Category Archives: Uncategorized

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FAMILY AND MEDICAL LEAVE ACT MODEL FORMS

The Department of Labor has provided updated model forms to use in administering Family and Medical Leave Act (FMLA) leaves of absence.  Although use of the old model forms was set to expire this past February, the DOL had allowed their continued use, pending the release of these new forms. Be sure that you are using the correct, updated model forms, or that your own customized forms reflect the needed information, especially regarding the Genetic Information Nondiscrimination Act.

  • Compliance Bulletin: DOL Updates Model FMLA Forms   #123008

Government guidance

  • US Dept of Labor website Wage & Hour Division     FMLA links 
  • Certification of Health Care Provider for Employee’s Serious Health Condition                        Form WH-380-E
  • Certification of Health Care Provider for Family Member’s Serious Health Condition                Form WH-380-F
  • Notice of Eligibility and Rights & Responsibilities   Form WH-381
  • Designation Notice   Form WH-382 
  • Certification of Qualifying Exigency For Military Family Leave    Form WH-384  
  • Certification for Serious Injury or Illness of a Current Service member for Military Family Leave   Form WH-385  
  • Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave                    Form WH-385-V 

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OUT-OF-POCKET MAXIMUM REQUIRED FOR NON-GRANDFATHERED PLANS

An annual limit for employee health sharing on essential health benefits is required for non-grandfathered health plans under the Affordable Care Act. Effective for plan years beginning on or after January 1, 2016, the ACA’s ‘self-only’ out-of-pocket maximum must apply to all individuals, including those with family coverage. For 2016 plan years, this amount is $6,850. This is an especially difficult issue for high-deductible health plans.  Please contact Touchstone if you need more assistance than the information below provides.

  • Health care Reform Legislative Brief: Embedded Out-of-Pocket Maximum for Family Coverage   #123021

Government guidance

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OUTSOURCING COBRA ADMINISTRATION

In-house administration of tasks related to continuing health coverage under the rules of the Consolidated Omnibus Budget Reconciliation Act of 1986 can be time-consuming and legally tricky.  Many plan sponsors choose to outsource these responsibilities to vendors who have focused expertise.  This article provides some guidance on what you might want to consider in determining if outsourcing COBRA is the right move for your organization.

  • HR Insights: COBRA Administration Outsourcing   #122615

Government guidance

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SPECIAL ENROLLMENT RIGHTS

In addition to initial and annual enrollment opportunities, employees have the right to revise their health plan elections under certain circumstances.  These ‘special enrollment’ rights were set in the Health Insurance Portability and Accountability Act (HIPAA).  The article below provides helpful detail on the many aspects of following these rules, especially describing which events trigger special enrollment rights.

  • Legislative Brief: HIPAA Special Enrollment Rights   #113335

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HELP FOR ORGANIZING JOB INTERVIEWS 

This 36-page manual can assist you in organizing your responsibilities related to interviewing potential employees.  It advises you of important legal considerations, provides an overview of the interview process (including preparation, best practices, and appropriate questions), covers pre-employment testing, and guides you through candidate evaluation and making the hiring decision.  In addition, it includes checklists and samples which are especially helpful if you are delegating some responsibilities.

  • HR Toolkit: Interviewing   #122987

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STATE EMPLOYMENT LAW UPDATES 

Our library of state employment law summaries has been recently updated with several entries on Workers’ Compensation (Colorado and New Jersey) as well as on Chicago’s new minimum wage law and an overview of LOAs under Maine law.  Please contact Touchstone if you would like to see more articles on a specific state.

  • Colorado Workers’ Compensation – Employer Responsibilities    #123185
  • Colorado Workers’ Compensation – Employer Penalties   #123184
  • Colorado Workers’ Compensation – Employee Eligibility  #123183
  • Colorado Workers’ Compensation – Employee Benefits  #123182
  • Colorado Workers’ Compensation – Claims Process  #123181
  • Illinois: Chicago Minimum Wage Laws  #122820
  • Maine: Employee Leave Laws Overview  #122033
  • New Jersey: Workers Compensation – Claims Process   #122362
  • New Jersey: Workers Compensation – Employer Penalties  #122364
  • New Jersey: Workers Compensation – Employer Responsibilities   #122365
  • New Jersey: Workers Compensation – Employee Benefits  #122432
  • New Jersey: Workers Compensation – Employee Eligibility  #122438

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 POPULAR WELLNESS TOPICS 

The following articles discuss several popular wellness topics that you might want to include in your own employee newsletter, or distribute as given: the use of non-traditional workstations, the health benefits of sunlight, the FoodKeeper app from the Department of Agriculture, swimming, and the dangers of cataracts.

