combsandco


Practical Information & Resource Guide for You & Your Business during the Covid-19 Pandemic

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We understand there have been numerous emails out there each day on Covid-19, believe us, we get about 50 a day as of late.  Below you’ll find helpful information broken into section topics for what your needs may be during this time.  We know we will all get through this, we are New Yorkers and we have seen far worse in our day.  Stay safe.

The Combs Crew

Business Interruption:

One thing to understand is that your broker serves in the role as an insurance intermediaries we are not the decision maker, but instead report claims and administer the communication between the carrier and the customer.  As brokers, we represent you as the client, not the insurers.  We are your advocates and will fight for you, but ultimately the decision rests on the carrier.

We all know this is a very stressful time all Small Businesses across the country and are getting multiple requests a day about coverage of a potential claim for Business Interruption.  Unfortunately, the carriers are being very tight lipped on if the Covid-19 would result in a Business Interruption claim being paid until they are able to review all aspects of the policy and claim.  We have been suggesting to all of our clients, to go ahead and move forward with a claim if they are able to prove a loss for their business during this time as there is zero chance of recovery if you never put in a claim.

Facts about Business Interruption:

  1. If you have Business Interruption coverage, your policy should list or describe the type of events it covers.  Events that are not listed on, or not described in the policy, are typically not covered.
  2. Business Interruption coverage typically can ONLY be triggered if you have a property loss that leads to the business interruption.
  3. Often times there are exclusions for epidemics and pandemics in Business Interruption policies.

Example:  You have a fire in your office which has caused you to suspend your business activities, for more information CLICK HERE

Many state and city municipalities are working on Disaster Loan Assistance programs at this time, below you will find that information.

Disaster Loan Assistance:

For Disaster Loan assistance information by state, please CLICK HERE for more information from the SBA.  If you are local to NYC, CLICK HERE for local disaster loan assistance.

Please let us know if we can assist in any way during this time and if you are looking for overall general information on potential business impacts and resources, please CLICK HERE for Risk Advisory bulletins from EPIC.

Health Insurance:

For Individuals – NY State of Health and New York State Department of Financial Services Announce Special Enrollment Period for Uninsured New Yorkers, as Novel Coronavirus Cases Climb.

*Remind New Yorkers That There is No Cost Sharing for COVID-19 Testing Across Medicaid, Child Health Plus, Essential Plan, and Qualified Health Plans*

ALBANY, N.Y. (March 16, 2020) – NY State of Health, together with the New York State Department of Financial Services (DFS), today announced that New York will make a Special Enrollment Period available to New Yorkers during which eligible individuals will be able to enroll in insurance coverage through NY State of Health, New York’s official health plan Marketplace, and directly through insurers. This step is being taken in light of the COVID-19 public health emergency to further protect the public health of New Yorkers.  NY State of Health, DFS, and New York State health insurers are taking this action due to the exceptional nature of the public health emergency posed by the COVID-19 so that individuals do not avoid seeking testing or medical care for fear of cost. The open enrollment period for coverage in 2020 had previously ended on February 7, 2020.

Individuals who enroll in Qualified Health Plans through NY State of Health or directly through insurers between March 16 and April 15, 2020 will have coverage effective starting April 1, 2020.  Individuals who are eligible for other NY State of Health programs – Medicaid, Essential Plan and Child Health Plus – can enroll year-round.  As always, consumers can apply for coverage through NY State of Health on-line at www.nystateofhealth.ny.gov , by phone at 855-355-5777, and working with enrollment assistors.

If you have any questions or would like more personalized assistance, please reach out to Colleen Blum via email at:  cblum@combsandco.com

Workers Compensation:

Workers’ compensation insurance helps employees recover from work-related injuries or illnesses. Every state has its own workers’ compensation insurance laws and regulations that govern the coverage available. To file a workers’ compensation claim, the employee will need to demonstrate that the injury or illness arose both out of and in the course of their employment.

Mental Health Assistance: 

Many health insurance carriers are providing Mental Health Assistance at this time.  Below is some information on what United / Oxford is doing for their members and in some instances all citizens regardless if they are a member.  Please reach out to your health insurance provider to see what services they are providing specifically for you.

