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Frequently Asked Questions

Below are some of our frequently asked questions. If you have any other questions or concerns, please feel free to contact us.

  1. How do I know how many Full Time equivalent employees work for us?
  2. How do I know if our health plan provides "minimum value" based on the ACA rules?
  3. How do I know if our non-profit is liable for the Cadillac Test which is effective in 2020?
  4. What does our non-profit have to do regarding the "Patient's Bill of Rights"?
  5. Where can I find an ACA Large employer calculator?
  6. We need help with education for our employees. What's the best place to find this?
How do I know how many Full Time equivalent employees work for us?

Using Carriage Trade Benefit Services Large Employer Calculator and Full-time Employee Tracker, we can help you determine an employee’s full time status and identify whether you are considered a large employer, and, therefore, subject to the shared responsibility penalty. You can also use our comprehensive Pay or Play Calculator to calculate potential penalties you may receive for not offering affordable coverage—enabling you to determine the best strategic option for your business.



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How do I know if our health plan provides "minimum value" based on the ACA rules?

Carriage Trade Benefit Services can help you evaluate your plan offerings by estimating your plan’s value using our sophisticated Pay or Play Calculator. In addition, we can provide information on how to ensure that your plan provides minimum value so you stay in compliance.



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How do I know if our non-profit is liable for the Cadillac Test which is effective in 2020?

Carriage Trade Benefit Services provides a Cadillac Tax Calculator that can help you identify which plans are likely to incur the excise tax. Our tool even estimates the amount of tax that could be owed as a result, allowing you to better manage your bottom line.



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What does our non-profit have to do regarding the "Patient's Bill of Rights"?

The ACA imposes three new requirements on group health plans and group or individual health insurance coverage—referred to as “patient protections”—related to the choice of a health care professional and requirements relating to benefits for emergency services, effective for plan years beginning on or after Sept. 23, 2010.

These rules do not apply to grandfathered plans. In addition, the rules regarding choice of health care professional apply only to plans that have a network of providers.

Choice of Primary Care Provider

If a group health plan or group or individual health insurer requires a participant to designate a primary care provider, the participant must be able to choose any participating primary care provider who is able to accept the participant as a patient. This rule includes the designation of a pediatrician as the primary care provider for a child.

The plan must provide a notice informing each participant of the plan’s terms regarding primary care provider designation. The notice should be included in the plan’s summary plan description. The DOL has provided model language for this notice.

OB-GYN Care

Plans that provide coverage for obstetrical and/or gynecological care (ob-gyn care) and require the patient to designate an in-network primary care provider may not require preauthorization or referral for a female participant seeking such care. However, a plan may still require the ob-gyn provider to follow any policies or procedures regarding referrals, prior authorization for treatments and the provision of services.

The plan must inform each participant of these rules and should include the notice in its summary plan description. Model language has been provided for plans to use.

Emergency Services

The ACA places additional requirements on plans and health insurance issuers that provide hospital emergency room benefits. Plans and issuers must provide those benefits without requiring prior authorization, and without regard to whether the provider is an in-network provider.



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Where can I find an ACA Large employer calculator?

Contact us. We will provide you with a simple tool which your finance and HR departments can use to make the calculation.

mjakob@carriagetradeinsurance.com



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We need help with education for our employees. What's the best place to find this?

re you effectively communicating with your employees?

·         Most workers leave their jobs because of miscommunication about expectations, broken promises or excessive workloads. Check out our articles to learn more about how to improve your communication strategies.

Do your employees know about and understand your benefits package?

·         Unless your employees are aware of and understand your benefits offerings, they won’t be nearly as effective. Tackle your mounting employee communication concerns with customizable benefits announcements, employee newsletters and presentations.

Are your employees wise health care consumers?

·         Empower your employees to take charge of their health care. We have the resources to educate your employees on health care consumerism—and save you money.



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