Trump Signs Executive Order on the ACA

On Jan. 20, 2017, President Donald Trump signed an executive order addressing the Affordable Care Act (ACA), as his first act as president. The order states that it is intended to “to minimize the unwarranted economic and regulatory burdens” of the ACA until the law can be repealed and eventually replaced.

The executive order broadly directs the Department of Health and Human Services (HHS) and other federal agencies to waive, delay or grant exemptions from ACA requirements that may impose a financial burden.

An executive order is a broad policy directive that is used to establish how laws will be enforced by the administration. It does not include specific guidance regarding any particular ACA requirement or provision, and does not change any existing regulations.

As a result, the executive order’s specific impact will remain largely unclear until the new administration is fully in place and can begin implementing these changes.

The executive order gives federal agencies broad authority to eliminate or fail to enforce any number of ACA requirements, as permitted by law.President Trump’s executive order begins by emphasizing his administration’s long-stated goal of repealing the ACA. Pending these repeal efforts—which are already underway in Congress—the executive order is intended to:

• Minimize the ACA’s unwarranted economic and regulatory burdens; and
• Prepare to afford states more flexibility and control to create a free and open health care market.

Specifically, the executive order directs HHS and other federal agencies responsible for administering the ACA to “exercise all authority and discretion available to them to:

• Waive, defer, grant exemptions from, or delay implementation of any ACA provision or requirement that would impose a fiscal burden on any state or a cost, fee, tax, penalty or regulatory burden on individuals, families, health care providers, health insurers, patients, recipients of health care services, purchasers of health insurance, or makers of medical devices, products or medications;

• Provide greater flexibility to states and cooperate with them in implementing health care programs; and…

• Encourage the development of a free and open market in interstate commerce for the offering of health care services and health insurance, with the goal of achieving and preserving maximum options for patients and consumers.”
The executive order specifically states that it does not, itself, make changes to any existing regulations. To the extent that the executive order’s directives would require revision of regulations, that will be done by federal agencies through the normal regulatory process.

Impact on ACA Provisions
The executive order is very broad, and does not include any detailed guidance as to how it should be carried out. Instead, it gives federal agencies broad authority to eliminate or fail to enforce any number of ACA requirements, as permitted by law. As a result, until the new heads of federal agencies are in place, it is difficult to know how the ACA will be specifically impacted.

There is some indication that the executive order is partially aimed at eliminating or providing exemptions from the ACA’s individual and employer mandates, since those requirements impose tax penalties that may impose a “fiscal burden” on individuals and employers. In addition, it is clear that the executive order is intended to help accomplish an idea that has been long supported by President Trump, which is to allow health insurers to sell policies across state lines in an effort to increase free market competition.

However, the immediate impact of the executive order will likely be small, since it will take time to implement policies, regulations and other subregulatory guidance to carry out the directives. In addition, health insurance policies for 2017 are already in place, and state law, in many cases, prohibits significant changes from being made midyear.
No ACA provisions or requirements have been eliminated or delayed at this time as a result of President Trump’s actions. Therefore, employers should continue to prepare for upcoming requirements and deadlines to ensure full compliance.


Affordable Care Act Changes Beginning in 2015

shutterstock_34855237The provisions implemented by the Affordable Care Act created changes that began in 2010. The health care reform revised the way many businesses are conducted. Specifically, employers have many more requirements with which they are to comply. Other compliances become active between now and 2018, as well, listed below. ERM Insurance Brokers will be happy to help you understand how these changes will affect your business. 


  • Starting this year, employers with 100+ individuals working for them must provide minimum essential health care for employees and their children, covering at least 60% of the health care costs.


  • The definition of a “small group” business will change from between 1 and 50 employees, to between 1 and 100 employees.
  • Employers with between 51 and 100 employees will be penalized if full-time employees are not offered affordable, minimum essential coverage.
  • Increasing from 2015, employers must offer coverage to 95% of their employees and their employees’ children, consisting of affordable, minimum value coverage.


  • “Cadillac” plans, which cost more than $10,200 for individual coverage or $27,500 for family coverage, will incur a 40% excise tax, payable by the insurer or employer.


Health Care Reform Due to the Affordable Care Act from 2010-2014: What You Need to Know

In light of the Affordable Care Act and Health Care Reform, regulations, plans, and coverage have changed and developed significantly since 2010. Moving forward, many shutterstock_35220673more adjustments to health care for individual and corporations will be seen, making it even more important that you are aware of where you stand currently in health care reform. ERM Insurance brokers are privy to the ACA regulations in the past, and those forthcoming, and are glad to keep you up to date on them. Below is a list of changes to health care in a year-to-year compilation from 2010-2014. 


  • Children age 19 and younger cannot be denied coverage due to preexisting conditions. In addition, teens and young adults can stay on their parent’s health insurance plans until the age of 26.
  • If a health care claim is denied, you may now challenge this final decision in hopes for an adjustment. Limits on a member’s health care coverage because of a dollar-amount is no longer allowed annually or in a lifetime.
  • Generally, preventive care is now covered entirely. Checkups, shots, generic medications, and tests necessary to prevent illness are now covered at no cost to the member.


  • Medical Loss Ratios (MLR) is the percentage of member paid premiums that insurers spend on medical care. Health insurance companies are required to spend 85% of premiums on MLR in the fully insured large group market. Fully insured small group and individual markets require 80% of premiums to be spent on MLR. Self-funded plans, also known as Administrative Services Only, are exempt.
  • Members no longer need prior authorization, or special authorization, for emergency care. Out of network emergency room care will no longer result in a higher copay.


  • A standard Summary of Benefits and Coverage statement has been created, and all insurance companies must use this to best inform people of health care benefits in a simplistic and uniform manner. 


  • Insurers, sponsors of health plans, and self-insured individuals must now pay a Comparative Effectiveness Research fee. This will aid in the research needed to determine effectiveness, risks and benefits of medical treatments through the Patient-Centered Outcomes Research Institute.
  • Limits have been imposed on Flexible Spending Accounts, which are used to cover health insurance expenses per plan throughout one year. The new limit of $2,500 prevents workers from adding more than that to their accounts for estimated annual medical expenses. You may only roll over $500 from these accounts at the end of the year if they are left unused, unless you have a grace period.
  • In compliance with the ACA, businesses are now required to inform their workers of the Health Insurance Marketplace, also know as the Exchange. They must also assist in their employees knowledge of how to gain cost assistance through subsidies and tax credits.
  • Though optional in 2012, businesses must now report the value of their health care plans on W-2 forms if they have more than 250. Employers with less than 50 W-2s can hold off on reporting until 2014.


