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October 13, 2011

Medicare Mandatory Reporting for HRAs: Increased Threshold Levels and Exhausted Account Balances

As a means of enforcing the Medicare Secondary Payer (MSP) Rules, the Centers for Medicare and Medicaid Services (CMS) impose a reporting requirement upon insurers, third party administrators, and plan administrators of self-funded, self-administered group health plans.  CMS considers health reimbursement arrangements (HRAs) to be a group health plan for purposes of the MSP rules; and thus, subject to the Medicare Mandatory Reporting Requirement (see prior Benefit Beat articles, Mandatory Medicare Reporting for HRAs Clarified, Aug, 2010, and Updated Information: Mandatory Medicare Reporting for HRAs, June, 2010). 

October 13, 2011

Should You Re-Classify Your Employees?

Employment classification has created much angst between government agencies, both federal and state, and employers.  At the heart of this conflict is whether an individual should be classified as an independent contractor, or as an employee.  Contrary to popular belief, an employer does not necessarily have the discretion to classify employees as independent contractors, or as common law employees; rather, it is determined by the facts and circumstances of the work relationship.  

August 30, 2011

Expiration of COBRA Subsidy

The COBRA premium assistance subsidy ended May 31, 2010, and has not been reinstated. Therefore, individuals who were involuntarily terminated after May 31, 2010, do not qualify for the subsidy. However, individuals who qualified for the subsidy on or before May 31, 2010 could continue to pay reduced premiums for the full subsidy period (15 months), as long as they are not eligible for another group health plan or Medicare.  For employees who elected the subsidy in May 2010, and had no access to other health coverage since, their 15 months of COBRA premium subsidies expired at the end of August 2011. There may be some additional months of subsidy available in the limited situations in which a qualifying event on or before May 31, 2010, but COBRA did not commence until some date thereafter.

August 30, 2011

Keeping Medical Information Confidential

What can employers do with medical information, particularly medical information that is protected by the Americans with Disabilities Act (ADA) or the Genetic Information Nondiscrimination Act (GINA), is an open-ended question.  The Equal Employment Opportunity Commission (EEOC) is the division of the Department of Labor responsible for administering both the ADA and GINA.  The EEOC has recently issued two informal, non-binding Opinion Letters expressing some thoughts on these matters. 

August 30, 2011

Reminder: Change in Medicare Part D Open Enrollment Period

As mentioned earlier this year (see Medicare Part D Updates, Benefit Beat, May 2011), the health care reform law changed the Medicare Part D annual enrollment period.  Beginning this year, the Medicare Part D enrollment period will take place from October 15, 2011 through December 7, 2011.   Therefore, all Medicare Part D notices of creditable or non-creditable coverage must be provided prior to October 15, 2011.  CMS issued revised model Notices of Creditable and Non-Creditable Coverage to be used on or after April 1, 2011, in both English and Spanish:

August 30, 2011

Updated Medicaid/CHIP Premium Assistance Notice Issued

Individuals who are eligible for employer-sponsored group health coverage, but are unable to afford the premium, may be eligible to receive premium assistance from a state’s Medicaid agency or CHIP program.  Employers are required to provide premium assistance information to their employees.  This can be accomplished by using a model notice provided by the Department of Labor (see Medicaid/CHIP Premium Assistance Notice Issued, Benefit Beat, 3/4/10).  The DOL has recently released its revised Medicaid/CHIP notice that can be obtained from its website (click here for 7/31/11 version).

August 23, 2011

HRB 39 - Relief for Stand-Alone Health Reimbursement Arrangements

August 23, 2011 -- Some welcome new guidance for stand-alone health reimbursement arrangements (HRAs) has just been issued by the HHS’ Center for Consumer Information and Insurance Oversight (CCIIO). As background, the Affordable Care Act prohibits health plans from imposing annual and lifetime limits. Certain plans, primarily so-called "mini-med plans," can seek a waiver from the prohibition of annual and lifetime limit provision. Earlier guidance on this issue exempted integrated HRAs. CCIIO has now issued a class exemption for stand-alone HRAs that were in existence on September 23, 2010.

August 18, 2011

HRB 38 - Proposals on Exchanges, Premium Assistance and Uniform Benefit Summary

August 18, 2011 -- In recent days, the governing Agencies (HHS, DOL and IRS) responsible for implementing the Patient Protection and Affordable Care Act (referenced as the “Affordable Care Act” or “ACA”) have been busy.  A number of proposed guidance have been issued, specifically relating to Exchanges, premium assistance (“Health Insurance Premium Tax Credit”), and perhaps of most interest to employers, the uniform benefits summary, now dubbed the Summary of Benefits and Coverage (SBC). 

August 8, 2011

Extension for Self-Reporting of Welfare Benefit Plan Violations

For the past two years, it has been incumbent upon employers sponsoring group health plans, as well as certain other responsible entities, such as insurers or third party administrators, to self-report certain welfare benefit plan violations (see Welfare Benefit Plan Violations: Self-Reporting Required from the November 2009 Benefit Beat).  Such violations would include those relating to:

August 8, 2011

San Francisco HCSO Expenditure Rates for 2012

Covered employers who are subject to San Francisco’s Ordinance are required to make health care expenditures (HCE) to, or on behalf of, their covered employees.  These expenditure amounts are adjusted annually, in accordance with the San Francisco Ordinance.  Nonprofit entities with fewer than 50 employees, and small employers (those with fewer than 20 employees) are exempt from these provisions. 

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