The Affordable Care Act and You: 10 essential health benefits insurers must now offer

The Affordable Care Act is changing how Americans receive health care.  Plans are changing across the board and often the topic of Essential Health Benefits is mentioned as the driving force behind many of the changes.  What are these 10 Essential Health Benefits, or EHBs, that everyone is referring to?

  1.  Ambulatory Patient Services – This is outpatient care and the most common form of health care.
  2. Prescription Drugs – All plans will cover at least one drug in every category and class in the US Pharmacopeia, the official publication of approved medications in the US.
  3. Emergency Care – Visits do not require pre-authorization.
  4. Mental Health Services – This benefit could be new to your plan, as many current plans do not carry this coverage.
  5. Hospitalization – Your insurer must cover your hospitalization, but with co-pays and deductibles.
  6. Rehabilitative and Habilitative Services – Existing coverage will expand under most plans.
  7. Preventive and Wellness Services – Insurers are now required to provide 50 preventative services at no extra cost.
  8. Laboratory Services – Preventive screening tests are covered, while “diagnostic” tests may not be.
  9. Pediatric Care – This is directed at Dental and Vision care.  Children under the age of 19 now will be covered for cleanings, x-rays, fillings and medically necessary orthodontia.  Eye exams and one pair of glasses or contacts included as well.
  10. Maternity and Newborn Care – This change now classifies prenatal care as a preventative service that must be provided at no extra cost.

The new law mandates that every carrier participating in the exchanges offer the 10 Essential Health Benefits and set certain standards that all insurers must meet, whether they are providing health insurance through an employer or directly to individuals and small groups.

Prior to the law only 2 percent of existing individual health plans provide all 10 essential benefits.  On average, today’s plans offer 76 percent of these benefits.

Health plans and options are changing,  so be sure to consult with BCN Services if you have questions or concerns about how your health benefits will be affected by these Essential Health Benefits.  Read more here. Contact us at 1-800-891-9911 or email us at

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Health Care Reform: What Small Groups Can Expect for 2014

Large employers with 50 or more full time and full time equivalent employees have been given an extension of one year (until 2015) before many of the Patient Protection and Affordable Care Act requirements will need to be met to avoid fines.  The focus has now shifted to small employer groups with 50 or less full time and full time equivalent employees.  Although small employers are not required to provide a group health plan for their employees, most will continue to do so in order to remain competitive within their industry.  These employers will see many changes occur with their group health plan during the coming year.

Starting with all small group (group size 2-50) renewals after January 1, 2014, we will say goodbye to the traditional 3-or-4 rating tiers that employers/employees are accustomed to.  There will be no more Single, Two Person, and Family tiers.  There will be no more Employee, Employee with Spouse, Employee with Child(ren), and Family tiers.

Premium rates are age-banded

This method of attaching a premium rate to each individual in a contract has been coined “counting belly buttons.”  Rates will be age banded, which means that premiums will be based on age ranges.  There will be an age banded rate applied to each subscriber, another to their spouse, and then a rate for each of their first 3 children under the age of 19.  If a family has more than 3 children under the age of 19, an additional rate will not be applied to those children.  But for each child over the age of 19 until their 26thbirthday, an additional rate will be applied regardless of family size.

On a positive note, carriers will no longer be able to rate group plans based on medical conditions, or exclude member coverage of pre-existing conditions.

Essential Health Benefits (EHBs) coverage will be mandatory for all small group plans renewing after January 1, 2014.  The Affordable Care Act has a list of compiled services which they consider to be essential to a person’s well-being.  These EHBs are:

  1. Ambulatory Patient Service
  2. Emergency Services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs (this will no longer be optional with small group plans)
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care

For small group health plans, the additional requirement of providing pediatric (birth to age 19) oral and vision care will also mean additional cost added to each child’s premium.  Vision will be a nominal upcharge but the addition of pediatric dental care will increase the cost for each child by an estimated $22-$24 per month.  Families that already have dental coverage through a dental carrier, such as BCN Services’ Delta Dental plan, will be able to “carve out” that extra premium added to their children’s health coverage.

