Source: https://probityinsurance.com/category/uncategorized/
Timestamp: 2020-04-09 19:32:43
Document Index: 440607826

Matched Legal Cases: ['in fine', '§423', '§ 423', '§ 125', '§ 125', '§ 414']

Category Uncategorized – Probity Insurance Services
IRS RELEASES FAQs REGARDING PAID FAMILY AND MEDICAL LEAVE
The Internal Revenue Service recently released the following answers to Frequently Asked Questions related to the employer credit for paid family and medical leave.
1. At least two weeks of paid family and medical leave (annually) to all qualifying employees who work full time (prorated for employees who work part time), and
2. The paid leave is not less than 50 percent of the wages normally paid to the employee.
1. Birth of an employee’s child and to care for the child.
2. Placement of a child with the employee for adoption or foster care.
3. To care for the employee’s spouse, child, or parent who has a serious health condition.
4. A serious health condition that makes the employee unable to perform the functions of his or her position.
5. Any qualifying exigency due to an employee’s spouse, child, or parent being on covered active duty (or having been notified of an impending call or order to covered active duty) in the Armed Forces.
6. To care for a service member who is the employee’s spouse, child, parent, or next of kin.
7. If an employer provides paid vacation leave, personal leave, or medical or sick leave (other than leave specifically for one or more of the purposes stated above), that paid leave is not considered family and medical leave. In addition, any leave paid by a State or local government or required by State or local law will not be taken into account in determining the amount of employer-provided paid family and medical leave.
Data Breach Security Law Takes Effect June 1
Effective on June 1, 2018, Act No. 2018-396 becomes one of the most stringent data security laws in the country. The Alabama law can be categorized into four obligations:
· All entities subject to the law (covered entities and third-party agents) must implement and maintain reasonable security measures to protect sensitive personally identifying information against a breach of security.
· A covered entity shall conduct a good faith and prompt investigation into a breach of security that has or may have occurred in relation to sensitive personally identifying information.
· A covered entity must notify each affected Alabama resident, and a third-party agent must notify the covered entity of a breach of security involving sensitive personally identifying information.
· A covered entity must notify the Alabama Attorney General and credit reporting agencies of a breach involving more than 1,000 Alabama residents.
Aside from the obligation to maintain reasonable security measures noted above, the other requirements of the Alabama law are triggered by a covered entity’s determination that “a breach of security has or may have occurred in relation to sensitive personally identifying information that is accessed, acquired, maintained, stored, utilized, or communicated by, or on behalf of, the covered entity.” A breach of security is defined as the “unauthorized acquisition of data in electronic form containing sensitive personally identifying information.”
Sensitive personally identifying information (“SPII”) includes an Alabama resident’s first name/first initial and last name in combination with one or more of the following:
· A non-truncated Social Security or tax-identification number.
· A non-truncated driver’s license, passport, or other government identification number.
· A financial account number combined with security/access code, password, PIN, or expiration date necessary to access or enter into a transaction that will credit or debit the account.
· An individual’s medical history, mental/physical condition, medical treatment/diagnosis by a health care professional, health insurance policy/subscriber number, or other insurance identifier.
· A user name or email address combined with a password or security question/answer permitting access to an online account affiliated with the covered entity that is reasonably likely to contain or is used to obtain SPII.
Limitations Period for Unpaid Wage Claims Clarified
In the recent ruling of the case Hernandez v. Domenico Farms, Inc., the Colorado Supreme Court held that a terminated employee’s right to seek unpaid wages or compensation at termination is subject to the two- or three-year statute of limitations under the Colorado Wage Claim Act (“CWCA”). The court also clarified that the statute of limitations begins to run when the wages or compensation first become due and payable.
The Supreme Court agreed with the plaintiff that Section 109 of CWCA allows employees to seek wages and compensation that (1) “only become due and payable” when an employee terminates his or her employment, and (2) “had previously become due and payable.” The court further held that the statute of limitations for those wages begins to run on the date that each set of wages first became due and payable — not on the date of separation.
Recently-passed Senate Bill 1287 has repealed the provision in Idaho’s 2016 non-compete law that shifted the burden to key employees and independent contractors to prove that they have no ability to adversely affect the employer’s legitimate business interests as a result of their competitive employment.
Maine recently amended its sexual harassment training law to now require that employers use a checklist prepared by the Maine Department of Labor (“MDOL”) to develop their sexual harassment training programs. To download the MDOL training checklist, click here.
