Upload
vivian-goodman
View
228
Download
6
Embed Size (px)
Citation preview
Brokers and HRCompliance Requirements
The true stories of …
Manny,
Mo,
and Mike.
• Long Term EmployeeLong Term Employee• Manager because of Manager because of
tenure and dedicationtenure and dedication• Runs the shipping part Runs the shipping part
of the business 10 EEof the business 10 EE• Paid Salary of 50kPaid Salary of 50k• Can hire and fire EEsCan hire and fire EEs• Given Mgr BenefitsGiven Mgr Benefits
• ““Benefits” IncludeBenefits” Include– Fixed SalaryFixed Salary– Designated ParkingDesignated Parking– Vacation PackageVacation Package– Bonus w/ MgmtBonus w/ Mgmt– Set dept. scheduleSet dept. schedule– 4X Earnings Life Ins.4X Earnings Life Ins.– Participates in policy Participates in policy
making for companymaking for company
MannyManny
• FLSA Issues– Fails 541 Tests
Work Tolerance > 50%
– No other exemption– Record keeping– OT Pay– OT on Bonus– Benefits …
• Benefits Issue– Manny dies – Family wants 200k for Life
Insurance Benefit– Audit by Life Carrier
determines benefit to be …
$10,000– Policy Mgr Criteria NOT
MET!
MannyManny
• Single Mom• Marries Employee• No prior health
coverage• Pregnant• $250,000 Birth Bill• Not on company
coverage
• Husband declined coverage
• Coverage not offered again
• Signed Declined on Carrier Form
• Employee took time off for “honeymoon”
MoMo
• HIPAA Issues– Special Enrollment
Rights Notification– Carrier Form not
adequate for Employer Compliance
– Carrier not bound for coverage for mistakes made by ER
• Benefits Issue– Coverage and HIPAA
Enrollment Rights communications violated by ER
– ER must “make the employee whole”
– ER has no recourse with carrier or EE
MoMo
• 5 year employee• Earned two weeks of
sick pay (accrued)• Earned two weeks of
vacation (accrued)• Plays softball• Single / no phone
• Company Policies– 3 days no call, no
show, NO JOB!– Voluntary Quits w/o
notice = Loss of vacation pay
– Sick Pay is never paid on termination
– Final Check Mailed
MikeMike
• EE hurt on Saturday playing softball
• Fails to call or show for work for two months
• Comes back and asks for his job or any job and is refused
• EE was reminded of policies in handbook
• EE had copy and ER had signed receipt
• ER had done this type of discipline many times without question
MikeMike
• FMLA Issues– ER has > 50 EEs– Two Day Notice
Requirements– Incorrect Policy in
Handbook – Managers not trained
and share liability exposure
• Benefit Issues– Health Policy not
reviewed with Company Policy and federal guidelines
– Managers not trained for FMLA issues …
$50,000 settlement
MikeMike
• Employer – Posting, Mailing, and
Notifications.– Documentation of actions
and communications– Reviewing policies and
practices
• Broker / Consultant– Coordination of carrier
contract and practices– Facilitation of
documentation and training for mgrs
– Education of client’s administrative and management staff
Who is Responsible?Who is Responsible?
Increasing Challenges
• Cost of “doing business”– Benefits– Payroll– Regulatory Compliance
• Magnified by Large Competitors– Market Consolidation– Economies of Scale
Specific Issues
• Health Insurance Trend = 20% Annually• Rating / Underwriting for Small Groups• Carriers favor large groups• High expectations for benefits
– Insurance = No Bills– Health care where ever and when ever …– 401(k) = Assured Retirement Income
Employer Issues
• Allocation of $ to Direct and Indirect Comp• Education of Employees• Staff training and system maintenance for:
ADA
ADEA
COBRA
CRA Title VII
DFWA
ERISA
FLSA
FMLA
Handbook
HIPAA
IRCA
JSIA
LMRA
NLRA
OSHA
Policy Provisions
USERRA
WARN
Difficult Obstacles• Multiple vendors for “products”
– No responsibility assigned for coordination– No responsibility assigned for education– No responsibility assigned for managing– No responsibility assigned for:
• System setup
• Maintenance
• Updates
• HR / Payroll Integration
So What About 1987?So What About 1987?
