by admin | Apr 6, 2018 | Benefit Management, Employee Benefits, ERISA
The Department of Labor’s new claim rules for disability benefits took effect April 2, 2018. The changes were announced over a year ago, but the effective date was delayed to give insurers, employers, and plan administrators adequate time for implementation. Although we’ve reported on the key issues in this blog previously, now seems like a good time for a refresher on how the new rules affect employer plans.
Affected Plans
The new claim rules apply to disability benefits provided under plans covered by the Employee Retirement Income Security Act (ERISA); that is, plans sponsored by private-sector employers. Then the new rules apply if the ERISA plan must make a determination of disability in order for the claimant to obtain the benefit. Group short- and long-term disability plans are the most common examples, but pension, 401(k), and deferred compensation plans also may be affected.
Many plans do not make their own determination of disability, but instead condition the plan’s benefit on another party’s determination. For instance, employer plans that base the benefit on a disability determination made by the Social Security Administration (SSA) are not affected by the new rules.
New Rules
For ERISA plans affected by the new rules, the following additional requirements apply to disability claims filed on or after April 2, 2018:
- Disclosure Requirements: Benefit denial notices must explain why the plan denied a claim and the standards used in making the decision. For example, the notices must explain the basis for disagreeing with a disability determination made by the SSA if presented by the claimant in support of his or her claim.
- Claim Files and Internal Protocols: Benefit denial notices must include a statement that the claimant is entitled to request and receive the entire claim file and other relevant documents. (Previously this statement was required only in notices denying benefits on appeal, not on initial claim denials.) The notice also must include the internal rules, guidelines, protocols, standards or other similar criteria of the plan that were used in denying a claim or a statement that none were used. (Previously it was optional to include a statement that such rules and protocols were used in denying the claim and that the claimant could request a copy.)
- Right to Review and Respond to New Information Before Final Decision: Plans are prohibited from denying benefits on appeal based on new or additional evidence or rationales that were not included when the benefit was denied at the claims stage, unless the claimant is given notice and a fair opportunity to respond.
- Conflicts of Interest: Claims and appeals must be adjudicated in a manner designed to ensure the independence and impartiality of the persons involved in making the decision. For example, a claims adjudicator or medical or vocational expert could not be hired, promoted, terminated or compensated based on the likelihood of the person denying benefit claims.
- Deemed Exhaustion of Claims and Appeal Processes: If plans do not adhere to all claims processing rules, the claimant is deemed to have exhausted the administrative remedies available under the plan (unless exceptions for minor errors or other conditions apply). In that case, the claimant may immediately pursue his or her claim in court. Plans also must treat a claim as re-filed on appeal upon the plan’s receipt of a court’s decision rejecting the claimant’s request for review.
- Coverage Rescissions: Rescissions of coverage, including retroactive terminations due to alleged misrepresentations or errors in applying for coverage, must be treated as adverse benefit determinations that trigger the plan’s appeals procedures.
- Notices Written in a Culturally and Linguistically Appropriate Manner: Benefit denial notices must be provided in a culturally and linguistically appropriate manner in certain situations. Specifically, if the claimant’s address is in a county where 10 percent or more of the population is literate only in the same non-English language, the notices must include a prominent statement in the relevant non-English language about the availability of language services. The plan would also be required to provide a verbal customer assistance process in the non-English language and provide written notices in the non-English language upon request.
Action Steps for Employers
Employers are reminded to work with their carriers, third-party administrators, and advisors to make sure their plans comply with the new requirements. Consider these steps:
- Identify all plans that are subject to ERISA. (Plans sponsored by governmental employers, such as cities and public school districts, and certain church plans, are exempt from ERISA.)
- Does the ERISA plan provide any benefit based on disability? If so, is the benefit conditioned on a determination of disability made by the plan or by another party, such as Social Security?
- For insured plans, such as group STD and LTD insurance plans, the carrier generally is responsible for compliance with ERISA’s claim rules. The employer, however, does have a duty to make reasonable efforts to ensure the carrier is complying.
- For self-funded plans, the employer is responsible for compliance. Although the employer may engage the services of a third-party claims administrator, the employer remains responsible for the plan’s compliance with all rules.
Originally Published By ThinkHR.com
by admin | Mar 23, 2018 | Employee Benefits, Human Resources
Fear of missing out—is more than just a hashtag. Many Millennials admit that #FOMO drives a lot of their decisions on what they wear, what they do, even what they eat and drink. We live in a world of social influence.