The MDOL’s document provides a summary of the training that employers with 15 or more employees must provide, including the requirement for additional training for supervisory and managerial employees within one year of being hired or promoted into a supervisory or managerial position. Employers are also now required to keep records of the sexual harassment training conducted and to maintain these training records for at least three years.
Pregnant Workers Fairness Act Guidance Issued
The Massachusetts Commission against Discrimination (“MCAD”) recently issued questions and answers to provide additional guidance about the Massachusetts Pregnant Workers Fairness Act (“PWFA”) that went into effect on April 1, 2018.
The PWFA requires that employers with 6 or more employees notify all employees of their rights under the Act by April 1, 2018, at hire thereafter, and within 10 days of an employee’s notice to the employer of pregnancy. The MCAD guidance document provides sample language to satisfy the employer’s notice requirement. For more information click here: MCAD Guidance
Preemption Law to Cover Job Interview Limitations Expanded
Effective June 24, 2018, Public Act 84 prohibits local governments from regulating the information employers can request from prospective employees during the interview process. The act also restricts a local government’s ability to implement “ban-the-box” ordinances that prohibit employers from inquiring about an applicant’s criminal conviction history.
The act is in response to municipalities passing ordinances that prohibit employers from seeking salary information from applicants.
Breach Notification Law Enacted
Under recently-enacted SB 62, businesses must disclose a breach of system security to any resident of South Dakota whose computerized personal or protected information was acquired by an unauthorized person.
Furthermore, if the breach exceeds 250 South Dakota residents, the state attorney general must also be informed. These notices must be provided within 60 days after the breach is discovered, unless a law enforcement agency determines that the notification will impede a criminal investigation.
A failure to comply with the notice requirement would be considered a “deceptive act” under South Dakota’s unfair trade practices law, which can trigger criminal as well as civil enforcement.
Personal Liability for Unpaid Wages Now Limited to Company Officers
The Utah Payment of Wages Act (“UPWA”) was recently amended under HB 364 to limit personal liability for unpaid wages only to officer-level employees. The UPWA previously applied personal liability for unpaid wages claims to an employer’s control group, including all those who have power to hire or fire, supervise work, determine the rate and method of pay, and maintain employment records.
Ban-the-Box Law Limits Criminal Background Inquiries
The Washington Fair Chance Act (“WFCA”) prohibits inquiries regarding applicants’ conviction histories until the employer has determined the applicant is “otherwise qualified” for the position. Once the employer has initially determined that the applicant is otherwise qualified, the employer may make further inquiry.
All employers in Washington will be prohibited from:
· Advertising openings in a way that excludes people with arrest or conviction records from applying, such as using advertisements that state “no felons,” “no criminal background,” or that otherwise convey similar messages;
· Including any question in an employment application, inquiring orally or in writing, receiving information through a criminal history background check, or otherwise obtaining information about an applicant’s arrest or conviction record, until after the employer has initially determined that the applicant is otherwise qualified for the position;
· Having automatic disqualifiers or categorically disqualifying an individual based a criminal record before initially determining the person is otherwise qualified for the position; or
· Rejecting or disqualifying an applicant for failure to disclose a criminal record prior to initially determining the applicant is otherwise qualified for the position.
· Any employer hiring a person who will or may have unsupervised access to children under the age of 18 or a vulnerable adult or person, as defined by Washington law;
· Any employer, including a financial institution, who is expressly permitted or required under any federal or state law to inquire into, consider, or rely on information about an applicant’s or employee’s criminal record for employment purposes;
· Various law enforcement agencies or criminal justice agencies in Washington;
· Any employer seeking a nonemployee volunteer; or
· Any entity required to comply with the rules or regulations of a self-regulatory organization, as defined by the Securities Exchange Act.
The statewide WFCA does not preempt Washington municipalities from enforcing their own ban-the-box ordinances. Current related local ordinances in place include Seattle’s Fair Chance Employment Ordinance and Spokane’s Fair Chance Hiring Act.
Employment Discrimination Protections Expanded to Cover Victims of Domestic Violence
Effective June 7, 2018, House Bill 2661 provides job applicants and employees in Washington who are survivors of domestic violence, sexual assault, or stalking new protections against employment discrimination and adds a new section requiring reasonable safety accommodations.
Under the Act, all employers in Washington State will be prohibited from:
· Refusing to hire a qualified individual because he or she is an actual or perceived victim of domestic violence, sexual assault, or stalking;
· Discharging, threatening to discharge, demoting, suspending, or in any way discriminating or retaliating against an individual because he or she is an actual or perceived victim of domestic violence, sexual assault, or stalking; and
· Refusing to make a reasonable safety accommodation requested by a victim of domestic violence, sexual assault, or stalking, unless such an accommodation would pose an undue hardship on the operation of the employer’s business.
