What Is HIPPA?

HIPPA or “The Health Insurance Portability and Accountability Act of 1996” was enacted on Aug. 21, 1996. The focus was to improve portability and continuity of health coverage. It contains provisions that:

  • Provide individuals with additional rights through its pre-existing condition, special enrollment, and nondiscrimination requirements,
  • Impose insurance market rules that apply to health insurance carriers which require guaranteed availability and renewability of health insurance plans,
  • Govern the privacy and security of health information, and
  • Require that claims information be exchanged in a standardized format.

Who and what kind of benefit has to comply with HIPAA? Insured and self-funded Group Health Plans and health insurance carriers that offer group Health Insurance Coverage must comply with HIPAA’s pre-existing condition, special enrollment, and nondiscrimination requirements. Prior to health care reform, self-funded, non-federal governmental plans were permitted to opt out of HIPAA’s portability and nondiscrimination requirements, but were still required to issue Certificates of Creditable Coverage. This took effect on Sept. 23, 2010.

Most Excepted Benefits do not constitute Health Insurance Coverage therefore the do not have to comply with HIPPA. Coverage’s include but are not limited to:

  1. Coverage only for accident  (including accidental death and dismemberment),
  2. Disability income coverage,
  3. Liability insurance, including general liability insurance and automobile liability insurance,
  4. Coverage issued as a supplement to liability insurance,
  5. Workers’ compensation or similar coverage,
  6. Automobile medical payment insurance,
  7. Credit-only insurance (for example, mortgage insurance), and
  8. Coverage for on-site medical clinics.

HIPAA also requires that Group Health Plans and Health Insurance Coverage issuers recognize Special Enrollment Periods beyond open enrollment or new employment.  If an individual applies for coverage during a Special Enrollment Period, he or she may not be treated as a Late Enrollee.  HIPAA provides for Special Enrollment in the following situations

  • Loss of Eligibility for other coverage
  • Marriage, Birth or Adoption
  • Loss of eligibility for other coverage subsequently obtained after initial enrollment.
  • Eligibility for Assistance.
  • Loss of eligibility for other coverage subsequently obtained after initial enrollment.
  • Moving Outside the HMO Service Area.
  • Lifetime Benefit Limits.

What is an MLR (Medical Loss Ratio) & Health Insurance Rebates?

Health Care Reform or The Affordable Care Act (ACA) requires health insurance issuers to spend a minimum percentage of their premium dollars on claims and wellness cost. Specifically, this percentage is 85% for large groups and 80% for small and individual groups. Issuers that do not meet the applicable MLR standard must provide rebates to their plan participants. The MLR regulation was put into effect in 2011 and enforced by the Dept. of Health and Human Services (HHS).  This means that Health Insurers are required to pay rebates at renewal (ex. If your renewal date is 7/1/11 then the rebate is payable 7/1/12).

Rebates are payable to the policyholders which is typically the employer.  They have 2 options in issuing the rebate: lump-sum or premium credit which is a reduction in premium owed by the policy holder. The Issuer could also institute a premium holiday which is permissible under state law and if the issuer meets certain requirements that are non-discriminatory.

Most Health Plans with the exception of some Church and Government organizations are governed by ERISA. The Dept of Labor has made it very clear that any rebate amount that qualifies as a plan
asset must be used exclusively as a benefit of the plans participants and beneficiaries. In order to determine whether the rebate is a plan asset depends on the identity of the policyholder and the source of premium payments.  In other words, if the plan, its trust or the employer is the policy holder then the portion of the rebate is to be treated as a plan asset and the remainder is distributed to whom else paid a portion of the insurance premiums.  Distribution of funds can be paid in full or applied to future participant premium payments or benefit enhancements. The administrator of the rebate has 3 months to distribute the participant’s portion of the rebate.  Tax treatment of the distribution depends on whether the initial payment of the benefit was paid pre or post tax.

Social Media Employee Policy

The Problem: Your employees are almost certainly “friends” with employees of your suppliers, customers, etc. When your employees say something on a social media website like Facebook or a blog this information is seen by all of their “friends”.

Whether the social media comments are gripes, complements, confidential information, etc., it is basically publicly known once it gets posted.

Best Current Solution: The General Counsel of the National Labor Relations Board has published a safe harbor policy. You will find a copy of it attached. You can find the full release at the below web address. http://mynlrb.nlrb.gov/link/document.aspx/09031d4580a375cd (The safe harbor policy is the last 3 pages of the full release.) I encourage you to consider putting this in your employee handbook.

