leevena

Don't know if I understand what you are asking for, so please bear with me. It sounds like you want to offer three types of medical plans and you are asking for advice on how to design the rx benefits under each, is that correct? If so, it is difficult to for someone to answer you without knowing much more about the risk and what you are trying to accomplish. Just slapping a benefit design into a medical plan without knowing will not do much for you.

Section 105 nondiscrimination applies to self-insured HDHP (I assume yours is fully insured), and no for the HSA. However, if you are making the HSA contribution outside of the 125 plan you must follow the comparable contribution rule. If the contribution is made inside the 125, it then becomes subject to the 125 nondiscrimination rules.

If your plan covers mastectomy then it must provide notices when you enroll and then yearly. However, church and govt plans are not subject to this law. The requirement is on the carrier side (health plan or issuer).

The unfunded, self-insured plan exception applies regardless of the size of the plan or whether they have to file 5500s. Did not know that, thanks so much.

I was just saw these posts, and that 's what I was thinking too. I am under the impression that groups above 100, that are required to file 5500's are required to do SAR's.

Compliance is the responsibility of the Plan Administrator, which should be identified in a variety of documents made available to the covered employee. If you don't have any, the employer/employers' HR should know.

I agree with you, ERISA clearly states that summary annual reports are to be made available automatically each year. Here is a link to the DOL site. http://www.dol.gov/dol/topic/health-plans/planinformation.htm

If you read my first post I do state that it is not impossible, just difficult.

With all due respect, I believe your comment to be incorrect. Yes, there are a few ways of counting employees, and yes a possible plan design for them (60%) could very well be in the mid-$200 per month range. The reality is that there are very few, if any, of these types of organizations that will not reach the 50+ level. So it is safe to say that most, if not all of these organizations will be subject to PPACA. While the price point of $250 or so does not sound like much, you need to consider it within the context of the cost to the staffing company. The first issue will be how to maintain the required participation level (75% in most instances) that the carrier will require. This is usually done via the employer contribution. A good rule of thumb is that the employer portion will need to be around 75% of the cost (not what is required by the carrier, but what is needed to achieve and maintain the participation requirement), or roughly $200-225 per person. The second issue is that of the value of providing that level of contribution ($200-225 per month) with respect to the total compensation paid. For a staffing company that specializes in higher income (IT for example, that might be paying $60k-70k per year) the cost is relatively low and makes sense. But for the majority of staffing firms that specialize in lower income ( $15 per hour or $450 per week) the contribution cost is a much higher pecentage cost of compensation. I am not saying that these organizations can't find a solution, in fact I state there are solutions. It is just that finding the right combination of plan/costs with the right type of staffing (compensation paid, size, etc) will make this market very tough. Just take a look at Massachusettes, which has a similar health care requirement that PPACA is now requiring. Very few (if any) of those staffing companies kept health plans and opted to pay the penalty.

Mini meds are generic term that refers to plans that have limited benefits, such as a cap of $25,000. These plans have been very popular in certain industries that wanted to offer benefits, but needed low cost, such as restaurants.

I don't know. As the law is written now, there appears to be an opportunity to structure a version of a "mini-med" that will satisfy the requirements. My guess is that the cost will be somewhere around the penalty cost, allowing the temp agency to offer something. But I am not in that world, I do traditional employer coverage in the self-funded world.

I don't have any written materials, but PPACA is akin to a steamroller heading towards any staffing company. The chacne of finding a traditional major medical plan is almost nil. If you consider the type of risk (high turnover, lower wages,) it is difficult to project costs, which leads carriers to just say no. Most of these staffing companies could not meet the participation requirements anyway. Self-funded is not a solution either. If they do decide to develop a benefits plan they need to proceed with caution and get good advice. There are ways to do this, but it will still be costly and will not be a major medical type plan.

Plan year is the effective date. Did I understand your question correctly?

See question 18 http://www.irs.gov/uac/Newsroom/Questions-and-Answers-on-Employer-Shared-Responsibility-Provisions-Under-the-Affordable-Care-Act

That is an interesting question, and my guess is no. But again, I am assuming you mean waiting for an eligible expense. For example, if the group health plan covers weight loss surgery as an eligible expense, you cannot deny that coverage to someone.

Sorry, but I must have misread your first question. I thought you asked if you could have a seperate waiting period for a particular expense that is covered under the health plan. You can have a waiting period up to 90 days, and actually there can be some slightly more due to issues such as obtaining a certification/license for work. You can also have different waiting periods. I don't understand the last part "Also, is a period tied to "particpation" in the plan as opposed to service itself really a waiting period? It is not based "solely" on the passage of time"

You cannot have a seperate waiting period for any eligible expense under the group plan. Sorry.

Treasury released guidance on this a few months ago and does allow for groups to change their dates to delay. It is called "Transitional Relief for Non-1/1 Effective Date Plans." Hope this helps.

It sounds like you are getting tripped up on the term employee, which is easy to do. Think of the HRA being used to fund certain reimbursable expenses within the medical plan. For example, the employer purchases a $10,000 deductible plan from an insured carrier and now self-funds the eligible expenses below the $10,000. The employer will usually have some type of plan design underneath the $10,000, for example it might be a $1,000 deductible, and then 80/20 of the remaining expenses. When presented to the employee for their enrollment, it appears as though it is one plan, so if the employee elects medical coverage they are electing the HRA and the fully insured plan. If the employee elects dependent coverage, those dependents are covered. The selection of "dependent coverage" by the employee is all that is needed to satisfy the rule. Hope this makes sense. Good luck.

GMK is correct, but please check your plan documents for the definition of a dependent. It is possible that your company has elected to offer coverage down to this level...highly unlikely but well worth the 5 minutes it will take for you to research.

If you are referring to the 105 non-discrimination testing, that testing is only done on the population in the self-funded plan, not the fully-insured. Assuming that the employer has structured the two plans correctly, there should be not be a problem. But keep in mind, I have very little of the information I need and you are asking people on a web site, so be careful. Go to the IRS site or google 105 non discrimination and you will find many resources to help you.