BAS Blog


 

Employers Must Consider Application of MLR Rebates

The Medical Loss Ratio (MLR) provisions of the Affordable Care Act require insurers to spend at least a specified percentage of employees’ premium dollars on clinical care, rather than on administrative expenses such as executive salaries, overhead, marketing and profit. If an insurer does not spend enough on patient care to satisfy the MLR provisions, the insurer must make financial adjustments and provide rebates to customers. Health care reform sets the minimum MLR level at 85 percent for the large group market (policies covering over 50 employees) and 80 percent for the small group market. This means that administrative and other non-clinical costs can be no more than 15 or 20 percent of the insurer’s revenue. If an insurer fails to meet these standards, the insurer will be required to provide a rebate to customers beginning this year.

Rebates from insurers will differ depending on if the rebate is to a group health plan policyholder or an individual policyholder. See below for a chart of rebate dollars per state. For group health plans, the policyholder is usually (but not always) the employer sponsoring the plan. Insurer rebates to employer policyholders can be paid either in cash or in form of reduced premiums.

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EEOC Confirms Protections for Transgender Employees and Job Applicants

The Equal Employment Opportunity Commission (EEOC) recently held that discrimination against transgender employees and job applicants is prohibited under Title VII of the Civil Rights Act.

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We’re Listening! Tell us what you think.

The service experience of our clients and their employees is very important to BAS. In addition to providing our clients with comprehensive benefits eligibility management software, we are committed to providing efficient, cost-effective and knowledgeable service. To help us understand our clients and their employees’ needs, we offer many ways to give feedback.

Nearly every electronic communication from us includes a link to an email address for the recipient to immediately contact us.

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OCR Announces HIPAA Audit Protocol

The U.S. Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) is responsible for enforcement of the Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security and Breach Notification Rules, including the recent amendments made by the Health Information Technology for Economic and Clinical Health Act (HITECH). OCR has begun conducting audits of covered entities, including group health plans, hospitals, laboratories, pharmacies, physicians, and dentists. Click here for a direct link to the OCR audit protocol.

The audit protocol (165 total) provides a road map for covered entities and business associates to develop a self-audit. OCR auditors will review a covered entity’s HIPAA processes, policies, and controls to ensure compliance with federal regulations. OCR developed 77 areas of accountability for the Security Rule and 88 areas of accountability for the Privacy and Breach Notification Rules.

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Question of the Week - Dependent Day Care Reimbursement for After-School Math Enrichment Program

Q. - My daughter will be attending an after-school math enrichment program next school year while I am at work. I have been told that the cost of the program cannot be reimbursed from my Dependent Day Care Flexible Spending Account Plan. Is that true?

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Health Insurance Exchanges Important for Small Businesses

Affordable Health Insurance Exchanges are a major component of health care reform. Beginning in 2014, each state must offer individuals the opportunity to purchase health coverage through a state-established Exchange. An Exchange is an insurance marketplace intended to help individuals and small businesses access affordable and quality health insurance. States across the country are working to implement the health insurance Exchange requirements. Toward that end, states can apply for Exchange grants through the end of 2014.

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Third Circuit provides Guidance on Joint Employment for FLSA

Dual-employment is a serious concern for some employers. Joint-employment issues may arise when individuals work among parent corporations, subsidiaries and affiliates, or when employers hire independent contractors to perform services.

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Question of the Week - FSA Reimbursement of Orthodontia Up-front & Installment Payments

Q. - My daughter is getting braces on her teeth. The orthodontist requires us to pay an up-front amount, and then pro-rate the remaining cost over the length of her treatment. May I be reimbursed from my health FSA for my up-front and installment payments?

