2014 ACA Implementation: Important Dates to Remember

January 1:
Exchange Coverage Begins

Individual coverage purchased through the federal and state-based Exchanges by December 24, 2013 went into effect January 1. Further, small employers generally may start offering health insurance coverage to their employees through the SHOP Marketplace (where enacted) at any time during the year.

As ACA-compliant policies are being issued, more reforms covering pricing transparency, guaranteed issue, elimination of annual and lifetime coverage limits, incorporation of Essential Health Benefits for many plans and new wellness program incentives will continue to take hold.

Individual Mandate Takes Effect

In addition to the new plans, the Individual Mandate took effect January 1. While there are limited exceptions, almost all Americans are required to maintain a minimum level of health coverage or face a tax penalty.

January 10: 

Insurance Payments Due for January 1 Coverage

While Americans had until December 24 to enroll in a plan to receive coverage starting January 1, many health plans are accepting first payments for these policies until January 10. America’s Health Insurance Plans announced late last year that “Health plans across the country are voluntarily giving individual market enrollees who select a plan by December 23 more time to pay their first month’s premium.”

If enrollees pay their first premiums by January 10, they will be able to claim benefits retroactive to January 1. The goal of this extension is to allow as many people to keep coverage following the tumultuous year-end rush to enroll.

March 31:

Open Enrollment Period Ends

The initial Exchange “open enrollment” period that began October 1, 2013 closes at the end of March. Federal regulators wanted to allow as many people to enroll in health plans under the new system as possible. In light of the early difficulties with federal and state Exchange systems, the lengthy enrollment period affords consumers more time to learn about the new system and shop for a plan that suits their needs.

After March 31, consumers will only be able to enroll in new plans following qualifying events such as the birth of a child or loss of employer-sponsored coverage. Americans who do not purchase coverage by this date may be subject to a tax penalty under the ACA.

May 31: 

Health Plan Rate Filings Due

Rate filings for 2015 plans must be submitted by the end of May. The filing deadline was initially April 30, but the deadline has been extended by a month to allow insurers more time to calculate their expected costs. Because 2014 open enrollment does not end until March 31, insurers have been given more time to analyze the enrollment data. While last year’s premium rates were highly anticipated, 2015 rates will be equally important to watch as insurers begin to factor real information about Exchange enrollment trends into their premium calculations.

October 1: 

All Renewal Coverage Must Be ACA Compliant

After receiving critical feedback last fall about Americans losing coverage, President Obama made an administrative policy change to uphold his promise that people could keep their insurance. According to Centers for Medicare & Medicaid Services (CMS), plans renewed after October 1, 2014 must be one of the plans originally "grandfathered in" back in 2010, or they must meet ACA coverage requirements. It’s possible a new wave of complaints about cancelled coverage will emerge next fall, which was avoided for one year due to the President’s administrative action.

November 4:

Mid-Term Elections

The mid-term elections will play a role in the future of the ACA and the 2016 presidential election. In particular, Republicans may have a chance to regain control of the U.S. Senate, which they lost in 2006. This could have a significant impact on key elements of the ACA in 2015. 

November 15: 

2015 Open Enrollment Begins

Because of the extension of the rate filing deadline, open enrollment will begin a month later than expected. Running from November 15, 2014-January 15, 2015, next year’s open enrollment period will be significantly shorter than the inaugural year, but will be lengthier than traditional enrollment periods. Once again, we will be analyzing trends in Exchange and non-Exchange-based enrollments.

January 1, 2015: 

Employer Mandate Begins

At the end of 2014, the Employer Mandate will re-emerge as a hot potato as it will take effect for large employers on January 1, 2015. As we have discussed in previous blogs, the Employer Mandate was delayed a year. Starting next year, it requires employers with more than 50 full-time equivalent employees to provide full-time workers with affordable coverage, or face penalties/taxes of either $2,000 or $3,000 per employee. The goal is to ensure as many American workers are covered by health plans through their employers as possible.

It’s important to note that the federal health care reform initiative discussed in this blog is referred to by several different acronyms including ACA, PPACA and ObamaCare.

