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Our news articles are posted on a regular basis to give our clients relevant and timely information about matters pertaining to our financial services. Browse through our current and archived articles to learn more.

Category: Group Health Benefits

Healthcare & Benefit Services News :: Special Health Care Reform Update: New Proposed Rules for Wellness Programs

New proposed rules issued under Health Care Reform address certain amendments to the nondiscrimination requirements for group health plans offering a wellness program to comply with the federal Health Insurance Portability and Accountability Act (HIPAA).

Specifically, the proposed rules would increase the maximum permissible reward under a wellness program that requires an individual to satisfy a standard based on a health factor in order to obtain a reward, from 20% to 30% of the cost of coverage (and to 50% for programs designed to prevent or reduce tobacco use). The rules also include other proposed clarifications regarding the requirements for such wellness programs to avoid prohibited discrimination, including reasonable design and reasonable alternatives that must be offered for individuals to obtain the reward.

Other Proposed Rules Released Under Health Care Reform
Separately, new proposed rules have been issued for health insurance companies regarding the law’s requirements related to guaranteed availability of coverage and essential health benefits.

  • Under one set of proposed rules, issuers offering non-grandfathered health insurance coverage in the individual or group market would be required to accept every individual and employer that applies for coverage, with limited exceptions. Issuers in the individual and small group markets would be allowed to vary premiums within limits, only based on age, tobacco use, family size, and geography.
  • Another set of proposed rules outline issuer standards related to coverage of “essential health benefits.” Essential health benefits are a core set of items and services that must be covered by non-grandfathered plans in the individual and small group markets beginning in 2014.

The new proposed rules would apply for plan years beginning on or after January 1, 2014. An overview of the proposed rules is available on Our Summary by Year offers updates on other requirements related to Health Care Reform.

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Human Resources Services :: 7 Topics to Cover During New Employee Orientation

New employee orientation (also called onboarding) introduces new employees to the workplace and familiarizes them with some of the company’s basic practices. Onboarding should be conducted as soon after an employee’s start date as possible. Some of the topics you may wish to cover include:

1. Welcome
Give your new employee a brief tour of the workplace and introduce managers and co-workers. Be sure the employee’s work station is neat and organized to make him or her feel welcome.

2. New Hire Paperwork
Orientation is a good time to collect and complete any necessary paperwork, such as Form I-9 (employee must complete no later than the first day of work for pay), Form W-4 and any required state income tax withholding forms.

3. Compensation and Benefits
Provide details on pay periods, direct deposit, payroll deductions, health insurance and any other benefits to which your new employee may be entitled. Prepare a benefits packet ahead of time to give to the employee and let him or her know who can answer questions.

4. Attendance and Leave
Review the employee’s expected hours of work, as well as the company’s policies regarding absenteeism, meal and break periods, and time off (including notice required).

5. Employee Conduct
Make sure the employee understands the rules regarding dress code, telephone and computer use, and other expectations. If your policies are explained in an employee handbook, be sure the employee receives a copy.

6. Safety and Security
Explain necessary safety and security procedures and distribute building keys, employee identification, and parking passes as appropriate.

7. Required Training
Schedule training sessions as soon as possible so the employee can learn about the technology, safety, and any other special skills necessary to perform his or her job.

Regardless of whether you distribute a full employee handbook, it’s a good idea (and in some instances may be legally required) to inform employees in writing of your company’s policies. Remember to follow-up with your employee during the first several weeks to address any concerns and answer any questions that may come up. For more information about how your company can benefit by working with G.R. Reid’s Human Resource Services, contact us.

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Healthcare & Benefits Services :: Preventing Common COBRA Mistakes — Do’s and Don’ts

With so many requirements under COBRA, it’s easy to make a mistake that could result in costly penalties. Understanding your responsibilities when it comes to compliance is the best way to prevent expensive mistakes. The following do’s and don’ts can help you get started.

