News and Blog

Blog

Subscribe

Monday, 06 April 2020
clear

Employers across Tennessee are making decisions they never would have dreamed of only a few weeks ago as the Corona Virus moves throughout the world. Most want to do the right thing for their employees because they know this is temporary and will want to continue their relationships as soon as things get back to normal. Here is a really good article on different ways TN employers can release their employees from work. 

This is go into great detail of what your options are and those of  your employees for: 

  • Remote Work
  • Furlough
  • Temporary Layoff
  • Perminant Layoff

The Novel Coronavirus (COVID-19) pandemic has caused a shift in the way our society operates, forcing businesses to adapt to mandatory closures, less foot-traffic, social distancing, and even quarantines. In these uncertain times, many businesses find themselves unable to keep their employees at work. You may be struggling to understand your options for your business and your workforce. The purpose of this article is to provide you with information about many of your options in these challenging times, to assist you in making informed and intelligent business decisions.

You may hear terms like “furlough,” “layoff,” “separation,” or “termination” used interchangeably to describe your options. These terms may refer to the same thing in a non-union setting, but in a union setting, your labor agreement may define them differently. We want to define these and other terms for the purposes of this article. “Remote work” means that the employees will continue to work from a location other than your office or facility. “Furlough” means that the employee is still expected to work, but with a reduction in hours or days of work. A “temporary layoff” means a temporary, finite or undefined period (depending on the business circumstances) where the employee will be off-duty without pay. With a “temporary layoff,” the employer has the intention of bringing the employee back to work when business circumstances warrant doing so, although depending on how things are structured, that may not be guaranteed. A “permanent layoff” means that the employee is terminated without cause, and there is no intention at the time of bringing the employee back to work.

Read More

clear
Posted on 04/06/2020 8:49 AM by David Moore
Monday, 06 April 2020
clear

Apr 2, 2020

Members will not be responsible for any out-of-pocket costs through May 31, 2020

CHATTANOOGA, Tenn. — BlueCross BlueShield of Tennessee will waive all member cost-sharing for COVID-19 treatments, including hospitalizations, through May 31, 2020.

“As part of our mission, our first priority is the health of our members and the communities we serve,” said JD Hickey, M.D., president and CEO. “And since the COVID-19 pandemic is unlike anything our members have faced in recent memory, we want to make sure we remove any barriers to receiving the care they need.”

If a BlueCross member is diagnosed as having COVID-19, they will not have to pay any out-of-pocket costs for testing and treatment administered through in-network providers, including at a doctor’s office, urgent care facility and emergency room, as well as related inpatient hospital stays, through May 31, 2020.

clear
Posted on 04/06/2020 8:40 AM by David Moore
Monday, 06 April 2020
clear

Federal Law Alert

FFCRA: New Rule and Guidance from DOL and IRS

New FFCRA Guidance in Temporary Rule and FAQs

The Department of Labor (DOL) has released rules related to administration of leaves under the Families First Coronavirus Response Act (FFCRA) and answered more common questions on their Questions and Answers page. Below are some key highlights to keep in mind when administering these leaves. We also recommend reading our summary of the FFCRA in Comply if you have not already done so.

Documentation: Employers may not require more documentation from employees than is described below. For instance, employers may not request a doctor’s note or an official notice from a closed school or daycare.

Childcare Provider: The definition of childcare provider includes anyone who generally cares for the children in question. This includes individuals paid to provide childcare, like nannies, au pairs, and babysitters, as well as individuals who provide childcare at no cost and without a license on a regular basis, for example, grandparents, aunts, uncles, or a neighbor.

Reasons for Self-Quarantine: Employees are only eligible for emergency paid sick leave (EPSL) if a health care provider directs or advises them to self-quarantine because the health care provider believes the employee may have COVID-19 or is particularly vulnerable to COVID-19.

EPSL due to Stay-at-Home Orders: In some narrow circumstances, an employee who is subject to a stay-at-home order may be able to receive EPSL. They will only be eligible if the business is open and has work for them to do, but a stay-at-home order that applies specifically to them as an individual prevents them from working. For instance, if the retail store where an employee works as a cashier is still open, but the employee is over 65 and subject to an executive order from their governor that all people over 65 should stay home, they would be eligible for EPSL.

Exempt Healthcare Workers: The exemption for healthcare workers is optional and the DOL encourages employers to be judicious in denying leave (if someone is sick with something that looks like COVID-19, you are encouraged to provide them leave anyway, even if they could be exempted). Healthcare facilities should still post the Employee Rights Poster required by the FFCRA.

Limited Small Employer Exemption: Although this is not new information, we want to reiterate that small employers are only potentially exempt from the childcare leaves provided by EPSL and emergency Family and Medical Leave Act (EFMLA) leave. For instance, one reason for exemption is that providing leave would cause the employer to cease functioning at a minimal capacity. If a single employee asks for intermittent childcare leave one day per week, but can telework the other four days, that is very unlikely to be a financial burden that causes the employer to cease operations. It would therefore be inappropriate (or illegal) for an employer to announce that they will not be considering or granting any childcare leaves.

