by admin | Aug 23, 2024 | Blog
Health plans must communicate effectively with all members, regardless of their language. The Affordable Care Act (ACA) mandates that claims and appeals notices be provided in a culturally and linguistically appropriate manner. Here’s how health plans can meet these requirements.
Key Requirements
1. Population Threshold: If 10% or more of a county’s population speaks a non-English language, notices must include a statement in that language explaining how to get help. This is based on U.S. Census data and updated on government websites.
2. Oral Language Services: Health plans must offer phone assistance in the non-English language to answer questions and help with claims and appeals.
3. Written Notices: All English notices must have a clear statement in the non-English language about how to access language services.
4. Translation Upon Request: Full notices must be provided in the non-English language if requested.
Implementation Tips
- Stay Updated: Regularly check the Department of Labor (DOL) and Health and Human Services (HHS) websites for the latest information.
- Use Provided Language: Utilize the sample statements provided by the agencies to ensure compliance.
- Train Staff: Ensure customer service representatives are trained to assist in multiple languages.
Conclusion
Providing notices in different languages is crucial for fair access to healthcare information. By following these guidelines, health plans can better serve their diverse members and comply with the ACA.
Source: Thomson Reuters
by admin | Aug 15, 2024 | Blog
Navigating the complexities of federal laws like HIPAA and FMLA can be challenging for employers. One common question is whether HIPAA requires an individual’s authorization before an employer can receive their Protected Health Information (PHI) for Family and Medical Leave Act (FMLA) compliance purposes. This blog post aims to clarify this issue and provide guidance on how to handle PHI in compliance with both HIPAA and FMLA.
What is HIPAA?
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law designed to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. It sets the standard for protecting PHI and applies to healthcare providers, health plans, and healthcare clearinghouses.
What is FMLA?
The Family and Medical Leave Act (FMLA) allows eligible employees to take unpaid, job-protected leave for specified family and medical reasons. Employers may require medical certification to support the need for leave due to a serious health condition.
When is Authorization Required?
Whether an employer needs an individual’s authorization to receive PHI under HIPAA depends on the source of the information and the relationship to the individual.
- Employee Provides Information:
- If an employee seeking FMLA leave obtains the necessary medical information from their healthcare provider and then forwards it to the employer, no HIPAA authorization is required. The employee has the right to share their own PHI.
- Direct Communication Between Employer and Provider:
- If the employer communicates directly with the healthcare provider, HIPAA requires the employee’s authorization for the provider to disclose PHI. This authorization must meet HIPAA’s technical requirements.
- Family Member’s Health Information:
- If the FMLA leave is for a family member’s serious health condition, the family member’s authorization is required for the provider to release their PHI to the employee or employer.
FMLA Regulations on Employer-Provider Contact
FMLA regulations limit the contact an employer can have with an employee’s healthcare provider. If the employee submits a sufficient medical certification, the employer cannot request additional information from the provider. However, the employer may contact the provider for clarification and authentication through a designated representative, not the employee’s direct supervisor. If this involves disclosing PHI, the employee’s HIPAA authorization is necessary.
Conclusion
Employers must navigate both HIPAA and FMLA regulations when handling PHI. Understanding when authorization is required can help ensure compliance and protect the privacy of employees and their family members. Always consult with legal counsel to address specific situations and ensure adherence to all applicable laws.
Source: Thomson Reuters
by admin | Aug 15, 2024 | Blog
Navigating the complexities of Dependent Care Assistance Programs (DCAP) can be challenging, especially when dealing with midyear election changes and nondiscrimination rules. This blog post will explore whether an employee can begin contributing to a DCAP midyear if their spouse’s contributions are cut off to avoid a nondiscrimination failure, and whether an employer can cut off an employee’s salary reductions midyear for the same reason.
Midyear DCAP Election Changes
One common scenario involves an employee who initially elected not to make DCAP salary reductions because their spouse, employed elsewhere, made a $5,000 DCAP election. If the spouse’s contributions are discontinued midyear to avoid a nondiscrimination test failure, the employee may wish to start making DCAP salary reductions. According to IRS officials, a cafeteria plan may permit this midyear election change if it allows changes due to a “change in coverage under another employer plan.”
Key Points to Consider:
- Plan Provisions: Ensure your cafeteria plan includes provisions for election changes due to changes in coverage under another employer plan.
- Employee Certification: The employee must certify that the change in coverage event occurred.
- Contribution Limits: The maximum annual DCAP exclusion for a married couple filing jointly is $5,000. Employees should not exceed this limit, considering the spouse’s contributions already made for the year.
Cutting Off Salary Reductions Midyear
Employers may also need to cut off an employee’s salary reductions midyear to comply with nondiscrimination rules. While not explicitly mentioned in IRS regulations, IRS officials have informally commented that such provisions do not violate the irrevocable election requirement.
Steps for Employers:
- Plan Provisions: Include provisions in your plan that allow the plan administrator to reduce or discontinue salary reductions to comply with nondiscrimination rules.
- Monitoring Compliance: Regularly monitor compliance with nondiscrimination rules throughout the plan year to make necessary adjustments before year-end.
Understanding and implementing midyear DCAP election changes and managing nondiscrimination compliance are crucial for both employers and employees. By ensuring your cafeteria plan includes the necessary provisions and monitoring compliance, you can navigate these challenges effectively.
Source: Thomson Reuters
by admin | Aug 8, 2024 | Blog
COBRA, the Consolidated Omnibus Budget Reconciliation Act, provides employees with the option to continue their health insurance coverage after leaving their job. However, certain circumstances can lead to the early termination of this coverage. One such circumstance is the submission of fraudulent claims.
