The convenience of a Multiple Employer Welfare Arrangement comes with an additional regulatory burden. It takes a deep understanding of compliance requirements to keep both your employees and your bottom line healthy when it comes to MEWA.
Skip the struggle with complicated legal briefs and sort out your strategy in this one-hour seminar with our benefits attorney.
Insights from the Paycheck Protection ProgramJasonSchupp1
Analysis of the Small Business Administration's initial release of data on loans approved under the Paycheck Protection Program as design considerations for a future Pandemic Risk Insurance Program
A final regulation defining who is a "fiduciary" of an employee benefit plan under the Employee Retirement Income Security Act of 1974 as a result of giving investment advice to a plan or its participants or beneficiaries.
This proposal starts from the premise that the States must be fundamentally accountable for any pandemic business income coverage program because:
• The orders triggering pandemic business income loss originate and terminate as decisions made by the individual States; and
• The responsibility to manage the economic consequences of those individual State decisions should likewise reside with the respective States.
Insights from the Paycheck Protection ProgramJasonSchupp1
Analysis of the Small Business Administration's initial release of data on loans approved under the Paycheck Protection Program as design considerations for a future Pandemic Risk Insurance Program
A final regulation defining who is a "fiduciary" of an employee benefit plan under the Employee Retirement Income Security Act of 1974 as a result of giving investment advice to a plan or its participants or beneficiaries.
This proposal starts from the premise that the States must be fundamentally accountable for any pandemic business income coverage program because:
• The orders triggering pandemic business income loss originate and terminate as decisions made by the individual States; and
• The responsibility to manage the economic consequences of those individual State decisions should likewise reside with the respective States.
I recently returned from the MDRT meeting in Vancouver BC, many of the "big hitters" are using the "Living Benefit" policies because of the "added value" they bring to the client along with "something new and different" to the insurance discussion ( i.e. do you have the "old" insurance or the "new" insurance? etc.) They also mentioned the statistic that 80% of the people will have a Heart, Stroke, or Cancer concerns ( Critical Illness) in their lifetime.
Intertwined Guidelines: Untangling Your Enrollment Notice Requirementbenefitexpress
DOL, PPACA, ERISA, COBRA, and HIPAA all have guidelines for enrollment notices - learn best practices for including the notice in your benefits strategy.
I recently returned from the MDRT meeting in Vancouver BC, many of the "big hitters" are using the "Living Benefit" policies because of the "added value" they bring to the client along with "something new and different" to the insurance discussion ( i.e. do you have the "old" insurance or the "new" insurance? etc.) They also mentioned the statistic that 80% of the people will have a Heart, Stroke, or Cancer concerns ( Critical Illness) in their lifetime.
Brett S. Lininger, Esq., Principal at Semmes, Bowen, Semmes presented - “Property & Casualty Legislative Up-Date” at the October 2013 67th Annual F. Addison Fowler Seminar held by The Insurance Roundtable of Baltimore in Hunt Valley, MD
Broad Application of Medicare’s Mandatory Insurer Reporting Requirements to N...NationalUnderwriter
Broad Application of Medicare’s Mandatory Insurer Reporting Requirements to Non-U.S. Property & Casualty Carriers Flouts Supreme Court Limitations on Extraterritorial Reach of U.S. Law By Richard L. McConnell and Kathryn Bucher
This article attempts to demystify some of the issues regarding possible extraterritorial application of the
requirements under Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007, comments on
claim situations that frequently may confront non-U.S. insurers, and alerts readers to the need to evaluate the potential Section 111 ramifications of claim payments to Medicare beneficiaries.
ACA (mis)Management: What Everyone Has Learned & the Game Plan for 2017benefitexpress
After our first ACA reporting season, it’s time to regroup and review what we’ve learned for 2016. The IRS is eliminating extensions and good faith efforts, raising penalties, and strictly limiting transitional relief.
With higher stakes, ERISA attorney Larry Grudzien reviews the changes to ACA reporting for 2016 and common ACA management issues.
A Q&A guide to workers' compensation law for employers in Georgia. This Q&A addresses Georgia laws requiring workers' compensation coverage, including the benefits process, penalties for an employer's failure to obtain workers' compensation coverage, and anti-retaliation provisions. Federal, local, or municipal law may impose additional or different requirements. Answers to questions can be compared across a number of jurisdictions (see Workers' Compensation Laws: State Q&A Tool)
Winding up is a means by which the dissolution of a company is brought about and its assets are realized and applied in the payment of its debts. After satisfaction of the debts, the remaining balance, if any, is paid back to the members in proportion to the contribution made by them to the capital of the company.”
