Employee Benefit Compliance

The Affordable Care Act Minimum Essential Benefits

Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Prescription Drugs
Mental health and Substance —Abuse disorder services
Rehabilitative and habilitative services and devices
Pediatric services, including oral and vision care
Preventive and wellness services, and chronic disease management

Are you required to have health insurance under the ACA?

Following is a list of the states, as of 2019, that have mandated residents purchase qualifying health insurance (which is similar to the federal essential health benefits), or face a tax penalty when they file their income taxes.

Updated in 2023…

California – The penalty for not having coverage the entire year will be at least $850 per adult and $426 per dependent child under 18 in the household. The penalty can also be calculated based on percentage; you could also be charged 2.5% of the gross income that exceeds the filing threshold, whichever is greater.

Massachusetts – the tax penalty amount varies depending on your income, age and family size, but note the maximum penalty can be no more than half the price of the lowest premium plan available on the Massachusetts healthcare marketplace.

New Jersey – the tax penalty is $695 for adults and $347.50 for each child, with a maximum family penalty of 2.5% of annual income,. The penalty is capped at three times the adult penalty ($3,661), or the state average cost for a bronze-level plan, whichever is greater.

Rhode Island – the tax penalty is $695 for adults and $347.50 for each child, with a maximum family penalty of 2.5% of income, or three times the adult penalty ($2,100), whichever is greater. The maximum tax penalty is based on the average bronze health plan premiums cost.

Vermont – Vermont requires residents to have qualifying health insurance, but currently, there is no cash penalty for non compliance.

Washington, D.C. – the tax penalty is $700 for adults and $350 for each child, with a maximum family penalty of 2.5% of income, or three times the adult penalty ($2,100), whichever is greater. The maximum tax penalty is based on the average bronze health plan premiums cost.
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Group Life Insurance and Accidental Death and Dismemberment Insurance (AD&D)

It has been proven that employees are more productive when they feel secure that their loved ones will be taken care of, in the event of illness or an untimely death. That’s why smart employers consider life insurance a key part of the benefit package, and a valuable tool in attracting top talent. A good life insurance policy provides for an employee’s final expenses, taxes, mortgage and more. Additionally, it may even pay for their children’s education.

We offer the following life insurance options, either as part of the employer paid main benefit offering, or on a voluntary bases. Coverage is typically for a flat amount or for up to 2x to 3x the employee’s salary, with the option for the employee to buy up the policy, and or include coverage for dependents (spouse and children). Typically there is no exam required up to a certain amount. Coverage is portable when on a voluntary basis, meaning the employee can take the policy with them when they change employers.

Term Life Insurance

This type of life insurance does not build cash value. However, it will pay a set amount to the named beneficiary upon the death of insured within the stated term. Additionally, some policies may also make payments upon terminal or critical illness. If AD&D is added, the rider portion will pay a set amount for an unintentional death or dismemberment of the insured. Dismemberment includes the loss—or the loss of use—of body parts or functions (e.g., limbs, speech, eyesight, and hearing).

Permanent Life Insurance

A Term Life policy protects employees during their working years, however Permanent Life provides additional coverage that employees can utilize later in life. Employees can widen their safety net with premiums and benefits they can count on, as they don’t ever change.

Several advantages of Permanent Life include borrowing against the policy or building a tax deferred investment income, in addition to paying a death benefit.

Whole Life, Variable Life and Universal Life are all types of cash value life insurance. Cash value insurance is also known as permanent life insurance because it provides coverage for the policyholder’s entire life.

Traditional Health Insurance

Following are types of major-medical health plans you can purchase from one of our top carriers. Note you must purchase your health plan during open enrollment – November 1st through December 15th.

Health Maintenance Organization Or HMO
An HMO offers lower premiums and a significant savings on routine and preventative healthcare. However, this type of health plan requires you to appoint a primary care physician and to use doctors and facilities that are affiliated with the HMO. Thus, if you use healthcare service providers outside of the HMO, there is a good chance those charges won’t be covered by your policy. But, the great thing about an HMO is that the only charges you incur, outside of your premiums, are co-pays for doctor’s visits and other services such as procedures and prescriptions.

Preferred Provider Organization Or PPO
A PPO will save you money on services if you use the preferred providers within the network. Keep in mind that deductibles must be met on this plan before some services will be covered. The good thing about a PPO is they generally will allow a certain amount of services annually outside of the deductible with a small co-pay, and most often the PPO has a large network with quality care providers and excellent prescription drug coverage.

Health Savings Account (HSA)
An HSA is a tax-advantaged bank account tied to certain high-deductible health plans. It allows you to use tax free dollars to pay for allowable health expenses, such as copays, prescription drug costs and more.

