Are you ready to lose your choice of health plans? That is what is likely to happen for large and small employers, and the thousands of families they cover through group health insurance if Gov. Chris Gregoire signs E2SHB 2319.

Engrossed Second Substitute House Bill 2319 (E2SHB 2319) passed the Legislature earlier this month and is awaiting review by the governor. The purpose of the bill is to further define the state-based health insurance exchange required under the new health care reform law.

As written, two sections in E2SHB 3219 would effectively eliminate employer choice over the type of coverage purchased and reduce the number of insurers offering coverage in our state. Sections 6 and 7 address insurer requirements regarding catastrophic health plans as well as the requirement to offer both silver and gold level plans if they also offer bronze level plans outside the exchange.

If you are a large employer (more than 100 employees) – you lose. If you are a small employer (fewer than 50 employees) – you lose. The bill will significantly reduce the number of available plan options to both groups.

Under the new federal law, if you are a large employer (more than 100 TOTAL employees), you cannot purchase coverage from the exchange. Sounds like good news, but the catch is that the state exchange legislation will restrict the sale of catastrophic high deductible plans to just the exchange. With this restriction if you currently offer a plan with a deductible of higher than $1,850 you could be forced to drop this option, regardless of how beneficial it might be to your employees.

Small employers (fewer than 50 employees) wishing to offer a catastrophic or high deductible plan will be forced to purchase their coverage through the exchange. The primary problem here being, that the insurers providing these products are likely to leave the market if they are unable to also sell to the large group market.

Washington’s Health Insurance Exchange goes beyond what is required by federal law. E2SHB 2319 brings to mind a scenario similar to what happened in 1998, when more than a dozen health insurers left the state due to market reforms put in place by the Legislature. Choice was extremely limited and thousands were left uninsured during that time.

Sections 6 and 7 of this bill would have a dramatic impact on the quality of health care coverage employers can offer their employees. According to Don Brunell, President of the Association of Washington Business, “In our view, this is unacceptable and unnecessary for the implementation of the exchange. Washington’s employers want to provide good, affordable health care coverage for their employees. This bill effectively removes their choices and drives carriers out of the state. That can’t be good for Washington.”

Section 25 which defines “Navigators” those designated to help you purchase coverage through the exchange – specifically states that navigators not be required to be licensed or to carry Errors & Omissions Insurance!

Contact the Governor today by calling 360-902-4111 and encourage her to veto Sections 7, 8 and 25 of E2SHB 2319. Without that veto, Washington’s health insurance exchange will mean loss of coverage, fewer choices, less competition and ultimately, higher prices.

Individual Health Plan Enrollment for Children – 3/15 – 4/30/2012

Do you need individual health insurance for your child or would you like to add them to your family plan? The first open enrollment of the year is March 15 – April 30.

The open enrollment periods apply to all health plans in the individual market. And the only time outside of qualifying events (such as birth, adoption, loss of coverage, etc.) that children under 19 can enroll for coverage.

Federal health reform prevents health insurers from denying coverage to children with pre-existing health conditions. As a result, individual plans have created openenrollment periods. During these times, children under age 19 do not have to complete a health questionnaire and cannot be denied health insurance because of a preexisting condition. In addition, once enrolled children under age 19 are not subject to any pre-existing condition waiting periods.

The next open enrollment period is September 15 – October 31, 2012.

If you need coverage for your child, please contact Amy Mosley immediately for personalized assistance before this window of opportunity closes. She can be reached at 253-851-4408 or by email at amy@olympiccrest.com.

Have an HSA? Don’t forget the proper forms for your Tax Return!

If you own an HSA (Health Savings Account), the IRS requires that you complete certain forms when you file your federal tax return. Following is a list of forms you may need (please check with your tax advisor for guidance with your specific situation).

IRS Form 1099-SA: Reporting for HSA distributions or withdrawals in 2011

IRS Form 5498-SA: Reporting for HSA contributions made between 1/1/11 – 12/31/11 and 1/1/12 – 4/17/12

IRS Form 8889: HSA Worksheet which will accompany your 1040. The purpose of this worksheet is to:

• Report your HSA contributions (including those made by you, other parties and/or your employer.)
• Report your HSA distributions (qualified medical expenses, non-qualified rollovers, and withdrawals for excess contributions)
• Figure your HSA above-the-line deduction (pre-tax contributions are deducted from your total contributions and are not included in the above-the-line deduction)
• Figure amounts that must be included in your income and additional taxes owed if you were not eligible for your HSA contributions through the testing period
• Report and HSA you acquired upon the death of an HSA owner

IRS Form 5329: Necessary only to report excess HSA contributions not withdrawn prior to the tax filing deadline
Source: umb.com

Other PPACA Benefits  Coming Soon to a Plan Near You!