  • In compliance with the individual mandate, all individuals who can afford it must have basic health coverage. 
  • Employers must offer minimum essential coverage to their employees if they have more than 50 workers. If your business has between 50 and 99 employees, offering minimum value coverage to employees may be postponed until 2016. A penalty calculator has been devised to determine if your business is qualified to offer this, and it also calculates the penalty you could incur if you don’t.
  • Health insurance providers now incur an annual tax called the insurer fee that funds premium subsidies and Medicaid expansion. This does not apply to self-funded plans. The reinsurance fee, also new, applies to both providers and self-funded plans. 
  • All taxes and fees as a result of the Affordable Care Act can be viewed on this chart.
  • For fully insured plans. higher paid workers are not allowed to receive better health coverage. Plans may not be based on eligibility, level of benefits, or a worker’s wage. 

If you have any questions or concerns in regard to this information, feel free to reach out to an ERM Insurance Agent on our site or over the phone at (949 )222-0444. 


Health Care Reform Pay or Play Rules: IRS Proposes Different Measurement Period

health care insurance

Health Care Reform Pay or Play limitations place fines on those who do not “play” by new rules necessitating employer’s provide affordable health insurance.

As of 2015, applicable large business employers are required to offer affordable, minimum value health insurance coverage for their full time employees. Otherwise, a fee will be fined per full-time employee, or per individual who works a 30+ hour work week.
The IRS has created a look-back measurement approach to calculate an employee’s measurement period changes that would result from the following:

  • an employee transferring to a new position within the same applicable large employer in a division that uses a different measurement period. Or,
  • The applicable large employer changes the measurement period that is applicable to a category of employees.

These changes would necessitate the employer accurately measure these employee changes. The two methods of calculation the IRS has provided for businesses are the Monthly Measurement Method and the Look-Back Measurement Method.
Look-back measurement method applies when the standard monthly measurement does not apply. This method uses the average hours of an employee’s work week during a given measurement period to determine if they are full time or part time during the subsequent stability period, or the next period without change.
Two measurement periods result:

  • Standard Measurement Period is used for ongoing employees, generally those who are employed for one full standard measurement period.
  • Initial Measurement Period is used for employees with variable hours, including seasonal and part time employees.

If applicable to your business, you may use these for :

  • All employees regardless of collective bargaining, salaried and hourly employees, and employees whose primary residence is in a different state.


Employers may adopt rules that make an employee eligible for coverage before they otherwise would qualify if an employee is:

  • firstly, employed by an applicable large employer  that uses look back, and
  • secondly, if the second position is for the same applicable large business under an employer that uses a different measurement period.

When employees transfer within an applicable large employer, they retain their stability period. Those whose first position lacks a stability period who are transferring to a second position that uses a stability period can determine their full time status using the hours from the first position.

Those taking on more hours who are elevated from part time, or season, to full time of 30+ hours are eligible for applicable large employer coverage by their fourth month in the new position.

One year in a standard measurement period is required before a look back measurement can used. 

Employees transferring from a non standard measurement period position to a standard measurement period position determine their full time status based on the employee’s average hours of work during the second position standard measurement period.

Employers can initiate measurement period changes if they fall under these qualifications: The “special rule” detailed in Notice 2014-49 clarifies that an applicable large business may change the measurement methods used to determine full time status if they want to:

  • Switch from a look back measurement to a monthly measurement method, or vice versa
  • Change the duration or start date

Each affected employee’s full time status is determined with this special rule. 

Corporate transactions such as mergers and acquisitions, necessitate their own clarifications. Corporations that acquire entities using different measurement methods to determine employee full time status may become employed by the same applicable large business.

These stipulations are reliable methods by which to determined full time status until at least the end of 2016.

employment law and minimum wage increases

Employers are facing many changes due to the Affordable Care Act, and ERM Insurance is dedicated to keeping you informed about the regulations imposed on your business. 

If you have any questions or concerns about Orange County group health insurance and the Affordable Care Act, contact ERM Insurance. You can reach us at (949) 222-0444. 


Individual Health Insurance Reimbursement by Employers Prohibited

affordable care act 2015

Employers facing the rising costs to provide health coverage have shown interest in helping employees pay for individual health care, instead of offering an employer sponsored plan.  These arrangements do not comply with the Affordable Care Acts reforms and can incur penalties. 

To clarify, after-tax reimbursements and cash compensations from the employer to cover the individual premiums of employees are prohibited under the Affordable Care Act, and can trigger excise penalties. This applies whether employers reimburse pre-tax or post-tax amounts to employees.

Health insurance reimbursement arrangements, certain health flexible spending arrangements, and any other employer payment plan involving the employee fall under group health plans and are subject to the Affordable Care Acts market reforms, such as the annual limit prohibition and the preventative care coverage requirement. Affordable Care Act market reforms cannot be integrated with individual policies while satisfying the above requirements, rendering these plans prohibited. 


The penalty the IRS has laid out for violating these parameters is $100 a day, per applicable employee.

If an employer offers the choice between enrollment in the standard group health care plan or cash only to employees with high claims risk, they are practicing unlawful discrimination and are in violation of federal nondiscriminatory laws. It is not considered benign discrimination. This also applies to employers offering the choice between taxable cash and tax-favored qualified benefits only to high-risk employees.

In this case, employers violate the nondiscriminatory provisions, regardless of whether:

  • The employee treats the case as pre-tax or post-tax
  • The employer is involved in purchasing or selecting any individual market product
  • The employer obtains any individual health insurance

Be wary that certain vendors are marketing that instead of providing a group health insurance plan, employers can establish a reimbursement plan with health insurance brokers, which would help employees select individual insurance policies allowing them to access subsidies for Exchange coverage. This is problematic because:

  • These arrangements would act as a group health plan, exempting them from being eligible for Exchange subsidies.
  • If employers are not involved with individual employee selecting or purchase process, it doesn’t prevent the arrangement from being a group health plan.

The noted employer health care arrangements cannot be integrated with individual market policies to satisfy the market reforms. Because they do not conform to Affordable Care Act regulations, they are liable to trigger penalties and excise taxes. 

