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Notice of Creditable Coverage due October 15th

Employers who sponsor group health plans must provide notices of creditable or non-creditable coverage to Medicare-eligible individuals before each year’s Medicare Part D annual enrollment period by October 15th.  This notice is meant to educate Medicare beneficiaries of their options by informing them of whether the group health plan is “creditable”, meaning it is expected to cover, on average, as much as the standard Medicare Part D prescription drug plan.  The timing is also tied to the Medicare open enrollment period so beneficiaries can compare their group health plan options against their Medicare options.
Some employers will choose to provide the notice to all covered employees while others, generally smaller companies, will distribute the notice to only those who are Medicare eligible. Keep in mind, however, that Medicare eligibility can include people under 65 with disabilities.
If your company has fewer than 100 employees, we advise that you give this notice just to those Medicare eligible employees or dependents who are members of your health plan.  If your company has 100 or more employees, we recommend sending the notice to all health plan subscribers.  A short cover note explaining why the notice is being sent can help prevent calls from confused recipients.
CMS also requires that employers disclose to CMS within 60 days of the status of the company’s creditable coverage.  The disclosure form can be found in the link below.
The link also contains the most current copy of the Model Notice.  Please let us know if you have any questions in completing the form or prefer to have a copy of the notice forwarded to you.
Matt Hollister, L.I.A., M.P.H.
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Update on health plans for groups with 51-100 employees

A bill that gives states the authority to set the size requirements for “small group” health plans (H.R. 1624) passed both the House of Representatives and US Senate this week.  If it is signed into law, Massachusetts will be able to keep the definition of small groups for the purposes of health plan rates at 50 and under.  The legislation will be presented to President Obama for his consideration.
Insurance carriers estimate that about 85% of employers who have between 51 and 100 employees when rated as a small group will have higher rates than if they stayed with large group.  Therefore Hollister Insurance, along with others in the brokerage community and industry groups such as the National Association of Health Underwriters have been advocating on behalf of affected employers to find a permanent fix to this issue.
We hope this information is helpful and we will keep you posted as soon as we receive updates on this important legislation.
Matt Hollister, L.I.A., M.P.H.
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Delay of Small Group Expansion Mandate

Governor Charlie Baker Announced last Thursday that the Federal Health Care Reform mandate, which would expand the definition of “small group” up to 100 employees, has been delayed for at least a year. Governor Baker cited “price shock” for employers with between 50 and 100 employees as a reason for Massachusetts to seek a waiver in the new rule.  Governor Baker had originally sought a permanent waiver but was granted a delay of the expansion by federal regulators instead.
According to our sources, insurance carriers will have the option of whether or not to delay the expansion of small group, and some may move ahead with the change regardless of the announcement.  At Hollister Insurance, as we prepare for 2016 renewals, we will be working closely with clients in the development of a renewal strategy that works best given the regulatory environment.
Overall we feel that this is a step in the right direction, although we still support a permanent waiver which would allow Massachusetts state government, along with the MA Division of Insurance with the flexibility in defining the size of a “small group.”
More information on this announcement can be found on Governor Baker’s website.
Matt Hollister No Comments

Revised Massachusetts Earned Sick Time Law Safe Harbor and Notice to Employees

The MA Attorney general posted last week on its web site a revised safe harbor for employers with existing paid time off policies.  These revisions directly address use of the safe harbor by employers that have some employees who do not currently receive a paid leave/sick benefit under the employer’s existing paid time off policy.

The revised safe harbor also clarifies that employers opting to use the safe harbor may also choose full compliance with the Earned Sick Time law and regulations beginning July 1, 2015 for some or all employees — which would include the ability to create a separate EST compliant plan for employees who do not currently receive a paid leave/sick benefit under the employer’s existing paid time off policy.


Also today, the AG released the English-language version of the “Notice to Employees.” The statute requires that employers “shall post this notice in a conspicuous location accessible to employees in every establishment where employees with rights under this section work, and shall provide a copy to their employees.”

The Notice to Employees is now available for download on the Attorney General’s Earned Sick Time website: Notices in other languages will be coming soon.

Matt Hollister No Comments

Seminar – ACA Employer Reporting

Hollister Insurance and J.F. Conlon and Associates will be hosting a seminar on: Wednesday, May 27th, from 9:00am to 10:30am, to discuss the ACA Reporting Requirements, including forms 1094-C and 1095-C, which will need to be completed by all applicable large employers for 2015. Clients and prospective clients are welcome to attend.

