During the first part of January, eligibility reports will be generated based on HRA account balances and insurance eligibility codes in SCUPPS, the System’s electronic personnel management system.  Based on those reports, a $600 account will be established for each eligible Administrator and $800 will be established for each eligible IFO member at Eide Bailly, the Administrator for the HRA program. 
 
Employees  who had $700 or more in their HRA account at Eide Bailly as of close of business on December 31, 2011, but who satisfy the HCSP eligibility criteria (see criteria a) and b) in Question No. 2) will have a contribution sent to MSRS, for posting to a Health Care Savings Plan account (HCSP) (see Q# 9 for more information on this program).
 
 
Health reimbursement arrangements (HRAs) are subject to COBRA, just like the medical plan. When a member qualifies for COBRA, they can continue to receive the same HRA employer contributions as active employees and must be offered the
opportunity to do so.

Figuring premium is not as easy as dividing annual HRA contribution by 12 and then adding 2%...1 of 2 methods (actuarial or past
cost) are supposed to be used to determine HRA COBRA premium for ex-employees.

The ACTUARIAL METHOD, is used first by assuming a reasonable estimate of the cost of providing HRA coverage to employees and then applying a formula to create a monthly premium. Companies with a newly established HRA must use the actuarial determination method because they have no HRA claim history for the prior year.

With the PAST COST METHOD, calculating the HRA COBRA premiums are based on past HRA expenses and then applying a formula to create the premium.
 
 
We hosted a webinar on the new Summary of Benefits & Coverage (SBC) requirements for HRA, FSA and HSA Plans.  Click HERE for the link to the 20 minute session!
 
 
Health information is considered to be personally identifiable if it relates to a specifically identifiable individual:
1. Health care claims or health care encounter information, such as documentation of doctor's visits and notes made by physicians and other provider staff;
2. Health care payment and remittance advi...ce;
3. Coordination of health care benefits;
4. Health care claim status;
5. Enrollment and disenrollment in a health plan;
6. Eligibility for a health plan;
7. Health plan premium payments;
8. Referral certifications and authorization;
9. First report of injury;
10. Health claims attachments.
 
 
Actuarial Value Bulletin Allows for State Flexibility and Accommodates CDHC Plans On Friday, the Department of Health and Human Services (HHS) released a bulletin that describes their approach to valuing plans that will be offered in the small and individual markets after January 1, 2014. HHS’s proposed approach to the actuarial value requirements established by PPACA would be to create a national standardized approach to determining a plan’s actuarial value (AV) and develop a national “actuarial value calculator" to score plans based on their included benefits. 
 
 
Summaries of Benefits and Coverage (SBC) - rules released on the NEW benefit summary that will need to be released for HRA/HSA/FSA. We will be working with our customers to be sure their plans are in compliance.

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One of biggest areas to highlight is the changes that Healthcare Reform has made to 26 year old age out rules. This specific ruling could likely make the Plan non-compliant, risking the entire pre-tax benefit everyone receives. The most overlooked, but nearly every time needs to be updated, the Premium Only Plan.
 
 
Beginning 10/1/10, HRA plans were required to report on a quarterly basis all covered HRA participants and dependents that meet specific criteria.  If Employers self administer their HRA, they are required to abide by this reporting as we

The purpose of reporting is to enable CMS to correctly pay for health insurance benefits of Medicare beneficiaries by determining primary vs. secondary payer responsibility. The employee/dependent data helps to assure that claims will be paid by the appropriate organization at first billing.
 
 
Health Reimbursement Accounts (HRA's)
PRO:
  Employer owns the money shared by the employees.  Any balance at the end of the year falls back upon the employer.
PRO:  Employees have a substantial percentage of their claims reimbursed by their employer, often pre-deductible and post-deductible.
PRO:  An HRA Arrangement is typically the best way to address concerns from those nervous about HDHPs.
MYTH:  Most or all claims must be substantiated by the HRA Administrator, a process that can take weeks. 
TRUTH:  HRA Claims administered by Polestar Benefits are processed within two business days.
MYTH:  Because claims are processed by an HRA Administrator, employees must pay bills first with their own money.  These costs can be quite high and burdensome to some individuals and families. 
TRUTH:   We offer "Pay to Provider" option which allows employees to submit their reimbursement requests and the money is paid directly to the Provider, without being a burden on the employees pocket.

Flexible Spending Accounts (FSA's)
PRO:
  Pre-tax contributions.
PRO:  Employees have total control over how they spend their money; so long as it is a health care or dependent care related expense (depending on which type of account is opened).
PRO:  Can use an FSA with all types of health care plans, not only high deductible plans.
PRO:  Can be used for "optional" medical procedures not covered by insurance, such as LASIK eye surgery, non-elective cosmetic surgery, braces, etc.
PRO:  Can be used for child care or dependent care (with a Dependent Care Account)
CON:  Use it or lose it.