Starmark Self-Funded Plans Give Deductible Credit for New Groups On Calendar Year Deductible. February 2015 Newsletter. Hello Brokers!

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1 February 2015 Newsletter Glandon Insurance Agency 1100 Laskin Road., Ste. 200 Virginia Beach, Virginia Hello Brokers! It is hard to believe we are already in February, except for the weather! :) See below for the GREAT articles this month! Starmark Self-Funded Plans Give Deductible Credit for New Groups On Calendar Year Deductible A member continuously covered under a prior individual or group health plan with a calendar-year deductible will be credited for any portion of the deductible satisfied under the prior plan during the same calendar year. Deductible credit

2 will not be given if moving to or from a health plan with a plan-year deductible. Credit is not provided for out-of-pocket amounts, prescription drug card deductibles or for employees added to a self-funded plan after the group's initial effective date. First Information Returns Due in 2016 The Internal Revenue Service (IRS) has released finalized forms and instructions to help employers prepare for compliance with the new information reporting provisions under the Affordable Care Act (ACA). Because of transition relief provided for 2014, information reporting is voluntary for calendar year 2014 and reporting entities will not be subject to penalties if they first report beginning in 2016 for Background The ACA requires insurers, self-insuring employers, and other parties that provide minimum essential health coverage to report information on this coverage to the IRS and to covered individuals (referred to as "section 6055 reporting"). Large employers (generally those with 50 or more full-time employees, including full-time equivalents) are also required to report information to the IRS and to their employees about their compliance with the employer shared responsibility provisions ("pay or play") and the health care coverage they have offered (referred to as "section 6056 reporting"). Forms and Instructions To help reporting entities prepare for compliance, the following forms and instructions have been released by the IRS: Minimum Essential Coverage Reporting (Section 6055)

3 o Form 1094-B o Form 1095-B o 2014 Instructions Large Employer Reporting (Section 6056) o Form 1094-C o Form 1095-C o 2014 Instructions As a reminder, Forms 1094-B, 1095-B, 1094-C and 1095-C are not required to be filed for However, in preparation for the first required filing of these forms (that is, filing in 2016 for 2015), reporting entities may, if they wish, voluntarily file in 2015 for 2014 in accordance with the forms and instructions. For more information, including details on how to report and compliance deadlines, visit our section on Information Reporting Under Sections 6055 and Elimination of Individual Conversion Due to the guaranteed issue provision within the Affordable Care Act (ACA), beginning January 1, 2015, Individual Conversion will no longer be available to members who terminate coverage through their group-sponsored health plan. Groups not eligible for COBRA must offer a 12-month Continuation of Coverage. The terminated member will also have the option to purchase an ACA-compliant Individual & Family plan, either though the Optima Health website or HealthCare.gov. HELPFUL NOTES:

4 ** The group should notify the member of the continuation of coverage option within 30 days of the qualifying event. ** If the member wants to enroll in continuation of coverage he/she should complete the enrollment application with "Continuation of Coverage" written at the top of the application. ** The group is responsible to track the member for the 12 months continuation of coverage and notify Optima Health as to when they are to be removed. ** If the member declines the continuation of coverage, it is advisable for the group to obtain a waiver declining the continuation of coverage option for their file! ** If the member is currently on continuation of coverage and the group renews, they should notify the member of any changes and give them the opportunity to continue or decline coverage from that point forward. If they decline, it is still advisable to obtain a waiver! ** If the employee fails to pay the premium, the group has the right to remove the member from coverage. ** You can use the attached model notice to notify employees of the continuation of coverage. It is advisable to keep copies of any notifications and/or waivers! Certificate of Creditable Coverage Effective January 1, 2015, members who lose coverage under their group health plan will no longer receive a Certificate of Creditable Coverage with their termination letter. As a result of guaranteed

5 issue, members no longer need to provide verification to enroll in another health plan. If you have any questions on any of the above information, please contact us! Starmark Gives You Control Over Your Compensation Option Take advantage of Starmark's competitive rates and choose the compensation option that best fits your needs - on a group by group basis! Choose between one of two compensation calculation options: Percent of Paid Stop-Loss Premium or Per Employee Per Month (PEPM). When you offer Starmark self-funded plan designs with stop-loss insurance to your small to mid-size groups, your clients get: Strong regional and national network access, including Aetna Signature Administrators (ASA) PPO and Cigna PPO networks Better control over healthcare benefits Numerous options of plan designs to meet their specific needs The opportunity to receive a refund if their group's claims are lower than expected And, you get: Personalized service to be successful in today's healthcare market Access to key information and tools to support your sales efforts 24/7 online access to your group's important documents including your broker compensation information and statements via the Document Center

