Posted by Eric Falkner | Nov 28th, 2013 | Tags: Union, Community, Healthcare, Affordable Care Act
Dear IATSE National Health and Welfare Fund participating Local Union: Recently your members, as well as your office, have received many notices from the IATSE National Benefit Funds. There is a lot more information on its way via our year-end newsletter which includes important information about the Pension, Annuity and Vacation Funds. You will also be receiving an important notice shortly about improvements to the Mental Health Benefit provided by the National Health & Welfare Fund. So far we’ve told you about a number of changes in Health and Welfare Fund Plan C, including CAPP rate changes for April 1, 2014, DOMA, and changes to the Medical Reimbursement Program (“MRP”), as required by the Affordable Care Act (“ACA”). We have also advised you of significant pension benefit increases for retirees and active participants in the Pension Fund, The notice on the changes to the Health Fund’s stand-alone MRP Plan, which are required by the ACA, has generated numerous inquiries from many of our Locals and many of our participants. Since there seems to be a broad-based need for clarification on many ACA topics and their application to the National Health & Welfare Fund, I have prepared the following FAQs. I hope you will find them useful in guiding your members, your office staff, and yourself. I have compiled these particular FAQs based on the questions we are being asked most often.
- What is the definition of a “group health plan” as defined by ACA?
In order to qualify to enroll in a Health Reimbursement Arrangement (HRA), which is what the National Health and Welfare Fund’s MRP is, you must have primary health coverage that is a group plan sponsored by an employer (that is, obtained through employment) or sponsored by a union. Your primary health coverage cannot be “individual” coverage for this purpose.
- What is the definition of individual coverage?
Individual coverage is coverage that you purchase on your own (whether directly from an insurance carrier, such as Cigna, Aetna, United, BlueCross or BlueShield, or through a state insurance Marketplace (previously called the “Exchange” such as in the state of Massachusetts) or that you obtain through a government program such as Medicare, Medicaid, Veterans Administration, National Programs (such as the U.K.) etc.
- Why can I no longer use my individual coverage as the basis for enrollment in the stand-alone MRP Plan?
Guidance was issued by the government on September 13, 2013 which dictated that, in order for someone to enroll in an HRA (like the MRP Plan), they must be actually enrolled in an employer/union sponsored group health plan. The National Health & Welfare Fund must comply with this legal requirement.
- What happens if I do not provide the Fund Office with proof of other employer/union sponsored group health coverage and the required certification by the open enrollment deadline of December 16, 2013?
If you fail to timely submit the required proof of other employer/union sponsored group health coverage along with the completed and signed certification that such other coverage provides “minimum value” (as defined by the ACA), you will be defaulted into Plan C-2 or C-3 single coverage if your CAPP account balance is sufficient to cover the entire cost of such coverage for one quarter. If you were enrolled in the MRP as a stand-alone option in 2013 and wish to waive your CAPP balance entirely so that you may be eligible for a government subsidy if you buy coverage on the Health Insurance Marketplace, you may request a waiver form from the Fund Office or download it on our website at iatsenbf.org.
If your CAPP account balance is not sufficient to cover the cost of at least one quarter of C-3 single coverage (and the current $150 administrative fee), your coverage from the Fund will lapse. Once your coverage lapses, you will not be offered Plan C coverage again until you have enough in your CAPP account to cover the cost of at least one month of C-3 single coverage (and you may at that time opt for that coverage or co-pay for more expensive coverage). You will not be automatically defaulted into Plan C coverage until your account is sufficient to cover at least the cost of one quarter of C-2 single coverage (and the current $150 administrative fee). If a member qualifies for coverage through the National Health & Welfare Fund, can they still obtain coverage through the Marketplace? As far as we understand, there is no prohibition on purchasing coverage through the Health Insurance Marketplace even if a person has other health coverage. However, if you have coverage under the Fund (or an offer to opt into coverage), you may be disqualified from receiving a federal subsidy for coverage purchased through the Marketplace.
- Does coverage obtained through the Marketplace qualify as valid group coverage in order to enroll in the stand-alone MRP Plan?
No. In order to enroll in the stand-alone MRP Plan, your other coverage must be employer or union sponsored group health coverage.
- Is coverage through Medicare, Medicaid, or the Veteran’s Administration acceptable as “other group health coverage” pursuant to ACA requirements?
No. These are not employer/union sponsored plans and are therefore not considered acceptable other coverage for enrollment in the Fund’s MRP stand-alone option pursuant to ACA guidance.
- What if I am currently enrolled in Medicare? How am I affected?
The National Health & Welfare Fund recently sent you a notice advising that the Board of Trustees has created a separate MRP Plan designed solely for retired Plan Participants who are on Medicare. It is called the Retiree-Only Medical Reimbursement Program (“MRP”) Plan. As of January 1, 2014, a Medicare enrollee’s Plan C CAPP account balance (with employer contributions received through October 31, 2013) will be converted to a Retiree-Only MRP account, unless the individual (i) is deemed active by current Plan rules at January 1, 2014, (ii) timely enrolls in active coverage (Plan C-1, C-2 or C-3), or (iii) timely submits an election form requesting that his or her Plan C CAPP account balance stay in the Active Plan for purposes of obtaining such coverage in the future, in addition to his or her Medicare coverage.
