Listen to Tom Quigley Talk About Obamacare on ClaimLinx Podcast

It’s been said leaders should “be a voice, not an echo.”

Well, ClaimLinx has found its voice and is broadcasting it on Blog Talk Radio.

ClaimLinx now records a biweekly podcast, Cutting-Edge Benefits, which puts traditional health insurance buying on the chopping block. During each show, Tom Quigley, National Business Consultant, covers important topics business owners need to know so they can make informed health care decisions.

Related Post: ClaimLinx Launches Podcast Digging Into Traditional Health Insurance

The next episode of Cutting Edge Benefits will be recorded today at 4 p.m. Listen live or call in with questions as Tom takes a look back at the past five years with the Affordable Care Act.

Previous episodes have covered topics such as deciphering the difference between benefits and insurance.  Listen to the entire show, during which Tom said:

“Insurance should take away catastrophic risks that owners don’t want to take on. And also, with the new Affordable Care, preventative risks and all the benefits within the health insurance plan must cover the ten essential benefits with no limits.”

“Why are you offering benefits? And if the answer is to provide better benefits than the competition and take care of your employees, why would, every year when the broker comes out, would you go from paying $10,000 a month to $11,000 a month? And it would have been $13,000 a month but you decided to raise the deductible from $1,000 to $2,000 and your copays go from $25 to $35.  Why do you keep doing the same thing over and over again? Owners, you have to step up to the plate, get involved. This is an owners’ decision, with a CFO, CPA or tax attorney who understands the new Affordable Care Act. It is a huge opportunity for business owners to provide better benefits at a fraction of the cost.”

In the next episode, he went on to discuss who exactly should be in the room making these decisions. You can still listen to the full episode, when Tom said:

“Health insurance wasn’t a top ten expense 20 years ago. It has become, in some cases, a top three expense for companies. The problem is the owners need to be involved in every aspect of their business, when it comes to their balance sheet and the top three expenses. What they’ve done is they’ve allowed people within their company to make the decision and it’s becoming a major, major headache not only for the owner, but also for the employees. The decisions made with the new tax law called the Affordable Care Act are some of the worst decisions I’ve seen in the last twenty years in this business.”

Related Post: Tom Quigley Breaks Down Employee Expectations for Benefits

“There’s a problem in this country starting in Jr. High. They should be teaching these kids about finance and insurance and things that they need to know. Because you have people running around this country who don’t understand that buying a $20 copay from an insurance carrier makes absolutely no sense. It would be like buying oil change insurance for your car or plumber’s insurance for your home … and it boils down to education.”

Follow Cutting-Edge Benefits by ClaimLinx on Blog Talk Radio or Twitter for updates on new episodes. Look for #CLVoice for more information.

After Five Years With The ACA, Approval Is Low But Success Is High

The end of March marked the five-year anniversary of the Affordable Care Act being signed into law by President Barack Obama.

“It’s working despite countless attempts to repeal, undermine, defund and defame this law,” Obama said in his speech during the anniversary ceremony on March 23.

The Affordable Care Act is responsible for a number of significant changes to health care requirements for insurance companies, employers and individuals.

Related Post: Another Affordable Care Act Mandate Delayed

Insurance companies are no longer allowed to deny coverage because of a preexisting condition. There are no longer any annual or lifetime limits. Preventative care is now covered at no cost. Companies are no longer allowed to charge women at higher rates than men, and any young adult is now allowed to stay on his or her parent’s plan until turning 26 years old.

Regular individuals are now required to have coverage for a majority of the year or pay a penalty tax. Likewise, employers with more that 100 full time employees are now required to provide an affordable plan or pay a tax penalty.

All the while, these changes have been met with constant disapproval and derision. Even now, the future of law is uncertain, as the Supreme Court is expected to make a decision on the case King v. Burwell, which could have drastic effects on peoples’ eligibility for subsidies.

And the now GOP-dominated Congress has already put plans in motion to make changes to the employer mandate, which has been so hotly contested since the enactment of the law.

One thing is certain though — the Affordable Care Act has provided people with the resources and incentives necessary to get coverage. As of March 2015, more than 16 million people were covered because of the federal and state exchanges, Medicaid expansion, and the provision allowing young adults to remain on their parents’ plan.

It’s the primary point Obama focused on in his speech, the difference the law has made in getting people the coverage they need.

“For folks who are basing their entire political agenda on repealing the law, you have got to explain how kicking millions of Americans off their insurance is somehow going to make us more free.”

Overall approval of the law among Americans is still split, but the gap between favorable and unfavorable opinions has narrowed to the closest margin in two years, with 43 percent opposed to the ACA and 41 percent in favor, according to the Henry J. Kaiser Family Foundation.

Approval among employers is still low, as in some cases it has required an increase in coverage or implementation in plan administration. Recently, in two separate House subcommittee meetings, employer and industry representatives testified about the effectiveness of the mandates as well as expressed real-world experience with the law.

Sally Roberts, director of human resources at Morris Communications Company, who testified on behalf of the Society for Human Resources Management said she now spends twice as much time administering benefits.

“The ACA has made benefits much more complicated than they were before,” she said to Employee Benefit News.

Related Post: Listen to Tom Quigley Talk About Obamacare on ClaimLinx Podcast

However, the law has not had quite the adverse effect on business or insurance plan rates that was once predicted. In fact, premium increases are significantly lower than they have been in the last 50 years.

Premiums for family policies in the group market grew by 72 percent between 1999 and 2004; 34 percent between 2004 and 2009; and 26 percent between 2009 and 2014.  But in 2014, premiums increased by only 3 percent, according to the Henry J. Kaiser Family Foundation.

