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Opinion: Federal laws create new paths to health coverage

HR Solutions

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Several changes and additions in federal laws and declarations have significantly affected health insurance and benefits. Small-business owners and sole proprietors now have a new path to access affordable, quality health insurance coverage.

Up ahead: Organizations may take a tax credit for providing family and medical leave. The declaration of the opioid crisis as a national public health emergency under federal law has employers rethinking health care plans. And contribution limits for HSAs have changed for 2018 and 2019.

Association Health Plans
Association Health Plans work by letting small businesses, including self-employed workers, band together by geography or industry to secure health care coverage as if they were a single large corporation.

President Donald Trump signed an executive order last year charging the Department of Labor to modify the Affordable Care Act and increase small organization access to AHPs. The DOL announced a final rule on June 19 that permits small business to form AHPs.

For the first time, sole proprietors and their families will be allowed to join AHPs, establishing a new avenue to access affordable, quality health coverage. A small-business owner or a self-employed individual may even create their own AHP for themselves and their associates.

Before, AHPs were mandated to cover the 10 “essential” health benefits under the ACA. Now, health insurers may customize policies for AHPs, including only the services wanted by employers, which is expected to decrease premium costs. The new regulations also remove the geographical constraint that formerly did not enable AHPs to offer coverage across state lines.

Family and medical leave credits
As part of the Tax Cuts and Jobs Act, Section 45S was added to the Internal Revenue Code permitting corporations to claim a general business credit for offering paid family and medical leave to certain employees.

In order to be entitled to the credit, the enterprise must have a written policy that authorizes a minimum of two weeks of paid family and medical leave each year. The time period is prorated for part-time staff.

The policy must also state the amount of wages associates will receive while on leave, which has to be at least 50 percent of their normal wages. The leave does not have to be offered under the Family and Medical Leave Act requirements.

However, if the organization is not covered under the FMLA, the policy must incorporate nonretaliation verbiage. Types of leave qualified for the credit are comparable to the FMLA.

Opioid abuse
According to some reports, up to 40 percent of opioid addicts are enrolled in employer group health plans. Most health plans cover the treatment and counseling a laborer or his family member will pursue when desiring to overcome addiction.

However, several plan features might dissuade an individual from seeking treatment. Businesses should consider these factors when considering plans and working with their insurance companies:

First, does the plan mandate prior authorization for anti-addiction medications? The removal of this barrier has been found to decrease the number of opioid prescriptions. Second, are there stringent quantity restrictions on opioids? Third, are substance abuse treatment facilities readily available where team members live and work? Fourth, does the plan network include choices of treatment facilities? If the plan does not provide options and the worker is compelled to go “out of network,” is there a penalty? Fifth, do employees live in rural areas or small towns where they are hesitant to obtain treatment due to fear of discovery?  Sixth, is telemedicine offered for those who are averse to being seen in a counselor’s office or at group therapy? Seventh, does the plan limit coverage for both counseling and medication simultaneously? Eighth, are alternative therapies permitted, such as acupuncture, massage therapy and chiropractic treatment?

Health Savings Accounts
On March 5, the IRS slightly decreased the 2018 contribution limit for family coverage to $6,850 from $6,900 due to a stipulation in the Tax Cuts and Jobs Act. However, the IRS withdrew that modification on April 26 because of unforeseen administrative and financial problems. In 2019, the maximum contribution for an individual with self-only coverage will increase to $3,500 from $3,450. For an individual with family coverage, it will increase to $7,000 from $6,900.

Lynne Haggerman, M.S., is president/owner of Lynne Haggerman & Associates LLC, a Springfield firm specializing in management training, retained search, outplacement and human resource consulting. She can be reached at


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