1. “The liquidation or winding up of a company is the process whereby its life is ended and its property is administered for the benefit of its creditors and members. An Administrator, called a liquidator, is appointed and he takes control of the company, collects its assets, pays its debts and finally distributes any surplus among the members in accordance with their rights.”
Voluntary liquidations under the Insolvency and Bankruptcy Code (IBC) are becoming popular for promoters to close down 'unviable' companies. The Quarterly Newsletter (April-June 2019) issued by Insolvency and Bankruptcy Board of India (IBBI), the insolvency regulator, shows as many as 452 companies have filed for voluntary liquidation till 30 June 2018. Of that, 56 firms have so far been dissolved, final reports have been submitted in 114 cases and 338 are at different stages of the process.
A company can file for voluntary resolution only if it has no debts or promises to pay the debt in full from the proceeds of assets to be sold under voluntary liquidation process. The application of voluntary liquidation should not also be to defraud any person.
I recently returned from the MDRT meeting in Vancouver BC, many of the "big hitters" are using the "Living Benefit" policies because of the "added value" they bring to the client along with "something new and different" to the insurance discussion ( i.e. do you have the "old" insurance or the "new" insurance? etc.) They also mentioned the statistic that 80% of the people will have a Heart, Stroke, or Cancer concerns ( Critical Illness) in their lifetime.
Intertwined Guidelines: Untangling Your Enrollment Notice Requirementbenefitexpress
DOL, PPACA, ERISA, COBRA, and HIPAA all have guidelines for enrollment notices - learn best practices for including the notice in your benefits strategy.
I recently returned from the MDRT meeting in Vancouver BC, many of the "big hitters" are using the "Living Benefit" policies because of the "added value" they bring to the client along with "something new and different" to the insurance discussion ( i.e. do you have the "old" insurance or the "new" insurance? etc.) They also mentioned the statistic that 80% of the people will have a Heart, Stroke, or Cancer concerns ( Critical Illness) in their lifetime.
Brett S. Lininger, Esq., Principal at Semmes, Bowen, Semmes presented - “Property & Casualty Legislative Up-Date” at the October 2013 67th Annual F. Addison Fowler Seminar held by The Insurance Roundtable of Baltimore in Hunt Valley, MD
Broad Application of Medicare’s Mandatory Insurer Reporting Requirements to N...NationalUnderwriter
Broad Application of Medicare’s Mandatory Insurer Reporting Requirements to Non-U.S. Property & Casualty Carriers Flouts Supreme Court Limitations on Extraterritorial Reach of U.S. Law By Richard L. McConnell and Kathryn Bucher
This article attempts to demystify some of the issues regarding possible extraterritorial application of the
requirements under Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007, comments on
claim situations that frequently may confront non-U.S. insurers, and alerts readers to the need to evaluate the potential Section 111 ramifications of claim payments to Medicare beneficiaries.
ACA (mis)Management: What Everyone Has Learned & the Game Plan for 2017benefitexpress
After our first ACA reporting season, it’s time to regroup and review what we’ve learned for 2016. The IRS is eliminating extensions and good faith efforts, raising penalties, and strictly limiting transitional relief.
With higher stakes, ERISA attorney Larry Grudzien reviews the changes to ACA reporting for 2016 and common ACA management issues.
A Q&A guide to workers' compensation law for employers in Georgia. This Q&A addresses Georgia laws requiring workers' compensation coverage, including the benefits process, penalties for an employer's failure to obtain workers' compensation coverage, and anti-retaliation provisions. Federal, local, or municipal law may impose additional or different requirements. Answers to questions can be compared across a number of jurisdictions (see Workers' Compensation Laws: State Q&A Tool)
Winding up is a means by which the dissolution of a company is brought about and its assets are realized and applied in the payment of its debts. After satisfaction of the debts, the remaining balance, if any, is paid back to the members in proportion to the contribution made by them to the capital of the company.”
1. “The liquidation or winding up of a company is the process whereby its life is ended and its property is administered for the benefit of its creditors and members. An Administrator, called a liquidator, is appointed and he takes control of the company, collects its assets, pays its debts and finally distributes any surplus among the members in accordance with their rights.”
Voluntary liquidations under the Insolvency and Bankruptcy Code (IBC) are becoming popular for promoters to close down 'unviable' companies. The Quarterly Newsletter (April-June 2019) issued by Insolvency and Bankruptcy Board of India (IBBI), the insolvency regulator, shows as many as 452 companies have filed for voluntary liquidation till 30 June 2018. Of that, 56 firms have so far been dissolved, final reports have been submitted in 114 cases and 338 are at different stages of the process.
