Don’t Be Caught Unaware, the Cadillac Tax Is Waiting To Time In

Cadillac-Tax

It’s all about taxes.

According to the Affordable Care Act of 2010, requiring the purchase of a product is illegal, but mandating a tax for not purchasing that product is legal. At this point, as a business owner, insurance broker, or HR professional, you have weathered the first season of regulations that have come, but are you prepared for the next season of changes? At MBA we want to make sure that you are ahead of the forthcoming benchmarks and understand that another tax mandate is coming right around the corner.

Cadillac automobiles have long been the luxury standard in their industry. In the medical benefits industry the term Cadillac plan describes a high-end, expensive medical benefits provided by employers. Medical insurance, and other perks have been considered part of the employee’s overall compensation package, but it is a payout that is not taxed. Employers can offer additional insurance and incentives to their team, without paying taxes on that expenditure. All of that is about to change and we don’t want you to be caught off guard.

The fine print of the Cadillac tax

In 2018 the Affordable Care Act will begin placing a 40% tax on the cost amount above and beyond $10,200 for an individual’s coverage and $27,500 for a family coverage. This cost does not include stand alone dental and vision plans, but it does include the cost for; insured and self funded group medical plans, wellness programs, flexible spending accounts, health savings accounts, health reimbursement accounts, archer medical savings accounts (all pre-tax contributions), on-site medical clinics, executive physical programs, pre-tax coverage for a specific illness (laser insurance), hospital indemnity, federal/state/local government-sponsored plans for employees, retiree coverage and multi-empower plans.

What’s included in Cadillac plans that most others don’t have?

Medical benefits vary drastically from employer to employer, so what is included for one group may be completely different for another. However, research has shown that just because a plan qualifies as a Cadillac plan, with the higher costs, doesn’t necessarily mean that the insured are receiving better care or more benefits. Health Affairs published a study in 2009 that showed only a, “3.7% of the variation in the cost of family coverage in employer-sponsored health plans is attributable to differences in the actuarial value of benefits. Only 6.1% of the variation is attributable to the combination of benefit design and plan type (e.g., PPO, HMO, etc.).”

The bottom line is that the higher costs to having a Cadillac plan is often determined by two factors; the industry being covered, such as employees in high-risk positions; and the rising and exorbitant cost of receiving medical care in our country. In many cases the insured aren’t necessarily receiving more benefits or superior service with that high price sticker of the Cadillac plan, they are just absorbing the cost of being their industry, as well as the huge markups by network hospitals and providers.

How can I use this information to maintain benefits for my employees and avoid the tax?

It is time to start listening to leaders who are using innovation to move forward in the health benefits industry, who are helping groups maintain a high quality of benefits, while simultaneously decreasing costs. (On average first year plans save 25% from their previous plan year.) Phyllis Merrill, CEO of MBA Benefit Administrators has been looking for evidence-based ways to save clients’ money for more than 30 years. She explains, “Let’s be sure we are looking at the total costs when looking at information on the Cadillac plan.” Often times big companies can maintain their longstanding, high-end benefits, without going over the ACA’s price limit by looking into the areas that actually save money, which is what Merrill recognizes as, “The handling of the ‘other’ factors, with medical management and effective audit and repricing of hospital and doctor charges.”

As a third party administrator (TPA) MBA has created an innovative system that not only supports members in medical distress with medical management, (which by the way, is the number one cause for long standing expensive premiums for a company, no matter what happens to that particular employee), but that also keeps in check the runaway price gouging that is so often witnessed with large groups and hospitals. There are three simple steps that MBA has used in their new medical benefits plan called, The Open SolutionTM that have proven over and over again that maintain quality benefits and save groups hundreds of thousands, and often times millions of dollars.

  • First, eliminate the PPO networks. This opens up opportunities across state lines, and within a community to choose the right healthcare provider for the situation, rather than the mandated one that is in network.
  • Second, help members with chronic conditions take control of their recovery from disease or injuries with medical management.
  • Third, provide top of the line audit and repricing of medical claims, to ensure the provider receives a reasonable profit, but doesn’t price gouge the consumer. This important component includes legal protection and court precedence in favor of this innovative model.

If you have questions about your medical benefits and the impact of the looming Cadillac tax in the years to come, or want to know more about the “other factors” that can impact your bottom line, please reach out to our team online, or call us at 1-800-877-3727.