Wellness Benefits
Most insurers include wellness benefits in their comprehensive coverage, designed to improve lives and keep members healthy. Your plan from the Marketplace will generally include services like preventative screenings, free or discounted gym memberships, diet advice, disease management, telehealth, and much more.

Through our sister company, CastleHR, our clients have access to one of the most efficient, user-friendly online benefits manager/portal available. Click below to visit the CastleHR website, which will open in a new tab. Simply switch back to our main website at any time to continue exploring all of our services and products.

Learn More

Through our sister company, CastleHR, our clients have access to one of the most efficient, user-friendly online benefits manager/portal available. Click below to visit the CastleHR website, which will open in a new tab. Simply switch back to our main website at any time to continue exploring all of our services and products.

Learn More

Travel Health Insurance Plans

Medical travel insurance is typically very affordable and provides valuable medical coverage when traveling in the US or abroad, much like a regular health insurance policy. Most often these types of policies will cover care and services that are not typically covered by your regular health policy or Medicare, and will safeguard your finances against an unforeseen illness or accident while traveling.

Short Term Health Plans

Short Term Medical Plans are health plans designed for times of transition and help to bridge gaps in coverage for individuals and families. Short term plans are generally less expensive than traditional health insurance, but they do not provide full coverage and they typically do not cover pre-existing conditions. Based on your needs, you can select the length of time (up to a year in many states, with option to extend to 36 months) and from a range of available deductible amounts.

Additionally, short-term health insurance plans do not contain the essential benefits required by the Affordable Care Act (ACA). We encourage you to call us for assistance to be sure you are in compliance with all federal and state healthcare laws.

Christian Cost Sharing Health Plans

Cost sharing ministry plans are Christian-based health plans wherein members share each other’s eligible medical bills. Every month, you and many other members pay a set monthly amount into a fund (pool). Claims are paid by that fund when someone who is covered (member) gets sick. However, each covered member has a certain amount of out-of-pocket expenses that must pay each year. Like traditional health insurance, the higher your out-of-pocked expenses (deductible), the lower your shared monthly (premiums) amount you need to pay.

The plans are significantly less than traditional health insurance (marketplace plans), yet they are considered comprehensive and provide good coverage. You will have to submit health history and there are some fees involved in the application process.

If you live in Illinois, click below:

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If you live in Texas, click below:

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Use GeoBlue for individual or group, single or multi-trip travel, short-term for groups, for educational (group) purposes, missionaries, general corporate travel, expatriate and captain-crew coverage.

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Use IMG for long-term individual and family, or patriot travel.

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Use HTH (GeoBlue division) for Trip Cancellation coverage

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Health Insurance Help Request

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Vision Plans

Take care of your eyes with an individual vision plan that can be purchased anytime of the year. Monitoring your eye health with regular exams helps to prevent serious eye diseases like glaucoma and cataracts, and also helps to detect early stages of diabetes, high blood pressure, and high cholesterol. Individual vision plans are similar to individual dental policies, as they are inexpensive and save you money on several services:

Eye Exams
Eyeglass Frames
Contact Lenses
Discounts on LASIK
And more

Dental Plans

According to studies, dental care contributes greatly to you and your family’s overall wellness, while preventing and detecting serious health conditions such as heart disease, diabetes, and more. Coverage is relatively inexpensive and can be purchased any time of the year.

Dental plans can range from a PPO or HMO to Pre-Paid, Fee-for-Service, and Discount on a variety of diagnostic and preventative care services including:

Cleanings, exams and x-rays 100{b6d890d0f7b5537aa7b422be7d42f2d4fbbf19f41f312582af280868184f458d} covered
Fillings & Orthodontia
Emergency care while traveling

Life Insurance

In addition to taking care of those you leave behind and paying for your major expenses after your death, different types of life insurance can even help you save and grow your cash for life’s future needs.

Term Life Insurance
Term Life is a simple, budget friendly life insurance solution for young people, families on a budget, and for people who may want to convert their term policy to a more permanent solution later down the road. You may also want to supplement a permanent life insurance policy. Generally, it provides the largest immediate amount of protection for the lowest cost and pays a death benefit upon your death.

Permanent Life Insurance
This type of life insurance policy has multiple purposes, however, can be a good fit for anyone who has loved ones who depend on them. Young people who want to invest in their future, or someone nearing retirement may also consider permanent life insurance. Permanent life insurance provides a death benefit to help your family maintain their lifestyle after your death and pays your final expenses and debts. However, it also helps you build wealth and save for the future by building a cash value. Several other advantages of permanent life include borrowing against the policy or building a tax deferred investment income. Types of permanent life insurance include Whole Life, Variable Life and Universal Life are all types of cash value life insurance. Cash value insurance is also known as permanent life insurance because it provides coverage for the policyholder’s entire life.

