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



Insurance 101: Employer Responsibility

Check our our quick video about Employer Responsibility!

For more Insurance 101, check our our Combs & Co YouTube Channel!



What is a Cost-Sharing Subsidy?

Check out our quick video on What a Cost-Sharing Subsidy is!

More videos where this came from… Check out the Combs & Co YouTube channel for more!



2016 DEADLINES – ACA IRS HEALTH COVERAGE INFORMATION REPORTING FOR ALEs

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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.



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.



Wondering if the penalty is less for *NOT* offering Group Insurance come 2015?

Insurance Audit

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!



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.



So do I really get to keep my insurance if I got canceled?

As many have heard, Obama has offered a “fix” to many of the people that have gotten notifications of their insurance being canceled.  I believe that this report, gives a good picture of it and I want to point out a few things before people start popping the cork and celebrating:

  1. Obama said that carriers “could” offer the plan for 1 more year…
  2. Obama pushed the ultimate decision over to the States and the Carriers…so far California, Idaho, Virginia and Kentucky have said no to this fix.
  3. If the carrier choose to offer to extend, then they are going to have to send the customers a comparison that shows the differences between their plan and all the Exchange Plans that they are offering, what this translates to is more work when we are already 45 days out, and the carriers do not have the extra time on their hands right now.
  4. The carriers do not have an actuarial value of any of these plans since they are not in their plan offerings and I believe that this would result in even higher prices as they would have to put in more man hours to reincorporate these plans.

If you have gotten a cancelation notice, I encourage you to call your carrier and see if they are going to pony up and continue to offer your plan, but don’t be shocked if you end up being one of many that they tell no.