October 17, 2017

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Everything listed under: health insurance

  • Health Insurance Open Enrollment

    Did you know Gary Thompson Agency can assist with your health insurance needs?

    The annual Open Enrollment for individual and family health insurance plans begins on November 1, 2016 and continues through January 31, 2017Current health policyholders will begin receiving renewal notices in October. You may see up-to double-digit increases in your premium when compared to 2016, some changes in provider networks and new benefit plans.

    3 insurance carriers remain in the Individual Market for 2017. 
    Two on the Marketplace – Medica and Aetna.
    Three off the marketplace – Medica, Aetna and Blue Cross Blue Shield 

    Notes:
    Medica was new to Nebraskans in 2016. The company has been offering health insurance products in Minnesota, Wisconsin, North Dakota and South Dakota for 40 years.

    United Health Care will no longer be available to purchase in 2017.

    Aetna is the name now for Coventry. Coventry was acquired by Aetna and will be available both ON and OFF the marketplace.

    What happens next? 

    Late October
    You will receive a renewal notice from your current health insurance company.

    October-November
    After reviewing your renewal, if you'd like to see other options, please call in or email us to set up an appointment for a full review of your benefits plan, we'd be happy to help you out.

    November 1 - December 15
    December 15th is the enrollment DUE DATE for your policy to be effective January 1, 2017.

    December 16 -January 31
    Open enrollment continues with later effective dates.

    If you're looking for more information on Health Insurance or are ready to get started, click here to begin the next steps.

  • BCBS Exiting the Marketplace


    BCBS Nebraska is exiting the federal government’s public Health Insurance Marketplace, effective January 1, 2017. This decision affects certain individual health plans, not Medicare Supplement or group plans. What does this mean for you? Find out more by reading their public announcement issued today.

    Gary Thompson Agency can assist as you start to plan for your 2017 health insurance. Click here to get started!

  • Upcoming changes to Coventry Health Insurance

    While many of you know, Aetna acquired Coventry Health Care in 2013. Since then, in Nebraska, they continued to operate under the Coventry name. However, effective 1/1/2017 that is going to change to Aetna.

    Coventry will be sending out a letter to all current policy holders after July 1st notifying them of this change. If you are a current policy holder, it's important to note, your existing coverage will continue until your policy period ends on December 31, 2016. There is no action on your part needed at this time.

    Stay tuned to our website, Facebook and Twitter to stay informed on the latest health insurance updates. If you have any questions, contact our Benefits department.

  • Health Insurance Announcement: UHC Exiting Individual Market in 2017

    United Health Care (UHC) Exiting the Individual Market in 2017

    United Health Care has made the decision to exit the Individual Market next year (2017). While this is unfortunate, Gary Thompson Agency is aware of the situation and are able to provide our current and future customers other carrier options.

    UHC will be sending out communication to their current policyholders this month informing them about their upcoming exit. Stay on the look-out for this, however, turn to your agent with any questions. Your coverages for 2016 will not change and the only action you need to take will be in the fall, during open enrollment, to select a new carrier and plan.

    Gary Thompson Agency will continue to update our customers with any new information. If you have any questions, please contact our Benefits Department by email or calling 308.384.0388.


  • Attention Employers: Marketplace Notices Are Coming

     

    Marketplace Notices Are Coming

    May 25, 2016

    (Full article from: https://www.thinkhr.com/blog/marketplace-notices-are-coming Written by Laura Kerekes, SPHR, SHRM-SCP)

    Under the Affordable Care Act (ACA), each Health Insurance Exchange (Marketplace) must notify employers when they have an employee who has received a government subsidy to enroll in a health plan through the Marketplace. These notices will begin being sent to employers in the coming weeks and months, either individually or in batches. Because the notice procedure is being phased in, you may or may not receive notices, even if you have employees who received subsidies through a Marketplace. Here’s what you need to know.

    Reason for Notice

    These notices, also called 1411 Certifications in reference to the pertinent section of the ACA, will be sent to employers as part of the government’s verification efforts regarding persons who received Marketplace subsidies for individual health insurance. Marketplaces want to confirm whether the individual was eligible for, or enrolled in, an employer’s health plan since those facts can affect someone’s eligibility for subsidies.

    You may receive a notice (similar to the sample found here) for each employee that received a subsidy to enroll in insurance through a Marketplace. The notice only informs you that the employee was granted a subsidy — it is not a notification that you have been assessed any penalty. Under the ACA’s play or pay rules, penalties may be assessed later by the Internal Revenue Service to applicable large employers for failing to offer full-time employees affordable minimum value coverage; however, play or pay penalties, and notice of them, are a separate process entirely.