The Consolidated Omnibus Budget Reconciliation The Consolidated Omnibus Budget Reconciliation Act of 1985 (or COBRA) is a law passed by the Act of 1985 (or COBRA) is a law passed by the U.S. Congress on a reconciliation basis.U.S. Congress on a reconciliation basis.
Signed by President Ronald ReaganSigned by President Ronald Reagan
Mandates an insurance program giving some Mandates an insurance program giving some employees the ability to continue health employees the ability to continue health insurance coverage after leaving employment. insurance coverage after leaving employment.
It was the end of Group Insurance …It was the end of Group Insurance …
Just Kidding!Just Kidding!
What Else Has Changed?What Else Has Changed?
Section 125 – 1979Section 125 – 1979
FMLA - 1993FMLA - 1993
HIPAA 1996HIPAA 1996
HDHP's - 1997 HDHP's - 1997
HRA's - 2002HRA's - 2002
PPACA 2010
Passed by Reconciliation ...
Has implementation steps through 2016.
Overlays previously State controlled issues of Medical insurance coverage, participation and eligibility issues.
PPACA Letter Requirements
How did this requirement come about?
The Patient Protection and Affordable Care Act (PPACA) amended the Fair Labor Standards Act (FLSA).
The purpose is to make the employer responsible for the education about the Marketplace, via the mailing requirement.
• This requirement was originally set for March of 2013 and was delayed until October 1, 2013.
• ALL employers must send the letter to ALL employees.
• This requirement was amended to the FLSA and should NOT be paid for by brokers because it is NOT part of the servicing duties for a group carrier contract.
PPACA Letter Requirements
PPACA Letter Requirement
The letter we will send will fully comply with the requirements.
Data will be retained to begin building the database for future reporting.
All images will be accessible 24/7.
Mailing logs will be generated for proof of mailing.
PPACA Letter Requirement
Employer, Navigator, Broker or Marketplace will accept and respond to employee inquiries regarding the Marketplace letters.
Including copies of letters being e-mailed to the employees.
Basic questions about the Marketplace must also be answered.
PPACA Letter Content
On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act(PPACA) designed to reform healthcare in the United States. The law is complex and contains numerousemployer requirements. One mandates that employers notify their employees about Health Insurance "Marketplaces" (or "Exchanges"). These Marketplaces are websites where individuals may purchase or compare medical insurance plans.
PPACA Letter Content
The attached document provides information on Health Insurance Marketplaces as well as medical insurance offered through Sample Company.
PPACA may provide financial assistance in the form of reduced insurance premiums to individuals (meeting certain income levels) as well as employees whose company plan does not meet the "minimum value standard."
PPACA Letter Content
The law defines "minimum value standard" as a group medical plan that:
1) Pays at least 60 percent of the plan's total allowed benefit costs; and
2) Has a premium contribution of less than 9.5 percent of the employee's income.
PPACA Letter Content
The letter will state:
“Upon review of our firm's medical health plan, it has been determined to meet PPACA's ‘minimum value standard’.
This is important for you to know because if you are offered a group plan meeting this standard, you would not be eligible for a tax credit through the Health Insurance Marketplace.”
PPACA Letter Content
PPACA Letter Content
PPACA Letter Content
PPACA Letter Content
PPACA Letter Content
PPACA Letter Content
PPACA Letter Content
PPACA Letter Content
How are we doing?How are we doing?
FLSA Preamble
ALL employees must be paid … Federal Minimum Wage Keep a record of all hours worked And … be paid 1½ times their
Regular Rate for all hours over 40 worked each week, specifically exempted.
Breakdown the statement ...
History of the FLSA
Sam Gompers
John Lewis
Definitions Contained in the FLSADefinitions Contained in the FLSA
Exempt / Nonexempt Not interchangeable with …
Salaried and Hourly Many industry specific “exemptions” Terms are used in carrier contracts Terms and applications are misunderstood Clients use historical practices not FLSA
Coverage Issues for FLSACoverage Issues for FLSA
Frequently used for LTS and GTL Overtime calculations often incorrect Records are poor or absent Ignorant of DOL / Wage Hour Enforcement Look back is 2 years
Review of Exemptions
Four Most Used Exemptions WC Administrative (Almost Never Allowed) WC Executive WC Professional Outside Sales
OT (Premium Pay) includes ...
Let Us Hear It!
Voice and Fax 888.994.9392
www.MoneyWiseSolutions.com
www.prnHR.com