I’ve struggled with even starting this article, but this topic has been weighing on my mind for well over a year. In our industry, we talk so much about mental health and wellness, which is great. And as those of us in the industry know, under the Affordable Care Act (ACA), we now have Mental Health Parity. And in some places like New York, even before the ACA we had things like Timothy’s Law that gave New Yorkers access to unlimited mental health sessions in network years prior. This is all incredible.
But you know what we haven’t talked about?
The family of the mentally ill or person struggling with addiction. The people who are showing up as caregivers time and time again only to have their hearts broken for the umpteenth time.
I know I live a pretty open life and many of you reading this probably know that I have been sober for over two decades. I’ve chosen a path for myself that has led me to have an incredible life, and I am grateful that I learned at an early age what a degree from the School of Hard Knocks had to offer by making some pretty big mistakes for myself prior to the age of 23. But I know I put my family through a lot and I own it. I have gone on to make my amends and mend the fences that were damaged but not broken. I have worked hard to try and make the right choice each day for myself and others. Of course, this doesn’t mean I’m perfect or that I don’t blunder and step in it from time to time.
I’m not a big one for having regrets, because I truly feel that you are denying yourself your place in the world right now when you say you have them. I choose to not regret the things I have done because I know that they shaped me as the person I am today and as a result, I have been able to help others. But I broke my parents’ hearts. I made the General cry…
Until recently, I don’t think I realized what it was like being in my parents’ shoes. Dealing with someone who is being irrational when you are trying to be logical can be the definition of frustrating. But about a year and a half ago, I got a major life lesson that I didn’t want and certainly didn’t need. This all comes back to a promise I made to my dad before he passed. My dad and I were “Team Type A” in our family, and I knew that when he was dying, he needed to take comfort in knowing that everything would be OK within our family unit. I promised my dad that “I got this” and that I’d look after my mom and my brothers. The year before my dad passed, “Team Type A” got together and we spreadsheeted, we had all the information organized, I knew who to call if a pipe burst in our little apartment building, I knew who to call to sell the Winnebago, I knew who to talk to about VA benefits that passed to my mom, I had all the passwords, we had everything mapped out. But we didn’t talk about my oldest brother, who has dealt with severe mental illness for well over three decades. We just missed it.
Eighteen months ago, I had my ass handed to me. I had never dealt with a mentally ill person who had gone off their meds. It’s uncomfortable; it’s hard. Everything logical doesn’t work. It reminded me about being around someone who is highly intoxicated, which as a sober person, feels unsafe. It was triggering. He ended up getting arrested and then things really got tough. I’m in NYC, he’s in Kansas; there is so much I can do from here….but I promised my dad. This was a dance I had to make up as I went along. A legal eviction led us to have to purchase a home for him to live in, because no rentals would take him with a felony record, a legal eviction, and other charges. I lost a lot of sleep, but ultimately, I felt that I “fixed” the problem, because I am nothing if not tenacious and can basically figure out any problem you give me. But you can’t fix mental illness. You can’t throw money at it and hope it goes away. You can’t pray it away. You can’t act like it doesn’t exist. Because guess what? When you think things are fine, when you start sleeping soundly and things feel back to normal, it breaks again. And it did. It broke again a few months ago, which led to an involuntary commitment into a state hospital. I don’t think it’s necessary to give you a play by play of what happened, but when death threats are happening and you are being told by your brother that he, “Just got off the phone with Dad” (our father passed away in 2018) it’s rough. It makes you want to run away from the situation and never look back.
But I promised.But what did I promise? Did I promise I would put my own health on the line at the sacrifice of someone else? No. Did I promise I would be a horrible boss and a shit wife because I didn’t have the capacity to show up in the world for the people who depend on me? No. Did I promise to put so much stress on myself that I would have chronic diarrhea for 6 weeks straight because I carry my stress in my stomach? No. Would my father want me to work so hard at fixing an unfixable problem for someone who doesn’t put the work in for themselves? Absolutely not. But I did and I have.
When is it time to walk away?
When is it time to put your own mental health and wellbeing first?
I honestly can’t answer those questions for you, because I’m still figuring that out for myself. But I can tell you what I have done. I have shared about it in my 12-step program, I have shared about it with my therapist, and I’ve shared about it with my tight crew. But you know where I’ve gotten the most support? Just like there is a “Dead Dad’s Club” that you never know about until you are indoctrinated into it, there is the “Mental Illness Family Club” and those are the people who have really helped during this time. Those who have it in their families know how hard it can be. How thankless it can be. How “I’ll never get an apology” it can be. How unaccountable it can be. How abusive it can be. To my Superman fans, it’s what I picture Bizarro World to be. And it sucks.