PPACA contains a number of market reforms that you may be unaware of such as:

Elimination of Pre-existing Condition Exclusions or Waiting Period.

Effective for new and grandfathered plans beginning on or after January 1, 2014 – no
health plan may impose any pre-existing condition exclusion.

Automatic Enrollment.

Employers with 200 or more employees will be required to automatically enroll new full-time employees in coverage with proper notice and the opportunity for employees to opt out of any coverage.

Prohibition on Excessive Waiting Periods.

Waiting periods or probation periods will not be allowed to exceed 90 days for all group coverage – effective with plan effective dates on or after January 1, 2014.

Expanded coverage for Medicaid Prescription Drugs.

Beginning January 1, 2014, smoking cessation drugs, barbiturates and benzodiazepines will be covered.

Increase in Medicare Tax Rate.

In 2013, the Medicare Part A (hospital insurance) tax rate will be increased by 0.9%, from 1.45% to 2.35% on earnings over $200,000 for individuals and $250,00 for married couples filing jointly. A 3.8% assessment will be imposed on unearned income for higher income taxpayers.

Limit on FSAs under Cafeteria Plans.

Contributions to flexible spending arrangements will be limited to $2,500 per year beginning in 2013. This limit will be indexed by the CPI for years after 2013.

Download the March/April 2012 Newsletter

The Family Medical Leave Act of 1993 (FMLA) has been in effect for nearly 20 years now, but if you don’t deal with it often, it can be tricky and difficult to understand, so let’s take a tour of the key points.

FMLA applies to all employers who employed 50 or more employees within a 75 mile radius in 20 or more workweeks in the current or preceding calendar year. This includes joint employers, companies with common ownership and successor employers.

To be eligible for FMLA, an employee must:

• Work for a covered employer;
• Worked for the employer for a total of at least 12 months;
• Have worked at least 1,250 hours over the past 12 months; and
• Work at a location where at least 50 employees are employed by the employer within 75 miles

Any covered employer must grant an eligible employee up to a total of 12 weeks (workweeks) of unpaid leave during any 12 month period for one or more qualifying reasons.

Qualifying reasons for FMLA leave entitlement include:

• Birth and care of a newborn child of the employee;
• Placement of a child for adoption or foster care with the employee;
• To care for a spouse, son, daughter or parent with a serious health condition;
• For certain qualifying circumstances when the employee’s spouse, son, daughter or parent is on or called to active duty with the Armed Forces, National Guard or Reserve

Maintenance of Health Benefits – A covered employer is required to maintain group health insurance coverage for an employee on FMLA leave on the same terms as if the employee were still actively at work.

• The employee is still responsible to pay for their portion of the premium – however the employer can NOT cancel coverage if it is not received.
• In some instances, the employer may recover premiums it paid to maintain coverage for an employee who fails to return to work from FMLA leave
• COBRA is applicable if the employee fails to return to work. The COBRA qualifying event date is the earlier of the date the employee informs the employer of their intent to not return, or the expiration of qualified FMLA leave & the employee fails to return to work

Job Restoration - upon return from FMLA leave, the employee must be restored to their original job or an equivalent job with equivalent pay, benefits, or other terms and conditions of employment

Employee Notice and Certification – - in most cases employees must provide 30 day advance notice of their intent to use FMLA leave.

• If leave is foreseeable, notice must be provided 30 days in advance;
• If leave is foreseeable less than 30 days in advance, then notice must be provided as soon as practicable (the same or next business day);
• When the need is NOT foreseeable, the notice must be provided as soon as practicable based on the circumstances of the individual case.
• Employees must provide adequate information for an employer to determine whether FMLA applies to the leave request.
• If an employee seeks leave for the first time for an FMLA-qualifying reason, they do NOT need to expressly state or even mention FMLA. (this does not apply for any future FMLA leave for the same circumstance)
• Employers may require certification from a health care provider of the serious health condition precipitating the FMLA request.

The Wage and Hour Division of the U.S. Department of Labor investigates all complaints and violations may be brought to court to compel compliance. Individuals are also able to bring private civil action against an employer for violations.

For more information, visit the DOL Wage & Hour Division Website at http://www.wagehour.dol.gov or call their toll-free helpline at 1-866-847-9423.

IRS Posts W‐2 Health Reporting Guidance

One of the provisions of the PPACA (Healthcare Reform Act) was the requirement for employers to begin reporting premiums paid for healthcare in 2011. This was delayed until 2012 (this year), but small employers still get a pass (for now) on this cumbersome reporting mandate.

The purpose of this reporting to employees on the cost of their employer-sponsored group health plan coverage is to “provide useful and comparable consumer information to employees on the cost of their health care coverage.” Currently nothing in the regulations or guidance causes, or will cause employer-provided health care coverage to become taxable.