To discuss options for providing health insurance to your employees under ACA regulations contact ERM Insurance at (949) 222-0444. We service Orange County and Los Angeles and strive to keep your business current on the latest healthcare reform regulations, so get in touch with one of our expert brokers today! 

Regulations on Exception Benefits for Group Health Care Plans Adjusted in Light of Affordable Care Act

supreme court rules on the affordable care act

The final regulations established to define “exception benefits” for group health care plans have been adjusted in light of new Affordable Care Act (ACA) standards, set to be implemented January 1, 2015. The Health Insurance Portability and Accountability Act’s  (HIPPA) regulations do not apply to exception benefits. Exception benefits cannot be part of an integral group health plan. They may not be obtained under the same group health plan, policy, certificate, or contract as the integral benefits.

The following has been finalized on excepted benefits:

  • Self-Insured plans can cover dental and vision benefits without additional premium cost.
  • Employee Assistance Programs (EAP) for physical and mental health care and wellness are now qualified as excepted benefits under certain circumstances.
  • EAPs with very limited coverage may make the employee ineligible to receive a premium tax credit if they enrolled in QHP coverage through an Exchange.
  • “Wraparound” coverage qualifies as excepted benefits if an employee would potentially receive these benefits were they able to afford the group health plan premium. Since they cannot afford the group plan premium, they cannot enroll in the employer-sponsed plan to reap the benefits.This allows employers to provide employees with overall coverage that is comparable to the group health care plan coverage.


The Health Insurance Portability and Accountability Act provides the following definitions to further clarify what are excepted benefits for group health care plans:

  • Benefits that are not health coverage are not excepted benefits. Therefore,  excepted benefits do not include automobile insurance, liability insurance, workers’ compensation, accidental death and disbursement coverage.
  • Limited Excepted Benefits include limited scope vision or dental benefits, long term care benefits, nursing home care, home health care, or community based care benefits.
  • Under certain circumstances, a Health Flexible Spending Arrangement may qualify as limited excepted benefits.
  • Non-coordinated Excepted Benefits cover a specific illness or disease and hospital indemnity or another type of fixed indemnity insurance.
  • Supplemental Excepted Benefits must be supplemental to Medicare or CHAMPVA/TRICARE and must be provided under  a separate policy, certificate, or contract of insurance.


2013 proposed regulations on limited exception benefits simplified the requirements to qualify if the excepted benefits are provided under a separate policy, certificate, or contract of insurance and are not an integral part of a group health plan:

  • Limited-scope vision or dental benefits now qualify as excepted benefits.
  • Employee Assisted Health Care, individual health care plans, and wrap around coverage are now recognized as limited excepted benefits in certain circumstances.

The final regulations on exception benefits eliminate the requirement that participants pay a premium or contribution. Because of this, an individual is now eligible to receive a premium tax credit if they enrolled in QHP coverage through an Exchange in most circumstances.

Benefits fall under the category of “not integral to the health plan” if participants have the right to elect not to receive coverage, and if they pay an additional premium or contribution for them. 

  • Participants must be able to decline coverage.
  • Benefit claims must be administered under a separate contract from other benefits under the plan

The Departments of Labor, Health and Human Services, and Treasury want to prevent employers from shifting primary coverage to a separate “EAP plan” because it may exempt existing consumer protection provisions

To further clarify, an EAP constitutes as excepted benefits if:

  • The EAP does not provide significant health care benefits.
  • The EAP’s benefits are not coordinated with benefits under another group health plan and cannot be financed by another group health plan.
  • No employee premiums are required for participation and cost sharing requirements may not be imposed.


If you have any questions regarding “excepted benefits” or how health care reform affects your company, contact ERM Insurance Brokers at (949) 222-0444. 


Comply to the Health Care Reform Affordable Care Act; Avoid Violations, Penalties, and Excise Taxes


New obligations are arising from the Affordable Care Act (ACA), and your business needs to be aware of the penalties and excise taxes in order to avoid them. The ACA was established to encourage employers to provide affordable health coverage to their employees and employees’ families, without cost sharing or exclusions due to preexisting conditions.

Applicable large employers are required to pay or play; in other words, they either pay penalty fees or play by the ACA rules to provide affordable, minimum coverage to employees. Failure to comply may lead to a $100 fine per individual to whom the failure relates.


This $100 per person fee occurs due to violating one or more of the following:

  • Health plans offering dependent coverage must cover adult children up to 26
  • No health plan may impose a lifetime or annual limit on the dollar value of essential health benefits
  • Coverage recessions, or decline, may only occur in the case of intentional fraud
  • Pre-existing conditions do not allow for exclusion
  • Preventative health coverage must be offered with no cost sharing, or fee to the employee
  • Patient coverage extends to the designation of a primary care physician, a pediatrician, an obstetrician, a gynecologist, and improved emergency services


  • Internal claims and appeals process must be improved
  • Documentation providing a summary of benefits and coverage is required
  • No waiting periods may exceed 90 days
  • Nondiscrimination for fully insured health plans
  • The limits of cost sharing may not exceed $6,600 on self and $13,200 for a dependent in one year
  • Approved clinical trials must be covered


  • Nondiscrimination based on health status
  • Nondiscrimination against health care providers
  • Comprehensive health insurance must include essential health benefit coverage
  • Businesses with health plans sponsored by a single employer must pay an excise tax.

This does not apply to health plans sponsored by government employees or health insurance issuers, but it does apply to churches providing health plans. The employer must file form 8928 and pay the tax by the employer’s federal income tax return. Again, the penalty for noncompliance with the ACA’s requirements will result in a $100 fine per individual, per violation.

  • If the IRS discovers this in an audit, the minimum excise tax is $2,500
  • If the violations are significant, this charge is increased to $15,000


For single employers, the minimum excise tax for an unintentional violation is less than 10% of what the employer paid in excise tax the previous year for group plan coverage, or $500,000. If the violation is corrected with reasonable diligence within the following 30 days, the tax is forgiven.

Smaller employers with 50 or fewer employees are forgiven if the violation was solely because of health insurance coverage offered by the insurer. Failure to provide a summary of benefits and coverage incurs a penalty of $1,000 a day, and can also trigger the excise tax of $100 per day, per individual.


Health plans and insurers must provide 60 days notice for any material modifications to plan terms. A failure to do so may trigger a $1,000 penalty and the $100 per day, per individual excise tax.

