About Raphy Timour

Find more about me on:

Here are my most recent posts

Pasadena Now Article And Interview With Raphy Timour About The Affordable Care Act

Reprinted from with permission from Pasadena Now,  this Business Article was titled:

How Is The Affordable Care Act Affecting Small To Mid-Sized Businesses In Pasadena?

The institution of the Affordable Care Act and its effects on business owners and their employees is one of the biggest national stories of 2014. Pasadena Now wanted to break down the implications of this national story by understanding what is happening on a local level. To illuminate how the ACA changes are affecting small to mid-sized businesses in Pasadena, Pasadena Now spoke with Raphy Timour of Pontrelli, Timour & Associates, Inc.

Like most insurance brokers that handle employee benefits, Raphy Timour recommended that most his clients take the early renewal option. As a result, their current plans will stay in place until December of 2014. Most companies will not experience major changes until the end of the year. When those changes come, however, Raphy Timour told Pasadena Now what will happen:

affordable care act, pasadena now

Raphy Timour on ACA

“The fourth quarter is going to be a real wake-up call for most employers. There are going to be a lot of shocked and surprised people. Most plans had to bulk up to meet the minimum essential coverage requirements of the ACA. These new comprehensive plans are both less flexible and more expensive. I believe the middle class in Pasadena are going to be hit the hardest. They won’t qualify for the low-income subsidies and employers will pass off most of the new expenses onto their employees. They will have higher premiums, and higher out of pocket costs when they go to seek services. Healthcare reform will make life harder for a lot of people.”

What exactly is meant by the new coverage requirements? Won’t healthcare reform be beneficial for most people? Aren’t the new essential health benefits a positive thing? When asked this question, Raphy Timour shook his head in frustration:

“You would think that would be the case, but it actually is the opposite. If you currently offer your employees a small group health plan in California that was established or renews in 2014, your plan is mandated to include 10 categories of essential health insurance benefits. Some of these essential benefits make perfect sense like the preventative services that include both annual screenings and wellness visits, inpatient hospital services, emergency services, and prescription drug coverage.  On the other hand, so-called essential benefits now also include the following: acupuncture, pediatric dental and vision services, and a host of other specialized items. These specialized services increase the costs for everyone.  People should have more choices; one size does not fit all.”

Wanting to know more, Pasadena Now asked for a concrete example of how a small business could be affected by these rate increases. Raphy Timour responded by telling us a story about one of his Pasadena-based clients:

“We do the benefits for a small local restaurant and the owner is a woman in her early 60’s. She chose not to early renew. Over the years, to help offset the rising cost of healthcare, she moved to  a higher deductible PPO plan. Although the out-of-pocket costs were greater, she chose to pay less each month in premiums. Her group benefits plan renews in March 2014 and her individual rate is going from $532 a month to $925 a month!  Yes, her benefits are more extensive, but nowhere near justifying a 74% increase over last year. Why should a woman in her 60’s with adult children be required to have a plan that covers maternity and pediatric dental and vision?”

By removing the ability to choose what should be covered, ACA is adding significant costs. Moving forward, what is the best choice for small to mid-sized businesses to make in regards to health insurance? Should they go on the Covered California exchange? Raphy Timour answered these questions with a resigned honesty:

“Healthcare reform is a very complex issue with many perspectives and market forces. Right now, the group insurance market is still the best choice as opposed to the exchanges and the individual policies. There are significantly more options and carriers available with the off-exchange group insurance market, including the largest network of hospitals and medical providers. What is frustrating is that all of the options under the Affordable Care Act seem to be more expensive and less helpful. They tried to squeeze everyone into the same little box. When it comes to healthcare, one size simply is not enough.”

IRS Modifies “Use It Or Lose It” Rule For Health Flexible Spending Arrangements Under The Affordable Care Act


Pressures of Use It Or Lose It

On October 31, 2013, the Internal Revenue Service issued Notice 2013-71 about the “Use It Or Lose It” Rule for health flexible spending arrangements under the Affordable Care Act.

The notice instituted significant changes that will affect the administration of cafeteria plans under section 125 of the Internal Revenue Code. Pontrelli, Timour & Associates offers a brief outline of these changes as a public service. If you need to know how the specific details affect your healthcare plans, please contact PT Benefits for help.

Use It Or Lose It Update

The main change is a modification of the regulations proposed under section 125 to add a limited exception to the “use it or lose it” rule for health flexible spending arrangements. Employers are permitted to amend plans that provide health flexible spending arrangements to permit up to $500 of unused credits to be carried over and applied towards the following plan year.

It is important to realize that the “use it or lose it” rule is not  completely eliminated. Any unused credit in excess of $500 will still be forfeited.

This new carryover is an alternative to the current “grace period” rule. As a result, a health FSA may not provide for both the new carryover and the current grace period. From a pragmatic perspective, if a carryover is to be provided at all, the choice is between (a) permitting a carryover of a limited amount (up to $500) that can be applied during the entire following year, or (b) permitting a potentially larger carryover that can only be applied against expenses incurred during a specific period of time (one month, two months, three months) that is designated as the grace period.

