Tag: Compliance QA

Question Our company uses the look-back measurement method to identify full-time employees. I recently hired an employee who was expected to work full-time hours. We offered her medical insurance coverage and she accepted. Since then, however, she dropped to part-time hours. What should I do about her benefits? Summary If an employee who is initially…

Question When is COBRA continuation coverage required, and what are some common missteps to avoid? Summary The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) grants individuals the right to continue employer-sponsored health insurance coverage for a limited period after experiencing qualifying events such as a job loss or reduction in work hours. Despite its…

Interested in the steps plan sponsors need to take to comply with the RxDC rules? Learn these steps and how they fit into the larger picture of healthcare transparency laws in this compliance QA.

Question We switched to a new health Flexible Spending Account (FSA) third-party administrator (TPA). The new TPA deactivated one of our employee’s FSA debit card because of $20 in unsubstantiated expenses, stating this was an Internal Revenue Code requirement. Our prior TPA told us expenses under $25 did not need to be substantiated and that…

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…

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…

Questions We provide a basic group term life insurance policy of $50,000 to employees. We understand that providing a group life insurance policy under $50,000 would not require an imputed income calculation, but what about supplemental life insurance? Can you provide a high-level overview of group term life insurance and when an employer might have…

Question One of our employees has been on medical leave for the past four months. Do I have to continue offering our medical insurance benefits or can I go ahead and terminate the medical coverage? Summary Ideally, the question of how long to continue benefits during an employee’s leave of absence (LOA)1 has been proactively…

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…