Search results for: “Group Health Plan”

  • Compliance Q&A: Fiduciary Duties in Vendor Selection and Management

    Question My company hired a vendor to outsource the utilization management and appeals processes for our health plan. I have heard that we, as the plan sponsor, have a fiduciary duty to monitor the vendor’s activities. What does that mean, and, if this is really required, how can we comply? Summary The 1974 Employee Retirement…

  • 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…

  • 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…

  • Compliance Q&A: Can We Pay for Executive Physicals?

    Question Can employers provide physicals for their executives? Summary Yes, but as with most things in benefits, you’ll need to think through the compliance considerations. Unfortunately, it’s not as easy as just reimbursing or paying the cost of the physical. Although it seems like a small thing, simply paying or reimbursing for the cost of…

  • Do I Really Need Employee Benefits Counsel?

    When it comes to group health plans, many HR managers rely on their insurance broker and account teams to guide them through the complexities of regulatory requirements and best practices. While an insurance broker should provide valuable support and direction, an implicit (or sometimes explicit) question can arise when complex issues are encountered: “Do I…

  • Why You Should be Auditing Your Monthly Carrier Invoices: Bill Reconciliation from a Compliance Perspective

    Have You Reviewed Your Bills Lately? While conversations about finances are always first on the agenda at annual renewal meetings, there are a variety of reasons why plan sponsors and HR should be paying attention to carrier invoices year-round. As a former account manager, I cannot count the number of times that a client who…

  • New Simplified Rules for Medicare Part D Creditable Coverage—What HR Professionals Need to Know in 2025

    A New Era of Simplicity for Creditable Coverage Notices In the first and second quarters of 2025, the Centers for Medicare & Medicaid Services (CMS) finalized changes to how employer-sponsored group health plans determine if their prescription drug coverage is “creditable” for Medicare Part D purposes. For HR professionals, this marks a shift to simplified…

  • Compliance Q&A: Accidental MEWA

    Question Our company (Company A) is a closely owned family business and there is a related company (Company B) that has somewhat similar ownership. Company A is owned by four brothers, W, X, Y and Z, and each owns 25% of the common stock. Company B is owned by the same four brothers (10% ownership…

  • 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…

  • Compliance Q&A: Classing Out Executive Benefits

    Question Our company would like to reward our executive team for their hard work in turning around the company’s recent financial difficulties and making the company profitable again. We would like to pay a greater portion of the premiums for our group health plan for our executives than we pay for our rank-and-file employees. Can…