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Displaying items by tag: Group health insurance brokers

Wednesday, 25 January 2017 20:13

Update on ACA Repeal and Replace Strategy

It was no secret before President Trump signed the executive order that he wanted the Affordable Care Act (ACA) repealed, and now he has made his intentions clear. His first signed executive order requires federal agencies to ease the economic burden of the ACA “to the maximum extent permitted by law” until it is repealed. Although the executive order doesn’t grant the administration any powers that it didn’t already have, it does signal to the public that change is coming. 

Published in Healthcare Legislation
Wednesday, 18 January 2017 13:56

On Wellness, One Size Fits ONE

Guest Article by Brad Cooper, CEO of US Corporate Wellness


The research is in, and it warrants an exclamation point!  An effective employee wellness program will provide a 125-600% ROI or more through decreased health care, sick time and disability costs, as well as improved recruitment, retention and employee engagement (and that doesn’t take into account the personal enhancements participants experience in their own lives!).  The result of this research has been a two-fold increase in the number of organizations that have launched wellness programs for their employees in recent years.  Only one problem – the first word in the phrase “Effective Employee Wellness Program.”


There are many approaches to employee wellness.  Common entry level approaches include holding an internal “biggest loser”-like contest or providing paid memberships at the local health club. 

Published in Wellness
Tuesday, 10 January 2017 23:43

21st Century Cures Act and Small Employer HRAs

The 21st Century Cures Act was signed into law on December 13, 2016 by then President Obama. The bulk of the Cures Act covers areas such as medical research and drug and device approvals. This new law also revokes a ban in effect since 2014 on small employer pre-tax funding of individual health insurance premiums. Beginning in 2017, this new act will allow small employers to create “Qualified Small Employer Health Reimbursement Arrangements” or “QSEHRAs.” 

Published in Healthcare Legislation

The annual Kaiser Family Foundation/Health Research & Education Trust Employer Survey is always a great source of information about the trends in employer-sponsored health coverage.  This year’s big conclusion is that while final premium increases were not that high, the average was markedly reduced by even more movement to cost-saving High Deductible Health Plans (HDHPs), which means employees likely have less rich benefits than before.

Published in Industry Trends
Wednesday, 13 July 2016 14:32

Fall River Inspiration Scholars Announced

We are so excited to share that we have chosen the winners of our annual Fall River Inspiration Scholarship. Each year, employees of Fall River clients, as well as their children/grandchildren, are eligible to apply. We had an outstanding pool of applicants this year (in both quantity and quality of applications) and have decided to increase the number of scholarships we gave. We are awarding two $1,000 scholarships as well as three $250 book stipends.
Published in Fall River News
Monday, 07 April 2014 12:00

Final Colorado Exchange Enrollment

Now that the deadline for Open Enrollment on the Exchange Marketplace has passed, we’d like to update you on some of the enrollment figures.
Colorado has an Exchange site of its own, Connect for Health Colorado, as do about a dozen other states, separate from the federally-run enrollment website, hhs.gov.
In Colorado alone, the Connect for Health Colorado site was visited by 1,260,008 people.  Of that number there were 277,149 who signed up for health insurance.  This total reflects two distinct categories of insurance.  In the category of private health insurance (through Connect for Health Colorado) there were 118,628 new subscribers.  The vast majority of this enrollment is in individual plans, with a small percentage in the small business plans through the SHOP Exchange.
The rest of the enrollments were individuals who qualified for coverage under Medicaid.
For additional information and metrics, please visit http://connectforhealthco.com/news-events/metrics .
The figures on a national level have not been finalized at this time.


Published in Healthcare Legislation
Sunday, 23 March 2014 12:00

Are You ERISA Compliant? Try This Checklist!


