Health Care Reform Made Easy

Our goal is to help provide solutions that make Health Care Reform simple for you. American Fidelity Administrative Services, LLC (AFAS) is helping organizations just like yours to untangle the complexity of the rules, develop and implement their strategic plans, and outsource ongoing administrative tasks. We can assist with the following:

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  • Analysis

    Performing a detailed analysis of how certain Health Care Reform provisions could impact your organization's health and welfare benefit plans provides a strong foundation for strategic decision-making. The following are examples of the types of analysis we can provide:

    • Impact of the Free Rider Penalty:
      • Who are considered full-time employees?
      • Which full-time employees are not currently eligible for adequate and affordable coverage?
      • What would it cost to avoid a Penalty?
      • What could the Penalty be if you don't make changes?
    • Contribution rate calculations;
    • Budget impact of Health Care Reform;
    • "Strawman" examples of how employees could be impacted;
    • Impact of changing rate structure:
      • Affect on employer and employee costs;
      • Alternative contribution strategies; and
      • Discussion of potential changes in elections;
    • Illustration of the potential impact of the Cadillac Tax and suggest cost management strategies;
    • Employee surveys; and
    • Benchmarking of your plans against the market.
  • Health and Welfare Benefit Plan Consulting

    Our objective is to help you develop or refine your health and welfare benefit plan options and/or administrative procedures so you can best meet your organization's goals. We can help you apply best practices in health and welfare plan design and operations to create a compliant and competitive health and welfare benefits program. The following are some of the ways our consultants can share their expertise:

    • Explore your long-term options in light of Health Care Reform and design a health and welfare plan strategy that meets the organization's objectives;
    • Identify changes in health and welfare benefit plan design that maybe required;
    • Explain how employers could take advantage of public and private Exchange plan options;
    • Suggest strategies for cost-management;
    • Describe opportunities for population health management (e.g., wellness);
    • Help design and implement high deductible health plans, including:
      • HRA and HSA options;
      • Premium pricing and account contribution strategies;
      • Supplemental benefits to help bridge the deductible gap; and
      • Employee communication campaigns; and
    • Help explore additional or alternative compensation to offset health and welfare benefit plan contribution increases or benefit reductions.
  • Compliance Support

    We offer a number of solutions to help you with compliance and to streamline administrative activities. In some cases we can perform administrative tasks on your behalf. The following are examples of the services we provide:

    • Help develop and document administrative procedures;
    • Review plan operations for efficiency and compliance;
    • Provide compliance checklists;
    • Help draft employee benefit summaries;
    • Send required employee notices;
    • Fill out Summary of Benefits and Coverage templates;
    • Calculate hours worked during a "measurement period" for employees working variable hours;
    • Answer questions about reporting health costs on W-2 Forms;
    • Help identify the coverage and workforce information that needs to be reported beginning in 2014;
    • Provide Exchange information;
    • Perform nondiscrimination testing;
    • Conduct dependent verification reviews; and
    • Assist with automatic enrollment compliance.
  • Health Care Reform Eligibility Software

    Large employers (with 50+ full-time equivalent employees) that fail to offer adequate and affordable coverage to substantially all full-time employees could trigger a Free Rider Penalty. This requires you to know who your full-time employees are and how many of them are eligible for coverage during any given month. This can be particularly challenging if your workforce includes employees whose hours vary from week to week or are seasonal.

    System Features

    Many organizations are assessing potential ad hoc workarounds to stay on top of these demands. AFAS has partnered with WorxTime to offer an automated solution to relieve you of this burden. The WorxTime platform include the following features:

    • Monitors employee hours in real time and sends automated alerts to the employer whenever action is required;
    • Calculates whether variable hour employees will be considered full-time under the law;
    • Projects probability of part-time employees moving to full-time status;
    • Monitors percentage of full-time employees who are eligible for coverage;
    • Provides affordability testing, rate of pay safe harbor testing, and a penalty calculator; and
    • Captures information that will need to be reported to the IRS.

    Service Features

    Our time and eligibility management solution also includes the following:

    • One hour setup meeting with an expert Health Care Reform Consultant;
    • Training on the WorxTime platform;
    • Data input from your payroll and/or time management systems;
    • Dedicated professional to answer questions;
    • Platform customer service support; and
    • Easy contracting terms.
  • Variable Hour Employee Billing

    For variable hour employees who are not reasonably expected to work a full-time schedule, the employer can use an optional look back period to determine whether an employee averaged 30 or more hours of service per week. If an employee was considered full-time during this measurement period, the employee must be treated as a full-time employee for benefit purposes for a subsequent stability period, regardless of the employee's number of hours worked during the stability period.

