We Go Beyond
Many employers only hear from their brokers when renewal comes around each year. Not us. At Nikssarian Insurance Services, we want our clients to understand the impact of health care on their businesses, whether that's through plan option presentations months before renewal, California Law compliance training, or just being a phone call away for any questions at any time of the year. Our mission is to equip our clients with the knowledge to provide cost-effective coverage for their employees.
In sum, your needs come first, and we work hard to serve you beyond the industry standard. Leveraging 40 years of multi-industry expertise, we ensure you can:
UNDERSTAND
Every available health plan at a glance to find the best option to save you money.
TRUST
In the legal reliability of our custom proprietary Annual Open Enrollment documents.
PROTECT
Yourself against costly compliance errors and hidden penalties from complex health care laws.
Solutions IN DETAIL
Election & Enrollment Forms
We have created bilingual proprietary election forms that are compliant with the IRS Employer Shared Responsibility Provisions (ESRP) and have been successfully accepted for Covered California/Health Insurance Marketplace (HIM) appeals.
When your employees elect or waive their health coverage, we have identified four critical items on your election forms that play a pivotal role in HIM appeals or audits. For instance, each election form has to provide the full plan name exactly as written on the Summary of Benefits & Coverage. The form wording needs to strike a balance between being readable for the employee and compliant with ever-changing regulations.
We keep up to date with these regulations, and we have provided our employers with updated editions of our election forms each year since 2015. If your employees prefer Spanish, our forms are translated and proofread by professional translators and our Spanish-speaking staff. Everything we do goes through an extensive internal review before coming to you, allowing you to put your compliance concerns to rest.
Rate Analysis & Spreadsheets
Each year, our standard is to show you every plan from every carrier in your area using custom spreadsheet displays to help you find the most cost-effective health plan(s) for your company and employees. The presentation is made in an easy-to-understand format.
Almost every health plan discussion we have boils down to cost, benefits, and PPO network, and of course, we work to provide the clearest answers. That is why we give you your renewal before you receive it from the carrier and show you quotes from every plan in your area. Our corporate standard is to ensure you know well before your renewal what your options are for the next plan year, and if it makes sense to do so, we will guide you through the process of switching to another carrier.
Our renewal presentations offer deep dives into “what if?” scenarios for plan costs and employee contribution amounts. If you are on the fence between a few different plans or employee contribution percentages, we will create a custom calculator spreadsheet that lets you see the effects of changing different variables over the entire plan year with a single click of a button.
For renewals, plan cost is only one part of the equation, and that is why we will also comb through all the plan changes year-to-year to show you what is really going on in your renewal. When our work is completed, you will receive a plan comparison document for your employees to easily understand how their benefits will change.
Eligibility Policies
We help you establish a written health plan eligibility policy, and we provide initial and ongoing training to HR and benefits staff to ensure consistent implementation.
Many employers do not have formal, written eligibility policies on file. Unfortunately, without a written eligibility policy to set a consistent precedent, employers often open themselves up to liability in the form of unfair treatment allegations. In these situations, employers do not have much of a leg to stand on if a complaint is filed.
Employers in the agricultural sector with seasonal workers have an added layer of difficulty when it comes to waiting periods and rehire date rules. We meet with HR staff and work through the details of their eligibility policies, making sure the language is clear, consistent, and compliant in every situation.
Routine Billing & Enrollment Assistance
Our team is just a call or email away to go over your day-to-day servicing, whether it is a lost ID card, a misspelled name, or any other enrollment issue. We work closely with our general agents and even our carrier representatives, courtesy of our preferred broker status, to get the problem solved quickly and efficiently.
Billing problems can be a major source of frustration when they arise, so we keep track of our client bills and notify you about late payments. Any mystery charges on the bill get an immediate and thorough investigation.
We are happy to spend just as much time with our two-person employee groups as we do with our groups over two thousand.
Small groups without HR or Benefits managers will find our services particularly valuable as we handle their new employee enrollment process from start to finish.
Industry Updates
We are always expanding our expertise to meet the intricate and rapidly changing trends of the health insurance industry to keep our insights up-to-date and your mind at ease.
Our agents undergo state-mandated continuing education each year in order to maintain their licensed status. Our President/CEO, David Nikssarian, teaches the employee benefits module of the Human Resource Professional in Agriculture Certificate Program classes offered by the Agricultural Personnel Management Association since 2011.
Additionally, we keep our finger on the pulse of healthcare news, research, and trends from the county to the national level. The moment a new piece of legislation is signed into law, we stay on top of letting our employers know what changes they might experience to their own benefit plans or eligibility policies.
A recent example of our approach is the American Rescue Plan Act of 2021 (ARPA). This law, signed by President Biden in March of 2021, provides COBRA at no cost for qualifying former employees. To allow us to become as knowledgeable as possible about this new law, we rely on more than one source. All of our staff has attended webinars from an Authorized General Agent, a Third-Party Administrator, two carriers, and one attorney specializing in employee benefits. Additionally, we have read the entire law’s healthcare provisions.
