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3 Options to Consider for Surgery Center Employee Benefits |
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Written by Administrator
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Wednesday, February 23 2011 14:01 |
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1. Provide benefits via the ASC directly as the employer of the employees. This option provide the ASC the opportunity to create a benefits package that is specific to the ASC and manage costs based on what the ASC can afford. The challenge is these benefits can be costly because to the size of the group (few employees to spread the risk across). For start-up centers, the first three employees do not have access to benefits due to the requirement that most insurance companies will not provide group benefits to employers with fewer than three benefit eligible employees. Typically, they will not even provide a benefit quote if you have fewer than three employees — unless it is for an individual policy.
In order to receive a quote, insurers require a census of three employees. In this scenario, benefit costs are based on employee census and claims experience.
2. Use a management company to employ the staff. If the ASC is part of a management company, some management companies employ the staff on behalf of the facility. This is a great option because you have the benefit of a larger number of employees, thus you are able to provide a competitive benefit package at a lower cost than doing it as a stand-alone ASC. You are able to leverage economies of scale by utilizing this option. Benefits costs are not predicated on the individual’s medical history and benefits are available immediately because group policies are already in existence.
3. Employ the staff via a Professional Employer Organization. [This option involves] outsourcing all other aspects human resource management to include benefits while maintaining the daily control and management of the staff. This model allows the ASC to focus on its core business, caring for patients and outsources all of the HR functions to a third party employer.Depending on the model, the ASC may be able to leverage economies of scale for some benefits, thus providing a more robust benefit package that is competitive and lower in cost than a free-standing ASC. |
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Written by Administrator
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Thursday, October 14 2010 09:33 |
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The new Patient Protection and Affordable Care Act (PPACA) requirement for employers to report health care contributions on an employee's W-2 will be optional in 2011, according to the IRS. The IRS has released a draft form for the requirement along with its announcement that the requirement will be optional in 2011. Notice 2010-69 provides: "This notice provides interim relief to employers with respect to reporting the cost of coverage under an employer-sponsored group health plan on Form W-2, Wage and Tax Statement, pursuant to § 6051(a)(14) of the Code. Specifically, this notice provides that reporting the cost of such coverage will not be mandatory for Forms W-2 issued for 2011. The Treasury Department and the IRS have determined that this relief is appropriate to provide employers with additional time to make any necessary changes to their payroll systems or procedures in preparation for compliance with the reporting requirement." |
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Written by Administrator
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Thursday, September 23 2010 14:18 |
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The Employee Benefits Security Administration (EBSA) has issued Technical Release 2010-2 regarding the internal claims and appeals process required by PPACA. EBSA has already issued interim rules on this issue, which are available on the EBSA health care reform page. Under the just-released technical guidance, EBSA and the IRS are providing a grace period until July 1, 2011, for some, but not all, of the requirements. Group plans and self-funded plans will have this grace period for requirements related to the timeframe for urgent care decisions, the cultural/linguistic notice requirements, certain other notice requirements, and the substantial compliance requirement. |
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Expected Health Care Changes Effective 2010 |
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Written by Administrator
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Wednesday, September 08 2010 12:37 |
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The time-line of implementation has created an equal amount of confusion all on its own. Generally speaking, much of health care reform is not effective until 2014; however, there are a number of reforms that are effective for plan years that begin on or after six months after the enactment date. We thought it would be helpful to provide you with a recap of the 2010 provisions. At this point, the “bill” is only one part of the set of federal and state mandates, rules and regulations that will be written in over the next several weeks and months. Although we don’t know the exact implications of all the provisions of PPACA, what we do know is the journey to a new health care system has begun. This Legislative Alert is intended to provide you with a recap of the 2010 provisions of the bill. Purpose of Reform The overall intended purpose of the PPACA is to improve the U.S. health care system by expanding coverage, improving quality of care, reforming government programs, reducing costs, increasing focus on wellness/prevention and reforming the payment and delivery systems. 2010 Health Care Reform Summary of the PPACA, as amended by the
Health Care and Education Reform Act - An End to Pre-Existing Conditions
- Health Insurers cannot deny children health insurance because of pre-existing conditions. A ban on adult discrimination will take effect in 2014.
- Small Business Tax Credits
- Businesses with fewer than 50 employees will get tax credits covering up to 50 percent of employee premiums.
- Seniors Receive ‘Donut Hole’ Rebate
- Seniors will receive a rebate to fill the ‘donut hole’ in Medicare drug coverage, which severely limits prescription medication coverage expenditures over $2,700. As of next year, 50 percent of the donut hole will be filled.
- Transparency in Insurance Companies
- Insurers must now reveal how much money is spent on overhead.
- Customer Appeals Process
- Any new plan must now implement an appeals process for coverage determinations and claims.
- Indoor Tanning Services Tax
- This tax will impose a 10 percent tax on indoor tanning services. This tax replaced the proposed tax on cosmetic surgery, effective for services on or after July 1, 2010.
- Enhanced Fraud Abuse Checks
- New screening procedures will be implemented to help eliminate health insurance fraud and waste.
- Medicare Expansion to Rural Areas
- Medicare payment protections will be extended to small rural hospitals and other health care facilities that have a small number of Medicare patients.
- Deductions for Blue Cross Blue Shield
- Nonprofit Blue Cross organizations will be required to maintain a medical loss ratio (MLR) – money spent on procedures over money incoming.
- Nutrient Content Disclosure
- Chain restaurants will be required to provide a nutrient content disclosure statement alongside their items. Expect to see calories listed on both in-store and drive-through menus of fast food restaurants soon.
- Better Coverage for Early Retirees
- The bill establishes a temporary program for companies that provide early health benefits for those ages 55-64 in order to help reduce the often expensive cost of that coverage.
- Better Consumer Information on the Web
- The Secretary of Health and Human Services (HHS) will set up a new website to make it easier for Americans in any state to seek out affordable health insurance options.
- Encouraging Investment in New Therapies
- A two year temporary credit (up to a maximum of $1 billion) is in the bill to encourage investment in new therapies for the prevention and treatment of diseases.
- Break Time for Nursing Mothers
- Requires employers to furnish reasonable break times for nursing mothers for up to one year after the child’s birth.
- Cost-sharing obligations for preventive services are prohibited.
- Coverage for emergency services at in-network cost-sharing level with no prior authorization is mandated.
- Group Plans IRC Section 105(h) Rules
- Group plans will be required to comply with the IRC section 105(h) rules that prohibit discrimination in favor of highly compensated individuals. These rules apply to both self-funded and fully-insured plans.
- Wellness Grants for Small Employers
- Small employers seeking to implement wellness programs can now access federal grant money.
Grandfathered Plans- More Young Adults Covered on Parents’ Plans
- The cut-off age for young adults to continue to be covered by their parents’ health insurance rises to the age of 27.
- No Lifetime Caps
- Lifetime caps on the amount of insurance an individual can have will be banned. Annual caps will be limited, and banned in 2014.
- Adults with Pre-Existing Conditions Covered
- A temporary high-risk pool will be set up to cover adults with pre-existing conditions. Health care exchanges will eliminate the program in 2014.
- New Insurance Plans Must Include Preventive Care
- New plans must cover checkups and other preventive care without co-pays. ALL plans will be affected by 2018.
- The End of ‘Rescissions’
- Insurance companies can no longer cancel policies when an individual gets sick.
As you can see, there are many changes that have already taken effect and many more to come by the end of 2010. Through this timeline, we hope you gain knowledgeable information that will help prepare you and your clients for these future changes. |
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Benefits
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