The seminar is designed to provide employers with the background and important deadlines for the forms, as well as specific instructions on how to complete them.  There are numerous service providers who have developed products designed to complete and file the forms.  However, in order to assess whether these forms should be done in house or outsourced will require a basic understanding of what is involved.

Coffee, Tea, Juice & Muffins/Bagels will be served

WHEN:    Wednesday, May 27th, 2015,  Registration 8:30; Program 9:00 – 10:30 AM

WHERE:   Cyprian Keyes Golf Club, 284 E Temple St, Boylston, MA 01505, Phone: (508) 869-9900

RESERVATIONS:  Please email [email protected] by Wednesday, May 20th.

Program Speaker:

RAS photoRick has more than 25 years of experience as an ERISA employee benefits lawyer and consultant. He is Of Counsel to Parker Brown Macaulay & Sheerin, P.C., in Foxborough, Massachusetts, where he concentrates his practice exclusively in employee benefit matters including compliance with state and federal health care reform. During the past 7 years Rick has also been a special legal advisor to the MA Health Connector Authority in connection with Mass Health Care Reform.  Rick is a graduate of the University of Massachusetts and Marquette University Law School.
Matt Hollister No Comments

Hollister Insurance Acquires JF Conlon and Associates

Effective in March, Hollister Insurance of Clinton, Massachusetts has acquired J.F. Conlon and Associates, of Amherst Massachusetts.  J.F. Conlon has been a leading employee benefits broker in Western Massachusetts for 20 years.  Jim Conlon, President of J.F. Conlon and a former BCBS of MA regional director, has plans to retire within a year of the transition and Matt Hollister has assumed the role of CEO for the overall business.  April Williams, who has worked at J.F. Conlon for 15 years as a producer and account manager has been promoted to regional manager and will head up the Amherst office.

The consolidated business gives Hollister Insurance a broader presence in the Massachusetts employee benefits market, increases the number of carriers and plans offered and adds significantly to the depth of experience in the brokerage staff.

J.F. Conlon will continue to maintain the same close relationships with customers while being able to offer clients additional support available through Hollister Insurance, such as Human Resources expertise and electronic enrollment solutions.

Hollister Insurance will continue the strong partnership J.F. Conlon has with the business community in Amherst and will look for opportunities for further expansion in the region.

Matt Hollister No Comments

Mass. Parental Leave Act (PLA)

Mass. Parental Leave Act (PLA) replaces the Maternity Leave Act (MMLA) to add Paternity and other new provisions

Key terms and conditions about PLA that you need to know:

  • PLA is effective April 7, 2015 for all Mass. Employers with 6 or more employees,
  • Requires equal treatment of male and female employees,
  • Provides up to a minimum of 8 weeks of unpaid, job-protected leave for full-time employee-parents:
    • o   At the time of childbirth or adoption, and
    • o   When a child is placed pursuant to a court order.
  • Important nuances of the law that you also need to know include:
    • o   Employees cannot be required to use accrued sick, vacation or other paid time off (PTO) during this time although they may voluntarily elect to do so.
    • o   Should both parents be employed by the same company, the same 8 week minimum leave will concurrently apply to both.
    • o   Employee date of eligibility cannot exceed three months from date of hire, with or without a probationary period.
    • o   If you do not intend to permit such a leave to extend beyond 8 weeks, you must notify your employee, in writing, before the leave begins. Failure to do so may automatically extend the leave beyond 8 weeks.
    • o   Employees desiring such a leave must provide you with at least two weeks’ advanced written notice, or as soon as practicable, if such notice is beyond the employee’s control.
  • For employers with 50 or more employees who come under the Family Medical Leave Act, the 8 weeks leave covered under the PLA may be counted concurrently with the first 8 weeks of the FMLA’s 12 week leave period.
  • You must be sure to post proper notice of employee rights and your company’s policy under the PLA at all job locations.
  • You need to be sure to update your policies and procedures and effectively communicate with and train all those in a position to have any impact on the proper administration of the PLA at your company.
  • Employees on approved PLA leaves must be restored to the same or similar position with the same status, pay, seniority, and other such conditions as existed for the position held prior to going out on leave.
  • Should there be a layoff due to economic or operating conditions during an employee’s leave, job protections of the PLA will not apply to such employees if it is determined that they would have been so affected if they had not been on leave. However, the employee must retain any preferential consideration for another position, the same as they may have had prior to taking a leave.
  • Nothing in the PLA is meant to affect any bargaining agreement or company policy that provides for greater or additional benefits beyond the PLA.
Matt Hollister No Comments

New MA Earned Sick Time Law Webinar

Hollister Insurance is offering a free webinar regarding the new MA Earned Sick Time Law, scheduled to take effect in 2015.  The webinar will take place on: Wednesday, March 18th, from 1:30pm to 2:30pm.  The webinar is designed to provide employers with timely information on the new law within a platform that will allow questions and answers, helping participants gain a thorough understanding of the law’s requirements.

