Tag: Compliance QA

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…

Question We are considering moving from a fully-insured to a level-funded group health plan. What should we be thinking about from a compliance perspective? Summary Often considered a hybrid approach, level-funded plans provide the stability of fixed premiums (similar to fully-insured plans) along with the ability to share in a degree of cost savings (a…

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…

Question My company is an Applicable Large Employer using the look-back measurement method to determine full-time status of our employees. One of our full-time employees left the company to pursue another career. Four months later, he returned to the company as a part-time employee. Do I need to offer him health insurance coverage? Summary In…

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…

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…

Question We are an applicable large employer (ALE) and we currently operate medical plans and other benefits on a plan year ending March 31st (current plan year ending March 31, 2026). We want to amend our plan year to a calendar year plan so that our employees can better understand the timing and election of…

Question I have hired a couple of interns. They’re scheduled to work full-time hours but they’re only going to be with us for about four months. Am I at risk of any Affordable Care Act (ACA) “Pay or Play” penalties if I decide not to offer these interns health coverage? Summary If the employer is…

Question My company offers a health flexible spending account (FSA) funded by employees. I saw on the IRS website that health FSAs are subject to Patient-Centered Outcomes Research Institute (PCORI) fees unless they are an excepted benefit. When is a benefit considered “excepted” and why else might this status matter? Summary Broadly speaking, excepted benefits…

Question I thought Affordable Care Act (ACA) reporting was a federal requirement and that individuals are no longer required to have health insurance to avoid penalties under the individual mandate, but I’ve heard that coverage and reporting may be required in some states. Is this true? Summary While health insurance is no longer required at…