Public Announcements

     

    Wichita Falls Insurance Agent Kelly Fristoe Named Vice President of NAHU

    Wichita Falls Insurance Agent Kelly Fristoe Named Vice President of NAHU

    WASHINGTON, DC -- Kelly Fristoe, a Wichita Falls, Texas-based insurance agent, was appointed vice president of the National Association of Health Underwriters’ Board of Trustees at its 90th Annual Convention, hosted virtually earlier this week.

     

    "Kelly has spent over two decades supporting and leading his fellow NAHU members," said Janet Trautwein, CEO of NAHU. "I am confident he will continue his excellent track record as our next vice president."

     

    Fristoe has worked in the insurance industry for 30 years, most recently as a partner and founding member of Wichita Falls, TX based Financial Partners. He joined NAHU in 1993 and has served in over two dozen leadership positions across his local and national chapters. Fristoe served as president of the Texoma Association of Health Underwriters from 1995-96 and president of the Texas Association of Health Underwriters from 2012-13. He was secretary of the NAHU Board of Trustees from 2018-19 and treasurer from 2019-20.

     

    Fristoe attended both Lubbock Christian University and Texas Tech University. He currently resides in Wichita Falls with his wife, Jana. 

     

    "I am thrilled to be serving as vice president of NAHU's Board of Trustees," Fristoe said. "I have spent three decades working to improve our industry, and I look forward to continuing that work with my fellow board members."

     

    The National Association of Health Underwriters represents 100,000 professional health insurance agents and brokers who provide insurance for millions of Americans. NAHU is headquartered in Washington, DC. For more information, visit www.nahu.org.

     

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    IRS Releases FAQs on COVID-19-related Tax Credits

    IRS website, "COVID-19-Related Tax Credits for Required Paid Leave Provided by Small and Midsize Businesses FAQs"

    On its website, the IRS has released a series of frequently asked questions regarding credits for wages paid for family and medical leave and for emergency paid sick time.

    Background. The Families First Coronavirus Response Act (P.L. 116-127, the FFCRA or the Act), which is intended to ease the economic consequences stemming from the novel coronavirus disease (COVID-19) outbreak, provides family and medical leave, and sick leave, to employees and providing tax credits to employers providing the leave.

    Family and medical leave. The Act includes the Emergency Family and Medical Leave Expansion Act (EFMLEA) (Division C of the Act), which requires employers with fewer than 500 employees ("Eligible Employers") to provide both paid and unpaid public health emergency leave to certain employees through December 31, 2020. The first 10 days of leave may be unpaid and then paid leave is required, calculated based on an amount not less than two-thirds of an employee's regular rate of pay and the number of hours the employee would otherwise be normally scheduled to work, not to exceed $200 per day and $10,000 in the aggregate.

    Emergency paid sick time. Under the Emergency Paid Sick Leave Act (EPSLA) (Division E of the Act), private employers with fewer than 500 employees, and public employers of any size, must provide 80 hours of paid sick time to full-time employees who are unable to work (or telework) for specified virus-related reasons.

    For more information on EFMLEA and EPSLA, see Coronavirus information relevant to tax professionals - a summary, Federal Tax Update (03/20/2020).

    Employer tax credits. The Act provides tax credits to employers to cover wages paid to employees while they are taking time off under the EPSLA and EMFLEA (referred below as "qualified leave wages"). (Act Sec. 7001; Act Sec. 7003) The credits have three components:

      1. The EPSLA credit for each employee is equal to the lesser of the amount of his leave pay or either

        1. $511 per day while the employee is receiving paid sick leave to care for themselves, or
        2. $200 if the sick leave is to care for a family member or child whose school is closed.

         

        An additional limit applies to the number of days per employee: the excess of 10 days over the aggregate number of days taken into account for all preceding calendar quarters. (Act Sec. 7001(b))

         

      2. The EMFLEA credit for each employee is the amount of his leave pay limited to $200 per day with a maximum of $10,000. (Act Sec. 7003(b)(1))

       

    1. The amount of the EPSLA and EMFLEA credits are increased by the portion of the employer's "qualified health plan expenses" that are properly allocable to qualified sick leave wages or qualified family and medical leave wages. Qualified health plan expenses means amounts paid or incurred by the employer to provide and maintain a group health plan (as defined in Code Sec. 5000(b)(1)), but only to the extent that such amounts are excluded from the gross income of employees by reason of Code Sec. 106(a). (Act Sec. 7001(d); Act Sec. 7003(d))
    2. In addition, the credits allowed to employers for wages paid under the EPSLA and EFMFLEA are increased by the amount of the tax imposed by Code Sec. 3111(b) (the 1.45% hospital insurance portion of FICA) on qualified sick leave wages, or qualified family leave wages, for which credit is allowed under Act Sec. 7001 or Act Sec. 7003. (Act Sec. 7005(b))

    IRS FAQs. The IRS has issued a series of FAQs regarding the credits.