IRS Guidance on Required Documentation for Leave Tax Credits

Employers have been anxious to find out what kind of documentation they will need to claim a payroll tax credit. The documentation that can be requested of employees is listed below. The IRS has a very helpful overview and FAQ that covers other common questions about the tax credits in detail.

Employers can substantiate eligibility for the sick leave or family leave credits by receiving a written request from the employee that includes the following:

Their name;

The date or dates for which leave is requested;

A statement of the COVID-19 related reason they are requesting leave and written support for such reason; and

A statement that they are unable to work, including by means of telework, for such reason.

For leave based on a quarantine order or self-quarantine advice, the request should include the name of the governmental entity ordering quarantine or the name of the health care professional advising self-quarantine. If the person subject to quarantine or advised to self-quarantine is not the employee, that person’s name and relation to the employee should be included.

For a leave request based on a school closing or child care provider unavailability, the statement should include the name and age of the child (or children) to be cared for, the name of the school or place of care that has closed, and a representation that no other person will be providing care for the child during the leave. If a child who needs care is 15 or older, the employee must affirm that there are special circumstances (but need not explain them) — the IRS otherwise assumes kids 15 and older can take care of themselves for the length of a workday.

According to the DOL, this is the extent of the documentation you may require.

We have an FFCRA Leave Request Form available in Comply that asks employees for in the information necessary based on their reason for leave.

 

This information is made available by ThinkHR

April 2, 2020

clear
Posted on 04/06/2020 8:37 AM by David Moore
Friday, 20 March 2020
clear

On March 18, 2020, President Trump signed the Family First Coronavirus Response Act in response to the spread of COVID-19. The Act is an economic stimulus plan that affects coverage for COVID-19 testing and provides expanded federal family and medical leave and a new federal paid sick leave law.

This is brand new and we are awaiting more details. This is the best information I have found so far explaining how it works and how the tax credit to pay for it will work for employers. 

Read More Here

clear
Posted on 03/20/2020 3:36 PM by David Moore
Monday, 09 March 2020
clear

There is still time to contribute tax-deductible dollars for 2019 if you are looking for ways to reduce your tax burden. You must have been covered under a qualified High Deductible Health Plan "HDHP" and not be covered under any other health insurance (spouse, Medicare, TriCare). If so, you can contribute up to $3,500 and if you have dependents on your plan up to $7,000. For those over age 55 there is a $1,000 catch up contribution. You can contribute until you file your taxes or April 15th. 

If you contributed for last year there are three forms you will need to file your taxes. IRS form 1099-SA shows the amount of money you spent from your HSA during the tax year. IRS form 5498-SA shows the amount of money deposited into your HSA for last year. IRS form 8889 is the form you fill out and submit with your tax return. 

Want more information about offering an HSA qualified plan to your employees? Give us a call we would love the opportunity to explain why this strategy works and help lower your group insurance costs and give employees a better way to pay for the medical expenses. 

David Moore 615-724-1699

 

clear
Posted on 03/09/2020 10:56 AM by David Moore
Friday, 28 February 2020
clear

I watched a news story on Channel 5 last night and needless to say was more than a little disappointed in how unfair the story was. It seems they wanted to tell one side only making the big bad insurance company the bad guy again. As a group insurance broker we work with employers and employees trying to manage benefits and costs. One the biggest challenges today is the high cost of prescriptions and all the new specialty prescriptions being prescribed. That is exactly what is happening in this story and Channel 5 makes it sound like the patient is going to go blind because of this new "policy change". 

What BlueCross BlueShield of TN is not saying they are not going to cover this medication nor are they going to limit it. All they are doing is requiring members to purchase it through a Specialty Pharmacy where they have some control over the cost of the medication. This story is about Lucentis a shot that treats macular degeration. What they failed to mention is that the medication costs $2,000 per shot. 

How much Dr. Awh charges BlueCross of TN for this medication I do not know. Nor, do I know how much the specialty pharmacy charges. I do suspect there is a pretty big difference in cost between the two and while patients and doctors may need to order the prescription the day before the office appointment the goal of BlueCross BlueShield of TN is help control costs and medical spending for all of their members. 

I am writing this because we get a lot of calls from frustrated members because the expect their expensive treatments and prescriptions to be immediately covered with no questions asked. For the most part, everyone gets the treatment or prescription the doctor is ordering but I think it's important that the insurance companies do everything they can to make sure that treatment or Rx is necessary since it is saving me and our clients money. 

Here are the resources I am using in this post. 

Cost of Lucentis 

News Channel 5 story

clear
Posted on 02/28/2020 10:31 AM by David Moore
Wednesday, 12 February 2020
clear

One of the biggest claim issues we are now dealing with is our clients getting bills from out of network providers and labs even though they used an in network facility. In the past this rarely happened but it seems some doctors have found out they can make more money by not contracting with an insurance companies PPO network. Even more worrysome is hospitals and out patient surgery centers knowingly allow these providers to work on their patients even though they know the problems it will create. 