  • Live Well, Work Well Newsletter: June 2015  #113199
  • HR Insights: Standing and Treadmill Desks  #123014

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SUPREME COURT DECISION

On June 1 the U.S. Supreme Court spoke clearly that an employer may not consider religious accommodation as a factor in denying employment.   The significant impact for employers is that the court has established a lower standard for proving discrimination; the law no longer requires that discrimination be proved by demonstrating the employer’s actual knowledge of the need for an accommodation (e.g., that an accommodation has been requested), but merely that the employer assumed an accommodation would be requested.

  • Compliance Bulletin: Supreme Court Rules on Abercrombie Religious Discrimination Case           #123148

benefits_headerAFFORDABLE CARE ACT:  PREPARING FOR 2015

It’s time to start planning for 2015!   Consult our updated Compliance Checklist to be sure that you are preparing for the basic compliance elements of the Affordable Care Act.

  • Health Care Reform Legislative Brief: 2015 Compliance Checklist    Document #105375

Government guidance

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COBRA GUIDANCE ISSUED AND MODEL NOTICES UPDATED

The Employee Benefits Security Administration of the Dept. of Health and Human Services recently issued a Frequently Asked Questions (FAQ XIX) announcement.  Among the issues discussed in the FAQ, there is significant guidance on COBRA, including updates to both the model general notice and the model election notice.

The following articles provide helpful guidance, including simplified templates for the election notice (health plan and a health FSA).  Touchstone also has reports regarding compliance with state vs federal continuation coverage rules.   The Rhode Island report is included below, as an example.  Please contact us if you’d like to receive a report on your state.

  • Health Care Reform Bulletin:  Agencies Release New COBRA Guidance for Individuals and Employers  Document #103865
  • Benefits Buzz:  New COBRA and CHIPRA Model Notices, and COBRA and Exchange Rules Clarified  Document #94325
  • COBRA Election Notice Template  Document #45260
  • COBRA Election Notice Template – Health FSA  Document #45259
  • COBRA Rhode Island – Comparison of Federal and Rhode Island Continuation Laws    Document #11542

Government guidance

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ACA PREVENTIVE CARE – BEWARE OF CHANGES!

Along with the updated COBRA guidance and notices described above, and clarifications on Out-of-Pocket Limits (described in the following article), FAQ XIX also addressed ACA-mandated preventive services.

FAQ XIX notably addressed coverage for drugs that reduce the risk of breast-cancer.   These must be included in preventive care for plan years beginning 9/24/2014, so plans should check now to be sure that their coverage is in compliance.

Good news in the FAQs included specifics on a safe harbor for tobacco counseling programs.   In the section entitled “Coverage of Preventive Services”, check the response to Q5 for details.

The services which are required to be provided at no cost to the plan participant may change or be more clearly defined over time, so it is important for benefit professionals to refer to the details provided on the HealthCare.gov website (see links below).

The following articles offer some summary guidance:

  • Health Care Reform Legislative Brief – Preventive Care Coverage Guidelines   Document #43291
  • Health Care Reform Legislative Brief – Recommended Preventive Care Services     Document #57767
  • Health Care Reform Legislative Brief – Preventive Care Guidelines for Women   Document #54187
  • Health Care Reform Legislative Brief – Tobacco Use Surcharge in 2014.    Document #103854

Government guidance

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ACA OUT-OF-POCKET LIMITS – SOME FLEXIBILITY IN PLAN DESIGN

The FAQ XIX released on May 2 clarified how cost-sharing restrictions may be satisfied by health plans.  Responses to Questions 2, 3, and 4 dealt with the following issues regarding out-of-pocket maximums:  balance billing, patient insistence on using brand drugs over generics, and reference-based pricing.

FAQ XVIII issued in January also clarified certain issues regarding the application of out-of-pocket maximums:  as applied to essential health benefits, division of the annual maximum across different categories of benefits, out-of-network payments, and non-covered items.

