3rd Quarter Compliance Newsletter

Posted October 1, 2018 by Megan DiMartino

In this quarter’s Compliance Newsletter:

  • Medicare Part D Notices
  • Summary Annual Reports Due
  • ACA Reporting
  • Affordable Health Plans in 2019
  • Exchange Model Notice
  • New Model FMLA Forms
  • Health FSA Carryovers
  • Employers Not Required to Provide Specific Requested Reasonable Accommodations
  • MLR Rebates
  • Federal Court Approves $115 Million Settlement
  • Save American Workers Act of 2018

Please contact your AssuredPartner’s Sales Executive or Account Manager for any further questions or assistance.


For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

Are Remote Workers Eligible for FMLA?

Posted September 25, 2018 by Megan DiMartino

With the ever-growing population of telecommuting employees comes the question if they’re eligible for FMLA (Family and Medical Leave Act). Most believe that telecommuters can’t qualify for FMLA because they are usually not within proximity of 49 other company employees within a 75-mile radius of a company worksite. But Section 825.111(a)(2) of the FMLA regulations clears up how to determine whether 50 employees are employed within a 75-mile radius of a worksite:
  • An employee’s personal residence is not a worksite in the case of employees, such as salespersons, who travel a sales territory and who generally leave to work and return from work to their personal residence, or employees who work at home, as under the concept of flexiplace or telecommuting. Rather, their worksite is the office to which they report and from which assignments are made.

For example, a company based out of Harrisburg, PA has 49 employees and also has an at-home employee who works from Chicago, IL. The at-home employee still gets their assignments from the main headquarters in Harrisburg,so under FMLA, their worksite is Harrisburg and qualifies them for FMLA.

There are also special regulations for employees who have no fixed worksite, such as construction workers. In that situation, the worksite is the site to which the employee is assigned as their home base, or from which their work is assigned, or to which they report. FMLA has provided an example for such situation:

  • [I]f a construction company headquartered in New Jersey opened a construction site in Ohio, and set up a mobile trailer on the construction site as the company’s on-site office, the construction site in Ohio would be the worksite for any employees hired locally who report to the mobile trailer/company office daily for work assignments, etc. If that construction company also sent personnel such as job superintendents, foreman, engineers, an office manager, etc., from New Jersey to the job site in Ohio, those workers sent from New Jersey continue to have the headquarters in New Jersey as their worksite. The workers who have New Jersey as their worksite would not be counted in determining eligibility of employees whose home base is the Ohio worksite, but would be counted in determining eligibility of employees whose home base is New Jersey.
There are many intricacies to FMLA and these are just a couple common examples. If you have any other questions or concerns, please feel free to contact your Account Manager or Account Executive at AP Benefit Advisors for further assistance.

Source: Jackson Lewis | The Devil Is in the Detail – FMLA Eligibility and Remote Workers

For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

New FMLA Forms from the DOL

Posted September 17, 2018 by Megan DiMartino

The Department of Labor (DOL) has released new Family and Medical Leave Act (FMLA) Forms – which the only thing that has changed is the expiration date. In the upper-right hand corner of the forms you’ll notice it now reads, “Expires: 8/31/2021.”

Links to the PDF forms:

Now’s a good time to start updating your forms, whether you use the DOL’s or your own, to make sure you stay compliant with FMLA requirements.

For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

HRCI & SHRM Pre-Approved Webinar | J-Codes: Your Healthcare Plan’s Biggest Enemy

Posted September 13, 2018 by Megan DiMartino

“J-Codes” and “medical specialty pharmacy” claims are going to be one of the top two procedure categories in terms of cost within your health plan. Knowing the amount of waste and abuse can give you insight into how you can develop strategies to drive more cost-effective utilization of the plan, and even enhance the benefits to the plan members for that efficient behavior. By identifying these specific issues within your plan and implementing targeted, value-based strategies to address them, you could eliminate tremendous costs without any adverse effects to your population.