This article isn’t meant to be a “poor me” piece; like I said before, I have a big beautiful life and I was given so many tools and lessons in my life that have prepared me for this … kinda. This article is meant to see the unseen. For those of you who are in this boat, please know that you aren’t alone. I encourage you to share your stories and find support where you can get it. It’s up to you what that looks like.
Don’t ever apologize for putting your wellbeing first when someone is making you the price of admission.
You and/or your employees may be receiving information about a Blue Cross Blue Shield Class Action Settlement soon.
You may be eligible to submit a claim if you are an INDIVIDUAL, INSURED GROUP (and their employees) or a SELF-FUNDED ACCOUNT that purchased or was enrolled in a Blue Cross or Blue Shield from February 7, 2008 through October 16, 2020. This includes groups (and their employees) purchasing coverage through an Association Plan that utilizes one of these insurance companies.
The Net Settlement Fund is estimated to be approximately $1.9 billion after attorney fees, administration expenses and other costs are deducted from the total $2.67 billion Settlement Fund.
We can not estimate how much you might be eligible to receive as it will be based on the number of claimants and several other factors. If the total payment for any claimant is equal or less than $5.00, no payment will be made.
THE INSIDER LEGISLATIVE UPDATES BROADCAST Click the play button below for a broadcast where Colleen Patterson, Director, Employer Services and Compliance, and Christine Guzzardo, J.D., Senior Employer Services Specialist, ERISA, discuss the latest updates on the Blue Cross Blue Shield Settlement.
Below is also some additional contact information for your reference.
As we have been getting several clients that have been reaching out and asking on what would be covered under their health insurance in terms of testing and treatment we wanted to share this helpful chart identifying what the Fully Insured carriers will be doing that our General Agent, Savoy Associates published.
Feel free to reach out with any questions, and remember….WASH YOUR HANDS!
So we are in the home stretch! Three more days to go and then Open Enrollment ends for 2016. From experience, I have learned that many people wait until the last minute to pick a plan and some people just continue to bury their heads in the sand. So for those of you that are wondering, how much it’s going to cost you if you don’t get your act together, take a look at this user friendly graphic that will show you what to expect!
WHO? . . . ALEs must report.
For 2015 information reporting requirements, an Applicable Large Employer (ALE) is subject to the Affordable Care Act health coverage information reporting requirements. For more information on Employer Shared Responsibility and which employers are required to offer coverage, contact our office.
Please note that this applies to:
• Employers who had 50 or more full-time employees, including full-time equivalent employees, in 2014
• Governmental, tribal, tax-exempt, or for-profit employers
• ALEs-whether or not the employers offered health coverage to employees
WHAT? . . . IRS reporting is required for health coverage information.
An ALE must file information returns with the IRS and provide statements to each employee who was a full-time employee for at least one month of the year about health coverage. The employer is required to indicate if they offered health coverage or did not offer health coverage.
WHICH FORMS? . . . Forms 1094-C and 1095-C must be submitted to the IRS.
• Form 1094-C. Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Return is used to report to the IRS summary information for each employer and to transmit Form 1095-C to the IRS.
• Form 1095-C. Employer-Provided Health Insurance Offer and Coverage, is used to report required information to your employees and to report information about each employee to the IRS.
WHEN? . . . Prepare now for the upcoming due dates.
• Forms 1095-C must be provided to your employees by March 31, 2016.
• Forms 1094-C and 1095-C are due to the IRS by May 31, 2016, if filing by paper, or June 30, 2016, if filing electronically.
NEED HELP?
Contact us immediately for a solution that fits your unique filing needs.
This morning, the Internal Revenue Service (IRS) made an announcement that may affect your clients regarding compliance to new Affordable Care Act (ACA) mandated coverage reports (6055 and 6056) for 2015. The IRS announced that it is giving employers additional time to file certain reports. In Notice 2016-4, the IRS stated that it is delaying filing deadlines after determining that “additional time to adapt and implement systems to gather, analyze, and report this information” was needed by employers, insurers, and other providers.
The deadline for employers to electronically file 1094 forms for 2015 was extended by three months from March 31, 2016, to June 30, 2016. The deadline for filing by paper was also extended by three months from February 29, 2016, to May 31, 2016. Additionally, the deadline for providing employees with 1095 forms for 2015 was extended from February 1, 2016, to March 31, 2016.