    General issues. FAQ 4 says that Eligible Employers claiming the credits for qualified leave wages (and allocable qualified health plan expenses and the Eligible Employer's share of Medicare taxes), must retain records and documentation related to and supporting each employee's leave to substantiate the claim for the credits, and retain the Forms 941, Employer's Quarterly Federal Tax Return, and 7200, Advance of Employer Credits Due To COVID-19, and any other applicable filings made to the IRS requesting the credit.

    FAQ 16 explains that a business is considered to have fewer than 500 employees if, at the time an employee's leave is to be taken, the business employs fewer than 500 full-time and part-time employees within the US, which includes any State of the United States, the District of Columbia, or any Territory or possession of the US. Department of Labor (DOL) guidance provides a more detailed summary of which workers must be taken into account for purposes of the fewer than 500 employee threshold. DOL guidance also explains when business entities should be treated as separate employers and when they should be aggregated as a single employer for purposes of determining their total number of employees. For more information, see the Department of Labor's Families First Coronavirus Response Act: Questions and Answers.

    FAQ 18 asks whether an Eligible Employer can receive both the tax credits for qualified leave wages under the FFCRA and the employee retention credit under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act)?

    The IRS says yes. If an Eligible Employer also meets the requirements for the employee retention credit, it may receive both credits, but not for the same wage payments.

    For more information about the employee retention credit, see Business tax provisions in Senate-passed third coronavirus relief package (03/27/2020).

    Qualified health plan expenses. FAQ 31 says that the amount of qualified health plan expenses taken into account in determining the credits generally includes both the portion of the cost paid by the Eligible Employer and the portion of the cost paid by the employee with pre-tax salary reduction contributions. However, the qualified health plan expenses should not include amounts that the employee paid for with after-tax contributions.

    FAQ 32 asks, for an Eligible Employer that sponsors more than one plan for its employees (e.g., both a group health plan and a health flexible spending arrangement (health FSA)), or more than one plan covering different employees, how are the qualified health plan expenses for each employee determined?

    The IRS says that the qualified health plan expenses are determined separately for each plan. Then, for each plan, those expenses are allocated to the employees who participate in that plan. In the case of an employee who participates in more than one plan, the allocated expenses of each plan in which the employee participates are aggregated for that employee.

    FAQ 33 and FAQ 34 ask, for an Eligible Employer who sponsors a fully-insured group health plan (FAQ 33) or a self-insured group health plan (FAQ 34), how are the qualified health plan expenses of that plan allocated to the qualified sick or family leave wages on a pro rata basis?

    The IRS says that an Eligible Employer may use any reasonable method to determine and allocate the plan expenses, including

    1. The COBRA applicable premium for the employee typically available from the insurer,
    2. One average premium rate for all employees, or
    3. A substantially similar method that takes into account the average premium rate determined separately for employees with self-only and other than self-only coverage.

     

    FAQ 35 asks, for an Eligible Employer who sponsors a health savings account (HSA), or Archer Medical Saving Account (Archer MSA) and a high deductible health plan (HDHP), are contributions to the HSA or Archer MSA included in the qualified health plan expenses?

    The IRS says that the amount of qualified health plan expenses does not include Eligible Employer contributions to HSAs or Archer MSAs. Eligible Employers who sponsor an HDHP should calculate the amount of qualified expenses in the same manner as an insured group health plan, or a self-insured plan, as applicable.

    FAQ 36 asks, for an Eligible Employer who sponsors a health reimbursement arrangement (HRA), a health flexible spending arrangement (health FSA), or a qualified small employer health reimbursement arrangement (QSEHRA), are contributions to the HRA, health FSA, or QSEHRA included in the qualified health plan expenses?

