This presentation reviews the topic of Medicare and how it can affect Employers Health Coverage offerings, including: employer secondary rules, COBRA, notice requirements, and reporting requirements.
This presentation reviews: what information must be protected, what policies and procedures need to be in place, what disclosures have to be given to employees, what agreements have to be in place for business associates, and what breach procedures have to be followed.
This presentation covers how Medicare affects employer health coverage in: Providing opt out amounts | Paying for Medicare for active employees | Electing COBRA
This webinar covers a basic review of the requirements under ERISA, including: what is an ERISA benefit, what documentation requirements have to be met, what disclosure requirements have to be met, what reporting requirements need to be met, what is a fiduciary, and what are other requirements.
The Marketplace: What Every Employer Should Knowbenefitexpress
This presentation helps assist employers in talking to their employees about the Marketplace. It will cover all you need to know about the Marketplace.
Cadillac Tax for Employers 101 - How to Avoid Penalties?benefitexpress
This webinar covers: what coverages are subject to the tax, how the excise tax is determined, what adjustments will be available in determining the tax, and who collects the tax.
Temporary Employees and the Employer Mandatebenefitexpress
This presentation reviews - when temporary employees become your employees, the factors the government uses to determine employment status, the steps you can take to avoid these employees becoming your employees, and consequences under Health Care Reform if it is determined that they are your employees.
Independent Contractor or Employee: Avoiding the Game of Guess Whobenefitexpress
Uber is in the news for a multimillion dollar settlement following a dispute over whether their drivers are employees or independent contractors, and they aren’t the only ones. Misclassifying an employee as an independent contractor is one of the costliest mistakes an employer can make.
Sort out which your employees are and learn your options for reclassifying workers in the webinar you literally can’t afford to miss.
This presentation reviews: what information must be protected, what policies and procedures need to be in place, what disclosures have to be given to employees, what agreements have to be in place for business associates, and what breach procedures have to be followed.
This presentation covers how Medicare affects employer health coverage in: Providing opt out amounts | Paying for Medicare for active employees | Electing COBRA
This webinar covers a basic review of the requirements under ERISA, including: what is an ERISA benefit, what documentation requirements have to be met, what disclosure requirements have to be met, what reporting requirements need to be met, what is a fiduciary, and what are other requirements.
The Marketplace: What Every Employer Should Knowbenefitexpress
This presentation helps assist employers in talking to their employees about the Marketplace. It will cover all you need to know about the Marketplace.
Cadillac Tax for Employers 101 - How to Avoid Penalties?benefitexpress
This webinar covers: what coverages are subject to the tax, how the excise tax is determined, what adjustments will be available in determining the tax, and who collects the tax.
Temporary Employees and the Employer Mandatebenefitexpress
This presentation reviews - when temporary employees become your employees, the factors the government uses to determine employment status, the steps you can take to avoid these employees becoming your employees, and consequences under Health Care Reform if it is determined that they are your employees.
Independent Contractor or Employee: Avoiding the Game of Guess Whobenefitexpress
Uber is in the news for a multimillion dollar settlement following a dispute over whether their drivers are employees or independent contractors, and they aren’t the only ones. Misclassifying an employee as an independent contractor is one of the costliest mistakes an employer can make.
Sort out which your employees are and learn your options for reclassifying workers in the webinar you literally can’t afford to miss.
Employee vs. Independent Contractor - How to Differentiate and Avoid Penalties?benefitexpress
This presentation reviews: which factors the IRS uses to determine common law employee status | how does this affect compliance with ACA | what penalties may apply.
Medicare & Employer Health Coverage - a Coordination Conversationbenefitexpress
Let's talk about Medicare and Employer Health Coverage. The rules on coordinating Medicare and employer coverage can be complex. How it complements other programs (such as COBRA, HSAs and the ACA) are also areas of question for both employees and their employers.
Medicare Rule Review: Overview of Secondary Payersbenefitexpress
Learn how the Medicare Secondary Payer Rules impact an employer’s health and welfare plans. This covers which employers are subject, what employers can do to comply, and the penalties that can be imposed for noncompliance.
Completing ACA Reporting for Employers With Self-Insured Coveragebenefitexpress
This presentation reviews how to complete Forms 1094-C and 1095-C for employers with self-insured coverage, in addition to: What codes to use in lines 14 and 16 of Form 1095-C | What boxes should be checked on line 22 of Form 1094-C | How Form 1094-C has to be completed if your employer is a member of a controlled group | Reporting for COBRA participants, retirees, and other non-employees for self-insured coverage
In today's multi-generational workforce, health and wellness benefits are weighted equally with salary expectations. This is why it's important for small and large businesses alike to embrace health and wellness benefits to recruit top talent as well as retain valued employees.
While offering these benefits has been shown to improve employee engagement and productivity, it comes with some challenges. This webinar reviews common questions human resources professionals confront when offering health and welfare benefits to employees.
Facilitated by ERISA attorney Larry Grudzien, this webinar covers the following:
- Questions Surrounding Tax
- Reporting Disclosures
- ERISA, COBRA & FMLA
- Workers Compensation
- Affordable Care Act (ACA)
Benefits are a critical piece of an employee compensation package, with health care benefits reigning most important. Whether you're already offering these benefits or considering adding them to your benefits offerings, view our webinar to learn more and remain competitive in the talent marketplace.
Review all of the requirements of the Employee Retirement Income Security Act of 1974. Training will go over which employers have to comply, which benefits are subject to ERISA, what documentation employers must provide, and penalties for noncompliance.
[Medi]Caring About Delayed Retirement: A Closer Look at Medicare Strategybenefitexpress
With questions about millennials dominating our conversations about benefits, it’s easy to forget that the work force is growing from both ends. Baby boomers are delaying retirement while millennials (and even Gen Z) start their careers. As boomers become Medicare eligible, many remain on their employer’s coverage, whether or not that’s the best choice for them. Get the tools you need to:
- Navigate paying claims
- Understand how Medicare interacts with COBRA and other healthcare
- Lead eligible employees through their options
- Craft a compliant notification strategy
Completing aca reporting for employers with insured coveragebenefitexpress
This webinar reviews how to complete Forms 1094-C and 1095-C for employers with insured coverage, in addition to: what codes to use in lines 14 and 16 of Form 1095-C | what boxes should be checked on line 22 of Form 1094-C | how Form 1094-C has to be completed if your employer is a member of a controlled group | reporting for COBRA participants, retirees, and other non-employee issues.