Use It Or Lose It Modifications

PT Benefits understands if all of these new rules and regulations sound like a sputtering of ancient Greek to you. As a businessman, you are focused on growing your business and not getting lost in a maze of such technical particulars.

If you contact Pontrelli, Timour & Associates with questions, we can provide you the support you need to make sure the “Use It Or Lose It” modifications are effectively applied to your business. To learn more about how PT Benefits can deliver premium health coverage and benefits packages to your employees and guide you as an employer through the maze of the Affordable Care Act, please call 866-782-9899 or fill out our handy contact form.

4 Healthcare Changes And Affordable Care Act Challenges In 2014


Healthcare Changes In 2014

With the Affordable Care Act now in full force, the overall societal goal is for millions of uninsured Americans to either now have health coverage or to be able to obtain it within the coming calendar year. As a Southern California provider of employee benefits programs and solutions for small to mid-sized companies, Pontrelli, Timour & Associates, Inc. make it a point to keep our clients updated about the ongoing evolution of upcoming healthcare changes and Affordable Care Act challenges in 2014.

Healthcare Changes & ACA

As the new year begins, more than 1.1 million people have gained coverage through the offerings of the Affordable Care Act.  Through the combination of HealthCare.gov with the federal and state exchanges, millions more will be enrolled before the cut-off date at the end of March. By looking ahead at what is to come, the goal of PT Benefits is to make the process of adapting to the changes as smooth and easy as possible for both the employers and the employees at our client companies.

Here Are 4 Healthcare Changes Coming In 2014:

The Shadow Of The Employer Mandate:

Employers need to prepare for the Employer Mandate requirement that companies with more than 50 employees provide health insurance for their employees. Although this requirement was delayed a year by the Obama administration, employers will be surprised by how quickly the deadline approaches. Given the choices that need to be made like wellness discounts and health incentive strategies for employees, decisions need to be made well in advance.

The Requirement Of Pricing Transparency:

A major part of the Affordable Care Act is the emphasis on clarity in relation to health insurance costs. Transparency means an understanding of what exactly needs to be paid by both employers and employees and why.  PT Benefits believes that such price transparency will allow both employers and employees to make better educated choices with less surprises.

The Inevitability Of Shrinking Networks:

In order to save money, insurers will continue to shrink their networks of health care providers, going with the best deals that might not always be the best options for consumers. By relying on providers offering the best rates, insurance companies will limit the options in many plans. Such a shrinking of networks will have a greater effect on ongoing consumers with histories with certain providers. The loss of those providers will prove challenging. In contrast, first-time insurance purchasers won’t miss what they never had in the first place.

The Need For Electronic Records & HIPAA Compliance

With the institution of the PPACA in 2014, the need for electronic records will increase. Electronic records will provide better tracking and analytics while helping to ensure higher standards of record keeping and maintenance. The challenge of more electronic records will be a greater need for HIPAA compliance.

For Pontrelli, Timour & Associates emphasize the above updates are only short capsule descriptions of the bevy of healthcare changes to come in 2014. Luckily, the client companies of PT Benefits do not need to be healthcare experts. We handle such challenges and questions for you, providing a customer-centric approach that focuses on the specific needs of your organization. To learn more about how we can help you, please call 866-782-9899 or fill out our handy contact form.

Glassdoor 2013 Employment Confidence Survey Reveals A Strong Belief In Premium Health Benefits

A new survey conducted by Harris Interactive shows that employees want premium health benefits. A third of all employees believe the benefits packages they are offered are not as good as benefit packages provided by other companies. When taken side-by-side with the a greater employee confidence in the post-recession job market, it is clear to PT Benefits that many employers should be looking for better options when it comes to providing premium health benefits. These important findings can be found in Glassdoor’s Q2 2013 Employment Confidence Survey.

 Premium Health Benefits Preferred

When it comes to employee benefits, the 21st century shift into specialized perks does not seem to catch the fancy of most workers. Whether it is as simple as complimentary coffee and donuts at the office or as specialized as pet insurance and discounted gym memberships, such incentives simply do not rank high when compared to premium health benefits. Google gives employees free gourmet food and General Mills provides free dry cleaning, but those fancy perks ultimately do not have much of an impact. The in-depth survey found only one in five employees believe such fancy perks plays a part in determining job choice.

According to the Glassdoor Employment Confidence Survey, the number one perk for employees is premium health benefits. Done online and anonymously, the survey clearly demonstrates that more than three out of four workers rank quality medical plans as the employee benefit they care the most about and truly value. Pontrelli, Timour & Associates believes such findings should not be ignored.

The Survey’s List of the Top Employee Preferences:

premium health benefits

Glassdoor Survey Highlights Premium Health Benefits

While the top four were included by 60% at the low end to 76% at the high end of the employees surveyed, the bottom five were all in the low to mid 20s. The results reveal a desire by employees to receive quality care and support from their employers, both in the short-term and the long-term. Such an expression of preference should be taken seriously by every employer, particularly in light of the secondary conclusions about employee confidence in relation to the current job market.