• DO count part-time employees to determine whether your plan is subject to COBRA. COBRA generally applies to group health plans maintained by employers with at least 20 employees on more than 50% percent of typical business days in the prior year. Each part-time employee counts as a fraction of a full-time employee, equal to the number of hours the part-time employee worked divided by the hours an employee must work to be considered full-time.

• DO stay on top of required notices. Use the Model General Notice and Model Election Notice provided by the U.S. Department of Labor to help satisfy notice requirements. Keep track of when and to whom notices are sent (and don’t forget to provide a separate notice to the spouse or dependent child if necessary).

• DON’T overlook qualifying events. Remember that if a plan measures eligibility for coverage by the number of hours worked in a given time period, an employee’s failure to work the minimum number of required hours may be considered a reduction in hours that gives rise to COBRA election rights.

• DON’T terminate COBRA coverage too early. There are very specific rules regarding when COBRA may terminate prior to the end of the maximum period of coverage (for example, when premiums are not paid). In certain circumstances the maximum period of COBRA coverage may be extended due to disability or the occurrence of a second qualifying event.

• DON’T forget about state law. Many states have enacted what are commonly referred to as ‘mini-COBRA’ laws, which typically require continuation of group health plan coverage provided by employers with fewer than 20 employees. Employers of all sizes should check to see if a state mini-COBRA law applies to their plans and if so, how the law differs from federal COBRA.

Most importantly, DO consult with a trusted employment law attorney or benefits advisor if you have any questions as to how COBRA applies to a particular plan or your obligations under the law.  For more information on how we can work with you to manage your Employee Healthcare & Benefit issues, contact us.

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Healthcare & Benefit News :: Group Health Plan Compliance and The Health Care Reform Act

Waiting periods for group health plans under Health Care Reform


Limitation on Waiting Periods

Beginning with plan years starting on or after January 1, 2014, a group health plan may not use a waiting period that exceeds 90 days. A waiting period is the period of time that must pass before coverage for an employee or dependent who is otherwise eligible to enroll under the terms of the plan can become effective. According to the new guidance form The US Department of Labor:

  • For purposes of defining the “waiting period,” being eligible for coverage means having met the plan’s substantive eligibility conditions (such as being in an eligible job classification or achieving job-related licensure requirements specified in the plan’s terms).
  • Eligibility conditions that are based solely on the lapse of a time period are permissible for no more than 90 days. Other conditions for eligibility under the terms of a group health plan are generally permissible, unless the condition is designed to avoid compliance with the 90-day waiting period limitation (examples are included in the guidance).
  • If, under the terms of a plan, an employee may elect coverage that would begin on a date that does not exceed the 90-day waiting period limitation, the 90-day waiting period limitation is considered satisfied. Accordingly, a plan will not be considered to have violated the rule merely because employees take additional time to elect coverage.

Eligibility for Group Health Coverage Based on Number of Hours Worked
The new guidance also addresses the application of the 90-day limitation on waiting periods where eligibility for group health plan coverage is conditioned on an employee regularly working a specified number of hours per period (or working full time), and it cannot be determined that a newly-hired employee is reasonably expected to regularly work that number of hours per period. In such cases:

  • The plan may take a reasonable period of time to determine whether the employee meets the plan’s eligibility condition.
  • In general, this time period will not be considered to be designed to avoid compliance if coverage is made effective no later than 13 months from the employee’s start date (plus the time remaining until the first day of the next calendar month, if the employee’s start date is not the first day of a calendar month).

For More Information:
Please contact Julie Seiden at G.R. Reid Healthcare & Benefit Services at 631-923-1595 ext. 310.



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Healthcare & Benefit News :: EmblemHealth now is offering a low-cost, hospital-only plan with preventive care services

For groups that have 2-50 employees and are concerned with costly hospital bills, HealthEssentials is an affordable plan that can give members peace of mind.


Key Features*

  • A hospital-only plan that covers in-network services provided in and billed by network hospitals or ambulatory surgical centers.
  • In order for hospital-related doctors’ fees to be covered, the treating physician must be employed by the hospital or facility and cannot bill the member separately for their services.