A company can file for voluntary resolution only if it has no debts or promises to pay the debt in full from the proceeds of assets to be sold under voluntary liquidation process. The application of voluntary liquidation should not also be to defraud any person.
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
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.
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...
On March 20, 2014, the Financial Accounting Standards Board (FASB) issued Accounting Standards Update (ASU) 2014-07 Consolidations (Topic 810): Applying Variable Interest Entities Guidance to Common Control Leasing Arrangements (hereafter ASU 2014-07 or the standard). This standard is the third accounting alternative proposed by the Private Company Council (PCC) and endorsed by the FASB. It is an accounting alternative that permits a private company reporting entity to elect to not apply the variable interest entity (VIE) guidance to certain leasing arrangements. If elected, the guidance of this standard must be applied to all qualifying lease arrangements.
The adoption of ASU 2014-07 may result in the deconsolidation of commonly controlled lessor entities that were previously consolidated under the VIE guidance, the removal of disclosures prescribed by the VIE guidance for consolidated and certain non-consolidated commonly controlled lessor entities, or the reduction in the documentation and procedures necessary to evaluate these types of entities under the VIE guidance.
[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
This session focuses on Ed Health, a medical stop loss group captive consisting of 11 Boston-area colleges that Spring assisted in the development of. It details Ed Health’s success to date and lessons learned through the development and ongoing management of a medical stop loss group captive.
That's a Wrap! Employee Benefits Year-End Reminders (and a Preview of 2019 Ch...Quarles & Brady
Join us for this interactive session where we will discuss the top employee benefits changes in 2018 and provide a preview of what to expect in 2019. We will discuss:
- Based on recent case law, should your plans contain a "choice of law" or "mandatory arbitration" provision?
- What retirement plan amendments must you do—and which are optional?
- New health plan changes, including the new proposed HRA rules.
Life and Health Insurance FIN 3660 Chapter 2 The Life and .docxSHIVA101531
Life and Health Insurance FIN 3660
Chapter 2
The Life and Health Insurance Industry
Objectives
Distinguish among the three types of business organizations and explain why insurance companies must be organized as corporations.
Distinguish among stock insurers, mutual insurers, and fraternal benefit societies.
Describe the financial services industry and explain how insurance companies function within that industry.
Identify two primary types of insurance regulation in most countries.
Describe the roles that the federal and state governments play in U.S. insurance regulation.
2
Types of Business Organizations
Businesses are structured in three basic ways.
A sole proprietorship is owned and operated by one person. The owner receives all profits and is responsible for all the debts of the business.
A partnership is a business that is owned by two or more people known as partners. They divide the profits, and generally each of them is personally responsible for all the debts of the business.
A corporation is a legal entity that is created by the authority of a governmental unit and is separate and distinct from the people who own it. Corporations are different from other businesses in two ways. First, because they can be sued, can enter into contracts, and can own property. The assets and liabilities belong to the corporation itself, not the owners; thus, a corporation continues beyond the death of any or all of its owners.
An asset is an item of value, such as cash, buildings, or investments.
A liability is a company’s debt or future obligation.
Equity represents the owners’ interest; the amount on which owners have a claim.
3
Types of Insurance Company Organizations
1. Stock Corporations
Most corporations, including most life and health insurers, are stock corporations, a corporation whose ownership is divided into units known as shares, or shares of stock. A stockholder, or shareholder, is a person or organization who owns stock in the corporation.
Stock insurance companies are insurers organized as stock corporations.
Stockholders elect a board of directors, who are responsible for overseeing the company’s management.
Stockholder dividend is a portion of the corporation’s earnings paid to the owners of its stock.
4
Mutual Insurance Companies
2. Mutual Companies
This is an insurance company that is owned by its policyowners, who elect the company’s board of directors.
Mutual insurers historically have been older and larger than stock insurers and thus provide a significant amount of the life insurance in force.
5
Fraternal Benefit Societies
3. Fraternal Benefit Societies
Fraternals are nonprofit organizations that are operated solely for the benefit of their members and provide social, as well as insurance, benefits to their members.
Members of such societies share ethnic, religious, or vocational backgrounds, although some allow membership to the general public.
Members elect the officers of a fraternal society who manage its ...