But one area where #FOMO really does you a disservice? No one is afraid of missing out on the benefits of life insurance. And why should you? There are so many other things competing for your dollars. That said, do you know what you’re missing out on by not having it? Are you making one or more of these mistakes?
You think life insurance is much more expensive than it actually is. Three in four Millennials overestimate the cost of life insurance—sometimes by a factor of 2, 3, or even more! (2017 Insurance Barometer Study by Life Happens and LIMRA) Imagine being able to afford life insurance for the cost of that daily latte, and for less money than your avocado toast habit!
You think you can’t qualify for life insurance. Nothing could be further from the truth, and yet four in 10 Millennials think this is true, according to the same study! Younger candidates have an easier time getting life insurance because they are generally healthier.
You’ll turn to GoFundMe if something goes wrong. In an era where social networking does all things, it’s natural to think that your loved ones can crowdfund their way to solvency after something happens. But life insurance benefits aren’t taxed like GoFundMe proceeds are, and life insurance has a defined, immediate payout that GoFundMe does not. Plus, your loved ones don’t need the stress or the stigma of having to ask others for help.
You’d rather spend that money on other things. In fact, one study recently suggested that many Millennials are more concerned about planning their next night out with a significant other than planning for their financial future. But sensible steps now will make for a better future with that significant other long past tomorrow night’s date.
You don’t care because you don’t have people depending on you for money. Take a look at your student loans. Were any of them private loans? Who is liable for them—in full, often immediately—if something happens to you? There are other debts you may need to consider as well—anything where you have a co-signer.
You keep saying you’ll get around to buying insurance, but don’t. Millennials are getting married, having families! Young families have enough to worry about with daycare costs and increased medical costs, right? Well, imagine what your young family would do about those bills if something happened to you. Could your spouse pay the rent or mortgage without your income?
You tune out when “adulting” gets too hard. One recent college grad recently confessed to me that he hadn’t elected into any of his employee benefits at the dream job he got in his field because “my dad takes care of that.” He was shocked to learn what he was missing out on!
Yes, adulting *is* hard, but a sound financial plan that includes retirement and insurance coverage (health, life, and disability insurance are all part of that plan) goes a long way to making sure that you don’t look back on your younger years and think, “Oh, why didn’t I start this sooner?” Plus, you don’t have to do it alone—that’s what insurance agents are for. They will sit down with you at no cost, or obligation, to discuss what you need and how to get coverage to fit your budget. But then, signing up—that IS on you. Don’t miss out.
By Helen Mosher
Originally published by www.LifeHappens.org
by admin | Feb 6, 2018 | Benefit Management, Employee Benefits, Group Benefit Plans
As we head into the second month of 2018, companies have already begun the arduous task of submitting budgets and finding ways to cut costs for the new year. One of the most effective ways to combat increasing health care costs for companies is to move to a Self-Funded insurance plan. By paying for claims out-of-pocket instead of paying a premium to an insurance carrier, companies can save around 20% in administration costs and state taxes. That’s quite a cost savings!
The topic of Self-Funding is huge and so we want to break it down into smaller bites for you to digest. This month we want to tackle a basic introduction to Self-Funding and in the coming months, we will cover the benefits, risks, and the stop-loss associated with this type of plan.
THE BASICS
- When the employer assumes the financial risk for providing health care benefits to its employees, this is called Self-Funding.
- Self-Funded plans allow the employer to tailor the benefits plan design to best suit their employees. Employers can look at the demographics of their workforce and decide which benefits would be most utilized as well as cut benefits that are forecasted to be underutilized.
- While previously most used by large companies, small and mid-sized companies, even with as few as 25 employees, are seeing cost benefits to moving to Self-Funded insurance plans.
- Companies pay no state premium taxes on self-funded expenditures. This savings is around 1.5% – 3/5% depending on in which state the company operates.
- Since employers are paying for claims, they have access to claims data. While keeping within HIPAA privacy guidelines, the employer can identify and reach out to employees with certain at-risk conditions (diabetes, heart disease, stroke) and offer assistance with combating these health concerns. This also allows greater population-wide health intervention like weight loss programs and smoking cessation assistance.
- Companies typically hire third-party administrators (TPA) to help design and administer the insurance plans. This allows greater control of the plan benefits and claims payments for the company.