Small group health plans cannot be customized with flexible options for office visit co-pays or additional riders to enhance or decrease the cost of your plan.  In order to comply with meeting certain levels of coverage of EHBs, all plans sold by health carriers will be packaged and will not be able to be altered.

Health plans designed to cover actuarial value

Health plans will be designed to cover the “actuarial value (AV)” of EHBs on 4 different metal levels: Bronze, Silver, Gold and Platinum.  The AV is the estimated amount of coverage a subscriber will receive for EHBs.  The AV of each metal level will be as follows:  Bronze – 60 percent, Silver – 70 percent, Gold – 80 percent, and Platinum – 90 percent.  All plans must fall within these percentages of AV with a 2% margin either up or down.

For example, a Gold metal level plan will cover between 78 percent and 82 percent of AV of EHBs (with the margin of 2 percent taken into account), and a Platinum level plan will cover between 88 and 92 percent of AV of EHBs.  Would your plan be compliant if it covered 85 percent of AV or EHBs?  No, it would not.  Plans must fall within these metal bands to be compliant with ACA requirements.

Small group health plans will be required to have a maximum Out-of-Pocket (OOP) amount for all of their plans starting at the group’s renewal after January 1, 2014.  The 2014 OOP maximums will be $6,350 for individuals, and $12,700 for families.  After these OOP maximums are reached, all EHBs will be covered at 100 percent for the remainder of the plan year.  However, pediatric and adult dental costs will not apply to the OOP maximum even though pediatric dental is included in the list of EHBs.

Throughout this blog, I have indicated that all of these requirements and changes take effect upon the group’s renewal after January 1, 2014.  To clarify, if your current small group plan does not have its annual renewal until, for example, November 1, you will be able to keep your current plan design and rating structure until that date.  Upon renewal after January 1, 2014, is when your plan will need to comply with these ACA small group requirements.

The health insurance landscape will be a strange new world in 2014.  BCN Services will be blazing the trail for you and your employees to be able to navigate through all of these changes and the questions they will bring.  Please contact your BCN Partnership Manager if you’d like to discuss in further detail what to expect in 2014.




Frank Lewandowski, Partnership Manager

PPACA – Changing the landscape for employers, small and large

The Patient Protection and Affordable Care Act continues to dominate the news  every day,  with the realization that what was passed into law in 2010 and upheld in the Supreme Court as a tax to all Americans is now about to take effect – or is it?

The concept of mandated payments into the “health system” still is an overwhelmingly unpopular topic, and the realization that everyone, not just those that choose it, will be funding our health care system.  To understand what will happen, just follow the money.

Take care of us, sons and daughters

Young, healthy, and generally un (or under) insured populations are now going to see the largest increases in cost (particularly if they were paying nothing!) and will support those who are older, unhealthy, or more likely to need health care (those with coverage).  In addition, for those employers or citizens who buy plans through an exchange or through a fully insured group health plan,  will pay more on average due to the mandates that started back in 2010.  These include:  health coverage to age 26 for those living at home/college, dental to age 19,  unlimited maximums, no pre-existing conditions, just to highlight a few.

I am looking for a couple of part-time jobs

For employers with more than 50 employees,  we have been working through the logistics of converting many of our clients to a part-time workforce.  While it isn’t for everyone,  many industries cannot afford the burden of paying health insurance for all employees, or cannot pass along those costs in form of price increases for their product.   Employers care about employees, and those that can’t afford to hire full time are even trying to arrange for another employer to make up the difference by hiring their staff when they are not working for them.

