It seems like it’s easier for people to find a job if they’re already employed. Consequently, it seems like the longer someone is unemployed, then the more unemployable he or she may appear. To combat this perception the Department of Labor has announc…
By Josie Martinez
Senior Partner and Legal Counsel
EBS Capstone, A UBA Partner Firm
The Department of Labor (DOL) collected more than $1.6 billion in fines in fiscal year 2013 and has hired 700 new agents to enhance its enforcement and plan audit efforts. As a result of an uptick in DOL audits, those employers that might not have been targeted before are now being targeted, regardless of size, industry, or location. What we have come to learn is that the easier and smoother an employer makes the audit process for the auditor, the less painful the audit will be for the employer. What may have been scheduled as a multi-day audit can instead be wrapped up in a matter of hours. Preparation and organization are vital.
Recently, it seems that the audit letters received by employers grant a short window of time until the on-site field investigation is scheduled to take place, thereby making adequate preparation almost impossible, particularly when one considers the fact that many of the documents requested need to be obtained from third parties. Therefore, upon receipt of the DOL audit letter, an employer should immediately contact the DOL investigator assigned to the case and ask for a 30-day extension. This will give the employer some breathing room to collect and organize the necessary information.
Break down what the DOL wants. Along with the audit letter, the employer will receive an attachment that lists the various documents and information requested. Sometimes, requests such as “Materials describing …” or “samples of …” are vague. It is important to identify exactly what documents and information will be responsive to each request before the collection process can begin so you have a thorough, exhaustive list of what documents to obtain and from whom to request them.
Collection of requested documents and information. Having created a detailed list of the necessary documents, it is now time to reach out to carriers and relevant third parties to obtain the necessary documentation. As the documents arrive, each should be indexed in a folder according to the DOL request to which each is responsive. For example, if the DOL request number 1 seeks “plan document and all amendments,” then the employers’ wrap document should be identified to respond to this particular request. It is also wise to designate sections of documents or excerpts from plan documents that may be responsive to a particular request and have those provisions copied separately so that the auditor does not have to search for the information relevant to the request. The more specific and narrow the employer is in providing the information, the easier it will be for the auditor to review it.
Provide a roadmap. To make the process even more efficient, provide a log detailing the request number, the item description and the responsive documentation including any necessary comments so that the auditor has a master list from which he or she can work. The list helps to demonstrates that every request has been met and, if not, the reason why such documents are not available, or why such information is not applicable and does not exist.
Whatever process the employer chooses to follow in order to prepare for the on-site investigation, preparation, organization, and accessibility of information are critical to an efficient audit.
Many group health plans will need to be amended to reflect the required changes to benefits and waiting periods that take effect in 2014. Employers also should consider whether eligibility language will need to be updated to reduce the number of hours the employee must work to be eligible, to address look-back periods, and/or to base eligibility on actual hours worked instead of the “regularly scheduled to work” standard that is common now.
Section 125 plans have until December 31, 2014, to amend the plan for any or all of these changes:
HRAs must be amended to allow an employee, or a former employee, to permanently opt out of and waive future reimbursements from the HRA and to provide that upon termination of employment either the remaining amounts in the HRA will be forfeited or the employee will be permitted to permanently opt out of and waive future reimbursements from the HRA. The IRS has added this requirement because a person is ineligible for a premium tax credit if covered by minimum essential coverage. HRAs are considered minimum essential coverage, and the IRS does not want individuals to lose a premium tax credit simply because they have a small balance in their HRA.
Health plan amendments are an important part of preparation for PPACA. For information on all aspects of PPACA readiness, including determining “large employer” status, 2014 benefit requirements, and 2015 requirements for large employers, download Preparing for PPACA – A Readiness Checklist.
