News and Blog

Tuesday, 30 October 2018
ACA - Employer requirements are still there

With all the talk about repealing the ACA and the "individual mandate" penalty going away next year, business owners might think they are off the hook to comply with all the ACA laws. This is not the case, nothing has really changed if you have more than 50 full time equilvalent employees. 

The number one thing to be aware of is providing "qualified, affordable health insurance" is still the rule of the land and not complying can cost you dearly. The IRS is enforcing "employer shared responsibility payments" (ESRP) penalties against large employers who fail to meet the ACA requirements. 

The IRS is assessing penalties using 226-J letters

This letter explains that the employer may be liable for the penalty, based on information obtained by the IRS from Forms 1095-C filed by the employer for that coverage year and the tax returns filed by the employers employees. If an employee indicates on their taxes that the coverage offered by their employer is not affordable it can trigger the penalty by the IRS. The employer has only 30 days to respond to the 226-J letter, using IRS form 14764, which is enclosed with the 226-J letter. Not responding to the letter in the 30 day limit will result in a final assessment of the proposed penalty. 

The penalties of non-compliance can be severe. In the worst case, an employer with inadequate or unaffordable health insurance could pay for the cost of the coverage as well as penalties of $2,000/year for every full-time employees (less 30), even those who received health coverage from the employer. 

The real key here is to reply in the 30 day limit and make sure the lowest cost plan does not charge employees more than 9.56% of an employees income. 

Posted on 10/30/2018 9:42 AM by David Moore
Friday, 26 October 2018
Welcome Oscar Health Insurance to Nashville

We have a new group health insurance product in Middle TN beginning January 1, 2019. Oscar Health who last year partnered with Humana to give small employers a new "high tech" option for health insurance is now a stand alone carrier. While Oscar looks like a traditional health insurance company on the outside, they do everything possible to break the mold of the traditional carrier and hope technology and customer service will reduce costs and improve satisfaction. 

Oscar's main interface is through their cell phone app. On the app you can look at claims and find a doctor but you can also make a doctors appointment and more importantly talk with your personal representative who can assist in finding the right doctor and appointment. Their "talk to a doctor" feature is easy, seamless and free on most plans. 

Most middle TN hospitals are in the network and they are adding more doctors on a weekly basis. For a new carrier the local network is quite strong. Here again, the work somewhat differently in that you do not have benefits if you go out of network. That is something you should not take lightly and be sure to do your homework before seeing a new provider. 

Premiums are regulated by the state and are community rated just like the other carriers in the under 50 employee small group market. You have many different benefit options and premiums are lower than many of the other carriers. There are no pre-existing conditions as these are ACA compliant plans. 

Oscar Health is available in middle TN only. If you have employees who live outside of this area or are traveling out of state you can access the Humana CHC network which is a great national network of doctors and hospitals. 

Want to see a quote for your company? We will be happy to show you options and prices. Call David at 615-724-1699 or email 

Posted on 10/26/2018 2:14 PM by David Moore