The Act offers examples of a “reasonable safety accommodation”:
· Transfer or reassignment;
· Modified job schedule;
· Change in work telephone number, email address, or workstation;
· Installed locks;
· Implementing safety procedures; or
· Any other adjustment to a job structure, workplace facility, or work requirement in response to an actual or threatened domestic violence, sexual assault, or stalking.
An employer may require verification for an employee’s request for leave or a reasonable safety accommodation under the Act.
Equal Pay Opportunity Act Amends Equal Pay Act
Effective June 7, 2018, the Equal Pay Opportunity Act (“EPOA”) amends Washington’s 1943 Equal Pay Act.
While the original act allowed an employer to assert a “good faith” defense, the updated EPOA goes further and lists the factors a court may consider in an employer’s “good faith” defense. “Good faith” factors include, but are not limited to, business necessity education, training, experience, seniority, merit, and regional differences. An employee may recover reasonable attorneys’ fees in a successful private action.
The EPOA also prohibits an employer from using wage secrecy measures such as requiring nondisclosure of wages as a condition of employment or requiring employees to contractually agree to nondisclosure. Further, an employer may not discharge or retaliate against employees who discuss or compare wage information.
Employers Cannot Prohibit Guns in Vehicles
Effective June 8, 2018, the Business Liability and Protection Act (House Bill 4187) limits a West Virginia employer’s ability to prohibit the lawful possession of firearms locked in vehicles parked in company parking lots. Previously, employers and other property owners in West Virginia had the ability to prohibit the carrying or concealing of firearms on any property “under his or her domain,” including parking areas.
Under the new law, employers may not prohibit any customer, employee or other person lawfully on the premises from storing a lawfully possessed firearm inside of a privately-owned vehicle in a company parking lot, as long as the firearm is out of view and locked inside the vehicle.
Further, employers are prohibited from asking about the presence of a firearm locked inside a vehicle or performing an actual search for a firearm within a vehicle on a company parking lot and from conditioning employment on an employee’s agreement not to keep a firearm locked inside his or her vehicle or on whether an employee holds a concealed-carry license.
The act applies only to privately-owned vehicles and does not apply to vehicles owned, rented or leased by the employer.
in	Uncategorized	by Soheil Hosseini	 14 May 2018 0	comments
The following classes of business can be quoted:
Airport (Local/Regional)
Ambulance Service- Private
Assisted Living (other than nursing homes) Auto Dealership* Auto Repair/Garages
Bank- US-Owned*
Catering Service- No Banquet Halls & Facilities Cemetery/Funeral Home Church Condominium/Homeowners Associations Consultants
Contractor- Artisan Contractors
Country Clubs*
Credit Operations*
Daycare Center- Commercial
Hotel/Motel Management Company
Hotel/Motel Owner
Insurance Agents- Not USLI appointed
Law Firm- Other than Entertainment Law (<50 employees) Maintenance/Janitorial
Manufacturer- All Other
Nursing Home/Home Health Care Providers* Plumber Printer/Publisher Property Management Companies* Real Estate Agencies* Recreation/Membership Organization- All Other Rent to Own Furniture Store* Rental Car Agencies*
Retail Store- All Other
Schools- All Other
Security Guard Services- All Other*
Transportation/Trucking- All Other
*Indicates class is not eligible for Third Party coverage. Other classes of business are eligible for quote consideration. An application may be submitted. As always, we appreciate your business! Please let us know if you have any questions!