The more it stays the same, the more it changes

PPACA is a massive piece of legislation.  By last count, it is more than 20,000 pages of words, much of it subject to interpretation, intent, and implementation (i.e. more words).  The federal Health and Human Services (HHS) and Internal Revenue Service (IRS) agencies are charged with interpretation and enforcement of this law.  BCN continues to monitor the changes that are made and the deadlines that approach.  As has been demonstrated by our government throughout this process,  nothing is certain until it is implemented.

We’ve got your back

We welcome your questions and debate the implementation of the bill.  While it is tempting to watch the news, and attend $299 seminars, – there is no need because we are your eyes and ears on this matter.  We continue to meet formally every week to discuss what is new, what has changed,  and what is allowed.  We commit to help you through this period by presenting any and all options available, and deploy or help deploy the pieces of PPACA that are required of employers.   Our goal is to allow you to continue to operate your successful business.Stay in touch…

Reply to this blog privately, send an email/or call your PM, or inquire of any of our HR Contact Center Team, and we’ll respond.   Call (800) 891-9911 or email


Andrew (Andy) C. Hans, CEO

EPLI: What is Employment Practice Liability Insurance and why do I need it?

If you are a PEO client of BCN, your company is provided with employment practice liability insurance (EPLI), a benefit that may not be used every day, but is important nonetheless.

This specialized insurance is designed to protect against losses incurred in litigating and settling wrongful employment practices liability claims. It covers such things as discrimination, breach of contract and wrongful discharge suits, which usually are not covered by general business liability insurance.

In today’s business world, the threat of being sued is an everyday reality. The dangers are even more real if your company doesn’t’t have a dedicated human resources department or formal training to deal with myriad laws, rules and regulations that exist to protect employee rights.

Statistics show that in a bad economy employment lawsuits increase dramatically. One disgruntled worker can put your entire business at risk if he brings a lawsuit or discrimination charge against you — whether valid or not. The cost to defend the allegations alone could put your company out of business, not to mention the price you would pay if you lose.

Here are the top 5 reasons your company should have EPLI coverage:

  1. Employee lawsuits and discrimination charges are excluded under standard general liability policies;
  2. Every employer, large or small, can be the target of legal action from past, present, and prospective employees;
  3. Owners’, directors’ and officers’ personal assets can be at risk;
  4. Employees file more than 90,000 complaints each year with the U.S. Equal Employment Opportunity Commission;
  5. Employees can easily file lawsuits, often with no risk or cost to them.

While you are responsible for deductibles and legal costs not covered by the policy,  BCN Services has made it easier and cost efficient in 2013 to mitigate your expenses of a claim by negotiating an arrangement with our carrier to allow us to provide the initial investigative work to our clients on EPLI claims with our law firm’s oversight, saving significantly on legal expenses.  To minimize claims, BCN’s trained and certified HR professionals will help guide you through employee relations and other compliance issues thereby greatly reducing your risk.

Remember to always report any incident which could give rise to a claim immediately to the BCN Human Resource Department by phone.  For further information about EPLI,  contact us at 800-891-9911 or contact us here.

Kate Douglass (200x174)

Kate Douglass, Senior HR Generalist

Small Business Health Options Program (SHOP) delayed until January 1, 2015

On March 11, 2013 The U.S. Department of Health and Human Services (HHS) published a proposal for delaying the Small Business Health Options Program (SHOP) for small businesses until January 1, 2015.  This proposal is expected to be approved.

SHOP is an insurance exchange for businesses that is part of the Affordable Health Care Act (ACA), the new federal health care law.

This delay in SHOP would affect the 33 states where the health insurance exchange will be run on a federal level.  HHS reports that administrative delays and operational challenges have prevented them from securing the variety of affordable care options for small businesses to offer to their employees beginning January 1, 2014.  The agency has advised the 17 States that have opted to manage their own exchange programs that they may either move forward with the full version of SHOP for January 1, 2014, or delay their programs until January 1, 2015.