Please join us for this HRCI* and SHRM** pre-approved, complimentary, one-hour webinar as our Director of Data Analytics, Scott Mayer, talks about the financial perils and pitfalls of “J-Codes” within an employer-sponsored health plan, and how the power of data can unlock the secrets to managing its spend.

Topics include:

  • What J-Codes are, how they differ from pharmacy claims, and how plans bill for them
  • How providers negotiate reimbursements through the medical benefit and how if differs from the pharmacy benefit
  • The role of channel management, site of care, manufacturer assistance programs and others

Webinar Details:

  • Thursday, September 27, 2018
  • 2:00pm – 3:00pm EDT
  • No cost to attend
  • This webinar is open to all HR and Finance Professionals – but not to brokers, agents, TPAs and PEOs
For more information contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

*The use of this seal confirms that this activity has met HR Certification Institute’s® (HRCI®) criteria for recertification credit pre-approval.

**AP Benefit Advisors, LLC is recognized by SHRM to offer Professional Development Credits (PDCs) for SHRM-CP or SHRM-SCP. This program is valid for 1 PDC for the SHRM-CP or SHRM-SCP. For more information about certification or recertification, please visit shrmcertification.org.

Employers Not Required to Provide Specific Requested Reasonable Accommodations

Posted August 24, 2018 by Megan DiMartino

The Americans with Disabilities Act (ADA), as well as state and local laws, requires that employers provide reasonable accommodations to employees with disabilities. Employees are able to request specific reasonable accommodations, but employers are not required to provide all requests as they may choose among these reasonable accommodations or provide alternatives (as long as the reasonable accommodation is effective).

In a recent court case, Sessoms v. Trustees of the Univ. of Pennsylvania (June 20, 2018), the Third Circuit Court of Appeals (covering DE, NJ & PA) ruled in favor of the University of Pennsylvania saying they demonstrated good faith in its negotiations on reasonable accommodations for their employee. The employee, who suffered from mental and physical disabilities as well as having difficulties with her supervisor, requested that the University of Pennsylvania allow her to work on a part-time basis, before returning to full-time, after her medical leave and to transfer her to a new, “lower-stress” department under a new supervisor.

The University of Pennsylvania chose to accommodate her request for a part-time schedule but kept her in the same position under the same supervisor. The employee declined this reasonable accommodation and was ultimately terminated. She filed the lawsuit claiming they did not engage in a good-faith effort to reasonably accommodate her requests/disabilities. As already stated, the court ruled in the University of Pennsylvania’s favor and concluded that the employee did not provide evidence of other available positions and that her unwillingness to accept the part-time schedule which included working under the same supervisor was unreasonable.

The Equal Employment Opportunity Commission (EEOC) already stated long before this that an employer is not required to provide the requested reasonable accommodations and can instead consider alternatives, stating that:

“If there are two possible reasonable accommodations, and one costs more or is more burdensome than the other, the employer may choose the less expensive or burdensome accommodation as long as it is effective (i.e., it would remove a workplace barrier, thereby providing the individual with an equal opportunity to apply for a position, to perform the essential functions of a position, or to gain equal access to a benefit or privilege of employment). Similarly, when there are two or more effective accommodations, the employer may choose the one that is easier to provide.”

So, before rejecting an employee’s request for reasonable accommodation, discuss the request and propose effective alternatives, if necessary, with the employee to find a common ground and an acceptable reasonable accommodation that truly meets their needs and capabilities.


For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

Updated/Current Healthcare Reform Timeline

Posted August 15, 2018 by Megan DiMartino

Healthcare Reform Timeline – Perpetual timeline of all healthcare reform updates from 2010 to 2020 (and 2022 – when the Cadillac Tax is scheduled to “begin”).

 

 

 

 

 

 

 

 

 

 

HC_Reform_Employers_V19e_05-14-2018

If you have any questions or concerns, please contact your Account Manager or Sales Executive.