Here is (some of) what you need to know right now:

• 2012 W-2 Forms, which will be distributed in January 2013 must include the aggregate cost of employer-sponsored health coverage.
• In 2012, employers filing fewer than 250 W-2 forms for the preceding calendar year are exempted from the reporting requirement. This exemption will stand, until further guidance by the IRS is issued.
• Employers that are Federally recognized as Indian tribal governments are NOT subject to the reporting requirements.
• The aggregate reportable cost is reposted on From W-2 in box 12, using code DD.
• The aggregate cost of applicable employer-sponsored coverage is the TOTAL cost of coverage under all applicable employer-sponsored coverage provided to the employee. This means coverage under any group health plan made available to the employee by an employer that is excludable from the employee’s gross income under Section 106.
• A group health plan is defined as meaning “a plan (including self-funded plans) that an employer contributed to in order to provide health care (directly or otherwise) to the employees, former employees, the employer, others associated or formerly associated with the employer in a business relationship, or their families.”
• The cost of coverage for a dental plan or vision plan is not required to be included in the aggregate cost UNLESS is attached to the health plan in such a manner that participants do not have the right to decline dental or vision coverage separately from the health plan.
• The aggregate reportable cost generally includes both the portion paid by the employer and the portionpaid by the employee, regardless of whether the employee paid for that cost through pre or post-tax contributions. This also includes any amounts the employee paid for dependent coverage.

For more information, refer to IRS Notice 2012-9.

Tips for a Healthier You in 2012!

Every January, many people vow to get in shape and focus on healthier eating. Here are some tips to help you succeed in 2013!

Eat a variety of nutrient rich foods.

You need more than 40 different nutrients for good health. Your daily food selection should include fruits, vegetables, dairy, protein and whole grain products.

Enjoy plenty of whole grains, fruits and vegetables.

Your daily intake should include 3 servings of whole grains, 3-5 servings of vegetables and 2-4servings of fruit. Look through cookbooks for tasty ways to prepare unfamiliar foods.

Maintain a healthy weight.

Excess body fat increase your changes for high blood pressure, heart disease, stroke, diabetes, some types of cancer and other illnesses.

Eat moderate portions.

If you keep your portion sizes reasonable, it’s easier to eat the foods you want and stay healthy. A serving of meat is 3 ounces, about the size of the palm of your hand.

Eat regular meals.

Skipping meals can lead to runaway hunger, often resulting in overeating. Packing small healthy snacks can help curb hunger and keep your metabolism up.

Get moving…with baby steps.

Make this the year you get off the couch, but do it slowly. Take the stairs instead of the elevator. Try parking at a little further away from the office or store.

Stretch!

Don’t forget to stretch. It will help reduces sore muscles and prevent injuries. Stretch both before and after exercising.

Download Jan/Feb 2012 Newsletter

President Barack Obama has signed the first rollback of last year’s healthcare law, a bipartisan repeal of a burdensome tax-reporting requirement extremely unpopular with businesses.

The move marked the first successful effort to repeal part of the national healthcare overhaul. Last week, then Senate voted 87-12 to repeal the 1099 provision and the House passed the measure in March on a bipartisan 314-112 vote.

The provision would have required all businesses to report to the IRS all purchases of $600 or more. Speculation was that the amount of reporting this would have generated had the potential to not only place an unnecessary burden on businesses, but could potentially cripple the IRS.

The Senate-passed bill would cover the estimated $22 billion cost of eliminating the provision by forcing greater repayment of health insurance subsidies for families whose income unexpectedly exceeds certain thresholds.

In a statement, the President was quoted as stating, “I was pleased to take another step to relieve unnecessary burdens on small businesses.”

The President’s signature caps off nearly a year of wrangling over the health-care law’s 1099 provision.

Sen. Mike Johanns (R-NEB) has led the effort for repeal in the senate. In a statement on 4/14, he said, “Job creators can finally celebrate: the 1099 tax paperwork owners everywhere in keeping this issue at the forefront, because of the good judgment of my colleagues in both houses in recognizing the foolishness of this mandate, and now because of the President’s signature, our job creators can go about their business without fear of being hammered by mountains of additional, unnecessary tax paperwork.”

Group Health Individual Plans Set to Renew 7/1/2011

The annual renewal date for Group Health Cooperative’s individual medical plans is July 1st. In preparation for this renewal, Group Health has begun the communication process of advising clients of the changes that will occur at that time.

Because of the benefit changes being made, state regulation requires that Group Health eliminate and replace the current offering with an entirely new plan. They are also required to notify members that they are replacing their current plan with a new plan that is most like the one they currently have. Each benefit change notification letter includes a high level benefit comparison of both current and new July 1 plans.