Click here for today’s IRS announcement or for background about the mandated ACA coverage reports.
I have been traveling and speaking at many conferences this past year and often attend seminars on PPACA. The thing that perplexes me is how my colleagues who are spending thousands of dollars to attend these conferences are still bitching about it. Get over it people… If you are still going to church and lighting a candle that it is going to be repealed, in my opinion, you are wasting time that could be better spent educating yourself and helping your clients.
When I’m faced with a challenge the first thing I ask myself is: “What would it look like if…?” Click here to take a step back and do that.
Since the start of 2014 we’ve been approached by CPAs, attorneys, and other trusted advisors to assist them with Affordable Care Act (ACA) audits, to determine if their clients will be subject to the “Pay or Play” provision come 2015, and then in 2016 if they have more than 50 Full-Time Equivalent (FTE) employees. I wanted to take this opportunity to introduce our ACA auditing services to you.
Currently I’m one of seven brokers in the New York Metro area with a Patient Protection & Affordable Care Act (PPACA) certification through the National Association of Health Underwriters (NAHU). The certification is key, as I’m trained on all the variables within the ACA law and how it impacts companies of various sizes; plus the continuing education keeps me fully informed as Washington adjusts different provisions of the law.
For 2015, companies that have more than 100 FTE employees will be required to offer health coverage to all employees or they will be subject to a fine. That coverage must include the 10 Essential Benefits, or the company will be subject to a different fine. Combs & Company will perform the ACA audit and produce a report that highlights all provisions with which a company must comply (and the consequences if they don’t). We’ll also devise a look-back measurement the company should use to minimize any potential penalties. We’ll also review any Common Ownership issues, as these are often overlooked areas that can impact companies.
This is not a pitch to replace a company’s current broker. We’re offering this service to support a company’s current setup and because we know the level of expertise we bring to the table is not yet common in the industry. (Nor do most brokers want to assume the liability.) We will work with your client’s current broker to gather as much information as possible and then incorporate them into the audit process.
Our service is offered at a rate of $250/hour. The length of each audit depends on the complexity of your client’s business and health plans. We also have an in-house ERISA Attorney who can provide additional services for a flat fee, should any compliance issues come to light during the ACA audit.
If you’re interested in finding out more or having your client schedule a planning meeting with us, feel free to reach out!
You’d be amazed at how many phone calls and emails we have been getting about signing up for the exchange after the deadline. Unfortunately….people that have waited are not special. Everyone had an Open Enrollment Period began October 1st and officially ended in the state of NY as of March 31st, that was 6 months….no one can say they didn’t have enough time but still so many people chose to bury their head in the sand. So if you are one of these people that didn’t sign up what does this actually mean to you:
If you had started an enrollment on the New York State of Health Exchange Marketplace (https://nystateofhealth.ny.gov/) you have until April 15th to get your act together and get your application completed.
If you haven’t started an application yet and you are CURRENTLY UNINSURED, then you are out of luck with Exchange and other Private options until the next Open Enrollment which is set to begin on 11/15/14 for an enrollment of January 1st, 2015. Sorry, no one’s special here.
If you are CURRENTLY INSURED you will be able to take coverage with the Exchange or other private insurance for effective dates after 4/1 as long as you can prove that you have had a Qualifying Life Event. These are listed below:
Individual or dependent loses minimum essential coverage due to:
job loss
divorce
death of a spouse
becoming ineligible for Medicaid or Child Health Plus
expiration of COBRA
health plan is decertified
Marriage, birth, adoption, or placement for adoption
Gaining status as a citizen, national, or lawfully present individual
Consumer is newly eligible or ineligible for tax credits and/or cost sharing reductions
Permanent move to an area that has different health plan options
Marketplace staff or contractor enrollment error
Qualified Health Plan violated a provision of its contract
American Indians can enroll or change plans one time per month throughout the year
Not considered a Qualifying Life Event:
Voluntarily dropping other health coverage
Being terminated for not paying your premiums
Losing coverage that is not minimum essential coverage, in accordance with HHS guidelines
Moral of the story: Be more proactive next year!!!
This morning, the Internal Revenue Service (IRS) made an announcement that may affect your clients regarding compliance to new Affordable Care Act (ACA) mandated coverage reports (6055 and 6056) for 2015. The IRS announced that it is giving employers additional time to file certain reports. In 
combsandco 