CEB

Self funded plans can determine the subsidy percentage based on dependent type. If you’re looking for savings, go after your RX plan first. Tons of opportunities there such as removing compound drugs except for kids. Preventing diabetes drugs for only diabetes or other FDA conditions. People are using them for weight loss and costing employers so much $$ for weight loss. Remove any drugs that are basically over the counter medications combined into a brand drug prescription (yes several of those allowed on employer plans). Consider adding speciality drug rebate program like Prudent RX. Join a collective RX group so your RX goes up to bid with 20 other companies rather than just your own. You’re buying at 100,000 lives rather than 2000 for example. Willis Towers Watson and Mercer both have them. Then decide if you want to make an employee pay the full cost of premiums for their spouse. Maybe instead have a spousal surcharge for working spouses that are on your plan but have access to their employer plan. And for child coverage why not do employee plus 1 child, employee plus 2 children, etc instead of one flat premium for all kids. Best of luck 🤞

Really appreciate your comments. I was thinking it would be associated with a HIPAA event as well.

Self Funded plans select the state for their plan. For example in Texas most employers select Utah for their because they are more relaxed. Self-Funded plans still have a state they have to operate under, you would need to understand that state rules like chaz was mentioning.

agree, the file could have been opened and that is putting their mistake on the recipient

Hello, can you provide me with some guidance on the "relaxed deadlines" in the "out-break period" when an employee fails to verify their dependents. The dependent was removed from the plan in May. But they are now providing documentation and asking for reinstatement. Under normal circumstances we do not allow the dependent to be re-enrolled until Open Enrollment.

I should probably mention this is not an outcome based program, just participation

My question is about the alternative wellness credit rule and how that impacts biometric screenings in remote work locations. We would like to use a national Lab to do our Biometric Screenings. Unfortunately, some of our job locations do not have a national retail lab nearby them. The national lab could send electronic interfaces that would allow wellness credits to be provided to employees without using to much of the benefit department staff. Are we required to provide an alternative solution for biometric screenings for remote work sites that would not have a national lab near them or could those employees be excluded, unless they are willing to drive several hours to a lab retail location, to avoid manual payroll credit entries. In other words, possibly avoiding giving credits for each employee doctors lab work with manual upload files for small town remote locations. At some point we would like to maybe do mail order kits, but not right now.

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Is the maximum limit for high deductible plans a combo of in and out of network or can the limit be for each type of structure? We have a shared family deductible and then individual out of pocket limits. This year we are thinking about adding an out of network structure and the costs in the network would not be credited towards the out of network limit.

Opinion only....You should only enter the amount that was distributed from the HSA for qualified medical expenses $1899.08. You wouldn't enter $2,100 unless the HSA actually distributed the amount from that account. The amount entered should be $1899.08 in my opinion. It is checking to see if there was a distribution that possible took place that should be taxed such as spending $20 on groceries included in the $1899.08. In that case you would say $1879.08 for qualified medical expenses, the system will then know to apply tax on the $20 paid from the HSA. If your child had a massive amount of medical expenses there is a different section that you would work through for a deduction, but most people wont be able to use that section unless they don't have insurance or they have a high deductible and/or OOP plan. I am not an accountant, but I use a tax filing software and the software looking to determine if any of the distribution should be taxable.

Hello, For retirees living abroad, may their international or government provided health insurance premiums and insurance out of pocket expenses be reimbursed by an USA HRA (former employer lumpsum awarded at retirement for medical expenses)? I would think no to other government premium insurance cost, but yes to private international medical polices and OOP. ? Carrie

Well in some states we claim sales tax on our IRS annual filing (standard or itemized), so this is going to get interesting for possible double dipping if people itemize every sales receipt they have for the year and also claim it on the HSA not thinking about the reimbursement from two sources.

Anyone else get a pretty large number of errors related to SSN & Employee name match for the 1094 reporting? It is really strange that IRS would reject employees Name/SSN that were not exactly the way it is on their Social Security card. So someone like Samuel Smith should have been Samuel Michael Smith on 1095. I don't recall anything saying that an employee needs to have their exact name in any employer system to be the same on their SSN card. So a abbreviated middle name may not be possible in the future because it causes errors or even the suffix like Jr. or II, etc could even be another problem. How are you approaching this problem if you received the errors back that SSN and Name do not match their records. How are you going to collect the data from the employees? A simple response would be I9 (unless employee provided passport/DL instead), but for so many errors, it will take a very long time to fix.

The plan language states employee can have working spouse as a dependent in plan because the plan was originally set up as EE+1 or 2 or 3 etc. coverage, but new plan rates are EE+Sp or EE+family.