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...with powerful health care and claims management systems to save them money.
We believe your investment in a health plan should be treated like any other aspect of your business, with upfront knowledge of the costs and all attempts to weed out waste. MBA saves employers more than nickels and dimes with many methods of management, including: Metrics Based Pricing: Why rejoice over a 30% discount on a claim that is 1000% too high? Metrics Based Pricing reduces claims to a “cost of service + reasonable margin” level by auditing claims for unfair markups and inaccurate or fraudulent billing. This results in an average $1500 per employee savings – AND WE DO IT WITHOUT RESTRICTIVE NETWORKS! Medical Management Services: Proven to reduce hospital admissions and the average length of stay. HealthSteps™: Wellness plans and initiatives that do make a difference in the overall health of your workforce and drive down health claims. Prescription Benefit Management: With an average reduction of 9.4%. Internet Prescription Bidding: Allowing employees to save up to 87%. Actuarial Projecting: The projection of benefit costs and savings is one of our underwriting core competencies. Go ahead – suggest benefit changes, add or drop a plan component, change eligibility: MBA will accurately determine the financial impact on the plan and offer suggestions to tweak the benefits to suit your objectives. We offer the facts then you call the shots.
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We're neighbors you can talk to...
Where else can you get a direct line to a claims adjudicator, plan manager or even the President of the company? Only at MBA Benefit Administrators. We’re the big third party administrator for health plans with personal service that you can only wish others would provide. Like talking to a friend over a fence, we have that neighborly feel…but we provide world class advantages.
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With “outside the box” flexibility in health plan administration…
Since 1987 MBA Benefit Administrators has successfully served large and small employers, public entities, associations, tribal nations, school districts, non-profit organizations and insurers. We have the capability to administer anything from single-plan 25-life groups to complex employee organizations with multiple medical, dental and vision benefits or employees in multiple states. We also provide a wide array of ancillary services such as COBRA and HIPAA administration and HSAs. When you discover:

  • The depth of our experience
  • The flexibility we offer in benefit design
  • Our commitment to technology to make your life easier
  • Our can-do attitude toward service

 

…we’re confident you too will see why MBA is a national leader in third party administrative healthcare benefits.

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…and we prove real solutions do exist for escalating healthcare costs.
We’ve received national kudos for our multiple, proven strategies which reduce claims and plan costs without harmful benefit reductions for our clients’ employees. Proof of MBA’s effectiveness in this is in the numbers. Our clients see:

  • An immediate average reduction of up to 25% in maximum health plan costs the first year,
  • Flat renewals after that, and because of this and our commitment to impeccable service…
  • Our clients remain with us an average of 12 years…an unheard of accomplishment in the health insurance industry.
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…and state-of-the-art technology for painless administration and integration of services, we make your life easier.
No one thinks about making your life easier and more efficient than MBA Benefit Administrators. Our technological investments are totally integrated across services so that employees and employers – with HIPAA-compliant and appropriate need-to-know safeguards – can view at a glance their standing for benefits, claims, plan reporting and other services. These advancements provide:

A Comprehensive On-Line Enrollment Wizard: Employee self-enrollment or HR department enrollment methods, including ancillary program enrollments and billings.

HR On-line Capabilities: View, adjust and approve on-line employee eligibilities; check claims status, print reports and plan documents all from one place.

Multiple Employee Access Channels: Employees can view on-line their claims status, eligibility and account balances of reimbursement plans such as HRA, HSA, Flex and Executive Reimbursement plans. In addition, we offer all employees our MBA App, where they can:

  • Carry a virtual ID card,
  • Check on the status of a claim,
  • Submit secure documentation to MBA,
  • Contact our support team,
  • …and more!

On-line Document Management: In one place view specific documents such as:

  • Plan Documents
  • Temporary ID Cards, and
  • Employee Communications and Forms

HSA Services Integration: MBA seamlessly integrates HSA plans with HealthEquity Services. Claims information is electronically transferred from MBA’s claims system to HealthEquity employee accounts. There is no need for paper claim filing or second-guessing the eligibility of expenses. Even employee eligibility is updated through MBA data feeds.

HRA Reimbursement Plans: MBA’s administration processes allow clients and their participants to rely on accurate and timely processing of reimbursements. Eligibility, billing and remittance of claims, integrated scanning and storage allow for real-time remote access.