Some of the changes are fairly significant, so please take the time to review this letter and make an informed decision regarding your renewal offering.

In the Spotlight

Nancy Giacolone – President

Nancy is the owner/founder of Olympic Crest Insurance. The company was founded 15 years ago when she took a leap of faith and left a brokerage in Tacoma to go out on her own. The driving force was to accommodate the schedule of her then young son.

Today, that son is 19 and the business has grown as well. Olympic Crest Insurance has moved from a home-based business to a thriving member of the Gig Harbor community, employing 5 people.

Nancy is dedicated to maintaining the highest standards for both herself and her business through continuing education and professional affiliations. She has been a Registered Health Underwriter (RHU) since 1990 and participates on several insurance company broker advisory committees and peer groups.

In her spare time, Nancy enjoys spending time with her husband of 25 years, friends and family. She loves reading, working out and a good movie. She is also a passionate cook and budding photographer. She has combined her love of food and photography in an amateur blog sharing her food adventures. You can check it out at http://cookshootblog.com

Nancy can be reached at our regular office numbers or via email at : nancy@olympiccrest.com.

April 23‐30 is National Infant Immunization Week

National Infant Immunization Week (NIIW) is an annual observance to promote the benefits of immunizations and to improve the health of children two years old or younger. NIIW is part of a broad global initiative with the World Health Organization Regions of the Americas, European, Eastern Mediterranean, Western Pacific, and Africa to promote vaccination through education and communication activities. Since 1994, local and state health departments, national immunization partners, health care professionals, community leaders from across the United States, and the Centers for Disease Control and Prevention (CDC) have worked together through NIIW to highlight the positive impact of vaccination on the lives of infants and children, and to call attention to immunization achievements.

Through immunization, we can now protect infants and children from 14 vaccine preventable diseases before age two.

For more information visit: http://www.cdc.gov/vaccines/events/niiw/overview.html

New Benefits for Preventive Care – What does it Mean to You?

One of the recent changes to affect your healthcare plan as a result of Healthcare Reform (PPACA) is the expanded preventive care benefit. Non-grandfathered plans are now required to cover in-network preventive care services at 100% without any required copay or cost share to you.

What is considered Preventive Care and who makes the determination? The law requires that services that are Grade A or B Recommendations by the Health and Human Services (HHS) U.S. Preventive Services Task Force are included in the preventive benefit. This is a very comprehensive list of services, some of which include:

• Services for Adults: Blood Pressure Screening -Cholesterol Screening – Colorectal Cancer Screening – Depression Screening – Immunization Vaccines
• Services for Women: Breast Cancer Screening – Cervical Cancer Screening – Osteoporosis Screening – Tobacco Use Screening & Intervention
• Services for Children: Autism Screening – Behavioral Assessments – Fluoride Supplements – Immunization Vaccines – Oral Health Risk Assessments – Vision Screening

For a complete listing of covered services under the Affordable Care Act, please visit their web page at: http://www.healthcare.gov/law/about/provisions/services/lists.html

Tips for Coping with Seasonal Allergies

Have you ever wondered exactly what is causing your sneezing, runny nose and itchy eyes? It may be seasonal allergies. During the months of March & April, tree pollen from oak, elm and birch are the primary factors. From May through July, grass pollen dominates the seasonal allergy scene.

There are a few things that everyone can do to help themselves with seasonal allergies:

1. Close your windows and limit the entry of pollen into your home. Use your airconditioning and keep your air and furnace filters clean.
2. Reduce your outdoor activities when pollen is at its highest. Be particularly careful on windy and humid days.
3. Shower right before you go to bed. If you shower at night, you help get rid of any pollen you’ve picked during the day
4. Wash your bedding frequently and dry it indoors.
5. Take the right antihistamine for you. Many are non-sedating. You may also need a decongestant to help relieve nasal symptoms.
6. Don’t forget to see a doctor. Your doctor can help identify your particular allergen triggers and get you the right treatment.

Source: http://www.allergyrelief101.com

Download April/May 2011 Newsletter

If you are looking for individual medical coverage for your family which includes children under the age of 19, you may have been frustrated to find that you can not enroll them outside of the special “open enrollment periods” which will occur twice a year. If you miss these windows, you are out of luck!

This is just one of the unintended consequences which are a result of the recently enacted Affordable Care Act otherwise know as Healthcare Reform. One of the provisions is that insurers cannot impose pre-existing condition waiting periods on children under age 19, which is a good thing if you are looking for coverage for your children. However, as a result, insurance carriers are wary of the risk involved in taking on children without the benefit of the Standard Health Questionnaire.