Our guest who will be presenting the webinar is Rick Szczebak, Esq.  Rick has more than 25 years of experience as an ERISA employee benefits lawyer and consultant. He is Of Counsel to Parker Brown Macaulay & Sheerin, P.C., in Foxborough, Massachusetts, where he concentrates his practice exclusively in employee benefit matters including compliance with state and federal health care reform. During the past 7 years Rick has also been a special legal advisor to the MA Health Connector Authority in connection with Mass Health Care Reform.  Rick is a graduate of the University of Massachusetts and Marquette University Law School.

For more information or to RSVP to the seminar, please contact [email protected]

Matt Hollister No Comments

Anthem BCBS Data Breach

The data breach at Anthem is a very big concern to all of us, as employers, benefits professionals and health plan members.  Naturally, we have received inquiries as to how this might affect members of BCBS of Massachusetts and we wanted to offer this information.
Today, BCBS of MA released a statement about the Anthem breach.  The statement does not specifically say whether or not information on BCBS of MA members was breached, but that they are actively looking for more information.  However, BCBS of Massachusetts and Anthem BCBS operate separately and independently of each other.  Because of this, I don’t have any reason to think that any personal information or claims information for a BCBS of MA customer would find its way into the Anthem BCBS system(s).
When a BCBS of MA member uses providers outside of Massachusetts, BCBS of Massachusetts relies on using the networks of other BCBS organizations, including Anthem.  However, the local BCBS organization (e.g. Anthem BCBS) does not adjudicate claims for BCBS of MA, nor are they a “pass through” for claims information.  Providers, regardless of their location, send claims directly to BCBS of MA, where all of the member and policy information is located.  If a provider were to send a claim to Anthem by mistake, Anthem would reject it because they would not recognize the group number or member ID associated with a BCBS of MA plan.
Again, although this is a very concerning issue, everything I have heard so far indicates it was limited to Anthem BCBS members and not those of any other insurance company.
If anything changes or we find out that our customers are in any way affected, we will be sure to let you know.
Matt Hollister No Comments

Update on ACA employer reporting requirements

We have received several questions about the Affordable Care Act (ACA) reporting requirements and prepared this primer to give some basic information on the reporting rules.  Our main message is don’t worry about this now, because as we get closer to the end of the year we will be providing more detailed information and talking with employers individually to let them know what needs to be done in 2016.

What is the ACA reporting?  In general it is the IRS’s way to find out directly from employers and insurers that the ACA rules are being followed.  Since the ACA rules are different for large groups (those subject to Employer Shared Responsibility) and small groups, the reporting requirements are also different.  Most small groups (those that have fully insured health plans) won’t have to do any reporting because the insurance carriers will take care of it.  However, large groups and employers with self funded health plans will have to provide information both to their employees and to the IRS.

As we stated, the requirement starts in early 2016 for most people.  However, employers may voluntarily report in 2015 on health coverage they provided in 2014.  Most health insurance carriers will issue the required reports in 2016 and annually thereafter.

There are three reports that will be filed, depending on the source of insurance and size of company, the 1095-A, 1095-B and 1095-C.  We have created the following explanation for your information and planning:

1095-A: By January 31, 2015, Marketplaces (such as the Massachusetts Health Care Connector) will issue Minimum Essential Coverage (MEC) Forms 1095-A to individuals covered through a qualified health plan in the Marketplace in 2014. These forms will list all members covered under the plan and the calendar months in which they had coverage.

1095-B: By January 31, 2016, insurance carriers and small self-insured employers will be required to issue Form 1095-B MEC forms directly to members covered through small employers. The forms will list all members covered under the plan and the calendar months in which they had coverage. Insurers and small self-insured employers will also send MEC information directly to the IRS.

1095-C: By January 31, 2016, large employers, whether fully insured or self-insured, will have to provide information to their employees on whether the plan met 60% minimum value (MV) and was affordable (i.e. single only coverage is not more than 9.5% of employee’s income). Large employers will also be required send the same information to the IRS on form 1094-C.