If you live in the following states, click below:

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Alabama
Arizona
Arkansas
California
Colorado

Florida
Georgia
Illinois
Indiana
Iowa

Kentucky
Louisiana
Maine
Massachusetts
Michigan

Minnesota
Missouri
New Jersey
New York
Nevada

North Carolina
Ohio
Oklahoma
Pennsylvania
Tennessee

Texas
Utah
Virginia
Wisconsin

For all other states, click below:

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What if you miss the annual open enrollment deadline?

You can still sign up for health insurance after the deadline if you meet any of the following qualifying events:

change in legal marital status
a change in the number of dependents
a change in place of residence and the current carrier is not available
significant cost or coverage change
a change in coverage of a spouse or dependant
a COBRA qualifying event
legal judgements, decrees and orders
entitlement to Medicare or Medicaid

We also have several NON-ACA options so you don’t have to go without coverage. Call us or review the plans on this page.

Group Health Plans

What is a fully-funded health plan?

A fully-funded health plan is one where the insurance carrier assumes all the risk in exchange for a monthly premium. The carrier pays all claims on the plan, and services the plan’s administration. The main advantage of a fully-funded plan is the employer knows exactly what the plan is going to cost them. The downside of a fully-funded health plan is when benefits go unused, the employer does not get any money back.

What is a partially-funded health plan?

Partially-Funded Plans (aka Level-Funded) are a variation of a Self-Funding and allows small employers to take advantage of all the cost saving and benefit design features of a self-insured plan, however, they share the risk with one of our top national carriers. The premiums for shared funding plans are generally much lower than fully insured plans. An employer may save even more by implementing wellness programs into the benefit strategy.

Following are types of fully-funded and partially funded plans our top carriers offer:

A Health Maintenance Organization (HMO)
An HMO group health plan requires employees to appoint a primary care physician who directs treatment utilizing service providers affiliated with the HMO. HMOs offer access to a comprehensive package of health care for a low monthly premium. A small co-payment is often required for services, depending upon the type provided.

Preferred Provider Organization
PPO group health plans offer a vast network of quality healthcare providers and facilities. Employees save the most money on healthcare if they use providers within the network, as some services may be only partially covered or not even covered at all when outside providers are used. Also, many services may not be covered if deductibles are not first met, however, the plan includes important wellness and preventative services provided outside of the deductible with a small co-pay.

Point of Service Plans (POS)
POS plans combine features of HMOs and PPOs. Most POS plans require members to choose a primary care physician from within the POS network, but allow them to use out-of-network specialists with a referral from a primary care physician. Co-payments will be higher for out-of-network services.

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Group Dental & Vision Plans

Employees always appreciate dental & vision coverage as part of the benefits package. We offer both dental and vision as part of the employer sponsored package or on a voluntary basis.

Dental Plans

Studies have shown that regular dental exams help employees to stay healthier and more productive in the work place. Additionally, you can detect serious underlying conditions such as heart disease and diabetes, through regular dental exams. In fact, the National Association of Dental Plans and the Centers for Disease Control have performed studies that show that employees with dental insurance have better attitudes and are less likely to suffer from depression, a common condition in today’s fast-paced world.

Dental insurance offers a variety of diagnostic, preventative care and corrective services. This includes cleanings, exams, x-rays, fillings, root canals, orthodontia for children, and emergency care while traveling.

Vision Plans

Similar to dental policies, vision plans are inexpensive and save employees money on routine eye care. Examples of care include exams, eyeglass frames and lenses, contacts, and even discounts on procedures like LASIK. Additionally, monitoring your eye health with regular exams helps to prevent serious eye diseases like glaucoma and cataracts. In addition, regular eye exams help to detect early stages of diabetes, high blood pressure, and high cholesterol.

Group Disability Plans

When an employee is unable to work due to illness or an accident, the financial impact can be devastating for them. When this happens, Disability Insurance replaces a portion of your employee’s income, while they are unable to work. While worst case scenario might seem remote, employees are often surprised to learn statistics show chances of becoming disabled are greater than dying between the ages of 25 & 45. In fact, more than one in four 20-year-olds will experience a disability for longer than 90 days before the age of 67.

With these statistics, it is no wonder that national surveys continue to show that Disability Insurance remains of high importance for most employees as an affordable strategy to widen their financial safety net. Those who wish to purchase a wrap-around policy to augment their employer provided coverage may do so.

Short Term Disability

During the time an employee is unable to work due to a qualifying disability (illness or injury), STD generally allows for income payments to the employee to begin after about a two-week waiting period and will continue to pay the employee until he/she recovers or maxes out the benefits–usually anywhere between one month to two years, depending on the policy.

Long Term Disability

During the time an employee is unable to work due to a qualifying disability (illness or injury), LTD generally allows for income payments to the employee to begin after about a 90-day waiting period. However, it could be much longer depending on the policy. The policy will pay the employee far longer than STD–for a few years, up to age 65, or even for life.

