This webinar focused on Common Compliance questions from the following areas: ERISA, COBRA, HIPAA, Cafeteria Plans, HSAs, and Health Care Reform.

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2. Copyright 2014- Not to be reproduced without express permission of Benefit Express Services, LLC
Common Compliance
Questions
By
Larry Grudzien
Attorney at Law
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Agenda
• ERISA
• COBRA
• HIPAA
• Cafeteria Plans
• HSAs
• Health Care Reform
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ERISA
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• Does an employer with under 100 participants in their medical plan need
a plan document?
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ERISA

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• When is a benefit considered funded for purposes of ERISA?
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ERISA

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• When is an employee assistance plan and/or a wellness program subject
to ERISA?
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ERISA

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• When is a employee paid only benefit subject to ERISA?
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ERISA

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• Is there a statute of limitations on unfiled Form 5500s’?
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ERISA

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• Is an employer required to cover same sex spouses under its health and
welfare plans under ERISA?
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ERISA

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COBRA
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• Can qualified beneficiaries change and add benefits at open enrollment?
• Do qualified beneficiaries have special enrollment rights?
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COBRA

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• If coverage ends for retirees, does the employer have to give them the right
to elect COBRA?
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COBRA

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• When does entitlement to Medicare terminate COBRA coverage and
when?
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COBRA

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• Does an employer have to offer COBRA to participants in employee
assistance programs and wellness programs?
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COBRA

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• How does health care reform affect COBRA?
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COBRA

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HIPAA
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• What benefits are considered “excepted” and why it is important?
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HIPAA

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• If an employer wants to charge a smoker a higher premium, must it meet
the requirements for a wellness program under the HIPAA regulations?
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HIPAA

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• Can employer deny coverage under a health plan to an employee if he or
she does not participate in a employer sponsored wellness program?
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HIPAA

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Cafeteria Plans
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• Can premiums from individual policies be reimbursed pre-tax under a
cafeteria plan?
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Cafeteria Plan

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• If an employer switches to a High Deductible Health Plan in the
middle of the year, can employees have the right to change their
election for coverage under the health FSA?
• Can a change in cost or coverage be a reason to change an election
under a health FSA?
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Cafeteria Plan

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• Can an employer give an employee the right to change the character of
any carryover?
• Will the carryover make an employee ineligible to make a HSA
contributions for the next year?
• How does an employer determine the COBRA premium on a carryover?
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Cafeteria Plan

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• My employees want to drop our coverage and elect coverage on the
exchange. Is that a qualifying event?
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Cafeteria Plan

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• Is an employer required to recognize same sex spouses as spouses
under its cafeteria plan?
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Cafeteria Plan

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HSAs
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• An employee is covered by a HDHP. He also covers his spouse. His
spouse has other coverage that is not a HDHP. Can he contribute at the
family coverage level?
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HSAs

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• An employee covers himself, his wife and their sons age 21, 22 and 24 in
a HDHP. He does not claim his sons as tax dependents.
• Are his son’s eligible to contribute to their own HSA. If so, how much?
• Can the employee reimburse his son’s medical expenses from his HSA?
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HSAs

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• An employee participates in a HDHP with his wife and children. His wife
also participates in a health FSA at work. She can be reimbursed for his
medical expenses under the Health FSA, but does not submit any for him
for the year.
• Does that affect his eligibility to contribute to an HSA for the year?
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HSAs

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• Can a husband and wife have a joint HSA?
• If an individual has single coverage and contributes at the single
coverage rate can he or she reimburse expenses for his wife and
children?
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HSAs

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Health Care
Reform
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• When is the employer mandate effective?
• January 1, 2015 or on the employer’s renewal date?
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Health Care Reform

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• In determining whether an employer is large employer for employer
mandate purposes, are seasonal and part-time employees considered in
the count?
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Health Care Reform

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• Does the 30 hour requirement for full-time employees apply to small
employers?
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Health Care Reform

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• Can employer sponsor a stand alone Health Reimbursement Arrangement
in 2014?
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Health Care Reform

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• Do seasonal or variable hour employees have to be offered coverage in
2015?
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Health Care Reform

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• For the subsidies, how are they determined and what happens if your
income does up or down during the year?
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Health Care Reform

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• Do you have to be a citizen to be eligible to buy coverage on the exchange
and obtain a credit or subsidy?
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Health Care Reform

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Larry Grudzien
Attorney at Law
708.717.9638
larry@larrygrudzien.com
www.larrygrudzien.com
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Contact Information