The new survey also reveals that over 40% of employees believe they could find a job in the next six months that matches both their experience level and salary expectations. What is so impressive is that this confidence measurement point is the highest it has been since the third quarter of 2009. Such a finding in regards to employee confidence  should put employers on notice when it comes to effectively fulfilling the new healthcare requirements of the Affordable Care Act and providing premium health benefits.

Rusty Rueff, Glassdoor career and workplace expert, who ran global HR departments at Electronic Arts and PepsiCo, explains the implications of this shift for companies across the board: “In today’s environment of greater workplace transparency – combined with employees’ growing sense of confidence about the state of the job market – job seekers will be looking for companies that communicate clearly about the future of the business, the path for career advancement, and who address their benefit needs.”

Premium Health Benefits Delivered

Pontrelli, Timour & Associatess wholeheartedly agrees with the conclusions of the Glassdoor’s Q2 2013 Employment Confidence Survey. While providing premium health coverage is becoming a necessity in order to remain competitive in your field, being able to clearly communicate both the details of such packages and the future of the business as a whole is important as well. If employees are going to embrace the culture of your company, they need to feel embraced by the company. To learn more about how PT Benefits can deliver premium health coverage and benefits packages to your employees, please call 866-782-9899 or fill out our handy contact form.

Affordable Care Act Delays and Deadlines: A PT Benefits Guide To Recent PPACA Changes And Upcoming Healthcare Reform Benchmarks

affordable care act, obamacare, healthcare reform, ppaca, employer mandate

Affordable Care Act Guidelines

As the U.S. Labor Department, Department of Health and Human Services and the Treasury Department figure out Affordable Care Act guidelines and specify the deadlines for PPACA, PT Benefits offers a guide to recent changes and upcoming benchmarks related to the new healthcare reform laws and regulations. The goal is to help our clients and potential clients navigate the complex maze of healthcare reform and the Affordable Care Act. As a full service benefits agency, PT Benefits provides the guidance and the support needed to find success for your company when it come to benefits administration.

Recent PPACA Changes & Upcoming PPACA Benchmarks

One Major Affordable Care Act Delay —

1) The Employer Mandate

The mandate of the Employer Mandate of PPACA is that employers with 50 or more full-time workers or equivalents will have to pay a tax penalty of $2,000 to $3,000 per employee. The penalties will kick in if the employers fail to offer health insurance plans to their employees or if the plans they do offer do not meet ACA minimum standards. Delayed until 2015, to learn more, please check out this, check out this link to the Internal Revenue Service website.

Two Major Affordable Care Act  Deadlines —

1) Notification of Marketplace Coverage

If an employer is subject to the Fair Labor Standards Act, they are required to notify all their employees of the health care options available by October 1, 2013. At the time of hiring, each employee must be provided with a written notice. The written notice must inform the employee of the existence of the Marketplace, including a description of the services provided. Under the regulations of the Affordable Care Act, the employee must also be made aware of how to contact the Marketplace to request assistance.

In practice, this requirement affects the majority of employers. FLSA applies to employers with at least two employees and $500,000 in annual revenue or sales. What is intriguing is the requirements also applies to hospitals, nonprofits, schools and government agencies. Notices in the workplace must tell employees whether their employer-sponsored plan meets the minimum value standard.

In addition, within the parameters defined by PPACA, employees must be informed of whether or not the employer’s plan is considered affordable. Employees also need to know whether or not they can qualify for a premium tax credit if the insurance offered by the employee fails to meet these benchmarks. It is the employer’s responsibility to inform their employees across the board. With the Oct. 1, 2013 deadline already passed, to learn more, check out this link to the website of the U.S. Labor Department.

2) Employee Status

The delay of the employer mandate  of  the Affordable Care Act does not delay the necessity of employers to start collecting information needed to manage the potential penalty they will have to pay if they violate the Employer Mandate of 2015. If an employer wants to minimize their tax exposure, a 12-month period will have to be chosen to measure employee job status. Such a period can only be chosen if the proper records have been kept and the reporting requirements have been met. Without question, any employees determined to be working full time will need to be offered coverage in 2015. If they are not offered insurance, the employers will be liable for the penalty. With the deadline being in the fall of 2013, to learn more, check out this link to a PDF from the Internal Revenue Service website.

Since PT Benefits understands how intimidating and overwhelming healthcare reform and the Affordable Care Act can be for small to mid-sized business owners, we hope this guide has been helpful. As benefits administration experts, we provide the guidance our clients need to navigate through the maze of potential fines and trouble. To learn more about how we can help you, please call 866-782-9899 or fill out our handy contact form.


Welcome to our New Website!

We’ve completely updated our website and brought it in to the modern age. Now you can follow us on Twitter, friend us on Facebook, or connect with us on LinkedIn as well as follow our blog for updates on the rapidly evolving world of Employee Benefits and Health Insurance, especially with all the changes being wrought by the Affordable Care Act and ACA Compliance questions.

Feel free to use our Contact form whenever you have questions not directly addressed in the site or better yet give us a call at 626-795-4138 for immediate assistance.