in	Uncategorized	by probityadmin	 11 Jul 2017 0	comments
ERISA, which stands for the Employee Retirement Income Security Act, is a federal law regulating employer-sponsored group benefits. Nearly every employer, regardless of their size, is subject to ERISA if they offer even one employer-provided group benefit such as health, dental, vision, accidental death & dismemberment, disability, or group term life insurance; medical flexible spending account or health reimbursement account; wellness and employee assistance program; or any other benefit for which the employer contributes to the cost. The only exempt employers are churches and government entities. Besides requiring certain plan features, the law also mandates detailed reporting requirements, both to the Department of Labor and other government agencies and to employees and covered members under your policies. While ERISA was first enacted in 1974, recent changes under the Patient Protection and Affordable Care Act (PPACA) have added additional requirements and changed reporting deadlines. REQUIREMENTS UNDER ERISA & PPACA If you offer any of the above-mentioned health and welfare benefits, you must meet specific requirements, specifications, and deadlines for plan documents under ERISA as well as under PPACA. The key ERISA and PPACA provisions are listed here and details of each follow: · distribute a written plan document and Summary Plan Description (SPD) for every health and welfare benefit and any voluntary benefit pre-taxed under a 125 plan to all plan participants including spouses and COBRA enrollees, · distribute ERISA benefit notices to all eligible employees on enrollment and re-enrollment of your health plan, · notify participants of any change to a plan that materially affects the design or pricing, · file Form 5500 and all applicable schedules within 7 months after the plan year ends for each plan that has more than 100 participants (not just employees) on the first day of the plan year, · meet all fiduciary standards and plan terms, · establish a trust fund that holds the plan’s assets, if applicable, · establish a recordkeeping system to track contributions, benefit payments, maintain participant and beneficiary information, and to prepare reporting documents, · provide a summary of benefits and a coverage explanation (SBC) and documentation of how and when it was distributed each year, · verify fiduciary bonding needs for individuals handling funds and other property of employee benefit plans like a 401(k) plan, if applicable. The deadline for each requirement varies, depending on when your plan was enacted, whether it is grandfathered under PPACA, whether material changes have been made, and other exceptions. Copies of certain plan documents must be also available to participants and beneficiaries on written request. SPD and Wrap Requirements An employer must have a written Summary Plan Description (SPD) for each separate welfare benefit plan, informing participants of eligibility requirements, benefits, claims and appeals procedures, and rights under ERISA. Your insurers may provide some but not all information required for SPD compliance. It is a common mistake by employers to think the summary insurance information they receive from their insurance provider meets the SPD requirements. A common approach is to combine all SPDs into one overall SPD Wrap notice, tying in the required ERISA language and simplifying the SPD notice process. A customized SPD Wrap must include the name of the plan, plan sponsor, plan administrator, plan year, employer tax identification number, type of welfare plan, type of administration, summary of the benefits, detailed description of plan benefits for group health plans, provider network availability for group health plans, procedures for Qualified Medical Child Support Orders (QMCCOS), COBRA rights, plan contributions, and claims procedures. A Statement of ERISA Rights is also required. The SPD and Wrap must be distributed to newly-enrolled participants within 90 days of when coverage started, or within 120 days of a new plan being established. ERISA Benefit Notices All eligible employees must receive ERISA Benefit Notices upon enrollment and re-enrollment of your health plan. Depending on company size and other criteria, you may be required to provide employees with the following employee notifications: · Medicare Part D Notice · CHIP (if applicable in your state) · Wellness Program Disclosure · Women’s Health & Cancer Rights · Hospital Stay Rights for Childbirth · Mental Health & Parity Act · HIPAA Notice · Disclosure of Grandfathered Status · COBRA Rights – Initial Notice In the event of certain Qualifying Events, additional required notices may include: · COBRA Qualifying Event Letter · HIPAA Breach Notice · Medical Child Support Order Notice (MCSO) · National Medical Support Notice (NMS) Form 5500 and Summary Annual Report ERISA further requires employers with 100 or more participants to annually report certain information to the DOL on Form 5500. Form 5500 returns ask for information about the plan, including plan name, plan year, plan sponsor, plan number, participants, insurance costs, and financial data. Employers who set up an SPD Wrap can file one 5500 report for the SPD Wrap covering all health and welfare plans. Once a Form 5500 is completed and filed, you must prepare a Summary Annual Report (SAR) for each of your welfare benefit plans subject to ERISA reporting, or just one if done under an SPD Wrap. The SAR summarizes Form 5500 information and notifies participants Form 5500 has been filed and a copy is available to those who request a copy. SARs must be distributed to covered participants within nine months after the end of the plan year. A SAR is not required for plans that are not required to file a Form 5500. AUDITS AND ENFORCEMENTS The Department of Labor’s Employee Benefits Services Administration (EBSA) routinely conducts audits of group health benefit plans to investigate or audit the plan’s compliance. In addition, the Health Benefits Security Project (HBSP) was recently established under PPACA to add to EBSA’s compliance and enforcement initiatives. It has been reported that smaller groups of fewer than 100 are being particularly targeted since the DOL does not have the ability to monitor them through a Form 5500 