Information Reporting: 1094s and 1095s

March 25th, 2015

IRS signThe Affordable Care Act has imposed significant information reporting responsibilities on employers. The latest one, the 1094s and 1095s do not need to be filed until 2016, but businesses need to start tracking information now.

What are the 1094s and 1095s?

The new information reporting system will be similar to the W-2 in that an information return (1095-B or 1095-C) will be prepared for each applicable employee. These returns will be filed with the IRS using a single transmittal form (1094-B or 1094-C). Employers must file these returns annually by February 28 (March 31 if filed electronically). Therefore, employers will be filing these forms for the 2015 calendar year by February 28 or March 31 of 2016.

The filing requirements are based on an employer’s health plan and number of employees. Forms that will be filed are:

  • 1094-B (Transmittal of Health Coverage Information Returns) and 1095-B (Health Coverage): These forms will be filed by insurance companies to report individuals covered by employer-sponsored group health plans. Small employers (those who have less than 50 full time employees) with self-insured health plans will use these forms to report the name, address and social security number (or date of birth) of employees and their family members who have coverage under their self-insured plan.
  •  1094-C (Transmittal of Employer Provided Health Insurance Offer and Coverage) and 1095-C (Employer Provided Health Insurance Offer and Coverage) will be filed by applicable large employers. These forms will be required if the employer offers an insured or self-insured health plan, or does not offer any group health plan.

The 1094s and 1095s were created to track your employees’ health insurance coverage for the year. The forms are used in determining whether an employer owes a payment under the employer shared responsibility provision. They are also used in determining eligibility of employees for premium tax credit.  

The Forms Businesses Need to File

The question that most businesses have is, what forms apply to them?

  • Self-funded employer groups (those who have 50 or more full time employees):
  1. Employers must submit form 1094-C to the IRS
  2. Employers must distribute to all full time and enrolled part time employees form 1095-C
  3. Employers must distribute to each non-employee  form 1095-C (non-employees includes Cobra beneficiaries and retirees)

Self-funded employers must include dependent information on these forms.

  • Fully insured groups (employers with 50 or more full time employees):
  1. Employers must submit form 1094-C to the IRS
  2. Insurance companies must submit form 1094-B to the IRS
  3. Employers must distribute to all full time employees and enrolled part time employees  form 1095-C (excludes dependent data; employee information only)
  4. Insurance companies must distribute to all full time and enrolled part time employees  form 1095-B (this includes dependent data)

The penalty for non-compliance is $100 per form.

How IAA can Help

Insurance Administrator of America realizes that completing these forms can be complicated. That is why IAA is offering to complete the 1094-C and 1095-C for businesses that are in need of some assistance. For a fee, here is what IAA can do for you:

  • Data mapping: IAA will map your employer and employee data from one or multiple source systems to the appropriate 1095-C box(s) relieving you of the burden of determining the correct IRS mapping code.
  • Data reconciliation and validation: IAA will reconcile and validate your data to ensure the information on the form ties to the data you supplied. Two levels of testing are performed throughout the year.
  • Form printing and mailing: IAA will facilitate the printing and mailing of the 1095-C forms to your employees prior to the statutory due date.
  • Corrections: When necessary, IAA will handle individual form corrections and generate new forms which will be sent directly to the employees.
  • IRS filing: IAA will ensure that our experts submit your 1094-C electronically to the IRS in the correct format by the required due date.

If you are interested in IAA handling your 1094-C and 1095-C form filing please feel free to contact Rebecca Friedman at Remember, with IAA one call does it all.

Interested in learning more about what IAA can do for you? Click here and here.

A Rise in Urgent Care Centers

March 18th, 2015

Urgent Care Center SignWhen you are in medical bind the emergency room might seem like the only solution. The only problem is waiting for hours on a minor medical issue. That is where urgent care centers come in: a less costly and more time effective method of handling those minor medical problems that happen outside of your doctor’s normal office hours.

What are Urgent Care Centers?