Preventive services are covered in full in network, in or out of hospital.  Rates for a Single Employee are as low as $222.33 per month.

For more information, please contact Julie Seiden, Managing Director of G.R. Reid Health & Benefit Services, LLC at 631-923-1595 x310.

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Healthcare & Benefit News :: Health care law gives women control over their care, offers free preventive services to 47 million women

Forty-seven million women are getting greater control over their health care and access to eight new prevention-related health care services without paying more out of their own pocket as of Aug. 1, 2012, which was announced by Health and Human Services (HHS) Secretary Kathleen Sebelius at the end of July.

Previously some insurance companies did not cover these preventive services for women at all under their health plans, while some women had to pay deductibles or copays for the care they needed to stay healthy. The new rules in the health care law requiring coverage of these services take effect at the next renewal date – on or after Aug. 1, 2012—for most health insurance plans. For the first time ever, women will have access to even more life-saving preventive care free of charge.

According to a new HHS report also released today, approximately 47 million women are in health plans that must cover these new preventive services at no charge.  Women, not insurance companies, can now make health decisions that will keep them healthy, catch potentially serious conditions at an earlier state, and protect them and their families from crushing medical bills.

“President Obama is moving our country forward by giving women control over their health care,” Secretary Sebelius said. “This law puts women and their doctors, not insurance companies or the government, in charge of health care decisions.”

The eight new prevention-related services are:

  • Well-woman visits.
  • Gestational diabetes screening that helps protect pregnant women from one of the most serious pregnancy-related diseases.
  • Domestic and interpersonal violence screening and counseling.
  • FDA-approved contraceptive methods, and contraceptive education and counseling.
  • Breastfeeding support, supplies, and counseling.
  • HPV DNA testing, for women 30 or older.
  • Sexually transmitted infections counseling for sexually-active women.
  • HIV screening and counseling for sexually-active women.

The health care law has already helped women in private plans and Medicare for the first time gain access to potentially life-saving tests and services, such as mammograms, cholesterol screenings, and flu shots without coinsurance or deductibles. Today’s announcement builds on these benefits, generally requiring insurance companies to offer, with no copay, additional vital screenings and tests to help keep women healthy  throughout their lives.

These services are based on recommendations from the Institute of Medicine, which relied on independent physicians, nurses, scientists, and other experts as well as evidence-based research to develop its recommendations. These preventive services will be offered without cost sharing beginning today in all new health plans.

Group health plans and issuers that have maintained grandfathered status are not required to cover these services. In addition, certain nonprofit religious organizations, such as churches and schools, are not required to cover these services. The Obama administration will continue to work with all employers to give them the flexibility and resources they need to implement the health care law in a way that protects women’s health while making common-sense accommodations for values like religious liberty.

For women who are pregnant or nursing, the new preventive services include gestational diabetes screening as well as breast-feeding support, counseling and supplies. Health services already provided under the health care law include folic acid supplements for women who may become pregnant, Hepatitis B screening for pregnant women, and anemia screening for pregnant women.

Women Medicare beneficiaries may already receive such preventive services as annual wellness visits, mammograms, and bone mass measurement for those at risk of osteoporosis and diabetes screening.  Approximately 24.7 million women with Medicare used at least one free preventive service in 2011, including the new annual wellness visit.

Because of the Affordable Care Act, secure, affordable coverage is becoming a reality for millions of American women and families. Men and children are also able to take advantage of preventive services at no extra charge under the health care law. These services include flu shots and other immunizations, screenings for cancers, high blood pressure and cholesterol, and depression.


To learn more about the health care services you may be eligible for at no extra charge under the Affordable Care Act, go to

For information about the U.S. Department of Health and Human Services report on the number of adult and adolescent women eligible for the preventive services at no charge after Aug. 1, 2012, see


See more information on G. R. Reid Healthcare and Benefit Services.

Contact: Julie Seiden, Managing Director.