    What You Should Do

    Even if you do not believe that any of your employees obtained individual coverage through a Marketplace, be on the lookout for these notices because you have 90 days from the date of the notice to file an appeal, if necessary. Notices may go to a subsidiary instead of the parent company or to a particular work site instead of the employer’s main office, depending on the information the employee provided to the Marketplace. Alert all departments and work sites to watch for mail in envelops from a government agency or insurance Marketplace.

    Important: Keep these notices confidential because employers are prohibited by law from discriminating or retaliating against employees who may receive subsidies. Consider segregating functions so staff involved in reviewing notices is separate from staff involved in employment or benefit plan decisions.

    Establish your audit process for reviewing any notices you may receive and for filing appeals when appropriate. Confirm that the information is correct based on your employment and payroll records. If you are an applicable large employer subject to the ACA’s play or pay rules, you also should check if the employee was a full-time employee and, if so, whether you had offered affordable minimum value coverage to the employee. Read more about the notice and appeal process here.

    File an appeal within 90 days of receipt of the notice if any of the information is incorrect. To do this, be sure to retain the notice and follow the directions for appeal. Remember that these notices will not advise you of any penalties on large employers, so appeals at this stage are to correct any mistakes in employment information.

    In addition:

    -If you are a small employer and not subject to the ACA play or pay rules, you are not impacted directly but your appeal may alert the Marketplace that the individual was enrolled in your group health plan and not eligible for subsidies.

    -If you are an applicable large employer who is subject to the ACA’s play or pay rules, you should be proactive in appealing the Marketplace’s subsidy determination if any information is incorrect. (An applicable large employer generally is one that employed an average of 50 or more full-time and full-time-equivalent employees in the prior calendar year. Related employers in a controlled group are counted together.) Although Marketplaces cannot access play or pay penalties, your appeal may help establish the facts and head off later penalty action by the IRS.

    You may not receive Marketplace notices, but if you do, be prepared, review them thoroughly, and appeal incorrect information quickly.

    Contact Gary Thompson Agency’s Benefits Department with any questions or for more information.

  • Why Health Insurance?

    The Open Enrollment period is coming to a close – if you haven’t purchased a health insurance policy yet, you still have time. Enroll prior to January 15th for coverage effective on February 1, 2016. Besides having health insurance because it protects you from large medical bills and covers preventive care costs; The Affordable Care Act (ACA) also provides another incentive to obtain insurance—a penalty for not having coverage.

    The ACA’s individual mandate requires most people to have health insurance or pay a penalty tax. The fee for not having medical coverage in 2016 and subsequent years will be whichever of the following two options is higher:

    • 2.5 percent of your yearly household income. Only the amount of income above the tax filing threshold—about $10,000 for an individual—is used to calculate the penalty. The maximum penalty is the national average premium for a bronze plan.

    • $695 per person ($347.50 per child under 18). The maximum penalty per family using this method is $2,085.

    Instead of paying a fee, make your money worthwhile by putting it toward health insurance premiums! Talk to an agent at Gary Thompson Agency today to discuss your options.

    Copyright Zywave. All rights reserved.


  • Health Insurance Open Enrollment

    Gary Thompson Agency has all the information you need regarding your 2016 Health Insurance Open Enrollment options. Listen to information directly from our Employee Benefits Manager, Ryan Hansen, during his recent radio interviews on KRGI 1430 AM. Ryan is on part 3 of a series of 4 radio interview. His clips answer your most basic questions, yet detail the most important information you need to know in order to sign up for Health Insurance by the January 31st deadline.

    Unable to listen to our audio clips? We’ve highlighted some of his main points below:

    • December 15, 2015 is the deadline to sign up for coverage effective January 1, 2016. Don't delay, start this process now to ensure you're covered timely.
    • Open enrollment for individuals runs to January 31, 2016.
    • Choosing a health plan is more than finding the lowest rate. It’s about finding a balance between your plan’s monthly costs and the medical costs you may encounter throughout the year.
    • Tax penalties double in 2016 if you’re not enrolled by January 31, 2016!
    • If unsure of what to consider, call your local GTA office. We provide Benefit solutions for Individuals and Groups.

    Ready to sign up or have further questions? Click here to get started & find out more!

    Listen now :

    Part 1: Radio Audio (click here) - GTA Open Enrollment with Ryan Hansen.mp3
    11.11.15

    Part 2: Radio Audio (click here) - GTA Open Enrollment with Ryan Hansen Part 2.mp3
    11.18.15 

    Part 3: Radio Audio (click here) - GTA Open Enrollment with Ryan Hansen Part 3.mp3
    12.08.15 

  • Health Care Information: The Individual Mandate

     

    As we approach Open Enrollment, Gary Thompson Agency wants you to know we not only offer Health Insurance, we also provide information regarding your benefits and coverages.