It’s perhaps because of these victories that Obama remains optimistic about the progress and future of the law, despite all of the issues so far.

“We’ve made our share of mistakes since we passed this law. But we also know without a shred of a doubt that the policy has worked. Coverage is up. Cost growth is at a historic low. Deficits have been slashed. Lives have been saved”

IRS Guidance Causes Confusion About ACA Requirements

Once again, the world of employer-provided benefits is swirling with confusion because of an additional guidance the Internal Revenue Service released on Feb. 18.

First and foremost, know that if you are a ClaimLinx member, your plan meets the ACA requirements. ClaimLinx is constantly partnered with tax attorneys to be absolutely certain we understand any new information so that if adjustments need to be made to your company plan, we can do so immediately.

Related Post: IRS Will Not Penalize Those Who Received Incorrect Health Care Form

What this notice is all about:

IRS Notice 2015-17 concerns employer payment plans and their compliance with the Affordable Care Act’s requirements for group health plans.

In this case, employer payment plans refers to those group health plans in which employers set an annual limit for health insurance premium and reimburse employees for an individual health insurance plan, until he or she reaches that limit.

This was a common practice in the past, for those companies that could not afford to provide a traditional group health plan purchased from an insurance company. However, the ACA now requires that all group plans have no annual or lifetime benefit limits. Therefore, this strategy for a group plan does not meet the requirements of the ACA market reforms and would involve the employer paying a tax penalty, under Internal Revenue Code § 4980D.

Why this can be misleading about your plan:

Unfortunately, the IRS guidance does not specifically make distinctions about the type of employer payment plans it is referring to, so many employers with non-traditional benefits strategies, like clients of ClaimLinx, have been concerned by its general release.

The ClaimLinx strategy for purchasing benefits does not include setting a specific annual limit on health care premium. Instead, the employer purchases an individual plan for the employee, sets an employee contribution level and supplements any remaining benefits through the secondary Medical Expense Reimbursement Plan.

Related Post: ClaimLinx Glossary: Medical Expense Reimbursement Plan (MERP)

How your group plan meets ACA requirements:

A group health plan’s level of compliance with ACA requirements refers to its fulfillment of certain new market reforms. The law now requires that all plans include the following provisions:

— There are no annual or lifetime benefit limits

— No one is denied coverage because of a preexisting condition

— The ten essential benefits are covered

Meeting these requirements can be done in a number of ways, including purchasing a traditional group plan through an insurance carrier, purchasing individual plans on the marketplace, purchasing individual plans through an insurance carrier or even completely self-funding the benefits.

As a ClaimLinx client, you know we have found the most cost-effective way of providing group benefits is to purchase high-deductible individual plans or one high-deductible group plan and then add any extra benefits through a Medical Expense Reimbursement Plan.

It is clear, in studying the actual requirements within the Affordable Care Act, that this strategy for purchasing benefits complies with the market reforms and would not incur tax penalties from the IRS.

Additionally, the IRS specifically acknowledges in Notice 2013-54, referenced in the most recent guidance, that employer payment plans do qualify as group health plans, as long as they fulfill the market reforms.

“A group health plan, such as an employer payment plan, that reimburses an employee’s substantiated individual insurance policy premiums must satisfy the market reforms for group health plans.”

Therefore, as long as your group plan continues to follow the market reforms, there can be no problems or challenges to your compliance with the law.

How to decipher guidance in the future:

As the ACA continues to change and evolve, we can guarantee there will be more misleading guidance that will be released from the IRS, Department of Labor, Department of Treasury and other government bodies.

When guidance is released, it is important to remember it is sent to the general public indiscriminately, whether it applies to how you purchase your benefits or not. It can be especially frightening for businesses that do not have traditional group plans purchased directly from insurance companies, but this does not automatically mean that your plan is not meeting ACA requirements.

It’s also important to note guidance and notices released from these government organizations are interpretations and/or applications and are not directly associated with the law itself. As the IRS states, “in its role in administering the tax laws enacted by the Congress, the IRS must take the specifics of these laws and translate them.” For this reason, it is important to always reference the actual law, rather than exclusively depending on guidance and FAQs.

If you have more questions regarding your company’s compliance with the ACA requirements, please email

Changes on Horizon for ACA Employer Mandate

The GOP-dominated House of Representatives moved forward yesterday in its goal of redefining some of the key requirements in the employer mandate of the Affordable Care Act.

H.R. 30, the “Save American Workers Act,” passed in the House by a vote of 252-172. The bill would change the definition of a full-time employee under the Affordable Care Act from one who works 30 hours per week to one who works 40 hours per week.

Related Post: Senate Republicans Fail to Pass ACA Replacement Bill

Despite threats from the White House that President Barack Obama would veto the bill should Congress approve it, Senator Susan Collins (R-ME) introduced the same bill this week in the Senate.

Last year, the same legislation passed in the House, but was ignored by the Senate. However, it is much more likely the bill will see consideration in the now Republican-controlled Senate.

The passage of the legislation in the House has been met with mixed reviews. Opponents of the 30-hour rule have long argued that it would cause employers to limit hourly workers’ schedules. Supporters of the law say that it protects employees’ access to coverage.

Related Post: After Five Years With the ACA, Approval Is Low But Success Is High

No matter which side you support, the action only supports what people who have long watched the changes to the Affordable Care Act have known for a while: the employer mandate requirements for 2016, and likely even 2015, will be markedly different from those in the original document.