 

How to Keep your Pipes from Freezing

by: Texas Plumbing Diagnostics

Most people are aware that when water freezes, it expands. That’s why your forgotten can of soda in the freezer exploded. When water freezes in a pipe, it will expand in the same way.

If it expands enough, it will burst, water will escape, and serious damage may occur. A 1/8-inch crack in a pipe can spew up to 250 gallons of water in a day. But this is one disaster you can prevent by taking a few simple precautions.

Both plastic and copper pipes are susceptible to freezing. Pipes freeze for a combination of three reasons: a quick drop in temperatures, poor insulation and a thermostat that is set too low.

Water pipes in warmer climates may be more vulnerable to winter cold spells, since the pipes are more likely to be located in unprotected areas outside of the building insulation. Homeowners can be proactive by determining whether they have any plumbing items that need protection, and then ensuring that they provide that protection.

Pipes in attics, crawl spaces and outside walls are all vulnerable to freezing, especially if there are cracks or openings that allow cold outside air to flow across the pipes.

Research at the University of Illinois has shown that wind chill, the same cooling effect of air and wind that causes the human body to lose heat, can play a major role in accelerating ice blockage, and thus, bursting water pipes.

When is it cold enough for pipes to freeze?

Homeowners should be alert to the danger of freezing pipes. Any time temperatures dip to 32 degrees, pipes may freeze, especially when wind chill is a factor.

 Tips to avoid frozen pipes:

• Know where the water cut-off valve is located in your home. Make sure that every responsible person in the home is aware of its location.

• Remove, drain and carefully store hoses used outdoors.

• Keep garage doors shut if any water lines are located inside.

• Seal all openings where cold air can get at unprotected water pipes. As stated above, it’s especially important to keep cold wind away from pipes.

• Pipes in attics and crawl spaces should be protected with insulation or heat. Pipe insulation is available in fiberglass or foam sleeves. Remember, the more insulation you use, the better protected your pipes will be.

• During freezing weather, leave cabinet doors open under kitchen or bathroom sinks (especially if they are located against an outside wall) to allow warmer room air to circulate around pipes. You can also place a small lamp with an incandescent bulb near the pipes. Be sure to remove anything flammable from the area to prevent fires.

• Let faucets drip slowly to keep water flowing through pipes that are vulnerable to freezing. If the dripping stops, it may mean that ice is blocking the pipe. Keep the faucet open to assist in pressure relief.

• Heating cables and tapes are effective for freeze protection. Follow manufacturer’s directions closely when using these products.

• Exterior pipes and hose bibbs (outdoor faucets) should be drained or enclosed in 2-inch insulation sleeves.

• When weather is very cold, keep thermostats at the same temperature day and night. Lowered temperatures at night may contribute to colder attic temperatures and thus, more vulnerable pipes.

What to do if your pipes freeze:

If you turn on your faucets and nothing comes out, the water in your pipes is probably frozen. You may be able to thaw a frozen pipe with the warm air from a hair dryer. Make sure the faucet is open, and never stand in water while operating an electric appliance. Do not use a blowtorch or any open flame to thaw a pipe, to prevent fires.

If your water pipes have already burst, turn off the water at the main shut-off valve in the house. Leave the water faucets turned on. Again, make sure your family members know where the water shut-off valve is and how to operate it. Then call a plumber to help.

Why would my organization need Cyber Liability Coverage?

A large majority of non-profit and social service executive directors, boards of directors and risk managers are not aware that their standard insurance coverages (Commercial GL, Property, D&O, crime) typically don’t provide proper coverage for cyber liability. Most employees and IT professionals don’t know that they (along with their organization) have an exposure to cyber risks and how that exposure can pose a significant financial threat to their institutions.

 A Non-Profit or Social Service organization that...