    The below is information about penalties that may arise if individuals/families do not enroll in health insurance during the Open Enrollment time-frame, November 1st – January 31st.

    The Affordable Care Act (ACA) requires most individuals to obtain acceptable health insurance coverage for themselves and their family members or pay a penalty. This rule, which took effect in 2014, is often referred to as the “individual mandate.” Individuals may be eligible for an exemption from the penalty in certain circumstances. The following provides an overview of the ACA’s individual mandate.

    How Much Is the Penalty?

    The penalty for not obtaining acceptable health insurance coverage is being phased in over a three-year period, and is the greater of two amounts—the “flat dollar amount” and “percentage of income amount.” For purposes of calculating the penalty, income is the taxpayer’s household income minus the taxpayer’s exemption (or exemptions for a married couple) and standard deductions.

    The penalty started at the greater of $95 per person or 1 percent of income for 2014. The penalty increased to $325 or 2 percent of income in 2015. In 2016 and thereafter, the penalty increases to $695 or up to 2.5 percent of income.

              2015             $325 per person/ 2 percent of income
     2016    $695 per person / 2.5 percent of income

    Families will pay half the penalty amount for children, up to a family cap of three times the annual flat dollar amount. Also, the penalty is capped at the national average of the annual bronze plan premium.

    2015 Bronze Plan Premium Cap: IRS Rev Proc. 2015-15 provides the 2015 national average of bronze plan premiums to be used when calculating the cap. The monthly national average bronze plan premium for 2015 is $207 per individual, and $1,035 for a family with five or more members (or, annually, $2,484 for individuals and $12,420 for a family with five or more members).

    Who is Liable for a Penalty?

    The penalty will be assessed against an individual for any month during which he or she does not maintain “minimum essential coverage” (MEC) (unless an exemption applies). The requirement to maintain MEC applies to all individuals of all ages (including children), unless that individual falls within a specific exception or is exempt. An individual is treated as having coverage for a month if he or she has coverage for any one day of that month.

    Exception for Certain U.S. Citizens Living Abroad

    All U.S. citizens who do not qualify for an exemption are subject to the individual mandate, regardless of whether they live in the U.S. or abroad. However, U.S. citizens who are not physically present in the United States for at least 330 full days within a 12-month period are treated as having minimum essential coverage for that 12-month period. In addition, U.S. citizens who are bona fide residents of a foreign country (or countries) for an entire taxable year are treated as having minimum essential coverage for that year.

    In general, these are individuals who qualify for a foreign earned income exclusion under section 911 of the Internal Revenue Code. Individuals may qualify for this rule even if they cannot use the exclusion for all of their foreign earned income because, for example, they are employees of the United States. Individuals that qualify for this rule will not need to take any further action to comply with the individual mandate during the months when they qualify. See Pub. 54, Tax Guide for U.S. Citizens and Resident Aliens Abroad, for information on the foreign earned income exclusion.

    U.S. citizens who meet neither the physical presence nor residency requirements will need to maintain minimum essential coverage, qualify for an exemption or pay a penalty for each month of the year. One exemption that may be particularly relevant to U.S. citizens living abroad for a small part of a year is the exemption for a short coverage gap, which provides that no penalty will be due for a once-per-year gap in coverage that lasts less than three months.

    Liability for Dependents

    Liability for a dependent’s lack of MEC falls on the taxpayer who may claim the individual as a dependent, regardless of whether the taxpayer actually claims the individual as a dependent for the taxable year. For this purpose, a dependent includes a taxpayer’s qualifying children and qualifying relatives (such as parents or siblings who are supported by the taxpayer).

    This liability may not be assigned to another taxpayer, even if the other taxpayer has a legal obligation to provide the child’s health care. However, Exchanges may grant a hardship exemption to the custodial parent for a child in this situation, if the child is ineligible for coverage under Medicaid or CHIP.

    Special rules apply for adopted and foster children. If a taxpayer legally adopts a child and is entitled to claim the child as a dependent for the taxable year when the adoption occurs, the taxpayer is not liable for a penalty with respect to that child for the month of the adoption and any preceding month. Conversely, if a taxpayer who is entitled to claim a child as a dependent for the taxable year places the child for adoption during the year, the taxpayer is not liable for a penalty with respect to that child for the month of the adoption and any following month.