Under the new proposed timeline, SHOP will be available to small businesses and their employees for open enrollment beginning October 1, 2014 for a January 1, 2015 effective date.  HHS has announced that one plan option will be made available to small employers for the original January 1, 2014 effective date, but it is still unknown which health carriers will be involved, what the plan design will look like and what the monthly premium cost will be.

The SHOP weighed heavily during initial debates to the Affordable Care Act, with supporters citing that the SHOP option would offer small businesses opportunities historically afforded to large businesses.  States will decide whether “small businesses” will be classified as fewer than 100 employees, or fewer than 50 employees.

SHOP will allow small business employees to choose from a variety of health plans through multiple carriers that will best suit their family’s needs and budget.  The SHOP will simplify administration on the employer’s end by uniting all plan premiums into one billing statement for the employer to pay on a monthly basis.

SHOP is designed to simplify decision-making for employees by offering side-by-side comparisons for the multiple options available to them.  Online access, and customer support, will provide employees with the tools they will need to make an informed decision about the quality and cost of individual or the family’s health plan choice.

Within the SHOP program, insurers will no longer be able to deny enrollment to employees with unfavorable health histories or deny treatment for pre-existing conditions.  Premiums will no longer be based on employees’ health histories or the industry for which their company does business.  Premiums can, however, be based on ages and smoking histories of employees that are subscribing to the SHOP plans.

Many view this as a very disappointing set-back to the implementation of ACA and the promise of “affordable care” and multiple options and choices.  With the individual mandate still set for January 1, 2014, it will be interesting to see if further proposed delays are announced.  Those individual plan options are scheduled to be available for open enrollment October 1, 2013.

Yet, only months away, there has still been little guidance as to how those individual options will be structured, what carriers will offer them, how many options there will be or premium rates, among other concerns.

The wait has been stressful for all business owners while they try to anticipate their insurance options and costs for 2014.  BCN  Services will continue to evaluate options and proactively communicate them to its clients.

Follow the HR blog for updates on this topic and others relating to the Affordable Care Act.  Contact BCN Services for further discussion and guidance as this new law is implemented.  Contact us at 800-891-9911 or visit



Frank Lewandowski, Partnership Manager

Tracking employee time can really add up

Managing employee time is an essential part of most businesses, from retail to manufacturing to professional.  The Patient Protection and Affordable Care Act (PPACA),  or Obamacare, has put new focus on employer calculations of time, in order to calculate the status of their workforce.  Here is a real-world example:

The PPACA mandates that employees with more than 30 average hours per week (based on a calculated look back period average of between 90 days and one year) be deemed full time for the purposes of health coverage.   This company’s cost will be a minimum of $2,000 (tax) up to the cost of family health insurance for this employee ($15,000)

A more global tracking issue that affects costs for all employees in your company is simply the LOSS of time due to inadequate data collection.  The Return on Investment (ROI) of investing in current technology and data capture is well documented in human error, auditing, and lost time.

In the following example, bad timekeeping costs this 50-member employee group more than $21,000 per year, or $439 per employee per year. This shows the effects of an inadequate data collection system*:

Human Error Factor Savings- A


     Number of Employees



     Average hourly rate



     Average hours worked per week



     Total weekly payroll (A x B x C =D)



     Human error factor


     Total weekly savings (D x E)



Auditing Savings- B


     Number of Employees



     Minutes saved per card



     Total pay period minutes saved (A x B=C)


     Total pay period hours saved (C/60)


     Hourly rate for Department Heads


     Weekly Department Head savings



Lost Time Savings- C


     Lost productivity per day



     Avg. employee’s rate/hour



     Avg. wages overpaid/day/emp (A x B= C)



     Avg. wages overpaid/wk/emp (C x 5)



     Total number of employees


     Total wages overpaid/wk (D x E)





     Human error savings (F1)



     Audit savings (F2)



     Lost time savings (F3)



     Total weekly savings (A + B + C)



Total annual savings (D x 52)



Savings/worksite employee


*Studies conducted annually by national payroll and staffing associations

BCN works closely with its clients to create efficient, cost-effective data capture of employee time, which gives clients greater control of scheduling and time management.  Call us at (800) 891-9911 for further information about tracking your employees’ time.  Or contact us here.


