New Speaking Topic: Waving the RED Flag –The Top 10 Things You Need to Do To Prepare for the ACA for 2016

Red FlagSpeaking Topic:  Waving the RED Flag –The Top 10 Things You Need to Do To Prepare for the ACA for 2016

Sometimes you just need to waive a red flag out there to make sure people hear what they need to hear.  Since the ACA passed in 2010,  we have been sifting through the law, and communicating the mandates and issues with, and for, our clients and friends.  Many have listened and planned intently and made changes, while others have chosen to wait to respond, hoping or thinking that elections or the Supreme Court would reverse the law.

Regardless or your initial response, it is now time for all organizations and businesses to make sure that they have all the relevant issues handled under the ACA for 2016.

As of 2016, the following issues must be resolved for your company….especially if you are over 50 FTEs and if you are classified as an Applicable Large Employer (ALE).

  1. Are you an ALE?
  2. If No, now what?
  3. If Yes, now what?
  4. What is your No-Offer Penalty Exposure?
  5. What is your  Unaffordable Coverage Exposure?
  6. How many hours do you currently require employees to work to qualify for group health insurance?
  7. What percentage of your full time employees (30 hours per week) are currently eligible for your group health plan?
  8. Is your coverage “Affordable” as defined by the ACA?  Can you fit into any of the safe harbors?
  9. Have you set up  Variable Hour Employee Status that uses the Look-Back Method?  Do you know how you will track it?
  10. Are you adequately tracking all of the data required to submit IRS Forms 1094-C and 1095-C?  How will you create those forms by the 2016 deadlines?

Please contact me at if you are interested in this topic for either an on-site presentation, or a webinar.  Other speaking topics and endorsements are listed here.

Speaking Topic:  Waving the RED Flag –The Top 10 Things You Need to Do To Prepare for the ACA for 2016

DOL says ACA Requires Coverage for all 18 Contraceptive Measures

DOL: Plans Must Cover All Contraceptives, Not Some

May 11, 2015 – 4:02 pm | By Todd Leeuwenburgh | Comments are off for this post

Plans and insurers must cover all 18 contraception methods approved by the U.S. Food and Drug Administration, according to a new set of questions and answers on the Affordable Care Act’s preventive care coverage requirements.

“Reasonable medical management” still may be used to steer members to specific products within those methods of contraception. A plan or insurer may impose cost-sharing on non-preferred items within a given method, as long as at least one form of contraception in each method is covered without cost-sharing.

However, an individual’s attending provider must be allowed to override the plan’s drug management techniques if the provider finds it medically necessary to cover without cost-sharing an item that a given plan or insurer has classified as non-preferred, according to one of the frequently asked questions from the U.S. Departments of Labor, Health and Human Services and the Treasury.

The ACA mandated all plans and insurers to cover preventive care items, as defined by the Public Health Service Act, without cost-sharing. Eighteen forms of female contraception are included under the preventive care list. The individual FAQs on contraception clarified the following requirements.

  • Plans and insurers must cover without cost-sharing at least one version of all the contraception methods identified in the FDA Birth Control Guide. Currently, the guide lists 18 forms of contraception that must be thus covered.
    Plans may use “reasonable medical management” to control the offerings within the 18 contraceptive forms covered. This includes encouraging the use of generic instead of brand-name drugs, by imposing cost-sharing on non-preferred brand-name drugs or items.
    However, policies that impose costs on non-preferred drugs and items must be subject to an exception process that is “easily accessible, transparent and sufficiently expedient.” The process must not be unduly burdensome on the individual, provider or individual acting on the individual’s behalf, and must cover an item or service without cost-sharing if a treating physician deems it medically necessary. “The plan or issuer must defer to the determination of the attending provider with respect to the individual involved,” the guidance states.
  • Plans that try to offer coverage for some — but not all — FDA-identified contraceptive methods will not comply with the health care reform law and its rules. For example, plans cannot cover barrier and hormonal methods of contraception while excluding coverage for implants or sterilization.

The FAQ comes just weeks after reports and news coverage detailed health plan violations of the women coverage provisions of the ACA.

Source:  From:

Here is a Link to FDA Contraceptive Methods:

Speaking for Ohio Provider Resource Association 2015 Annual conference #OPRA


What a great time yesterday speaking in Columbus to a great crowd of health care professionals in town for the OPRA annual conference.   Great people, great conversation,  Preparing for ACA requirements for 2015 and beyond.

Topic:  Top 10 Questions You Need to Ask About the ACA.  Read more about it here:

10 Steps and 57 Pages to get Small Business Tax Credit Under the ACA / SHOP Program

SHOP Steps 3-2015

Last week, I attended a seminar regarding how to take clients through the Small Business Health Options Program.  Starting in 2015, employers could earn a potential tax credit, but would the credit would only be available if the employer and employees all purchased coverage through

The speaker used 57 slides and 60 minutes to describe the 10 set process.  Approximately 300 agents were in attendance.  Given the small monetary return in the tax credits, and the amount of time expected to be required to follwo the 10 steps, the general consensus among those in attendance was that the return on investment would not be strong enough to merit the time required.

Prior to this year, small employers were able to apply for the tax credit with a simple tax form as they filed their federal taxes.

HHS Releases State by State Obamacare Enrollment Figures

A March 11, 2014 reports the following number of People who “Have Selected a Marketplace Plan”.  A footnote clarifies this to mean that they are people who are deemed to be eligible to purchase a plan and who have selected a plan.  However, the footnote explains “with or without payment having being received directly by the Marketplace or the insurer”

Here is the link to the HHS Report

So for all purposes, these are people similar to someone who goes to Amazon, puts a book in their shopping basket, but never pay.

Nevertheless, here are the number from 10/1/13 – 3/1/14

  • Total All Marketplaces:  4,242,325
  • Total State Marketplaces:  1,621,239
  • Total Federal Marketplaces: 2,621,086
  • Total Ohio:  78,925

The report also shows that 83% of all people who enrolled received financial subsidy.  That would mean they are below 400% of Federal Poverty.  


Obamacare Open Enrollment Exention Announced

After a full 6 months of open enrollment, the Obama Admin has announced that you can now request an extension.  According to multiple sources, people will have up until April 15 to goto and request an extension.  The extension will allow people to not be penalized for not having coverage.  Image

From the Washington Post:
Under the new rules, people will be able to qualify for an extension by checking a blue box on to indicate that they tried to enroll before the deadline. This method will rely on an honor system; the government will not try to determine whether the person is telling the truth.

The rules, which will apply to the federal exchanges operating in three dozen states, will essentially create a large loophole even as White House officials have repeatedly said that the March 31 deadline was firm. The extra time will not technically alter the deadline but will create a broad new category of people eligible for what’s known as a special enrollment period.

Full article here: