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Benchmark Planning Group Proudly Presents W-2 Reporting What You Need to Know

As you may already know, under the Patient Protection and Affordable Care Act (PPACA,) employers will be required to report the cost of employer-sponsored health benefits on W-2 forms. This informational reporting is required under § 6051(a)(14) of the Code, enacted as part of the Affordable Care Act to provide useful and comparable consumer information to employees on the cost of their health care coverage. Below is a Q&A that we thought you may find useful.

Since health coverage costs are now listed on the w-2, does this mean that it is taxable?

No, there is not an effect on the taxed amount this is a reporting requirement only.

When will employers need to start issuing W-2s with health coverage costs listed?

This requirement starts in 2012 (groups have the option to report in 2011.)  If an employer issues less than 250 W-2 forms, they do not have to start reporting until the 2013 tax year.

How is the aggregate reportable cost reported on the Form W-2?

The aggregate reportable cost is reported on Form W-2 in box 12, using code DD.

Are there any types of coverage that would not need to be reported on a W-2 form?

    Yes, the below coverage’s an employer would not need to report amounts on the following:
  • Standalone Dental & Vision
  • Workers Compensation Insurance
  • Long Term Care (LTC) Insurance
  • Employee contributions to FSAs or HSAs
  • Disability Insurance
  • Automobile medical payment insurance

What is a group health plan?

A group health plan is a plan (including a self-insured plan) of, or contributed to by, an employer (including a self-employed person) or employee organization to provide health care (directly or otherwise) to the employees, former employees, the employer, others associated or formerly associated with the employer in a business relationship, or their families. For purposes of identifying whether a specific arrangement is a group health plan, taxpayers may rely upon a good faith application of a reasonable interpretation of the statutory provisions and applicable guidance.

Does the aggregate reportable cost include both the portion of the cost paid by the employer and the portion of the cost paid by the employee?


How may an employer calculate the reportable cost under a plan?

An employer may calculate the reportable cost under a plan using the COBRA applicable premium method.  Alternatively, (1) an employer that is determining the cost of coverage for an employee covered by the employer’s insured plan may calculate the reportable cost using the premium charged method; and (2) an employer that subsidizes the cost of coverage or that determines the cost of coverage for a year by applying the cost of coverage in a prior year may calculate the reportable cost using the modified COBRA premium method.  For employers that charge employees a composite rate (the same premium for different types of coverage under a plan, for example, a premium for self-only coverage versus family coverage).

If you have any questions please call us at (732) 678-8801

Benchmark Planning Group Proudly Presents Self Funding with Protection from Larger than Expected Claims! For Groups 2 to 50

Assurant Self-Funded Health Plans offer an alternative to traditional health insurance that can lower your group health care costs now and for years to come.  This unique package of services and protection allows you to gain control over those expenses by helping you establish and fund your own health benefit plan.

Unlike other types of health plans, Assurant Self-Funded Health Plans will refund a percentage of premiums if your company runs better than expected.  They give a stable monthly cash flow for NJ based groups 2 to 50.  There is also a stop loss coverage in place to protect groups from larger than expected claims.
Assurant Self-Funded Highlights
  • Your maximum cost for the year is determined up front and guaranteed
  • It’s typically lower than the cost of a comparable fully-insured plan
  • Protection against high and unexpected claims by aggregate stop-loss benefit
  • Detailed claims reporting
  • Fixed monthly expenses
  • Reimbursement for groups whose claims run better than expected

Health Benefit Highlights

  • For NJ small business 2-50
  • Stable monthly cash flow
  • Copays for visits to network doctor offices and urgent care facilities
  • Tax Advantage Plans (HSA’s and HRA’s)
  • Covers New Jersey based companies with out of area employee’s
  • No penalty’s and protection against large claims


Preventive Care Coverage and What You Need to Know

Under the Patient Protection and Affordable Care Act, all plans must cover certain preventive care services with no member cost-sharing – with an exception for grandfathered plans – as of plan years beginning on or after Sept. 23, 2010.  The theory behind offering preventive care services with no cost-sharing is that members will schedule annual exams and chronic or catastrophic conditions can be detected earlier, thus improving health and lowering costs over time.