    The IRS says that the amount of qualified health plan expenses may include contributions to an HRA (including an individual coverage HRA), or a health FSA, but does not include contributions to a QSEHRA. To allocate contributions to an HRA or a health FSA, Eligible Employers should use the amount of contributions made on behalf of the particular employee.

    Wages and credits included and deducted from employer income. An Eligible Employer must include the full amount of the credits for qualified leave wages (and any allocable qualified health plan expenses and the Eligible Employer's share of the Medicare tax on the qualified leave wages) in gross income. (FAQ 49)

    In addition, generally, an Eligible Employer's payments of qualified leave wages (and any allocable qualified health plan expenses and the Eligible Employer's share of the Medicare tax on the qualified wages) are deductible by the Eligible Employer as ordinary and necessary business expenses in the tax year that these wages are paid or incurred.

    An Eligible Employer may deduct as a business expense the amounts paid to an employee for qualified leave wages (and any allocable qualified health plan expenses and the Eligible Employer's share of Medicare tax on the qualified leave wages) for which the Eligible Employer expects to claim the tax credits under sections 7001 or 7003 of the FFCRA, if the Eligible Employer is otherwise eligible to take the deduction. (FAQ 50)

    The IRS continues that, generally, an employer's payment of certain federal employment taxes is deductible by the employer as an ordinary and necessary business expense in the tax year that these taxes are paid or incurred, and the amount deductible is generally reduced by credits allowed. Although the tax credits under Sec. 7001 and Sec. 7003 of the FFCRA are allowed against the Eligible Employer's portion of the social security tax, the credits are treated as government payments to the employer that must be included in the Eligible Employer's gross income. If the employer is otherwise eligible to deduct its portion of the social security tax on all wages, the proper amount deductible by the employer is the amount of federal employment taxes before reduction by the tax credits. (FAQ 51)

    Other issues for employers. FAQ 54 asks whether employees can make salary reduction contributions from the amounts paid as qualified leave wages for their employer sponsored health plan, a 401(k) or other retirement plan, or any other benefits?

    The IRS says that the FFCRA does not distinguish qualified leave wages from other wages an employee may receive from the employee's standpoint as a taxpayer; thus, the same rules that generally apply to an employee's regular wages (or compensation, for RRTA purposes) would apply from the employee's standpoint. To the extent that an employee has a salary reduction agreement in place with the Eligible Employer, the FFCRA does not include any provisions that explicitly prohibit taking salary reduction contributions for any plan from qualified sick leave wages or qualified family leave wages.

    FAQ 55 asks whether Eligible Employers should withhold federal employment taxes on qualified leave wages paid to employees?

    The IRS says yes. Qualified leave wages are wages subject to withholding of federal income tax and the employee's share of social security and Medicare taxes. Qualified leave wages are also considered wages for purposes of other benefits that the Eligible Employer provides, such as contributions to 401(k) plans.

    FAQ 56 asks whether a tax-exempt employer can receive the credits?

    The IRS says yes. Tax-exempt organizations that are required to provide such paid sick leave or expanded paid family and medical leave may claim the tax credits.

    Special issues for employees. Qualified sick leave wages and qualified family leave wages are taxable to employees. (FAQ 57) And they are not excluded from gross income as "qualified disaster relief payments." (FAQ 58)

    An employee can receive both "qualified sick leave wages" and "qualified family leave wages," but at different times. Qualified sick leave wages are available for up to 80 hours during which an employee cannot work or telework for any of six reasons related to COVID-19, including because the employee must care for his or her child whose school or place of care is closed, or whose child care provider is unavailable, due to COVID-19 related reasons. By contrast, qualified family leave wages are available only because the employee must care for his or her child whose school or place of care is closed, or because the employee's child care provider is unavailable, due to COVID-19 related reasons, and only after an employee has been unable to work or telework for this reason for 80 hours. (FAQ 59)

     

    Example. Your child-care provider is unavailable indefinitely due to the COVID-19 outbreak, leaving you unable to work or telework to care for your child. For up to the first 80 hours of any period of leave to care for your child, you are entitled to qualified sick leave wages, up to $200 per day and $2,000 in the aggregate. After that, you are entitled to qualified family leave wages for up to ten weeks of additional leave you need, up to $200 per day and $10,000 in the aggregate.

