Welfare Benefit Plan ERISA News
June 2013

 
Avoiding "Play or Pay" Penalties
This article presents some practical approaches an employer can take to avoid penalties under ACA or reduce them to a manageable risk, whether that employer is over or under 50 FTEs. (See ERISA Wonk for more details)
Role of Agents & Brokers in Insurance Exchanges
Consumers who access health insurance coverage through an Affordable Insurance Exchange, or Health Insurance Marketplace, will be able to receive assistance in a variety of ways, including in-person, online, and through telephone support. Agents and brokers, including web-brokers, are among those who will play a role in educating consumers about Marketplaces and insurance affordability programs, and in helping consumers receive eligibility determinations, compare plans, and enroll in coverage. In particular, CMS anticipates that agents and brokers will play a critical role in helping qualified employers and employees enroll in coverage through the Small Business Health Options Programs (SHOPs). (CMS Guidance)
New Short Apps for Exchange Coverage under ACA
In our April Newsletter, we reported that the application for insurance in an Exchange was 21 pages long, and we included a flowchart to help assess eligibility for tax subsidies. Responding to criticism, CMS released 3 new applications: 1) a 5 page individual short form for single adults seeking a tax credit who are not offered health coverage by their employer, do not have any dependents, cannot be claimed as a dependent by someone else, and do not itemize deductions, 2) a 5 page single or family application for anyone not applying for financial assistance, and 3) a 12 page application for anyone in a family seeking tax credits. Applications may be submitted beginning Oct. 1, 2013 for plans that take effect Jan. 1, 2014. The initial open enrollment period will last six months.
Deadline for Exchange Notices Announced: October 1

In our February newsletter, we reported that the deadline for employers to provide Exchange Notices was extended beyond March 1, 2013 while regulations were being developed. The DOL has now confirmed that notices must be automatically provided to current employees by October 1, 2013, and to new employees hired after October 1, 2013, within 14 days of their start date. All employees must receive a notice regardless of their full- or part-time status and regardless of whether they are enrolled in the employer's plan. Separate notices for dependents or other individuals who are or may become eligible for coverage are not required. The DOL has provided two model notices to assist employers in providing the required information: Notice for Employers with Health Plans and Notice for Employers without Health Plans. (More details at ERISA Wonk)

First GINA Lawsuit Settled for $50,000
GINA makes it illegal to discriminate against employees or applicants because of genetic information, which includes family medical history. It also restricts employers from requesting, requiring or purchasing such information. Fabricut, Inc. was fined $50,000 for asking a woman for her family medical history in its post-offer medical examination and violated the ADA when it refused to hire her as a memo clerk because it regarded her as having, or being predisposed to develop, carpal tunnel syndrome. (Details)

 

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© 2017 ERISAPros, LLC, All rights reserved. Information on ERISAPros' website, its newsletter, “News & Views,” and its blog, “ERISA Wonk,” is published as a general informational source. Information and articles are general in nature and are not intended to constitute legal or tax advice in any particular matter. Blog posts and comments reflect the personal views of their respective authors - not those of ERISAPros. Transmission of this information does not create an attorney-client relationship. ERISAPros, LLC is not a law firm and is not giving legal or tax advice. It does not warrant and is not responsible for errors or omissions in the content on its website or in its newsletters. ERISA is a complicated and confusing law. Summary Plan Descriptions (SPDs), Wrap Plan Documents, and Form 5500s require review and updating by qualified ERISA compliance professionals.

 

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