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New Limit for Health FSA Contributions in 2013

Recent IRS guidance provides information on the new rules under Health Care Reform that limit the amount of salary reduction contributions to a health flexible spending arrangement (FSA) to $2,500 annually (adjusted for inflation) beginning in 2013.

The new guidance addresses a number of issues related to the limit on contributions, including:

  1. The $2,500 limit applies on a plan year basis and is effective for plan years beginning after December 31, 2012;
  2. Plans may adopt the required amendments to reflect the limit at any time through the end of calendar year 2014;
  3.  Relief is provided for certain salary reduction contributions exceeding the $2,500 limit that are due to a reasonable mistake and not willful neglect and that are corrected by the employer; and
  4. Comments are requested on whether the current “use-or-lose” rules for health FSAs should be modified in light of the new limit.

Limit Applies to Health FSAs Only
The guidance makes clear that the $2,500 limit does not apply to contributions or amounts available for reimbursement under other types of FSAs, health savings accounts (HSAs), or health reimbursement arrangements (HRAs), or to salary reduction to cafeteria plans used to pay an employee’s share of health coverage premiums.


Contact us for more details and to arrange an appointment.

Email us:

G.R. Reid Associates, LLP

181 Main Street, Huntington, New York 11743
Phone: 631.425-1800 / Fax: 631.425.4656

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Life Insurance Considerations for Empty Nesters

When the last child has moved out of the house, many “empty nesters” question if maintaining a life insurance policy is necessary. Before cancelling or reducing your insurance coverage, take some time to re-evaluate how your circumstances have changed, and consider what your future needs may be.

“Many empty nesters are faced with financial obligations, such as the mortgage on a home or second home, and could be financially devastated if a spouse dies or becomes disabled,” said insurance expert Gary Lardy.

If the unthinkable happens so close to retirement, you may be forced to work long into your golden years. Marvin H. Feldman, CLU, ChFC, RFC, President and CEO of the Life Foundation ( recently posted, “Researchers are telling us that the expected retirement age for U.S. workers is rising and that people are planning on working longer, as opposed to saving more.”

He refers to a study conducted by Mathew Greenwald & Associates, Inc. and the Employee Benefit Research Institute stating that “the percentage of workers who expect to retire after age 65 increased to 36%, from 25% in 2006, and the percentage that expect to work in retirement increased

to 74%, from just last year. Researchers found that workers with less than $100,000 in savings are especially nervous about retirement.”

Life insurance will protect your retirement savings, ensuring that you or your spouse will remain secure, and that your estate will be passed on, intact, to your survivors. Unfortunately, you can’t rely on Social Security benefits to add additional relief. These benefits are not available to a surviving spouse during the “blackout period,” which extends from the date the youngest child leaves high school until age 60.

The good news is that regardless of your age, you have a wide variety of choices that can be tailored to your unique life circumstances. Weighing the differences between term insurance and permanent (whole life) insurance, you may elect one over the other, or combine them. Term insurance covers you for a term of one or more years. It pays a death benefit only if you die in that term. Term insurance offers the largest insurance protection for your premium dollar, but does not build up cash value, and it may not be renewable at the end of the term or may cost considerably more to continue.

Permanent life insurance (which is also referred to as universal life, variable universal life and whole life) may provide long-term financial protection. These policies include both a death benefit and, in some cases, cash savings. Because of the savings element, premiums tend to be higher. Life insurance can act as a safety net and may help secure your retirement plans for you as an empty nester, should the unthinkable occur.

Contact us for more details and to arrange a courtesy appointment with William Katz, Managing Director, Life, Long Term Care and Disability Insurance


G.R. Reid Healthcare & Benefit Services, LLC

181 Main Street, Huntington, New York 11743
Phone: 631.923.1595 / Fax: 631.425.4656

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Healthcare & Benefit Services

As your broker, we provide the following services and support to your company:

Research and analyze client’s groups benefits needs and physician networks.

  • Review current plans and level of satisfaction.
  • Determine key person’s objectives.
  • Collect census.