Urgent care, also known as immediate care, is similar to the retail health clinics operated by CVS, Target and others. They are generally open in the evenings and on weekends to treat routine maladies. Urgent care centers differ in that they also offer a board-certified physician and additional services such as on-site x-rays.

Urgent care centers do not replace primary care physicians. An urgent care center is a convenient option when someone’s regular physician is on vacation, unable to make a timely appointment or when an illness strikes outside of regular office hours. Urgent care offers an alternative to waiting for hours in an ER.

According to the Urgent Care Association of America, more than 8,000 urgent and immediate care centers across the country have opened with growth estimated at eight to 10 percent annually

Urgent Care Centers vs. Emergency Rooms

Urgent care differs from emergency room services in that its primary focus is on acute medical problems at the lower end of the severity spectrum. Other ways that the two services differ are:

  • Cost: Visits to the ER generally cost much more than those to a doctor’s office or urgent care center. Plus, your plan may not cover the ER visit if they determine your condition was not a true emergency.
  • Wait time: ERs treat patients with the most serious conditions first, so patients with less urgent needs will often wait longer to see a doctor. Urgent care centers only see patients with routine conditions and it’s usually on a first come, first serve basis.

There are of course medical issues where the ER is the first stop:

  • Coughing or throwing up blood
  • Deep wound
  • Dizziness or weakness that does not go away
  • Heavy bleeding
  • High fever that does not get better with medicine
  • High fever with a headache and stiff neck
  • Inhaled smoke or poisonous fumes
  • Pain in the arm or jaw
  • Passing out or fainting
  • Poisoning or overdose of drugs or alcohol
  • Possible broken bones, especially if the bone is poking through the skin
  • Seizures
  • Serious burn
  • Severe allergic reaction with troubling breathing, swelling or hives
  • Severe chest pain or pressure
  • Severe pain anywhere on the body
  • Sudden confusion
  • Suddenly not able to speak, see, walk, or move
  • Suddenly weak or drooping on one side of the body
  • Suicidal thoughts
  • Trouble breathing
  • Unusual  or bad headache that started suddenly

What IAA has to Say

Insurance Administrator of America wants you to keep money in your pocket. A way to save on your medical expenses is to head to an urgent care facility when your primary care physician’s office is not open or unable to give you a timely appointmentIAA encourages its clients and client members to look into in-network urgent care centers so you can keep money in your pocket the next time a surprise medical issue arises.

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March is National Chronic Fatigue Syndrome Awareness Month

March 11th, 2015

CFS Awareness BannerChronic fatigue syndrome or CFS is a devastating and complex disorder. People with CFS have overwhelming fatigue and a host of other symptoms that are not improved by bed rest and that can get worse after physical activity or mental exertion. Those with CFS often function at a substantially lower level of activity than they were capable of before they became ill

Possible Causes of CFS

Despite a vigorous search, scientists have not yet identified what causes CFS. While a single cause of CFS may yet be identified, another possibility is that CFS has multiple causes. Some potential causes of CFS are:

  • Hypothalamic-Pituitary Adrenal (HPA) Axis: The central nervous system plays an important part in CFS. Physical or emotional stress (commonly reported as a pre-onset in CFS patients) alters the activity of the HPA axis, leading to the altered release of hormones. These hormones can influence the immune system and many other body systems. 
  • Immune system and allergies: The immune systems of people who have CFS appear to be impaired slightly. 
  • Infection: Various types of infections have been studied to determine if they might trigger or cause CFS, such as mononucleosis and enterovirus infection.  
  • Nutritional deficiency

Factors that may increase your risk of CFS include:

  • Age: CFS can occur at any age, but it most commonly affects people in their 40s and 50s.
  • Gender: Women are diagnosed with CFS much more often than men.
  • Stress: Difficulty managing stress may contribute to the development of CFS.

Managing CFS can be as complex as the illness itself. There is no cure, no prescription drugs have been developed specifically for CFS, and symptoms can vary over time. Thus, people with CFS should closely monitor their health and let their doctor know of any changes.