    If the employee enrolls in coverage but does not have enough wages in the given payroll period to cover the required premium, the employer can require the employee to pay his or her share of the premium out-of-pocket. The regulations adopted rules from COBRA that further complicate this process.

    Service Features

    We can eliminate the hassle of billing and collecting premiums from variable hour employees. Our goal is to provide you with a simple solution. Our billing service includes the following:

    • Providing coupon books to variable hour employees;
    • Collecting premiums on your behalf;
    • Balance billing for any unpaid premiums;
    • Tracking payment deadlines;
    • Sending notice of coverage termination if the premium is not received by the end of the grace period; and
    • Responding to questions from employees.

    We also provide a convenient and intuitive online portal for you to monitor payment activity. Watch our video to better understand the WorxTime system.

  • Consulting Retainer

    Many employers are concerned about staying on top of the changing Health Care Reform rules and want to have an expert available to answer questions as they come up during the year. For an affordable annual fee, you can continue to have access to your Health Care Reform Consultant for assistance when you need it.

    • Your Consultant will meet with you once a year to review and refine your strategy and compliance plans;
    • Your Consultant remains available throughout the year to answer your questions and provide assistance for up to 30 minutes per month, which you can save and utilize at your discretion; and
    • You will also have access to our Monthly Educational Webinars on timely benefit topics, such as Health Care Reform developments ($50 per webinar fee is waived for 12 months).
  • Employee Notice and Reporting Solution

    A variety of federal laws require employers and plan sponsors of health and welfare benefit plans to provide periodic notice to individuals and reports to various federal agencies. Health Care Reform added several new such requirements

    Our employee notice and reporting solution provides a basic administrative guide to help make satisfying these obligations easier for you and, if you would like, enhanced notice fulfillment services where we draft certain documents and/or mail notices on your behalf.

    Basic Notice and Reporting Support

    Our basic service includes the following:

    • An administrative guide that includes a summary of each of the federal health and welfare plan notice and reporting requirements and copies of the model notices;
    • Instructions for completing the forms and reports;
    • Electronic versions of all model documents;
    • A compliance calendar to remind you of all due dates;
    • Training with a Consultant to help you understand your obligations; and
    • Annual updates to incorporate changes in the law.

    Enhanced Notice Service Options

    Our enhanced services provide your benefits team relief from the administrative burdens created by the growing number of notice compliance requirements.

    Notice Fulfillment

    Certain notices must be provided at certain times to employees, participants, and/or beneficiaries. We will send the specified notices via First Class mail on your behalf. We will also check the National Change Of Address (NCOA) database to ensure all addresses are valid before mailing and provide you with a copy and list of recipients for your records.

    Summary Plan Description (SPD)

    Some notices are required to be included in the SPD for plans subject to ERISA. We can provide a standard SPD that "wraps around" your existing benefit summaries. The purpose of this type of document is to provide general information about the health and welfare benefit plans that you offer and a summary of participant rights. The document then incorporates specific benefit plan summaries and certificates of insurance by reference.

    Enrollment Materials

    Health Care Reform requires plan sponsors to provide a new government-developed document to plan participants in connection with enrollment materials. The Summary of Benefits and Coverage (SBC) is intended to provide a high-level description of group health plan coverage. Plan sponsors of self-funded plans must fill in the government-provided template with the required information for their plan(s). We can complete the SBC template on your behalf and assist you with annual updates.

  • Nondiscrimination Testing

    Federal law requires testing of certain health and welfare benefits to demonstrate the plan is not providing a greater benefit to highly compensated individuals than to non-highly compensated individuals. Health Care Reform expanded these rules and authorized potentially severe penalties for noncompliance.

    Conducting nondiscrimination testing can be expensive; the cost of your time and the money you may have to pay for an inadvertent compliance failure all add up. Our nondiscrimination testing services help you mitigate your compliance risk, streamline your processes, and conserve valuable financial and human resources.

Schedule an appointment today to discuss how we can be of assistance to you.

Neither AFA nor AFAS provide tax or legal advice. AFAS Consultants provide information for plan sponsors about health and welfare benefit plans but do not provide guidance on specific insurance products, we can provide a referral to an insurance agency if you would like assistance implementing or revising an insurance product.

Some products and services may be provided by third-party contractors or affiliated companies.


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