All of this allows us an informed viewpoint, aided by forty years and counting of industry experience, of where the health industry is and where it is going. Our clients get hand-picked briefings telling them exactly what they need to know when they need to know it, leaving them free to focus on running their own businesses.
HSA, HRA, & FSA Programs
We have extensive experience with Health Savings Account (HSA) programs and have worked to establish these programs for clients from as few as 2 to over 100 employees. With a one-page display, we can illustrate the cost-effectiveness of changing to an HSA program.
We have worked with Health Reimbursement Accounts (HRA) for more than twenty-five years. Just recently on January 1, 2021, we moved a large group to a HRA program, allowing for significant savings.
Flexible Spending Accounts (FSA) and Dependent Care programs—especially during the COVID-19 pandemic—are constantly changing and require attention to have a compliant program. Our Compliance Team will assist you with the creation and implementation of an FSA program by using our own resources along with the services of a licensed Third-Party Administrator.
Compliance
Our approach to compliance is simple: Comply with the law and avoid all penalties. To accomplish this, we assist employers with the establishment and implementation of eligibility policies, guide the 1095-C form creation process, assist with Covered California appeals, and handle the IRS 226-J Letter process.
Additionally, we help establish, implement, and service IRS Section 125/POP programs and cafeteria plans. We answer your questions about the many Federal and State laws that affect group health plans, including the PPACA, HIPAA, ADA, ADEA, COBRA, and ERISA.
Navigating the myriad of Federal and State laws and regulations can be a headache for anyone. We use our Compliance Team’s expertise to ensure your group health programs comply with all provisions of the law that apply to your specific organization.
1095-C Compliance Assistance
With our training and assistance, the process of preparing annual 1094-C and 1095-C forms will be less lengthy, intricate, and tedious.
We have experience training and answering questions from employers, including difficult scenarios that occur with seasonal employees located in multiple states.
In 2023, our largest client alone generated over 8,000 1095-C forms for the 2022 plan year based on the guidance of our Compliance Team.
We will also be glad to meet with your Human Resources staff and conduct a training seminar on the 1095-C process, giving you our methods so your staff can be better prepared to complete them.
Covered California/HIM Letters & Appeals
We help you understand and catch penalty risks before they occur, and even if they do, we have an excellent track record in successfully guiding our clients through the appeals process.
Employers with 50 or more full-time employees are required to offer a health plan that meets minimum value standards and is affordable.
Some employees may not realize that this offer of coverage prevents them from obtaining a tax credit from the Health Insurance Marketplace (HIM) for affordable coverage. After all, the HIM is forbidden by law to subsidize coverage if they knew the employer was already making that offer. If employees do receive tax credits, employers will be notified by the HIM and will have 90 days to respond.
These HIM notices can be successfully appealed, but most employers who fill out the appeal forms may miss a tiny detail that results in a denial. With our time-tested approach, we help you get the paperwork right on the first try.
IRS 226-J Penalty Letter Resolution
If you have received an IRS Penalty Letter, there is still a good chance you can avoid paying anything if your eligibility policies and forms have been properly administered. We will carefully examine what you are being assessed a penalty for and give you helpful guidance to minimize the impact on your business.
If your business is legally obligated to offer affordable health insurance and is not doing so, the IRS will notify you that you are being assessed with a penalty. This notice is known as an IRS 226-J penalty letter.
These penalty letters can be appealed, but you need to act fast. The letters need to be processed quickly and carefully, as they have only a 30-day turnaround time. Our office has succeeded for years in getting every one of our appeals accepted. Since 2015, our clients have been assessed a total of $1,026,915 in penalties, however none of them have been required to pay a single cent thanks to our help.
If there is a question of whether your business is required to offer a health plan because it is close to 50 or more full-time equivalent employees, we can run calculations to determine just how close you are. Our formulas consider seasonal and part-time workers that will affect the final employee count, pursuant to Federal law.
Claim Reduction & Cost Containment
We work with our clients to establish customized loss reduction programs. With the PPACA requirement forbidding calendar or lifetime maximums on essential health benefits, cost containment programs are more important than ever before.
We will work with our clients to create a customized program that improves employee health while minimizing cost to the company. This can range from paycheck stuffers to disease management programs, from on-site clinics to health screenings and everything in between.
Self-Funded Group Health Programs
Our expertise with self-funding goes back over 30 years. We will assist you to create a self-funded program that will provide the traditional benefits of cash flow, cost savings, and customization by using state of the art cost-containment and risk structuring.
We have developed relationships in the Specific Stop Loss marketplace to ensure you will have access to dozens of Specific Stop Loss carriers. We structure our Specific Stop Loss program to have layers of protection, based on your specific needs.
Our strategy is to have a well written Plan Document to avoid any denied claims by the Specific Stop Loss carrier. We read each word in the Plan Document before we present it to you for your approval. We focus on eligibility, leave of absence, and termination rules, which historically have been a major source of denied claims in our industry, and our clients have a very successful track record in reimbursement approvals due to the work we have done well before the claim has been incurred.