The individual health insurance market will have two special open-enrollment periods for children this year. Parents who want to add their children to their individual health plans or buy child-only plans can do so from March 15-April 30, 2011 and from Sept. 15-Oct. 31, 2011.
During open-enrollment times, children under age 19 cannot be denied health insurance because of a pre-existing condition. People looking for coverage for their children outside of the enrollment dates can apply either to the Washington State Health Insurance Pool (WSHIP), or if they qualify, to the new Preexisting Condition Insurance Plan (PCIP-WA). To enroll in PCIP-WA, you must have been uninsured for at least six months and have a pre-existing medical condition.

Exceptions where parents can apply for individual coverage for their kids anytime include the birth or adoption of a child or if a child or the parent:

• Is no longer eligible for a state program.
• Loses coverage due to a divorce.
• Loses employer-sponsored coverage.
• Moves and their plan is not available where they live.

In 2014, when the full health reforms take effect, no one of any age can be denied insurance because of a pre-existing condition . The question is, which insurance companies will continue to offer coverage?

Implementation of Non‐Discrimination Provisions Delayed

The federal health reform law, the Patient Protection and Affordable Care Act (PPACA), includes applying Internal Revenue Code 105(h) to employers offering insured benefit plans. This prohibits employers from discriminating in favor of highly compensated employees and is referred to as “nondiscrimination.”

In late December 2010, the IRS issued a notice that it will suspend enforcement of the health reform law’s nondiscrimination provision until it issues and finalizes regulatory guidance. Based on the best information available to us at this time, that follow-up guidance is expected to be issued in mid-2011.

The IRS’s nondiscrimination rules will apply to non-grandfathered, fully insured groups (selffunded groups are already subject to the nondiscrimination rule in Internal Revenue Code 105(h)). The effective date of new rules, once final, likely will be the first plan year after the rules are finalized.

All plans will be required to comply with the non-discrimination rules beginning in 2014.

Staff Spotlight

Melissa Nesland joined Olympic Crest Insurance in 2010 as an Account Executive with nearly 10 years of business experience in Human Resources and Employee Benefits.

Melissa has re-entered the work force after staying home with her children for a few years. While at home, Melissa worked as an independent contractor, assisting a former client, Talyst, with their Human Resources function. Prior to that, she was with Kibble & Prentice in Seattle for 5 years. While at Kibble & Prentice, Melissa worked her way up from an Account Manger to an Account Executive where she worked on a wide range of groups from large to small. While at Kibble & Prentice, Melissa was awarded the “Heavy Hitter” award for her outstanding sales numbers and the Employee Benefits “Pathfinder” (Employee of the year) award. Before joining Kibble & Prentice, Melissa worked in the Human Resources field.

Melissa is a licensed agent and broker in Washington, with an expertise in Medical, Dental, Disability and Life.
Melissa is currently a member of the Society of Human Resources Management. She enjoys volunteering at her church and just completed a term as Finance Manager for her local MOPS group.

Melissa grew up in Eastern Washington and has lived in the Pacific Northwest her entire life. She currently resides in Gig Harbor with her husband and three children.

Melissa can be contacted via our regular phone numbers or by email at: melissa@olympiccrest.com.

February is Healthy Heart Awareness Month

Valentines Day inspires thoughts about those that make our hearts go pitter patter, but February has another reason to think about your heart as well, it is American Healthy Heart Month.

According to the CDC (Center for Disease Control) Heart Disease is the number one cause of death in America. About every 25 seconds, an
American will have a coronary event.

The chance of developing coronary heart disease can be reduced by taking steps to prevent and control factors that put people at greater risk. Knowing the signs and symptoms of heart attack are crucial to the most positive outcomes after having a heart attack.

Some heart attacks are sudden and intense; however, most heart attacks start slowly, with mild pain or discomfort. Often people affected aren’t sure what’s wrong and wait too long before gettng help. Here are signs that can mean a heart attack is happening:

• Chest Discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness, or pain.
• Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
• Shortness of breath. May occur with or without chest discomfort.
• Other signs. These may include breaking out in a cold sweat, nausea, or lightheadedness.

Source: www.cdc.gov

Caught a Cold? Try These Tips.

‘Tis the season for a runny nose, cough, sore throat and other symptoms of the common cold.

You shouldn’t treat a cold -always caused by a virus -with antibiotics, since these medicines are meant to treat bacterial infections. But there are things you can do to feel better while the cold runs its course.

The University of Virginia Health System offers these suggestions:

• Try over-the-counter medications, such as an antihistamine, decongestant or cough medicine.
• Get plenty of sleep.
• Increase the amount of fluids you drink.
• Take a pain reliever to control headache and fever.
• Soothe a sore throat by gargling with warm salt water.
• Apply petroleum jelly to sore, dry skin around the nose and lips.
• Use a warm steam to ease congestion.

