leevena

I am a little confused, sorry. Why do you consider the payment to be a premium? As I read your post it states that an employer has allowed an outside vendor to set-up a medical clinic on the employers property. I suppose the clinic could set up a payment methodology based on either 1) pay for services, or 2) some form of capitation, but neither would be considered a premium. What am I missing?

I too stand corrected, but for a different reason. I assumed that the group was under it's own contract and the transfer would have been to another group with a different contract. Never thought to consider the PEO was the contract holder. And the 401(K) comment in the reply did not even strike me. Guess I should have re-read it. Sorry. Lee

hr for me is correct.

I agree with Flyboy, you should review the contract/plan documents and not pay attention to the name given the plan. Minimum Premium Plans (MPP) is not considered a self-funded plan, and as such is subject to state regulation. That being said, I am not saying that your plan is insured. There is considerable confusion in the marketplace about these types of plans and considerable use of terms incorrectly.

I am in North Carolina, and am not familiar with NM. But surcharges such as this is no an ERISA issue, sorry. See New York State HCRA for an example, It even extends the surcharge to groups out-of-state who have an employee incur medical expenses in NY. I am sure there are others.

Hi. This is not my area of expertise but I just received a legal newsletter that may help you. Have not read thru it. Having a difficult time with pasting, so here is the website. www.healthcare-attorneys.com/determine-applicable-large-employer-status-2016. Hope this helps. Lee

I am a health guy, not retirment, so I am guessing that IRC 414 refers to common ownership. The law states that groups above the 50 FTE level are classified as a large group, and as such subject to the ACA. Appears that the group is subject to the penalties and provisions. Tried to paste the link and could not, go to www.irs.gov/affordable-care-act/employers.

QDROphile is correct. Soon after ACA, there was/is substantial confusion around this strategy of allowing employees to fund their medical premiums via the fsa. There are some vendors out there pushing it very hard, even with marketing materials that are written in such a way that it looks legit. One that comes to mind is Zane, but there are others even today pushing the concept. See Technical Release 2013-03. Good luck.

Don't be too surprised, the math is working against you anyway. The group has a community-rated plan, which is akin to an average cost in your area. To be cost competitve it means that this group needs to be below the community rate. The math tells you that half the groups in this area will be below the community-rate. Sorry, don't know any tpa that will do this. All of the tpa's that I work want the stop-loss, otherwise they can't make any money. Sure this is one out there, just don't know them.

If group is subject to ACA you will be required to limit ee cont to no more than 9.5% of income. If self-funded, 105 discrimination testing too.

What you want to do is easy, it's called an Agg Only. There are a few carriers out there that do this. Dont' know where the group is, so cannot guarantee that it's available in that state. You may want to also consider a level-funded self-funded plan too. As a rule of thumb, level-funded plans should have a lower fix cost. Available to discuss if you would like.

Well as one who has viewed this twice, I will chime in. I came back to see what others had posted. What did go through my mind was how the employer is viewing this as a burden. With the wide acceptance of Section 125 and 401(k) plans, I suspect most people know about pre and post tax. The amount of eduction should be very little. Additionally, why would an employer want to create the impression of favoritism within their organization. At some point someone is going to cause an issue with it. Just my two cents.

What type of coverage do you have, group or individual? If it is group coverage all you need to do is request cancellation, in writing, to your HR department. If your employer has on-line services, do it that way. If you are in a 125 prem conversion you will need to continue. If individual coverage, notify the carrier and stop the payments.

There is a variety of methods available to the employer, incluidng; purchasing a plan that the carrier has already measure, having an actuary review, or using the calculator available via the govt. Little confused aobut your comment regading small enough to no self-insure. Am I missing something here? Why make the comment?

Saw that, sorry was focused in another direction. When I first read "note the author" I immediatly thought that it was going to be someone from this forum. Thanks.

Good article. Sorry, but the name does not mean anything to me, who is the author?

Is this a trick question? My initial reaction was that it is a settlor decision, which is in-line with what I have known over the years. But then I considered the network issue (floriday vs idaho) and thought to myself who in the world would create a network that requires most/all people to be out-of-network. And if such a design was created I would not be surprised if there was a lawsuit brought and I would not be surprised if the courts ruled against the plan. Would be interested in hearing others opine.

We are doing the same. Our concern is based on a conversation that some legal people had with the compliance people. They asked the compliance people if there would be any other consequences to the group if they did not provide the notice. The answer was not a definitive "no" to that, so some of are a little skeptical. For instance, could the DOL come after a group and say that ERISA requries disclosures and that notice was not provided, therefore you are in violation of your fiduciary responsibility?

I believe so.

Some times you can use the 125, sometimes you cannot. See Public Law 111-48, Section 1515©, which amended Section 125. Long story short, if you purchase an individual plan via the puplic exchange then that plan is no longer considered a qualified benefit under Section 125. If you purchase the individual plan off the public exchange, then you can use the 125 pre-tax dollars.

I am a little confused and need some clarification. Are you saying there are two employers under one contract or are there two seperate companies with their own contract. If there are two employers with two contracts then the second employer does not have to offer cobra. If you have one contract for the two groups, you may have a variety of other problems, such as participation levels, if the contract is still valid, possible 105 discrimination if you are self-funded, rates may be no longer valid, and others. I would begin with who is the plan sponsor. This is usually one of the employers.

Chaz, we do this all the time. The way you have described the process I would say there is no issue, but I do have a concern. Ours is web-based, with each employee receiving a an email with a link from which they can complete the form. Once completed the forms are placed in a pdf file and submitted to the carrier. Other than the employer sending a cover letter with the link, there is no employer/broker involvment, so there is no need for an agreement. Your situation is a manual approach, so while the employer may not be receiving any PHI information, is it possible that someone at the group is able to view these forms? If there is a possiblity, then an agreement might be worthwhile. I could envision a situation where the employee completed the form, placed in a sealed envelope and returned to the broker, which would not be an issue for the employer. Rambled a little, hope it helped. Lee

Ok, thanks.

Chaz, or anyone else. Your post made me consider this from a different perspective. At the time HIPAA came in, I was at a healthplan. In many of the different seminars/training we attended at the time we were all cautioned about making sure we had agreements with all of our vendors that might come into our facility/office. The one that comes to mind immediatly is the outside cleaning service we used. They were subjected to an agreement. The reasoning being that they could come upon PHI. So, did we overreact? And if not, shouldn't the school sign one anyway just in case one of their employees come upon PHI? thanks.

Your question gets a little confusing, so excuse me if I get it wrong. The clinic is clearly a CE, the school is the BA and an agreement should be required. I assume that the clinic is conducting the exams on behalf of the school and that the results/information will be provided to the school. I don't know if your comment (in the last paragraph) "to the extent that it should provide any services for or on behalf of the clinic" because I am assuming that some type of information is going back to the school. Correct?