More than 75 cents of every health care dollar spent in the United States goes toward treating chronic diseases such as arthritis, asthma, cancer, cardiovascular disease, and diabetes, according to the Centers for Disease Control and Prevention. Becaus…
Form 5500 Filing Requirements
Tuesday, May 13, 2014 – 2:00 p.m. ET / 11:00 a.m. PT
Most employee benefit plans are required to file a Form 5500 annually, and penalties for not meeting this obligation can be costly. During this 90-minute basic-to-…
A U.S. Surgeon General’s Report issued in January marks fifty years since the Surgeon General’s landmark report in 1964 that set in motion a nationwide campaign to reduce and hopefully eliminate tobacco smoking in the United States. Also in January, rules under the Affordable Care Act (ACA) went into effect, enhancing employers’ ability to provide financial incentives to employees to “kick the habit!”
By Lisa Weston, CWC, CWPC
Director of Employee Wellness Promotion
the bagnall company, a UBA Partner Firm
More than 75 cents of every health care dollar spent in the United States goes toward treating chronic diseases such as arthritis, asthma, cancer, cardiovascular disease, and diabetes, according to the Centers for Disease Control and Prevention. Because these conditions are the No. 1 cause of death and disability, and consequently the primary factor in rising health care costs, moving toward prevention-based care will be the key that helps both employers and employees pull health care costs back from the edge of crisis over the long term.
According to the 2013 UBA Health Plan Survey of nearly 11,000 employers, 19.2% of all insurance plans offer some sort of wellness program. Health Risk Assessments (HRAs) remain the most popular offering with 81% of plans participating, 62.3% offer incentive awards (a 3.1% decrease), 61.3% offer a physical exam (a 1.1% decrease); the programs that saw the biggest increase were coaching at 56.2% (a 4.9% increase) and online wellness portals at 54.7% (a 4.7% increase).
The questions are whether comprehensive wellness programs are effective and how are results measured?
Whether or not a wellness program is effective depends on many factors, and most importantly, the organization’s goals. Typically, a wellness program is trying to increase employee engagement and productivity, while lowering long-term costs.
For all employers with wellness programs, the goal is to meet the needs of the employees to impact their overall health. In order to measure effectiveness, keep track of everything. Track participation in all events, onsite education, and challenges. Track cost per person, and most importantly, total population participation. Track progress and participation from year to year to see the overall impact of the program. Also, develop the wellness program around the medical claims trends. If available, use Health Risk Assessment (HRA) data and biometric data, as well.
How wellness programs impact productivity is difficult to measure, but not impossible. Return on investment of wellness related to worker productivity can be determined primarily with the utilization of an employee HRA that addresses the following four areas:
Implementing an HRA and having employees self-report how their health problems or specific conditions impact these four areas will provide employers with a method to determine the impact wellness has on productivity. Furthermore, the utilization of the HRA allows for employers to obtain aggregate reporting specific to productivity and participation.
Unfortunately, not all employers wish to implement an HRA campaign. Without having HRA data available, determining the impact wellness has on productivity is very difficult.
As previously mentioned, the key to finding value in developing a wellness program is ensuring the program has offerings and programs in which employees actually want to participate. Careful planning is essential. Employers must assess employee’s needs with an HRA or biometric data and also assess their wants with interest and incentive surveys. The question each employer should ask themselves is “What target am I trying to hit?” Then they should plan their program accordingly.
For further information about wellness trends, download a copy of the 2013 UBA Health Plan Survey Executive Summary http://bit.ly/PSEFrx.
PPACA brings numerous responsibilities and options to employers. Below is a summary of the PPACA provisions that apply to group health plans and whether the provision applies to insured mid-sized group plans.
Tacked into the Medicare provider payment fix bill was a repeal provision that removed the $2,000 single deductible maximum. The bill passed the U.S. House of Representatives in late March, passed the U.S. Senate on March 31 and was signed into law on …
By: Carol TaylorEmployee Benefit AdvisorD&S Agency, a UBA Partner Firm
Tacked into the Medicare provider payment fix bill was a repeal provision that removed the $2,000 single deductible maximum. The bill passed the U.S. House of Representatives in…
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