What Do You Know About Wellness Programs?

Wellness programs are gaining in popularity as employers look for new ways to incentivize employees to become active in their own health. Before implementing a program, it is important to understand the role of HIPAA and non-discrimination.

There are basically two types of programs. The first type does NOT require an individual to meet a health related standard in order to receive a reward, such as gym membership discounts , diagnostic testing, or reimbursement for smoking cessation programs.

The second type of program bases the reward on satisfying some type of requirement or standard related to a health factor. For example, a program which rewards a non-smoker or a person who exercises a certain amount with a higher premium contribution. A program is allowed to discriminate on health factors if the following safeguards are followed:

• The reward must be limited to 20% of the employee only premium under the plan.
• The program must be reasonably designed to prevent disease or promote health.
• The program must give eligible members an opportunity to qualify at least once per year.
• The reward must be available to all comparable individuals. Also, a reasonable alternative must be available for whom it may be medically unadvisable to participate.
• The alternative must be communicated as part of the program.

Going Green…E‐Newsletters Coming!

This will be the last issue of our newsletter to be mailed out via the postal service. We have made the decision to transition to an electronic only version. Please make sure we have your current email address so that you can continue to receive the newsletter. It will also be posted on our website under the NEWS tab.

Download February 2011 Newsletter

OLYMPIA, Wash. – The individual health insurance market will have two special open-enrollment periods for children this year. Parents who want to add their children to their individual health plans or buy child-only plans can do so from March 15-April 30, 2011 and from Sept. 15-Oct. 31, 2011.

Insurance Commissioner Mike Kreidler filed a regulation today, creating this year’s open-enrollment periods in the individual market.  The individual health insurance market is for people who do not have access to employer-sponsored health insurance.

New consumer protections under the federal Affordable Care Act prevent health insurers from denying coverage to children with pre-existing health conditions.  However, special open-enrollment periods are allowed.During open-enrollment times, children under age 19 cannot be denied health insurance because of a pre-existing condition. People looking for coverage for their children outside of the enrollment dates can apply either to the Washington State Health Insurance Pool (WSHIP), or if they qualify, to the new Pre-existing Condition Insurance Plan (PCIP-WA). To enroll in PCIP-WA, you must have been uninsured for at least six months and have a pre-existing medical condition.

 Exceptions where parents can apply for individual coverage for their kids anytime include the birth or adoption of a child or if a child or the parent:

•  Is no longer eligible for a state program.
• Loses coverage due to a divorce.
• Loses employer-sponsored coverage.
• Moves and their plan is not available where they live.

 In 2014, when the full health reforms take effect, no one of any age can be denied insurance because of a pre-existing condition.

Anyone with questions about the individual health insurance market can call our Insurance Consumer Hotline at 1-800-562-6900.

In addition, the annual open enrollment period runs from November 15 – December 15 for a January 1st effective date.  Children enrolling during this period are NOT required to complete the Standard Health Questionnaire.

All children under the age of 19 are not subject to ANY pre-existing condition waiting periods regardless of their effective date.

On September 27, 2010, Regence Blue Shield announced that they will no longer sell individual policies to applicants under the age of 19.

In addition, individual policy subscribers will NOT be able to enroll a child under the age of 19 outside of an annual open enrollment period established by state regulators. This open enrollment period will be November 1— December 15 of each year for a January 1st effective date. Limited exceptions will apply such as birth, adoption and court orders.

This will not affect currently enrolled individual subscribers under the age of 19.

A family seeking individual coverage will not be able to enroll any child under the age of 19 for coverage outside of the annual open enrollment period.

At the present time, Lifewise, Group Health and KPS Heath Plans are all still accepting applications and offering coverage for all ages.

IRS Delays W-2 Reporting Requirements

The IRS today issued a draft Form W-2 for 2011, which employers use to report wages and employee tax withholding. The IRS also announced that it will defer the new requirement for employers to report the cost of coverage under an employer-sponsored group health plan, making that reporting by employers optional in 2011.

The draft Form W-2 includes the codes that employers may use to report the cost of coverage under an employer-sponsored group health plan. The Treasury Department and the IRS have determined that this relief is necessary to provide employers the time they need to make changes to their payroll systems or procedures in preparation for compliance with the new reporting requirement. The IRS will be publishing guidance on the new requirement later this year.

Although reporting the cost of coverage will be optional with respect to 2011, the IRS continues to stress that the amounts reportable are not taxable. Included in the
Affordable Care Act passed by Congress in March, the new reporting requirement is intended to be informational only, and to provide employees with greater transparency into overall health care costs.

Sign Up Now for Free Individual Medical and Medicare Informational Seminars

As many of you know by now, Regence Blue Shield is discontinuing many of their individual products and clients are being transferred to the new products. To help answer questions, we have scheduled two informational seminars to discuss these changes as well as the new child eligibility rules.