Section 125 Flexible Spending Plans: MBA Benefit Administrators coordinates with employers to offer Section 125 Flexible Spending administration and help employees save money on medical expenses. Providing this benefit for your employees is like getting a 30% discount on Medical Premiums, uncovered medical expenses and dependent care.

COBRA Administration: MBA Benefit Administrators can handle all of your COBRA requirements. We will mail and track notifications, coordinate COBRA payments, receipts and reporting and ensure claims match “paid through” dates, plus give you on-line access to all activities.

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At MBA employers are cared for too…
MBA goes the extra mile to ensure that as an employer your health plan does not complicate your life. We give you things like:

  • Business intelligence for advanced reporting and critical analysis of your plan’s performance, costs, payouts, claims analysis and large claims submitted for insurance.
  • Billing and Funding services integrated with enrollment, customized to your specifications and handled electronically.
  • Account balancing systems produce cost accounting reports and perform bank reconciliation activities, available for review at any time.
  • And the ability to review multiple reports regarding your plan; check registers, active employee reports, YTD recaps, claims reviews and lots more.
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1. It’s an “easy in”.
Almost every larger employer (50+ employees) annually shops their company’s health insurance. Rapidly rising rates and diminishing benefits have traditionally caused them to shop this aspect of company insurances more than any other.

With very little work this easily opens a lot of doors you wouldn’t otherwise get through. Furthermore, local employers like local expertise. They welcome the neighborhood broker who can answer service questions or help with the employee enrollment process. All you have to do is be ready with competitive products at the appropriate time.

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2. Group health opens the door to other profitable sales.
There are a lot of needs that are begging for solutions within the corporate world, whether that world employs 50 or 5,000. CEOs and business owners want to retain key employees or prepare themselves for the future. Employees need guidance during life changes, such as an impending retirement, the buying of a new house or the birth of a child.

If you wander the halls of your group clients under the guise of service, you’ll be surprised what you uncover and how much more you can sell – just because you’re accessible.

With very little work this easily opens a lot of doors you wouldn’t otherwise get through. Furthermore, local employers like local expertise. They welcome the neighborhood broker who can answer service questions or help with the employee enrollment process. All you have to do is present your own insurance lines and solutions – the same products you currently sell – when the need arises…and it will!

• Key Person Insurance
• Buy/Sell Agreements
• Deferred Compensation
• Disability
• Estate Planning
• Retirement Plans
• P&C Products – Both Business and Personal

…the list could go on and on. MBA doesn’t provide these products, but with the group health business already captured you’ll be in a position to favorably present your own policies and services.

Each easy cross-sell has the potential to be very profitable as now you, the group health broker, are a trusted resource. Make one sale and it won’t be long before everyone wants to talk to you just because you are the tacit face of insurance within a group client’s company.

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3. The larger group health market offers long term financial stability.
It is a proven fact that the more products you have in place within a group the less likely it is that some other broker will be stealing your business. With a competitive group health plan, a passion for service and additional products in place, employers think twice about switching brokers. MBA, for example, has an average client retention rate of 12 years.

Group health is rarely a stand-alone product. With today’s tax codes a group health plan almost always immediately calls for HSAs, COBRA administration and the like. In addition you’ll be finding a lot of ancillary sales.

That’s a good, stable building block for a broker’s income. Year after year the same commission is paid the broker and year after year the deep well for cross-sells keeps on giving.

In the meantime, adding new groups just keeps the broker’s income growing to the upside.

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4. Commissions are recurring and high, perhaps higher than any other product line.
To put things into perspective:

• What’s the average commission on a home owner’s or auto policy?
• How often do you dig up on your own a million dollar life policy or high 6-figure annuity?
• How easy is it to scrape up new business?

Contrast that with the group health broker. MBA, for example, pays brokers handsomely (on average $25 per employee per month) for every group they sign up. On top of this are your multiple cross-sells for several product lines. With a good base group health income and constant cross-sells, a commission from one group can rack up quickly.

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4. Commissions are recurring and high, perhaps higher than any other product line.
To put things into perspective:

• What’s the average commission on a home owner’s or auto policy?
• How often do you dig up on your own a million dollar life policy or high 6-figure annuity?
• How easy is it to scrape up new business?

Contrast that with the group health broker. MBA, for example, pays brokers handsomely (on average $25 per employee per month) for every group they sign up. On top of this are your multiple cross-sells for several product lines. With a good base group health income and constant cross-sells, a commission from one group can rack up quickly.

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