As you can see, Self-Funding has many facets. It’s important to gather as much information as you can and weigh the benefits and risks of moving from a Fully-Funded plan for your company to a Self-Funded one. Doing your research and making the move to a Self-Funded plan could help you gain greater control over your healthcare costs and allow you to design an original plan that best fits your employees.
by admin | Jan 10, 2018 | Employee Benefits, Human Resources
Have you heard the saying “the eyes are the window to your soul”? Well, did you know that your mouth is the window into what is going on with the rest of your body? Poor dental health contributes to major systemic health problems. Conversely, good dental hygiene can help improve your overall health. As a bonus, maintaining good oral health can even REDUCE your healthcare costs!
Researchers have shown us that there is a close-knit relationship between oral health and overall wellness. With over 500 types of bacteria in your mouth, it’s no surprise that when even one of those types of bacteria enter your bloodstream that a problem can arise in your body. Oral bacteria can contribute to:
- Endocarditis—This infection of the inner lining of the heart can be caused by bacteria that started in your mouth.
- Cardiovascular Disease—Heart disease as well as clogged arteries and even stroke can be traced back to oral bacteria.
- Low birth weight—Poor oral health has been linked to premature birth and low birth weight of newborns.
The healthcare costs for the diseases and conditions, like the ones listed above, can be in the tens of thousands of dollars. Untreated oral diseases can result in the need for costly emergency room visits, hospital stays, and medications, not to mention loss of work time. The pain and discomfort from infected teeth and gums can lead to poor productivity in the workplace, and even loss of income. Children with poor oral health miss school, are more prone to illness, and may require a parent to stay home from work to care for them and take them to costly dental appointments.
So, how do you prevent this nightmare of pain, disease, and increased healthcare costs? It’s simple! By following through with your routine yearly dental check ups and daily preventative care you will give your body a big boost in its general health. Check out these tips for a healthy mouth:
- Maintain a regular brushing/flossing routine—Brush and floss teeth twice daily to remove food and plaque from your teeth, and in between your teeth where bacteria thrive.
- Use the right toothbrush—When your bristles are mashed and bent, you aren’t using the best instrument for cleaning your teeth. Make sure to buy a new toothbrush every three months. If you have braces, get a toothbrush that can easily clean around the brackets on your teeth.
- Visit your dentist—Depending on your healthcare plan, visit your dentist for a check-up at least once a year. He/she will be able to look into that window to your body and keep your mouth clear of bacteria. Your dentist will also be able to alert you to problems they see as a possible warning sign to other health issues, like diabetes, that have a major impact on your overall health and healthcare costs.
- Eat a healthy diet—Staying away from sugary foods and drinks will prevent cavities and tooth decay from the acids produced when bacteria in your mouth comes in contact with sugar. Starches have a similar effect. Eating healthy will reduce your out of pocket costs of fillings, having decayed teeth pulled, and will keep you from the increased health costs of diabetes, obesity-related diseases, and other chronic conditions.
There’s truth in the saying “take care of your teeth and they will take care of you”. By instilling some of the these tips for a healthier mouth, not only will your gums and teeth be thanking you, but you may just be adding years to your life.
by admin | Jan 3, 2018 | Compliance, Employee Benefits, ERISA
Two tri-agency (Internal Revenue Service, Employee Benefits Security Administration, and Centers for Medicare and Medicaid Services) Interim Final Rules were released and became effective on October 6, 2017, and were published on October 13, 2017, allowing a greater number of employers to opt out of providing contraception to employees at no cost through their employer-sponsored health plan. The expanded exemption encompasses all non-governmental plan sponsors that object based on sincerely held religious beliefs, and institutions of higher education in their arrangement of student health plans. The exemption also now encompasses employers who object to providing contraception coverage on the basis of sincerely held moral objections and institutions of higher education in their arrangement of student health plans. Furthermore, if an issuer of health coverage (an insurance company) had sincere religious beliefs or moral objections, it would be exempt from having to sell coverage that provides contraception. The exemptions apply to both non-profit and for-profit entities.
The currently-in-place accommodation is also maintained as an optional process for exempt employers, and will provide contraceptive availability for persons covered by the plans of entities that use it (a legitimate program purpose). These rules leave in place the government’s discretion to continue to require contraceptive and sterilization coverage where no such objection exists. These interim final rules also maintain the existence of an accommodation process, but consistent with expansion of the exemption, the process is optional for eligible organizations. Effectively this removes a prior requirement that an employer be a “closely held for-profit” employer to utilize the exemption.
On November 30, 2017, the Centers for Medicare and Medicaid Services (CMS) released guidance on accommodation revocation notices. Plan participants and beneficiaries must receive written notice if an objecting employer had previously used the accommodation and, under the new exemptions, no longer wishes to use the accommodation process. The Interim Final Rules required the issuer to provide written revocation notice to plan participants and beneficiaries. CMS’ recent guidance clarifies that the employer, its group health plan, or its third-party administrator (TPA) may provide written revocation notice instead of the issuer.