     

    U.S. Department Of Labor Announces New Paid Sick Leave and Expanded Family and Medical Leave Implementation

    Today, the U.S. Department of Labor announced new action regarding how American workers and employers will benefit from the protections and relief offered by the Emergency Paid Sick Leave Act and Emergency Family and Medical Leave Expansion Act, both part of the Families First Coronavirus Response Act (FFCRA). The Department’s Wage and Hour Division (WHD) posted a temporary rule issuing regulations pursuant to this new law, effective today, April 1, 2020.

     

    FFCRA helps the United States combat the workplace effects of COVID-19 by reimbursing American private employers that have fewer than 500 employees with tax credits for the costs of providing employees with paid leave for specified reasons related to COVID-19. The law enables employers to keep their workers on their payrolls, while at the same time ensuring that workers are not forced to choose between their paychecks and the public health measures needed to combat the virus. WHD administers the paid leave provisions of the Emergency Paid Sick Leave Act and Emergency Family and Medical Leave Expansion Act.

     

    WHD will post a recorded webinar on Friday, April 3, 2020 to provide interested parties a more in-depth description and help them learn more about the FFCRA.

     

    To view the webinar visit https://www.dol.gov/agencies/whd/pandemic

     

    WHD invites webinar viewers to call the agency’s toll-free help line at 866-4US-WAGE to speak with a trained WHD professional about any questions they may have.

     

    WHD offers a number of plain-language compliance assistance materials to explain the FFCRA’s benefits and requirements. Tools include a Fact Sheet for Employees and a Fact Sheet for Employers, available in both English and Spanish, and an expansive list of Questions and Answers addressing the questions WHD has most frequently received from stakeholders to-date. Available guidance also includes two new posters, one for federal workers and one for all other employees, available in both English and Spanish, that will fulfill notice requirements for employers obligated to inform employees about their rights under this new law, Questions and Answers about posting requirements, and a Field Assistance Bulletin describing WHD’s 30-day non-enforcement policy.

     

    WHD provides additional information on common issues employers and employees face when responding to COVID-19 and its effects on wages and hours worked under the Fair Labor Standards Act and job-protected leave under the Family and Medical Leave Act at https://www.dol.gov/agencies/whd/pandemic.

     

    For more information about the laws enforced by the WHD, call 866-4US-WAGE, or visit www.dol.gov/agencies/whd.

     

    For further information about COVID-19, please visit the U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention.

     

    TDI Bulletins and Guidance on COVID-19

    The Texas Department of Insurance (TDI) has been busy over the last few days with guidance and bulletins for industry, relating to the COVID-19 pandemic:
    April 1st - Coverage for COVID-19 testing and network adequacy 
    March 31st - Alternative health plan coverage for COVID-19 testing 
    March 30th - TDI expedites review of COVID-19 filings 
    March 27th - Claim-submission deadlinesManaged Care Quality Assurance filing requirementsElectronic signatures for escrow checks and directly issued policies; and Suspension of certain provisions of the Labor Code and DWC rules.

    For all TDI bulletins and guidance, click here: https://www.tdi.texas.gov/general/covid-19-guidance-to-industry.html 

     

    Update: COVID-19 Executive Order GA-14, Issued 3/31/20

    Today, Governor Abbott issued a new Executive Order, GA-14, establishing statewide “Essential Services and Activities Protocols.”  This E.O. does NOT substantially change the current status of "essential services" in Texas, as it is reflective of the numerous local and county orders already issued. Rather, it is aimed at providing statewide continuity of essential services and activities during the COVID-19 pandemic disaster.
     
    The Governor’s E.O. directs all people to minimize social gatherings and in-person contact, except where necessary to provide or obtain essential services. The Order defines “essential services” to include the U.S. Dept. of Homeland Security Guidance on Essential Critical Infrastructure Workforce, version 2.0, plus religious services, and anything TDEM adds to the list. It further directs that all persons should attempt to conduct or obtain essential services remotely, unless this is infeasible, in which case social distancing must be implemented.
     
    The order will remain in effect from April 2, 2020 at 12:01 a.m. through April 30, 2020, unless extended. (All schools will remain closed until May 4, 2020). This statewide order supersedes any conflicting order issued by local officials in response to COVID-19, but only to the extent that such a local order restricts essential services allowed by the E.O. or allows gatherings prohibited by the E.O.  We will continue evaluating whether there are any conflicts; however, if you have a specific question about how a local order may interact with the Governor’s E.O., please reach out.  
     