Andrew (Andy) C. Hans, CEO

Tips for coordinating Medicare with group health plans

Advances in healthcare and the drive towards healthier lifestyles have many Americans living and working longer than ever before.

According to the U.S. Bureau of Labor and Statistics, in the past decade the number of employees working past the Medicare eligibility age (currently 65) has increased by 52 percent.  Many of them are opting to keep their employer-sponsored health insurance group plan and coordinate it with their Medicare benefits.  Confusion often arises as to which plan will pay for which claims.  Following are some tips for knowing how to use the employer-sponsored plan in conjunction with Medicare.

  • Medicare consists of three parts.  Medicare Part A (hospitalization), Part B (medical insurance), and Part D (prescription coverage).  All eligible Americans are entitled to elect Medicare Part A at the age of 65 at no cost.  Medicare Parts B and D have additional monthly charges.  Elections for Parts B and D can be deferred to a later date provided the employee is covered by another creditable health plan, which means as good or better than Medicare.  If the group-sponsored plan is not creditable, the employee will pay a lifetime penalty for late enrollment into Parts B and D when they actually enroll.
  • Because Medicare coverage is not all inclusive and can involve substantial out-of-pocket costs for services, many people opt to either supplement their Medicare coverage with a “gap” policy which fills in where Medicare does not provide full coverage.  There are many insurance plans through multiple resources that a Medicare eligible subscriber may elect.
  • Another option is to elect Medicare Part C, also known as Medicare Advantage Plan, which is a wrap of Parts A, B, and D plus the gap coverage.  The difference between electing Parts A, B, D, and a gap policy versus electing Part C/Medicare Advantage is that with the a-la-carte method, Medicare coverage is offered and administered through the federal government.  If someone elects Medicare Part C/Medicare Advantage, all parts are administered through a private insurer sanctioned by Medicare.
  • If the employee opts to continue with the employer-sponsored plan, they have the right to do so.  The Age Discrimination in Employment Act (ADEA) prohibits employers from forcing an employee over the age of 65 to leave to plan, or to take a plan with lower benefits than what the rest of the group is offered.  The employee may opt to enroll in Medicare Part A (free plan) and use the group-sponsored plan to fill in additional coverage needs.
  • For groups with 20 or more employees, the group health plan will be considered primary, and Medicare Part A secondary.  The employee would not be required to elect Medicare Part B in order for the group insurance to pay claims for office visits.  For groups of less than 20, Medicare would be considered Primary.  Claims would be processed through Medicare first, then through the group health plan as secondary.  In this instance, the employee would be required by the health plan carrier to elect Medicare Part B before paying claims on a secondary basis.

As you can see, there are many variables that come into play for employees over the age of 65.  Confusion often occurs when those employees are faced with making those coverage decisions.  BCN Services can help your employees navigate through the sea of Medicare options. Please feel free to call  us at 1-800-891-9911 or contact us here.




Frank Lewandowski, Partnership Manager

PPACA-Important Update: Exchange Notification Delayed

The Affordable Care Act requires employers to notify their employees of the existence of health benefits exchanges. That notification requirement was to be fulfilled by March 1, 2013.

The notification date has been postponed.   A new date most likely in late summer or early fall will be announced.  The goal is to coincide with open enrollment on the Exchanges, which begins Oct. 1, 2013 (for a Jan. 1, 2014 effective date.)

Two reasons were cited for this delay:

1.  To coordinate with educational efforts and guidance on minimum value (the rule that employer-sponsored coverage must be affordable and cover at least 60% of services).

