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Displaying items by tag: group health insurance broker

Effective June 27, 2016, the Colorado Medicaid program is now called Health First Colorado. The new name reflects the significant changes that have been made to modernize Colorado’s Medicaid program to engage members and improve the quality and coordination of care. The name itself – Health First Colorado – aims to convey Colorado’s commitment to putting its residents’ health first, as well as encourage its 1.3 million members to put their own health first.
Published in Healthcare Legislation
Wednesday, 29 June 2016 11:56

Mental Health Compliance in the Workplace

Last month we wrote about mental health awareness in the workplace. This month we’d like to bring your attention to compliance surrounding mental health issues, and how not following proper procedure could cost your company profoundly.
The Americans with Disabilities Act (ADA) prohibits discrimination against individuals with mental and emotional impairments in companies with at least 15 employees. But how do you know if the ADA rules apply to the situation at hand? If a mental health impairment is brought to your attention, what do you need to do?
Published in Wellness
Wednesday, 29 June 2016 05:40

Reminder: Key Compliance Deadline in July

The Patient Centered Outcomes Research Institute (PCORI) fee is due July 31, 2016 for employers with any type of self-funded plan and/or a Health Reimbursement Arrangement. The fee helps fund unbiased research that evaluates the clinical effectiveness of medical treatments regardless of the profit potential. This fee is also known as the Comparative Effectiveness Research Fee, or CERF. 
The amount of the fee depends on your health plan’s effective date. The fee is $2.08 per covered life for employers with February 1 through October 1 effective dates, and $2.17 for employers with November 1, December 1, or January 1 effective dates. 
Published in Compliance
Wednesday, 29 June 2016 11:23

Do Your Employees Travel Abroad for Business?

Traveling abroad for work can be an exciting experience but anything can happen while you're away from home. Losing your passport, malaria, auto accident, food poisoning – it's important to be prepared for any unexpected illness, injury or medical emergency. Unfortunately, most domestic medical plans reimburse after the fact for emergencies only, and simply are not designed for regular international travel. 
It’s no secret that the quality of healthcare can vary widely around the world. The quality of care your expatriate employees experience in their new country may not be to the standard they were used to back home, nor are they likely entitled to any free or subsidized national healthcare. As an international employer, it’s important to provide the proper type of medical coverage for your employees. You want to ensure that they receive worldwide access to quality care, superior international claims administration, and 24-7 translation, logistics, and medical evacuation service. 
Published in Best Practices
What is Amendment 69?
Also known as ColoradoCare, Amendment 69 is a single-payer healthcare initiative that will create a government run, universal healthcare system in Colorado. Due to appear on the 2016 general election ballot, the passage of Amendment 69 would eliminate private health insurance and subsidies provided through Colorado’s insurance exchange and funding for Medicaid.
Who is responsible for assuring care?
Published in Healthcare Legislation
Thursday, 19 May 2016 03:36


The Fall River Team recently attended the annual Colorado Culture of Health conference, and the theme of mental health in the workplace was prevalent.  It continues to be a taboo and uncomfortable topic that employers tend to avoid.  However it’s becoming clear that employers can’t afford to take a hands-off approach any longer, due to the enormous impact it has on companies.  The World Health Organization has stated that mental health illnesses in the U.S. are becoming more costly than physical conditions such as cancer, diabetes, and respiratory illnesses combined.
Published in Wellness
As consumers, we spend so much time focusing on medical benefits and sometimes forget the importance of disability coverage. Although many states do not require that employers offer any type of disability benefit to its employees, there are a handful of states that mandate employers to offer paid-Short-Term Disability (STD) benefits for employees. STD benefits are not available from Social Security or elsewhere in the federal government. If you are disabled less than a year, you can’t collect Social Security disability or State Disability Insurance (SDI).
Published in Compliance
Monday, 09 May 2016 03:18

HSA Contribution Limits for 2017 Set

On April 29, 2016, the IRS provided inflation-adjusted HSA contribution limits for 2017, as well as the HDHP minimum deductible and maximum-out-of-pocket expenses associated with HSA's. Click here for the IRS publication.  
The contribution limits for HSA's in 2017 will increase by $50 for self-only coverage.  Family contributions to HSA's will remain unchanged, as will the minimum deductible and maximum-out-of-pocket expenses for the High Deductible Health Plans (HDHP).  All changes are based on cost-of-living adjustments determined by the IRS.
A comparison of the last several years is shown below:
Published in Compliance
Monday, 15 February 2016 17:00

Three Steps to More Accurate Carrier Invoices

Have you ever experienced billing or invoice issues? Frustrated with people you already terminated still showing up on your bill? Look no further as your Fall River team is here to help! 

When processing eligibility changes such as enrollments, changes or terminations, you can follow these three simple steps to improve the accuracy of your carrier bills. 