Tax-Advantaged Employee Benefit Plans

Following are employee benefit plan options designed to save both employers and employees money on healthcare and premiums. The plans are similar in some ways, but also vary, each having unique advantages and savings opportunities. The interface feature of our all-in-one online benefits management system makes it extremely easy to add and manage these programs to your benefit offering, including administration and compliance.

Health Savings Account (HSA)

A Health Savings Account combines a high deductible, lower premium group health insurance plan (HDHP) with an employee owned, interest earning savings account. Both employer and employee can contribute, with pre-taxed dollars, to the savings account. This effectively reduces the employee’s taxable income as well. Tax-free withdrawals are used directly by employee to help fund the deductible and other qualified medical expenses (including prescription, dental, and vision related healthcare). Any unused contributions can roll-over to the next year, and the HSA is portable and stays with the individual, even when that person changes employers. For all qualified medical expenses see See IRS Publication 502.

Health Reimbursement Arrangement (HRA)

A Health Reimbursement Arrangement pairs a high deductible, low premium health insurance plan (HDHP) with a tax-favored savings account to cover the high deductible. The HRA is funded by the employer and money is distributed only when a claim is incurred, typically for co-pays and other qualified expenses submitted by the employee, prior to the deductible being met. HRA contributions are not considered income to the individual. This type of arrangement helps both the individual and the business owner. The individual gets financial assistance paying medical bills and the employer only pays money when a claim is incurred, plus gets a business deduction.

Flexible Savings Accounts (FSA) (Section 125 Plan)

A Flexible Spending Account is a tax-favored savings account funded solely by the employee through regular pre-tax payroll deductions. The funds can be withdrawn, tax-free, to pay for eligible medical, dental, vision, prescription and dependent daycare expenses. Employees elect how much they want withdrawn from each pay period. By participating in a FSA, an employee always has cash to pay for these expenses, and as an added benefit, their taxable income is reduced which also increases the percentage of pay they take home. One disadvantage of using an FSA is that funds not used by the end of the plan year are lost to the employee, known as the “use it or lost it’ rule. In 2021, the maximum allowed per employee in a medical flexible spending account is $2750 per plan year.

Voluntary Benefits

At little or no cost, voluntary benefits help to augment and enhance the employer sponsored benefit package, and further support the financial wellness of your employees. Following are just a few advantages of offering voluntary benefits, and what many employees say are a “necessity” when searching for a new employer.

-Allows employees to tailor coverage to fit their personal needs.
-Creates financial wellness by providing benefits that go beyond traditional employer paid benefits.
-Lower’s payroll taxes for both employer and employee.
-Increases job satisfaction, loyalty and employer’s ability to attract the very best talent.
-Provides a financial safety net for your employees, giving them piece of mind and consequently boosts your morale and productivity.

Additionally, our user-friendly benefit management portal provides an interface to several top-rated carriers and partners, which makes it easy for employers to add voluntary benefits, without adding costs to the bottom line. The consolidated billing feature allows managers to see all of their invoices across all products with one total premium.

Voluntary plans available included highly desired benefits such as Accident, Critical Illness, Disability, and Life Insurance, as well as telemedicine, Dental and Vision.

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The Affordable Care Act

As employee benefit experts, it is our top priority to understand and follow the status of the ACA. We’ll help you develop an affordable benefit strategy that includes all the benefits and perks your employees desire, while reducing your risk associated with the ACA.

Assist you in determining your eligibility for a tax credit which could reduce your monthly premiums.
Help you avoid non-compliance penalties. Businesses with 50+ full time equivalent employees must offer a Minimum Essential Coverage (MEC) plan otherwise they could incur a penalty of $2,700 (in 2021) times the number of full time employees (minus the first 30 employees). A $4,060 (in 2021) penalty can also occur if an employee goes to the exchange and gets a subsidy (tax premium credit). Penalties can increase each year by the growth in insurance premiums.
A MEC plan must include 60{b6d890d0f7b5537aa7b422be7d42f2d4fbbf19f41f312582af280868184f458d} of the costs of the following essential benefits:

-Ambulatory patient services
-Emergency services
-Hospitalization
-Maternity and newborn care
-Prescription Drugs
-Mental health and Substance —Abuse disorder services
-Rehabilitative and habilitative services and devices
-Pediatric services, including oral and vision care
-Preventive and wellness services, and chronic disease management

Arizona
Arkansas
California
Colorado
Florida
Georgia
Illinois
Indiana
Iowa
Kentucky
Maine
Massachusetts
Michigan

Minnesota
Missouri
New Jersey
New York
North Carolina
Ohio
Oklahoma
Pennsylvania
Tennessee
Texas
Utah
Virginia
Wisconsin

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