RESIG’s Employee Benefits Department was created in 2008 to offer a dedicated, local service team for our member-districts, their employees, retirees and COBRA members. Rose Burcina,Director and Patty Baumunk, Administrative Assistant are both CA licensed Life & Health agents and along with Elizabeth Matheny, Clerical Assistant, are available to assist with phone calls and walk-ins including active employees, retirees, COBRA members and our district administrative teams. Thirty-three member-districts participate in our fully-insured Medical program while 26 participate in our self-insured Dental program. Additionally, we administer the vision plan benefits for 19 districts. Administrative services are offered at no cost to our health plan member-districts; a fee schedule applies to administrative services performed for non-member-districts. At least three Benefits Managers meetings are held annually to give our district administrative teams updates on Affordable Care Act (commonly known as Healthcare Reform or ACA) and from our carriers as well as assistance with the renewal and open enrollment processes.
RESIG’s broker, Alliant Insurance Services, negotiates with health benefit program carriers on an annual basis. The current plan period is October 1, 2012 to September 30, 2013. The Health Program includes Kaiser and SISC Blue Shield plans. Kaiser offers three HMO plans and a High Deductible Health Plan (HDHP); compatible with a Health Savings Account (HSA); SISC offers four PPO plans including an HDHP compatible with an HSA. The HSA plans are administered by RESIG. Kaiser’s Senior Advantage and SISC’s Blue Cross Medicare plans are available for retirees over age 65 with Medicare Parts A & B. Every district offers a Kaiser High Option Plan and
Twenty-six member-districts participate in RESIG’s self-insured Dental Program with Delta Dental. The current plan period is October 1, 2012 to September 30, 2013. Please contact the Benefits Department for plan and rate information.
RESIG has partnered with Misty Humphrey, the Healthy Eating Specialist from Whole Foods Market in Coddingtown to provide important and relevant health and wellness information to our community of school districts. Our mutual goal is to create a “trickle down” effect to influence what our school children eat and how they view and understand nutrition by providing the information to district employees. Misty conducts two FREE Health Study Courses a month (one in the Coddingtown Whole Foods Store and the other at Wilson School in Petaluma). Pleasecontact the Benefits Department for the schedule of classes.
RESIG’s district employees and their immediate family members are eligible to enjoy the special “Educators” discount of 50% off enrollment fees including a complimentary fitness orientation when you join and 20% off monthly dues. A free 7-day guest pass to try the club before you join is also available. There are five locations for your convenience (Larkfield Center by Molsberry’s Market, Santa Rosa Ave by Costco, Mountain Hawk Way in Rincon Valley, Golf Course Drive in Rohnert Park and Lakeville Highway in Petaluma). Simply say that you’re a RESIG district employee to get started soon!
2012-2013 Plan Renewal Information
Kaiser and SISC Blue Shield will remain our plan carriers throughout the upcoming 2012-2013 renewal period.
SISC Blue Shield’s active and early retiree rates will increase approximately 5-7% for Blue Shield PPO plans. The SISC Blue Cross CompanionCare plan will decrease again from $427 per retiree/per month to $373.
Kaiser’s active and early retiree rates will not increase for th2012-2013 renewal period. Kaiser’s Senior Advantage rates will decrease slightly again.
- Delta Dental’s rates will increase approximately 10-12%.
- VSP’s vision rates and renewal periods vary district-by-district.
Rate sheets for each coverage plan are posted in the Forms section. Please contact RESIG Benefits if you would like more detailed information.
President Obama’s reelection essentially guarantees that the Affordable Care Act (ACA) implementation will proceed and that significant amounts of new guidance will be published.
Although much is still uncertain about ACA at this time, a brief overview of upcoming events is below for your review.
Pay or Play Rule
The ACA requires certain large employers (including private, public, churches and non-profits) to provide health plan coverage to its employees or pay a penalty tax to the federal government.
A “large” employer is an employer who employed an average of at least 50 full-time employees, working at least 30 hours per week, on business days during the preceding calendar year.