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Loss and Theft – Common Sources of HIPAA HITECH Breaches

The HITECH amendments to HIPAA require covered entities to report what HITECH considers a "breach" of unsecured electronic Protected Health Information (EPHI). If unsecured EPHI is compromised, the HITECH amendments require an analysis to determine if the compromise rises to the level of a "breach" under HIPAA that must be reported. If the entity determines that the compromise is a reportable breach, the covered entity must notify the individual whose data was compromised and the Department of Health and Human Services (HHS). Since self-reporting began in 2009, there have been more than 450 reported incidents. Of the twenty largest HIPAA HITECH breaches reported since January 2011, only 3 were due to internet hacking. Loss or theft of portable devices was the most frequent cause of a reportable breach. Employee training and diligent IT policies could have prevented some of these breaches.

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Confirmation of Qualifying Event Email Helps Prevent Employer COBRA Mistakes

The self-service MyEnroll.com portal is an easy and efficient way for plan administrators and their designees to process and launch COBRA qualifying event notices. The portal is available for users to enter qualifying event details 24 hours a day, 7 days a week.

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Question of the Week

Q.- I have cancer and I am using medically-prescribed marijuana as part of my treatment. May I be reimbursed from my health FSA for the cost of the marijuana?

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Mobile Device Security

Consider the following scenario: Joe Tech, HR Benefits Manager for ABC, Inc. accesses his work email on his personal smartphone via webmail. Joe carries his smartphone everywhere and frequently responds to ABC work emails from his smart phone before and after work hours. Joe’s phone is stolen from his car while Joe is at the gym. If Joe’s smartphone contains Protected Health Information (PHI) or permits access to PHI, ABC Inc.’s group health plan may have experienced a HIPAA HITECH breach, triggering reporting requirements and opening the door for a HHA OCR Audit.

Every entity should establish a policy to address employee use of personal devices for official employer business. Some employers simply prohibit the use personal devices to access company networks. Other organizations develop what are generally referred to as Bring Your Own Device “BYOD” Policies. There are several considerations in developing a BYOD policy. They include:

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Form 5500 Filing Requirement

Employers with calendar year benefit plans should be gearing up for the Form 5500 filing deadline, which is quickly approaching. Unless an extension is requested, calendar year plans must file their Form 5500s by July 31, 2012.

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Form W-2 Reporting of Health Coverage Under Health Care Reform

The Affordable Care Act created a new health coverage reporting requirement intended to provide employees useful and comparable consumer information about the cost of their health care coverage. Form W-2 reporting is for informational purposes only and does not change the taxability of the health coverage provided.

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Question of the Week

Q. I am a COBRA continuant and I am enrolling in Medicare. My initial qualifying event was termination of employment. Since my wife and children were covered under my employer's plan at my termination, they also elected to continue coverage under COBRA. When I enroll in Medicare, does anything happen to the COBRA coverage of my wife and children?

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Revocation of HIPAA Authorization

There are many reasons that an employee might want to execute a HIPAA Authorization Form, which allows an employee to designate a personal representative to interact with BAS on the employee's behalf. Refer to our Newsletter Article dated May 3, 2012 for information about HIPAA Authorizations.

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IRS Increases Scrutiny of COBRA Compliance

The IRS recently updated the guidelines its agents use to conduct COBRA compliance audits. The COBRA audit guidelines are not directly aimed at employers, but employers can certainly benefit from understanding the procedures IRS agents follow to review COBRA compliance for group health plans. Now is a good time for employers to review their COBRA administration practices to make sure their plans are in compliance with the COBRA rules. BAS' Cobra Control Services can assist with COBRA compliance, as its processes and systems are intended to help employers meet their COBRA obligations.

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What Health Care Reform Means to Employers and Employees

Last week we provided a detailed analysis of the United States Supreme Court's ruling in National Federation of Independent Business et al. v. Sebelius holding that the individual mandate set forth in the Affordable Care Act is constitutional. As a result of the National Federation decision, existing provisions of the Affordable Care Act already in effect remain intact. Moreover, employers, individuals, health plans and others will need to comply with additional health care reform requirements as they become effective. Today and in the coming weeks, we will address important aspects of health care reform and outline what those requirements mean for both employers and employees.

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