filing. Audits are anticipated to increase significantly, given increased audit budgets and concerns over ERISA and PPACA violations. If your company is selected for a DOL audit, a letter will be sent to the Plan Sponsor containing the list of documents the DOL would like to review. The request for information typically goes back three to six years. AUDIT TRIGGERS AND PENALTIES Every audit is unique. However, reported trends show the following are typical areas of concern, in recent audits: · Summary Plan Descriptions · HIPAA compliance, particularly notices to employees about special enrollment rights · PPACA Grandfathered Plan notices and documentation of coverage for adult children · PPACA lifetime and annual limit requirements · inadvertently excluding people who may be eligible to participate in the plan, including dependents up to age 26 The DOL reports common audit triggers include: · the Department’s internal audit initiatives · employee complaints · press tips and public visibility of a company or its third-party vendors · the Department’s Memorandum of Understanding with the IRS · form 5500 filings inconsistencies or suspect information · an audit of a plan’s auditor (if 100+ group) · randomly selected In the future, DOL audits will also likely focus on: · employer communications and documentation · employer reporting requirements · coverage of essential health benefits, cost-sharing and out-of pocket limits for applicable plans · annual limits, on non-essential health benefits only · structure of group health benefit plans and offers of coverage · waiting period limitation of 90 days · exchange notice documents · adherence to PPACA requirements The employer is solely responsible for ERISA compliance. Penalties may be enforced for failure to comply with ERISA regulations, including DOL enforcement actions and penalties as well as employee lawsuits. Certain infractions can entail up to $100/day penalty for every employee that is affected by a violation until the violation is corrected. The penalty for late delivery of SPD or Wrap can be as much as $110/day per plan. Late filing of form 5500 can result in fines as high as $1,100 per day. The DOL estimate three out of four plans they audit have an ERISA violation, and about 70 percent of audits with violation have resulted in monetary fines to the employer. AUDIT PREPARATION Knowledge and familiarity of compliance requirements, complete documentation, and policies that show good faith efforts to comply are the best way to be prepared for an audit (as well as to avoid one in the first place). Below is a summary of the items you should have in place to ensure ERISA compliance. 1. ERISA & PPACA requirements mentioned above 2. Written ERISA plan document 3. SPDs or the combined SPD Wrap prepared and distributed to all plan participants within 90 days of first day of coverage 4. Summary of Material Modification (SMM) for any amendments such as carrier change, eligibility change, benefit structure change, etc. to your plans 5. Form 5500 and SAR filed annually (only if you have over 100 enrolled participants in any benefit) An organized employer with meticulous records who has a health insurance broker who helps review all of the company’s
in	Uncategorized	by probityadmin	 06 Apr 2017 1	comments
HCSO Annual reporting Form
All employers covered by the Health Care Security Ordinance (HCSO) are required to submit the 2016 Annual Reporting Form by May 1, 2017. Covered employers who fail to submit the Annual Reporting Form will be subject to a $500 penalty for each quarter that the violation occurred. An employer is covered by the HCSO for any calendar quarter if it meets the following three conditions:
Is required to obtain a valid San Francisco business registration certificate pursuant to Article 12 of the Business and Tax Regulations Code, AND
Is a for-profit business with 20 or more persons performing work OR a nonprofit organization with 50 or more persons performing work. This includes all persons working for the entity, regardless of whether they are located in San Francisco or outside the city.
Resources for completing the 2016 Annual Reporting Form (due by May 1, 2017) or to learn more about HCSO, are provided below:
2016 Annual Reporting Form
2016 Annual Reporting Form Instructions
HCSO Official 2017 Notice – Posting Required
If you would like to notify your clients of the impending deadline, simply copy the details within this email to create your own message. If you have any questions about HCSO compliance or reporting for 2016, please contact the Office of Labor Standards Enforcement (OLSE) at hcso@sfgov.org or 415.554.7892.
in	Uncategorized	by probityadmin	 04 Apr 2017 04 Apr 2017 1	comments
Family Medical Leave Act Notice (FMLA)
Family Medical Leave Act entitles eligible employees of covered employers to take unpaid, job-protected leave for specific family and medical reasons if the employee has been with the company for one year, has worked at least 1250 hours during the prior 12 months and works in an area where there are at least 50 employees within 75 miles. For additional details, visit the Department of Labor FMLA page. Notify the organization when you have a qualifying leave such as birth or adoption of a child, a serious health condition, to care for a spouse, child or parent with a serious medical condition or for reservist or national guard provisions related to you or an immediate family member leaving for military duty or being injured in active duty.
Additional information and notices can be found at: http://www.dol.gov/whd/fmla/index.htm
in	Uncategorized	by probityadmin	 11 Jan 2016 17 Mar 2017 0	comments
1. Complying with breach notification laws costs time and money
2. Third party data is valuable and you can be held liable if you lose it
3. Data is one of your most important assets yet it is not covered by standard property insurance policies
4. Systems are critical to operating your day to day business but their downtime is not covered by standard business interruption insurance
5. Cyber-crime is the fastest growing crime in the world, but most attacks are not covered by standard property or crime insurance policies
6. Retailers face severe penalties if they lose credit card data
in	Uncategorized	by probityadmin	 08 Dec 2015 17 Mar 2017 0	comments
WHAT IS CREDITA BLE COVERAGE?