Covert Taxes: Spying Issues in Health & Welfare Benefitsbenefitexpress
Avoid a tax season surprise and make sure your benefits are actually beneficial to your employees. It’s time to ensure you’re keeping your plan non-taxable to your employees and tax deductible for you by learning:
- How to pass the Benefits Test
- Common pitfalls in nondiscrimination requirements
- Covered plans beyond basic health and disability insurance
- The best way to provide tuition assistance to employees
Get your maximum deduction come tax time while maintaining your top-tier benefits with this webinar, featuring advice from benefits attorney Larry Grudzien.
Webinar: Mid-Year Election Changes for Cafeteria Plansbenefitexpress
Let's talk about cafeteria plans. When can participants make election changes?
While cafeteria plans can be a great option for employees wishing to pick and choose benefits based on cost, when and how to facilitate election changes outside of open enrollment can be tricky to navigate for employers. As the use of cafeteria plans continue to grow, we take a deeper look at the rules and regulations of these plans, particularly as they pertain to mid-year election changes.
With Department of Labor audits on the rise, this presentation reviews all the requirements under ERISA. This includes the requirements for plan documents, disclosures and reporting.
Navigate New Legislation: The Road Into 2017benefitexpress
As new regulations kick in for 2017 and ACA reporting season is coming to a close, review all recent legislative changes. This webinar focuses on what you need to know for your 2017 benefits strategy.
Learn about new legislation from DOL, HHS, IRS, and EEOC. ERISA attorney Larry Grudzien will cover all relevant rulings since his previous webinar and host an interactive Q&A with the audience.
FSAs can do some heavy lifting for your benefits plan – they allow employees to save pretax dollars for healthcare costs without the price tag of other financial wellness initiatives. However, many HR professionals lack a deep understanding of the compliance requirements to offer and administer a well-rounded program for their employees.
If ACA is repealed, there will be significant implications for FSAs. Devise your strategy to:
- Accurately catch employee election changes
- Manage rollover requirements
- Determine who pays first – HSA vs FSA
- Understand COBRA’s impact on an FSA
Get coaching from benefits attorney Larry Grudzien on how to prep now for the legislative impact on FSA administration.
Review the requirements for offering HSAs. This will include what coverages must be offered, documentation to be completed, what rules the employer and employee must follow (including HSA employer contribution rules), and commonly made mistakes.
Constructing HRA: Blueprints for Solid Administrationbenefitexpress
Learn the ins and outs of offering a private benefits marketplace for your employees, HRA administration, and various agencies regulating what's included.
6 Facts/Updates You Must Know About the Employer Mandatebenefitexpress
This webinar covers:
• What is a large employer and how to determine it?
• Coverage requirements
• Penalties
• Who is a full time employee and how to determine it?
• Who is a variable hour employee?
• Reporting requirements
Understanding Health Care Reform: A Dose of Accounting MedecineJames Moore & Co
The affordable Care Act was signed into law on March 23, 2010 and upheld by the Supreme Court in June 2012. These reform measures will have wide-spread impacts to most businesses and individuals. In this presentation, we discuss the tax consequences, small business health care credits, fees, and provide a summary of the Affordable Care Act and the status of reform.
Employee vs. Independent Contractor - How to Differentiate and Avoid Penalties?benefitexpress
This presentation reviews: which factors the IRS uses to determine common law employee status | how does this affect compliance with ACA | what penalties may apply.
Medicare & Employer Health Coverage - a Coordination Conversationbenefitexpress
Let's talk about Medicare and Employer Health Coverage. The rules on coordinating Medicare and employer coverage can be complex. How it complements other programs (such as COBRA, HSAs and the ACA) are also areas of question for both employees and their employers.
Medicare Rule Review: Overview of Secondary Payersbenefitexpress
Learn how the Medicare Secondary Payer Rules impact an employer’s health and welfare plans. This covers which employers are subject, what employers can do to comply, and the penalties that can be imposed for noncompliance.
Completing ACA Reporting for Employers With Self-Insured Coveragebenefitexpress
This presentation reviews how to complete Forms 1094-C and 1095-C for employers with self-insured coverage, in addition to: What codes to use in lines 14 and 16 of Form 1095-C | What boxes should be checked on line 22 of Form 1094-C | How Form 1094-C has to be completed if your employer is a member of a controlled group | Reporting for COBRA participants, retirees, and other non-employees for self-insured coverage
In today's multi-generational workforce, health and wellness benefits are weighted equally with salary expectations. This is why it's important for small and large businesses alike to embrace health and wellness benefits to recruit top talent as well as retain valued employees.
While offering these benefits has been shown to improve employee engagement and productivity, it comes with some challenges. This webinar reviews common questions human resources professionals confront when offering health and welfare benefits to employees.
Facilitated by ERISA attorney Larry Grudzien, this webinar covers the following:
- Questions Surrounding Tax
- Reporting Disclosures
- ERISA, COBRA & FMLA
- Workers Compensation
- Affordable Care Act (ACA)
Benefits are a critical piece of an employee compensation package, with health care benefits reigning most important. Whether you're already offering these benefits or considering adding them to your benefits offerings, view our webinar to learn more and remain competitive in the talent marketplace.
Review all of the requirements of the Employee Retirement Income Security Act of 1974. Training will go over which employers have to comply, which benefits are subject to ERISA, what documentation employers must provide, and penalties for noncompliance.
[Medi]Caring About Delayed Retirement: A Closer Look at Medicare Strategybenefitexpress
With questions about millennials dominating our conversations about benefits, it’s easy to forget that the work force is growing from both ends. Baby boomers are delaying retirement while millennials (and even Gen Z) start their careers. As boomers become Medicare eligible, many remain on their employer’s coverage, whether or not that’s the best choice for them. Get the tools you need to:
- Navigate paying claims
- Understand how Medicare interacts with COBRA and other healthcare
- Lead eligible employees through their options
- Craft a compliant notification strategy
Completing aca reporting for employers with insured coveragebenefitexpress
This webinar reviews how to complete Forms 1094-C and 1095-C for employers with insured coverage, in addition to: what codes to use in lines 14 and 16 of Form 1095-C | what boxes should be checked on line 22 of Form 1094-C | how Form 1094-C has to be completed if your employer is a member of a controlled group | reporting for COBRA participants, retirees, and other non-employee issues.
