Benefits For Small Businesses in Louisiana

Small Business Benefits Packages

There are many benefits to utilizing a personalized small business benefits package. It will increase employee morale knowing their life is secured with a comprehensive benefits plan complete with individual health plans, disability insurance, life insurance, and dental benefits.

Health reform is complicated and time-consuming, and our benefit specialists are here to ease the transition. If you have a small business in the New Orleans or Metairie area or along the Gulf Coast, the experts at AWS Insurance will work with you and review your small business’ currently existing employee compensation benefits package in relation to your competitors and cost, or create a comprehensive cost-efficient benefit plan that meets your needs.

Contact us today to begin creating your personalized benefits package for your small business in Louisiana.

Healthcare Plan Requirement Exceptions For Grandfathered Healthcare Plans

For better or for worse, Healthcare Reform has implemented many changes to the American healthcare system. However, as with any rule, there are exceptions. A “grandfathered plan” is a group health plan in effect as of March 23, 2010 (the date that Health Care Reform was signed into law) that has not made certain noteworthy changes that either lower benefits or increase out-of-pocket costs for those covered under the plan. (The date a particular employee joins the program does not necessarily need to match up with the date the plan was launched. New employees and new family members can be added to grandfathered group plans after March 23, 2010.)

What Is So Important About Grandfathered Plans?

Grandfathered plans do not have to comply with some requirements laid out under Healthcare Reform. These plans can still lose their grandfathered status if they do not meet certain minimum criteria. If a plan loses its grandfathered status, it will need to come into compliance with all of the requirements of healthcare reform under the ACA.

Health plans that consider themselves to be grandfathered must disclose this information in their plan materials and provide certain other information in the Disclosure of Grandfathered Status.

Grandfathered Plans Are NOT Exempt From:

Key Requirements That DO Apply to Grandfathered Plans

Many of the changes under Health Care Reform apply to all plans, regardless of grandfathered status. Key requirements that grandfathered group health plans must meet include:

  • 90-Day Limit on Waiting Periods. In plan years beginning on or after January 1, 2014, group health plans may not apply any waiting period that exceeds 90 days. These waiting periods are periods of time that must pass before a plan goes into effect for an employee or his/her dependents.
  • Dependent Coverage to Age 26. Grandfathered group health plans that offer coverage for dependents must continue to make the coverage available until a child reaches the age of 26. The exception to this is if the adult child has another offer of employer-based coverage (such as through his or her job). Beginning in 2014, a child up to age 26 can stay on the parent’s plan even if the adult child is eligible to enroll in another employer-sponsored health plan.
  • Elimination of Preexisting Condition Exclusions. Preexisting conditions are conditions affecting someone before they join a health plan. Group health plans cannot limit or deny benefits or coverage for a child younger than age 19 on the basis of a pre-existing condition. Effective for plan years beginning on or after January 1, 2014, this rule applies to both children and adults.
  • Medical Loss Ratio (MLR) Rebates. Employers who sponsor group health plans and receive rebates, as a result of insurance companies not meeting specific standards related to how premium dollars are spent, may be responsible for annually distributing the rebates to those eligible and enrolled in the plan.
  • No Lifetime or Annual Limits. Group health plans cannot impose lifetime limits on coverage of certain “essential health benefits.” Annual limits on essential health benefits are prohibited for plans issued or renewed beginning January 1, 2014. Until then, annual limits are being phased out according to the limits set by the law.
  • Prohibition on Rescission of Coverage. Group health plans are not permitted to rescind health coverage (meaning declare the coverage invalid from the time of enrollment). The exception to this is in the case of fraud or intentional misrepresentation by a person covered under the plan.
  • Summary of Benefits and Coverage (SBC). Effective for plan years and open enrollment periods beginning on or after September 23, 2012, group health plans and health insurance issuers offering group coverage are required to provide those participating in or benefiting from the plan with a summary of the benefits and coverage at several points during the process of enrollment and upon request.

Key Requirements That DO NOT Apply to Grandfathered Plans

Grandfathered group health plans are not required to comply with certain changes under Healthcare Reform, including those requirements relating to:

  • Coverage of Preventive Services Without Cost-Sharing
  • Essential Health Benefits Coverage
  • Guaranteed Availability and Renewability of Coverage and Limits on Premium Variations
  • Providing Certain Internal Appeals and External Review Rights
  • Selection of Health Care Providers and Access to Emergency Care

Health Benefits Available

Our benefit specialists will help you maximize your benefits while reducing your overall cost. We will save you time and money by finding the best policies on the market and comparing them for you. Below is a list of some of the products and services we provide.

Maintaining Grandfathered Status

Employers and those administering group health plans are allowed to make certain “routine” changes without losing grandfathered status. This includes changes such as adding new benefits, cost adjustments to keep pace with medical inflation, making modest adjustments to existing benefits, or any changes needed to comply with state or other federal laws. Note that changes in premiums are not taken into account when determining whether or not a plan is grandfathered.