Free Emotional Support Help Line

Optum is offering a free emotional support help line for all individuals impacted.  Our toll-free emotional support help line at (866) 342-6892 is free of charge and available to anyone, so you can share it with family and friends. Caring professionals will connect people to resources. It will be open 24 hours a day, seven days a week.  Additionally, there are several coping and disaster tools and resources available to you on liveandworkwell.com. Log on to liveandworkwell.com with your HealthSafeID. Type the keywords “coping” or “disaster” into the search bar to get support.

Behavioral Health Virtual Visits

Also, as UnitedHealthcare members, you have access to Behavioral Health Virtual Visits where you can access a behavioral health professional through your mobile device, tablet, or computer.  Behavioral Health Virtual Visits are a separate benefit from the Virtual Visits with Teledoc, Amwell, and Doc on Demand.  For behavioral health, virtual visits are subject to the same out of pocket as an in-office visit (behavioral health outpatient office visit). Services are delivered by a network provider licensed within your state and may include psychiatrists, psychologists, and other practitioners licensed in behavioral health such as nurse practitioners and master level clinicians. Providers are able to prescribe medications in compliance with federal and other regulatory limitations.

Coronavirus Response Bill, with Required Paid Sick Leave, Enacted into Law:

Action Taken:  On March 18, 2020 President Trump signed into law H.R.6201, a $104 billion bill that, among other things, requires small employers (those with fewer than 500 employees) to provide paid sick leave to employees dealing with COVID-19 or with exposure to the coronavirus.  Family and medical leave both go into effect April 2 and expire December 31, 2020.  

 

Expanded FMLA.

    1. Who? The new law applies to all employers with fewer than 500 employees and to employees who have worked for at least 30 days.
    2. Reasons for Leave? An employee may take up to 12 weeks of leave to allow an employee who is unable to work or telework to care for the employee’s child (under 18 years of age) if the child’s school or place of care is closed or the childcare provider is unavailable due to a public health emergency. A public health emergency means an emergency with respect to COVID-19 declared by a federal, state, or local authority.
    3. Pay? Unpaid for the first 10-days after which the employer must pay full-time employees at two-thirds the employee’s regular rate for the number of hours the employee would otherwise be normally scheduled. The pay is limited to $200 per day and $10,000 in the aggregate. Part-time employees pay should be based on the average number of hours the employee worked for prior six months; or, if less than six months, based on the employee’s reasonable expectation at hiring of the average number of hours the employee would be scheduled to work.
    4. Job protection? Employers with 25 + employees have to return the employee to the same or equivalent position upon their return to work. Employers with fewer than 25 employees are excluded from this requirement if the employee’s position is eliminated due to economic conditions or other changes resulting from the public health emergency. Keep in mind, employers must still reasonably attempt to return the employee to an equivalent position and make efforts for the next year to return the employee to work.
    5. Exempt? The law allows small businesses with fewer than 50 employees to seek an exemption from the expanded leave entirely if the required leave would jeopardize the viability of their business.

Paid Sick Leave.

  1. Who? Employers with fewer than 500 employees; all employees regardless of their tenure
  2. Reasons for Leave?  An employee may take paid sick leave if he/she is unable to work or telework because:
    • the employee is subject to a federal, state, or local quarantine or isolation due to COVID-19;
    • a health care provider advised the employee to self-quarantine due to concerns related to COVID-19 (self-imposed quarantine does not qualify);
    • the employee is experiencing symptoms of COVID-19 and seeking a medical diagnosis;
    • the employee is caring for an individual who is either subject to a federal, state, or local quarantine or isolation due to COVID-19 or has been advised to self-quarantine due to concerns related to COVID-19;
    • the employee is caring for the employee’s child whose school has been closed or place of care is unavailable due to COVID-19 precautions; or
    • the employee is experiencing any other substantially similar condition as specified by the government (and to be clarified later).
  1. Pay? Full-time employees receive 80 hours of paid sick leave; part-time employees receive the equivalent of the number of hours they would work, on average, during a two-week period.  Paid sick leave is paid at the employee’s regular rate if for a reason in paragraph (i), (ii), or (iii) above and caped at $511 per day and $5,110 in the aggregate; and two-thirds of an employee’s regular rate if based on reason (iv), (v), or (vi) and capped at $200 per day and $2,000 in the aggregate.
  2. Misc. The leave does not carry over. Employers may not require employees to first use other paid leave before using paid sick leave. Employers can require reasonable notice procedures after the first workday that an employee receives paid sick leave. Employers must post a notice that advises employees of their rights which should be available by March 25.
  3. Exempt? Like the FMLA above, the Act does contain language allowing small business with less than 50 employees to seek an exemption from the requirement.