Coverage must be offered to “substantially all” employees, which is equal to 70% of an employer’s full time employees and dependents.

You can reach ERM Insurance at (949) 222-0444 with any questions or concerns you may have about Health Care Reform Compliance fees, or other questions pertaining to insuring your small business, and a broker would be happy to advise you.

Online Enrollment in Federal SHOP Exchanges Available in 2015 


November 15th 2014 marked the beginning of the online enrollment period for the Federal Small Business Health Options Program Exchange, or the SHOP Exchange. Previously required to utilize “direct embroilment,” now, employers are encouraged to complete an application online, choose appropriate health insurance coverage for their employees, and enroll themselves in a SHOP Exchange program. An ERM Insurance broker would be glad to help you with this process. Some states, including California, Oregon, New York, and Kentucky, to name a few, operate state run SHOP Exchanges.

Businesses are eligible to participate in these exchanges on a yearly basis depending on their size. Employers with 50 or less employees are currently eligible. As of 2016, this increases to include businesses with 100 or less employes, and businesses with more than 100 employees are eligible in 2017. 

Small businesses may enroll throughout the year on a monthly basis to phase in the SHOP Exchange process. The enrollment process is conveniently online now at


Because the online enrollment in federally facilitated SHOP Exchange programs was delayed from 2013 to 2014 due to a transition policy, small employers previously negotiated with an insurance broker during their direct enrollment.

shutterstock_129468845The Small Business Tax Credit is now in place, and covers up to 50% of an employer’s premium contributions, if eligible. SHOP Tax Credit Estimator determine if you are eligible.  This tax credit is only available through the SHOP Exchange after two consecutive taxable years within the program.

Employers can choose from the “employee choice model” to select which level of coverage they would like to provide for their employees, and their contribute amount. Bronze, silver, gold or platinum are available.

Here is a list of all the states and their participation in state SHOP Exchange programs. 

The SHOP is designated to assist employees who are enrolled in multiple Qualified Health Care Plans, and premium aggregation will become implemented before January 1, 2015. Premium aggregation is the process of adding all the premiums owed by an employer in one month to all Qualified Health Care Plans in which their employees are enrolled. This removes the hassle of paying multiple bills to various different Qualified Health Care Providers each month.

shutterstock_100831564Our knowledgeable brokers at ERM Insurance are here to assist you in making the right choices in employee health care insurance, so feel free to contact us at (949) 222-0444 with an questions or concerns.

ERM Insurance Brokers provides health insurance in Orange County. Our health insurance agents are located in Irvine, California and we serve businesses and individuals in Orange County, Los Angeles and the surrounding area.

Obamacare 2015: What You Need to Know Before January

The Obamacare 2015 employer mandate becomes effective on January 15, and your business should be taking the necessary measures to offer the appropriate options to your employees. Keep yourself updated on the recent changes to health care requirements to better manage your business.


  • To refresh your memory, a full time employee works an average of 30+ hours per week. Two part-time employees whose hours add up to 30+ a week equal one full time equivalent employee. 
  • Businesses with 100+ full time equivalent employees must provide health benefits to at least 70% of their employees. In 2016, this percentage is increased to include 95% of your employees.
  • Otherwise, your business must pay $2,000 annually per employee as a penalty, exempting the first 30 employees. 
  • The IRS website, , has more extensive details.
  • Subsidies, or financial support from the government, are granted to businesses with the following qualifications: containing 25 or fewer full time equivalent employees, paying below $50,000 in average annual wages, and are covering at least half of the premium cost for employee health insurance. 
  • To lower the number of employees you are required to cover, encourage lower wage workers who are eligible to apply for Medicaid. See if your state is approved for Medicaid expansion.
  • As a small business, you can shop for insurance plans either directly through an insurance broker, or through a state or federal SHOP exchange found now online at
  • SHOP stands for Small business Health Option Program, and is both a state and federally run exchange allowing small businesses and individuals to shop for government health insurance. 
  • Be wary that buying insurance for your employees through SHOP may limit you to choosing one plan for all your employees. There are only 14 states that allow you to choose specific plans for each particular employee, and networks of doctors and hospitals may be limited. 


Feel free to reach out to ERM Insurance at (949) 222-0444 if you have any questions or concerns about the new healthcare laws. Experts are here to help you!

Serving Orange County and Los Angeles

New ACA Compliance and Reporting Requirements for 2015

The fourth quarter is a good time to make sure your business is compliant with the ACA (Affordable Care Act) requirements that take effect in 2015.

6 Things to Know for 2015

The delayed employer penalty kicks in next year for applicable employers, increasing the cost of non-compliance. Consult the checklist linked to below or contact us for details to see if the penalty applies to your business. If your business employs between 50 and 100 you may qualify for a 1 year delay, but it is not automatic and filings are still required.

Plans seeking transitional relief need to be created and in effect no later than December 31st, 2014.

Stay tuned for new rules and limits for Flexible Health Savings Accounts, expected later this year. Until the IRS releases new guidelines the $2500 limit currently in use remains in effect.

Transitional reinsurance fees will need to be paid for each enrollee, the rate for 2015 is $44 per year. HIPPA Certification of self-insured health plans will be required by the end of 2015. Insured plans may need to certify as well.

New coverage reporting requirements may require filings in just a few months, as early as February 28th. For additional information, please see our 2015 Compliance Checklist.

For help selecting an insurance provider that will meet your business’s needs, call ERM Insurance Brokers! We specialize in risk management and can help you lower your costs while increasing productivity and safety!
Call today! (949) 222-0444

California Health Insurance Rates in 2015

As 2015 rolls nearer, many Californians are going to see a small increase in their health insurance premiums for next year. Averaging at about a 4.2% overall increase, some plans are going up while some are even going down – as much as 8.5% lower.

The reason for these fairly low increases is because Covered California actively negotiated with insurance companies to keep rates down while delivering wider networks of doctorsHealthcare Rates 2015 and hospitals. What’s more, individuals are not locked into their current plans for 2015, which means that consumers have a choice from many options.

