Do you find it difficult to keep up with legislation affecting insurance, your industry, and your business?
Employers Select Insurance Services Inc., provides guidance and Legislative Brief educational articles to help you understand important regulations and stay in compliance. Our materials cover health care reform, COBRA, HIPAA, FMLA, Medicare Part D, ADA, state-specific legislation, and more.
We will also provide all required employee benefit filings and documentation, SPD/Wrap documents, and annual required employee notices.
Understanding Benefit Laws
Consolidated Omnibus Budget Reconciliation Act is a federal law that allows many employees to stay on their employers’ group health plans for a period of time after losing their jobs. Private-sector employers with more than 20 employees must generally provide the option for COBRA coverage.
Employers Select Insurance Services Inc. provides complete Federal COBRA services at no additional cost. This service includes notifications to employees, receiving payments, tracking time limits, as well as assisting COBRA participants with questions and claims.
Health Insurance Portability and Accountability Act is a federal law that restricts access to individuals’ private medical information.
Children’s Health Insurance Program Reauthorization Act authorizes the Children’s Health Insurance Program (CHIP) provides eligible parents and their children, premium assistance to help pay the premiums for an employer-sponsored plan using funds from their Medicaid or CHIP programs.
The Women's Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that provides protection to patients who choose to have breast reconstruction in connection with a mastectomy.
When applicable, it is important that individuals enrolled in a plan or health insurance coverage know of their rights to (1) choose a primary care provider or a pediatrician when a plan or issuer requires the designation of a primary care physician; or (2) obtain obstetrical or gynecological care without prior authorization. Accordingly, the interim final regulations regarding patient protections under section 2719A of the Affordable Care Act require plans and issuers to provide notice to participants of these rights when applicable. The notice must be provided whenever the plan or issuer provides a participant with a summary plan description or other similar description of benefits under the plan or health insurance coverage. This notice must be provided no later than the first day of the first plan year beginning on or after September 23, 2010.
Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section.
This law is a result of a medically necessary leave of absence from a post-secondary educational institution or other change in enrollment that:
(1) begins while the child is suffering from a serious illness or injury;
(2) is certified by a physician as being medically necessary; and
(3) causes the child to lose student status for purposes of coverage under the plan.
If the dependent child’s treating physician does not provide written documentation that the child is suffering from a serious illness or injury and the leave of absence is medically necessary, the plan will not provide continued coverage.
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards you or your dependents’ other coverage). However, you must request enrollment within 30 days after you or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).
If your agency is covered by the Fair Labor Standards Act, it should provide a written notice to its employees about the Health Insurance Marketplace. The notice should inform employees:
- About the Health Insurance Marketplace;
- That, depending on their income and what coverage may be offered by the employer, they may be able to get lower cost private insurance in the Marketplace; and
- That if they buy insurance through the Marketplace, they may lose the employer contribution (if any) to their health benefits
Mental Health Parity and Addiction Equity Act is a federal law amended in 2008 by the Patient Protection and Affordable Care Act. It requires most health insurance providers to cover mental health and substance use disorder benefits the same way they cover physical health benefits.
The Uniformed Services Employment and Reemployment Rights Act requires that a person reemployed under its provisions be given credit for any months and hours of service he or she would have been employed but for the USERRA-covered service in determining eligibility for Family and Medical Leave Act (FMLA) leave.
An insurance company that offers health coverage to opposite-sex spouses must do the same for same-sex spouses. As long as a couple is married in a jurisdiction with legal authority to authorize the marriage, an insurance company can’t discriminate against them when offering coverage. This means that it must offer to same-sex spouses the same coverage it offers to opposite-sex spouses. This is true regardless of the state where the couple lives; the insurance company is located; and where the plan is sold, renewed or in effect.
These IRS-prescribed tests determine if employer-provided benefit plans disproportionately favor highly compensated employees (HCEs) over non-highly compensated employees (NHCEs). This is to ensure all employees have equal access to their company’s plans, thus supporting increased financial equality in the workplace.
Plans that must be tested include:
- section 125 cafeteria plans (all pre-tax benefits);
- self-insured health plans;
- flexible spending accounts (FSA);
- group term life insurance;
- self-insured health reimbursement arrangements (HRA); and
- health savings accounts (HSA).
There are 9 different types of nondiscrimination tests; which ones apply to an employer’s plans will depend on the structure of the arrangement and which benefits are available.
The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans.
ERISA requires that you provide several types of documents to the Department of Labor (DOL) and plan participants. Noncompliance can result in fines, so make sure you're providing the right documents at the right times.
- Plan Document, within 30 days of a written request
- SPD, within 90 days of enrollment
- SMM, within 210 days after affected plan year ends
- Form 5500, before end of 7th month after plan year ends
- SAR, within 210 days after the plan year ends, or 2 months after Form 5500 due (If due date extended)
This report is a narrative report of the Form 5500 and includes a statement of the participant's right to receive the annual report.
The comprehensive health care reform law enacted in March 2010 (sometimes known as ACA, PPACA, or “Obamacare”). We have all the resources you need to successfully navigate the ACA.
- ACA reporting
- Complete legislative guides
- Timely updates
- Employee education materials
- Health care reform video content
On June 20, 2019, the Internal Revenue Service, the Department of the Treasury, the Department of Labor, and the Department of Health and Human Services issued final rules regarding health reimbursement arrangements (HRAs) and other account-based group health plans. Specifically, the final rules allow HRAs and other account-based group health plans to be integrated with individual health insurance coverage or Medicare if certain conditions are satisfied (an individual coverage HRA). The final rules also set forth conditions under which certain HRAs and other account-based group health plans will be recognized as limited excepted benefits (an excepted benefit HRA).
Medicare is the national health insurance system that Americans qualify for if they're 65 or older or have certain disabilities. The program was signed into law in 1965. Today, it covers about 63.1 million Americans. Medicare is run by the U.S. Centers for Medicare and Medicaid Services agency.
Part D Notices, or notices of “Creditable Coverage,” is simply an official document given to an employee from their employer (or union) that states whether their prescription drug coverage plan is equal to or better than the prescription drug coverage provided through Medicare.
IRS Section 125 Code Cafeteria Plan Documents are one of the most underused employee benefits for small businesses. These plans allow employees to pay tax-free premiums for group health insurance and other qualified benefits (such as group term life, accident, and long-term care), medical expenses, and dependent care expenses.
A Summary Plan Description (SPD) is a document that employers must give free to employees who participate in Employee Retirement Income Security Act -covered retirement plans or health benefit plans. The SPD is a detailed guide to the benefits the program provides and how the plan works.
Preparing for a DOL Audit
The Department of Labor (DOL) has broad authority to investigate or audit an employee benefit plan's compliance with the Employee Retirement Income Security Act (ERISA). Audits are performed by the DOL's Employee Benefits Security Administration (EBSA).
DOL Audit Guide
- Preparing for (and avoiding) a DOL Audit
- Navigating a DOL Audit
- Checklist of Requested Documents
- Available Resources
- Sample Documents
This guide is not intended to be exhaustive, nor should any discussion or opinions be construed as legal advice. This guide may not address all compliance issues with federal, state, and local laws or identify all possible requests that may be made in connection with an audit.
Download your DOL Audit Guide today