Survey the marketplace for appropriate plans and carriers.

  • Analyze the available carriers and plans.
  • Check that key person’s physicians are in proposed network.

Present plan alternatives that meet client’s benefits and budgetary needs.

  • Prepare presentation.
  • Explain plan differences.

Define eligibility.

  • Explain the requirements for group coverage.
  • Acceptable waivers.
  • Participation requirements.

Prepare master application, supporting documents and employee enrollment.

  • Group Application which defines the terms of the plan.
  • Eligibility documents supplied by group and included with the application.
  • Employee enrollments completed by employees defining their status and named dependents.

Educate employees about their plan.

  • Install the plan upon acceptance by the carrier.

Support your client’s employee benefits and HR needs.

  • Be available to respond to questions regarding the plan, claims and eligibility.
  • Keep clients ahead of the curve by notifying them of changes in laws—issues that will directly impact their businesses.
  • Provide customer support throughout the plan year such as enrollment changes, claims and insurance I.D. cards.
  • Provide support when COBRA issues come up or mini-COBRA needs for less than 20 employees.

Help with open enrollment issues.

  • Provide support at open enrollment time with explaining choices and assisting enrollment.

Provide documentation such as SPDS when needed.

  • Arrange to provide the documents at inception and for changes in the plan.

Facilitate renewal and eligibility verification.

  • Provide explanation of renewal
  • Design plan alternatives in line with budget and priorities.


Contact us for more details and to arrange a courtesy appointment with Julie Seiden, Managing Director.

Email us:

G.R. Reid Healthcare & Benefit Services, LLC

181 Main Street, Huntington, New York 11743
Phone: 631.923.1595 / Fax: 631.425.4656

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Big dogs play nice with reform

:: Julie Seiden,Managing Director,
Health Benefits Services | 631.923.1595 ext. 310
G.R. Reid Healthcare & Benefit Services, LLC


UnitedHealthcare started it. Aetna and Humana soon followed.

Wellpoint’s waffling, holding out for the Supreme Court ruling.

What are they doing? Well, as we reported here, (“Other carriers jump on reform bandwagon”) some of the largest insurers in the business have come out to say they’ll still abide by some of the aspects of PPACA regardless of what the court does.

Three of the top five insurers in the country plan to carry on with preventative care coverage – such as immunizations and screenings – without a copay. They also said they’ll keep covering those older children under their parents’ policies – until they hit 26, anyway. They’re also gonna maintain a more streamlined appeals process for denied claims.

United and Humana actually stepped out a little further, insisting they wouldn’t enforce lifetime dollar limits on claims.

All in all, it sounds like they’re playing nice even if they don’t have to. Because there’s still a real chance even these earlier regs could get tossed. We’ll find out soon enough.

But as we reported, these are the most popular provisions of the law, anyway, and the carriers have already done the math, lumping the extra costs into the last round of premium bumps. If anything, dropping these provisions might be a bigger headache at this point. So they can score a public relations win without taking a hit on their bottom line. Nothing wrong with that. Although it will be interesting to see if Wellpoint faces any backlash for dragging its feet on this while its competitors come out looking like humanitarians.

And, honestly, why wouldn’t they? Have we already forgotten how the carriers jumped on board this legislation early on – after the public option died, of course. And while I think it’s a stretch to say these carriers are “embracing” reform as a few mainstream media outlets are pointing out, it’s safe to say they’re simply accepting a new reality – something brokers need to start doing, as well.

I think this is a good move, though, and not just from a PR perspective. But what this really shows, is that, cynicism aside, while this legislation remains a convoluted mess, it does have its worthwhile provisions – even if they are buried under red tape and rampant spending. It also shows that no matter what happens to this particular law, some of the things it’s ushered in are here to stay, whether it’s as simple as coverage provision or as far-reaching as the state exchanges.

© 2012 BenefitsPro. A Summit Business Media publication. All Rights Reserved.
Written by Denis Storey

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