Small business owners guide to the cares actVijar Kohli
The programs and initiatives in the Coronavirus Aid, Relief, and Economic Security (CARES) Act that was just passed by Congress are intended to assist business owners with whatever needs they have right now. When implemented, there will
be many new resources available for small businesses, as well as certain nonprofits and other employers. This guide provides information about the major programs and initiatives that will soon be available from the Small Business Administration (SBA) to address these needs, as well as some additional tax
provisions that are outside the scope of SBA.
Health Reform Bulletin 143 | Status of ACA Litigation; Murky Future of AHPs; ...CBIZ, Inc.
Litigation challenging and rescinding various aspects of the Affordable Care Act (ACA) continues to reign. Last December, Judge Reed O’Connor of the Fifth Circuit Court of Appeals opined that the individual mandate, in the absence of the tax repealed by the Tax Cuts and Jobs Act, is unconstitutional; and since it is a cornerstone of the ACA, then the entire ACA must fall (see our prior CBIZ Health Reform Bulletin 142).
Similar to Puzzling Precedents: Piecing Together MEWAs (20)
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.
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.
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.
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
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.
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.
Webinar | Training the Technique: Advanced ERISA Compliance
Puzzling Precedents: Piecing Together MEWAs
1. • Awesome Content
Supporting material
Supporting material
• Awesome Content
Copyright 2016 – Not to be reproduced without express permission of Benefit Express Services, LLC 1
Sample Topic
Sample image
3. Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 3
About Larry
Larry Grudzien
ERISA Attorney
Lawrence (Larry) Grudzien, JD, LLM is an attorney
practicing exclusively in the field of employee
benefits. He has experience in dealing with qualified
plans, health and welfare, fringe benefits and
executive compensation areas. He has more than 35
years’ experience in employee benefit law.
Mr. Grudzien was also an adjunct faculty member of
John Marshall Law School’s LL.M. program in
Employee Benefits and at the Valparaiso University’s
School of Law. Mr. Grudzien has a B.A. degree in
history and political science from Indiana University,
J.D. degree from Valparaiso University School of Law
and LL.M. degree in tax from Boston University
School of Law. He is a member of Indiana and Illinois
Bars.
4. • It is defined by ERISA as any employee welfare benefit plan or other
arrangement that is established or maintained by two or more
employers to offer or provide welfare benefits to their employees.
• MEWAs do not include plans or arrangements established or
maintained under collective bargaining agreements.
• Health insurance issuers and health maintenance organizations that
are licensed to provide health insurance to the public and employers
also are excluded from the definition of MEWAs.
• How can employer create a MEWA?
Include businesses that are related, but not part of a controlled group.
Offer medical coverage to 1099 employees.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 4
Basics
5. • Are PEOs MEWAs? It depends on the arrangement with the
Employer:
Payroll provider
Full-employer
Co-employer
• Co-employer arrangement is the most common
• Advantages for Small Employers:
MEWAs permit small employers to provide welfare benefits by pooling their
risks, resources, and employees to achieve group purchasing power.
Benefits are provided either by purchasing insurance at more favorable
rates or by establishing a joint self-insured plan funded through a tax-
exempt trust.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 5
Basics
6. Common-Bond MEWAs:
• Alternatively, a MEWA may be an association-sponsored plan where the
employers usually have a common bond such as membership in a trade
association representing a common industry.
Available Welfare Benefits in a MEWA:
• Generally, MEWAs are covered by ERISA only if they qualify as employee
welfare benefit plans.
• ERISA defines welfare benefits to include medical, surgical, hospital care,
sickness, accident, disability, death, unemployment, vacation benefits, training
programs, day-care centers, scholarship funds, prepaid legal services, or
financial assistance for employee housing.
• They do not include pensions, nor insurance to provide pensions.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 6
Basics
7. Excluded from the MEWA definition are any arrangements
that are established or maintained:
• under or pursuant to one or more arrangements which
DOL finds to be collective bargaining agreements
• by a rural electric cooperative
• by a rural telephone cooperative
• by two or more employers who are found to be members
of the same control group
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 7
Plans that are not MEWAs
8. • Although ERISA generally preempts state laws and
regulations, ERISA §514(b)(6) subjects insured MEWAs to
state insurance laws.
• Collectively bargained plans, which are not MEWAs, are
not subject to state insurance laws.
• To distinguish legitimate plans from fraudulent insurance
schemes marketed under the guise of collectively
bargained plans exempt from state regulation, DOL issued
final rules at 29 C.F.R. §2510.3-40 laying out factors that
would establish a bona fide collective bargaining
relationship.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 8
ERISA Exemption for State Regulation of MEWAs
9. • ERISA §514(b)(6) creates an exception to the ERISA preemption provisions,
which allows the states to regulate MEWAs under state insurance laws.
