Industry News & Information

Health Insurance Information

• MN: Section 125 Plan for individual insurance. MN Statute Section 62U.07: Effective July 2009, all employers with 11 or more current full-time employees in MN not offering health coverage to their employees shall establish and maintain an IRC Section 125 Plan to allow employees to purchase individual or employer-sponsored health coverage with pretax dollars. There are definite advantages to employers and employees alike. Employers may opt out; or they may apply for a $350 grant to help offset the costs of establishing the Section 125 Plan (which may be in the vicinity of $350). It is important to know the ins and outs of this statute in order to implement it so that it does not become subject to ERISA and therefore a new set of federal laws. A reputable third party administrator should be able to help install the Section 125 Plan and explain how to accurately maintain it. For information about applying for the $350 grant, contact the Minnesota department of Employment and Economic Development at 651.259.7435.
• US: For information about Section 125 Plans (aka "Cafeteria Plans") specifically for government entities, see "FAQs for government entities regarding Cafeteria Plans" on IRS.gov.
• US: COBRA Subsidy: Assistance Eligible Individuals (AEI's) must have had a qualifying event on or before May 31st, 2010. For more about the COBRA subsidy that was extended to 15 months of premium assistance, click the "COBRA Subsidy" link above.
• US: Medicare Advantage 2011 Data Spotlight from the Kaiser Family Foundation: National monthly average for Medicare Advantage Prescription Drug (MA-PD) plan weighted premiums (based on 2010 enrollments, assuming beneficiaries do not switch plans) in 2011 was determined to be $43.
• US: Medicare Part D Spotlight from the Kaiser Family Foundation: The average monthly PDP weighted premium for 2011 (based on 2010 enrollments, assuming beneficiaries do not switch plans) was determined to be $40.72.
• US: Medicare Advantage and Prescription Drug Fact Sheet from MCOL using data from the Kaiser Family Foundation and CMS.
• US: Who is CMS: Centers for Medicare and Medicaid Services? It is one of 11 operating divisions of the US Department of Health and Human Services (HHS). HHS is the principal agency entrusted to protect the health of all Americans. CMS oversees the Medicare, Medicaid, and Children’s Health Insurance Program (CHIP). Medicare and Medicaid together provide health care insurance for one in four Americans. Together, the three programs provide care to nearly one in three Americans. HHS’ Medicare program is the nation’s largest health insurer, handling more than 1 billion claims per year.
• US: FMLA (Family Medical Leave Act):  Employers and their employees on FMLA need to know employee rights concerning health coverage under the group's plan. FMLA is not a COBRA qualifying event. The employer must offer group coverage the same as if they were still at the workplace. There are FMLA-related situations where a COBRA qualifying even may occur, such as if the employee notifies the employer they will not be returning to work.
• US: Americans with Disabilities Act. ADA Amendments Act of 2008: Effective in January 2009. The U.S. Equal Employment Opportunity Commission's (EEOC) regulations to implement the equal employment provisions of the ADA Amendments Act are effective as of March 25, 2011. What qualifies as disability discrimination?
  Go to the EEOC site to learn the rights and obligations of employers and employees upon qualification. This effects group health coverage in that if the employee's hours are reduced below the group plan eligibility requirement, or if can no longer work; they may qualify for federal COBRA continuation. Each state may have its own added provisions which may further benefit employees eligible for COBRA. In general, where both federal and state continuation laws differ, the law that is more favorable to the employee applies. Link for Minnesota COBRA continuation information. See pages 9 and 10 of handbook: Health Insurance for Small Employers and Their Employees 2011 for Wisconsin COBRA continuation information.
• US: US Census Bureau health insurance information, the latest data available as of September 29, 2010.
• US: Current health care news and information on the US Department of Health and Human Services website.
• MN: Current Minnesota health care statistics and market.
• MN: Current health care news from the Minnesota Department of Human Services.
• MN: SF No. 3780 - Health Care Reform (Minnesota Laws 2008, Chapter 358). Generally, effective in 2009 or later.
• MN: The Minnesota Department of Health produced a "Health Insurance Exchange Study" in February 2008.
• WI: Health coverage statistics for Wisconsin; a 2007 report.
• WI: Wisconsin Office of the Commissioner of Insurance (OCI) consumer information regarding health insurance issues.
• WI: 2011 Wisconsin handbook: Health Insurance for Small Employers and Their Employees 2011.

HDHPs/HSAs in 2011

• For calendar year 2011, a "high deductible health plan" (HDHP) is defined as having "...an annual deductible of at least $1,200 for self-only coverage or $2,400 for family coverage, and annual out-of-pocket expenses up to $5,950 for self-only coverage or $11,900 for family coverage." There can also be no first dollar coverage, except dental, vision and preventive care (per IRS Code 223).
• For calendar year 2011, HSA contribution limits are the following: $3,050 for individual coverage (compared with $3,050 in 2010 and $3,000 in 2009 ) and $6,150 for family coverage ($6,150 in 2010; $5,950 in 2009).
• If over the age of 55: additional "catch up" contribution of $1000 allowed for 2011.
• Note: Health Savings Accounts (HSAs) can only be established with HDHP plans, and the particular HDHP plan must be "compatible." Confirm compatibility with your agent or the carrier if you wish to establish an HSA.
• For more information about HSA rules, go to the US Treasury website with links to the Internal Revenue Service (IRS) website. On both sites you can "search" for related information.
• For more information go to Benefit Design Group's chart designed by Sue Sieger "FSA/HRA/HSA Understanding Your Options - 2011."

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