Signs and Symptoms of CFS

CFS can be misdiagnosed or overlooked because its symptoms are similar to so many other illnesses. You may have CFS if:

  1. You have had severe chronic fatigue for six or more consecutive months which is not due to ongoing exertion or other medical conditions associated with fatigue.
  2. The fatigue significantly interferes with daily activities and work.
  3. The individual concurrently has four or more of the following eight symptoms:
  • A sore throat that is frequent or recurring
  • Headaches of a new type, pattern or severity
  • Muscle pain
  • Pain in the joints without swelling or redness
  • Post-exertion malaise lasting more than 24 hours
  • Significant impairment of short-term memory or concentration
  • Tender lymph nodes in the neck or armpit
  • Un-refreshing sleep

Other symptoms of CFS are:

  • Allergies or sensitivities to foods, odors, chemicals, medications, or noise 
  • Brain fog (like you are in a mental fog)
  • Chills and night sweats
  • Depression or mood problems (irritability, mood swings, anxiety, panic attacks)
  • Difficulty maintaining an upright position, dizziness, balance problems, or fainting
  • Visual disturbances (sensitivity to light, blurring, eye pain)

CFS in the News

In February of 2015, CFS received a new definition and a new name: systemic exertion intolerance disease or SEID for short. The name change is big news because many patients and experts in the field do not care for the name chronic fatigue syndrome; they feel it trivializes the condition.

On February 27, 2015 scientists announced their discovery that the immune systems of people with CFS differ from those of healthy people, and patients with recent diagnoses can be distinguished from those who have had the condition longer. The findings do not have immediate clinical applications for patients, researchers said. The biomarkers discovered, however, may eventually form the basis of the first diagnostic test for the illness.

What IAA has to Say

Insurance Administrator of America wants to bring awareness to CFS. IAA encourages you to share this blog post with others so they have a better understanding of the disease. Remember, with IAA one call does it all.

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What You Need to Know About FMLA

March 4th, 2015

Law signYou may have heard the term Family Medical Leave Act (FMLA), but do you understand the details of the process and who qualifies? Insurance Administrator of America is here to help you understand FMLA.

What is FMLA and Who is Entitled?

FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons. Group health insurance coverage continues under the same terms and conditions as if the employee had not taken leave.  Eligible employees are entitled to 12 weeks of leave in a 12 month period for:

  1. The birth of a child and to care for the newborn child within one year of birth.
  2. The placement with the employee of a child for adoption or foster care and to care for the newly placed child within one year of placement.
  3. To care for the employee’s spouse, child or parent who has a serious health condition.
  4. A serious health condition that makes the employee unable to perform the essential functions of his or her job.
  5. A qualify exigency arising out of the fact that the employee’s spouse, son, daughter, or parent is a covered military member on “covered active duty.”

Only eligible employees are entitled to take FMLA leave. An eligible employee is one who:

  1. Works for a covered employer
  2. Has worked for the employer for at least 12 months
  3. Has at least 1,250 hours of service for the employer during the 12 month period immediately preceding the leave
  4. Works at a location where the employer has at least 50 employees within 75 miles

About 62% of workers qualify to take leave under FMLA.

Who is a Covered Employer?

The FMLA only applies to employers who meet certain criteria. A covered employer is a:

  1. Private sector employer with 50 or more employees in 20 or more work weeks in the current or proceeding calendar year.
  2. Public agency including a local, state or federal government agency, regardless of the number of employees it employs. 
  3. Public or private elementary or secondary school, regardless of the number of employees it employs.

If you are qualified as a covered employer, it is important that you have knowledgeable staff or associates working to make sure you follow FMLA rules and regulations.

