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This year has been filled with many questions and not so many clear answers. One of the trickiest ACA issues that Applicable Large Employers (ALEs) have to navigate through is how measurement periods apply during furloughs and leaves of absences due to COVID-19. It’s important for ALEs that offer affordable and minimum essential health insurance coverage to be able to identify their full-time employees and offer group health benefits at the appropriate times; otherwise the employer may be subject to costly penalties.

Monday, 02 November 2020 13:34

The Flu vs COVID

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With the COVID-19 threat growing in Colorado every day and flu season quickly approaching, there are many questions to consider. What is the difference between the two? Can you have the flu and COVID-19 at the same time? Should you still get a flu shot? 

Fall River has written in past articles about how Health Reimbursement Arrangements (HRAs) can be a valuable cost-containment strategy while effectively rendering employees’ benefits unchanged. We recently completed an internal analysis of one client who was able to slash their effective renewal increase down from 15% to 5% by adjusting and expanding their HRA.

The Kaiser Family Foundation has released their 2020 Annual National Employer Benefits Survey. The survey has been tracking benefit statistics from private and public employers (other than the Federal Government) in the United States for the last 22 years. The 2020 survey included interviews with 1,765 employers.

Friday, 09 October 2020 10:59

Medical Loss Ratio Rebates

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The Medical Loss Ratio obligations under the ACA cap the percentage of premium dollars health insurers may use for administration, marketing, and profits. If a health insurer collects more than the allowed amount for these spending categories, they must provide a rebate to affected groups. A few of the medical carriers have recently sent out Medical Loss Ratio (MLR) rebates, so it’s important to know what can be done with that money. If employees paid any portion of the monthly premiums, employers will likely need to share the rebate with them.

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