Covert Taxes: Spying Issues in Health & Welfare Benefitsbenefitexpress
Avoid a tax season surprise and make sure your benefits are actually beneficial to your employees. It’s time to ensure you’re keeping your plan non-taxable to your employees and tax deductible for you by learning:
- How to pass the Benefits Test
- Common pitfalls in nondiscrimination requirements
- Covered plans beyond basic health and disability insurance
- The best way to provide tuition assistance to employees
Get your maximum deduction come tax time while maintaining your top-tier benefits with this webinar, featuring advice from benefits attorney Larry Grudzien.
Webinar: Mid-Year Election Changes for Cafeteria Plansbenefitexpress
Let's talk about cafeteria plans. When can participants make election changes?
While cafeteria plans can be a great option for employees wishing to pick and choose benefits based on cost, when and how to facilitate election changes outside of open enrollment can be tricky to navigate for employers. As the use of cafeteria plans continue to grow, we take a deeper look at the rules and regulations of these plans, particularly as they pertain to mid-year election changes.
With Department of Labor audits on the rise, this presentation reviews all the requirements under ERISA. This includes the requirements for plan documents, disclosures and reporting.
Navigate New Legislation: The Road Into 2017benefitexpress
As new regulations kick in for 2017 and ACA reporting season is coming to a close, review all recent legislative changes. This webinar focuses on what you need to know for your 2017 benefits strategy.
Learn about new legislation from DOL, HHS, IRS, and EEOC. ERISA attorney Larry Grudzien will cover all relevant rulings since his previous webinar and host an interactive Q&A with the audience.
FSAs can do some heavy lifting for your benefits plan – they allow employees to save pretax dollars for healthcare costs without the price tag of other financial wellness initiatives. However, many HR professionals lack a deep understanding of the compliance requirements to offer and administer a well-rounded program for their employees.
If ACA is repealed, there will be significant implications for FSAs. Devise your strategy to:
- Accurately catch employee election changes
- Manage rollover requirements
- Determine who pays first – HSA vs FSA
- Understand COBRA’s impact on an FSA
Get coaching from benefits attorney Larry Grudzien on how to prep now for the legislative impact on FSA administration.
Review the requirements for offering HSAs. This will include what coverages must be offered, documentation to be completed, what rules the employer and employee must follow (including HSA employer contribution rules), and commonly made mistakes.
Constructing HRA: Blueprints for Solid Administrationbenefitexpress
Learn the ins and outs of offering a private benefits marketplace for your employees, HRA administration, and various agencies regulating what's included.
6 Facts/Updates You Must Know About the Employer Mandatebenefitexpress
This webinar covers:
• What is a large employer and how to determine it?
• Coverage requirements
• Penalties
• Who is a full time employee and how to determine it?
• Who is a variable hour employee?
• Reporting requirements
Understanding Health Care Reform: A Dose of Accounting MedecineJames Moore & Co
The affordable Care Act was signed into law on March 23, 2010 and upheld by the Supreme Court in June 2012. These reform measures will have wide-spread impacts to most businesses and individuals. In this presentation, we discuss the tax consequences, small business health care credits, fees, and provide a summary of the Affordable Care Act and the status of reform.
Staffscapes, Inc. is a Human Resources Outsourcing firm that specializes in HR, Payroll & Benefits. We recently presented this slide show to a group of Colorado Small Business Owners and Managers and are sharing it with the general public today.
Latest and Greatest in HRA's and Cafeteria Plansbenefitexpress
This webinar covers:
• New guidance in the Health FSA carryover requirements
• Can individual premiums be reimbursed under HRA's or cafeteria plans?
• New rules on integrated HSA's and standalone HRA's
• When are health FSA's subject to Health Reform?
• New reporting and disclosure requirements
The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows individuals to continue their group health plan coverage in certain situations. Specifically, COBRA requires group health plans to offer continuation coverage to covered employees and dependents when coverage would otherwise be lost due to certain specific events...
The article below describes a new health care reform development (additional federal agency guidance on prohibition of premium reimbursement arrangements).
2016 Developments in HRA Administration: Reviewing Recent IRS Guidancebenefitexpress
This webinar reviews: the recent IRS guidance in HRA administration, when HRAs are free standing, what requirements must be met to be integrated, and HRA reimbursed Medicare premiums.
This presentation covers all the compliance issues with HSA's as well as: which employees are eligible, contribution requirements, distributions requirements, and reporting requirements.
69% of small business owners are either not prepared for the October 1st deadline with ObamaCare or do not even know what to do about Healthcare Reform.............
WAKE UP!!!
As a business owner you need to be a cut above the rest.
Find out what you need to do to protective yourself and take advantage of certain parts in this major American milestone.
This webinar will covers:
• What is COBRA?
• When does it need to be provided?
• What are the triggering events?
• How long does it have to be provided?
• What are notice requirements?
• Payment requirements
Similar to How Medicare Affects Employer Health Coverage (20)
COVID-19 Health & Welfare: Compliance for Employersbenefitexpress
As part of our continuing ERISA Compliance series, we covered such compliance topics and more in our April 9th webinar discussing COVID-19 and updates from the IRS and DOL concerning the Families First Coronavirus Response Act.
Plan Sponsor Webinar: Navigating COVID-19 for Employersbenefitexpress
In this webinar, we take a deeper look into how the novel coronavirus is not only affecting the way we live, but changing the way we work. From remote work environments, FMLA, contract agreements and more, we discuss how to navigate the changing workforce during this time of uncertainty, and answer questions to help you make the best decisions for the health and safety of your employees.
Part of our ERISA Compliance Series, this webinar is hosted by ERISA Attorney Larry Grudzien and moderated by chief marketing officer Julia Goebel. This webinar will discuss the top wage and hour issues that may be unknowingly lurking within your company.
The Affordable Care Act touches the lives of most Americans. In fact, nearly 21 million will be at risk if Obamacare is struck down, and may even lose health insurance completely if the law is ruled unconstitutional. This webinar will discuss what the outcome may be if ACA is repealed.
Watch our free one-hour webinar reviewing the rules for the new Individual Coverage HRA and the new Excepted Benefit HRA (ICHRA and EBHRA).