Plans may lose “grandfathered” status if they make significant changes that reduce benefits or increase costs to those enrolled in the plan. In order to maintain grandfathered status, group health plans:

  • Cannot Drastically Cut or Reduce Benefits. For example, a plan wishing to remain in grandfathered status cannot decide to no longer cover care for people with diabetes, cystic fibrosis or HIV/AIDS.
  • Cannot Increase Co-Insurance Charges. Typically, co-insurance requires a patient to pay a fixed percentage of a charge (for example, 20% of a bill from a hospital). Grandfathered plans are not allowed to increase this percentage.
  • Cannot Significantly Raise Co-Payment Charges. Frequently, plans require patients to pay a fixed-dollar amount called a co-pay for doctor’s office visits and other services. Compared with the copayments in effect on March 23, 2010, grandfathered plans will be able to increase those co-pays by no more than either of $5 (adjusted annually for medical inflation) or a percentage equal to medical inflation plus 15 percentage points, whichever is greater. For example, if a plan raises its copayment from $30 to $50 over the next 2 years, it will lose its grandfathered status.
  • Cannot Significantly Raise Deductibles. Many plans require patients to pay the first sets of bills they receive each year up to a certain amount. This is known as a deductible. Grandfathered plans can only increase these deductibles by a percentage equal to medical inflation plus 15 percentage points, compared with the deductible required as of March 23, 2010,
  • Cannot Significantly Lower Employer Contributions. Many employers pay a given portion of their employees’ insurance premiums. Grandfathered plans cannot decrease the percent of premiums the employer pays by more than 5 percentage points. For example, if the employer is paying 25% of the premium, they cannot shift down to 15% and pass those costs on to the employee.
  • Note: Final rules provide relief to issuers, plan sponsors, employers, and plans that take certain steps to communicate changes in contribution rates. Specifically, the rules provide that an insured group health plan will not relinquish its grandfather status immediately based on a change in the employer contribution rate if, upon renewal, an issuer requires a plan sponsor to make a representation regarding its contribution rate for the plan year covered by the renewal, as well as its contribution rate on March 23, 2010 (if the issuer does not already have it). Additionally, the issuer’s policies, certificates, or contracts of insurance must disclose in a prominent and effective manner that plan sponsors are required to notify the issuer if the contribution rate changes at any point during the plan year.
    • In addition, a group health plan that requires either fixed-dollar employee contributions or no employee contributions will not cease to be a grandfathered plan if the employer contribution rate changes so long as there continue to be no employee contributions or no increase in the fixed-dollar employee contributions towards the cost of coverage and there are no corresponding changes in coverage terms that would otherwise cause the plan to cease to be a grandfathered plan. Click here to read the final rules in their entirety.
  • Annual Limit Of What Insurer Pays Cannot Be Adjusted. Some insurers put a limit on the amount that they will pay each year for covered services. If the insurers wish for their plans to retain their grandfathered status, they cannot tighten any annual dollar limit in place as of March 23, 2010. Furthermore, plans that do not have an annual dollar limit cannot add a new one unless they are replacing a lifetime dollar limit with an annual dollar limit that is at least as high as the lifetime limit (which is more protective of high-cost enrollees).  
  • Insurance Companies May Be Changed. While an employer with a group health plan can change the company that administers the plan without losing grandfathered status, the new administrator cannot change the plan in a way that makes it non-compliant with the above stipulations.

Grandfathered Multiemployer Health Plans

Additionally, the rules clarify that the addition of a new contributing employer (or new group of employees of an existing contributing employer) to a grandfathered multiemployer health plan will not affect the plan’s grandfathered status, provided that the multiemployer plan is compliant with the requirements to remain a grandfathered plan.

Additional Requirements to Maintain Grandfathered Status—Disclosure and Recordkeeping

A final requirement for plans to retain grandfathered status is that they include a statement about their belief that the plan is a grandfathered one, along with contact information for questions and complaints, in any plan materials provided to a participant or beneficiary describing the benefits provided under the plan. The U.S. Department of Labor provides a model notice that may be used to satisfy this requirement.

In addition, to maintain status as a grandfathered health plan, a plan must maintain records documenting the exact terms of the plan that was in effect on March 23, 2010, and any other documents necessary to verify, explain or clarify its status as a grandfathered health plan. Such documents could include plan documents, certificates or contracts of insurance, summary plan descriptions (SPDs), documentation of premiums or the cost of coverage, and documentation of required employee contribution rates. These records must be available for as long as the plan is referred to and treated as a grandfathered plan.

Vice President

Michael A. Seeling

Graduated from the University of Louisiana at Lafayette with a B.A. in Insurance Risk Management and is a graduate of Archbishop Rummel High School in New Orleans. He joined AWS in October of 2008 and has been awarded the Patient Protection and Affordable Care Act Certification (PPACA). Additionally, he is working towards his Certified Insurance Counselor (CIC), Registered Health Underwriter (RHU) and Registered Employee Benefits Consultant (REBC) designations. He is also a member of National Association of Health Underwriters (NAHU), National Association of Insurance, Financial Advisors (NAIFA) and is an active member with the Fore!Kids foundation.

Account Executive

Melinda Martin, CPIW

Melinda began her insurance career in 1985 with Alexander & Alexander where she received her Property & Casualty and Life & Health  license . Since then she has worked at various agencies in the New Orleans area and in California as a senior account manager for Employee Benefit Plans.  While in California, she was also the Membership Director for the Burbank Chamber of Commerce. Melinda joined the AWS team in July of 2015.

AWS Insurance

Call Us Today 1-800-375-5563
New Orleans 504-883-4111

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Metairie, LA 70001

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