    The E.O. is enforceable by any law enforcement officer in the state of Texas, subject to fine and jail-time of up to 180 days, in addition to the potential issuance of a quarantine order against an individual.

     

    TAHU and TWC Commissioner Conference Call 03.26.20

    Listen to the recording of the conference call on 03/26/20 between TAHU members and TWC Commissioner, Aaron Demerson and his staff, who represent employers in Texas.  It's about an hour and 10 minutes long.  If you encounter any issues with the recording, please email [email protected] 

     

    FFCRA: Employer Paid Leave Requirements

    The Families First Coronavirus Response Act (FFCRA or Act) requires certain employers to provide their employees with paid sick leave or expanded family and medical leave for specified reasons related to COVID-19.[1] The Department of Labor’s (Department) Wage and Hour Division (WHD) administers and enforces the new law’s paid leave requirements. These provisions will apply from the effective date through December 31, 2020.

    https://www.dol.gov/agencies/whd/pandemic/ffcra-employer-paid-leave

     

    TWC Shared Work Program

    The Shared Work program provides Texas employers with an alternative to layoffs.

     

    US Department of Labor Q&A

    Furlough Questions and Answers
    Information which supplements the OPM Guidance on Furloughs

     

    Guidance on Paid Sick Leave and Expanded FMLA

    U.S. Department Of Labor Publishes Guidance Explaining Paid Sick Leave And Expanded Family and Medical Leave Under The Families First Coronavirus Response Act

    https://www.dol.gov/newsroom/releases/whd/whd20200324

     

    COVID-19 Important Memorandum

    Date:               Wednesday, March 25, 2020

    To:                   Members of the Texas Association of Health Underwriters (TAHU)

    From:              Tonya Booth, TAHU President

    Re:                  Important Updates on Emergency Orders, Bulletins and Document Regarding Insurance as an “Essential Service”

    In the event of a “Shelter-in-Place” order in their county or municipality and they are stopped by law enforcement, TAHU suggests that all insurance employees carry a copy of this memorandum and letter with them during their normal course of business.  This is not a guarantee that it will be accepted. 

    Each municipality has the authority to interpret the definition of an “essential business.” We recommend you contact your local government leaders and review their Orders for guidance as well. TAHU is advocating on behalf of our independent insurance agents and brokers and carrier representatives to achieve acknowledgement from the Texas state leadership that insurance is indeed an essential business. Some Orders already reference insurance agents, underwriters and/or brokers by name (Austin). Others define “Essential Services” as those professional services that supply other essential businesses with the support or supplies needed to operate or necessary to assist with compliance of legally mandated activities (Dallas). In those cases, print out a copy of the actual Order and keep it handy along with proof of your TDI license. We will communicate news as soon as we have more information and get clarification. Thank you for serving your communities in this time of need.

    This letter is based on guidance from the U.S. Department of Homeland Security’s memo on critical infrastructure workforce. For more clarification about specific jobs, visit: https://www.cisa.gov/publication/guidance-essential-critical-infrastructure-workforce

    Here is the language about Financial Services:

    FINANCIAL SERVICES

    • Workers who are needed to process and maintain systems for processing financial transactions and services (e.g., payment, clearing, and settlement; wholesale funding; insurance services; and capital markets activities)
    • Workers who are needed to provide consumer access to banking and lending services, including ATMs, and to move currency and payments (e.g., armored cash carriers)


    UPDATES FROM TDI EFFECTING LICENSURE REQUIREMENTS

    The Texas Department of Insurance has created a special page with COVID-19 updates and resources. You can access it from their homepage at www.tdi.texas.gov

    In addition, there are several Bulletins of note to our members under “Guidance to the Industry” on TDI’s COVID-19 page. Yesterday the Commissioner adjusted licensing and continuing education requirements including waivers and extensions of many deadlines and fees. On Monday, he extended the Prompt Pay deadlines by 15 days and encouraged use of the Grace Period for premium payments. Last week the Governor relaxed telemedicine regulations to allow for increased use during the crisis. Both TDI and the TMB are releasing rules specific to their stakeholders on this issue. The website also lists the carriers agreeing to waive consumer costs for medically necessary testing of COVID-19. There are also helpful Q&As on Travel Insurance, Business Interruption and Workers’ Comp.