    What is Minimum Essential Coverage?
    MEC includes coverage under:

    • A government-sponsored program, such as coverage under the Medicare or Medicaid programs, CHIP, TRICARE and certain types of veterans health coverage;
    • An eligible employer-sponsored plan (including COBRA and retiree coverage), defined as any plan offered by an employer to an employee which is a governmental plan or a plan or coverage offered in the small or large group market within a state (a self-funded plan can also qualify as an eligible employer-sponsored plan);
    • A health plan purchased in the individual market; or
    • A grandfathered health plan.

    MEC also includes any additional types of coverage that are designated by HHS or when the sponsor of the coverage follows a process to be recognized as MEC. HHS has designated the following other types of coverage as MEC:

    • Self-funded student health coverage and state high risk pools for plan or policy years that begin on or before Dec. 31, 2014 (for plan or policy years that begin after Dec. 31, 2014, sponsors of self-funded student health plans and state high risk pools may apply to be recognized as MEC);
    • Refugee Medical Assistance supported by the Administration for Children and Families; and
    • Medicare Advantage plans.

    MEC excludes any coverage, whether insurance or otherwise, that consists solely of excepted benefits (as defined by HIPAA). MEC does not include specialized coverage, such as coverage only for vision or dental care, workers’ compensation, disability policies or coverage only for a specific disease or condition.

    Government Programs with Limited Benefits
    Also, a number of government programs do not provide full coverage for medical expenses, and thus do not qualify as MEC. For example, Medicaid coverage for pregnant women or Medicaid programs that only cover family planning services, tuberculosis-related services or emergency medical conditions do not qualify as MEC. Similarly, TRICARE “space available care” and “line-of-duty-care” also do not qualify as MEC.

    Expatriate Group Health Coverage
    Under a federal law enacted in December 2014, coverage under an expatriate health plan (self-insured or fully insured) qualifies as MEC. A health plan must meet a number of requirements to qualify as an expatriate health plan. For example, the plan must:

    • Provide significant health coverage (hospitalization, outpatient facility, physician and emergency services) that is not limited to excepted benefits such as dental and vision coverage;
    • Satisfy the applicable pre-ACA requirements for health plans, such as HIPAA nondiscrimination, genetic nondiscrimination, minimum maternity stay and mental health parity requirements;
    • Meet the ACA’s minimum value standard by covering at least 60 percent of the total allowed costs of plan benefits; and
    • Cover dependent children until they turn age 26 (if the plan provides dependent coverage).

    What are the Exceptions to the Individual Mandate?

    The ACA provides nine categories of individuals who are exempt from the penalty. An individual who is eligible for an exemption for any one day of a month is treated as exempt for the entire month.

    Exemptions from the Individual Mandate

    • Individuals who cannot afford coverage
    • Taxpayers with income below the filing threshold
    • Members of federally recognized Indian tribes
    • Individuals who experience a hardship
    • Individuals who experience a short gap in coverage
    • Religious conscience objectors
    • Members of a health care sharing ministry
    • Incarcerated individuals
    • Individuals not lawfully present in the U.S.

    The religious conscience exemption and most categories of the hardship exemption are available exclusively through an Exchange. Individuals must apply for these exemptions by filing an application with the Exchange.

    Four categories of exemptions are available exclusively through the tax filing process—for individuals who are not lawfully present, individuals with household income below the filing threshold, individuals who cannot afford coverage and individuals who experience a short coverage gap. In addition, certain subcategories of the hardship exemption will be available exclusively through the tax filing process.

    The exemptions for members of a health care sharing ministry, individuals who are incarcerated and members of federally recognized Indian tribes can be provided either through an Exchange or through the tax filing process. Individuals who are denied an exemption will have the right to appeal. In addition, an applicant that no longer qualifies for an exemption but is otherwise eligible to enroll in an Exchange plan will be eligible for a special enrollment period.

    How is the Penalty Enforced?

    Starting in 2015, individuals filing a tax return for the previous tax year will indicate which members of their family (including themselves) are exempt from the individual mandate. For family members who are not exempt, the taxpayer will indicate whether they had insurance coverage. For each non-exempt family member who doesn’t have coverage, the taxpayer will owe a payment.

    Spouses who file a joint return are jointly liable for the penalties that apply to either or both of them. Any individual who is eligible to claim a dependent will be responsible for reporting and paying the penalty applicable to that dependent.

    The IRS will generally assess and collect individual mandate penalties in the same manner as taxes. However, the ACA imposes certain limitations on the IRS’ ability to collect the penalty. As a result, it is likely that any assessable penalty under the individual mandate will be subtracted from the tax refund that the individual is owed, if any.

     

    Disclaimer: This information is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.
    © 2013-2015 Zywave, Inc. All rights reserved.


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