In June 2019, Treasury, DOL and HHS released final regulations that are effective for plan years beginning on or after January 1, 2020. These regulations created two new HRAs, Individual Coverage HRAs (ICHRA) and Excepted Benefit HRAs (EBHRA).
These new HRAs will be subject to ERISA and COBRA, but will not be subject to the nondiscrimination rules under Code Section 105(h). Any employer can offer these new HRAs to their employees. They can be offered to common law employees, but cannot be offered to self-employed individuals, partners and more than 2% S-Corporation shareholders.
Facilitated by ERISA attorney Larry Grudzien, and moderated by Chief Marketing Officer Julia Goebel, this webinar will cover the following:
-Why are these new HRAs so important?
-Which employees can be included or excluded
-What documentation is needed to be completed by employers to adopt them
-What reporting and disclosure requirements must be met
-What types of expenses can be reimbursed
-The pros and cons of establishing and participating in these new HRAs for employers
How to Administer Wellness Programs in Today's Regulatory Environmentbenefitexpress
Are you struggling to make sense of the recent legislative updates surrounding employer sponsored wellness programs? Perhaps you are trying to decide whether to continue with current wellness plans, modify your plans without guidance from the EEOC, postpone new wellness programs or discontinue them all together.
It’s a complicated landscape ripe with several options for “next steps” for employees and plan sponsors of wellness plans in 2019 — with perhaps the biggest barrier of all being that employers cannot measure the risk of wellness plans at this time.
To help guide you through this maze of options, watch our one-hour webinar on-demand to learn what rules remain after the EEOC’s regulations were found invalid and what rules have to be met in 2019 in order to offer a valid wellness program.
How to administer wellness programs in today's regulatory environment
This webinar covers:
Requirements under HIPAA
Requirements under the Internal Revenue Code
Requirements under ERISA
Requirements under GINA
Requirements under ADA
Requirements under ACA
HIPAA Training: Privacy Review and Audit Survival Guidebenefitexpress
HIPAA Privacy Overview for Employers. Review a helpful checklist of requirements an employer must adopt to stay compliant with HIPAA and to survive an audit by Health and Human Services (HHS).
Webinar | Texas vs. United States - The Repeal of ACA?benefitexpress
Recently a Federal District Court held in Texas, et al. v. United States of America, et al. that the individual mandate in the Patient Protection and Affordable Care Act (ACA) is unconstitutional, and that the other provisions in the ACA are invalid because they are inseverable from the individual mandate.
Our ACA compliance webinar reviews:
- What the Federal District Court decided.
- The basis for the decision.
- The impact of the decision.
- What may happen over the next months or year.
- What Congress may do to address the situation.
Healthcare Check-in: The Latest Developments in Health and Welfare Plansbenefitexpress
We work in an exciting industry – which means quick changes are the norm, and adaptability is a necessity. Keep your compliance plans up to date with a download of all legislative changes since our last update webinar. This webinar covered legislation that's passed in the last six months, what's on the way, and what it means for your organization.
Webinar | From Analysis to Action: How Personalization Can Lower Employer Cos...benefitexpress
Personalization is everywhere – from Amazon to Spotify, and is now the expectation for consumers. Personalization in benefits elections is also the new normal, thanks to decision support tools and data analytics. Modern decision support tools draw on data points including demographics, preferences and medical need, all highly relevant towards personalization ... as opposed to the "one-size fits all" modeler of the past that relied on strict business rules.
Using data to advise clients can be a game changer for a broker. With analytics, you can quantify your benefit plan suggestions based on hard evidence, and advise based on unbiased data versus mere opinion. But where does this data come from? And how do you know which data to use?
This webinar shows how decision support tools can provide data to simplify health benefit decisions, allowing employees to feel more confident in their decisions, leading to lower costs for employers and client retention for brokers as a result.
In this webinar, brokers will learn how decision support analytics can reinforce their role as a trusted adviser by:
• Helping employer clients understand which health plans and programs are being used and which ones are the most cost-effective
• Minimizing the number of employees who are over-insured or under-insured, helping to save on annual and long-term costs for healthcare premiums, leading to better client retention over time
• Supporting healthy employee behaviors, resulting in lower health care expenses overall
FSAs can do some heavy lifting for your benefits plan – they allow employees to save pretax dollars for healthcare costs without the price tag of other financial wellness initiatives.
However, many HR professionals lack a deep understanding of the compliance requirements to offer and administer a well-rounded program for their employees. Engage your employees with a financial wellness benefit that works.
Key webinar takeaways:
- How different types of FSAs interact with benefit plans as a whole
- FSA and reimbursement limits for 2018
- Legal implications of offering an FSA to employees
- Best practices for administering a successful FSA benefit plan
Webinar | COBRA Pitfalls: Common Mistakes and How to Avoid Thembenefitexpress
Leaving the organization isn't the end of the benefits cycle for employees. This webinar focuses on how to avoid one of the most common compliance pitfalls in benefits ... COBRA administration.
Some of the top takeaways were:
• The basics of successful COBRA administration
• Required notices associated with COBRA coverage
• How Medicare interacts with COBRA for employees and dependents
• Penalties for noncompliance
Smooth and successful off-boarding of departing employees is as important as well-planned on-boarding of new hires. Log on to your roadmap for a smooth ride into COBRA compliance.
Webinar | Clients Calling “Mayday”? Design a Benefits Technology Strategy to ...benefitexpress
Benefits administration can be a delicate, and even difficult balancing act for employers. From managing costs and administrative demands, to maintaining compliance, and integrating with workforce wellness plans, it’s not surprising that three in four employers called “mayday” and turned to benefits administration outsourcing in 2017. With the administrative difficulty level rising, and advisory competition increasing, it is now critical to become the partner of choice to relieve this distress. But how?
Join Scott Evans, chief product officer at benefitexpress, this May Day, as he guides benefits advisers through the top considerations for building, buying or borrowing benefits administration technology solutions to offer clients. If you and your clients have benefits technology questions, Scott has answers.