Ten health insurance companies have been selected to participate in the California health exchange next year. While they are the same companies from 2014, each company had to submit bids in order to return for 2015. The list represents a mix of commercial, nonprofit, Med-Cal and regional plans:

  • Anthem Blue Cross of California
  • Blue Shield of California
  • Chinese Community Health Plan
  • Health Net
  • Kaiser Permanente
  • LA Care Health Plan
  • Molina Healthcare
  • Sharp Health Plan
  • Valley Health Plan
  • Western Health Advantage


* It’s important to note that initial rates that have been submitted by the above companies are subject to change based on a reasonability review by state regulators. Also, 9 out of 10 current enrollees in health plans through Covered California are receiving subsidies that reduce their overall costs and those subsidy rates will stay virtually the same or increase for 2015.

Also, the Affordable Care Act (ACA) has mandated that no one can be denied coverage due to a pre-existing condition and that will continue indefinitely.

To further understand how rates will affect you or your small business for 2015, ERM Insurance Brokers has experts standing by!
Call (949) 222-0444 with any questions you may have. We look forward to speaking with you!

ACA News: Conflicting Rulings on Federal Exchange Subsidies

When the Affordable Care Act (ACA) went into effect, a series of changes rolled out across the nation. Beginning in 2014, a mandate requires each state to provide an Exchange for individuals and small business to purchase private health insurance.

However, because Congress cannot require states to implement federal laws, the ACA Healthcare-Reformcreated the option for the Department of Health and Human Services (HHS) to create Federally Facilitated Exchanges (FFEs) for those states without their own Exchanges.

The government also provides subsidies to help individuals and small businesses purchase insurance through the Exchange. These subsidies are designed to lower out-of-pocket expenses in the form of either premium tax credits and cost-sharing.

Several different lawsuits have been filed by both employers and individuals to challenge the federal government’s ability to offer subsidies in states without their own Exchanges. On July 22, 2014, two federal appeals courts issued opposing rulings regarding FFE subsidy availability:

  • In Halbig v. Burwell, the D.C. Circuit Court ruled that the IRS cannot authorize subsidies in states with FFEs, claiming that the ACA restricts subsidies to states with their own state-run Exchanges.
  • In King v. Burwell, the 4th Circuit Court upheld the availability of subsidies both in states with and without their own Exchanges.


In response to these conflicting rulings, the current administration has decided that subsidies will continue to be offered in all states – even those with FFEs.

So, what does all this mean for you? To learn more about the details of this issue and how it may affect you in the future, take a look at the article below.

Federal Courts Issue Conflicting Rulings on Subsidies in Federal Exchanges

For more information on the Affordable Care Act, call a team member at ERM Insurance Brokers in Irvine, CA! (949) 222 – 0444

Healthcare Reform: Preventive Care For Adults

The Affordable Care Act (ACA) has overhauled America’s health care system. By now, you’ve probably experienced many of these changes first-hand. What you may not know is that this new legislation is bringing significant changes to your preventive care.

Let’s take a closer look at how the requirements for preventive services are changing under ACA and what that means for you.

Group Health Insurance Benefits

Under ACA, new health plans are required to offer coverage and and eliminate cost-health-coveragesharing requirements for preventive services. Starting on Sept 23, 2010, if you or any of your family members have enrolled in a new health plan, the plan MUST cover recommended preventive services without charging you a deductible, copay, or coinsurance.

(There is an exception: If your company sponsored a plan before March 23, 2010, then the plan is considered “grandfathered” and is exempt from certain health care reforms, including this one)

What Does This Mean For Me?

Depending on your age and health plan, this legislation means easier access to the following services:

General Health Services

  • Routine vaccines for diseases like measles, meningitis, and polio
  • Flu and pneumonia shots
  • Counseling for health issues like quitting smoking, eating healthy, losing weight, and treating depression


Pregnancy Services

  • Screening for conditions like hepatitis B, iron deficiency, bacterial infections, and immune conditions like Rh incompatibility
  • Pregnancy-tailored counseling to help mothers quit smoking or avoid alcohol use
  • Counseling to support breast-feeding


Heart Disease and Obesity Services

  • Blood pressure screening and tests for diabetes and high cholesterol
  • Obesity screening and counseling for dietary health and sustained weight loss
  • Counseling on daily aspirin use to reduce the risk of stroke


Cancer Services

  • Annual mammograms for women over 40
  • Referrals for genetic counseling and chemoprevention for women at an increased risk
  • Colon cancer screening tests for adults over 50
  • Regular Pap smear screenings for cervical cancer and HPV vaccine coverage
  • Counseling to help individuals quit tobacco products


For a full list of services, visit

ERM Insurance Brokers in Irvine, CA can help you find the best health insurance plan to suit your needs!

Call today speak with an expert! (949) 222-0444.


Health Premiums Likely to Rise in 2015

Big changes are coming to your health insurance premiums this fall. If you purchased a plan under The Affordable Care Act (ACA), your premiums are likely going to rise significantly unless you switch plans.

About 10 states have filed their proposed insurance rates for 2015 and the numbers might scare you: In 9 out of 10 states, the largest health insurer wants to increase premiums between 8.5% (Anthem Inc – Virginia) and 22.8% (Carefirst BlueChoice – Maryland). (Wall Street Journal)

This pull away from initial affordable pricing for the bigger carriers goes along with increasingly expensive medical costs and higher competition resulting from the implementation of ACA. Additionally, some big insurers that sat out 2014 will enter new markets in 2015. For example, United HealthCare is planning to enter the markets in Washington, Michigan, Rhode Island, and Connecticut next year.

Why are all the big carriers raising their premiums? Well, the answer is relatively simple. In Healthcare-Reformthe first year of enrollment under ACA, the insurers with the largest enrollment happened to offer the lowest prices for coverage in the first year of the health exchanges. Now, with so many enrolled in these programs, these carriers feel that they have an opportunity to raise their rates – roughly 10%, on average.

One example of this is Moda Health Plan Inc in Oregon state. During the first year of ACA enrollment, Moda managed to grab roughly 75% of the plans sold in the state. Now, Moda proposing a 12.5% rate increase for 2015.

But there is some good news! Many insurers are looking to grab those customers that big insurers like Moda will likely lose when they raise their rates next year. This means that many smaller carriers will start slashing rates to draw in more enrollees. For instance, Moda’s $221 Silver plan is proposing an increase to $249, while a new carrier, Oregon’s Health CO-OP, is planning to offer a $228 Silver plan. With mid-range, Silver plans (which cover 70% of medical costs) being the most popular choice for consumers, this will offer enrollees a new opportunity to keep lower rates through the exchanges in 2015.