For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

House Passes Enhanced HSA Bills

Posted August 10, 2018 by Megan DiMartino

​​​​​​​Breaking news from Washington, D.C. confirms the House of Representatives adopted two health care bills in late July 2018. In general, if these bills are passed they would allow for more flexibility in the definition of a High Deductible Health Plan (HDHP) and how healthcare consumers can spend their savings for medical related requirements.

The bills, H.R. 6199 and H.R. 6311, expand tax-advantage health care accounts, inclusive of Health Savings Accounts (HSAs), Flexible Spending Accounts (FSAs), and Health Reimbursement Arrangements (HRAs). These bills are broader than the versions passed by the House Ways and Means Committee recently as they also include aspects of other bills that had been previously approved by the Committee. The bills presented also received significant democratic support.

Here’s a breakdown of the two bills:

The Restoring Access to Medication and Modernizing Health Savings Accounts Act, H.R. 6199, was passed by a margin of 277 to 142.  This bill would:

  • Allow individuals to purchase over-the-counter medical products by reversing the Affordable Care Act’s (ACA’s) prohibition on using tax-favored health accounts. And, prescriptions would not be required for eligibility purposes.
  • Treatment of menstrual care products as qualified medical expenses with all tax-advantaged health care accounts.
  • Treatment of certain sports and fitness expenses – including gym memberships and costs associated with participation in certain physical exercise programs. These items would be recognized as qualified medical expenses up to a limit of $500 per year for individuals and $1,000 per year for a family.
  • Allow HDHPs coverage up to $250 for individuals and $500 for families on an annual basis for non-preventive services not currently covered as pre-deductible. Limited coverage outside the deductible would be allowed, i.e., for chronic condition treatments and telehealth services.
  • Allow individuals with HSA-qualifying family coverage to make contributions to an HSA if their spouse is enrolled in a medical FSA, which is currently not permitted.
  • Permit the use of employer-sponsored onsite medical clinics and other employment-related health services without imposing a risk to HSA eligiblity, as long as significant benefits are not provided.
  • Recognize direct primary care (DPC) provider fees as covered with HSAs and capped monthly at $150 per individual and $300 per family.
  • Shield HSA-eligible individuals who participate in a DPC from losing their HSA eligibility.
The Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act, H.R. 6311, passed by a margin of 242 to 176. This bill would allow the ACA’s premium tax credit to apply for low and moderate earners when buying lower-premium, “catastrophic” copper plans, allows individuals over the age of 30 to buy copper plans, and allows copper and bronze-level individual and small-group market plans to qualify for HSA contributions. The bill also includes the following tax modifications for tax advantaged accounts:
  • Increase HSA 2018 annual contribution to $6,650 for individuals and $13,300 for families. This represents the 2018 combined annual limit on out-of-pocket and deductible expenses under an HSA qualified insurance plan.
  • Allows HSAs to cover qualified medical expenses at the start of the HDHP coverage if accounts are opened within 60 days after coverage under an HDHP begins. This proposal includes a reasonable grace period between the timeframe the HDHP coverage starts and the set-up of the HSA.
  • Allow employees with an FSA or an HRA who enroll in a qualifying HDHP with an HSA to transfer balances from their FSA or HRA to their HSA. Transfers would be capped at $2,650 for individuals and $5,300 for families. This option is offered at the employer’s discretion.
  • Allow for health FSA balances to carry over to the following plan year. The carry over option could not exceed 3 times the annual FSA contribution limit.
  • Allow for spouses 55 years of age and older (currently only available for account holders) to make an annual catch-up contribution to an HSA that’s linked to a health plan providing family level coverage. The extra contribution amount cannot exceed $1,000.
  • Permit working seniors who participate in Medicare Part A and covered by a qualifying HDHP to contribute to an HSA.

What to expect next?

Senate approval is needed by year-end for both bills to become law. Analysts predict the likelihood of that happening to be challenging. Also, on the horizon – in September 2018, the House is also expected to vote on several of the other ACA related measures that were previously passed by the Ways and Means Committee. These bills include H.R. 4616, which is designed to delay the Cadillac Tax until 2021 and to also suspend the ACA employer mandate penalties for plan years through 2018.