CMS’ guidance also clarifies the timing of the revocation notice. Under the Interim Final Rules, revocation is effective on the first day of the first plan year that begins on or after 30 days after the revocation date. Alternatively, if the plan or issuer listed the contraceptive benefit in its Summary of Benefits and Coverage (SBC), then the plan or issuer must give at least 60 days prior notice of the accommodation revocation (SBC notification process). CMS’ guidance indicates that, even if the plan or issuer did not list the contraceptive benefit in its SBC, the employer is permitted to use the 60-day advance notice method to revoke the accommodation as long as the revocation is consistent with any other applicable laws and contract provisions regarding benefits modification.
Further, if the employer chooses not to use the SBC notification process to notify plan participants and beneficiaries of the accommodation revocation and if the employer instructs its issuer or TPA not to use the SBC notification process on the employer’s behalf, then the employer, its plan, issuer, or TPA must send a separate written revocation notice to plan participants and beneficiaries no later than 30 days before the first day of the first plan year in which the revocation will be effective.
Unlike the SBC notification process, which would allow mid-year benefit modification, if an employer uses the 30-day notification process, the modification can only be effective at the beginning of a plan year.
Employers that object to providing contraception on the basis of sincerely held religious beliefs or moral objections, who were previously required to offer contraceptive coverage at no cost, and that wish to remove the benefit from their medical plan are still subject (as applicable) to ERISA, its plan document and SPD requirements, notice requirements, and disclosure requirements relating to a reduction in covered services or benefits. These employers would be obligated to update their plan documents, SBCs, and other reference materials accordingly, and provide notice as required.
Employers are also now permitted to offer group or individual health coverage, separate from the current group health plans, that omits contraception coverage for employees who object to coverage or payment for contraceptive services, if that employee has sincerely held religious beliefs relating to contraception. All other requirements regarding coverage offered to employees would remain in place. Practically speaking, employers should be cautious in issuing individual policies until further guidance is issued, due to other regulations and prohibitions that exist.
By Danielle Capilla
Originally Published By United Benefit Advisors
by admin | Dec 5, 2017 | Employee Benefits, Flexible Spending Accounts, IRS
On November 2, 2017, House Republicans introduced a tax reform bill (H.R.1-115th Congress) called the “Tax Cuts and Jobs Act” that, if passed, would impact multiple aspects of the tax code. Many of these changes relate to employee benefit plans, particularly in relation to certain fringe benefits.
Dependent Care Accounts
A dependent care flexible spending account (DCFSA) is a pre-tax benefit account used to pay for eligible dependent care services. The IRS determines which expenses are eligible for reimbursement and these expenses are defined by Internal Revenue Code section 129 and the employer’s plan. Eligible DCFSA expenses include costs for adult day care centers, before and after school programs, child care, nannies, preschool, and summer day camp. Day nursing care, nursing home care, tuition for kindergarten and above, food expenses, and overnight camp are ineligible expenses. The employer determines the minimum election amount and the IRS determines the maximum election amount. The IRS sets the following annual contribution limits for a DCFSA:
- $2,500 per year for a married employee who files a separate tax return
- $5,000 per year for a married employee who files a joint tax return
- $5,000 per year for the head of household
- $5,000 per year for a single employee
The original version of the tax reform bill completely eliminated dependent care accounts. It is now reported that Representative Kevin Brady (R-Texas) has added an amendment to the bill that reverses the immediate repeal of DCFSAs, and would extend them for five more years.
Adoption Assistance
Employers may currently reimburse employees up to $13,570 (indexed) tax-free for qualified adoption expenses. This is eliminated in the bill.
Education Assistance
Employers may currently reimburse employees up to $5,250 on a tax-free basis for qualified education expenses. This is eliminated in the bill. Employers that are educational institutions can currently provide qualified tuition reductions to employees, their spouses, and dependents tax free, but this would be eliminated under the bill.
Employer Tax Deduction Impact
Under the proposed bill, employers’ corporate tax deduction credits for the following would be eliminated:
- Transportation fringe benefits
- On-premise athletic facilities
- Employer provided child care
The bill is now in markup, with the Ways and Means Committee working to draft a final bill for the House to vote on. If passed, it will be sent to the Senate to vote on.
By Danielle Capilla
Originally Published By United Benefit Advisors
