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