In the past insurance companies were more tolerant of this abuse and providers thought they had found a loophole to higher reimbursements. Because it became so common, the  group insurance companies began following the legal contracts they have in place which allows them to not pay for these procedures as in network benefits. Most policies have a separate deductible for out of network claims which is where these claims get filed. That creates a separate bill for the insured and unfortunately there are no in-network discounts so the provider can bill whatever they want for their services. 

Congress and President Trump have promised to create legislation to stop this abusive practice. Of course, they have also promised price transparency and lower prescription costs. We have yet to see those changes and in an election year they need all the Super Pac money they can get. 

It is estimated that 20% of all surgeries and hospital stays now have out of network charges with an average cost of $2,011. The scary thing is we are seeing it regardless of which insurance carrier they have and it seems most hospitals are allowing it to happen as well. Even worse, there is very little you can do as a patient on the front end to avoid this from happening. 

It is very important for you to understand, this is not the insurance companies fault. This is the hospitals fault loud and clear. They are allowing non contracted doctors to knowingly work on their patients and bill their patients huge amounts they should not owe. 

For more information click here

clear
Posted on 02/12/2020 11:24 AM by David Moore
Wednesday, 11 December 2019
clear

A new survey by JD Power compares the low adoption of Telehealth programs to mobile banking. Remember when you did not check bank balance or make deposits on your cellphone? Today mobile banking applications are the third most used apps nationally and they expect the same with Telehealth. 

Here are some of their findings; 

  • Customer satisfaction is very high at 851 out of 1000. For reference, only direct banking is higher at 855. 
  • Word of mouth is the best advertisement, 65% of new users tried it after talking with a friend or relative. 
  • Telehealth works - 84% of users said they were able to completely resolve their medical concern. 
    • 79% did not experience any issues or problems during their service
    • 87% said the enrollment process was somewhat/very easy
    • 49% said there were no barriers making the Telehealth service difficult
  • Fast and easy - The average amount of time spent was 44 minutes for a first visit: 17 minutes for the enrollment process, 9 minutes waiting for a callback and 18 minutes for the actual consultation. 

For more information about the 2019 Telehealth Satisfaction Study visit www.jdpower.com/business/resource/us-telehealth-study

 

clear
Posted on 12/11/2019 2:40 PM by David Moore
Friday, 06 December 2019
clear

That is my opinion and I am extremely frustrated because Mark and I are on the frontline of healthcare costs spiraling out of control while we increase deductibles to levels never imagined. For example, diabetes is one of the oldest and most common ailments with an estimated 9.4% of Americans affected by this awful disease. After all these years and all the medications created, why does insulin cost $500 per month (Reuters)

I am writing this because a story just came out that Nancy Pelosi and the Democratically controlled House of Representatives is expected to pass legislation that would allow Medicare to negotiate drug prices with the pharmaceutical companies. The Republican controlled Senate is expected to oppose it and not pass the bill. This is expected to save tax paying Americans $500 billion dollars over the next 10 years. More importantly, private insurance companies would be able to piggy back on the discounted prices. 

The Republicans say it's best left to the private insurance companies to negotiate the prices. What we need to remember is private insurance companies pay on average 40% more for all healthcare than Medicare. It is going to take the Government to intervene to get any kind of price control in place. Unfortunately, because of the strong Pharmaceutical lobby and political donations to super PACs, I don't much changing in the short term. 

read more here

 

clear
Posted on 12/06/2019 9:33 AM by David Moore
Tuesday, 22 October 2019
clear

Did you ever think you would see a $500 monthly employee premium for a $5,000 deductible HSA qualified plan? Welcome to 2020, it's going to be a challenging year for employers and employees. The Affordable Care Act is really not all that affordable for most. Yes, it has provided much needed protection for groups who have employees with serious medical conditions, unfortunately there are a lot of other companies paying more for it. 

While the $500 monthly premium is what we have see for companies with older employees everyone is seeing higher premiums regardless of who your insurance carrier is. Most of our groups with 50 or fewer employees use BlueCross BlueShield of Tennessee. They have the pricing advantage the S Network provides making them the lowest cost option if you want a HSA qualified plan. Unfortunately, our most popular plan last year, the Silver 40 is seeing 20-30% increases and the options to reduce costs dramatically reduce the benefits. 

One option that has helped a few of our groups is using a strategy called "Level Funding". These are self-insured plans that allow them to avoid the costly "community rating" provision of the ACA. These policies require you to go through medical underwriting so only the healthiest groups qualify. We have successfully used Level Funded plans with Aetna, Cigna, Humana and United HealthCare. 

Hold on, because of high cost specialty prescriptions and the commonality of high cost procedures like joint replacement we don't see a slowdown in rate increases. 

Want to see if your company can save money with a Level Funded group health insurance plan? Give us a call and hopefully we can help you like we have many of our great clients. 

David Moore

615-417-8102

clear
Posted on 10/22/2019 8:12 AM by Benefit Brokers, LLC
clear
1 2 3 4 5 Next Last