6 For more information on Starmark's compensation option, click here. To view compensation schedules or bonus programs, please contact Glandon Insurance. Out of Area - Mid-Market (51-99) Groups Optima confirmed that they no longer have the maximum out of area percentage stipulation on Mid-Market groups so they can have more than the previously allowed amount of 35% out of area...they can no longer decline to quote, so the out of area percentage is not an issue. Out of Area people will be fine as long as their zip codes check out to have a good network of doctors in the National PPO Network that Optima uses...phcs/multiplan. For any additional questions, please contact Terry! Do your groups have an ERISA compliant benefit plan summary? PrimePay offers a simple, easy and affordable ERISA Plan Wrap service that will have your clients covered. Glandon Insurance has partnered with PrimePay to help provide compliance and HR services to our brokers and their groups. What you need to know about ERISA Wrap Plans -- A wrap plan is a document that bundles all of the employer's health and welfare plans into a single plan. Under ERISA, an employer must: 1. Establish and maintain each benefit plan pursuant to a written plan document that contains certain required elements

7 2. Furnish a summary plan description for each benefit plan to each participant of the plan 3. File a Form 5500 report for each benefit plan ever year (certain exceptions apply) A PrimePay ERISA Wrap Plan will provide compliant ERISA documentation for any health and welfare benefit that your groups may offer. Please contact Will Drudge at or will@glandoninsurance.com if you would like further information. BusinessEDGE Quoting and Enrolling Calendar update: Earliest date to request a quote Latest date to request a quote Latest date to release a quote Latest date for group's decision All Plan docs delivered Eff Date of SF quote (90 days prior to eff date) (60 days prior to eff date)* (45 days prior to eff date) (40 days prior to eff date)* (30 days prior to eff date) 1/30/2015 3/2/2015 3/17/2015 3/20/2015 4/1/2015 5/1/2015 3/3/2015 4/2/2015 4/17/2015 4/22/2015 5/1/2015 6/1/2015 4/2/2015 5/1/2015 5/15/2015 5/22/2015 6/1/2015 7/1/2015 5/1/2015 6/2/2015 6/17/2015 6/22/2015 7/2/2015 8/1/2015 6/3/2015 7/3/2015 7/17/2015 7/23/2015 7/31/2015 9/1/2015 7/3/2015 7/31/2015 8/17/2015 8/21/2015 9/1/ /1/2015 8/3/2015 9/2/2015 9/17/2015 9/22/ /2/ /1/2015 9/2/ /2/ /16/ /22/ /30/ /1/2015 The dates highlighted in yellow are adjusted to reflect the business day before the holiday/weekend. * Suggested timeframes; need UW approval to change dates. Contact Elizabeth or Terry to ask for a BusinessEDGE Quote! Elimination of Minimum Employer Contribution Requirement for the 2-50 Market

8 Optima Health wants to help your small group clients do the right thing for their business and their employees. We understand that many groups with a wide range of compensation levels across their employee population are struggling with the affordability balancing act. They want to offer a valuable plan for all of their employees, which can be funded on a tax-advantaged basis. However, unless they are able to pay all or virtually all of their employees' premiums-and most groups certainly are not-then they may actually preclude their lower-compensated employees from being eligible for significant subsidies on the Individual Marketplace. To enhance your clients' flexibility to set a contribution structure that works well for all, Optima Health is eliminating the Employer Contribution requirement for small groups (2-50) as of December 1, 2014 effective dates. The client can reduce contributions to a level that will make their plan unaffordable for some employees (>9.5% of income), and those folks can then take advantage of the best deal available-a subsidized OptimaFitSM individual plan on the Marketplace. Then they can put an Optima Equity or Optima Design plan in place for the remaining group. They can use the funds that would have been paid toward the departing employees' premiums to significantly fund the HSA or HRA, providing a very valuable benefit to the employees sticking with the group plan. Dominion Dental has released their second quarter rates!!! Please click here to get their second quarter rates!

9 As a reminder 2015 Open Enrollment period ended on February 15, Once open enrollment is over, individuals must have a qualifying event to enroll on an individual plan. Proof of qualifying event must be submitted with the application and applications must be submitted within 60 days of the date of qualifying event. Applications without proof of qualifying event will not be enrolled. Individuals who do not have a qualifying event will not be able to enroll until the 2016 Open Enrollment. Please make sure you are using Optima's individual paper application for off-exchange business only. When applying for an on exchange plan you must apply using healthcare.gov, even if no subsidy is involved. Optima can not accept applications directly for an on exchange plan. Individual Payment options for 2015: New for 2015, Individual & Family plan members can pay their monthly premium at MoneyGram locations throughout Virginia, including 7-Eleven, Farm Fresh, CVS, and Walmart. There is no fee to use this service; members only need to know their member ID number and monthly premium amount. For a list of all participating locations, please visit moneygram.com/locations. In addition to MoneyGram, members can pay their premium by: Mailing a check, cashier's check, or money order to Optima Health, P.O. Box , Baltimore, MD, 21279; Signing in to MyOptima and clicking on Pay Monthly Premium in the left menu bar; Calling our automated attendant at or toll-free at , and selecting option 1; or

10 Completing an auto-debit form, located on MyOptima under Member Forms and Drug Lists to have their premium automatically deducted from their checking account every month. Happy Valentine's Day from Glandon Insurance Agency!