group health
This blog was originally posted on July 13, 2017.
Group health plans are almost always subject to the Employee Retirement Income Security Act of 1974, also known as ERISA.
This means employers must follow certain rules, such as:
- Providing participants with important information in writing about plan features and funding.
- Establishing an appeal and grievance process for participants to receive benefits from the plan.
Posted October 10th, 2017 in Producers, Employers, Individuals
The Affordable Care Act (ACA) requires most health insurance plans to cover in-network preventive care at 100%, including coverage for prescribed contraceptives available to women. This has sparked some controversy with organizations who have a religious objection to the use of contraceptives. The Obama administration addressed this controversy by doing the following:
- Exempted group health plans offered by churches and houses of worship from providing coverage for contraceptives if there was a religious objection.
Group health plans are almost always subject to the Employee Retirement Income Security Act of 1974, also known as ERISA.
This means employers must follow certain rules, such as:
- Providing participants with important information in writing about plan features and funding.
- Establishing an appeals and grievance process for participants to receive benefits from the plan.
- Providing fiduciary responsibilities for those who manage and control plan assets.
The Internal Revenue Service (IRS) issued Notice 2016-70 on November 18, 2016 which provides some relief to insurers, employers and other entities subject to ACA reporting requirements under Code Section 6055 and 6056. The Notice does not extend the due date of the filing requirement for the 2016 year, but it does extend the due date in which copies of the reporting forms must be provided to employees and individuals. The due dates are now as follows:
Group health plans typically make coverage available to current or former employees and their spouses and children. However, some employers extend coverage to certain groups of non-employees. The most common example would be letting a business owner participate in the plan. Most types of business owners aren’t classified as employees for tax purposes, but rather they are said to be self-employed.
The Internal Revenue Service (IRS), Social Security Administration (SSA), and the Centers for Medicare & Medicaid Services (CMS) are required to share information that each agency has about whether Medicare beneficiaries or their spouses are working. This sharing of information is referred to as the IRS-SSA-CMS Data Match, and the purpose of the Data Match is to identify situations where another group health plan may be primary to Medicare. In general, a group health will be primary to Medicare when:
The fourth installment of the Patient-Centered Outcomes Research Institute (PCORI) fees will be due on July 31, 2016.
As its name suggests, PCORI is a research institute, and it was created by the Affordable Care Act (ACA) as a way to improve clinical effectiveness. It is partially funded by fees charged to health plans.
The following list contains information and some reminders about the upcoming PCORI fee that is due:
Posted June 7th, 2016 in Producers, Employers, Individuals
Telemedicine can generally be defined as a way to provide a broad range of health-related services by phone or through an online platform. Several employers and insurance carriers offer telemedicine services in conjunction with their health plan(s) as a way to provide a cheaper alternative of diagnosing and treating common illnesses, such as the cold or flu.
The Illinois Department of Insurance (IDOI) issued a bulletin on March 20, 2015 as it relates to the renewal of certain health plans in 2016. In particular, the bulletin indicates that certain health plans may continue to be renewed for plan years on or before October 1, 2016 without being considered out of compliance with Affordable Care Act (ACA) regulations.
The bulletin impacts the following plan types:
The IRS and other agencies have issued three different sets of guidance making it clear that employers cannot give actively employed workers pre-tax dollars through a Health Reimbursement Arrangement (HRA) ,or any other type of arrangement, to purchase individual coverage on their own.
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