The Employee Retirement Income Security Act of 1974 (ERISA) was enacted to protect the interests of individuals who participate in an employer-sponsored group health, pension, and benefits plan. To ensure that these interests are upheld, certain requirements are in place for all plan sponsors and administrators to follow in order to meet their ERISA obligations.
It is a common misnomer that ERISA only applies to self-funded plans. ERISA applies to all employee benefit plans, self-insured and fully insured, regardless of size. This is why it is essential for plan administrators to understand the importance of ERISA, and take the necessary steps to stay in compliance to avoid possible penalties by the Department of Labor (DOL).  See the More Info Section below to see to which types of plans ERISA applies, and which employers are exempt.
What are the ERISA requirements for an Employer-sponsored Health Plan?
  • Written Plan Document – insurer certificates are not sufficient; a wrap document is often     required
  • Summary Plan Descriptions (SPDs)
  • Summary of Material Modification (SMM) for off-anniversary changes
  • Form 5500 and Summary Annual Report (SAR), for those with 100+ participants
  • Numerous required notices throughout the year – note that these changed recently
  • COBRA compliance
  • HIPAA and HITECH compliance – including the latest privacy regulations effective 9/23/13
  • Medicare Part D notifications to members and CMS if any beneficiaries could be Medicare eligible; note that even some non-ERISA plans such as churches and governments are also subject to this requirement
Once you have the above pieces in place (the Fall River ERISA Toolkit can help), we recommend an annual checkup where once a year you:
  • Collect and review all benefit  plan documents
  • Identify plan changes and initiate corrections
  • Mark calendar for the dates required forms are due and deadlines for reporting
  • Review and update required notices for employee distribution
Fall River understands the complexity of ERISA and feels it is important for employers big and small to know the “who, what and when” of ERISA compliance. If this is an area where you need some help getting fully into compliance, just This email address is being protected from spambots. You need JavaScript enabled to view it. or give us a call at (303) 369-3200!
The information provided only gives a brief summary and general guidance, and should not be considered legal advice. We always recommend you contact your ERISA attorney regarding the laws and regulations that interpret your health plan.
What plans are subject to ERISA?
  • Group Medical (PPO, HDHP, HMO, POS, etc.)
  • Dental
  • Vision
  • Group Life & AD&D
  • Disability
  • Prescription Drug Plans
  • FSA
  • HRA
  • Wellness programs (if medical care is offered)
  • Employee Assistance Programs (if counseling is provided)
What types of employers and plans are NOT subject to ERISA?
  • Government Plans (federal, state, city, county, public school districts)
  • Church
  • Health Savings Accounts themselves (though the underlying HDHP plans are)
  • Section 125 - Premium Only Plans
  • Payroll Practices
  • Voluntary Plans
Published in Best Practices


Many Affordable Care Act (ACA) compliance deadlines have already been delayed, mostly surrounding the Large Group Employer Mandate, now postponed until 2015 and 2016, depending on group size. The most recent extension has created confusion surrounding whether groups can keep their current plans beyond their 2014 renewal date. We all remember hearing during the ACA rollout that “If you like your plan, you can keep your plan.”  However, groups are finding out with their 2014 renewals that this is not the case, that their current plans are being discontinued, and therefore they must choose new plans that are ACA-compliant.
Perhaps in response to negative reactions from the public, in November of 2013 the federal government announced a one-year transition relief period, during which groups could continue offering their current non-compliant plans.  The March 5, 2014, an announcement extended that relief to 2 years.  So now that groups have another 2 years to transition to ACA-compliant plans, your current plans are fine, right?
Unfortunately, it’s not that simple.
At the time of the initial delay back in November, CMS provided guidance that at the option of each state, health insurance carriers could continue to offer non-compliant policies through October 1, 2016.  However, only about half the states opted to grant extensions for offering non-compliant policies.
The Colorado Division of Insurance was quick to say that they would not elect the extension, and therefore plan renewals in 2014 would have to be transitioned over to ACA-compliant coverage as planned. The reason is likely due to the large time and effort already spent by the DOI and carriers to create benefits and pricing for their new ACA-compliant plans.  The carriers hadn’t planned on being able to offer non-compliant plans any longer, so they did not calculate pricing for them.  It didn’t make sense to the DOI to put aside all the work they had already done, and focus back on plans that will eventually be obsolete.
As a result, in Colorado and many other states, the delay has no impact. The plans available when first moving to a new carrier, as well as your renewals, will include only ACA-compliant plans.
Published in Healthcare Legislation
Wednesday, 05 March 2014 10:00