    Our lobbyists have asked TDI for some relief on Senate Bill 51 requirements around data feeds of employer terminations to carriers in light of the volume of terminations TAHU agents are receiving daily.

    As you no doubt have experienced, the situation is fluid and things are changing daily. We encourage you to check our resources at www.tahu.org, our Facebook and Linked In pages for up to the minute details.

    OTHER HELPFUL LINKS

    Centers of Disease Control and Prevention (CDC)
    https://www.cdc.gov/coronavirus/2019-ncov/index.html

    World Health Organization (WHO)
    https://www.who.int

    Texas Department of State Health Services (DSHS)
    https://www.dshs.texas.gov/coronavirus/

    Texas Workforce Commission (TWC)
    https://twc.texas.gov/news/covid-19-resources-employers

    Texas State Comptroller
    https://comptroller.texas.gov/about/emergency/

    Stay calm and stay well.

     

    2020 DATC Presentations

    Thanks again to all of you for attending the TAHU 2020 Day at the Capitol in Austin last week.  We hope the event exceeded your expectations.  As promised, attached are copies of the presentations by Rich Lunsford, TDI Deputy Commissioner and Stacey Pogue, Center for Public Priorities.  In addition, Marcy Buckner, NAHU Vice President of Government Affairs' presentation can be found at this link https://prezi.com/view/zppVa8E3epiDe0sHqJPj/

    Please reach out to us if you need anything else.  Thanks again for your support of the Texas Association of Health Underwriters!

     

     

    TAHU PAC, Why Join and Donate?

    Ever wondered why the PAC is so important to our Association?  Find out HERE

     

    TDI Bulletin: Disclosure form for short-term limited-duration insurance policies

    To review the entire article, CLICK HERE.

     

    TAHU Summary of New Legislation effective 9-1-19

    Click HERE to read more about TAHU Summary of New Legislation effective 9-1-19

     

    TAHU News Release on Surprise Billing 6/14/2019

    For Immediate Release:June 14, 2019

    Media Contact:
    Mike Meroney (512) 589-2531
    [email protected]

    Texas Association of Health Underwriters (TAHU) Applauds Texas Lawmakers for Ending Surprise Billing

    Austin, Texas – Legislation protecting Texas patients from surprise medical bills was signed into law today by Governor Greg Abbott, and the Texas Association of Health Underwriters (TAHU) applauds the governor and Texas lawmakers who passed one of the nation’s strongest consumer protection laws against surprise (or balanced) billing.

    State Sen. Kelly Hancock (R-North Richland Hills) authored SB 1264, which prohibits health care providers from sending patients surprise bills in situations in which patients have no choice of provider, such as when a patient receives care from an out-of-network doctor at an in-network emergency room or when they receive care from an out-of-network doctor at an in-network facility.

    SB 1264:
    ?  Ends surprise billing by out-of-network doctors and facilities when patients have little or no choice over who provides their care.
    ?  Removes patients from the middle of the payment dispute resolution process between health care providers and insurers.
    ?  Makes patients responsible only for their applicable co-pays, coinsurance and deductibles amounts with no additional amounts due resulting from arbitration between the out-of-network provider and health plan.
    ?  Requires health plans to pay reasonable or agreed-to amounts to out-of-network emergency care and facility-based providers and allows those providers to dispute payment amounts through binding arbitration.
    ?  Protects consumers and employers from premium increases and high out-of-pocket costs from excessive billing and charges in Texas.

    TAHU’s President Nicole Scott of United Healthcare said, “TAHU thanks Sen. Hancock and his bipartisan Senate co-author and bill sponsors in the House of Representatives: Sen. John Whitmire (D- Houston), Rep. Tom Oliverson (R-Houston) and Rep. Trey Martinez Fischer (D-San Antonio).”

    “SB 1264 is a groundbreaking solution for Texas consumers who have had to deal with surprise bills for decades,” Scott continued. “TAHU is proud of the Texas Legislature for addressing this problem.”

    The Texas Association of Health Underwriters (TAHU) represents more than 1,450 licensed health insurance agents, brokers and benefit professionals throughout Texas. TAHU members service the health insurance needs of large and small employers as well as people seeking individual health insurance coverage.

     

    TAHU Legislative News: Texas Lawmakers Applauded... 6/14/19

    Legislative News – Mike and Shannon Meroney

    Texas Lawmakers Reign in Freestanding ER Abuses

    Governor Greg Abbott has signed two bills into law designed to protect Texas patients from price-gouging, deceptive practices and misleading information at freestanding emergency rooms (FERs).