Briefly, these clarifications are summarized in the following article:

  • Health Care Reform Legislative Brief – Cost-Sharing Limits for Health Plans      Document #78888

Government guidance

  • “FAQs about Affordable Care Act Implementation (Part XIX)”, U.S. Dept. of Labor, Employee Benefits Security Administration:  See “Limitations on Cost Sharing under the Affordable Care Act” and Q2, Q3, and Q4.    http://www.dol.gov/ebsa/faqs/faq-aca19.html
  • “FAQs about Affordable Care Act Implementation (Part XVIII) and Mental Health Parity Implementation”, January 9, 2014.  U.S. Dept. of Labor, Employee Benefits Security Administration:  See “Limitations on Cost Sharing”, Q2, 3, 4, and 5.   http://www.dol.gov/ebsa/faqs/faq-aca18.html

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MASSACHUSETTS – CHANGES TO EMPLOYER RESPONSIBILITIES AS STATE ‘HEALTH CARE REFORM’ IS COORDINATED WITH FEDERAL LAW

The Massachusetts Health Care Reform Act’s requirements regarding employers’ provision of health care coverage have been superseded by the requirements of the federal Affordable Care Act (ACA).  Although the Commonwealth no longer imposes the “fair share contribution” on employers, a new “Employer Medical Assistance Contribution” (EMAC) must be paid by most employers, regardless of whether the employer provides any health coverage.

As of January 1, 2014, the Unemployment Health Insurance (UHI) contribution was replaced by EMAC.  Employers are still required to file quarterly wage and employment reports through UI Online, and the applicable EMAC contribution will be calculated based on those filings.

Review the following information.   If you have further questions, contact the Commonwealth’s Department of Unemployment Assistance at 617-626-5075.

  • Massachusetts Finalizes Repeal of Employer Coverage Rules     Document #105804

Government guidance

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January 2014

The EXPERT’S CORNER | THE ACA IN 2014

So you’ve extended dependent coverage to age 26, issued a Summary of Benefits and Coverage (SBC) and included the cost of coverage on your employees’ W-2. You are now in compliance with the ACA, or are you?  Employers have made many changes to their benefit plans since the ACA was enacted.  However, there is still more to be done in 2014, including getting ready to comply with the employer mandate.

Despite the fact that the employer mandate penalties have been delayed from 1/1/2014 to 1/1/2015, there is still work to be done for employers in 2014.  Whether or not an employer is considered an applicable large employer, and therefore subject to the mandate to offer coverage, will be determined based on the number of employees in 2014.  Employers should have systems in place to track employee hours to determine if they exceed the threshold.  Employers who employ more than 50 full-time employees or full-time equivalent employees will be subject to the mandate.

Furthermore, employers who intend to utilize the safe harbor method for employee eligibility will generally need to begin tracking hours in late 2013 or no later than 1/1/2014.  The safe harbor allows an employer to use a measurement period followed by a stability period.  If an employee averages at least 30 hours per week during the measurement period, they need to be offered coverage for the duration of the stability period, regardless of their actual hours during the stability period.  The agencies had allowed a special rule for 2014 whereby an employer could have a measurement period that was a different length than the stability period so long as the measurement period began before 7/1/2013.  It is not clear if this will be extended for 2014.  Therefore, employers that intend to use a 12-month measurement period followed by a 12-month stability period on a calendar year basis will need to start their measurement period by the end of 2013.

Another item gaining attention for 2014 is the reinsurance fee.  This fee is assessed on both self-funded and fully-insured health plans, and the amount for the 2014 plan year is $63 per year per individual enrolled in the plan.  This applies to active employees as well as retirees.  Some relief was granted to plans that are both self-funded and self-administered (i.e., they do not use a third-party administrator to administer claims).  While the fee will not be due until December 2014, employers may want to consider this item when preparing annual 2014 budgets.  For self-funded plans, this means you can also consider including the reinsurance fee in your COBRA rate calculation.

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TOTAL WORKER HEALTH – THROUGH WELLNESS

Health advocates, care providers, and plan sponsors all agree that individuals need to become more engaged in efforts to improve their health. Even the federal Affordable Care Act promotes individual responsibility for healthy choices.

Over the past decade, employers with well-planned wellness programs have achieved real gains: reduced health premiums, lowered absenteeism, and better morale. The trend to coordinate with occupational safety and mental health programs has led to the concept of a ‘Total Worker Health’ approach, combining the expertise of risk management, operations, human resources and employee benefits professionals to reduce injuries and illness among the workforce.

