Tag Archives: Compliance

2015’s Open Enrollment Faces Several Hurdles

Fall open enrollment for the 2015 group health plan year is being dominated by employer frustration and uncertainty about implementing coverage and IRS reporting requirements under the health care reform law’s employer coverage mandate.

“Open enrollment is going to present employers with some huge challenges this year,” said Steven Friedman, shareholder and employee benefits practice group co-chair at Littler Mendelson P.C. in New York. “There are quite a few hidden traps in the reform law’s mandate that could ensnare employers.”

The mandate requires employers with 50 or more employees to offer health care benefits to 70% of their full-time workers — defined as any employee who works an average of 30 or more hours a week — beginning in January, and 95% of full-time workers in 2016.

Experts say much of benefit managers’ concern has been focused on the Patient Protection and Affordable Care Act’s rules requiring most employers to certify that benefits-eligible employees and their dependents have been offered minimum essential coverage, and that employees’ premium contributions fall within cost-sharing limits established under the law.

“The reporting requirements under ACA are probably the No. 1 issue that we’re dealing with right now,” said Adam Solander, a Washington-based associate at Epstein Becker & Green P.C.

Starting in January, employers will need to track benefits eligibility of their full-time employees and submit annual reports to the IRS to document their group plans’ compliance with the law. The first reports are due in early 2016 for employers with at least 100 employees.

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary

IRS Announces Inflation-Adjusted Increase for HSAs

The IRS released increases for HSAs and high-deductible health plans (HDHPs) for 2015.

The maximum annual HSA contribution for self-only HDHP coverage will increase from $3,300 to $3,350. The maximum annual HSA contribution for family HDHP coverage will increase from $6,550 to $6,650.

  • The age 55 catch-up contribution continues to be $1,000
  • The minimum HDHP deductible limit changes:
    • Self-only coverage increased from $1,250 to $1,300
    • Family coverage increased from $2,500 to $2,600

To read more, click here.

Jeffrey R. Ungvary

President

Jeffrey R. Ungvary

President of SWIM Featured in Life Health Pro

Look at the insurers’ own provider directories.

Jeff Ungvary, president of Strategic Wellness & Insurance Management Services Inc., said he thinks brokers should also talk about the ramifications of network decisions when helping customers choose health coverage.

When he helps midsize employers analyze networks, he gets a list of the enrollees’ primary care doctors and specialists, then checks to see how many are in the current health plan network and how many would be in other networks the employer is considering.

At one employer, for example, the employees were using 136 doctors, and 18 of the doctors were not in any of the networks under consideration.

When an employer compares the percentage of the listed doctors who would be in-network in Plan A and in Plan B, some employers will choose the cheaper network, and some will choose the bigger network, Ungvary said.

Some have suggested that the exchange plans may now have especially narrow networks. Ungvary said he thinks that, even if the new, narrow networks are often too small for many enrollees to keep their doctors, they are still larger than the staff model HMO networks of the 1980s.

“Realistically, people will still be able to get care,” Ungvary said.

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Jeffrey R. Ungvary

 

Jeffrey R. Ungvary

President

ERISA Explains It All

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for retirement and health benefit plans in private industry. ERISA does not require any employer to establish a plan. It only requires that those who establish plans meet certain minimum standards.

ERISA covers retirement, health and other welfare benefit plans (e.g., life, disability and apprenticeship plans). Among other things, ERISA provides that those individuals who manage plans (and other fiduciaries) must meet certain standards of conduct. The law also contains detailed provisions for reporting to the government and disclosure to participants. There also are rules aimed at assuring that plan funds are protected and that participants who qualify receive their benefits.

ISA has also been expanded to include health laws. For example, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) amended ERISA to provide for the continuation of health care coverage for employees and their beneficiaries (for a limited period of time) if certain events would otherwise result in a reduction in benefits. In addition, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) amended ERISA to make health care coverage more portable and secure for employees.
Health Plans as Welfare Benefit Plans Under ERISA

According to ERISA, an employee welfare benefit plan is any plan, fund, or program which is established or maintained by an employer or by an employee organization, or by both, to the extent that such plan, fund, or program was established or is maintained for the purpose of providing:

  • Medical, surgical, or hospital care or benefits;
  • Benefits in the event of sickness, accident, disability, death or unemployment;
  • Vacation benefits;
  • Apprenticeship or other training programs;
  • Day care centers;
  • Scholarship funds;
  • Prepaid legal services, or
  • Certain other benefits described in the Labor-Management Relations Act of 1947

Jeffrey R. Ungvary

 

Jeffrey R. Ungvary

President