Webinar takeaways include:
• How to assess your readiness: learn and identify the benefits administration business model that is right for you
• Key criteria for evaluating potential benefits technology partners, plus a valuable checklist
• How to create a benefits technology strategy for your business which is seen as an imperative – not a “value-add” – by your clients
• Tips for staying competitive in a changing market, using your solutions portfolio
Webinar | Training the Technique: Advanced ERISA Compliancebenefitexpress
If your organization offers any form of retirement plan, chances are you have questions about ERISA. This advanced compliance training will go beyond the basics of the requirements of the Employee Retirement Income Security Act of 1974.
Attend our one-hour training to learn:
- Which employers are affected by ERISA regulations
- Which benefits plans are subject to ERISA
- What documentation employers must provide to prove
compliance
- Penalties for noncompliance
ERISA attorney Larry Grudzien will share industry inside knowledge to help participants ensure total compliance with ERISA regulations.
Factors of Self-Funding: Evaluating the Pros and Consbenefitexpress
In a changing healthcare landscape, employers are increasingly considering taking the funding of their healthcare benefits into their own hands. If you're one of them, this webinar is the one-hour guide you must see.
Participants will learn:
- The legal implications associated with self-funding
- Common administrative pitfalls
- Solving employee issues involved in self-funded plans
- A full overview of laws and regulations governing self-funding
Our compliance expert will weigh in during a compact, one-hour guide.
Healthcare check in the latest developments in health and welfare plansbenefitexpress
We work in an exciting industry—which means quick changes are the norm, and adaptability is a necessity.
Keep your compliance plan up-to-date with a download of recent legislative changes.
We'll cover legislation that's passed, what's on the way, and what it means for your organization.
Topics Covered Include:
• IRS Information Letters
• Tax Reform Legislation
• Wellness Regulations - EEOC, AARP
• Comprehensive Guidance on QSEHRAs
• ACA: Elimination of Individual Mandate Penalty
• Employer Tax Credit for Paid Family and Medical Leave
• DOL Annual Adjustments to Employee Benefit Plan Penalties
• “Good Faith” Penalty Relief
• Final Disability Claim Regulations
• Cadillac Tax Updates
• And More!
Presented by Larry Grudzien, Attorney at Law
CDHP 101: Behind the Wheel of Consumer-Driven Plansbenefitexpress
The most effective benefits are the ones that fully engage employees - which is why employers are increasingly putting their employees in the driver's seat when it comes to choosing their plans.
"Cafeteria Plans" or Consumer-Driven Health Plans help employers efficiently offer tailored benefits to a diverse workforce.These plans can have immense benefits - but only if you don't hit common potholes in administering the plans. This webinar covers:
- A legal perspective on the pros and cons of CDHPs
- Compliance implications of using a benefits marketplace
- Best practices for administering a CDHP
Piece of Cake: Perfecting the Recipe for ACA Compliancebenefitexpress
Repeal and replace efforts have come and gone - it's time to prepare to comply with the Affordable Care Act for another year.
With chatter and speculation surrounding the ACA, it's easy to lose track of what's required of employers. Our one-hour refresher course covers:
- How to fill out form 1095-C
- Important filing dates
- Common compliance errors
- Penalties for noncompliance
Make this year’s ACA reporting a piece of cake.
Piece of Cake: Perfecting the Recipe for ACA Compliance
How Medicare Affects Employer Health Coverage
1.
2. Copyright 2015 - Not to be reproduced without express permission of Benefit Express Services, LLC
How Medicare Affects
Employer Health Coverage
3. Copyright 2015 - Not to be reproduced without express permission of Benefit Express Services, LLC
Agenda
Medicare Secondary Payer Rules
Medicare Part D
COBRA
Other areas
5. Copyright 2015 - Not to be reproduced without express permission of Benefit Express Services, LLC
Medicare Secondary Payer Rules
Can an employer in any way encourage active employees to elect out
of employer sponsored health coverage when they are eligible for
Medicare?
• No. The Medicare Secondary Payer statute prohibits a group health plan from
“taking into account” the Medicare entitlement of a active employees or family
members if such employees are still considered in “current employment status.”
• Employers are prohibited from discouraging employees from enrolling in their
group health plan or from offering “financial or other incentive for an individual
entitled to Medicare” not to enroll (or to terminate enrollment) under” a group
health plan that would otherwise be a primary plan.
• The above prohibition does not apply to employers with less than 20
employees for each working day in at least 20 weeks in either the current or the
preceding calendar year.
• This test must be run at the time the individual receives the services for which
Medicare benefits are claimed.
6. Copyright 2015 - Not to be reproduced without express permission of Benefit Express Services, LLC
Medicare Secondary Payer Rules
What does “current employment status” mean?
A person has current employment status if he or she is actively working as an
employee, is the employer (including a self-employed person), or is associated with
the employer in a business relationship.
7. Copyright 2015 - Not to be reproduced without express permission of Benefit Express Services, LLC
Can an employer drop employees or dependents who become
disabled from employer sponsored health coverage when they
become eligible for Medicare if such employees are considered in
“current employment status”?
No. The Medicare Secondary Payer statute prohibits a group health plan from
“taking into account” the Medicare entitlement of disabled employees or a family
member.
An otherwise covered individual who isn’t actively working is nevertheless
considered to be in “current employment status” if he or she (a) is receiving
disability benefits from an employer for up to six months; or (b) retains employment
rights in the industry, hasn’t had his or her employment terminated by the employer,
isn’t receiving disability benefits from an employer for more than six months or from
Social Security, and has group health coverage other than COBRA coverage
(whether or the individual receives pay).
Medicare Secondary Payer Rules
8. Copyright 2015 - Not to be reproduced without express permission of Benefit Express Services, LLC
Medicare Secondary Payer Rules
This prohibition does not apply to employers with less than 100 employees on a
typical business day during the previous calendar year.
This means that the employer must have 100 or more employees, whether full-time
or part-time, on at least 50% of its regular business days during the previous
calendar year.
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Who is considered a "disabled individual" under the MSP
rules?
Disabled individuals generally are those individuals who are under age 65 and who
have been entitled to Social Security disability benefits for 24 months.
Medicare Secondary Payer Rules
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Medicare Secondary Payer Rules
Which employees are counted in determining the number
of employees for the “small employer exception”?
In counting an employer’s employees for purposes of the small employer
exceptions, the following rules apply:
• Leased employees must be counted if they would be counted as employees
under Code § 414(n);
• All of the employees of the members of an “affiliated service group” (as defined
in Code § 414(m)) must be counted as if they were employees of a single
employer; and
• All of the employers that are considered to be a “single employer” under Code
§ 52(a) or 52(b) must be treated as a single employer.