Touchstone has extensive experience developing a broad range of programs, including many years fine-tuning sophisticated return-on-investment measurements for several Fortune 500 clients. We can assist any client in designing an appropriate, graduated wellness program that encourages employee participation and avoids the hefty legal and financial dangers of federal and state regulations.

Two links below provide just a small sample of materials that Touchstone can provide to help you foster a commitment to wellness at your organization. We’ve also given links to the 2013 wellness survey and to federal government guidance regarding the requirements for a compliant program.

Government guidance:

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VOLUNTARY BENEFITS

Tight budgets and ever-changing regulations put pressure on employers and unions to continue to meet the needs of their benefit plan participants. Workers want help in dealing with stresses that even the best-designed benefit programs may not address. And no one seems to have the time to deal with all of life’s concerns.

An increasing variety of voluntary benefit offerings can cover needs that are not satisfied by core benefit programs. These employee-pay-all benefits are attractive to employees, providing the flexibility to address their own life style and the convenience of letting the employer do the leg-work to find the best options and to set-up payroll deductions. Voluntary benefits foster the kind of consumer responsibility in employees that is becoming increasingly vital to the success of health and wellness programs, while allowing plan sponsors to expand benefits at no significant cost.

Additional layers of life insurance have commonly been offered as a voluntary benefit for many years. Now the range of voluntary benefits is stretching to meet gaps in personal, financial, and security needs that are as diverse as the people they serve.

Check out details on a few popular new voluntary benefits through the links below. The ‘Know Your Benefits’ communications educate prospective enrollees on the help that these coverages could provide.   Considerations for benefits professionals are also provided.


ACCOUNTING FOR BENEFITS FOR SAME-SEX SPOUSES

The Supreme Court’s Windsor decision on the status of same-sex marriages has prompted guidance from both the IRS and the Department of Labor on what administrative actions, documents, and enrollment rights and choices must be revised in employment-based plans. A quick look through any communications that contain the word ‘spouse’ gives an indication of how many policies and procedures need to be updated.

For purposes of ERISA, marriages that were legally valid in the state or country in which they were performed are valid in all states, regardless of law regarding same-sex marriage in the couple’s state of residence or employment.

These changes impact not just benefits and human resources documents, but may also require retroactive changes in tax records based on what had been considered imputed income for federal tax purposes. State laws often differ from the federal requirements, so care must be taken to determine which rules apply to each type of program in order to assure compliance.

The links below provide a sampling of communications which explain some effects of the Windsor decision to plan sponsors and/or plan participants. Links are also provided to IRS statements regarding applications under federal tax law.

Please contact Touchstone if we can assist your organization in updating your plans’ policies and procedures to keep pace with these changes.

Government guidance:


FSAs CHANGES FOR 2014; HRAs AND HSAs SHOULD BE EVALUATED

The Affordable Care Act has forced major changes in health benefits which can be offered through employment-related plans. The impact on individually-controlled health care accounts has been significant, but has not received as much press attention as some other changes. Some notable revisions to health flexible spending accounts (health FSAs) include:

  • For plan years beginning on or after January 1, 2014, all health FSAs must reimburse only excepted benefits and must be offered through a cafeteria plan. Stand-alone FSAs are no longer permitted.
  • Plan sponsors may (but are not required to) allow participants to carry-over an amount of up to $500 in unused 2013 funds into the 2014 plan year. (This option is not available to health FSAs which permit the 2 ½ month grace period for submitting eligible expenses.) These funds may reimburse 2014 plan year eligible expenses.
  • Plan documents must be amended to account for the above change, and participants must be notified.
  • Salary reduction contributions to a health FSA under a section 125 plan are limited to $2,500 in 2014, not including any amount carried over from 2013. This limit will be COLA indexed in future years.

Many plan sponsors will need to reevaluate the usefulness of a health FSA in light of the changes to their basic medical and prescription drug plan designs. Federal regulations seem to be promoting health savings accounts (and, to a lesser extent, health reimbursement arrangements) while boxing in the effectiveness of health FSAs. As these regulations continue to develop, Touchstone can help analyze what overall benefit elements would be most effective to meet the needs of your employees.

Below are links to communication materials and the federal regulations that they help interpret. The impact of developing regulations, as well as major changes in the health care marketplace, require a more thorough evaluation of an organization’s health care plans. Please give us a call for a consultation on how we can help you determine the appropriate direction for your programs.

Government guidance:

end January 2014 Newsletter