Create Great Healthcare Consumers


One of the many reasons that healthcare costs are so high in the United States is the third-party payer system disconnects so many of us from the true cost of healthcare.  Just as a teenager with unlimited access to the parents’ credit card may not make the most economical decisions, many of your employees are ill-equipped and poorly incented to make wise choices with your healthcare dollars.
The first step in solving this problem is to create incentives to be wise spenders, through consumer-directed plan designs, higher cost sharing on elective procedures, high performance physician networks, and other features we can recommend.  These features are completely separate from your wellness initiatives, and are designed to help employees choose efficient and high value levels of care.
Once the appropriate plan design is in place, the most important next step is education.  Because of the copay system that historically insulated your employees from their own healthcare spending, they need to be taught how to be good consumers of care.  We recommend the following topics be covered in open enrollment meetings, at staff meetings throughout the year, and summarized in the Benefit Guides your broker prepares for your employees.
Here are a few topics to be sure to cover:
Question Your Doctor
  • Prepare for doctor visits by bringing a list of questions and taking notes during the appointment
  • Bring someone else with you to take notes, especially when discussing complex conditions or treatment plans with your doctor
  • Research your condition or surgery prior your appointment so you come informed
Smart Prescription Use
  • Take prescription medications as directed and don’t stop without the instructions of your physician
  • Ask for generic prescriptions whenever possible and use the prescription mail order program for maintenance medications you take every day
Get Care in the Right Setting (non-emergency issues only)
  • Use your insurer’s online cost and quality data to determine where the best outcomes happen for the surgery or procedure you need
  • Avoid hospital or other high cost settings by asking your doctor for alternative locations where you could have a procedure or complex imaging performed
In the event of an emergency:
  • Call the 24/7 Nurse line if one is provided by your carrier
  • Make a doctor’s visit for the next day if it’s not serious
  • Visit your nearest covered Urgent Care facility (research ahead of time the nearest one to your home and your workplace)
  • Use the Emergency Room as a last resort for treatment
Let us know if you have other ideas of topics to cover. If you would like some ideas to help you create this type of education campaign, please This email address is being protected from spambots. You need JavaScript enabled to view it.!
Published in Best Practices


In recent years there has been a shift in the way companies are structuring employee benefits packages. With the rise in healthcare costs and the changes that are taking place with healthcare reform, many employers are finding it necessary to revamp the traditional benefit structure and integrate new innovative ways to cut costs without reducing the coverages offered to employees.

A great way to enhance an employee benefit package is with voluntary products. Examples of voluntary products that could be added benefits with no cost to the employer include:

  • Additional Life Insurance
  • Dental plans to replace or enhance your group plan
  • Accident Policies
  • Disability Insurance
  • Vision Insurance
  • Critical Illness
Other options that can strengthen a benefits package and bring value added services, include:
  • Legal Services
  • Financial Counseling
  • Credit Union Membership
  • Pet insurance
  • Discount programs
All of the above programs can be offered at no cost to the employer. Voluntary benefits can create a well-rounded benefits package, but there are some things to consider when selecting which plans are right for your employees.
  1. Conduct an employee survey or a focus group – determine your employee demographics and which products would interest your employee population to help ensure the success of the benefits offered
  2. Educate employees about the coverage offered –explain in both group and 1-on-1 meetings (all conducted by the carrier or broker) the value of the added layer of protection that voluntary products can provide for employees and their families
  3. Distribute communication pieces year round – don’t wait until the annual open enrollment to discuss benefit options available (i.e. web based enrollment, use of onsite enrollment counselors, payroll deductions for the premiums). Use email, employee portals or company specific social media sites to raise employee awareness and encourage participation.
Whether you’re trying to reduce cost or attract and retain employees, voluntary benefits have many advantages. The wide range of products will enhance any employee benefit package and increase employee satisfaction.
Published in Best Practices
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