The Medicare Annual Open Enrollment Period is almost here. Learn about the differences between Medicare Supplements, Medicare Advantage Policies and the changes in Medicare Part D coverage for 2011.

Coffee and cookies will be provided.

Sign up now for either of these seminars as space is limited to the first 10 attendees for each session. You can sign up by visiting our website: www.olympiccrest.com and clicking on “Healthcare Reform” Button or simply call the office to register at 253-851-4408.

Health Care Reform Limits Health FSA to $2500 effective January 1, 2013

Now is the time to increase your FSA maximum! Section 9005 of the Patient Protection and Affordable Care Act (“PPACA”) limits the amount employees can set aside in their Health Care FSA. In the past employers could set any Health Care FSA maximum—limits were self imposed with origins in nondiscrimination testing or reducing risk of loss. Effective January 1, 2013, PPACA will limit the amount participants can allocate toward their Health Care FSAs to $2500.

This rule sounds similar to the Day Care FSA but functions in a very different way. The new rule only limits employee contributions, there fore employers can “seed” or “fund” above the $2500 employee contribution limit. For example, an employer could match employee’s contributions of $2500 ($2500 from the employer and $2500 from the employee with a maximum total benefit of $5000).

Although the employer and employee could each contribute $2500 for a maximum benefit of $5000, Flex-Plan recommends that employers simply reduce their total Plan maximum to $2500 to avoid confusion and ensure that no employee exceeds the maximum as the penalties of exceeding the maximum are significant.

The new law states that, “such benefit shall not be treated as a qualified benefit unless the cafeteria plan provides that an employee may not elect for any taxable year to have salary reduction contributions in excess of $2,500 made to such arrangement.’’ Translation: if any employee contributes more than the $2500 threshold the entire plan could lose its pre-tax status.

Got asthma? Your pillow, a haven for dust mites, could be making matters worse. Wash your pillows regularly and replace them annually

No matter how picky we are about our bunkmates, there will always be unwelcome visitors. Namely, dust mites. They love a warm environment like your bed just as much as you do. And since they snack on dead skin cells, they have no reason to leave. (We’re guessing they never heard the saying about not relieving themselves where they eat.) Good news is, they’re harmless unless you have allergies or asthma.

To keep their count down, wash your sheets in hot water regularly, and fluff your pillow in the dryer on its hottest setting. The most recent information on dust mites suggests using a combination of physical measures – including pillow and mattress covers, washing bedding in hot water and carpet removal – rather than chemical treatments. But be forewarned: at least three to six months of sustained intervention is necessary to show real benefit. That means you should put measures in place that you can sustain over time and expect symptoms to improve gradually

IRS Announces Guidance on Over-the-Counter Medicines and Drugs

Effective 1/1/2011, PPACA requires that over-the-counter medications require a written prescription to eligible for reimbursement through an employer sponsored flexible spending accounts (FSAs), health reimbursement arrangements (HRAs) and health savings accounts (HSAs). It also is a requirement to be considered an eligible expense under an individual health savings account (HSA) or medical savings account (MSA). The guidance provides that OTC medicines or drugs purchased after December 31, 2010, may be reimbursed through an FSA only if such OTC medicine or drug is prescribed. This new rule excludes insulin.

Per IRS Notice 2010-59, items requiring a prescription include:

• Acid Controllers
• Allergy & Sinus medicine Antibiotics
• Anti-Gas Products
• Anti-Parasitic Treatments
• Cold Sore Remedies
• Digestive Aids
• Hemorrhoidal Preps
• Motion Sickness
• Respiratory Treatments
• Stomach Remedies
• Anti-Diarrheals
• Anti-Itch & Insect Bite
• Baby Rash Ointments/Creams
• Cough, Cold & Flu
• Feminine Anti-Fungal/Anti-Itch
• Laxatives
• Pain Relievers

Principal Financial Plans Exit from Medical Market

Principal Financial has announced their decision to exit the health insurance business by winding down operations within the next 36 months. They are working with United Healthcare to provide an easy transition for medical clients.

They are only exiting the medical market and will continue to provide life, dental, disability and vision products whether fully insured or self-funded. In addition they will continue to offer wellness programs, health savings accounts and retirement options.

In this environment of health care reform, rising costs and shrinking budgets, it is easy to be lured by the promise of an extremely affordable health plan.  Unfortunately, many of these plans are fake, and the only party benefiting is the scammer behind the plan. 