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Medicare Secondary Payer Rules
What does it mean to “take into account” Medicare
entitlement?
Under the MSP statute, a group health plan may not take into account:
• The age-based Medicare entitlement of an individual (or the individual’s
spouse) who is covered under the plan by virtue of the individual’s current
employment status; or
• The disability-based Medicare entitlement of an individual (or the individual’s
family member) who is covered under the plan by virtue of the individual’s
current employment status.
A plan must provide a current employee or a current employee’s spouse who is age
65 or older with the same benefits, under the same conditions, as are provided to
employees and spouses who are under age 65.
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Medicare Secondary Payer Rules
Examples of employer or insurer actions that constitute an
impermissible “taking into account” are provided in the regulations
and include the following:
• Failure to pay primary benefits;
• Offering coverage that is secondary to Medicare to individuals entitled to
Medicare;
• Terminating coverage because the individual has become entitled to Medicare,
except as permitted under COBRA;
• Denying or terminating coverage because an individual is entitled to Medicare
on the basis of disability without denying or terminating coverage for similarly
situated individuals who are not entitled to Medicare on the basis of disability;
• Imposing limitations on benefits for a Medicare-entitled individual that don’t
apply to others enrolled in the plan;
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Medicare Secondary Payer Rules
Charging a Medicare-entitled individual higher premiums;
Requiring a Medicare-entitled individual to wait longer for coverage to begin;
Paying providers and suppliers less for services furnished to a Medicare beneficiary than for
the same services furnished to an enrollee who is not entitled to Medicare;
Providing misleading or incomplete information that would have the effect of inducing a
Medicare-entitled individual to reject the employer plan, thereby making Medicare the primary
payer;
Including in its health insurance cards, claims forms, or brochures distributed to beneficiaries,
providers, and suppliers instructions to bill Medicare first for services furnished to Medicare
beneficiaries without stipulating that such an action may be taken only when Medicare is the
primary payer; and
Refusing to enroll an individual for whom Medicare would be the secondary payer, when
enrollment is available to similarly situated individuals for whom Medicare would not be the
secondary payer.
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Medicare Secondary Payer Rules
What are considered “incentives” under the rules?
Employers are prohibited from discouraging employees from enrolling in their group
health plans or from offering any “financial or other incentive” for an individual
entitled to Medicare “not to enroll (or to terminate enrollment) under” a group health
plan that would otherwise be a primary plan.
The prohibition applies “even if the payments or benefits are offered to all other
individuals who are eligible for coverage under the plan.”
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Medicare Secondary Payer Rules
Can an Medicare or Medigap premiums be reimbursed by
an employer for an active employees?
Generally no, but under Notice 2015-17, certain exceptions apply.
If an employer offers to reimburse Medicare premiums for its active employees, it
creates an employer payment plan because Medicare is not considered employer
group coverage.
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Medicare Secondary Payer Rules
An employer payment plan that pays for or reimburses Medicare Part B or
Part D premiums is integrated with another group health plan offered by the
employer for purposes of the annual dollar limit prohibition and the
preventive services requirements if:
• The employer offers a group health plan (other than the employer payment plan) to the
employee that does not consist solely of excepted benefits and offers coverage providing
minimum value;
• The employee participating in the employer payment plan is actually enrolled in Medicare
Parts A and B;
• The employer payment plan is available only to employees who are enrolled in Medicare
Part A and Part B or Part D; and
• The employer payment plan is limited to reimbursement of Medicare Part B or Part D
premiums and excepted benefits, including Medigap premiums.
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Medicare Secondary Payer Rules
Note that to the extent such an arrangement is available to active employees, it may
be subject to restrictions under other laws such as the Medicare secondary payer
provisions.
An employer payment plan that has fewer than two participants who are current
employees (for example, a retiree-only plan) on the first day of the plan year is not
subject to the market reforms and, therefore, integration is not necessary to satisfy
the market reforms.
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Medicare Secondary Payer Rules
Do any special rules apply if an employer participates in
multiemployer or multiple employer plan?
• Yes, With respect to age-based Medicare entitlement, the MSP statute provides
that if at least one of the employers in the plan has 20 or more employees, then
the group health plan will be subject to the MSP rules.
• However, the plan may elect not to have the age-based MSP rules apply to
employees of employers in the plan that have fewer than 20 employees.
• A different rule applies to multiemployer and multiple employer plans under the
disability-based Medicare entitlement provisions.
• Under these provisions, if any one employer in the plan employed 100 or more
employees on at least 50% of its regular business days during the previous
calendar year, the plan will be considered to be a large group health plan
subject to the MSP rules for disabled employees.
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Medicare Secondary Payer Rules
Are there any special rules for Medicare eligibility or
entitlement based on ESRD?
• Yes, a group health plan (including a retiree medical plan) cannot take into
account an individual’s ESRD-based Medicare eligibility or entitlement for the
first 30 months of such eligibility or entitlement.
• Medicare generally must be the secondary payer for the first 30 months of an
ESRD patient’s Medicare eligibility or entitlement (and will be primary
thereafter.)
• A plan may not otherwise differentiate in benefits provided under the plan
between ESRD patients and other individuals covered under the plan based on
the existence of ESRD, the need for renal dialysis, or in any other manner.
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Medicare Secondary Payer Rules
These prohibitions apply regardless of whether the individual has coverage by virtue
of current employment status, and there is no exception for small employers.
Medicare will remain primary, however, for an individual who was entitled to
Medicare due to age or disability on a primary basis at the time he or she becomes
eligible for ESRD-based Medicare.
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Medicare Secondary Payer Rules
Does an employer’s prescription drug plan have to be
coordinated with employee’s Medicare Part D drug plan?
Yes. The MSP rules are triggered when individuals who are enrolled in group health
plans offering prescription drug coverage also enroll in Part D plans.
Part D plans and group health plans are generally required to comply with MSP
laws and any other federal and state laws establishing payers of last resort.
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Medicare Secondary Payer Rules
Can an employee elect out of employer coverage on their
own and elect Medicare?
There is nothing preventing an employee electing out of employer coverage on his
or her on his or her own.
