Greetings!

In this edition of the PBG newsletter, you'll find informative articles on Fair Share Contribution Audits, Tufts Health Plan standard plan changes and last but not least, tips on how to protect yourself, coworkers, and family from this year's flu.

We hope you enjoy the articles. As always, please contact the office directly for any specific questions or requests for additional information.

Fair Share Contribution Audit

What you'll need on hand...

The Massachusetts Department of Workforce Development has been hard at work enforcing the Fair Share Contribution provision under Massachusetts Health Care Reform. Should your company receive an audit letter, here are the items that you will be asked to provide.

• Power of Attorney: Required if the employer has an agent or organization representing the employer
• Offer of Group Health Plan Documentation: Original documentation signed and dated by the full-time employees who were employed at least ninety days during the base period indicated. Examples include HIRD forms or equivalent for each filing
• Group Health Plan/Administrator Documentation: Terms and Conditions Agreement/Contract between employer and insurance carrier, dated and signed by both parties, or a Collective Bargaining Agreement between the employer and the employee union. Terms and Conditions may include employee and employer contribution (identifies Group Health Plan(s) and contribution percentages)
• Group Health Carrier Invoice Documentation: Group Health Carrier documentation specific to employer address(es), dated within the base period indicated with enrolled employees that are identified on the payroll records for the employer DUA number being audited
• Group Health Payment Documentation: Group Health Plan(s) payment documentation such as copies of checks, EFT/Debit transfer, etc.
• Employer Policy Regarding Benefit Eligibility: Employer Policy Handbook and/or communication with all full-time employees on the employer offer of Group Health Benefits (which identifies the terms of the offer(s) such employer/employee contributions, etc.)
• Federal Tax Filing Form: Identifies the type of organization, e.g. Corporation, Sole Proprietor, etc. which determines Fair Share auditing practices and may show Group Health Plan deductions
• Quarterly Payroll Records (summary & detail): Employer quarterly payroll records for the base period indicated. The payroll records should list the employee hourly wage, first employment date, last employment date (identifies FSC calendar month), hours worked during each quarter and wages for those hours worked during each quarter. Records should show employee Group Health Plan deductions
• Employer Worksheet (FSC Filing Question 1 Detail): Worksheets created by the employer to determine the answers to the Fair Share Contribution on-line filing entry for Question 1 & 4
• Work Schedules for All Employees: Time cards and posted work schedules (identifies hours of work for all employees including commission and salaried employees)
• 1099 Documentation: Supporting documentation for 1099 labor for the base period/tax years indicated
• Quarterly WR1 Forms: Wage reporting forms supplied by the employer to the Massachusetts Department of Revenue for the base period indicated
• Employer Worksheet (FSC Filing Question 2 Detail): Worksheet created by the employer to determine answers to the Fair Share Contribution filing question 2B
  

Tufts Health Plan

Small Group Updates:

Effective January 1, 2010, upon group anniversary dates, the following benefit changes will take place:

• Separate 30 visit annual limitation on physical and occupational therapy - for members of fully-insured plans, there will be a separate 30 visit limitation on physical and occupational therapy visits
• $25 high-tech imaging copay for HMO Premium plans - For members of the HMO Premium, PPO and POS plans, members will not pay a $25 copay for all high-tech imaging procedures. This copay will not apply when the imaging is required as part of an active treatment plan for a cancer diagnosis.
  

Infection Prevention

Flu season is here! In addition to getting the flu and H1N1 vaccines here are some helpful reminders to preventing infection and the spread of the flu...

• Keep your hands clean. Washing your hands regularly is the most powerful thing you can do to prevent infection. Make sure you always remember to wash after going to the bathroom, before you eat, or after taking out the trash. Since it's hard to always get to a sink, keep an alcohol-based hand sanitizer in your car or purse.
• Cover your mouth and nose if you cough or sneeze. Use a tissue or even the bend in your elbow to prevent spreading germs to others. Make sure to wash your hands afterwards.
• Take care of cuts, scratches and wounds. Your skin is your armor against harmful bacteria. Keep all cuts scratches and wounds clean and protected with a clean, dry bandage.
• Keep your skin healthy. If it starts getting dry or cracking, apply moisturizing cream to keep skin soft.
• Use prescription antibiotics responsibly. Be careful not to use prescription antibiotics too often. Doing this can actually make them less effective because it allows germs to build up resistance to medications. If you start taking antibiotics, be sure to take the full prescription. Stopping in the middle may allow the infection to return even stronger.

Sincerely,

Brittany Powers
Partners Benefit Group, Inc.

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