New York Emergency Paid Sick Leave.

  1. When? Only in the event of a “mandatory or precautionary order of quarantine or isolation issued by the State of New York, the NY Department of Health, a local board of health, or any government entity duly authorized to issue such order due to COVID-19”.
  2. Who?
    • Employers with 10 or fewer employees and a net income less than $1 million must provide unpaid leave (and job protection) for the duration of the quarantine order and guarantee their workers access to Paid Family Leave and disability benefits (short-term disability) for the period of quarantine including wage replacement for their salaries up to $150,000.
    • Employers with 11-99 employees and employers with 10 or fewer employees and a net income greater than $1 million will provide at least 5 days of paid sick leave, job protection for the duration of the quarantine order, and guarantee their workers access to Paid Family Leave and disability benefits (short-term disability) for the period of quarantine including wage replacement for their salaries up to $150,000.
    • Employers with 100 or more employees, as well as all public employers (regardless of number of employees), will provide at least 14 days of paid sick leave and guarantee job protection for the duration of the quarantine order.
  1. Has to be serious? These additional benefits are only available to employees who have been officially and formally quarantined or isolated by a local or state government agency; not those who are in voluntary quarantine or isolation, those who merely fear they have been infected, those who object to reporting to work, and those who are placed on leave, layoff, or furlough by an employer. It also does not apply to employees who are asymptomatic but have been quarantined or isolated, those who have not yet been diagnosed with any medical condition, and those who are physically able to work remotely.
  2. Other Changes.
    • With regards to NY Paid Family Leave, the definition of “disability” was expanded to include “the inability to do work because of a mandatory or precautionary order of quarantine,”; and the definition of “family leave” was expanded to include a) leave taken to comply with a mandatory or precautionary order of quarantine; or b) to provide care for the employee’s minor, dependent child who is subject to a mandatory or precautionary order of quarantine.

Don’t forget, these are in addition to any current paid leave/medical leave programs applicable to your workforce.

Resources for Families:

We know that many families are struggling to figure out homeschooling at this time while balancing working from home in most cases.  We wanted to share this excellent post from the Today Show that provides a wealth of information for your little ones during this time, CLICK HERE for the article “How to homeschool during the coronavirus crisis with free resources”.

Job Resources:

Chameleon Resume is offering free tools to help with job searches.  CLICK HERE to access them.

New York & New Jersey has developed a state portals to access jobs that are looking for candidates now during the Covid-19 pandemic.

CLICK HERE to access the New York portal

CLICK HERE to access the New Jersey portal

To Apply for NY State Unemployment, CLICK HERE

To Apply for NJ State Unemployment, CLICK HERE



NAHUThis 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 *forgot* to sign up for Health Insurance, now what?

ImageYou’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:

  1. 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.
  2. 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.
  3. 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:
    1.  Individual or dependent loses minimum essential coverage due to:
      1. job loss
      2. divorce
      3. death of a spouse
      4. becoming ineligible for Medicaid or Child Health Plus
      5. expiration of COBRA
      6. health plan is decertified
    2. Marriage, birth, adoption, or placement for adoption
    3. Gaining status as a citizen, national, or lawfully present individual
    4. Consumer is newly eligible or ineligible for tax credits and/or cost sharing reductions
    5. Permanent move to an area that has different health plan options
    6. Marketplace staff or contractor enrollment error
    7. Qualified Health Plan violated a provision of its contract
    8. American Indians can enroll or change plans one time per month throughout the year

 

Not considered a Qualifying Life Event:

    1. Voluntarily dropping other health coverage
    2. Being terminated for not paying your premiums
    3. Losing coverage that is not minimum essential coverage, in accordance with HHS guidelines

 

Moral of the story:  Be more proactive next year!!!