Things to watch out for: Most employers want to control employee social media activity in some way. However, court ruling and NLRB rulings have been all over the board. Some specific things to NOT DO:

  1. Do not ask for your employees user names and passwords for their social media account
  2. Managers should not become online “friends” with employees
  3. NLRB has stated that employees have the protected right to engage in a “protected concerted activity” on line. Including:
    • Improving the work environment
    • Forming a union
    • Complaining about a manager or fellow employee who is breaking the law or a company policy.
  4. Do not have a social media “policeman” inside your company

If an employee comes to a member of management with a specific concern or compliant, then you really must investigate it, and take appropriate action.

A sample social media policy can be found here.

Healthcare Reform Upheld – What Does That Mean For You?

Individual Mandate InsuranceWhat does the individual mandate that was upheld on June 28th 2012 mean for you?

  • You are not forced to have Health insurance but you could be taxed for not having it. Although it is still in debate, the rate has been discussed at being around $100 per household member.
  • Health Benefit Exchanges will be established for each state for individual and small group employers with 4 levels of coverage (Bronze, Silver, Gold and Platinum). The state will have the individual authority to define the size of the group for eligibility purposes
  • Health insurance brokers will be replaced as or with Navigators that advise applicants regarding what is available through the state exchanges vs. what their employer offers.
  • Although it is still in discussion: those households with income between 100% and 400% (between $23,050 to $92,200 for a family of 4) of the federal poverty line will only have to pay between 2% and 9.5% of their income towards health care.
  • Large employers with 200+ employees will have to pay a tax if they do not offer health coverage or if it is labeled as “Unaffordable”. Unaffordable is defined as the higher of 60% employer contribution or 9.5% above their household income. A “Pay-or-Play” tax will be set at around $2,000 per year per employee
  • Employers will have to have no longer than a 90-day waiting period
  • Unintentional Errors on an insurance application cannot be rescinded.

For more information, please contact an employee benefits specialist at CoVerica by calling us at 972.490.8800.

Tell us what you think by commenting below.

Sources:
Poverty Line Information http://aspe.hhs.gov/poverty/12poverty.shtml
Patient Protection and Affordable Care Act (full text) http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf

Health Benefits for Domestic Partners?

A growing number of U.S. companies provide benefits, such as health insurance coverage, for their employees’ domestic partners and their children. Businesses may decide to offer domestic partner benefits to attract and retain talented employees or because they desire to provide equal benefits regardless of marital status or sexual orientation.

At the federal level, no laws require or prohibit domestic partner benefits in the workplace. The federal Defense of Marriage Act of 1996 (DOMA) only impacts the taxation of employer-provided domestic partner benefits and defines “marriage” solely as the union between one man and one woman and “spouse” solely as an opposite-sex husband or wife.

So what does this mean and how can it effect the administration and taxation of domestic partner benefits on a Federal Level?

  1. Domestic partner benefits are non-taxable only if the domestic partner or same-sex spouse qualifies as a dependent under the Internal Revenue Code’s definition of “qualifying relative”
  2. To qualify as a dependent under this definition, the domestic partner or same-sex spouse must generally:

    • Have the same primary address as the employee/taxpayer for the year;
    • Be a member of the employee/taxpayer’s household;
    • Receive more than half of his or her support for the year from the employee/taxpayer;
    • Not be anyone’s “qualifying child” for tax purposes; and
    • Be a citizen or national of the U.S., or a resident of the U.S. or a country contiguous to the U.S.
  3. If a domestic partner or same–sex spouse does not qualify as a tax dependent of the employee, employers are required to report and withhold taxes on the value of employer-provided health coverage for the domestic partner or same-sex spouse.
  4. In addition, an employee cannot pay for a domestic partner’s, same-sex spouse’s, or the Children that do not belong to them but not the Employees coverage on a pre-tax basis through a cafeteria (or section 125) plan if the partner or spouse or children are not the employee’s tax dependent. Thus leading to more administration to the employer because the benefits must be taxed.
  5. It is common for employers to “gross up” an employee’s salary to offset the tax consequences of domestic partner benefits (that is, reimburse employees for the extra taxes they are required to pay on the value of domestic partner benefits).

