Search results for: “HIPAA”

  • Compliance Q&A: High-Cost Claimants: ADA, ACA, HIPAA and ERISA

    Question We are examining various health coverage and plan design options in order to save money. One employee, a hemophiliac, has experienced high claims and requires expensive, ongoing treatment. Our reinsurance carrier has imposed a laser at $500,000 for this employee, which is a significant financial burden. May we offer this high-cost claimant cash to…

  • Managing Third-Party Transportation Risks in Senior Living Organizations

    The Transportation Landscape Senior living operators outsource transportation to reduce capital investment, transfer liability, support ADA compliance, access specialized training, maintain regulatory flexibility, and scale services with census demand. Vendor Types Non-Emergency Medical Transportation (NEMT) Rideshare Platforms (Uber Health, Lyft Healthcare) Taxi/Car Services: Traditional providers Charter/Bus Services: Group transportation Regulatory Environment Transportation operates at the…

  • What to Know Before You Go It “Alone” and Offer a Supplemental Health Program to All Employees

    Has a vendor ever approached you about offering a medical or pharmacy benefit separate from your medical plan? When you offer a program to employees other than those who participate in your medical plan, we refer to it as a ‘stand-alone’ plan. These types of programs can be an inexpensive way to provide at least…

  • Compliance Q&A: What is the “Excepted Benefit” status and why does it matter?

    Summary The determination of whether a particular benefit may be “excepted” is important when structuring a particular solution – such as an FSA, EAP, or a carve-out point solution – to ease a plan sponsor’s compliance with laws such as HIPAA, the ACA, and MHPAEA. Click below to read more on excepted benefit status, why…

  • Compliance Q&A: On-site Clinics

    Question We are considering starting an on-site medical clinic where our employees can receive medical care. Can you explain the main employee benefits compliance concerns for such a clinic? Summary Employers providing access to an on-site medical clinic for their employees have several potential compliance issues to consider, including ERISA, COBRA, HIPAA, the ACA, and…

  • Common Misconceptions ERISA ACA Compliance

    Rules I’ve always been a rule-follower … to the point that my own family makes fun of me for never even breaking the speed limit! So, naturally, I am attracted to the field of Human Resources where we are bombarded with over 50 categories of rules and regulations affecting virtually every aspect of the employment…

  • Employment Practices Liability Insurance

    Employment practices liability insurance (EPLI) provides coverage for allegations made by employees, former employees, job candidates, customers and vendors related to your business’s employment practices. Often these allegations result in litigation, with costs quickly adding up into hundreds of thousands of dollars. Whether you run an established company or are starting a small business, it’s…

  • Compliance Q&A: COBRA Implications under Severance Agreements

    Question Typically, when we terminate a management or executive employee, we agree to pay all or part of their COBRA premiums for a period of time. What compliance concerns should we consider? Summary While an employer may subsidize COBRA for terminated employees, including management and executives, there are potential compliance traps for the unwary. These…

  • Leveraging Artificial Intelligence in Predicting Future Medical Claim Costs: An Actuarial Perspective

    In the realm of insurance, predicting future medical claim costs is pivotal for maintaining financial stability and offering competitive premiums. Traditionally, actuarial methods have been the backbone of this process, relying heavily on historical data and statistical models. However, the advent of artificial intelligence (AI) has revolutionized this landscape, offering unprecedented opportunities to enhance prediction…

  • Get Results from Your Wellness Program Instead of Just Giving Away Money

    A common problem with employer wellness programs is that they don’t really drive behavior change that improves health outcomes.   In a typical homegrown wellness program, an employer incentivizes their employees to complete basic health activities like an annual physical and lab work. The rewards often range from $150 to over $2,000 per year in some…