By: Cindy Wagner, AP Benefit Advisors’ Director of HR Professional Services

For additional information, visit:
GovTrack – H.R. 6199 & H.R. 6311
Congress.gov – H.R. 6311 & H.R. 6199
For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

SHRM Pre-Approved Webinar | Voluntary Benefits: Best Practices for Communication and Enrollment

Posted August 9, 2018 by Megan DiMartino

What are employers doing to stay on the cutting edge to ensure that employees fully leverage their benefits offering? There are several tools to achieve this while making the process proactive and engaging. We will review industry standards from employee polls regarding open enrollment processes to make sure the information is simple and clear as well as enrollment studies from our carrier partners to help re-invent the enrollment experience. With early campaigning, clear messaging and engagement tips to use available technology for all demographics, the enrollment experience can be enhanced for all parties involved.

Please join us for this SHRM* pre-approved, complimentary, one-hour webinar as our Director of Voluntary Benefits, Stephen Ivey, walks through best practices for communication and enrollment within the voluntary benefits marketplace.

Topics include:

  • State of the Industry
  • Essential vs. Fringe
  • Communication Studies
  • Millennials
  • Technology
  • Different Strategies
  • Integration

Webinar Details:

  • Wednesday, August 22, 2018
  • 2:00pm – 3:00pm EDT
  • No cost to attend
  • This webinar is open to all HR and Finance Professionals – but not to brokers, agents, TPAs and PEOs

 

*AP Benefit Advisors, LLC is recognized by SHRM to offer Professional Development Credits (PDCs) for SHRM-CP or SHRM-SCP. This program is valid for 1 PDC for the SHRM-CP or SHRM-SCP. For more information about certification or recertification, please visit shrmcertification.org.


For more information contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

AssuredPartners’ Webinar | HRCI & SHRM Pre-Approved – HIPAA Privacy Rule & Security Rule Risk Analysis

Posted July 18, 2018 by Megan DiMartino

The standards for Privacy and Security of Individually Identifiable Health Information establish a set of national standards for the protection of certain health information impacting covered entities. These standards are better known as the Privacy Rule and the Security Rule. Are YOU a covered entity? Do you know your duties as a covered entity? Now let’s say you’ve been following a thorough, detailed set of written security measures that you found on the internet and tweaked to fit your organization. Unfortunately, according to the HIPAA Security Rule – it’s not enough. Under the Security Rule, the process a plan uses to decide what it needs to do to protect electronic protected health information (ePHI) is just as important as the policies and procedures themselves. Enter: the risk assessment.

Please join us for this HRCI* and SHRM** pre-approved, complimentary, one-hour webinar as our speaker, Olivia Ash, MS, Compliance Consultant with Compliancedashboard, walks through what employers really need to do to be compliant with the HIPAA Privacy and Security Rules.

Webinar Details:

  • Tuesday, July 31, 2018
  • 3:00pm – 4:00pm EDT
  • No cost to attend
  • This webinar is open to all HR and Finance Professionals – but not to brokers, agents, TPAs and PEOs

Presenter bio:
Olivia Ash worked the last fifteen years in roles ranging from account management to business development contracting. After graduate school, Olivia spent ten years creating and implementing employer wellness programs. Within the past five years, Olivia has focused her career in the fields of law and compliance. She’s a licensed teacher with experience in higher education, presently serving as adjunct faculty for a local university. Olivia writes Compliancedashboard’s blog content as well as the activity content on the dashboard.


*The use of this seal confirms that this activity has met HR Certification Institute’s® (HRCI®) criteria for recertification credit pre-approval.
**AP Benefit Advisors, LLC is recognized by SHRM to offer Professional Development Credits (PDCs) for SHRM-CP or SHRM-SCP. This program is valid for 1 PDC for the SHRM-CP or SHRM-SCP. For more information about certification or recertification, please visit shrmcertification.org.
For more information contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.