Viewing posts from: September 2014

AP Benefit Advisors, LLC Partners with AssuredPartners, Inc.

Posted September 30, 2014 by Megan DiMartino

Group Benefits & Compliance

AP Benefit Advisors, LLC, announces a partnership with AssuredPartners, Inc. AP Benefit Advisors operations will continue under the leadership of Reagan Crawford. AP Benefit Advisors is a full-service benefits consulting, administration and brokerage firm that helps organizations manage and deliver the best value for employee health and welfare programs. Combining the industry’s top talent and web-based technology ensures Crawford can deliver innovative solutions that improve the health of company employees while optimizing bottom line results.

“Our number one priority is developing benefit programs for our clients that maximize employee value and improve the bottom line,” said Reagan Crawford, Managing Member of AP Benefit Advisors. “As part of the AssuredPartners team, our employees agents will leverage new tools and resources to deliver optimal solutions to our clients, while continuing to offer our Single-Source-Solution model to our client-partners.”

“Our growth strategy is to strengthen our presence in existing markets, and to expand the AssuredPartners footprint to new markets. The AP Benefit Advisors acquisition marks our entrance into the Maryland marketplace,” said Tom Riley, President and COO of AssuredPartners, Inc. “We welcome the AP Benefit Advisors staff and clients to the AssuredPartners family.”

AP Benefit Advisors produces a nationally renowned monthly benefits and ACA compliance webinar series which has been viewed by thousands of C-Suite and human resource executives. Over four years of webinars are now on-line and available at the AP Benefit Advisors website. Visitors will also benefit from white papers, tools, calculators, videos and a comprehensive benefits and compliance blog. For more information about AP Benefit Advisors, please visit:

ABOUT ASSUREDPARTNERS, INC – Headquartered in Lake Mary, Florida and led by Jim Henderson and Tom Riley, AssuredPartners Inc., a portfolio company of Chicago-based private equity firm GTCR, acquires and invests in insurance brokerage businesses (property and casualty, employee benefits, surety, MGA/wholesalers) across the United States and in London. From its founding in March of 2011, AssuredPartners has grown to approximately $380 million in annualized revenue and continues to be one of the fastest growing insurance brokerage firms in the United States with more than 80 offices in 27 states and a London office. Since 2011, AssuredPartners has acquired 69 insurance firms. For more information, please contact Dean Curtis, CFO, at 407.708.0031 or, or visit

The IRS Expands Permitted Election Changes for Health Plans under Section 125 Plans

Posted September 26, 2014 by PHaynes


The universe of permitted election changes under a cafeteria plan has been expanded. As with all IRS-permissible-change rules (often referred to by employers under catch-all phrases like “status changes”, “life events”, etc.), employers/plan sponsors have the option to implement these rules or not.

With Notice 2014-55, the IRS expanded the permitted election changes to allow for mid-year drops of the employer-sponsored coverage.

Situation One – Reduction of Hours

Your employee’s hours of service are reduced below 30 hours per week, but she has not lost her eligibility for coverage under your group health plan (perhaps because your compliance with the variable hour rules means you will keep her on the plan until the expiration of her “stability period”). She now wants to elect other coverage. The change/drop must correspond to Exchange enrollment for a plan that provides Minimum Essential Coverage (or “MEC” for short).  (The same is true for any affected family members).

Situation Two – Public Exchange Coverage is sought

Your employee would like to drop your group health plan to elect coverage on a federal or state exchange, and does not want any overlapping periods (“periods of double coverage”). Beginning September 18, 2014, cafeteria plans may allow her to prospectively revoke her election for your group health plan, that provides at least a MEC. However, she may not drop her Health Care FSA. Specific conditions do apply.

This employee’s new coverage must be effective no later than the 1st day of the 2nd month following the month in which the original coverage is dropped. Your plan may rely upon the employee’s word (“reasonable representation” that they “intend to enroll”).

An employee who seeks Exchange coverage during either a special enrollment period or an open enrollment period may drop her group health plan coverage mid-plan-year. Again, only if the change corresponds to her intended enrollment (and that of any affected family members).

Effective Now

While the IRS does plan to amend the permitted election changes under Section 125 regulations (to reflect this new guidance), employers/plan sponsors and taxpayers can rely on this guidance immediately.

Do I have to amend my plan?

If you want to make these optional features part of your plan, then, Yes, a plan amendment (E.g. an SMM) is required. Also, the changes may only be proactive. No retroactive election changes will be permitted.

When do I have to make a decision about this?

Your amendment must be adopted on/before the last day of the plan year in which the additional changes are allowed and can be effective, retroactively, to the 1st day of that plan year, provided the plan informs all participants of the change.

Under a special rule, employers/plan sponsors that begin to allow these changes during the 2014 plan year have until the last day of their 2015 plan year to adopt this amendment.

Reminder, even though a plan amendment may be adopted retroactively, any election change about revoking coverage, must be made prospectively.


Health Care Reform Has Cost $73 Billion So Far

Posted September 26, 2014 by Megan DiMartino

Costs of reform expected to continue growing – From the Washington Free Beacon imageThe Affordable Care Act and its companion electronic health records system have cost the U.S. more than $73 billion in the nearly five years since their passage–and the cost will only rise, Bloomberg Government reported.

The total also includes the cost of the website and its enrollment systems.