  6. Based on DOMA, the U.S. Department of Labor has concluded that domestic partners and same-sex spouses are not considered “spouses” for FMLA-leave purposes, although many employers allow employees to take leave to care for a domestic partner or same-sex spouse.
  7. Likewise, because of DOMA, domestic partners and same-sex spouses are not included in the protections and benefits provided by various other federal benefits laws, such as COBRA and HIPAA. In addition, retirement plans are primarily governed by federal law and, consequently, domestic partners and same-sex spouses are generally not entitled to spousal benefits under such plans.

What is the effect on the State level of Texas?

Since DOMA was enacted in 1996, several states have passed legislation prohibiting same-sex marriages. Recognition of these same-sex unions performed in other states has also been banned in some states. Both the Texas Constitution and statutory law prohibit same-sex marriage. In addition, Texas law prohibits same-sex civil unions, and does not recognize same-sex marriages or civil unions legally entered into in other jurisdictions.

Despite Texas’s ban on same-sex marriage, private employers are free to decide whether or not to provide domestic partner benefits for their employees. If you are an employer that is trying to decide on providing domestic partner benefits, please contact one of our benefits specialists at CoVerica and we would be happy to assist you with your decision.

Key Man Insurance

Key Man Insurance: What is my business and skillset worth to my employees and clients?

We can all agree that great ideas for a business start off with a simple thought, change, or skill set that a business owner has the ability to perform well and deliver.   Many ideas require certain skill sets or talents that only few people have so the question is: how do we protect that? Key man Insurance provides financial protection for a business in the event of a loss that would arise from death or an extended incapacity of a member of that organization whose skill set is essential and dependent on that single person (who is not easily replaced).

Along with protecting your core, there are a few other reasons to have Key Man Insurance.  If you have a Partnership with a partner(s) whose beneficiary would not want to take part in the business operations or lacks the skillset that you would need, then Key Man Insurance can provide the means to buy out the disabled or deceased partner allowing the remaining partner to maintain direction and control of the business.  Our last scenario before we look at an example is more practical regarding bank loans.  Banks will almost always ask for proof of a Key Man Policy when you apply for a business loan. You cannot blame them for having a concern for the financial health of their investment.

Let’s look at an example of where Key Man insurance is a great fit:

Dan has an IT and accounting business that specializes in the Dairy industry.  Josh is Dan’s partner and has the rights to a piece of software called Boxless solutions in which he is the only administrator to the program.  Both of them are very specialized in their industry and manage a large portfolio of clients along with about 40 employees.  Aside from tax season, their busy season is around the beginning of the 4th quarter when milks major activity tends to slow down.  They both estimate that the absence of either partner would lead to a substantial financial loss especially if they are disabled during their busy season.  Furthermore, Russ is Josh and Dan’s brother who is a physician and the beneficiary to all that they have whom has no interest in running his business. Both exposures give the partners substantial reasons to have Key Man Insurance.

There are many reasons to consider Key Man insurance and we would love to discuss your Key Man Insurance needs.

For more information, please call or email us at contact@coverica.com.

Health Insurance – 3 Tips to Save BIG Money

Increasingly due to the high costs of health insurance individuals are purchasing policies which only cover catastrophic health situations. The basic idea is for the individual to just pay out of pocket unless an injury or illness is so expensive that the cost of health care would financially destroy them. In this type of policy be sure to pay attention to the coverage for outpatient situations. Most of these catastrophic policies pay little to nothing for doctor visits and/or outpatient treatment. The definition of outpatient has changed over the past few years. Many people do not see how much this can affect them until it is too late.

A Real Example: Jill stepped off of the curb and broke her ankle. She went in for corrective surgery which she knew would be outpatient. She was held overnight in the hospital. After her surgeon came by to check on her the following morning, she was sent home. Total bill was just under $ 36,000. ALL OF IT WAS OUTPATIENT. Her catastrophic health insurance policy paid just over $ 1,500.  

What you need to learn from this:1. You can spend the night in the hospital and NEVER BE AN INPATIENT.  In fact, most hospitals do not consider you an inpatient unless you are going to be in their bed for at least 23 hours. (This standard was set by Medicare years ago and most hospitals use it for all stays to be consistent.)

2. Talk to your surgeon. When she/he bills the cost of the surgery have him/her include the total cost of all expected standard follow-up visits to his office.

3. READ YOUR POLICY.

In our above example, if Jill had just known 1 and 2 above she would have saved over $11,000.