Perspectives Vol. 1 2018

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Woman With Orange ShirtReporting Requirements of Employer Shared Responsibility Provisions

Employers with 50 or more full-time employees (including full-time equivalent employees) in the preceding calendar year should use FORM 1094-C and 1095-C to report offers and affordability of health insurance coverage to full-time employees and their family members. The forms used to report to the IRS will determine whether an employer is liable for a payment under the employer shared responsibility provisions of section 4980H.
  • WHAT IS FORM 1095-C: Employer-Provided Health Insurance Offer and Coverage provides employees with information about the health coverage offered by the employer and whether employees were enrolled in the coverage.
  • WHO NEEDS TO REPORT: Employers with 50 or more full-time employees – (ALEs) – whether the employer offers coverage or not.
  • WHAT DO THEY REPORT: FORM 1095-C will be filed and distributed for each employee who was a full-time employee of the ALE for any month of the calendar year, including any employee who was treated as a full-time employee for one or more months of the calendar year. The form will summarize eligibility, affordability and minimum value of coverage.
  • DUE DATE: IRS extended the due date for 2017 1095-C Forms from Jan.31, 2018, to March 2, 2018

Frequently Asked Questions about Portability of Health Coverage and HIPAA (pdf)

Frequently Asked Questions About Portability of Health Coverage and HIPAA is linked to government site.

IRS notice sent to Large Group Employers (pdf)

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How the Tax Bill Will Impact 2018 - Deb Muller, CEO

The Tax Cuts and Jobs Act signed into law on Dec 22, 2017, by President Donald Trump is the most significant piece of legislation to come out of Washington since the Patient Protection and Affordable Care Act (ACA) was signed by President Barack Obama on March 23, 2010. While the bills address tax reform and health care reform respectively, they share one thing in common: the full impact of the policy changes they invoke are not known until some future date.

With the ACA, we learned that additional legislative and executive action can have significant impacts to the affordability of health care premiums in the individual market. Examples include the failure to fund cost share reductions, the introduction of transitional policy status, and now the elimination of the individual mandate with the Tax Cuts and Jobs Act.

Beginning in 2019, the penalty for individuals not carrying health insurance will be reduced to $0, effectively repealing the individual mandate. Interestingly enough, the tax bill did nothing to adjust ACA requirements for large employers to continue to offer affordable coverage that provides minimum essential coverage to at least 95 percent of eligible employees or pay a penalty.

Prior to the Supreme Court ruling that the individual mandate was constitutional in 2012, we evaluated the impact of the individual mandate going away on an individual’s health insurance purchasing habits. Our conclusion was that in South Dakota, personal responsibility and premium affordability rather than a federal requirement to pay a penalty, were central to a consumer’s decision to go uninsured or to carry insurance. For South Dakota, this assessment still holds.

Yet the long-term implications of how the Tax Cuts and Jobs Act may affect health care policy are drawn out at the national level with its impact on the national debt. When the federal debt increases, which the Congressional Budget Office projects it will under the Tax Act, it triggers efforts to reduce federal spending. Because Medicare and Medicaid made up over 30 percent of federal spending in 2016, it is likely that those two programs will be required to look at ways to cut costs going forward.

As with the ACA, the Tax Cuts and Jobs Act implications will unfold over time.

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Woman Passing Piece of PaperWhat about the 1095-B?

Avera Health Plans will take care of the 1095-B form. This form provides details about the employee’s health insurance coverage, including who in the employee’s family was covered. Avera Health Plans will send this form directly to your covered employees. Employees should watch for the 1095-B from Avera Health Plans after Jan. 20, 2018. Please note, employees do not have to wait for the 1095-B to file taxes. Once received, the 1095-B should be retained with other tax records.

Member Resources (pdf)

Avera Health Plan Rural Network – Highlights from Avera Medical Group Marketing

Avera Cancer Institute
You have numerous treatment options through the Avera network. Take advantage of expert cancer care at an Avera Cancer Institute location near where you live:

For specialty physician consults, stay in the comfort of your community and save the time and expense of travel by scheduling real-time, face-to-face virtual visits with Avera Cancer Institute specialists through Avera eCARE Consult.

With eCARE Consult, you can meet with medical and radiation oncologists through our advanced telemedicine network. Then, you'll receive coordinated treatment and care at Avera outreach sites close to home.

Behavioral Health
Coping with today's fast-paced world often presents challenges. If you or a loved one feel overwhelmed or concerned about personal welfare or safety, rely on the behavioral health specialists at Avera.

When you choose Avera, the Upper Midwest's leader for confidential, personalized, family-centered care, you're treated as a whole person. That means you receive attention for all aspects of your health --mental, emotional, spiritual, physical --and it's tailored to your specific situation.

Get easy access to faster, simpler, effective and more comprehensive behavioral health care through Avera's multi-state network of providers and facilities. Although services vary by location, you can enter at any place and time to get the care you need. In our 13 regional clinics and outpatient sites, you can find: Would need to reword a little.

Women’s Health
When you choose Avera providers, you get the kind of confidential, compassionate
women's health care that puts your needs and interests first. You also benefit from access to the latest in advanced screening, diagnostic and treatment technology --including radiation therapy and minimally invasive, robotic-assisted surgical techniques --through our network of more than 200 clinic sites and 33 hospitals.

Take advantage of our expert physicians and care teams who deliver top-quality women's health care in comfortable, welcoming environments. You'll find us close to home at locations in five states across the Upper Midwest, including South Dakota, North Dakota, Minnesota, Iowa and Nebraska.

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News & Updates Across Avera

Follow These Heart Healthy Tips

  1. Don’t smoke, and if you do, quit. Smokers are two to six times more likely to suffer a heart attack than nonsmokers. Smoking also boosts the risk of stroke and cancer.
  2. Get moving. Make a commitment to be more physically active. Aim for 30 minutes of moderate-intensity activity on most, preferably all, days of the week.
  3. Eat for heart health. Choose a diet moderate in total fat and low in saturated fat, trans fat and cholesterol.
  4. Know your numbers. Ask your doctor to check your blood pressure, cholesterol and blood glucose. Work with your doctor to improve any numbers that are not normal.