BGOV’s analysis shows that costs for both and the broader reform effort are far greater than anything publicly discussed. They’re also substantially greater than what the Congressional Budget Office (CBO) initially estimated health reform would cost by this point, although not what the agency’s more recent piecemeal estimates suggest.

Meanwhile, the changes in health-care financing and delivery on which the money is being spent remain very much in their startup phase.

An expansion of health coverage that has reached millions of previously uninsured Americans still depends on a shaky and apparently incomplete information technology (IT) system.

A planned overhaul of health-care delivery is still experimenting with ways to improve care and reduce costs.

New IRS Publication Helps You Find out if You Qualify for a Health Coverage Exemption

Posted September 23, 2014 by PHaynes

IRS-logoBy the Internal Revenue Service


Taxpayers who might qualify for an exemption from having qualifying health coverage and making a payment should review a new IRS publication for information about these exemptions. Publication 5172, Health Coverage Exemptions, which includes information about how you get an exemption, is available on

The Affordable Care Act calls for each individual to have qualifying health insurance coverage for each month of the year, have an exemption, or make an individual shared responsibility payment when filing his or her federal income tax return.

You may be exempt if you:

  • Have no affordable coverage options because the minimum amount you must pay for the annual premiums is more than eight percent (8%) of your household income,
  • Have a gap in coverage for less than three consecutive months, or
  • Qualify for an exemption for one of several other reasons, including having a hardship that prevents you from obtaining coverage or belonging to a group explicitly exempt from the requirement.

On, you can find a comprehensive list of the coverage exemptions.

How you get an exemption depends upon the type of exemption. You can obtain some exemptions only from the Marketplace in the area where you live, others only from the IRS when you file your income tax return, and others from either the Marketplace or the IRS.

Additional information about exemptions is available on the Individual Shared Responsibility Provision web page on The page includes a link to a chart that shows the types of exemptions available and how to claim them. For additional information about how to get exemptions that may be granted by the Marketplace, visit

Health Care Reform Update: CMS Announces Plan to Auto-enroll Current Marketplace Members

Posted September 23, 2014 by Megan DiMartino

CMS_LogoThe Centers for Medicare & Medicaid Services (CMS) recently announced a plan to allow members to keep their current Marketplace plans in 2015. Those members who have no change to their income or family situation and want to keep their same plan do not have to do anything, and they will be auto-enrolled in the same Marketplace plan next year, with the same premium tax credit and financial assistance, if applicable.

Members are encouraged to visit the Marketplace to see if they qualify for additional financial assistance and to shop for plans. Specifically, those consumers whose 2013 tax return indicates that they had very high income, or who did not give the Marketplace permission to check updated tax information for annual eligibility redetermination purposes, will get auto-enrolled without financial assistance if they do not visit the Marketplace to check if they qualify for financial assistance.

To view the full release, click here. To learn more about health care reform and how these changes will affect your organization, contact us.

Webinar: Innovative MEC Plans Allowable Under ACA – Reducing Employer Penalties

Posted September 17, 2014 by Megan DiMartino

PPACAJoin AP Benefit Advisors Senior Counsel Patrick Haynes and UnitedHealthcare Vice President Patti Walsh as they review innovative larger employer MEC solutions, and how to differentiate and avoid employer penalties. What are the implications and nuances pertaining to MEC (Skinny) plans, and what can be done to ensure PPACA compliance with these plans? Topics for this webinar include:

  • Complying with PPACA
  • How these plans can reduce employer penalties
  • Employee mandate
  • Solutions to insure the high deductibles
  • MEC plan innovations

Date & Time: Thursday, September 25 @ 12:00 – 12:30pm EDT
Open to all HR professionals – but not brokers, agents, TPAs, PEOs

Space is limited – reserve yours now.

Top Benefits & Health Care Reform Blogs

Posted September 12, 2014 by Megan DiMartino

PPACA2Health care reform due to PPACA and related legislation continues to have a dramatic impact on all sectors of the market. Want your business to avoid significant penalties and fines? Stay on top of the latest rulings and their implications. Here are a few of our most popular recent benefits legislation and health care reform blogs:

Rising Popularity of Self-Insured Plans among Small and Midsize Employers

Posted September 5, 2014 by Megan DiMartino

healthcareAnalyticsThe affordable care act exempts stop-loss plans from minimum loss ratio requirements, and self-insured plans from industry fees, incentivizing such plans for small and midsize employers. This should increase demand for stop-loss insurance as businesses try to avoid the increasing costs associated with healthcare in the United States.

In spite of the fact that self-insured plans pose greater risk to the employer, the significant potential for cost savings is now outweighing these risks, even for smaller employers, a market in which self-insured plans were previously quite uncommon. This shift may have a positive impact on employee health and satisfaction, as workplace wellness will more effectively contribute to savings in benefits costs.

Given that many of these newly self-insured employers will be significantly smaller than the customary size for such plans, demand for stop-loss policies covering catastrophic claims will become increasingly important. Even with catastrophic stop-loss coverage, self-insured plans present increased risk. But the cost savings are potentially great, as employers can customize plans to their employee population, employers maintain control over interest-bearing health plan reserves, and self-funded plans follow federal Employee Retirement Income Security Act regulation instead of state health rules. Moreover, employers avoid paying state health insurance premium taxes.

To learn more about self-insured plans for employers of all sizes, contact us.

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