There are many explanations for why insurers want to raise their rates. From rising prescription drug costs to inflation, carriers say that premium increases are justifiable. Opponents of ACA claim that the law itself is responsible for driving up costs, while supporters of the law have shown evidence that rates were already rising for those who purchase policies without the help of an employer before ACA passed.

Nonetheless, there is one big deciding factor for how health insurance enrollments will take shape next year. Depending on how the Obama administration structures the re-enrollment process for those who purchased coverage in 2014, they may make it easier for current customers to skip many of the steps they had to take for their initial enrollment which may mean that more customers will keep their current plans.

What is your game plan? To find out what your money-saving options are for 2015, call your local expert at ERM Insurance Brokers! (949) 222 – 0444

Affordable Care Act: Supreme Court Rejects Contraceptive Insurance Mandate for Some Companies

On June 30, 2014, the U.S. Supreme Court issued a ruling in two cases that challenged the Affordable Care Act’s (ACA) contraceptive coverage mandate. The owners of Hobby Lobby and Mardel and Conestoga Wood Specialties did not want to be required to provide contraceptive coverage because it violated their personal religious beliefs. supreme court rules on the affordable care act

The ACA requires health insurance plans to cover women’s preventive health services without a copayment. This includes FDA-approved contraceptive methods, four of which the store owners objected to because of their religious beliefs.

The Supreme Court decided that the Religious Freedom Restoration Act applies to closely held corporations and there are less restrictive ways for the federal government to ensure that all women have cost-free access to FDA- approved contraceptives.

To read the full article, click here.

ERM Insurance Brokers can help Orange County businesses understand and comply with the Affordable Care Act.

Call (949) 222-0444 to speak to an expert.



COBRA and Healthcare Reform: FAQ

The Affordable Care Act (ACA) has brought numerous reforms to America’s health insurance industry. One of the primary concerns for individuals is how the new laws will affect their COBRA continuation coverage. To help Americans understand these changes, The Department of Labor (DOL) put out a Frequently Asked Questions list.


Did the ACA legislation eliminate COBRA?
No, the ACA did not eliminate COBRA or change the COBRA rules. For more information about COBRA, take a look at “An Employee’s Guide to Health Benefits under COBRA”.

Do the ACA reforms extend the COBRA premium reduction subsidy?
No, the ACA did not extend the eligibility time period for the COBRA premium reduction. The eligibility for this subsidy ended May 31, 2010.

Did the health care reform extend the COBRA time period beyond 18 months?
No, the maximum COBRA period was not extended. However, a plan may provide a longer coverage period beyond what’s required by COBRA. Typically, COBRA beneficiaries are eligible for group coverage for a maximum of 18 months for qualifying events, such as termination of employment or work hour reductions.

If during the initial period of coverage a second qualifying event occurs, a beneficiary may be permitted to receive a maximum of 36 months of COBRA coverage.

For individuals who become disabled, an extension of the 18 month period may be permitted under the qualifying events of a termination of employment or a work hour reduction. To qualify for this COBRA extension, the beneficiary must meet the following requirements:

  • The Social Security Administration must rule that the individual became disabled during the first 60 days of COBRA coverage; and
  • A copy of the Social Security ruling letter is sent within 60 days of receipt, but prior to the expiration of the 18-month coverage period. If the requirements are met, the entire family will qualify for 11 months of additional COBRA coverage.


How will my coverage be affected under my group health plan?
Many changes to employee health benefit plans have already taken place under the ACA. Beginning in 2014, many key changes will go into effect. One of the most important changes is the prohibition of exclusions for individuals with pre-existing conditions.

Does the ACA provide other coverage options for individuals eligible for COBRA?
Yes! The health insurance Exchange, also known as the Marketplace, was created under the ACA to offer other options that might be more affordable than COBRA coverage. Those eligible may be able to purchase more affordable plans for themselves and their families by using the Exchange website. Additionally, other options like Medicaid or a spouse’s group health plan may be available for your consideration during a “special enrollment period.”

For those who lose their job-based coverage, it is vital that you choose between your COBRA continuation coverage and other coverage options carefully. It may be impossible to switch to a different option once you’ve made your choice.

If I sign up for COBRA, can I switch to an Exchange plan? What about if I choose an Exchange plan and want to switch to COBRA? 
If you sign up for COBRA, you can switch to an Exchange plan during the Exchange open enrollment period. The next open enrollment period is from November 15, 2014 to February 15, 2015.

You can also end your COBRA continuation coverage early and switch to an Exchange plan if you have another qualifying event (such as the birth of a child or getting married) through a “special enrollment period.”  But be careful not to terminate your COBRA coverage early if you DON’T have another qualifying event because then you’ll have to wait until the next open enrollment period to enroll in Exchange coverage and may end up without coverage in the interim.

Once your COBRA continuation coverage expires, you’ll be eligible to enroll in Exchange coverage through a special enrollment period, even if the Exchange open enrollment period has ended.

What special transition rules, if any, would allow me to switch from COBRA to an Exchange plan outside of an open enrollment or special enrollment period?
Because many individuals eligible for COBRA and those enrolled in COBRA may not have understood or been aware of their Exchange enrollment options, the Department of Health and Human Services (HHS) has created a special enrollment period for exceptional circumstances. Under this special enrollment period, persons eligible for COBRA and COBRA enrollees may enroll in plans through the Exchange for a limited time. These individuals have through July 1, 2014, to select a plan through the Exchange.

Eligible individuals should contact the Exchange call center (1-800-318-2596) to activate this special enrollment period. They should inform the call center that they are calling about their COBRA benefits and the Exchange. If they are deemed eligible for the special enrollment period, individuals may view all plans available to them and complete the enrollment process over the phone or on the website by creating an account on or logging into their existing account.

The experts at ERM Insurance Brokers in Irvine, California can help you decide what type of continuation coverage is best for you.

Call (949) 222-0444 to speak with a member of our team.


The Affordable Care Act: How ERM is Looking Out for Orange County Businesses

If this year has taught us anything so far, it’s that 2014 has been the year of The Affordable Care Act (ACA). There have been countless changes to the way our country manages healthcare, from the Individual Mandate and Employer Mandate to changes to Small Employer Health Care Tax Credits.

As individuals and small businesses scramble to adapt to the ever-changing landscape ofhealthcare reform affordable care act compliance 2013 health care reform, it is becoming increasingly important to have insurance agents that are looking out for you and your business!

