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United Benefit Advisors Insight and Analysis Blog

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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.

Why HSAs Linked to HDHPs are Making a Comeback

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By Elizabeth Kay
Compliance and Retention Analyst for AEIS, UBA Partner Firm in San Mateo, CA

According to new information from United Benefit Advisors (UBA), health savings accounts (HSAs) are outpacing health reimbursement arrangements (HRAs) in both adoption and participation rates. And now that metal tier health plans  [e.g., platinum, gold, silver, etc.] are allowed higher deductibles, employers are increasingly looking at HSA qualified plans for their upcoming plan year. Here’s a look at why this trend is unfolding.


5500 Due Date Approaching

Generally, plans that must comply with ERISA must file a Form 5500 by the last day of the seventh month after the close of their plan year. For calendar year plans this means the due date for the Form 5500 is July 31. Government plans (which includes most public schools) generally do not need to comply with ERISA and therefore do not need to file a Form 5500. Many church plans also are exempt from this requirement.

FMLA and Same-Sex Spouses

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Last June, the U.S. Supreme Court ruled that a part of the Defense of Marriage Act (DOMA) that limits the definitions of "marriage" and "spouse" to opposite sex marriages and spouses is unconstitutional. Since then, the Department of Labor (DOL), the Internal Revenue Service (IRS), and the Department of Health and Human Services (HHS) have issued several notices that provide that, for purposes of federal taxes and employee benefits, a person legally married to a same-sex person in any state or foreign country is considered married even if he or she moves to a state that does not recognize same-sex marriages.

Top 10 FMLA Employer Mistakes

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The Family and Medical Leave Act (FMLA) regulations that became effective in 2009 provide employers with mechanisms by which we can better curb FMLA abuse. However, there are also some traps employers can fall into if they do not review the regulations carefully and administer leave requests appropriately. 

What Employers Need to Know about SCOTUS Hobby Lobby Ruling

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On June 30, 2014 the U.S. Supreme Court issued a decision in a case generally referred to as the Hobby Lobby case. Hobby Lobby is a family-owned for-profit corporation. The family that owns Hobby Lobby strongly believes that it would violate their deeply held religious values and obligations to provide coverage for four of the types of contraception that non-grandfathered plans must cover as preventive care. (The four drugs -- two types of IUDs and two types of "morning after pills" -- operate in a manner that violates their belief that life begins at conception.) Hobby Lobby sued HHS on the basis that the requirement to cover these contraceptives violates the Religious Freedom Restoration Act of 1993. The Court held that:

PPACA Update: Highlights of the PCORI Fee

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The Patient-Centered Outcomes Research Institute (PCORI) fee is due July 31, 2014, for virtually all group medical plans.

Pediatric Dental Benefits: Duplication of Coverage?

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By Josie Martinez, Senior Partner and General Counsel
EBS Capstone 

As of January 1, 2014, the Patient Protection and Affordable Care Act (PPACA) requires pediatric dental benefits to be one of the 10 essential health benefits (EHB) that must be included in individual and small group medical coverage, as well as coverage offered through the Exchanges. 


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