• In contrast to the expansive nature of ERISA's preemption blanket that covers
single-employer welfare plans, Congress permitted states to regulate certain
aspects of MEWAs.
• As a result, the degree of actual MEWA regulation varies from state to
state.
• This definition is determined by the following factors:
First, if the MEWA is fully insured and it is an ERISA-covered plan, all state laws are
preempted except those specifying standards requiring the maintenance of reserves
and the payment of contributions.
A MEWA is considered fully insured only if DOL determines that the amounts of all
benefits provided by the MEWA are guaranteed under a contract or policy of
insurance issued by a licensed insurance company, insurance service, or insurance
organization qualified to do business in a state.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 9
State Regulation of MEWAs
10. This definition is determined by the following factors:
• Second, if the MEWA is an ERISA-covered plan which is not fully
insured, only those state laws that are inconsistent with ERISA are
preempted.
• This category includes self-funded plans or stop-loss plans.
• Under a stop-loss arrangement, an insurance company generally
agrees to reimburse a plan when claims exceed a certain amount.
• The plan itself pays benefits out of its own assets until the stop-loss
trigger point is reached.
• State insurance regulation of these plans is not limited to reserve and
contribution requirements, but also encompasses other insurance laws
that are not inconsistent with ERISA.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 10
State Regulation of MEWAs
11. • ERISA permits states to regulate MEWAs whether they are self-insured or
insured.
• In practice, states have exercised this authority in diverse ways.
• Some states have no MEWA-specific laws.
• Others have simple registration requirements.
• More typically, states will treat MEWAs, to one degree or another, the same as
insurance companies and impose, for example, rules relating to licensing,
reserves, surpluses and mandated benefits.
• Some states may require employers that participate in MEWAs to accept
liability for benefits if the MEWA is unable to pay.
• Some states may prohibit MEWAs completely.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 11
State Regulation of MEWAs
12. • States often exempt fully insured MEWAs from the operations of their
MEWA statutes.
• However, they are prohibited from imposing regulations relating to
reserves and contributions including licensing, registration,
certification, financial reporting, examination, audit and other
requirements necessary to enforce standards regarding reserves and
contributions. In addition, States can effectively regulate them through
their group insurance laws that govern the issuance of policies to
associations of employers.
• For example, a state may prohibit issuance of a policy to an
“association” of employers, unless the association meets certain
criteria that are unlikely to be met by a group of unrelated employers
that wish to associate primarily for the purpose of obtaining insurance.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 12
State Regulation of MEWAs
13. • MEWAs that are not fully insured are subject to all state laws
that are not inconsistent with ERISA.
• Some states have created special rules that exempt
professional employer organizations from their MEWA laws.
• However, this does not affect their status as MEWAs under
federal law.
• While the specifics will vary with the laws of the respective
states, given the wide variations in state regulations, operation
of a multi-state MEWA can range from difficult to impossible,
particularly if the MEWA is self-insured.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 13
State Regulation of MEWAs
14. Examples:
• Illinois:
No registration of MEWAs
Prohibit self-insured MEWAs
• Indiana
MEWAs are also required to make quarterly filings.
MEWAs must file an annual renewal.
• Wisconsin:
Self-insured MEWAs are treated as unlicensed insurers MEWAs
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 14
State Regulation of MEWAs
15. • Michigan
Michigan requires licensure of MEWAs that do business with
Michigan employers and are not fully insured.
To obtain licensure, a MEWA must be controlled by its members,
have adequate cash reserves, and purchase excess loss insurance.
A complete description of MEWA licensure requirements can be
found in Chapter 70 or the Michigan Insurance Code.
• Employers may be subject to other state rules if cover
employees in other states
• Chart of state laws: http://www.naic.org/prod_serv/II-HA-
95.pdf
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 15
State Regulation of MEWAs
16. • Generally, MEWAs are covered by ERISA only if they
qualify as employee welfare benefit plans.
• The extent of state regulation of MEWAs depends on
whether a MEWA is an ERISA-covered plan.
• Employee welfare benefit plans are those that are
established or maintained by an employer or employee
organization, or both, for the purpose of providing health
care and other welfare benefits to its participants or their
beneficiaries through the purchase of insurance or
otherwise.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 16
MEWAs and Employee Welfare Benefit Plans
17. • Two-Step Process: A two-step process is involved in
determining whether a plan constitutes an employee
welfare benefit plan:
• The first step is to determine whether the benefits provided
by the plan are welfare benefits.