Employers can minimize exposure or prevent penalty by following three requirements:
1) Offer “Minimum Essential Coverage” under an “eligible employer-sponsored plan” to all its full-time employees (and, perhaps, dependents) who are eligible for subsidized Exchange coverage
2) Ensure employer’s plan provides “Minimum Value”
3) Ensure employee’s share of premium for self-only coverage under employer’s lowest-cost, Minimum Value plan is “Affordable” (i.e., 9.5% or less of W-2 wages).
Extended Effective Date for Non-Calendar Year Plans (proposed change – likely to go through)
The new regulation provides a slightly-delayed effective date for many non-calendar year plans (i.e. RESIG’s plan year runs from October 1 to September 30). The net effect appears to be that such plan will need to comply with the Pay or Play Rule by the first day of the 2014 plan year rather than January 1, 2014.
DeMinimis Rule (proposed change – likely to go through)
This was probably the number one concern of employers. An employer will not face a Pay or Play Rule penalty if it fails to offer coverage to five percent or less of its full-time employees. With the new standard, employers do not have to worry about being hit with penalties if, for example, a single employee was not offered coverage because of an inadvertent error.
You may request the Play or Play Rule Guide by email to firstname.lastname@example.org.
Patient Centered Outcomes Research Institute Fee
Regulations were issued recently on how plan sponsors and insurance carriers should calculate and pay the “Patient Centered Outcomes Research Institute” fee (PCORI fee).Basically, the PCORI fee applies to plans that provide major medical benefits including the plans for districts in RESIG’s health plan program. The PCORI does not apply to districts in RESIG’s dental program.
The fee is currently $1.00 per “covered life” and applies starting with the first plan year that ends on or after October 1, 2012. The fee is payable by July 31stof the calendar year immediately following the last day of the plan year. The fee is payable by the insurance issuer (SISC and Kaiser for RESIG’s health plan program) and although there has not been any mention of it yet, I would expect the fees to be passed on to employers through premiums at some point.
Beginning in 2014, new ACA regulations will impose a “temporary” fee of $63 per year, per covered life under an employer’s major medical health plan. The fee lasts for three benefit years (2014, 2015, 2016) and is expected to collect approximately $20 billion. The fee does not apply to dental or vision plans.
RESIG’s health plans are fully insured so the fee will be due by the insurance issuers; Kaiser and SISC in our case. Although it is not specifically mentioned at this point, we expect the cost of the reinsurance fee to be passed on to employers through premiums in the future.
RESIG will continue to provide updates to the Affordable Care Act through meetings and emails to our health program member-districts as information becomes available. Updates will continue to be summarized in the RESIG Rap newsletter as well.
Summary of Benefits and Coverage
Health Care Reform requires employers/plan sponsors to distribute a Summary of Benefits and Coverage (SBC) beginning with open enrollment periods that started after September 23, 2012. The SBC is intended to provide high-level descriptions of group health coverage and definitions of standard terms.
An SBC must be provided to all currently enrolled employees and their dependents during each open enrollment period – for the plan that the employee is currently enrolled in.
- A single SBC can be sent to the employee and his or her dependents, if they are all living at the same address. However, if any dependents live elsewhere, a separate SBC must also be sent to the dependents’ address.
- An SBC for each eligible plan option must to be provided to each new employee.
- Once enrolled, the carrier will mail the SBC for the newly selected plan to the employee.
- All SBC’s must be available to any employee who requests them.
Kaiser has recently provided the SBC’s for RESIG’s health plan member-districts. The SBC’s are posted in the Employee Benefits section of RESIG’s website (www.resig.org) or you may email your request to email@example.com. SISC has not released their final versions of the SBC’s; you will be notified when they become available.
The above information briefly summarizes some, but not all, aspects of the federal health care reform Affordable Care Act (ACA). It does not constitute legal or financial advice. The answer to a particular question may vary depending upon your district’s unique facts and circumstances.
Although there is much about Health Care Reform that we do not know or understand at this time, we will keep you informed as we learn more about how it will affect your day-to-day business concerning our Health Programs. If you have any questions in the meantime, please contact firstname.lastname@example.org for assistance.