• Obtains social security numbers, drivers license numbers, bank account numbers of clients or employees
• Has access to patient medical records
• Is in the process of going ‘paperless’ or keeps paper files onsite
• Provides online access to sensitive data
• Allows laptops or access to their network from a remote location
• Relies on their computer network on a daily basis 

Financial Threats to Your Institution:

• Costs to comply with federal and/or state required notification. Per individual, the average cost per record is estimated at $203
• Regulatory proceedings(including fines and penalties) as a result of a privacy breach. This includes HIPAA violations
• Employees (teachers, volunteers) and/or groups of affected individuals(alumni, current students, parents) suing for damages as a result of a privacy breach
• Liability for the transmission of malicious code to an outside party
• Denial of service attack on your network, causing computer system to go down and business interruption expenses
• Intellectual property/privacy lawsuits. These include libel/slander arising out of content that is on your internet or intranet sites 

Given our expertise in underwriting Commercial Package, D&O & EPLI for the social service industry
and other non-profit institutions. We recently developed a cyber product that...

• Is modular. You and your agent are able to pick and choose the appropriate coverage lines
• Is on PHLY’s admitted A++ paper in most states
• Provides industry leading coverage for both 1st party and 3rd party exposures
• Helps you understand. At any point, a cyber underwriter can help explain the coverage to an agent or insured

Information Needed for a Non-Binding Indication for current or prospective PHLY Customers:

• Annual revenues and number of employees

Claim Scenarios for Non-Profit Organizations

• Client information was on a case manager’s laptop that was stolen from her office. Files on the laptop contained patient names, social security numbers, dates of birth, addresses, phone numbers, medical condition information and case information
• Third-party vendor that hosted a foundation’s website experienced a security incident. Customers who donated to the organization may have had their names, dates of birth and credit card information accessed
• Adult day care’s computer network is down for 4 days as a result of a Trojan horse attack and are unable to provide any services as a result. There is a need to hire experts to correct their system and get it back to where it was functioning
• In an effort to go paperless,cleaningcrewataHIVawareness organization discards all employee files in an unsecured dumpster. Personal information of all employees is compromised and those affected join a class action suit against the non-profit
• Animal shelter holding a golf tournament posts information regarding the event on their website. As a result of the shelter not getting permission to use a golf company’s logo, they are sued for copyright infringement

Carbon Monoxide Safety

Update - Health Care Reform Implementation for Nonprofits

Henry Bogdan, Director of Public Policy, Maryland Nonprofits

Maryland is moving forward with health care reform.  Open enrollment for the individual health insurance exchange begins October 1 and "connector agencies" are doing outreach and promotion across the state.

The small employer ("SHOP") exchange will not open for enrollment until Jan. 1, 2014, and the coverage mandate for large employers (50 or more) has been delayed until 2015.  But small nonprofit employers may be eligible for tax credits even now if they provide qualifying coverage to employees, and the Affordable Care Act ("ACA") has notice and information requirements for most employers that take effect this Fall.

By October 1, all employers subject to the Fair Labor Standards Act ("FLSA") must provide a notice to their employees about the new Health Insurance Marketplace (the Exchange), informing employees that they may be eligible for a premium tax credit if they purchase coverage through the Marketplace, and advising employees that if they purchase a plan through the Marketplace, they may lose the employer contribution (if any) to any health benefits plan offered by the employer.

The U.S. Department of Labor has prepared alternate models for this notice, one for employers who offer, and one for those who do not offer an employer sponsored plan.  There is no coverage mandate for small employers with 50 or fewer full-time equivalent employees. The Maryland Health Benefit Exchange is also preparing models that will be tailored for Maryland employers.

Employers are also required to provide employees with a standard Summary of Benefits and Coverage ("SBC") form explaining what their plan covers and what it costs. The purpose of the SBC form is to help employees better understand and evaluate their health insurance options.  There is also a model for this at the Department of Labor website.  Employers should contact their group plan issuers, who should compile and provide these SBC's.  This may be similar to, but is a different form and requirement,  than the 'summary plan description' that insurance plan administrators are already required to provide under ERISA.

The Maryland Health Connection is organizing a series of information forums for small employers about the pending launch of the SHOP exchange.  Enrollment scheduled to open on Jan. 1, 2014 with policies taking effect March 1, 2014 or later.  The forums will be held in each of the six "connector" regions, with dates being planned between mid-October and mid-November.  Maryland Nonprofits will be a partner in promoting these programs. We have asked a number of potential conveners of local groups to join with the Exchange to assure that all nonprofit employers have an opportunity to learn more from the Exchange itself about how it may benefit their organizations and employees.  Contact Henry Bogdan for more information.

