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United Benefit Advisors Insight and Analysis Blog

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Part 3: The Affordable Care Act: Affordable ... or just an Act?

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(This is the third article of a three-part series. Read Part One here and Part Two here.)

Part 2: The Affordable Care Act: Affordable ... or just an Act?

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(This is the second article of a three-part series. Read Part One here.)

The Affordable Care Act: Affordable... or just an Act?

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Part 1 (the first article of a three-part series)

IRS Issues Drafts of Individual and Employer Responsibility Reporting Forms

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In order for the IRS to verify that individuals and employers are meeting their shared responsibility obligations, and that individuals who request premium tax credits are entitled to them, employers and insurers will be required to provide reporting on the health coverage they offer. Reporting will first be due early in 2016, based on coverage in 2015.

The Road to Better Absence Management

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By Stephen Coffman, Group Practice Leader
The Guardian Life Insurance Company of America  

A more meaningful attempt to manage absences can go a long way toward helping ease the staffing and morale challenges of small and midsize businesses that often feel the impact of absences more acutely than larger firms. What’s more, in an environment where government oversight is only intensifying, effective absence management may become more challenging and burdensome for employers unless they have access to a specialist who understands the increasing and ever-changing federal, state and local Family and Medical Leave Act (FMLA) laws. The Americans with Disabilities Act (ADA) also needs to be considered.  For example, requirements have expanded in recent years to include reasonable accommodations designed to reduce employee stress, which can trigger absences and erode productivity.  


Small Group Insured Plans and PPACA

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PPACA brings numerous responsibilities and options to employers. Below is a summary of the PPACA provisions that apply to group health plans and whether the provision applies to insured small group plans (50 or fewer employees) provided inside and outside the SHOP exchange.

Buyer Beware: Federal and State Law Issues with the FF-SHOP

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By Carol Taylor

Medical Loss Ratio (MLR) Rebate Deadline Approaching

As was the case last year, insurers with medical loss ratios (MLRs) that were below the prescribed levels on their blocks of business must issue rebates to policyholders. The MLR threshold for large groups is 85%, and the threshold for small group and individual policies is 80%. The MLR ratio is based on the insurer’s block of business in the state, and not on the specific policy’s claims experience and administrative costs. Insurers must pay rebates owed on calendar year 2013 results by August 1, 2014. The rules for calculating and distributing these rebates are essentially the same this year as they were last year.

Frequently Asked Questions about Grandfathered Health Plans

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As employers determine their plan designs for the coming year, those with grandfathered status need to decide if maintaining grandfathered status is their best option. Following are some frequently asked questions, and answers, about grandfathering a group health plan. 

Courts Issue Opposite Rulings in PPACA Subsidies Cases

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On July 22, 2014 two Courts of Appeals issued decisions that address whether only people who live in states that have state-run Marketplaces (which are also called exchanges) are eligible to receive premium tax credits or subsidies under the Patient Protection and Affordable Care Act (PPACA). One court held that the subsidy should only be available to people covered by state-run Marketplaces, and the other ruled that people should be eligible for subsidies regardless what type of Marketplace their state has.

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