    On behalf of all health care consumers, the Texas Association of Health Underwriters (TAHU) applauds the governor and Texas lawmakers who passed these sweeping consumer protection laws.

     HB 1941 (Phelan - R)(incorporating SB 866; Watson - D and SB 1549; Schwertner – R) creates a new cause of action against FERs that charge “unconscionable” prices (defined as more than 200% of the average charge for the same services provided by hospital emergency rooms) for emergency care. These charges now qualify as a "false, misleading, or deceptive act or practice,” triggering the Texas Deceptive Trade Practices Act which entitles the claimant to collect attorneys fees and triple damages.

    Additionally, HB 2041 (Oliverson – R) imposes new transparency requirements on freestanding ERs (FERs). The bill prohibits the use of health plan logos with which they are out of network, prohibits the use of the words “takes” and “accepts” in association with a patient’s insurance unless they are an in-network provider with the plan, and requires a signed disclosure of applicable facility and observation fees. These deceptive practices can leave Texans with outrageous medical bills and often struggling with huge medical debt. Senator Larry Taylor (R-Friendswood) sponsored HB 2041 in the Senate.

    Finally, HB 1112 (Davis - R) requires a facility that closes or has a license expire or suspended/revoked to immediately remove  any signs within view of the general public indicating that the facility is in operation.  The display of these signs after the facility has lost its license poses a public health risk to those who may mistakenly go there for emergency care only to find the facility is no longer operational.

    TAHU’s President Nicole Scott said, “On behalf of agents and brokers across Texas and our customers, TAHU thanks Reps. Oliverson and Phelan, and Sens. Taylor and Watson for recognizing and addressing the growing problem with bad actors in the freestanding emergency room market. HB 1941 and HB 2041 will go a long way to help heath care consumers be wary these facilities and better understand what they charge before care is provided. It will also help lower healthcare costs overall and help health plans eventually lower premiums. Texas has been the epicenter of these outrageously high prices for services that can be obtained elsewhere for much less. TAHU is proud to have supported and worked on all three pieces of legislation during the session.”

    All three bills will go into effect on September 1, 2019.

     

     

    SCOTUS Ruling Underscores Value of the Insurance Agent

    For more information, contact:
    Lee Manross @ 512-322-9787

    The Supreme Court has released its multi-page opinion in the King V. Burwell case, and the result is clear.  The PPACA was written with the intention that subsides be available in all states, not just those with state-based exchanges.

    The case offers some clarity on the future of health insurance in the United States, and will allow the business and insurance industries to move forward on implementing and adjusting the law.

    Tonya Booth, Vice President of Employee Benefits at Upshaw Insurance Agency in Richardson, says that “This ruling means the implementation of PPACA will continue and its reform provisions will remain in effect for the foreseeable future.  With the exchange question answered, we plan to continue our legislative work to improve the parts of this law that are quite simply broken.  With that being said, some very real and monumental challenges remain.”

    From a big picture perspective, the Court considered two possible scenarios: the reading of the law that subsidies are available in exchanges established by individual states, or the law for universal availability of subsidies in all states and all exchanges. We now know what they chose to do.  So, what next?

    The full-scale implementation of PPACA will continue unabated, all insurance reform provisions will remain in effect, and there’s the possibility that with the continuity of subsidies in all exchanges no longer in question, legislation to “fix” the PPACA will now have more traction to move forward in Congress after summer recess.  Janet Trautwein, CEO of the National Association of Health Underwriters, added “Our hope is that policymakers will now be able to focus on legislative efforts to truly reduce the cost of healthcare, something that the ACA did not. It’s also critical that lawmakers improve upon the portions of our healthcare system that work well. The employer-based system has reliably and effectively delivered quality health coverage to generations of Americans. We, as a nation, need to work to preserve it.”

    The ruling also means that the insurance industry will remain business as usual much as it’s been for the past couple of years.   Kelly Fristoe, President and CEO of employee benefit brokerage Financial Partners in Wichita Falls said, “For the agent community, business will continue as it has been.  We’ll continue to be a resource to our clients in helping them make the best financial decisions possible in their purchase of health insurance plans, both on and off exchange.”