How IAA can Help

IAA understands the burden and costs associated with trying to handle FMLA administration in-house. Hiring IAA can help:

  • Employers are kept informed and updated on FMLA regulations.
  • FMLA administration is centralized. For companies that have more than one location, this is especially important.
  • FMLA compliance is ensured, thereby reducing the possibility of associated liability and violations with federal law.
  • HR professionals are relived from the FMLA burden and are now able to focus on other important business functions. 
  • IAA can help keep accurate records. IAA has programs that provide secure tracking of all reported leaves and with the ability to generate real-time reports, gives the employer the tools they need to help proactively address absence-related productivity issues.
  • IAA works with employers to ensure employee abuse of FMLA is reduced. If an issue is spotted, IAA will notify the employer.

IAA is here to help! If you are interested in learning more about how IAA can work with you on your FMLA administration, please reach out. Remember, with IAA one call does it all.

Interested in learning more about how IAA can help you? Click here and here.

The Hidden Sodium in our Snacks

February 25th, 2015

Salt shakerWhen the snow falls and the cold winter weather makes us want to stay indoors, snacks and microwavable meals may seem like the ideal food solution. Unfortunately, snacks, frozen meals and even food at restaurants can be overloaded with sodium which is harmful to your health.

Sodium is Everywhere

The human body needs a small amount of sodium to maintain a balance of fluids, to keep muscles and nerves running smoothly, and to help certain organs work properly.  When there’s extra sodium in your bloodstream it pulls water into your blood vessels, increasing the total volume of blood inside. With more blood flowing through, blood pressure increases.  Excess sodium can increase your blood pressure and your risk for heart disease and stroke.

Americans get most of their daily sodium (more than 75%) from processed and restaurant foods. Sodium is already in these foods when you purchase them, which makes it difficult to reduce daily sodium intake on your own. The Dietary Guidelines for Americans recommends that everyone age two and up should consume 2,400 milligrams (mg) or less of sodium a day.

Learn to Read the Signs

The Nutrition Facts Label lists the Percent Daily Value (%DV) of sodium in one serving of food. The Percent Daily Value is based on 100% of the recommended amount of sodium (which is less than 2,400 mg per day).

 While the Percent Daily Value is listed for one serving, many packages contain more than one serving. Look at the serving size and see how many servings you are actually consuming. If you eat two servings, you are actually getting twice as much sodium (or double the %DV).  Make sure you understand what the %DV is telling you:

  • 5%DV (120 mg) or less of sodium per serving is low
  • 20% DV (480 mg) or more of sodium is high

Check the front of food packages as well to identify foods that may contain less sodium. You may find these labels:

  • Light in sodium or lightly salted: At least 50% less sodium than the regular product.
  • Low sodium: 140 mg or less of sodium per serving.
  • No salt added or unsalted: No salt is added during processing, but not necessarily sodium free.
  • Reduced sodium: At least 25% less sodium than in the original product.
  • Salt/sodium free: Less than 5 mg of sodium per serving.
  • Very low sodium: 35 mg of sodium or less per serving.

Cut Down on the Sodium

Americans are ingesting too much sodium! Try cutting down your sodium intake:

  • Add flavor without adding sodium: Use herbs and spices to add flavor to your foods.
  • Consider your condiments: Sodium in soy sauce, ketchup, salad dressing, and seasoning packets can add up.
  • Examine your dairy products: Choose fat-free or low-fat milk products.
  • Get fresh when you can: Buy fresh or frozen poultry, pork and lean meat rather than canned, smoked or processed.
  • Prepare your own food when you can: Don’t salt food before or during cooking and limit salt shaker use at the table.
  • Speak up at restaurants: Ask to see the nutrition information in restaurants and choose a lower sodium option.
  • Unsalt your snacks: Choose unsalted snack products that are marked low sodium or no salt added.

One estimate suggests that if Americans moved to an average intake of 1,500 mg a day of sodium it could result in a 25.6% overall decrease in blood pressure and an estimated $26.2 billion in healthcare savings.

What IAA has to Say

Insurance Administrator of America wants you to cut down on your sodium! While snacks may taste good, they are not so great for your overall health. When you go down those grocery store aisles, think of IAA reminding you to put down the chips and pick up the fresh vegetables.

Interested in reading more on this issue? Click here.