Step 1 – Process On Time

  • If you have an impending enrollment, change or termination, it is best to get these submitted to the carrier as soon as possible to prevent any processing delay. The cutoff for the next bill is often 2-3 weeks before the end of the month, which is why people you’ve already terminated can still be showing up if you didn’t terminate them soon enough.  If you want a person who’s terminating on 3/31, for example, to NOT be on your April bill, you may need to get that done as soon as 3/10, depending on your carrier and the billing cycle dates you’ve selected.
  • If terminations are not submitted prior to the actual termination date, carriers do have the right to bill you for the following month of coverage. It’s the most common billing issue and unfortunately, there’s not much that can be done about it. In the Colorado fully insured market for groups with 2-99 employees, carriers will not allow terminations after the effective date unless proof of other coverage is provided.  So, that 3/31 term MUST be done on or before 3/31, otherwise you may be tracking down a copy of the employee’s next ID card before the term can be done.

Step 2 – Process Online

  • Most carriers offer an Online Employer Portal for managing eligibility and paying premium invoices. The fastest way by far to process any eligibility enrollment, change or termination is to complete them online, as most carriers will update their systems in real-time or within 24 hours of the transaction. If you need help obtaining a login and password for an Employer Portal or would like additional training for your carrier-specific portal, please contact your Fall River Account Executive.
  • Billing and invoicing cycles vary from carrier to carrier. The invoice should show your due dates, remittance details (including overnight payment or wire transfer options) and/or other carrier-specific instructions. 
  • If you have signed up to receive electronic invoices, carriers will typically email you in advance when the invoice is ready to view. But watch out…sometimes these emails will appear in your junk folder and could go unnoticed unless you check that folder regularly. 

Step 3 – Audit Your Bill 

  • As soon as you receive your premium invoice, whether paper or electronic, try to reconcile it with your records as soon as possible - the sooner the better while it is still fresh in your mind. If you notice any concerns, reach out to your Fall River Account Executive and we can help you get it resolved. Clients have called us after finally noticing errors that have been on the bill for many months – it is very difficult to help you get your money back if too much time has passed.
  • Most carriers do not allow self-adjusting and require that you pay your invoice as billed.  There can be serious consequences to short-paying your bill, up to and including termination.  If there are folks on your invoice you’ve already terminated, the invoice will auto-adjust next month to credit the premiums back.
  • If payments aren’t received within the 31 day grace period, carriers may terminate coverage and it can be difficult to reinstate. To prevent a lapse in coverage, make payments by the due date or call the carrier to discuss financial arrangements, and don’t self-adjust (ie short-pay) your bill. 

We hope these tips are helpful – please feel free to call us at any time at 303.369.3200 with any billing challenges you may be having.

Published in Best Practices
Tuesday, 15 December 2015 23:00

Is the Cadillac Tax Dead?

On Friday, December 18th, Congress passed and the President signed a very significant Omnibus spending bill.  This bill includes several tax relief measures related to the ACA:

  • A two year delay (from 2018 to 2020) on the Excise Tax, commonly known as the Cadillac Tax
  • A two year moratorium (2017-18) on the medical device tax that is currently in effect
  • A one year moratorium (2017) on the ACA insurer tax which has been built into all fully insured premiums since 2014

Each of these changes is a temporary rather than permanent elimination of these taxes. The moratorium on the latter two taxes, since they are already in effect, may result in a slight easing of your 2017 renewal increase if you have a fully insured medical plan (self funded plans are not subject to the health insurer tax, which is by far the larger of the two).  In the absence of new legislation to make the changes permanent, the restoring of the insurer tax two years later could then bump up the 2019 fully insured renewal increases, much as employers experienced in 2014 when this tax first went into effect.

The great debate that will continue is whether these bills increase the likelihood of eliminating the taxes altogether.  While many employers are in favor of permanent elimination, the costs of even the temporary elimination could result in a significant addition to the national deficit, since there were no corresponding “pay for’s” in the legislation to replace the lost revenue. Permanent elimination could add quite a bit more to the deficit, which affects us all as taxpayers.

The spending bill also included some notable features unrelated to the Affordable Care Act, such as the extension of healthcare benefits for 9/11 first responders, the removal of the ban on U.S. exports of crude oil, and an extension of a business tax credit for research and solar/wind credits, as well as other popular tax deductions. Notably for employers with Section 132 pre-tax parking and transit benefits, the bill awarded equal status between transit and parking, allowing a monthly income exclusion of up to $250 for both transit passes/vanpools as well as parking.

If you have any questions about the impacts of this bill on your ACA planning or compliance, please This email address is being protected from spambots. You need JavaScript enabled to view it.

Published in Healthcare Legislation
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