Model HIPAA Notice of Privacy Practices Now Available

New model notices are available to help health plans comply with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. The Privacy Rule generally requires covered entities, including health plans, to develop and distribute a notice informing individuals of the entity’s privacy practices and of the individual’s privacy rights with respect to his or her personal health information (PHI).

Note: Group health plans providing benefits only through one or more contracts of insurance with issuers or HMOs, and that do not create or receive PHI–other than summary health information or enrollment information–are not required to develop this notice.

The model notices reflect changes made by the HIPAA final omnibus rule that became effective in March. Covered entities were required to revise their notices to reflect those changes by September 23, 2013, and must redistribute the notice as provided in the final omnibus rule. You can visit our HIPAA section for more information.

New Guidance on Health Care Reform Rules for HRAs & Other Arrangements

A new set of Q&As provides additional guidance regarding how the prohibition on annual dollar limits and the requirement to cover preventive services under Health Care Reform apply to health reimbursement arrangements (HRAs) and certain other employer healthcare arrangements. The following are key highlights that may be of interest to employers:

  • A group health plan, including an HRA and an employer      payment plan, cannot be integrated with individual market coverage.
    • An HRA or employer payment plan used to purchase       coverage on the individual market will therefore fail to comply       with the annual dollar limit prohibition and the preventive services       requirements.
  • An HRA that is integrated with a group health plan      will generally comply with the annual dollar limit and preventive services      requirements if the group health plan with which the HRA is integrated      complies with those requirements.
    • An HRA will be integrated with a group health plan for       purposes of the annual dollar limit prohibition and the preventive       services requirements if it qualifies under either of two integration       methods described in the Q&As.
  • A health flexible spending arrangement (FSA) that does      not qualify as excepted benefits is not integrated with a      group health plan, and thus will fail to meet the preventive services      requirement.
    • Effective retroactively as of September 13, 2013, a       health FSA that is not offered through a cafeteria plan (a plan which meets specific       requirements to allow employees to receive certain benefits on a pre-tax       basis) is subject to the annual dollar limit prohibition and will fail to       comply with this requirement.
  • Effective for taxable years beginning after December      31, 2013, an employer is prohibited from providing a qualified health plan      offered through a Health Insurance Exchange as a benefit under the      employer’s cafeteria plan.

The agency guidance applies for plan years beginning on or after January 1, 2014, with certain exceptions, but may be applied for prior periods. Visit our section on HSAs, FSAs, & Other Tax-Favored Plans for more information on these types of arrangements.

‘Pay or Play’ Requirements Delayed Until 2015

‘Pay or Play’ Requirements Delayed Until 2015

Employers subject to the ‘pay or play’ requirements under Health Care Reform–generally those with at least 50 full-time employees, including full-time equivalents–will not face penalties (also known as employer shared responsibility payments) for 2014.

According to formal guidance released by the IRS, the ‘pay or play’ provisions will be fully effective for 2015 and employers are encouraged to maintain or expand health coverage in 2014 in preparation for compliance. The delay is a result of transition relief being provided for 2014 with respect to certain employer and insurer reporting requirements which are necessary for the IRS to determine whether a penalty may be due.

The delay does not affect the application or effective dates of other Health Care Reform provisions, including the individual shared responsibility requirements scheduled to take effect on January 1, 2014.

2014 Contribution Limits and Minimum Deductibles for Health Savings Accounts

The IRS has released the 2014 inflation adjusted amounts for health savings accounts (HSAs). To qualify for an HSA, an individual must be covered under a high deductible health plan (HDHP) and meet certain other eligibility requirements.

HSA Basics
An HSA may receive contributions from an eligible individual or any other person, including an employer or a family member, on behalf of the individual. Contributions, other than employer contributions, are deductible on the eligible individual’s return. Employer contributions are not included in income. Distributions from an HSA that are used to pay qualified medical expenses are not taxed.

Annual Contribution Limitation
For calendar year 2014, the annual limitation on HSA deductions for an individual with self-only coverage under an HDHP is $3,300. The annual limitation on HSA deductions for an individual with family coverage under an HDHP is $6,550.

High Deductible Health Plan
For calendar year 2014, a ‘high deductible health plan’ is defined as a health plan with an annual deductible that is not less than $1,250 for self-only coverage or $2,500 for family coverage, and the annual out-of-pocket expenses (deductibles, co-payments, and other amounts, but not premiums) do not exceed $6,350 for self-only coverage or $12,700 for family coverage.

You can read more about HSAs in our section on Health Savings Accounts.

New Model Exchange Notices — Distribute to Employees No Later Than October 1, 2013

New Model Forms Released: Health   Insurance Exchange Notices and Revised COBRA Election Notice

Employers and group health plan   administrators will want to download new   model notices released by the U.S. Department of Labor (DOL) to   comply with changes as a result of Health Care Reform.