Modern Healthcare (8/12, Vesely) reports, “Federal and state law enforcement agencies are working together to crack down on fake ‘medical discount plans’” that typically “target the uninsured with the promise of cut-rate health coverage.” The FTC is acting with officials in 24 states on “54 lawsuits and regulatory actions to stop these scams. The charges include peddling sham insurance, conducting illegal robocalls and fax blasting.” Modern Healthcare notes that three companies, the Consumer Benefits Association, United States Benefits and Health Care One, “have been charged with deceptively marketing medical discount plans.” Authorities said that those companies took enrollment fees and “then did not allow customers to disenroll.”

Reuters (8/12) reports that such plans have proliferated since healthcare reform laws were passed, and the FTC’s David Vladeck said, “The uncertainty about the benefits that will be available under the new federal insurance program and the fact that the budget doesn’t kick in until 2014 is going to give scammers very fertile ground for this. … They’re going to try to capitalize on uncertainty.”

The Sacramento Business Journal (8/12, Robertson) says that Healthcare One “had already stopped operating in California, though advertisements were posted in the Sacramento area earlier this year.” State authorities “issued a cease-and-desist order in February, after concluding the company was engaged in deceptive marketing that misled consumers into believing they were buying health insurance.”

The South Florida Sun-Sentinel (8/12) reports that the Consumer Health Benefits Association operated in Coconut Creek, had “sold worthless policies to about 40,000 people nationwide” since 2003, “and collected an estimated $15 million over two years,” according to the FTC. The Sun-Sentinel adds that the FTC’s “suit against CHBA also names its Florida subsidiaries, National Benefits Consultants and National Benefits Solutions, as well as company President Ron Werner, Vice President Louis Leo and Operations Manager Rita Werner, all based in Coconut Creek.”

The St. Paul Pioneer-Press (8/12, Snowbeck) reports that Minnesota Attorney General Lori Swanson “brought a lawsuit against one of the three companies — Consumer Health Benefits Association of Florida — charging the firm with pressuring Minnesotans over the phone into buying a low-cost health plan that wasn’t really insurance and offered few benefits.” The state “won a consent judgment barring the company and its principals from selling health discount plans in Minnesota.” In addition, “the company must pay $500,000 in restitution and penalties.” Bloomberg News (8/12, Wayne) reports that Swanson “said economic conditions also created the potential for scams. In her state, the number of uninsured people increased to 9 percent last year from 7 percent in 2007,” creating what she called “a real spike in complaints.”

According to the Memphis Commercial Appeal (8/12), authorities “raided the Nashville office of United States Benefits LLC on Aug. 5 after numerous consumer complaints,” and the FTC filed a complaint in US District Court there accusing “the company and its owner, Timothy Thomas, of violating the Tennessee Consumer Protection Act and the Federal Trade Commission Act” as well as “the federal Telemarketing Sales Rule and the Do-Not-Call law.”

Before you sign, verify the legitimacy of the plan.  Call a reputable local insurance broker, the State Insurance Commissioner or the Federal Trade Commission.

By now, most everyone is aware that Healthcare Reform was signed into ef‐ fect back on March 23, 2010 in the form of the Patient Protection and Affordable Care Act (PPACA). We are just beginning to feel the first effects of this new law.
Changes that have already occurred which may impact you include; raising the age for dependent coverage to 26 and eliminating education or tax dependency qualifications, small business tax credits and the establishment of a national risk pool for individuals.

The temporary Federal High Risk Pool will be effective for coverage September 1, 2010 and will be operated in Washing‐ ton alongside the existing state high risk pool.

To be eligible for the Federal Pool, an applicant must have been uninsured for at least six months and have evidence of having one of the eligible pre‐existing medical conditions. For a list of eligible pre‐existing conditions, visit www.insurance.wa.gov . See the adjoining comparison of the two plans.

Regence Blue Shield ­ Individual Plan Rate Changes & Product Discontinuation

Regence Blue Shield has filed with the OIC for their annual adjustment to rates for individual plans. This rate adjustment is scheduled to take place 9/1/2010. If approved as filed, this will result in an average increase in current rates of approximately 16%.

Factors driving this increase include the new state mental health parity requirements, cost shifting of childhood vaccinations as of result of discontinued state funding, increased eligibility for child coverage as a result of health care reform and the impact of a larger percentage of enrollees coming on to coverage without health screening. Members exempt from health screening cost the plan an aver‐ age of 67% more than non‐exempt members.

Regence will also be discontinuing all of their closed individual plans as of 1/1/2011. Members will be mapped over to the most comparable Evolve product. Notices will be sent out in October notifying you of the change.

More Free Healthcare Reform Seminars Coming Soon!

Beginning in September, we will begin hosting our next series of lunch & learn seminars to help you understand the impact of health care reform on Medicare and Medicare Advantage Plans.

The seminars will be free and coffee and cookies will be provided. Check our website frequently for updates and availability as space will be limited.

Download July 2010 Newsletter