since taking office, the Trump Administration has engaged in a sustained effort to ’explode’ the ACA.” Announcing the Final Rule, the President proclaimed that it was another “truly historic step in our efforts to rescue Americans from ObamaCare and the ObamaCare nightmare” and would “escape some of ObamaCare’s most burdensome mandates.”

The lawsuit expressed concern that small group employees and individuals will be left unprotected, if AHP collective sourcing migrates them to the large group market, because they will not have the benefits of the small group and individual market protections. Practically, their concerns as stated revolve around the reduction of benefits (potential of eliminating 10 essential benefits under ACA policies), “cherry picking” underwriting (and advantageous pricing) of healthiest groups, eliminating pre-existing conditions, lower actuarially-valued benefits (lower coverage per dollar spent)…in short “The Final Rule would return the country to the pre-ACA world where people with pre-existing conditions will lack federal protections that enable them to obtain quality, affordable health insurance.”

The lawsuit as filed actually affirms the stance that traditional (or Old Rules) AHPs are valid as “federal courts for decades have interpreted that phrase to cover only associations whose members share a true commonality of interest, or close nexus, with one another”.

What happens next on the Lawsuit?

The Administration is expected to appeal this decision, and it is highly likely that the Court’s decision will be stayed pending appeal. If this is in fact the case, then the existing “geography” AHPs will likely continue to operate, but new geography-based AHPs will probably slow down until the case is finally resolved. The same is also true for AHPs that include sole proprietors. We also expect that individual states may respond with their own actions (regulatory and legislatively) over time with regard to AHPs operating in their states.

Questions or concerns can be directed to: Chris Duncan, EVP/COO Decisely Chris@decisely.com