The six listed connector agencies are also hoping that local nonprofits will assist them in getting information about the individual exchange to any of their clients or others they serve who may be uninsured or eligible for subsidies through the exchange.  

A short listing of web sources for more information on Health Reform and health exchanges:

Maryland Health Connection - http://www.marylandhealthconnection.gov/

National Council of Nonprofits - http://www.councilofnonprofits.org/resources/resources-topic/affordable-care-act-faqs#now

Small Business Administration - http://www.sba.gov/healthcare

Department of Labor - http://www.dol.gov/ebsa/healthreform/index.html 

Internal Revenue Service - http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions-Home

Marty's mother named 2012 Woman of the Year

Irene Spatafore, mother of Marty Spatafore, CSR here at Gorges & Company, has been named the 2012 Woman of the Year by the Baltimore County Commission for Women in a special ceremony held at the Confetti's Event Center, Towson, MD.

Mrs. Spatafore has made it her duty to help others, whether that be by lending a helping hand to the members of her community or making miracles in the lives of our military. "While I am active in five ministries, my biggest challenge is Angels Supporting Your Troops, Inc., " noted Spatafore. "Our organization name was given to us by the Secretary of Veteran Affairs, Edward Chow. We are a 501c3 non-profit organization, meaning all of our supplies and shipping costs are possible from donations." Angels Supporting Your Troops, Inc. which currently operates out of Sonshine Fellowship Church on Sollers Point Road, was recognized at the Fallen Hero's Ceremony of the General Assembly in Annapolis in February of last year. "The demand is strong in the war zone for supplies. Our military are in harm's way to protect the citizens of the USA. The least we can do is to make an effort and purchase items for our 'goodie' care packages to put a glow and a smile on their faces as they open the box," Spatafore commented. Spatafore added that she is sincerely appreciative for Sacred Heart of Mary, Graceland Park, which has been extremely devoted to assisting the Angles on their journey.

In addition to the churches, organizations and politicians, Spatafore's son Marty also stands strong in supporting the Angels. "He decided to hold a silent auction at his workplace on York Road. Marty baked two mouth-watering Jewish apple cakes at Thanksgiving time, which netted $88 - a big surprise!"

At age 70, Spatafore is more determined than ever to make a difference. Helping others is something she has done her whole life and she doesn't plan to stop anytime soon. "I cant stop, I don't know how to; this is who I am," she affirmed." I would like to give a special thanks to my daughter Valerie, for nominating her mom as Woman of the Year, and to my husband John who gave me three beautiful children, for standing by me as I have set up and worked tirelessly to organize this work dedicated to the troops, " said Spatafore. "The men and women who serve us are so thankful for all that we do. I receive so many letters of gratitude," she explained. "SSG Larry Posey wrote 'I want you to know that I appreciate you supporting the military...I want to let you know what you did was special.'"

In order for Angels Supporting Your Troops, Inc. to continue to provide soldiers with a little piece of comfort from home, they will need postage and supply sponsors. If you would like to support his cause, please send donations to Angels Supporting Your Troops, Inc c/o Irene Spatafore, 7914 Diehlwood Road, Baltimore MD 21222. For more information call 410-284-5274.

By:  Lena Sala

Towing Scams

At first glance, a friendly tow truck happening by after an accident or breakdown can seem like a godsend. But if you didn't call for a tow, there's a good chance it's what authorities call a "bandit" tow truck, which means you'll get your tow and an eye-popping bill.

There are a couple of easy ways to protect yourself. If you have AAA or belong to another roadside assistance program, that's where you should turn when you need a tow because you'll benefit from lower pre-negotiated rates.

Or, your auto insurance policy may offer roadside assistance. If you use it when an accident renders your vehicle undriveable, it's a good idea to ask about the policy's limits on towing and storage before you leave the scene.

If you must use an independent tow truck, it's best to call for one rather than go with a truck that's just passing by. It's also critical that you read the fine print before signing any towing contract. Experts say you should get a printed price or invoice of all towing and storage charges and any miscellaneous fees. The contract also should specify to where your vehicle is being towed.