Beginning January 1, 2006, Medicare beneficiaries will have the opportunity to receive subsidized prescription drug coverage through the new Medicare Part D program. Beneficiaries who choose not to sign up at the first opportunity may have to pay more if they wait to enter the program later after the open enrollment period.
Beneficiaries who have other sources of drug coverage – through a current or former employer or union, for example – may stay in that plan and choose not to enroll in the Medicare drug plan. If their other coverage is at least as good as the new Medicare drug benefit (a
nd therefore considered “creditable coverage” ), then the beneficiary can continue to get the high quality care they have now as well as avoid higher payments if they sign up later for the Medicare drug benefit. Under §423.56(a) of the final regulation, coverage is creditable if the actuarial value of the coverage equals or exceeds the actuarial value of standard prescription drug coverage under Medicare Part D, as demonstrated through the use of generally accepted actuarial principles and in accordance with CMS actuarial guidelines. In general, the actuarial equivalence test measures whether the expected amount of
paid claims under the entity’s prescription drug coverage is at least as much as the expected amount of paid claims under the standard Part D benefit.
REQUIRED DISCLOSURES TO CMS Section 423.56(e) of the final regulation requires all entities described in § 423.56(b) to disclose to CMS
whether their prescription drug coverage is creditable or non-creditable. The disclosure must be made to CMS on an annual basis, or upon any change that affects whether the coverage is creditable. Rules for making disclosures to CMS will be provided in future guidance.
REQUIRED DISCLOSURES TO MEDICARE BENEFICIARIES
In general, entities listed in section 423.56(b) of the final regulation must provide, or arrange for providing, a notice of creditable prescription drug coverage to Medicare beneficiaries who are covered by, or who apply for, prescription drug coverage under the entity’s plan
in	Uncategorized	by probityadmin	 09 Nov 2015 17 Mar 2017 0	comments
Insurance Plan Renewal and Benefit Reminders
•	Renegotiate insurance contracts, coverage and rates with providers.
•	Communicate insurance plan options, changes, rates and coverage options to employees.
•	Obtain needed insurance applications and waivers from employees.
•	Establish new Cafeteria 125 plan, flexible spending accounts (medical and child care), if applicable and obtain waiver agreements from all non-participants.
CMS Online Disclosure
•	If employer offers prescription drug benefits to any Medicare Part D eligible individual on the beginning date of their plan year, they are to complete the disclosure to CMS form for that plan year. This disclosure of creditable coverage status must be provided within 60 days after the beginning date of the plan year and must be made to CMS on an annual basis and upon any change that affects whether the drug plan is creditable. Provide online disclosure to CMS of creditable coverage status of your prescription drug plan at the following link: https://www.cms.gov/CreditableCoverage/45_CCDisclosureForm.asp
ERISA Summary Plan Descriptions (SPD) or SPD Wraps
•	Employers are to provide employees with a SPD communicating plan rights and obligations to participants and beneficiaries within 90 days after becoming covered under the employer’s plan. Plan administrators of a new plan must distribute an SPD within 120 days after the plan is established. An updated SPD must be furnished to all covered participants every 5 years, and every 10 years for plans with no changes. Summary of Material Modifications (SMM) must be furnished automatically to participants when a plan is amended or “materially” modified.
•	Insurers and group health plans must provide a summary of benefits and coverage (SBC) document to each full time employee, and to family members of those enrolled in coverage in a standardized, consumer-friendly format, making it easier for participants to compare with other plans. The health insurance carrier prepares this for fully insured plans, and employers are responsible to prepare the SBC for self-funded policies.
5500 Report Due
Groups with 100+ employees are to submit a 5500 report to the IRS for all health and welfare plans. For plan years commencing on or after January 1, 2009, employers must file electronically using the EFAST2 processing system. These employee benefit plan forms are due by the last day of the seventh month after the plan year ends.
Using your HR Service, Inc. Compliance Basic service, an employee notifications report is emailed to you for distribution to your employee’s when you complete or update your Company Profile. The notification report meets the below health & welfare ERISA notification requirements.
