Paradigm Group Blog

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Best Practices for a Compliant Open Enrollment

By Natalie Withers  

As open enrollment season ramps up, it’s easy to get bogged down by renewal decisions, enrollment logistics and employee communications in our quest for a smooth enrollment. But don’t forget the steps you need to take to also have a compliant open enrollment. Failure to meet annual compliance requirements can negatively affect your bottom line and cause stress down the road. Follow these three tips to ensure you check all the compliance boxes for your 2018 open enrollment:

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Senate Republicans Release Discussion Draft of ACA Repeal and Replace Proposal

By Natalie Withers  

With a possible vote next week, Senate Republicans released a “discussion draft” of their proposal to repeal and replace the Affordable Care Act (ACA), Thursday, June 22, 2017. The Congressional Budget Office (CBO) is to release its analysis of the 142-page bill, titled the Better Care Reconciliation Act of 2017, on Monday. You are probably wondering how this bill differs from the American Health Care Act (AHCA) that Republicans in the House passed in May.

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President Trump’s Executive Order: Minimizing the Economic Burden of the ACA Pending Repeal

By Natalie Withers  

ust a few hours after taking office, President Trump signed an Executive Order giving federal agencies the ability to dismantle large parts of the Affordable Care Act (ACA). In the two-page order, President Trump gave the authority to department heads of executive departments and federal agencies to “minimize the unwarranted economic and regulatory burdens” of the ACA. It also stated that they should prepare to give the States more “flexibility and control” to create more healthcare options for consumers.

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Civics 101: What Will Happen to the ACA in 2017?

By Susan Heard, SPHR  

Before Nov. 8, pundits were calling the 2016 national election the most important “in a generation” or “a lifetime,” or “ever.” Now that the results are in, we know who will be leading this country as of Jan. 20, 2017. Beyond who the people are, it’s unclear what comes next.

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What You Need To Know About BCBST Dropping ACA Coverage

By Ken Liberatore  

Tennessee’s largest insurer, BlueCross BlueShield of Tennessee (BCBST), recently announced that it would no longer offer individual medical plans in the Memphis, ​Knoxville and Nashville regions. This change will affect individual health insurance consumers both in and outside of the federal marketplace but does not affect those who have obtained BCBST coverage through their employers, Medicare Advantage or BlueCare.

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Reminder: PCORI Fee due Aug 1

By Natalie Withers  

The purpose of the PCORI fee is to fund comparative effectiveness research and to evaluate and compare health outcomes with clinical effectiveness. This fee applies to both fully-insured and self-insured medical plans and is based on the average covered lives on the plan.

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What You Need to Know about the CMS Data Match Program

By Natalie Withers  

Have you received a notice from the Center for Medicare and Medicaid Services (CMS) Data Match program? If so you probably have questions. “The purpose of the Data Match Program is to provide CMS with better information about group health plan coverage for Medicare beneficiaries. This process helps Medicare identify claims where it should not be the primary payer.” This information sharing is called the IRS-SSA-CMS Data Match. Here’s what you should know and what you should do…

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An ACA Case to Watch: Marin v. Dave & Buster’s

By Susan Heard, SPHR  

We are closely watching Marin v. Dave & Buster’s, along with our healthcare and hospitality industry clients. This is a class action brought by current and former employees of the restaurant chain thought to number in the thousands. The decision, in this case, may have significant repercussions on how we comply with the Affordable Care Act.

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Coming this Spring: Employer Notices

By Natalie Withers  

This spring applicable large employers (ALEs) will receive notices from the Employer Notice Program (ENP) about employees who have applied to the marketplace and are eligible for a tax credit or subsidy.

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Reminder: ACA Reporting Is Due In January

By Susan Heard, SPHR  

It is time to prepare for the new reporting requirements of the Affordable Care Act for IRS Code Sections 6055 and 6056. The IRS requires employers (with 50 or more full-time equivalent employees) to submit these forms in January 2016. Here are the most common considerations we discuss with our clients.