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This presentation reviews common questions in ERISA, COBRA, HIPAA, Cafeteria plans, Medicare, and Health Care Reform.
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Copyright 2014- Not to be reproduced without express permission of Benefit Express Services, LLC
By
Larry Grudzien
Attorney at Law
Copyright 2014- Not to be reproduced without express permission of Benefit Express Services, LLC
• ERISA
• COBRA
• HIPAA
• Cafeteria Plans
• HSAs
• Health Care Reform
Agenda
ERISA
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Does an employer with under 100
participants in their medical plan need a
plan document?
ERISA
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ERISA
When is a benefit considered funded for
purposes of ERISA?
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When is an employee assistance plan
and/or a wellness program subject to
ERISA?
ERISA
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ERISA
When is a employee paid only benefit
subject to ERISA?
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Is there a statute of limitations on unfiled
Form 5500s’?
ERISA
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ERISA
Is an employer required to cover same sex
spouses under its health and welfare plans
under ERISA?
COBRA
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Can qualified beneficiaries change and add
benefits at open enrollment?
Do qualified beneficiaries have special
enrollment rights?
COBRA
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COBRA
If coverage ends for retirees, does the
employer have to give them the right to
elect COBRA?
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COBRA
When does entitlement to Medicare
terminate COBRA coverage and when?
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COBRA
Does an employer have to offer COBRA to
participants in employee assistance
programs and wellness programs?
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COBRA
How does health care reform affect
COBRA?
HIPPA
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What benefits are considered “excepted”
and why it is important?
HIPPA
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If an employer wants to charge a smoker a
higher premium, must it meet the
requirements for a wellness program under
the HIPAA regulations?
HIPPA
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Can employer deny coverage under a health
plan to an employee if he or she does not
participate in a employer sponsored
wellness program?
HIPPA
Cafeteria Plans
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Can premiums from individual policies be
reimbursed pre-tax under a cafeteria
plan?
Cafeteria Plans
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Cafeteria Plans
If an employer switches to a High
Deductible Health Plan in the middle of
the year, can employees have the right to
change their election for coverage under
the health FSA?
Can a change in cost or coverage be a
reason to change an election under a
health FSA?
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Cafeteria Plans
Can an employer give an employee the right to
change the character of any carryover?
Will the carryover make an employee ineligible
to make a HSA contributions for the next year?
How does an employer determine the COBRA
premium on a carryover?
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Cafeteria Plans
My employees want to drop our coverage
and elect coverage on the exchange. Is
that a qualifying event?
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Cafeteria Plans
Is an employer required to recognize
same sex spouses as spouses under its
cafeteria plan?
HSAs
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An employee is covered by a HDHP. He
also covers his spouse. His spouse has
other coverage that is not a HDHP. Can
he contribute at the family coverage
level?
HSAs
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HSAs
An employee covers himself, his wife and their sons age 21, 22 and 24 in a HDHP. He does not claim his sons as tax dependents. Are his son’s eligible to contribute to their own HSA. If so, how much? Can the employee reimburse his son’s medical expenses from his HSA?
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HSAs
An employee participates in a HDHP with
his wife and children. His wife also
participates in a health FSA at work. She
can be reimbursed for his medical
expenses under the Health FSA, but does
not submit any for him for the year.
Does that affect his eligibility to
contribute to an HSA for the year?
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Can a husband and wife have a joint HSA?
If an individual has single coverage and
contributes at the single coverage rate can
he or she reimburse expenses for his wife
and children?
HSAs
Health Care Reform
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When is the employer mandate effective?
January 1, 2015 or on the employer’s
renewal date?
Health Care Reform
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Health Care Reform
In determining whether an employer is large
employer for employer mandate purposes,
are seasonal and part-time employees
considered in the count?
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Health Care Reform
Does the 30 hour requirement for full-time
employees apply to small employers?
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Health Care Reform
Can employer sponsor a stand alone Health
Reimbursement Arrangement in 2014?
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Health Care Reform
Do seasonal or variable hour employees
have to be offered coverage in 2015?
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Health Care Reform
For the subsidies, how are they determined
and what happens if your income does up
or down during the year?
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Health Care Reform
Do you have to be a citizen to be eligible to
buy coverage on the exchange and obtain a
credit or subsidy?
Questions?
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Contact Information
Larry Grudzien
• Phone: 708-717-9638
• Email: [email protected]
• Site: www.larrygrudzien.com
