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Business Insights, Research & Perspectives

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October 12, 2010

HRB 22 - Limited PPACA Exemption for Self-Funded, Non-Federal Governmental Plans

October 12, 2010 --  Since the enactment of HIPAA in 1996, if certain conditions are met, a self-funded or partially self-funded health plan sponsored by a State and local government entity, such as a city, township, or school district, can elect to exempt itself from being considered a group health plan for purposes of the HIPAA portability, preexisting condition exclusion limitation, and related provisions of the law.  This exemption is only available as it relates to the self-funded portion of the plan. 

October 5, 2010

HRB 21 - Early Retiree Reimbursement Program Updates

October 5, 2010 --  The Early Retiree Reinsurance Program (ERRP), established as part of the PPACA, is a program designed to encourage employers to establish or maintain retiree health coverage for their retirees, aged 55 to Medicare entitlement.  The ERRP will pay the equivalent of up to 80% of an early retiree’s claim between $15,000 and $90,000.  To be eligible for the program, an application must be filed with HHS; the application process opened on June 29, 2010. 

September 21, 2010

HRB 20 - Mini-Med Plan Relief from Annual Limit Restriction Offered

September 21, 2010 --  One of the requirements of the Patient Protection and Affordable Care Act (PPACA) that becomes applicable to all health plans, grandfathered or not, on the 1st day of the 1st plan year beginning on or after September 23, 2010, is a requirement to remove all so-called “lifetime limitations” and “annual limitations” on essential benefits.  There is a phase-in period placed on annual limits.  From now until January 1, 2014, the following schedule applies to annual limits on the dollar value of essential benefits:

September 9, 2010

VCP Relief for Sponsors of Pre-Approved Defined Contribution Plans

The IRS, in its Summer 2010 edition of Retirement News for Employers, explains some welcome relief for plan sponsors of pre-approved defined contribution plans that failed to adopt an approved restated document, or file for a determination letter application, by the April 30th deadline.  These types of plans, with some exceptions, were to have been amended for the Economic Growth and Tax Relief Reconciliation Act of 2001 (EGTRRA) restatement deadline on or before April 30, 2010. 

September 9, 2010

IRS COBRA Subsidy FAQs Updated

Recently, the IRS has updated its FAQs relating to the COBRA subsidy (note Q&As AE-36 and AE 38-50).  The COBRA subsidy, enacted originally on February 17, 2009, and extended several times, expired on May 31, 2010.

September 7, 2010

HRB 19 - Over-the-Counter Medication Prohibition Clarified

September 7, 2010 --  Currently, health plans, including medical flexible spending accounts (FSAs), health reimbursement arrangements (HRAs), health savings accounts (HSAs), and Archer medical savings accounts (Archer MSAs), may provide reimbursement for non-prescribed over-the-counter (“OTC”) drugs.  One of the many things that the health care reform law accomplished was to add a new section to Internal Revenue Code, specifically, IRC Section 106(f).  This new Code section states that reimbursement of expenses by these types of health plans for OTC medications is only permissible if the OTC drug is prescribed, or is insulin.  This change in the law does not affect the purchase of OTC items not considered medications, such as crutches, bandages, or blood sugar test kits.

September 1, 2010

HRB 18 - Update: Early Retiree Reinsurance Program

September 1, 2010 --  The Early Retiree Reinsurance Program (ERRP), established as part of the PPACA, is a program designed to encourage employers to establish or maintain retiree health coverage for their retirees, aged 55 to Medicare entitlement.  The ERRP will pay the equivalent of up to 80% of an early retiree’s claim between $15,000 and $90,000.  To be eligible for the program, an application must be filed with HHS; the application process opened on June 29, 2010. 

September 1, 2010

HRB 17 - Simple Cafeteria Plans

September 1, 2010 --  Included in the PPACA is a provision for a so-called, “simple cafeteria plan”.  A cafeteria plan, pursuant to IRC §125, is a plan that allows employees to purchase certain benefits on a tax-favored basis.  In effect, a cafeteria plan allows an employee to choose between tax-favored benefits, such as health coverage, life insurance coverage, or dependent care assistance, among others, and taxable compensation. 

August 30, 2010

HRB 16 - Federal External Claims Review: Interim Procedures and Model Notices

August 30, 2010 --  The PPACA requires health plans to comply with new internal claims and appeals procedures, and external review procedures (see Internal Claims and Appeals, and External Review Process).  These provisions become applicable to both non-grandfathered and plans that lose grandfathered status on the first day of the first plan year beginning on and after September 23, 2010. Interim guidance (Technical Release 2010-01) has just been issued, specifically relating to the external review process that is to be used by self-funded plans subject to ERISA1

August 24, 2010

HRB 15 - Salary-based Discrimination Rules Applicable to Fully Insured Group Health Plans

August 24, 2010 -- Among the myriad provisions of the Patient Protection and Affordable Care Act, lies a sleeping python. It is in the form of salary-based discrimination rules that are extended to fully insured group health plans.
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