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Benefits Lifecycle

The Affordable Care Act (ACA) and its long list of provisions are generating substantial changes for employers. Benefitfocus remains focused on delivering solutions that rapidly respond to the changes in the industry and evolving requirements.

As the benefits lifecycle becomes more intricate, the Benefitfocus Portfolio of Products & Services will assist employers as they address additional variables such as:

  • What tools will you need to capture employees’ reasons for opting-out of the coverage you provide?
  • Do you have a plan to communicate the option to enroll through a public exchange and then report employee acknowledgments for IRS auditing purposes?
  • How will you need to adjust plan designs to mitigate the impact of the impending Cadillac Tax?
  • Have you made room in your budget to offset increases in healthcare costs due to the changes in preventive care coverage?

Healthcare Reform Readiness Checklist

BENEFITFOCUS® Marketplace is built on a comprehensive eligibility rules engine that handles complex plan designs, business rules and reporting. Our cloud-based technology delivers the latest features and functionality to remain up-to-date with ACA provisions and to facilitate your compliance with new legislation.

Uniform Summary of Benefits & Coverage (SBC)

✓ Gives employers the ability to house all relevant information in the employee portal and set it up
so that employees must submit an acknowledgement form to ensure they receive and review the
initial SBC, as well as any changes within the 60-day limit.

✓ Mobile capabilities allow the employee to conveniently access these documents on the go from any
web-enabled device.

Employer Reporting

✓ Offers a consolidated report that allows employers to provide the IRS with required information about the type of health coverage offered to their full-time employees, the entity providing the coverage and which individuals are enrolled in coverage.

Employee Opt-Out Survey

✓ Identifies and captures the specific reasons employees are declining coverage through an
enrollment questionnaire, helping employers avoid the penalties for employees who opt-out of
coverage due to receiving a tax credit or cost-sharing subsidy through a public exchange.

Grandfathered Plans

✓ Provides plan and benefit summary information to comply with information transparency
requirements, allowing consumers to compare plan benefits, cost-sharing requirements, renewability
and continuation of coverage provisions.

Employee Notifications for Public Exchanges

✓ Enables HR staff to send mandatory notifications about public exchanges through HR InTouch Marketplace,
whether or not the employer’s plan meets minimum coverage requirements, and explains how to
access information regarding premium subsidies that may be available for exchange-based coverage.

Employer Shared Responsibility

✓ Enforces eligibility rules to account for new “safe harbor” classifications and other categories
needed by employers to ensure eligible employees are able to enroll in the appropriate plan options.

✓ Calculates Look-Back and Stability periods along with providing eligibility tools to assist employers
in ensuring employees are getting the coverage for which they are eligible in the proper timeframe.

✓ Incorporates employee opt-out surveys to help employers determine which employees plan to
purchase coverage through a public exchange so they can message them accordingly.

Wait Periods

✓ Configures wait periods to comply with the new requirement of 90 days, while proactively identifying
all existing sponsors whose medical new hire rules have a wait period of greater than 90 days.

Essential Health Benefits

✓ Supports complex business rules and a variety of plans with the ability to incorporate new
essential benefit packages designed by employers.

✓ Features customized workflows to require employee acknowledgement in the case that they
can only be covered in certain situations. For example, if they do not have coverage elsewhere.

Wellness Incentives

✓ Supports the automation of premium discounts and benefits based on wellness program participation.

✓ Provides employees access to Mayo Clinic syndicated wellness content, including more than
3,500 health-related articles.

✓ Offers the ability to connect directly with the Mayo Clinic EmbodyHealth Portal and Health Risk
Assessment, helping to drive employee behavior change and improve personal wellness management.

Cadillac Tax

✓ Provides a suite of data analytics and communication tools to assist with the impact of necessary plan design changes in advance of January 1, 2018.

Look-Back Calculation

The ACA has redefined the full-time equivalent as 30 hours per week. To determine benefit eligibility, employers with a high percentage of hourly employees are required to factor in both hours worked and seasonality for each employee. Benefitfocus offers a variety of products and services to help you maintain compliance with the ACA, including tools for look-back calculations related to variable hour employees.

Check out the ACA Management solutions offered through our platform by visiting our apps page.

Look-Back Provision Key Terms

  • Measurement Period – The time frame for which work hours are measured to determine if the average is equal to or exceeds 30 hours per week.
  • Administrative Period – The time allotted for employers to determine employee eligibility and complete enrollment after the Measurement Period and before the Stability Period.
  • Stability Period – The duration for which the employee is eligible to receive employer-sponsored medical benefits based on the eligibility defined during the Measurement Period.

Healthcare reform affects everyone, and explaining health insurance to your employees is more important than ever. Because ACA provisions can be difficult to interpret, Benefitfocus Video & Animation offers a healthcare reform video communication package to help explain the ins and outs of new legislation. These educational videos can be viewed anytime, using any web-enabled device, providing a consistent and engaging message for employees.

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To contact the Benefitfocus headquarters by phone, call 843-849-7476.