B. Ronnell Nolan said today here in New Orleans, at the annual meeting of Health Agents for America, that she started HAFA in 2012 to give agents a clear voice in Baton Rouge when there was talk that the state might prohibit Affordable Care Act exchange plans from paying agent or broker commissions.
This main focus of the group is still to make agents’ and brokers’ voices heard in Washington and in state capitals. “I don’t think I’m competition” to the bigger, older producer groups, Nolan said. “I’m the cherry on top.
This year, she said, one small but concrete victory was to get Louisiana lawmakers to pass a bill that will require health insurers to give producers at least 90 days’ notice before making material changes in compensation arangements. Now, HAFA is trying to play a role in shaping the draft bill that will be based on an ACA alternative proposal recently released by House Speaker Paul Ryan.
The HAFA meeting also featured a series of blunt speakers who talked about ACA financial and compliance issues.
For a look at some of what the speakers said that seemed to surprise at least some of the agents in attendance, read on:
(Photo: Allison Bell/LHP)
1. Jim Napoli
Jim Napoli, a partner in the Washington office of Seyfarth Shaw LLP, talked about a twist in the Affordable Care Act’s employee counting group rules that’s even more complicated and more obscure than many of the other employee counting rules: the control group rules.
The ACA now requires “applicable large employers,” or ALEs, to offer affordable coverage with a minimum value to most of their full-time employees or else pay a “shared responsibility” penalty. The actual size of the penalty depends on the number of full-time employees who lack access to employer-sponsored health benefits, but the government takes other types of employees into account when deciding whether an employer is an ALE.
The control group provision, which is a cousin of control group provisions for other federal benefits laws that involve employer size cut-offs, affects employers that may intentionally, or unwittingly, own what the federal government thinks of as stakes in other employers.
If, for example, a restaurant owner owns all of one restaurant and half of another restaurant, federal regulators might include the number of full-time equivalents in both restaurants when deciding whether the restaurant owner should comply with the ALE requirements.
If a doctor employs 49 full-time equivalents in a medical office, and a household worker at home, it’s possible that, under some circumstance, the household worker might put the doctor’s company over the 50-employee ALE cut-off. The employees of a spouse or other relatives could also turn a small-business owner client into the unwitting co-controller of a control group.
Napoli recommended that agents and brokers get legal advice about the issue but consider simply bringing up the issue with a question on a list of questions.
The form could ask an employer client, “Are you a member of a controlled group?” Napoli said.
Napoli said brokers could give a client that asks, “What does that mean?” a very general, standard response along with advice to ask a benefits lawyer.
“It’s your job to know that the control group rules exist,” Napoli said. ”You have to touch this base with your small business client.”
If a broker does raise the issue, and a client gets into trouble by turning out to be an accidental co-controller of a control group, “they’re going to sue you, because you didn’t ask the question,” Napoli said.
But, if a broker gives any actual advice about the control group issue, that could expose the broker to liability that would not be covered by a standard errors and omissions policy, Napoli said.
“The further you go down that rabbit hole, the deeper you’re in,” he said.
He said the best approach is probably to mention the existence of the rabbit hole and have the client go to a lawyer for any additional information about the issue.
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