Terminating COBRA Coverage for Fraudulent Claims
A qualified beneficiary’s COBRA coverage can be terminated for submission of fraudulent claims if three key requirements are met:
- The health plan must allow the termination of active employees’ coverage for the same reason.
- The plan must permit the termination of COBRA coverage for cause.
- The plan’s COBRA notices and communications must disclose the plan’s right to terminate coverage for cause.
Regulatory Guidelines
COBRA regulations specify that a qualified beneficiary’s coverage may be terminated for cause on the same basis that would apply to similarly situated active employees under the terms of the plan. This includes the submission of fraudulent claims. Thus, if an active employee’s coverage can be terminated for submission of fraudulent claims, COBRA coverage can be terminated early for the same reason, provided it is allowed by the plan and disclosed in COBRA notices and the plan’s summary plan description.
Proceeding with Caution
Terminating coverage early is a decision that should be made with caution. Employers wishing to terminate COBRA coverage early for other types of misconduct would need to analyze the circumstances to determine whether the plan would allow termination of an active employee’s coverage for that type of misconduct. It is advisable to consult with legal counsel and the plan’s insurer or stop-loss insurer if applicable.
Final Steps
If you decide to terminate the qualified beneficiary’s coverage based on fraudulent submission, remember to send the required notice of termination of COBRA coverage to any qualified beneficiary whose COBRA coverage terminates before the expiration of the maximum coverage period.
In conclusion, while it is possible to terminate COBRA coverage early due to fraudulent claims, it is a decision that should be made carefully, following the guidelines set forth by your health plan and COBRA regulations.
Source: Thomson Reuters
by admin | Aug 1, 2024 | Blog
As the back-to-school season approaches, parents and students are preparing for the new academic year. Beyond the usual school supplies, there are many health-related items eligible for purchase using your Flexible Spending Account (FSA) or Health Savings Account (HSA). These tax-advantaged accounts can help you save money on essential health products that support your child’s well-being throughout the school year.
1. First Aid Supplies
Accidents happen, especially on the playground or during sports activities. Stock up on first aid essentials like bandages, antiseptic wipes, and cold packs. These items are crucial for handling minor injuries promptly.
2. Contact Solution
If your child uses contact lenses, ensuring they have the right contact solution is essential for maintaining eye health and comfort. Both prescription glasses and contact lenses are eligible expenses, so make sure they have a clear view of the blackboard and their textbooks.
3. Over-the-Counter Medicines
Having a stock of over-the-counter (OTC) medicines can be a lifesaver for managing common ailments like colds, allergies, and headaches.
4. Acne Treatment
Managing acne is crucial for your child’s confidence and skin health. Various acne treatments, including creams, gels, and cleansers, are eligible for purchase with your FSA or HSA.
5. Sunscreen
Protecting your child’s skin from harmful UV rays is important year-round. Ensure you have an adequate supply of sunscreen, particularly if your child spends a lot of time outdoors.
Leveraging your FSA or HSA for back-to-school shopping not only ensures your child is well-prepared but also helps you save on essential health-related products. By planning ahead and purchasing these eligible items, you can take advantage of the tax benefits these accounts offer.
For a complete list of eligible FSA and HSA back-to-school items click here.
For more information on all FSA and HSA eligible items, visit the FSA Store.
by admin | Jul 25, 2024 | Blog
Navigating the complexities of medical coverage during unpaid Family and Medical Leave Act (FMLA) leave can be challenging for both employees and employers. One common question that arises is whether employees can prepay their share of medical plan coverage on a pre-tax basis. The answer is yes, but it depends on the specifics of your cafeteria plan.
Prepayment Option Under FMLA
The IRS FMLA regulations permit three payment options for employees wishing to pay their share of the premiums for group health coverage during an unpaid FMLA leave. These options are prepay, pay-as-you-go, and catch-up.
Prepay allows employees to pay the contributions due during the leave before the leave commences. This option cannot be the sole option offered to employees on FMLA leave, although it may be restricted to employees on FMLA leave.
Pay-as-you-go enables the employee to pay his or her share of the cost of coverage during the leave.
Catch-up involves the employer advancing payment of the employee’s share during leave, and the employee repays the employer upon return.
Your cafeteria plan may provide one or more of these payment options, as long as the options for employees on FMLA leave are offered on terms at least as favorable as those offered to employees not on FMLA leave.
How Does Prepayment Work?
Under the prepay option, employees are given the opportunity to pay, before starting FMLA leave, the contributions that will be due during the leave period. They can voluntarily elect to reduce their final pre-leave paychecks or make special salary reduction contributions to cover their share of the premiums for all or part of the expected duration of the leave. Prepay contributions could also be made on an after-tax basis.
During the leaves, your company would pay its share of the premium in the same manner as before. When an employee’s leave ends, the employee’s previous salary reduction election would resume for the rest of the plan year unless the employee makes a change in election permitted under IRS regulations upon return from leave.
Limitations of Prepayment
If an employee’s leave straddles two plan years, only the contributions for coverage during the first plan year can be prepaid on a pre-tax basis. This is due to the cafeteria plan “no-deferred-compensation” rule that generally prohibits the use of one year’s contributions to fund benefits in a subsequent year. However, a cafeteria plan with a grace period under its premium payment component could arguably allow employees taking an FMLA leave that straddles two plan years to make pre-tax prepayments for up to 2-1/2 months of coverage during the second plan year before the leave begins.
Conclusion
Understanding the options for medical coverage during unpaid FMLA leave is crucial for both employees and employers. While prepayment is a viable option, it’s essential to consider the specifics of your cafeteria plan and the IRS regulations to ensure compliance.
Source: Thomson Reuters