2.  To provide employers with sufficient time to comply.

When published, the notification must inform the employee of the existence of the Exchanges, including a description of the services provided by the Exchanges and the manner in which the employee may contact the Exchanges to request assistance.  In addition, the notification must convey the availability of premium tax credit to the employee if the employer’s plan doesn’t cover 60% of services and the employee purchases coverage through the Exchanges.  The employee may lose the employer contribution (if any) toward the cost of health benefits if the employee purchases coverage through the Exchanges.

BCN will work with you on Department of Labor and HHS requirements and provide the necessary notices needed for your Plans.  Please call us at 1-800-891-9911 or or contact us.




Sue Kester, HR Manager

Considerable benefit: Employers weigh how much to contribute to 401(k) plans

At this time of year, many employers are considering non-discretionary profit-sharing contributions to employee 401(k) accounts.

These are defined contribution plans allowing additional compensation to all eligible employees in the form of an employer 401(k) contribution.  An employer may decide each year whether there will be a contribution and, if so, how much will be contributed (out of company profits or other assets).

An employer’s contributions to the profit-sharing plan are generally tax deductible on a business’- federal income tax return for the year in which they are made.

Once a total contribution amount for the profit sharing contribution has been designated, your plan administrator (BCN uses Slavic Investments) will assist the employer in selecting a method of profit-sharing.  There are three commonly used contribution formulas:

  1. Traditional Method – Each 401(k) participant receives a proportional allocation based on eligible compensation.
  2. Age-Weighted Allocation Method – Allows the employer to allocate a contribution based on the compensation and age of eligible employees.  This method greatly benefits participants that are older and closer to retirement.
  3. New Comparability Allocation Method – Allows the employer to divide the employees into specific groups and allocate the contribution differently to each group (compliance testing is required).

BCN Services has experts to help you set up a 401(k) and handle other human resources needs for your business.  If you have questions or are interested in learning more about 401(k) profit sharing, please call us at 1-800-891-9911 or contact us here.


Alicia Jester, Manager-Benefits and Payroll

USERRA protects benefits for those in the armed services

The Uniformed Services Employment and Reemployment Act (USERRA) was passed by Congress in 1994 to protect the employment and benefits of an employee who is a member of the armed services while he or she is on military leave. Points to remember:

  • USERRA entitles an employee to return to work at his or her “escalator position,” i.e., a position of comparable seniority, status, and pay to which the employee “would have attained with reasonable certainty” but for the absence for service.
  • Under the absence, an employer may not discharge a reinstated employee for one year from the date of the individual’s re-employment.
  • Employees who leave work may elect to continue with their COBRA-like benefits while on military service for themselves and their beneficiaries for up to 24 months.
  • Employees also have the right to be reinstated in the employer’s health plans when reemployed, generally without any waiting periods or exclusions except for service-connected illness or injuries.

Finally, USERRA also prohibits employers from discriminating against past and present members of the uniformed services, and applicants to the uniformed services.

In 2008, the Military Family Leave Provisions of the Family and Medical Leave Act were expanded to protect the employment and benefits of employees who have a family member in the armed services who is called to or is on active duty and is injured, or who is in the military reserves or National Guard and has a qualifying exigency, or urgent need.

Points to remember:

  • Employees may use their 12- week entitlement to address certain qualifying exigencies
  • Qualifying exigencies may include: attending military events, arranging for alternative child-care, addressing certain financial and legal arrangements, attending certain counseling sessions, and attending post-deployment reintegration briefings.
  • Employees may take up to 26 weeks of leave during a single 12-month period to care for a covered service member who has a serious injury or illness incurred in the line of active that may render the service member medically unfit to perform his or her duties.

Both leaves are similar in that they protect the employee’s jobs and benefits.  The main difference is that USERRA should be applied when the leave is needed by an employee who is a member of the armed forces and the FMLA expansion applied when employees have a family member in the armed services who is called to or is on active duty and is injured, or who has a qualifying exigency.

BCN Services can offer assistance on these and other human resources matters, providing guidance to your company and your staff.  Please contact us here if we can help.



Lisandra Quinones, HR Administrator