    Joe Phifer, President-Elect for the Texas Association of Health Underwriters, believes “The SCOTUS ruling and the discussion around it underscores that health insurance is exceedingly complex.  So whether it’s an individual, small group or 5,000-life case that’s looking to make a health insurance decision, they’ll want and need the guidance of the best and brightest.  The role of the insurance consultant is even more valuable than ever after today’s ruling.”

    Businesses and consumers interested in locating a professional health benefits adviser in their community who can assist with questions about the Affordable Care Act may go to the “Find an Agent” link on www.tahu.org.

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    Texas Association of Health Underwriters (TAHU) is a state trade association representing licensed health insurance agents, brokers, consultants and benefit professionals who serve the health insurance needs of employers seeking health insurance coverage. TAHU is a state chapter of the National Association of Health Underwriters.

     

    Market Disruption Foreseen If ACA Change Goes Forward

    https://prmediarelease.com/market-disruption-foreseen-if-aca-change-goes-forward/#sthash.28yT257N.8azHZ3pK.dpbs

     

    Employers Should Prepare for Effect of Health Plan Cadillac Tax on Their Business, Health Care Costs

    For more information, contact:
    Emmanuel Winston @512-542-9955

    (AUSTIN, TEXAS – June XX, 2015) - A little-publicized component of the Affordable Care Act (ACA) is set to take effect in 2018 with potentially significant financial consequences to employers that offer benefit-rich health coverage. The “Cadillac tax,” passed as part of the sweeping health care reforms adopted in 2010, was included in the Act in an attempt to reduce health care costs by encouraging employers to offer cost-effective health coverage that would engage employees in sharing in the cost of their care. The belief is that if individuals are required to share in the cost of their health expenses, they will be less likely to seek unnecessary medical care.

    The levy, a 40 percent excise tax on high-cost employer-sponsored group health plans, is assessed on the amounts of total health plan premiums paid by the employer that exceeds established thresholds per employee. The tax is projected to generate $120 billion to help pay for the ACA. 

    The current thresholds for high-cost plans are $10,200 for individual coverage and $27,500 for “other than self-only” coverage. Thresholds will be updated for 2018 when final regulations are issued, and indexed for inflation in future years. While the goal of reducing health care costs has obvious benefits, the effect of the tax on unknowing businesses could be significant. Whether employers are small or large, the financial impact could be devastating and far-reaching. By 2022, an estimated 60 percent of all U.S. employers may be impacted by the Cadillac Tax.

    Janet Trautwein, CEO of the National Association of Health Underwriters, said, “Assessing the impact of this tax and having a plan for moving forward will be an essential financial exercise for businesses in the coming months. Many may realize the tax will result in higher projections for future health care cost projections than originally estimated.”

    Estimates project that upwards of 12 million employees at large companies will pay an average $1000 in additional income and payroll taxes. Alternatively, employees could see drastic reductions in health care benefits but without an increase in pay.

    Adjusting coverage provided to employees once the effect of the tax is determined could result in a dramatic shift in benefits and significant financial consequences for those covered. Such a transition may best be managed over several years rather than attempting to restructure benefit offerings in one enrollment cycle. With the tax set to take effect in 2018, planning for the effects of the Cadillac Tax should begin as soon as possible.

    Employers of all sizes would be well-served in consulting a certified benefits advisor or health insurance agent to better understand the full ramifications of the tax. The agent can serve as a partner in helping develop a game plan to manage the transition and minimize any adverse consequences on the business and employees.

    “Professional health agents have decades of experience supporting businesses in managing their health insurance options and can help employers navigate through the Cadillac Tax issues by evaluating coverage alternatives to find the best health insurance fit for their specific needs,” said Mark Kennedy, President/CEO of Benefit Concepts, Inc., a Houston member of the Texas Association of Health Underwriters.

    Businesses and consumers interested in locating a professional health benefits adviser in their community who can assist with questions about the Affordable Care Act may go to Find an Agent or tahu.org.

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    Texas Association of Health Underwriters (TAHU) is a state trade association representing licensed health insurance agents, brokers, consultants and benefit professionals who serve the health insurance needs of employers seeking health insurance coverage. TAHU is a state chapter of the National Association of Health Underwriters.

     

    State Employees Get New, Better Health Plan Option

    http://tahu.starchapter.com/images/downloads/Articles/tahu_press_release.pdf