A Guide to HHS Compliance Prep. Presenter: Melissa Koontz Client Manager

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1 A Guide to HHS Compliance Prep Presenter: Melissa Koontz Client Manager

2 Health & welfare benefits focus the fastest growing piece of the compensation pie Emphasis on federal regulations Not extending to employment law But still plenty to cover!

3 Enrollment Compliance Plan Design Red Flags Plan Administration Pitfalls Privacy & Security

5 Eligibility Framework Definition of spouse and dependent Domestic partner definition: same/opposite sex Number of days allowed for mid-year enrollment Length of waiting period Counting hours language NEW! Automatic Enrollment Delayed until after 2014 ACTION: Review & Apply

6 Enrollment Materials Distribution methodology Content of enrollment materials Content of enrollment forms Culturally and linguistically appropriate (PPACA) ACTION: Audit Against Rules

7 Other Considerations Domestic partners affidavit Smoking status affidavit and the health status reasonable alternative Declinations of coverage Pre-tax election forms ACTION: Review & Apply

Notices (Initial) Notice of Special Enrollment Rights Women s Health and Cancer Rights Act HIPAA Privacy Notice Medicare Part D Notice to participants CHIP Notice COBRA General Notice Wellness

8 Notices (Initial) Notice of Special Enrollment Rights Women s Health and Cancer Rights Act HIPAA Privacy Notice Medicare Part D Notice to participants CHIP Notice COBRA General Notice Wellness Program Disclosures (if applicable) Summary of Benefits and Coverage (PPACA) Patient Protections Notice (PPACA) Statement of Grandfathered Plan Status (PPACA), if applicable NEW! Marketplace Notice (PPACA) ACTION: Audit Against Rules

(if applicable) Michelle s Law Notice limited circumstances Notice of Annual Limit Waiver (PPACA) Summary of

9 Notices (Annual) Women s Health and Cancer Rights Act Notice Medicare Part D Notice to participants HIPAA Certificates of Creditable Coverage HIPAA Privacy Notice of Availability CHIP Notice Wellness Program Disclosures (if applicable) Michelle s Law Notice limited circumstances Notice of Annual Limit Waiver (PPACA) Summary of Benefits and Coverage (PPACA) Patient Protections Notice (PPACA) Statement of Grandfathered Status (PPACA) ACTION: Audit Against Rules

10 Annual Reporting Medicare Part D Creditable Coverage Notice to CMS W-2 Reporting PCORI Fee Reporting(Self-funded only) Transitional Reinsurance Fee Reporting (Self-funded only) NEW! Employer Reporting of Minimum Essential Coverage (Selffunded only) NEW! Employer Reporting of PPACA Employer Mandate Compliance NEW! Excise Tax Reporting for high valued plans (PPACA-2018) ACTION: Audit Against Rules

11 Section 125 Considerations Premiums, Dependent Care, Health Care Expenses Limited v. Full Scope Grace period NEW! $500 carryover (optional) Forfeitures Administrator Nondiscrimination testing ACTION: Review & Apply

13 Mandated Benefits: Self-Funded and Fully Insured Nondiscrimination Mental Health Benefits Women s Health and Cancer Rights Act Newborns and Mothers Health Protection Act Coverage for Adopted Children Michelle s Law Genetic Information Nondiscrimination Act (GINA) PPACA Patient Protections Preventive Care ER Annual/lifetime limits Nondiscrimination pending guidance No pre-existing conditions PPACA grandfathered plans

14 We want to offer a smoking cessation program. Employees who go through the program and actually quit smoking will qualify for a discount on medical premiums. Will it work?? Incentive cannot be dependent on the outcome unless meet wellness program criteria

secondary) Incentives to encourage employees to waive employer s plan in favor of Medicare are

15 Can we incentivize Medicare-eligible employees to take Medicare and decline our plan?? Group health plans are required to always be primary payers for active employees (Medicare secondary) Incentives to encourage employees to waive employer s plan in favor of Medicare are illegal unless offer incentive for all waivers Group health plans must offer employees over and under age 65 the same benefits

16 Can we incentivize Tricare-eligible employees to take Tricare and decline our plan?? Incentives to encourage employees to not enroll or terminate coverage under the employer s plan in favor of TRICARE are illegal unless offer incentive for all waivers TRICARE-eligible employees must have same right to elect group health coverage as any other employee

18 A long-term employee has gone out on disability leave. Can we just leave him on the plan as an active employee?? Check your plan document, but you will probably need to move him onto COBRA after an initial disability time period equal to the FMLA time period

19 ? What do we do if an employee defaults on her pay-as-you-go payment option during FMLA leave? Best to have an advance agreement. Can use catch-up payment option (even without an advance agreement) Cannot terminate them off coverage unless you provide timely notice of late payment

20 We are doing spring cleaning in the office.? Can we dispose of information relating to last year s benefits enrollment? No. You will need to postpone that spring cleaning until 7 years from the end of the plan year. Try cleaning out the pen drawer instead!

22 Can we post information on employees medical conditions on the lunch room bulletin board? No!

23 HIPAA Privacy & Security Privacy & Security Officials Protected Health Information Hands-off vs. hands-on PHI handling HIPAA Privacy Notice Plan document amendments HIPAA-secure communication platform with vendors Risk Analysis (administrative, physical & technical safeguards) Individual Access Employee Training Unique identifiers

26 Minimum Essential Coverage 6055 Self funded only All size employers Applicable Large Employer FTEs Fully-insured and self funded

27 6055 / 6056 Reporting Friday, May 8: 10:10-12:00 Convention Center 102 A/B Presenters: Charlie Isaacs, Practice Leader and Senior Client Consultant Zach Proett, Client Compliance Consultant

Federal Group Health Plan Mandates

Federal Group Health Plan Mandates Note: This document is best used via soft copy in order to link to the sample language and other resources. Federal group health plan mandates are federal laws that impact