• If these benefits are provided, the second step is to
determine whether the plan is established or maintained
by an employer or an employee organization.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 17
MEWAs and Employee Welfare Benefit Plans
18. • ERISA applies at the MEWA level only where the MEWA qualifies as a
“bona fide group or association of employers” within the meaning of
the ERISA §3(5) definition of employer.
• Several court cases and DOL advisory opinions have addressed this
issue.
• As these authorities recognize, a MEWA can be an ERISA plan for
Form 5500 reporting and other purposes only if the group or
association of employers participating in the MEWA satisfies the
DOL's “commonality of interest” and “control” tests.
• Both of these tests must be met before a MEWA will itself be
considered to be an ERISA plan.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 18
At what level does ERISA apply?
19. The commonality of interest test requires that the entity maintaining the plan,
and the individuals benefiting from it, be tied by a common economic or
representational interest, not simply the provision and receipt of welfare benefits.
According to DOL guidance, the determination of whether an association or
group of employers meets the test will depend on all of the facts and
circumstances involved, including—
• how the association solicits members
• who is entitled to participate and who actually participates in the association
• the process by which the association was formed
• the association's purposes
• the relationship of its members outside the organization
• the powers, rights, and privileges that a member enjoys as a result of joining
the association
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 19
At what level does ERISA apply?
20. • The control test requires the employer-members of the association to
control and direct the activities and operations of the benefit plan.
• The control must exist in both form and substance, although the DOL
will generally not rule on whether a group or association exercises
control in substance over a benefit program.
• The test is designed to exclude from ERISA coverage those entities
that exist only for the entrepreneurial purpose of selling health
coverage to employer-members.
• To pass this test, therefore, representative employer-members must
be involved in designing and administering the plan of benefits made
available to their employees.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 20
At what level does ERISA apply?
21. • MEWAs are required to file Form M-1, Annual Report for Multiple
Employer Welfare Arrangements and Certain Entities Claiming Exception,
with DOL for the purpose of determining whether the requirements of
HIPAA, the Mental Health Parity Act of 1996, the Newborns' and Mothers'
Health Protection Act of 1996, and the Women's Health and Cancer
Rights of 1988 are being met.
• The reporting requirements allow for earlier detection of unsound MEWAs
to reduce the risk of financial losses for employees, employers, and health
care providers if a MEWA fails to pay claims. MEWAs Form M-1 annual
reporting filings are available electronically on the website of DOL's
Employee Benefits Security Administration (http://www.dol.gov/ebsa).
• DOL's interim final rules also set civil penalties up to $1,527 per day for
failure to file Form M-1. (DOL Reg. 29 C.F.R. §§2520.101-2, 2560.502c-5)
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 21
MEWA Reporting Requirements
22. • The rules apply to other entities that offer or provide coverage
for medical care to the employees of two or more employers but
claim not to be MEWAs because they are established or
maintained pursuant to a collective bargaining agreement.
• An “entity claiming exception” (ECE) that has been in existence
for three years or longer is excepted from the reporting
requirements.
• An ECE is an entity that claims it is not a MEWA on the basis
that the entity is established or maintained pursuant to one or
more agreements that DOL finds to be collective bargaining
agreements under ERISA §3(40)(A)(i) and 29 C.F.R. §2510.3-
40.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 22
MEWA Reporting Requirements
23. • MEWAs are required to register with DOL before they
begin operations.
• In addition, under these rules, MEWAs must report to DOL
annually regarding ERISA compliance.
• MEWAs comply with both requirements by filing the Form
M-1.
• The Form M-1 must be filed electronically.
• ERISA-covered plans subject to the Form M-1 reporting
rules also must include proof of Form M-1 filings as part of
their Form 5500 filings.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 23
DOL MEWA Reporting Rules
24. • In the case where a MEWA is an ERISA plan, only one Form 5500
needs to be filed for the plan, because it will be considered a single
ERISA plan.
• Participating employers then would have no independent Form 5500
reporting obligation.
• Effective with the 2013 Form 5500, plans that are required to file Form
M-1 are no longer eligible to take advantage of the Form 5500 filing
exemption for insured or unfunded (or combination insured/unfunded)
plans with fewer than 100 participants.
• All MEWAs that are ERISA plans must file Form 5500, regardless of
size.
• Also, Form M-1 filing compliance information must be provided as part
of Form 5500 filings.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 24
DOL MEWA Reporting Rules
25. The reporting requirements apply to administrators—including third party
administrators—of MEWAs or ECEs. In the case of a MEWA or ECE that
is a group health plan and the administrator is not designated, the plan
sponsors, as defined at ERISA §3(16)(B), are responsible for filing the
M-1.
