lvena

An employer can still do this, as long as the plan design meets the PPACA benefits requirements, which is not too difficult. Yes, the size and risk appetite for the employer plays a significant factor in how an employer funds their medical benefits plan. In my mind, there are four types of self-funding available; 1) high-deductible with a fund underneath it (this one), 2) a cooperative self-insured plan either through a captive or not, 3) a stand-alone level-funded self insured plan, and 4) traditional self-funding. As for plan-document revision, cannot say for sure without reading it. But my guess is that there will probably be a need for a revision. Does this help?

Ignore my answer, sorry. I thought you were asking about all voluntary type (accident, dental, etc. ) plans, not supplemental. I did not read the question correctly.

When a group starts to consider if they should continue their broker relationship, the first question I ask if they have the bench-strength to do the job. And by this I mean both the FTE’s that will be needed and more importantly the knowledge. Your post indicates that you have a staff of 5, with yourself as the only benefits experienced person. I am going to assume that your benefits background is lacking any significant time as either a broker or carrier person. My gut tells me that you should probably not try to go this alone, at least not just yet. The physical enrollments and the FTE’s are the least of your worries. The lack of knowledge (please, don’t take any offense) would be my biggest concern. Assuming that your broker is competent, you would need to fill some significant holes, including; negotiating with carrier, choosing vendors that you might need, analyzing financing options available to you, benefit analysis, claims analysis and more importantly doing something about those claims, PPACA, legal issues, etc. Going out on a limb here, but based on what you have posted I am guessing that your plan costs are about $2,000,000 per year and the broker was paid 4% or $80,000. If this is close, my gut also tells me that ditching your broker may save you $80k, but that these savings would be eaten up quickly with the additional costs you will need to incur. Hope this helps.

Doubt if anyone tracks that type of information, would seem to be impossible.

GBurns is correct, ACA does not restrict the use of cash. My best guess is; 1) it was an excuse to not accept the patient or 2) confusion on the part of the receptionist. With many providers going to cash only (concierge) it is possible that this was such a provider, who knows.

Sorry, I don't know. Since it is a tax cost I would assume through the normal tax protocols, but don't hold me to it.

An employee can claim to have a right to the subsidy, but that means nothing. It is up to the exchange to review and decide. If the employee receives the subsidy then the employer is subject to the $3k fine at which point the employer could challenge if the employer believes that the $3k fine is being assessed incorrectly. Does this help?

Close. In a self-insured plan the penalty is applied to the HCE's, and they must claim the excess reimbursement as gross income. (see treas. reg 1.105-11(e). There are also some penalties for willful, such as fines and jail time, but I have no idea if that has ever been done.

See the benefits test for your answer, it requires that contributions be the same. I have cut and pasted. Benefits Test-Section 105(h) requires that all benefits provided to HCEs be provided to all other participants and that all benefits available to the dependents of HCEs are also available on the same basis to the dependents of all non-HCE participants. The benefits test has two components: Discriminatory On Its Face-a plan must meet the following four requirements: Required employee contributions must be the same for HCEs and non-HCEs The same type of benefits available to HCEs must be available to non-HCEs The maximum benefit level cannot vary based on age, years of service, or compensation HCEs and non-HCEs must have same waiting periods Discriminatory In Operation-a rare occurrence, such as if the group added a benefit for a short period of time, a HCE received coverage for treatment and then the plan terminated the coverage once treatment was completed.

Never seen anything like this before, not to say it can't be done though. I would ask the carrier, but my guess is the answer would be no.

Wow, I did not know that. Good thing I said 99%. Thanks.

I am 99% sure the answer is no. (Just hedging my bets) I have not seen any examples such as yours. The wording seen is integrating with the same employer coverage, not some other employers.

She is referring to affordable coverage as defined in PPACA.

Group does not have to offer coverage of any kind. If they do offer coverage the carrier will require some level of particiation and employer contribution, so to offer without any employer contribution would not achieve the participation requirements. There has never been non-discrimination rules on fully-insured coverage. If this group is self-funded then they would be subject to these rules and would be a problem.

All of them - if they are all available to active employees. COBRA beneficiaries have to be offered the same options (and enrollment/change rights) as active employees. I'm not talking about open enrollment, which I know the rule is that COBRA participants must be permitted to enroll in any benefit open to other similarly situated employees. That aside, ordinarily, COBRA coverage must be "identical" to what the QB has prior to the QE. In a transaction where the seller's plan goes away, there is no "identical" coverage under any of the purchaser's plans. What am I missing? Sorry for delay. The new employer does not have to offer an identical plan. They make available their current plan.

ERISA covers any health plan, self-funded or fully-insured. Your description of the union plan does appear to define it as a health benefit plan, so yes it would.

Probably a poor choice of words. I was using the word "legally" to differentiat from the scenario you just outlined. I interpreted this situation differently because one of the "partners" quit and took employees elsewhere. When a partner leaves the partnership is usually dissolved, which requires that start of new business.

What is the purpose of the additional charge? Are all the participants owners?

Depends on when you elect your COBRA coverage. If you select COBRA after becoming eligible for Medicare, you can use your COBRA as a supplement. If you have COBRA before being eligible for Medicare, and then enroll in Medicare, you cannot keep COBRA.

We just went through a similar situation. I agree that this is probably not the best forum, but you really do need to speak with an attorney about this. There are just too many variables that affect this decision. The bypass trust can be a good option, but without all the details of your estate, full explanation of your desires/wishes, and an good understanding of the laws in your state, it is impossible to make a good decision. We ponied up the money and went to an attorney. Best $400 we ever spent. By the way, I am not an attorney (just a benefits guy) but have had some family experience over the past few years.

My initial reaction was that you would be ok with the administrative correction strategy because as I read the regs they seem to focus on what the employee costs would be within the context of premiums/copays. But then I thought again. Let me play devil’s advocate. How did the employer not know about this? Personally, I would find it difficult to believe that an employer operating a benefit plan requiring self-funded dollars, and detailed reporting, did not know about this. (Assuming that this benefit design has been in effect long enough for experience to be given to them) This could lead one to believe that the employer did not make a mistake and intended to have this design all along. Seems to me that their "mistake" defense could become difficult to prove. Now factor into that the government person(s) that may have to pass judgment. Will they be looking to make a point, or a name for themselves? By the way, I searched but cannot find any similar cases, so I have not legal precedence to reference. Good luck, this sounds like a good case study.

I would answer your question, yes and no. Assuming the plan was started prior to 9/23/2010, and is grandfathered, it is true that the the non-discrimination rules do not apply. However, as of 9/23/2010, annual and lifetime limits are not allowed on ANY plans, grandfather or not. Assuming that your clients' plan has a limit, it does not matter if it is grandfathered.

I agree with you. Any expense must have a "medical need" behind it. Just because a court order is issued does not meet the medically needed requirement.

I'd like to comment about the future for you, since you mentioned in your post that the group intends to grow and will be over 50 lives soon. The HIPAA requirements are easy to find and understand, but can be difficult to implement and abide by. Depending on your company structure and resources, only you can make a judgement about self administering or contracting it out. For example, if your company is a Third Party Administrator, working in the FSA and HSA markets already, my guess is that you could easily self-administer. If your company is a manufacturing firm, with minimal HR staff/resources, it might be a little more difficult. Good luck.