- Is the MPIPHP coverage considered group health coverage?
Yes. Any group health plan coverage obtained through your employment or employment of your spouse or partner is acceptable “other group health coverage” for purposes of enrollment in the stand-alone MRP Plan, provided that you submit the required proof of other coverage and certify that the other coverage meets the ACA’s minimum value standard. You can check with your Plan Sponsor (typically your employer) or the insurance carrier whether the other coverage meets the minimum value standard. All benefit funds and insurance companies are required to issue SBCs (Summary of Benefits and Coverage) that indicate whether the plan of benefits meets the minimum value standard pursuant to the ACA’s requirements. The SBC will indicate that at the top of the form.
- What do I need to provide to the National Health & Welfare Fund in order to continue to enroll in, or elect to enroll in, the MRP Plan option for this year’s open enrollment?
You must send a front and back copy of your other insurance / coverage identification card along with the checked box and signed certification form that will be on your year- end statement or enrollment form. Your identification card must state that it is a group plan or have a group identification number on it (with the word “group” prominently displayed) or you must obtain a letter from your plan sponsor (typically, employer) or the insurance carrier stating that you are enrolled in an employer/union sponsored group health plan.
- If coverage is cheaper on the Marketplace, can I waive my current coverage and purchase coverage on the Marketplace?
You may not waive coverage under the Fund’s Plan C-1, C-2, or C-3 options. You may only waive an MRP balance if you are enrolled in the MRP Plan on a stand-alone basis. The only advantage to waiving an MRP balance is that this may allow you to qualify for a federal subsidy for coverage purchased through the Marketplace. We cannot offer guidance on this issue, since the subsidy is based on total household income, which is information that this Fund does not have.
- If I incurred claims during 2013 for which I want reimbursement in 2014 do I have to be enrolled in the MRP option in 2014 to make a claim?
Yes, you must be enrolled in the active stand-alone MRP option at the time of the claim submission. If you are covered under Plans C-1, C-2, or C-3 in 2014 and have excess funds in your CAPP account available for reimbursement, then you can submit for reimbursement any claims incurred during 2013 as long as they are postmarked by March 31, 2014. As of January 1, 2014, in accordance with ACA requirements, the following expenses are NOT eligible for reimbursement under the MRP: individual health coverage premiums, as well as amounts to cover deductibles, co-insurance or excluded items as determined by an INDIVIDUAL health insurance plan that you may have had in 2013.
- If I was enrolled in the stand-alone active MRP Plan through December 31, 2013 but are not enrolled in that option for January 1, 2014 do I still have until March 31, 2014 to submit my 2013 incurred claims for reimbursement?
No. Under the Plan rules, the claim for reimbursement must have been incurred while you were enrolled in the MRP Plan and must be submitted at a time while you are still enrolled in the MRP Plan. In addition, as explained above, as of January 1, 2014, the ACA prohibits HRAs (like the MRP Plan) from reimbursing individual health plan premiums [or any cost-sharing under such an individual plan (deductibles, co-payments, etc.). Your 2013 claims must be postmarked before the end of 2013 in order for them to be eligible for reimbursement.
- What happens if I have a loss of coverage during the year?
If you lose coverage under Plans A, C-1, C-2,or C-3, you will be offered COBRA(self-pay continuation coverage). You have the right to purchase COBRA continuation coverage through the National Health & Welfare Fund until you re-qualify for coverage through employer contributions. Instead of electing and paying for COBRA coverage, you may wish to obtain coverage through the Health Insurance Marketplace. With either COBRA or Marketplace coverage, you should avoid a tax penalty for being uninsured.
- How long can I be without coverage before a tax penalty for being uninsured is imposed
As long as your period of being uninsured is less than three (3) months and only occurs once in a calendar year then the IRS will not impose a penalty on you. Since the Health Fund’s coverage runs in quarters, a loss of coverage will be equal to, and in some cases greater than, three months. Therefore, to avoid a tax penalty you should exercise your right to obtain coverage through COBRA (by making a timely election and payment) or purchase coverage through the Health Insurance Marketplace.
- What does minimum value mean?
In general, the ACA’s minimum value requirement means that your group health coverage must cover at least 60% of plan costs. What does "affordable" mean?
Affordable means that any payment you make for your individual coverage only (excluding any cost to cover your dependents) cannot exceed 9.5% of your total household income. Since the Fund does not maintain information about your total income or that of your entire household we would be unable to guide you as to whether or not coverage through one of our Plan options or that of another group fits the government’s definition of affordable.
Sincerely, Anne J. Zeisler Executive Director November 13, 2013