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Medicare Secondary Payer Rules
Are Health FSAs, HRAs Archer MSAs or HSAs subject to
these rules?
• Health FSAs, HSAs, and Archer MSAs are not subject to the MSP Rules;
• HRAs are subject to the MSP Rules.
• CMS has indicated that for MSP purposes, health FSAs (as well as HSAs and
Archer MSAs) aren’t group health plans and aren’t subject to being a primary
payer under MSP laws.
• HRAs, however, are group health plans subject to the MSP rules—information
about HRAs should be reported to CMS in the same manner as group health
plan information is reported.
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Medicare Secondary Payer Rules
If an employee continues to be covered under an employer provided health
coverage, will he or she be penalized when he or she decides to elect
Medicare?
• No It is extremely important that an employee enrolls in Medicare during his or her initial
enrollment period.
• If an employee does not, he or she will be subject to late charges or a premium
surcharge
• The Part B premium goes up 10 percent for each 12-month period the employee was
eligible but does not enroll. The increase in the Part A premium (if the employee has to
pay a premium) is 10 percent no matter how late the employee enrolls.
• The employee may enroll in Part B or premium Part A at any time he or she is covered
under another group health plan.
• However, the employee may also choose to wait and enroll during a special eight-month
period. This special period would start with the month the employee or his or her spouse
stops working or when he or she is no longer covered by the employer plan, whichever
comes first.
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Medicare Secondary Payer Rules
Once a retiree becomes eligible for Medicare, can retiree
coverage be coordinated with Medicare?
Yes, EEOC provided final regulations that allows employers that provide retiree
health benefits to continue the longstanding practice of coordinating those benefits
with Medicare (or comparable state health benefits) without violating the Age
Discrimination in Employment Act (ADEA).
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Medicare Secondary Payer Rules
Are there any penalties if an employer violates these
Medicare Secondary Payer rules?
• The federal government and Medicare recipients are authorized to recover
double damages from group health care plans that treat Medicare as the
primary payer in violation of the rules.
• Violation of the financial incentives prohibition is subject to a civil money
penalty of up to $5,000 for each violation.
• Code Section 5000 also imposes an excise tax of 25% of expenses on all
employers, other than certain governmental entities, or employee organizations
whose group health care plans fail to comply with the Medicare secondary
payer rules. Employers or employee organizations may appeal HCFA
determinations of a failure to comply with Code Section 5000.
• The government has three years to collect health care payments that were
wrongly paid by Medicare from the primary party.
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Medicare Secondary Payer Rules
Is there any reporting requirements under the Medicare
Secondary Payer Rules?
Yes Under Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of
2007 (MMSEA), new mandatory reporting requirements was added for group health
plans and for non-group health plan arrangements (liability insurance including self-
insurance, no-fault insurance and workers' compensation).
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Medicare Secondary Payer Rules
Who Is required to report the mandatory reporting
information to CMS?
The responsibility for reporting information to help identify whether a group health
plan is (or has been) a primary plan to Medicare falls upon the “entity serving as an
insurer or third party administrator for a group health plan...and, in the case of a
group health plan that is self-insured and self-administered, a plan administrator or
fiduciary.”
CMS refers to entities that are responsible for complying with the reporting
requirements under Section 111 as “responsible reporting entities” (RREs).
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Medicare Secondary Payer Rules
What plans are subject to the Section 111 reporting
requirements?
Many types of group health plans are subject to the MSP rules in general.
Health FSAs and HSAs are not, but HRAs are.
• No reporting if annual benefits are less than $5,000.
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Medicare Secondary Payer Rules
What information should be reported to CMS?
CMS must be provided information regarding all individuals meeting the definition of
an “active covered individual.”
In general, an active covered individual is someone who may be Medicare eligible
and currently is employed, or the spouse or other family member of a worker who is
covered by the employed individual's group health plan and who may be eligible for
Medicare and for whom Medicare would be secondary payer.
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Medicare Secondary Payer Rules
For mandatory reporting purposes, CMS has defined
“active covered individuals” in its User Guide to include
all individuals covered in the group health plan who—
• Are ages 45 through age 64 with coverage based on their own or a family
member’s current employment status;
• Are age 65 and older with coverage based on their own or a spouse’s current
employment status;
• Have been receiving kidney dialysis or have received a kidney transplant,
regardless of their own or a family member's current employment status; or
• Are under age 45, are known to be entitled to Medicare, and have coverage in
the plan based on their own or a family member’s current employment status
regardless of their age.
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Medicare Secondary Payer Rules
How and when should information be reported to
CMS?
• Information may be submitted only through an electronic process under which
new group health plan RREs will register online through a secure website using
an interactive web portal designed for that purpose.
• Once data has been submitted, CMS will work with the RREs to set up the data
reporting and response process, and it will use the information to ensure that
payment is made in the proper order and to pursue recovery activities.
• CMS has indicated that RREs must submit information on a quarterly basis.
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Medicare Secondary Payer Rules
What the penalties for failure to comply with section 111
reporting requirements?
Entities that fail to comply with the MMSEA Section 111 reporting requirements are
subject to a civil monetary penalty of $1,000 for each day of noncompliance for
each individual for which information should have been submitted.
This fine is in addition to any other penalties prescribed by law and any potential
claims under the MSP regulations (e.g., a claim by Medicare that the group health
plan should have paid primary to Medicare).
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Medicare Part D
For those employee who are eligible for Medicare Part D
benefits, what disclosure must an employer provide
them?
Each year ( between 10/15 and 12/07) an employer must provide a notice to those
eligible employees whether its prescription drug plan is either “creditable” or
“noncreditable.”
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Medicare Part D
In what other situations must the Notice be distributed?
• Prior to an individual's initial enrollment period (IEP) for Part D—the timing of
the IEP varies according to several factors;
• Prior to the effective date of coverage for any Part D eligible individual that
enrolls in the employer's prescription drug coverage—the timing of the effective
date of coverage varies for each individual;
• Whenever the employer no longer offers prescription drug coverage or changes
it so that it is no longer creditable or becomes creditable—the timing of a
change in coverage generally varies according to the employer's actions; and
• Upon request by the Part D eligible individual—the timing of a request varies
according to the individual's actions.
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Medicare Part D
Why does an employer have to give this notice?
• If an employer’s prescription drug coverage is not considered “creditable,” the
employee may be subject to an late enrollment penalty.