In the case of a MEWA or ECE for which an administrator is not
designated and a plan sponsor cannot be identified, jointly and severally,
the person or persons actually responsible for the control, disposition, or
management of the cash or property received by or contributed to the
MEWA or ECE—irrespective of whether they directly exercise such
control, disposition, or management—are responsible for filing the M-1.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 25
DOL MEWA Reporting Rules
26. In addition to the annual filing, a special Form M-1 must be
filed 30 days prior to operating in a new state and within 30
days after triggering events including:
• operating in any new state not previously identified
• a merger with another MEWA
• the number of employees receiving coverage under the
MEWA increases by 50% or more
• a material change
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 26
DOL MEWA Reporting Rules
27. • Under 29 C.F.R. §2520.101-2, MEWA administrators must file a form with DOL
for the purpose of determining whether the requirements of certain health care
laws are being met.
• The rules also set penalties for failure to file the form and procedures for
hearings and appeals concerning the penalties.
• The principal purpose of the rule is to determine the extent of compliance by
MEWAs with ERISA §703, which was enacted as part of the Health Insurance
Portability and Accountability Act. ( 29 C.F.R. §2520.101-2 adds a definition of
“excepted benefits” and defines the term by reference to ERISA §733(c) and
29 C.F.R. §2590.732(b).
• The definition was added because of a clarification that MEWAs or entity
claiming exceptions that provide coverage consisting solely of excepted
benefits are not required to report under this section.
• ECEs are entity that are not MEWAs due to the exception in ERISA
§3(40)(A)(i).
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 27
MEWA Compliance with Health Care Laws
28. Section 29 C.F.R. §2520.101-2 provides the following requirements:
• The rule requires filing by the administrator of a MEWA that provides benefits
consisting of medical care on whether the MEWA is a group health plan
• The final rules also requires filing by the administrator of an ECE that offers or
provides coverage consisting of medical care during the first three years after
the ECE is originated
• A MEWA or ECE is not subject to filing a Form M-1 if it provides coverage that
consist solely of excepted benefits, such as a governmental plan, church plan,
or plan maintained solely for the purpose of complying with worker's
compensation laws
• However, if a MEWA provides coverage both to such excepted plans as above
and to any group health plan that is subject to ERISA, the MEWA is required
to file the Form M-1 due to the exception in ERISA §3(40)(A)(i)
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 28
MEWA Compliance with Health Care Laws
29. The rule also clarifies that reporting is not required if an entity would not
constitute a MEWA or ECE but for any of the three following circumstances:
• Common Control Interest of at Least 25 Percent:
A filing is not required on behalf of certain plans or other arrangements that provide
coverage to the employees of two or more employers that share a common control
interest.
If an entity would not constitute a MEWA or ECE but for the fact that it provides
coverage to the employees of two or more trades or businesses that share a
common control interest of at least 25 percent at any time during the plan year, a
Form M-1 filing is not required.
However, while use of a 25 percent test may result in a determination of common
control for purposes of the Form M-1 filing requirement, common control generally
means, under tax code §§414(b) and (c), an 80 percent interest in the case of a
parent-subsidiary group of trades or businesses a more than 50 percent interest in
the case of a brother-sister relationship among organizations controlled by five or
fewer persons that are the same persons with respect to each organization.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 29
MEWA Compliance with Health Care Laws
30. The rule also clarifies that reporting is not required if an entity would not
constitute a MEWA or ECE but for any of the three following
circumstances:
• Temporary MEWAs
Created by a Change in Control: A temporary arrangement providing
medical benefits to the employees of more than one employer created by a
change in control will not subject the plan to the Form M-1 filing
requirement.
Temporary in this case means the arrangement does not extend beyond
the end of the plan year following the plan year in which the change in
control occurs.
The change in control must occur for a purpose other than avoiding Form
M-1 filing.
ERISA §3(40)(A)(i)
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 30
MEWA Compliance with Health Care Laws
31. The rule also clarifies that reporting is not required if an entity would not
constitute a MEWA or ECE but for any of the three following circumstances:
• Very Small Number of Persons Who Are Not Employees or Former
Employees:
Entities that would not be a MEWA or ECE but for the fact that they cover a very
small number of persons (excluding spouses and dependents) who are not
employees or former employees of the plan sponsor, are exempt from the filing
requirements.
For example, an arrangement may cover nonemployee members of the board of
directors of the plan sponsor or individuals classified as independent contractors.
