by Arman Vahdatinia | Feb 27, 2017 | Featured, Group Benefits, Health Insurance |
The Department of Labor recently released their inflation-adjusted penalties for ERISA, the Family Medical Leave Act, and the Genetic Information Nondiscrimination Act. The chart below shows some of the more common penalties assessed from DOL audits. Failure to provide a summary of benefits and coverage$1,105 per employee Failure to inform employees of CHIP coverage opportunities$112 per employee per day Failure to comply with FMLA notice requirements$166 per employee per day Failure to comply with certain GINA requirements$112 per employee per day Failure to provide an SPD or plan documents$110 per employee per day Failure to provide documents to the DOL upon request$149 per day, not to exceed $1,496 per request Failure to file an annual 5500 form$2,097 per day The new ERISA penalties serve as important reminders to employers who sponsor benefit plans. Many employers either think they are too small to be audited (not true), or that the medical carriers adhere to all the rules and furnish employees with what is required (not true). It is for this reason that we have taken on the responsibility to protect our clients by providing them with the proper notices and instructions to maintain...
by Arman Vahdatinia | Jan 5, 2017 | Blue Shield of CA, Covered CA, Featured, Group Benefits, Health Insurance, Individual Benefits, News |
Sutter Health and Blue Shield of California have come to an agreement on a three year renewal of their provider contact through Dec. 31st, 2019. The contract is for all coverage – Individual, Group, Medi-Cal, and Medicare. Keep in mind that not all providers or facilities are available to all plans, so please double check with www.sutterhealth.org and www.blueshieldca.com for in-network specifics. Sutter Health participates in Blue Shield’s PPO plan through Covered CA, but please check for specifics on each respective...
by Arman Vahdatinia | Oct 26, 2016 | ACA Requirements, Featured, Group Benefits, Health Insurance |
With healthcare premiums continuously increasing year over year, many employers are searching for options to help reduce their benefit costs. A seemingly quick fix would be to eliminate dependent coverage, but you may want to consider eliminating dependent contribution rather than not offering coverage at all. First and foremost, the circumstances are different for Small Groups in comparison to Applicable Large Employers. If you are considered an ALE, with 51 or more full time equivalent employees, then you are required to offer dependent coverage by law, or you may face an employer shared responsibility penalty. Please note that the definition for Small Group plans has been expanded to include up to 100 employees, so it is possible to be an Applicable Large Employer and still offer Small Group plans (51-100 employee size). Per the Affordable Care Act, and the ‘pay or play’ provision, the definition of ‘dependent’ only applies to children under the age of 26. Spouses are not considered dependents, nor are step children or foster children. There are two types of penalties you may face if you do not offer proper coverage as an ALE. If you DO NOT offer minimum essential coverage to at least 95% of your full time equivalent employees and their dependents then you may face a penalty if at least one of your employees obtains premium assistance from the public marketplace (Covered CA). If just one of your employees receives premium assistance, then you are liable for a $2,000 penalty for each employee, after the first 30 employees. [Total employees – 30, multiplied by $2,000] If you DO offer minimum essential coverage...
by Arman Vahdatinia | Oct 14, 2016 | ACA Requirements, Featured, Group Benefits |
The Employee Retirement Income Security Act (ERISA) oversees group benefit plans, and with the onset of the Affordable Care Act, the ERISA Summary Plan Description (SPD) requirements are in the spotlight. More often than not, a plan administrator assumes that a Certificate of Insurance qualifies as an SPD, and that either the insurance company or their broker is responsible for preparing and delivering SPD’s. In this instance, the employer (plan administrator) is solely responsible for ERISA compliance. An employer must have a written SPD, which serves as the main vehicle for communicating plan rights and obligations to participants and beneficiaries. An SPD that includes the plan’s terms and conditions, such as a Certificate of Coverage, and includes (or ‘wraps’) it with the specific ERISA disclosure language is considered a ‘Wrap SPD.’ One step further would be to produce a mega-wrap document which would encompass all benefit lines into one document, which is HIPAA compliant as long as none of the benefits are self-funded. ERISA requires that a SPD be distributed to enrolled participants within 90 days of coverage, or 120 days of a new plan being established. If an SPD has not changed, an employer is required to furnish another copy to all participants every five years. Click Here to see a Sample Wrap SPD Document. An example of some of the information required in an SPD: Plan name Employer’s name and address Employer’s EIN Plan Administrator’s name, address, and phone number Type of plan and description of benefits Effective and End Dates of the plan Eligibility terms How refunds are allocated to plan participants Claims procedures ERISA legal...
by Ryan | Feb 10, 2016 | Featured, Group Benefits, Health Insurance, News |
Below I will describe how to check if your insurance broker is licensed in CA. In every state the process is very similar. As a consumer it is not your responsibility to check the creditability of your insurance broker, however I would urge you do so that you do not end up with the wrong insurance policy in the future. Step One: For CA employers, search by license number. If you would prefer you can search by the insurance broker’s name. Step two: Once you find your insurance broker’s name it is important that you verify that their license is “Active.” If their license is “Active” at least you know that your broker is current with the state continuing education and should be familiar with all of the products they are recommending. Tip: If the insurance company that your broker is recommending is not on the list of “Insurance Company Appointments” then it is likely your broker is selling you an insurance policy for that company for the first time. However, if your insurance broker works for an insurance agency then it is likely that the insurance policy will be placed under the managing broker. If you ever want to confirm who your broker is on your insurance policy, call the broker and ask to see the Master Application for any group insurance benefits (medical, dental, vision, life and disability insurance). For individual insurance plans many times there is a broker attestation or broker details section that clearly identifies who was the writing broker or broker of record for your insurance policy. If you are ever unsatisfied with your current insurance broker and...
by Arman Vahdatinia | Nov 4, 2015 | ACA Requirements, Featured, Group Benefits, Health Insurance, News |
Subject to ERISA (Employee Retirement Income Security Act) the SPD (Summary Plan Description) is one of the most important documents that participants under a health benefit plan must receive. The Department of Labor has increased its company audits, and more often than not employers are failing to provide their employees an SPD. Some may consider the information distributed by their insurance carrier as sufficient evidence of coverage and benefits to satisfy their SPD distribution requirement. Unfortunately, this is not the case, and the responsibility lies solely in the lap of the plans administrator (the employer that sponsors the group plan). Every employer that sponsors a group health plan must comply with this important ERISA requirement, or they run the risk of facing a hefty fine. Penalties of up to $110/day per participant or beneficiary for failing to provide an SPD or plan document within 30 days of receiving a request. The penalty accrues daily from the inception of the policy, not from the date of notification to furnish. It is considered a best practice to distribute the SPD to employees and maintain proper records that each beneficiary has in fact acknowledged receipt. This can be accomplished by employing an online administration system that can track and organize specific notices, and ensure compliance under ERISA. To learn more about how we can assist your company reduce its risk of an audit, and eliminate the risk of arbitrary penalties -please contact us via telephone or...