What Services Are Considered Preventive Care?
Affordable Care Act (ACA) defines preventive care services as follows:

  • Items or services recommended with a A or B rating by the U.S. Preventive Services Task Force
  • Immunizations recommended by the Advisory Committee on Immunization Practices of the CDC
  • Preventive care and screenings for infants, children, and adolescents supported by the Health Resources and Services Administration
  • Preventive care and screenings for women supported by the Health Resources and Services Administration
Examples of Preventive Care Typically Covered
  • A mother takes a young child in for a routine well visit and a MMR vaccination
  • A middle-aged woman has a conventional screening mammogram
  • During a preventive care office visit, blood is drawn for screening tests
  • A young woman has a preventive gynecological exam
Examples of Preventive Care Typically NOT Covered
Usually preventive care does not include any service or benefit intended to treat an illness, injury or medical condition. For example, a physician visit to treat your diabetes would not be considered preventive and would be subject to the deductible or copay.  Other examples of non-preventive care include:

Have specific questions?  Give us a call or email, we can help!  To see the preventive immunization schedules, sign up for our email newsletter and they will be sent to you shortly.

Benchmark Planning Group

732 678-8801




The 12 Most Common Direct Mail Mistakes…And How to Avoid Them

By: Robert W. Bly

Mistake Number 1- Ignoring the most important factor in direct mail success.  (The mailing list)

Mistake Number 2- Not testing.

Mistake Number 3-Not using a letter in your mailing package.

Mistake Number 4-Features vs. Benefits.

Mistake Number 5-Not having an offer.

Mistake Number 6-Superficial copy.

Mistake Number 7-Saving the best for last.

Mistake Number 8-Poor follow-up.

Mistake Number 9-The magic words.

Mistake Number 10-Starting with the product – not the prospect.

Mistake Number 11-Failing to appeal to all five senses.

Mistake Number 12-Creating and reviewing direct mail by committee.


NJ Temporary Disability Benefits- Savings of 6-12%

Temporary Disability Benefits (TDB) is a statutory benefit in NJ, and must be in place for all businesses in NJ.

We are proud to introduce a Temporary Disability Benefits Program that saves business owners between 6 and 12% annually.

Let us provide you with a no obligation quote.

As employee benefit specialist, we understand how important it is to business owners to save money especially when it comes to the cost of employee benefits!

Understanding Temporary Disability Benefits

The state of New Jersey mandates employers provide benefits to all employees who are injured as a result of a non-work-related event. The cost of these benefits can be paid entirely by the employer, or jointly by the employer and the employee.

At Benchmark Planning Group, we offer competitive Temporary Disability Benefits Insurance that can accommodate your business budget.

According to New Jersey state law, employees disabled off the job are entitled to:

  • A weekly benefit of 66 2/3% of average weekly wage up to $559.00


How to Get A Quote

To provide a quote, we will need a copy of your AC-174.1 form. Enrollment is also easy- we will just need the attached TDB checklist completed.  Then we will complete your DP1 master application on your behalf!  Please contact us with any questions you may have.

Carson Sorsby

(732) 678-8801


Horizon Blue Cross Blue Shield Market Update

As the person in charge of benefits every year you are confronted with combating health insurance costs, while maintaining your employee benefits.  We understand how expensive health insurance is and how important it is to have cost savings strategies.  As the carriers release new plans to the market, we like to keep our clients up to date, so they are aware of all their options.

Introducing Horizon Advantage EPO Effective July 1st

  • National BlueCard Network (coverage outside of NJ)
  • In-Network Coverage only, with no referral needed for a specialist visit
  • 24/7 coverage for emergency care
  • No co-pay for preventive care and well care coverage
  • Access to a full suite of online tools
  • Split co-payments- lower co-payments apply to visits to pediatricians, general practitioners, internists, & family pediatricians
  • Flexible Coinsurance and deductible options
  • Freestanding prescriptions options
  • Unlimited access to the Horizon Managed Care Network

There are a lot of choices, not only with different carriers, but with different plans.  At Benchmark Planning Group, we find “you” the right plan with the right carrier.  When it comes to your health insurance…”We’ve Got You Covered”.

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