Annual Notices :
	Medicare Part D Notice (Certificate of Creditable (or Non-Creditable)) Drug Coverage
	CHIP or premium assistance (if applicable in your state)
	Wellness Program Disclosure (if providing wellness plan that is subject to HIPAA)
	Women’s Health & Cancer Rights –Hospital Stay Rights for Childbirth
	Notice of Non-Federal Governmental Plan Opt-Out (if applicable) – prior to first day of plan year.
	Mental Health & Parity Act Notice of Availability of HIPAA Privacy Notice (every three years)
	Grandfathered status notice (grandfathered plans only) – first day of plan year starting on or after 09/23/2010.
Other notices that maybe required include:
	§ 125 Automatic/Evergreen Election Notice (applicable if automatic enrollment in place) For additional information go to: http://www.irs.gov/pub/irs-irbs/irb02-20.pdf
	Summary Annual Report (SAR) (only if required to file form 5500) – within 9 months of end of plan year. Additional information and model language available at: http://www.dol.gov/ebsa/faqs/faq_auditwaiver.html
Sample notices for many of the qualifying events listed below can be found in the compliance basic’s center.
Qualifying Event Notices:
	COBRA Election, Early Termination, Unavailability notice
	FMLA rights notice (50+ employees)
	HIPAA Notice of Breach or Unsecured PHI. – as soon as breach is determined and in no case later than 60 calendar days after discovery.
	HIPAA Certificate of Creditable Coverage – upon termination of coverage
	Qualified Medical Child Support Order Notice (QMCSO)
o	Notification of receipt of order – promptly after receiving order
o	Notification of determination – within a reasonable period
	National Medical Support Notice (NMS)
	Michelle’s Law – when plan is notifying participant of responsibility to certify student status.
	Individual Notice of Preexisting Condition Notice (if applicable) – within 5 days of determination.
	Summary of Material Modification (SMM) – within 210 days of end of plan year.
	Summary of Material Reduction (SMR) – within 60 days of adoption
	Wellness Program Disclosure (If subject to HIPAA) – any time plan materials are provided to participants.
	30-day Advanced Notice of Rescission – first day of the first plan year starting on or after 09/23/2010
	ERRP Notice – within reasonable time after the sponsor receives its first ERRP reimbursement (if employer receives reimbursement through Early Retirement Reimbursement Plan)
	Employer Medical Benefit Event Specific Notices:
Prior to Enrollment in Employer Plan (open enrollment)
•	General Notice of Preexisting Condition Exclusion (if applicable)
•	Notice of HIPAA Special Enrollment Rights (including CHIP events)
•	Certificate of Creditable (or Non-Creditable) Drug Coverage
•	Dependent coverage extension and special enrollment – one time only notice. On first day of first year enrolled on or after 9/23/2010 or eligible to enroll.
•	Lifetime limit elimination and special enrollment – one time only notice. On first day of first year enrolled on or after 9/23/2010 or eligible to enroll.
Upon Initial Enrollment in Employer Plan
•	COBRA general notice/initial notice (provide within 90 days of becoming covered under employer health plan)
•	Section 125 Pre-tax salary reduction agreement (If applicable)
•	SPD (Summary Plan Description) – within 90 days of first becoming covered. Should include:
o	Newborns and Mother’s Health Protection Act Disclosure NMHPA.
o	Mini-Med Waiver Notice (for each year plan receives a waiver)
o	PCP and OB/GYN choice notice (Non-grandfathered plans only)
•	HIPAA Privacy Notice (if applicable)
•	Women’s Health and Cancer Rights Act Notification
•	Non-Federal Governmental Plan Opt-Out Notice (If applicable)
•	§ 125 Automatic/Evergreen Election Notice (if applicable)
in	Uncategorized	by probityadmin	 09 Oct 2015 17 Mar 2017 0	comments
AFFORDABLE CARE ACT (ACA) CALCULATIONS
Am I an Applicable Large Employer (ALE)? What’s a look back period? What’s my measurement period? What’s my stability period? What’s an administrative period? Am I part of a controlled group? Which employees must be included in calculations? Do I have to report on sections 6055 and 6056 employer reporting?
There are so many different calculations governing the Affordable Care Act. If you get one of them wrong, you are in violation of the act and subject to fines and penalties. In this article, we are going to provide clear explanations to help you comply.
The Affordable Act and its enforcers, the Internal Revenue Service (IRS), Department of Labor (DOL) and Health and Human Services Department, require all organizations who are an “ALE” to offer medical insurance to their employees that meets minimum essential value requirements at affordable rates. They further require ALEs to submit reports 1095-C/1094-C reporting on sections 6055 and 6065.