New Model Exchange Notices —   Distribute to Employees No Later Than October 1, 2013
Following a delay in the original effective date, employers need to comply   with the new requirement to provide employees a written notice with   information about a Health Insurance Exchange (Marketplace) beginning this   fall. Two separate notices are available from the DOL:

  • Model Notice for Employers Who Offer a        Health Plan to Some or All Employees
  • Model Notice for Employers Who Do Not        Offer a Health Plan
Employers are required to provide   the written notice to each current employee not later than October 1, 2013,   and to each new employee at the time of hiring beginning October 1, 2013 (a   notice will generally be considered to be provided ‘at the time of hiring’ if   it is furnished within 14 days of an employee’s start date).

Employers must provide the notice   automatically and free of charge to each employee, regardless of plan   enrollment status or of part-time or full-time status. The notice may be   distributed by first-class mail, or electronically if certain requirements   are met. Employers do not need to provide a separate notice to dependents or   other individuals who are or may become eligible for coverage under the plan   but who are not employees.

Updated Model COBRA Election   Notice
A revised Model COBRA Election Notice is now available   for group health plans subject to federal COBRA to inform eligible   employees and dependents of the right to continue coverage and how to make an   election when a qualifying event occurs.

COBRA generally requires plan administrators to provide eligible   individuals (called ‘qualified beneficiaries’) an election notice within 14   days after receiving notice of a qualifying event. The updated model notice   includes additional information for qualified beneficiaries who may want to   consider and compare health coverage alternatives to COBRA that will be   available through the Health Insurance Exchanges (Marketplaces), which are   expected to begin operating in 2014.

Check out our Group Health Plan Notices Calendar for   information on other notice requirements and to download additional model   notices.

New Version of Form I-9

Employers Must Use New Version of Form I-9 Beginning May 7, 2013

Employers needing additional time to switch to the new Form I-9 (released in March) have until May 7th to begin using the revised version. Federal law requires all U.S. employers to verify the identity and employment eligibility of employees hired to work in the United States by completing Form I-9.

Prior versions of the Form I-9 will no longer be accepted effective May 7th, 2013. Employers should not complete a new Form I-9 for current employees if a properly completed Form I-9 is already on file.


(SBC) Summary of Benefits and Coverage for 2014

New Summary of Benefits and   Coverage Template for 2014

Employers responsible for   distributing a summary of benefits and coverage (SBC) to employees in   connection with group health plan coverage will need to include additional   language to satisfy new requirements under Health Care Reform becoming   effective in 2014. An updated SBC template, which includes the new language,   is now available for SBCs provided with respect to coverage beginning on   or after January 1, 2014 and before January 1, 2015.

SBC Notice Requirements
Group health plans are required to provide, without charge, a standard SBC   form explaining plan coverage and costs to employees at specified times   during the enrollment process and upon request. For insured group health   plans, the notice requirement may be satisfied if the issuer furnishes   recipients with a timely and complete SBC.

New Language Required for 2014

The updated SBC template includes   additional language indicating whether the plan provides “minimum   essential coverage” (the type of coverage an individual needs to satisfy   the individual responsibility requirement), and   whether the plan meets the “minimum value” standard under Health   Care Reform (meaning the plan pays for at least 60% of covered health care   expenses).

FAQs issued simultaneously provide some relief for plans   already working on preparing SBCs for 2014, where adding the new information   to the template would present an administrative burden. To the extent a plan   is unable to modify the SBC template for coverage beginning on or after   January 1, 2014 and before January 1, 2015, a plan may use the previously   authorized template, so long as the SBC is furnished with a cover   letter or similar disclosure stating whether the plan does or does not   provide “minimum essential coverage” and “minimum value.”

Stress at Work Solutions

5 Tips for Keeping Stress at Work in Check

Stress in the workplace, whether triggered by significant workloads or pressing deadlines, can sidetrack employees and prevent them from doing their best. The following simple steps for managers and employees can help reduce the pressure and increase team performance and productivity:

  • Avoid Setting Unrealistic Goals. Setting achievable goals with reasonable timelines helps your sense of accomplishment grow while your stress level declines.
  • Step-Out Complicated Projects. Dividing a complex project into phases provides specific direction, helps maintain a calm environment, and motivates the team. Daily or weekly to-do lists can also help prioritize tasks.
  • Make Time for Meetings and Completing Tasks. Blocking out the time necessary to complete a task on your calendar is just as important as scheduling time for meetings.
  • Communicate Regularly. Recognizing employee achievements can increase confidence, as well as reduce stress related to workloads. Employees may also be able to help identify new ways that they can contribute.
  • Schedule Time for Exercise. A regular exercise routine can help lower stress and recharge your batteries for the challenges ahead.

Does Your Health Plan Pass Section 105(h) Nondiscrimination rules?

Plan sponsors are required to do annual discrimination testing to remain qualified. The testing is two part; “The Benefits Test” and “The Eligibility Test”. Failure to properly preform and report these annual test can result in a failing plan. Penalties can include benefits becoming taxable as income! If you are not sure if your plan is in compliance gives us a call we can help!

Wellness! Wellness! Wellness!

“Well designed health promotion and disease prevention interventions work only if people participate. The higher the level of participation, the greater the potential savings to a health plan. These savings are not only from direct health care cost, but also from improved productivity at work and fewer absences. But the battle is how does a health plan engage members in participating in wellness and health promotion programming?”

Ask us; we will tell you how to engage your employees!