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How’s your progress on health care compliance? Time is running out!

Only a few months remain to comply with the legal mandates of the Health Insurance Portability and Accountability Act (HIPAA), the Affordable Care Act (ACA), and other laws that affect your plans.

Look to Us for Help

The complicated laws of the ACA are our specialty, so let us help. Below are just a few of the issues you need to know and address to comply with the ACA and HIPPA.

Affordable Care Act

  • Employer mandate: Most employers must provide health coverage to full-time employees under the ACA in 2015. The health plan you implement must meet value standards and must be offered to at least 70% of your full-time employees (30 hours per week) to avoid penalties. Check to be sure there are no gaps in the coverage you have chosen.
  • Waiting periods: The ACA limits waiting periods under group health plans to 90 days. Plans can require as many as 1,200 cumulative hours for eligibility and can include an orientation period of one month. It is especially important that employers with high rates of employee turnover refine their policies to address this.
  • Premiums for individual coverage: Active employees are now prohibited from buying individual health insurance with pretax dollars. Employers with an arrangement that involves the buy of individual health insurance coverage need to understand these new rules.
  • Health reimbursement arrangements: The 2013 notice offers two methods for integrating an HRA into a group health plan. The ACA prohibits annual and lifetime dollar limits and preventive care requirements. Both methods require the plans to allow employees to opt out of the HRA and lose amounts in their HRA accounts. Employers with HRAs should review their documents to make sure that they comply with these integration requirements.
  • Reporting: Naturally, all new laws bring with them new reporting requirements. Data needs to be collected for 2015, and employers need to have the systems in place to perform this task.
  • Cost-sharing limits: The ACA set up limits on in-network out-of-pocket expenses that must be paid before the plan reimburses at 100%. The limits are $6,350 (single) and $12,700 (family) in 2014, increasing to $6,600 and $13,200 in 2015. By 2015, employers must be sure their vendors can share data correctly to track and coordinate expenses against these limits.
  • Excepted benefits: Dental, vision, employee assistance, and wrap-around plans will not be subject to ACA requirements and will not disqualify individuals from getting a subsidy for coverage bought through a health insurance exchange. Employers may consider whether they wish to take advantage of any of these new rules.

HIPAA

  • Privacy and security: Have you fine-tuned your policies and procedures? How is your training going? Have you completed your revisions to long-standing business associate agreements to be sure they are compliant? The grace period for those revisions expires on September 23, 2014.
  • Health plan ID numbers: Larger employer health plans (those with receipts of at least $5 million) must have the new federally-mandated unique ID number by November 5, 2014. The process for obtaining this involves many complicated steps, so there is not much time left. Smaller plans have another year to get the ID number.
As always, we are here to help you navigate these complicated compliance issues, with your company's specific needs and interests in mind. Time is quickly running out to take care of these items and remain compliant with the many government regulations. Contact us with any questions to see how we can help.
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