An organization is considered an applicable large employer if they average 50 or more full-time or full-time equivalent (FTE) employees during the prior year. The employer looks back over an entire 12 month period of time, adding all full-time employees who averaged 30 hours or more work per week, along with all work hours performed by part-time, temporary and seasonal employees. Work hours include time paid (including sick, jury, disability, severance, leaves of absence, vacation and holidays).
1) Determine the number of full-time employees for each month (anyone averaging 30+ hours per week or 130 hours per month).
2) Total the full-time equivalent (FTE) service hours for all variable hour employees (part-time, temporary and seasonal employees) and divide this by 120.
3) Add the FT employee to the FTE for each month and divide by 12 to find the average.
If you have 50 or more, you are an ALE. (See below example.) Note: if your business has a seasonal hiring pattern (i.e. summer or holiday hires), you may be able to exclude those employees if the period of hire is less than 120 days in a calendar year. See http://www.irs.gov/Affordable-Care-Act/Employers/Determining-if-an-Employer-is-an-Applicable-Large-Employer, seasonal workers.
If you are part of a controlled group, you must include total FT and FTE for all applicable controlled groups together to determine ALE status for all group members. There are three applicable control groups as defined by the IRS Code § 414 (b) and 414 (c).
A Parent-Subsidy Group is when one or more businesses are connected through stock with a common parent corporation and (a) 80% of the stock of each corporation (excluding the common parent corporation) is owned by one or more corporations in the group and (b) the Parent Corporation owns 80% of at least one other corporation.
A Brother-Sister Group is a group of two or more corporations, where five or less common owners (common owners included individuals, a trust, or an estate) own a controlling interest (direct or indirect) of each group and have effective control.
A Combined Group is a group consisting of three or more organizations where (a) each organization is a member of either a parent-subsidiary or brother – sister group and (b) at least one corporation is the common parent of a parent-subsidiary and is also a member of a brother-sister group.
(See: http://www.irs.gov/pub/irs-tege/epchd704.pdf.)
If you are attempting to classify employees as independent contractors in attempts to fall below the 50 ALE number, be careful. The IRS and DOL are cracking down on any misclassifications. Read the new DOL guidance memo on this topic at http://www.dol.gov/whd/workers/Misclassification/AI-2015_1.htm.
Measurement, Stability, and Admin Periods
Measurement periods are the defined period of time where an employer calculates average work hours for variable hour employees to determine if they are eligible to participate in their medical insurance plan or not. Any variable employee who averages 30 hours or more during the measurement period is eligible. Measurement periods can be between three and 12 months in length. You can also define different measurement periods for new hires and for regular employees. Make sure to define your selected measurement periods, stability periods and administrative periods in writing, and consistently follow and administer benefit eligibility accordingly.
A stability period is the time period that an eligible employee can remain on medical coverage regardless of their current average work hours. The stability period must be equivalent to the same time period as the measurement period, but not less than 6 months.
Employers are allowed an administrative period of up to 90 days to perform initial measurement period calculation of eligibility for coverage and enrollment into plans. However, the measurement period and stability period combined cannot be more than 13 months for new employees. As soon as one Measurement Period ends, the next one begins with the Administrative Period overlapping the end of the prior Stability Period and the beginning of the next Measurement Period.
Calculating the Play or Pay Penalty
For businesses with fewer than 50 FTE, there is no play or pay penalty. Penalties are based on two areas of compliance: minimum essential coverage (plan pays on average at least 60% of the total allowed benefits and participants don’t pay more than 40%) and affordable coverage (not more than 9.5% of employee’s monthly wage for self only coverage). Businesses with 50 or more employees that do not offer minimum essential coverage will be assessed a $2,000 per employee (minus the 30 employee allowance allowed for this category only) per year tax penalty if even one employee enrolls in a health insurance exchange plan and qualifies for a premium subsidy or federal tax credit. This penalty goes to $3,000 per employee if the coverage offered is not affordable.
Sections 6055 and 6056 employer reporting
If you are an ALE with 50 or more FT or FTE employees, you are required to complete forms 1095-C/1094-C to report who is offered minimum essential coverage at affordable rates. This allows the IRS to determine if you or employees are to be fined. All self-funded plans must report as well, either on forms 1095-B (if less than 50 employees) or 1095-C.
Make sure you use the right calculations when determining which parts of the Affordable Care Act apply to you and in setting up eligibility. There are many facts to consider in adhering to these laws and ensuring compliance.
by Ken Spencer,
Ken@hrserviceinc.com.
in	Uncategorized	by probityadmin	 01 Sep 2015 17 Mar 2017 0	comments