July  2015   |  Vol. 1.5                                                                  [email protected]

Are You ACA Compliant When Distributing Documents?

   How is your company distributing compliance documents? Historically, companies have mailed out hard copies of their compliance packets, Summary Plan Descriptions (SPDs), Summary of Benefits and Coverage (SBC), and Summary of Material Modifications (SMM). If this packet contains the Patient Protection and Affordable Care Act (PPACA) State Exchange notification, it also needs to go to new hires within 14 days.

   The question asked repeatedly is, what alternatives are available for a client to distribute these documents to plan participants via a means other than the traditional delivery methods of mailing a paper copy to each participant's home address or handing out paper copies to participants?   Read my latest blog to learn how.


"We feel very passionate about our helping our clients reduce liability and improve their workplace through sound HR and benefits practices."



Larry Lawman

Lawman Benefits Consulting, Inc.


Breaking News...

Final Rules on Cost Sharing Parameters/Reductions Released


   The Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) ("the Departments") released their final rules on cost sharing parameters and cost sharing reductions on February 27, 2015. These rules finalize the medical loss ratio programs and a myriad of other related topics in 80 FR 10750. Of particular interest is the finalization of the annual limitation on cost sharing for self-only coverage that applies to all individuals - regardless of whether the individual is covered by a self-only plan or by a plan that is other than self-only (family) coverage. 

   These final rules on cost sharing for essential health benefits (EHB) require that the individual be responsible for paying the cost sharing related to the costs of medical care EHB up to the annual limit on cost sharing for self-only coverage regardless if the individual has family coverage. The annual limitation cost sharing applies on an annual basis regardless of whether it is a calendar year or non-calendar year plan. This is a major change in HDHPs for HSAs and could require carriers to change their systems and perhaps impact underwriting and rates for such plans.

   The Departments did point out that the deductible limit is not regulated in the same manner as the annual limitation on cost sharing. Therefore, family HDHPs that count the family's cost sharing toward the deductible limit can continue to be offered under this ruling. The only limit will be that the family HDHP cannot require an individual in the family plan to exceed the annual limitation on cost sharing for self-only coverage.

   For 2016, the maximum annual limitation on cost sharing for self-only coverage is $6,850. Consequently, for 2016, an issurer can offer a family HDHP with a $10,000 family deductible as long as it applies a maximum annual limitation on cost sharing of $6,850 to each individual in the plan, even if the family $10,000 deductible has not been satisfied. This standard does not conflict with IRS rules on HDHPs.

   Under the requirements for an HDHP, except for preventive care, an HDHP plan may not provide benefits for any year until the minimum statutory annual deductible for that year has been met. The minimum annual deductible for a family HDHP is $2,600 for 2016. Because the $6,850 self-only maximum annual limitation on cost sharing will exceed the 2016 minimum annual deductible amount for family HDHP HSA coverage, it will not cause the plan to fail to satisfy the requirements for a family HDHP. 

   What about large and self-funded group health plans? On May 26, 2015 the Departments issued FAQ Part XXVII to clear up any uncertainty about the type of group health coverage that must contain self-only embedded deductibles. All non-grandfathered group health plans, including self-insured and large group health plans must comply with the maximum annual limitation on cost sharing.

   This clarification applies for plan or policy years that begin in or after 2016. The purpose of cost sharing proposals was to ensure that issuers could not reset the annual limitation on cost sharing more frequently than once a year.

    Please feel free to contact us for further clarification.



HR Update...

Vacation Time Policies

Justine Loehlein
As employees get in to the summer months, they ask for time off to enjoy vacations.  As they do, employers may be getting worried about how they are going to accommodate all the requests for time off.  Can I deny someone's vacation because of business necessity?  If I do, will that open me up to liability?  How much notice can I reasonably require?  What if there are two employees wanting to have the same time frame off?  What are my requirements to provide time off according to the law?
   There are no laws governing the use of time off, so employers can create a plan that suits their business.  The most important thing to do is have a written policy for the sake of consistency.  Because this is considered a benefit, it can be used as a basis for discrimination claims.  Treating everyone fairly and giving vacation benefits consistently will help you avoid any issues with these types of claims. 
   Consider how much time off you can afford to give and if you would like to give more as employees become more tenured.  The more complex issues, such as; Can vacation be used before its accumulated? Can vacation be carried over into the next year or is this a "use-it-or-lose-it" policy?  Do I have to pay out accumulated balances at the time of separation? 
   Many states consider vacation time as a form of compensation, which must be paid out at the time of separation.  Florida does not have this type of legislation.  However, if the employer in Florida has a policy that says vacation is paid out at the end of employment, they need to fulfill that promise or risk a time-consuming lawsuit.  In the end, as long as employers can create a comprehensive policy that they clearly abide by, they will remain consistent, avoid lawsuits and be able to accommodate the requests of their employees while continuing to run their business effectively.



Client Spotlight ...


   The Employee Management Team, or EMT for short, is a PEO, a Professional Employer Organization, dedicated to helping employers by relieving the hard work of the human resources component of a business or nonprofit, and doing it right for them.
     Most of us got into our business out of passion for a type of work, idea, or opportunity and then find ourselves doing far less of what we love and a lot more of what we don't - hiring, firing, insurance, worker's comp and unemployment claims, employee benefits, payroll taxes and more. And now, to make running and owning a business a lot more complicated, there is the myriad of pending health care reform issues. It is a small miracle you actually get any "real work" done. 
    This is where the Employee Management Team comes in. The Employee Management Team is your PEO solution for the entire Sarasota area, and you can learn more at www.emtpeo.com.



Lawman Benefits Consulting, Inc.  |  941.966.2228  |  LawmanConsulting.com