 



What’s my penalty?

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A question that comes up time and time again with the Affordable Care Act is:  “How does the Individual Responsibility (aka Mandate) Penalty work?”

To avoid the penalty you must enroll in a marketplace plan OR have private coverage no later than March 31st, 2014. If you do not, below are a breakdown of the penalties you will face.

  • 2014: Greater of $95      per adult and $47.50 per child under age 18 or 1% of household       income
  • 2015: Greater of $325      per adult and $162.50 per child under age 18 or 2%
  • 2016: Greater of $695 per adult and      $347.50 per child under age 18 or 2.5% of taxable gross income capped      at the average bronze-level insurance premium (60% actuarial) rate for the      person’s family.

**The total family penalty is capped at 300% of any annual flat dollar amount for those 18 and over.

**If the penalty applies for less than a full calendar year, the penalty will be 1/12 of the annual amount per month without coverage.

Example:

Let’s look at the O’Brien family of 4 that has 2 children under the age of 18 and the family household income is $100,000 per year.

Just to make the example easier, we are giving everyone names….Meet the O’Brien Family:  Mom – Samantha; Father – Mark; Son – Luke; Daughter – Sarah

Upfront we know that the Max Penalty the O’Brien’s’ can be given is:  $570 (this is figured by a $95 penalty each for Samantha & Mark since they are the only ones over 18 x 300%), now let’s look at the breakdown if they would hit the Max Penalty….

Remember, it is the GREATER of the below up to the Max Penalty:

Flat dollar amount penalty calculation :  $95 (Samantha) + $95 (Mark) + $47.50 (Luke) + $47.50 (Sarah) = $285

Percentage amount penalty calculation:  1% of $100,000 = $1000

Results:  Since the Max Penalty the O’Brien family can be given in this example is $570, this will be the penalty they will be responsible for, since the 1% of household income exceeds this amount.  This amount will be tacked on when Samantha and Mark’s taxes are calculated at the end of the year, so if they were planning on a nice refund this year, that will be deducted from that refund.  Keep in mind that if the O’Brien’s do not pay taxes, as of now, there is no mechanism to collect this penalty.



Exchange Notice Deadline Approaching: October 1, 2013

Important Notice

Pretty much all employers will need to provide their employees with written notice that includes information regarding the Exchange (now called the Health Insurance Marketplace). The deadline to provide the notice is fast approaching; the notice must be provided to each employee not later than October 1, 2013.  Regardless of the size of your company and even if you currently do not offer coverage to your employees you *SHOULD* send this information out.  The reason we say should instead of MUST is because as of last week, this has been another penalty that has been delayed and they haven’t told us when it will come back.  Originally it was speculated a $100 fine for every day you have not complied with the request.  We still encourage everyone to comply now as then when / if the penalty goes into effect you are all in compliance.

Click below to view the English version of the notices that you can provide to your employees:

English notice if you DO offer coverage

English notice if you DO NOT offer coverage



Article Review: ‘Affordable’ Care: $1 Pay Hike Costs Middle-Class Family $9,355 Hike in Premiums
August 9, 2013, 4:26 pm
Filed under: Health Insurance, HR, National Healthcare, Reform

ImageI had a client that sent me this article and then asked if it was true, that if someone makes $1 more that the family would be paying $9,355 more annually.

I know there are a lot of confusing articles out there right now and this was written with a shock factor to get you to read the article, and for my client….it worked!   He read it, and he contacted me to be his “BS Meter” as he put it.

Here is an example to further explain why this article is saying what it is say:

Ok, so let’s say it is a family of 4.