Throughout Orange County, businesses of all types have turned to ERM Insurance Brokers to help them through this crucial health insurance transition. By keeping up to date with every new law and breaking down the complicated jargon, the agents at ERM are here to help you navigate these new waters while looking out for your company.

The experts at ERM Insurance Brokers in Irvine, California have been looking after local businesses and their employee benefits for over 35 years. Our friendly and straight-forward agents will work with you, taking the time to learn every nuance of your business and finding the best solution for you. With their incomparable expertise and connections, ERM works hard to secure low rates for your business, creating customized group health insurance that maximizes benefits while protecting your bottom line.

So, what are you waiting for?! Call ERM Insurance Brokers today to speak with one of our experts. We’re standing by. (949) 222 – 0444

Health Care Reform for Employees: Q&A

Everyone is talking about the new health care reform laws. When do they go into effect?

The Affordable Care Act (ACA) was signed into law in March 2010. The ACA changes will roll out over a period of years. Some laws, such as prohibiting exclusions for pre-existing conditions regardless of age, have already gone into effect. Many other reforms are on the way.

Can I keep the health coverage I have?

Although this has become somewhat of a hot-button issue, the short answer is yes. However, because of the ACA reforms going into effect, the coverage you currently have under your health plan may face some changes. If your employer’s health plan existed prior to March 23, 2010 and has not been changed, there is a possibility that the plan may have grandfathered status.

On November 14, 2013, a transition relief policy for 2014 will go into effect for non-grandfathered coverage for individual and small group heath insurance. If your state participates, this policy will enable health insurance issuers the option to renew policies that are currently carried without having to adopt all of the reforms required by the ACA.

On March 5, 2014, the Department of Health and Human Services (HHS) extended this transition relief for two years to policies that begin on or before Oct 1, 2016. This means that individuals and small businesses may have the ability to keep their ACA non-compliant coverage into 2017.

Are individuals required to have health coverage?

Starting in 2014, most individuals will be required to have acceptable health coverage for themselves and their dependents. If they do not have coverage, they face a penalty. This is called the “individual mandate”.

There are some exemptions, which you can read about here.

How long can my grown child keep coverage under my health plan?

Your child can stay covered until they turn 26 years old. This applies to all individual and non-grandfathered employer plans, and as of 2014, all grandfathered plans.

What about my pre-existing condition?

Beginning on January 1, 2014, health plans cannot exclude pre-existing conditions for any enrollees. This applies to all non-grandfathered and grandfathered plans.

Are my health benefits subject to lifetime limits or annual limits?

The ACA prohibits lifetime limits for most benefits. Lifetime limits refer to the total dollar amount the plan would spend on your covered benefits during your entire time on the plan.

The law also restricts the annual limits that a health plan can impose on most covered benefits. In prior years, the annual limit was $2 million. As of January 1, 2014, no annual limits are permitted.

Will I lose my coverage if I get sick?

Unless an individual has intentionally misrepresented themselves or committed fraud, a health plan or insurance company is prohibited from dropping your coverage. This applies to all grandfathered and non-grandfathered plans.

Do I really get free preventive care?

All non-grandfathered individual plans must provide free coverage for recommended preventative health services, such as vaccinations, screenings, and counseling. If the requirement applies to your plan you wont have to pay deductibles or co-payments to receive these services.

Some examples of preventative services include:

  • Cancer screenings
  • Well-baby and well-child visits up to age 21
  • Routine vaccinations
  • Diabetes, blood pressure, and cholesterol tests

There are exclusions. If you have a grandfathered plan, this many not apply. Additionally, if your health plan is through a network of providers, you may only be able to use these benefits through your network providers.

Did the Affordable Care Act get rid of COBRA?

No. COBRA coverage is still available and the rules have not changed.

I keep hearing about the Health Care Exchange or Marketplace. What is that?

The exchange is essentially an online marketplace where individuals and small businesses can go to research and buy health insurance coverage. There you can compare plans and get answers to questions regarding health insurance. You can also find out if you are eligible for tax credits or other cost-reducing benefits. Although enrollment for 2014 is now closed, you may still be eligible.

You can learn more at

ERM Insurance Brokers in Irvine, CA proudly offers customized health insurance packages for you or your business.

Call (949) 222-0444 to learn more!

HSA Limits to Increase for 2015

There’s some important news regarding Health Savings Account (HSA) contribution limits! On April 23, 2014, the IRS increased the limits for HSAs for the calendar year 2015. These increases include:

  • Annual contribution limits for single & family coverage
  • Minimum annual deductibles for High Deductible Health Plan coverage (HDHP)
  • Maximum limits for out-of-pocket expenses for HDHP coverage


New HSA Contribution Limits

For the calendar year 2015, the HSA contribution limits are as follows:

  • $3,350 (up from $3,300) for individuals with self-only coverage under an HDHP
  • $6,650 (up from $6,550) for individuals with family coverage un an HDHP


New HDHP Minimum Deductibles

For the calendar year 2015, the HDHP minimum annual deductibles are as follows:

  • $1,300 (up from $1,250) for self-only coverage under an HDHP
  • $2,600 (up from $2,500) for family coverage under an HDHP


New HDHP Out-of-Pocket Expense Limits

For the calendar year 2015, the HDHP expense limits are as follows:

  • $6,450 (up from $6,350) maximum out-of-pocket expenses for self-only coverage (including copays, deductibles, and other amounts, but not premiums)
  • $12,900 (up from $12,700) maximum out-of-pocket expenses for family coverage


** For a copy of IRS Revenue Procedure 2014-30, see

For any other questions regarding health insurance for 2015, ERM Insurance Brokers in Irvine, California is standing by!

Call (949) 222-0444 to speak with an expert.


Exchange Health Insurance Subsidies: How Do They Work?

By now you’ve probably noticed that the Affordable Care Act (ACA) is in full swing. What you may not realize is that as part of this legislation, the ACA has created health insurance subsidies, beginning in 2014, in order to reduce out-of-pocket premium costs for taxpayers.

These subsidies, in the form of tax credits and cost-sharing reductions, are available as part of the Affordable Health Insurance Exchanges – state-based marketplaces where individuals and small businesses can go to compare prices and services and purchase private health insurance.

If you beat the deadline and enrolled in health coverage through the Exchange for 2014, you have already begun to see how these subsidies can work for you. Let’s take a closer look at how these exchange health insurance subsidies will work if you plan to enroll in health coverage for 2015.