• A late enrollment penalty may apply after experiencing a lapse in creditable
prescription drug coverage for any continuous period of 63 days or longer at
any time after the end of the individual’s IEP for Part D.
• The penalty amount will be the base beneficiary premiums that would otherwise
apply will be increased by the greater of (1) an amount that CMS determines is
actuarially sound for each uncovered month in the same continuous period of
eligibility; or (2) 1% of the base beneficiary premium for each uncovered month
in the period.
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Medicare Part D
Are there any penalties if an employer either does not
provide the notice or provides an incorrect notice to
employees?
Neither the law nor the regulations provide mechanisms for CMS to enforce
penalties or other sanctions against employers that fail to comply with the disclosure
requirements, other than those claiming the retiree drug subsidy.
However, employers that don’t comply with such requirements are likely to
encounter adverse employee relations issues.
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Medicare Part D
Are there any other disclosures that an employer must
make under Medicare Part D?
• Group health plan sponsors must also notify CMS about creditable coverage
status.
• Part D plans, however, are exempted from this requirement, as are certain
employers that have been approved for the retiree drug subsidy.
• Notice must be given annually within 60 days after the end of the plan year.
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COBRA
When can the entitlement of Medicare terminate COBRA
coverage?
When any qualified beneficiary (including the covered employee) first becomes
entitled to Medicare after electing COBRA coverage, his or her COBRA coverage
can be terminated early (i.e., before the end of the maximum coverage period).
This rule does not, however, affect the COBRA rights of other qualified beneficiaries
in a family unit who are not entitled to Medicare (for example, the spouse and
dependent children of a Medicare-entitled former employee.
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COBRA
When does entitlement to Medicare extend the period of
COBRA coverage?
When a covered employee’s qualifying event (i.e., a termination of employment or
reduction of hours) occurs within the 18-month period after the employee becomes
entitled to Medicare, the employee’s spouse and dependent children (but not the
employee) become entitled to COBRA coverage for a maximum period that ends 36
months after the covered employee becomes entitled to Medicar.e
The covered employee remains entitled to a basic maximum period that ends 18
months after the termination of employment or reduction of hours.
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COBRA
Does the entitlement to Medicare before electing COBRA
terminate COBRA coverage?
• No. When any qualified beneficiary (including the covered employee) is entitled
to Medicare before electing COBRA, he or she still has the right to elect
COBRA coverage.
• The COBRA offer cannot be withheld because of Medicare entitlement.
• And this coverage may not be terminated early because of the Medicare
entitlement.
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COBRA
Is entitlement to Medicare ever a first qualifying event to
trigger COBRA?
• The covered employee’s entitlement to Medicare is one of COBRA’s listed
qualifying events.
• It is a qualifying event only for the spouse and dependent children, not for the
covered employee,
• But because Medicare entitlement will only infrequently cause a loss of
coverage under a group health plan, it will rarely be a COBRA qualifying event.
• It is permissible under the MSP rules for Medicare entitlement to cause a loss
of coverage for covered retired employees (and their spouses and dependent
children).
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COBRA
Will enrolling in Medicare preserve an employee’s special
enrollment rights under Medicare?
COBRA coverage is not considered a group health plan based upon current
employment.
Individuals who, in order to retain their COBRA coverage, do not enroll in Medicare
when first eligible will not have special enrollment rights under Medicare and may
expect to pay more for Medicare when COBRA coverage ends.
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COBRA
Must a plan still offer COBRA coverage to retirees when
alternative retiree coverage is offered?
Yes. Alternative retiree coverage might be offered under the plan covering active
employees, or it might be offered under a separate retiree plan.
In either case, the employer cannot avoid its obligation to offer COBRA coverage in
connection with the employee’s retirement simply by providing alternative retiree
coverage.
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COBRA
Must a plan offer COBRA to retirees when alternative
retiree coverage expires?
The regulations make it clear that if a retiree (and his or her family) are offered but
do not elect COBRA and instead choose alternative retiree coverage available for a
fixed period of time, no COBRA election must be offered when the retiree coverage
expires.
This result would be the same whether retiree coverage is offered under a
combined retiree/active plan or under a retiree-only plan.
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HSAs
When is an individual no longer eligible to contribute to an
HSA?
• Code § 223(b)(7) reads as follows: “Medicare eligible individuals. The
[contribution limit] under this subsection for any month with respect to an
individual shall be zero for the first month such individual is entitled to benefits
under title XVIII of the Social Security Act and for each month thereafter.
• An individual can become entitled to Medicare benefits (under Title XVIII of the
Social Security Act) for three reasons: age, disability, or end-stage renal
disease (ESRD).
• Entitlement to Medicare Part A is automatic for some individuals (i.e., a
separate application is not required) because they have already applied for and
are receiving Social Security or Railroad Retirement Act benefits.
• Other individuals must file an application in order to become entitled to Part A
benefits.
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HSAs
Can an HSA be used to reimburse an individual for
Medicare premiums?
• Yes Deductible health insurance premiums (other than for a Medicare
supplemental policy) for an account holder who is age 65 or older can be paid
or reimbursed through an HSA on a tax-free basis, including medical premiums
for an employer’s insured or self-insured retiree health coverage.
• When premiums for Medicare Part A (hospital and inpatient services), Part B
(physician and outpatient services), Part C (Medicare HMO and PPO plans), or
Part D (prescription drugs) are deducted from Social Security benefit payments
received by an account holder who is age 65 or older, he or she can take a tax-
free HSA distribution equal to the Medicare premium deduction.
• HSAs generally cannot be used by retired account holders for their health
insurance premiums prior to age 65—with the exception of COBRA coverage
(or premiums paid while receiving unemployment.
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HIPAA
Is Medicare coverage considered “creditable coverage”
for HIPAA purposes?
Medicare is subject to HIPAA’s certification requirements under the PHSA and thus
count as creditable coverage, but they are not otherwise subject to HIPAA’s
portability provisions (e.g., PCEs, special enrollments, and nondiscrimination)
because they do not constitute “group health plan” coverage as defined in the
PHSA, ERISA, or the Code.
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Contact Information
Larry Grudzien, Attorney at Law
Phone: 708-717-9638
Email: larry@larrygrudzien.com
Website: www.larrygrudzien.com