400% of the federal poverty level is around $95,000 for a family of four in 2014.  If they are making $95,000, then with their subsidy aka discount they will get in the Exchange / Marketplace they cannot spend more than 9.5% of $95,000 on healthcare.  Which translates to $9025 annually = $752 per month (just as a barometer, most family coverage in NY starts at around $1200 per month for a very watered down plan).

If the person makes $95,001, then they won’t get that discount and they’d be paying the full premium, so in my example $1200 x 12 = $14,400 annually, which translates into $5375 more annually if you make $1 more.

I’m not sure where they came up with that magic number of $9035 but it’s really not that far off if you start looking at richer benefit plans!



In Response to the New York Times Article Referencing a 50% Decrease in Premiums for New Yorkers

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We have been getting numerous emails with this article being referenced by our clients along with excitement that when they wake up on January 1st, 2014 that their insurance bills will now be cut in half.  I would like to draw your attention to a few items in this article and give you a bit of a reality check.

Point 1:  “Individuals buying health insurance on their own will see their premiums tumble next year in New York State as changes under the federal health care law take effect, Gov. Andrew M. Cuomo announced on Wednesday.”  The first thing that Groups need to look at is the first word….”Individuals”, this is not talking about Group Insurance, this is talking about the Individual Market in New York State that has been extremely expensive in the past.  For example, one carrier that currently has an Individual Plan, the rates are coming in around $2000 per month for an Individual.  Even with a 50% reduction, that is a $1000 premium for an Individual, which is still well over the average rate under Group Coverage in the State of New York.

Point 2:  “Beginning in October, individuals in New York City who now pay $1,000 a month or more for coverage will be able to shop for health insurance for as little as $308 monthly.”  I believe that this is very misleading, this is giving you the lowest price that is going to be in the Exchange aka Marketplace without a Subsidy (tax credit for being under 400% of the Federal Poverty Level).  This price references what is being called “Young Invincible” Plan meaning, that to get this plan, you must be under 30 years old and you are looking at having more of a catastrophic plan which would cover Preventative Care and then you would have a minimum of a $6000 Deductible before anything else would be covered.  Currently, New York does not offer any plans with this type of watered down coverage.

Point 3:  “With federal subsidies, the cost will be even lower. (than $308 monthly)”.  This will be ONLY if you as an Individual qualify for a Subsidy.  This means that as a single person, to get ANY type of price break in the Exchange / Marketplace you must make under 400% of the Federal Poverty Level, which translates into making under $45,960 annually.  If you do not make under that, then the plans you can get in the Exchange / Marketplace are going to be the exact same costs that you can get outside the Exchange / Marketplace

Things we are excited about in this article:

1.  That for Individuals that have struggled with the high cost of health insurance will get to see some relief.

2.  Department of Financial Services say they have approved 17 insurers to sell individual coverage through the New York exchange, including eight that are just entering the state’s commercial market.  Currently there are only a handful, so more choices will be better for everyone!  Keep in mind some of these may just be Medicare networks that only the lower income individuals will qualify to be a part of.

What else to keep in mind:

1.  Be looking for “Borough-centric” plans, meaning that carriers are going to come out with plans that limit the network dramatically in order to get the cost down.  A great example of this has been with Aetna’s NYC Community Plan, these plans have typically been under $400 a month in premium but they are an HMO plan where you must get a referral and they only have doctors in the 5 Boroughs.  The smaller NYC Community Network they are utilizing is about 40% of the size of the normal Aetna Network.  So be looking for these type of plans to be coming out In and Out of the Exchange / Marketplace.

2.  Brokers will be allowed to sell inside and outside of the exchange and there will be no difference in cost.  Be weary of signing up through a Navigator because as it stands right now, they are going to be glorified Enrollers that since they are not licensed, they cannot advise on Insurance, they can only present to you the plans and have you draw your own conclusions.  Also, 6 months down the road if you have a question about the benefits you bought or you are having a claims issue, you cannot go back to the Navigator, you’ll be dealing with the carrier directly and not have someone as your advocate as you would if you had got your plan through a Licensed Broker that is more qualified to help assist you with your needs.

3.  Be on the look out as groups to be getting hit with more taxes on your group plans, this is going to help to pay for the cost reduction for the Individual Plans.