The federal subsidies available through the exchange come in two forms: premium tax credits and cost-sharing reductions. These subsidies vary in amount based on household income.

  • Premium Tax Credits. If your income is up to 400% of the federal poverty level (FPL), this subsidy reduces your out-of-pocket premium costs in the form of tax credits.
  • Reduced Cost-Sharing. If your income is up to 250% of the federal poverty level (FPL), this subsidy makes it possible to enroll in plans that pay a greater share of covered benefits by reducing the costs for out-of-pocket services like deductibles and copayments.


How Is It Calculated?

Because your eligibility for these subsidies is determined by your federal income tax return for that year, the Exchanges will typically ask you to project your income for that year. This means that if you’re enrolling in an exchange plan for next year, you will have determine what you expect to earn in 2015. If you are unable to do this, the exchange will look at your federal income tax return for the previous year, or 2014.

At the end of the year, your subsidy amount will be recalculated based on the income reported on your tax return for 2015 and you will pay the difference. If you earned more than you expected, you may have to repay a portion of your subsidy as an adjustment to your owed or refunded taxes.

Amount of Premium Tax Credits

For those with household incomes of up to 400% of FPL that are eligible for premium tax credits, the contributions are determined as follows:

Income Level Expected Contribution
Up to 133% FPL 2% of income
133 – 150% FPL 3 – 4% of income
150 – 200% FPL 4 – 6.3% of income
200 – 250% FPL 6.3 – 8.05% of income
250 – 300% FPL 8.05 – 9.5% of income
300 – 400% FPL 9.5% of income

If your state participates in extending Medicaid coverage to individuals with incomes below 138% of FPL, the contribution is determined as follows:

Income Level Type Of Coverage Expected Contribution
Up to 138% FPL Medicaid No premiums
139 – 150% FPL Exchange 3 – 4% of income
150 – 200% FPL Exchange 4 – 6.3% of income
200 – 250% FPL Exchange 6.3 – 8.05% of income
250 – 300% FPL Exchange 8.05 – 9.5% of income
300 – 400% FPL Exchange 9.5% of income


Amount of Cost-Sharing Reductions

For individuals with household incomes up to 250% of FPL that are eligible for reduced cost-sharing, the reductions are determined as follows for 2015:

Income Level Reduced Maximum Annual Limitation on Cost-Sharing for Self-Only Coverage for 2015 Reduced Maximum Annual Limitation on Cost-Sharing for Family Coverage for 2015
100 – 150% FPL $2,250 $4,500
150 – 200% FPL $2,250 $4,500
200 – 250% FPL $5,200 $10,400

This is just the tip of the iceberg. For further information regarding health insurance subsidies, call ERM Insurance Brokers in Irvine, California! (949) 222-0444.

Health Coverage Deadline 2014: What You Need To Know

The Affordable Care Act, also known as “Obamacare”, was signed into law in 2010. The final phase of this legislation includes a mandate that all U.S. citizens must have health insurance by March 31, 2014 or they will face a fine on their federal taxes for 2014. But there are some important things you should know – let’s take a closer look.

New “Extra Time” Rule

  • If an individual started their application on or before March 31 but didn’t finish before the deadline, they will have extra time to complete the process. For more information, visit

Deadline Details

  • health-coverageCertain individuals may be exempt from the mandate. Here is a list of exemptions.
  • Certain individuals can still enroll in coverage if they meet certain criteria such as a marriage, divorce, etc. Here is a list of criteria.
  • Even though March 31 is the deadline for coverage, changes can still be made to your plan after this date.
  • The penalty for individuals without health coverage this year is $95 or 1% of your annual income, whichever is higher. There is also a $47.50 per child penalty for those have not acquired coverage for their dependents. These penalties will increase each year.
  • In order to sign up for coverage, an individual will need to have certain information including: the number of people in the household, proof of incomes, proof of citizenship or birth certificate, social security number, and birth date.
  • In many states, individuals can sign up on a state-run health exchange. Those states which do not operate an exchange may use the federal exchange. Check with your state for more information or
  • It is expected that 83% of individuals signing up for coverage in the exchange or marketplace will be eligible for subsidies that lower their cost.
  • The next open enrollment period begins November 15, 2014 and ends on January 15, 2015.

ERM Insurance Brokers in Irvine, California can answer any questions you may have regarding your health insurance for 2014!

Call (949) 222-0444 to speak with an expert.

Small Employer Health Care Tax Credit: Changes for 2014

In 2010, The Affordable Care Act (ACA) created a tax credit for small employers that offer health coverage for their employees. Although this credit will continue in the coming years, certain changes are coming for 2014. Let’s take a look at some of these changes that will affect the health care tax credit for small employers this year. To download a printable list with additional details, click here.


An employer must:

  • Employ less than 25 full-time equivalent employees (FTEs)
  • Pay wages less than $50,800 per FTE
  • Maintain a “qualifying arrangement”


Before 2014, a qualifying arrangement meant that an employer had to pay a premium of no less than 50% of the cost for each employee enrolled in their insurance coverage, also known as “uniform percentage requirement”. Beginning 2014, the uniform percentage requirement is subject to a cost-of-living adjustment.

Healthcare-ReformMaximum Credit

Only employers with 10 or less FTEs and annual wages averaging $25,400 or less for tax year 2014 can receive the maximum tax credit. If you’re eligible but exceed certain thresholds then you will receive a reduced credit.

Credit Period Limit

Starting in 2014, employers can only receive the health care tax credit for 2 consecutive years. If an employer has received credits prior to 2014, those years will not count against them.

Transition Rule

If an employer’s health coverage plan year does not line up with a calendar year, that employer will be viewed as offering SHOP Marketplace coverage. This credit is calculated at 50% for the entire 2014 tax year (35% for nonprofits). The two consecutive-year credit period limit still applies.

FF-SHOP Online Enrollment Delay 

The FF-SHOP (Federally-facilitated Small Business Health Options Program) will not be available until November 2014. Employers that choose to enroll their employees in SHOP coverage for 2014 will have to do so through an insurance broker providing a certified SHOP plan. However, this direct enrollment process applies only to states with FF-SHOPs. If your states operates their own SHOPs you will still be able to offer online enrollment to your employees and receive the tax credit.

So much is changing this year. ERM Insurance Brokers in Irvine, California is here to help!

Call (949) 222-0444 to learn more.