Employee Benefits

If your business has 2 or 200 employees we can save you 20-60% over what your present group helath plan offers without raising deductibles!  Let us explain how.  Did you know there are two little known features of the Afordable Care Act that benefit companies seldom offer to their clients that would greatly lower cost?  Why not?  The answer is either (1) Ignorance of these new features; (2) Greed- more money is made if these features are not mentioned; (3) Laziness- these features require more work on the part of the benefits company.

Compliance....Let us help you

Many CPAs and employers consider administering a HRA or HRP without proper HRP administration software. CPAs and employers often overlook important compliance obligations that put you at financial risk. Read on for an overview of why you need compliant HRA software. Failure to comply with the following requirements can be costly. monopoly go to jail card

Affordable Care Act (ACA) Requirements

The following ACA (federal health reform) pieces apply to HRA's and HRPs in certain cases:

  • Dependent Coverage for Adult Children up to Age 26
  • Coverage of Preventative Care Without Cost-Sharing
  • Annual and Lifetime Limit Rules
  • Over-the-Counter Medicines and Drugs Require Prescription
  • Form 720: Fees to Fund Research on Patient-Centered Outcomes
  • Summary of Benefits and Coverage (SBC)
  • 60-day Material Modifications
  • Form W-2 Reporting of Employer-Sponsored Health Coverage
  • Internal and External Claims and Appeals Processes for Health Claims

HIPAA Privacy

An HRP is a self-funded health plan and governed by the HIPAA Privacy Rules.  Employers that offer a fully-insured health plan and sponsor an HRP often overlook their HIPAA Privacy obligations.  In order to administer an HRP, the entity processing the claims receives protected health information (PHI) which is protected by HIPAA. Employers that offer a fully-insured health plan will rely on the insurance carrier to comply with the HIPAA Privacy Rules. However, the HRP compliance obligations rest with the employer.  Employers that do not comply can be subject to civil penalties of up to $100 per violation. Learn more about HIPAA Privacy for HRAs.

COBRA

An HRA is a group health plan subject to COBRA.  Employees that experience a qualifying event are entitled to continuation coverage under the employer’s HRA.  An employer that fails to extend COBRA coverage to HRA participants can be subject to substantial fines. Employers can be fined up to $110 per day for failure to provide an initial notice or election notice. Learn more about COBRA and HRAs.

Medicare Reporting

An HRA is a group health plan subject to Medicare Secondary Payer (MSP) provisions. New reporting requirements went into effect in the fourth quarter of 2010.  Employers are required to provide HRA coverage information to the Centers for Medicare and Medicaid Services (CMS).  The information reported to CMS will allow better coordination of payer responsibilities between the group health plan and Medicare. Failure to comply could result in fines of up to $1,000 per day. Learn more about HRAs and medicare secondary reporting.

IRS Plan Documents

An HRA is an employee welfare plan under ERISA.  ERISA requires that every [welfare] plan be established and maintained pursuant to a written instrument.  The written instrument or plan document serves to define what expenses are eligible for reimbursement, the amount of employer contribution, and whether the funds may be rolled over from year to year.  Not only could an enforcement action be brought against an employer for failure to have a plan document, but it is difficult for the employer to prove plan terms and enforce its provisions. Learn more about HRA plan documents.

ERISA-Compliant Reimbursement of Individual Health Plans

The U.S. federal government has specific regulations that employers must comply with in order to reimburse employees for individual health insurance premiums without triggering ERISA plan status for the individual health insurance policies. Learn more about ERISA compliant individual policy reimbursement.