The number of employees or former employees covered by the arrangement,
determined as of the last day of the year to be reported (or, in the case of a 90-day
origination report, determined as of the 60th day following the origination date) can
not exceed 1 percent of the total number of employees.
due to the exception in ERISA §3(40)(A)(i)
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 31
MEWA Compliance with Health Care Laws
32. • If ERISA does not apply at the MEWA level, each
employer providing benefits to its employees through the
MEWA will be considered to maintain a separate ERISA
health plan subject to COBRA.
• For example, if unrelated employers provide medical
benefits through a MEWA that is not an ERISA employee
benefit plan, each of these employers will be deemed to
maintain its own ERISA health plan.
• These plans exist separately for COBRA purposes, and
each employer would therefore be responsible for COBRA
due to the exception in ERISA §3(40)(A)(i).
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 32
MEWA Compliance with Health Care Laws
33. • If ERISA does not apply at the MEWA level (and this is often the case,
as discussed previously), each employer providing benefits to its
employees through the MEWA will be considered to maintain a
separate ERISA health plan subject to COBRA.
• For example, if unrelated employers provide medical benefits through
a MEWA that is not an ERISA employee benefit plan, each of these
employers will be deemed to maintain its own ERISA health plan.
• These plans exist separately for COBRA purposes, and each
employer would therefore be responsible for COBRA compliance.
• In the unlikely event that a MEWA is itself an ERISA plan, it appears
that instead of the participating employers, the designated plan
administrator of the MEWA would be responsible for COBRA
compliance.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 33
COBRA
34. • Each private-sector employer participating in a MEWA governed by ERISA
generally is considered to have established a separate group health plan for
the benefit of its employees.
• In that case, each separate plan is required to comply with HIPAA’s portability
requirements.
• In addition, the MEWA itself will be responsible for compliance with HIPAA’s
portability requirements.
• First, those MEWAs that are themselves considered group health plans under
ERISA would be subject to the HIPAA portability provisions set forth in
ERISA—since those MEWAs would fit the definition of a “group health plan”
for HIPAA portability purposes.
• Second, all MEWAs covering private-sector employers, regardless of whether
they satisfy the ERISA test for separate group health plan status, appear to be
subject to the HIPAA provisions set forth in the Code.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 34
HIPAA
35. • DOL the power to issue cease-and-desist orders against abusive MEWAs and
individuals associated with them, and to seize the assets of a financially
unstable MEWA if necessary to protect participants, employers or other
members of the public.
• Health insurance issuers that are licensed and approved by each state in
which they offer health insurance coverage are excepted from coverage under
the rules.
• The DOL may issue a cease-and-desist order, without prior notice or hearing,
when it determines it has reasonable cause to believe that the MEWA or any
individual acting on behalf of the MEWA (including a third-party administrator)
has engaged in conduct that:
Is fraudulent
Creates an immediate danger to the public safety or welfare (in that it unreasonably
increases the risk of nonpayment of benefits)
Is causing or can be reasonably expected to cause significant, imminent, and
irreparable public injury
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 35
Enforcement
36. • The DOL also has the authority under ERISA and the final
rules to summarily seize a MEWA’s assets if it appears
that the MEWA is in financial jeopardy.
• In the normal course, the rules require the DOL to obtain
court authorization prior to seizing assets.
• DOL may issue a summary seizure order without prior
court authorization if it reasonably believes that a delay in
issuing the order will result in the dissipation of plan assets
or the destruction of plan records.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 36
Enforcement
38. Company Background - Services
Eligibility
Enrollment
Integration
Self Service
Communications
EE Call Center
Decision Support
Retiree H&W Admin.
COBRA
Direct Billing
Total Rewards
Reimbursements (HSA / FSA)
Commuter Benefits
Dependent Verifications
ACA & Other Compliance Svc.
We help participants understand and use
their benefits wisely so that they can be
accountable for their healthcare.
We enable you, as the plan sponsor, to
enable and deliver your benefits strategy.
benefit wise. relationship driven.
39. 39
Company Background – Book of Business
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC
Clients & Services Supported
226
Administration Participants 1,500,000+
3,952Technology Clients
Reimbursement / COBRA clients 187
Average client size - participants 4,100
Mid/Large Administration clients
ACA 1095 Forms Generated 250,000
250 employees serving our clients from two services
center; Schaumburg, IL and Rancho Cordova, CA.
40. Copyright 2016 – Not to be reproduced without express permission of Benefit Express Services, LLC 40
Some of Our Partners
42. Larry Grudzien
Attorney at Law
(708) 717-9638
larry@larrygrudzien.com
www.larrygrudzien.com
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC
Contact Information
42