It’s almost impossible to manage the endless array of required employee notifications and keep on top of the latest compliance mandates associated with ERISA law and its’ many amendments. Staying on top of COBRA healthcare administration is certainly no easy task, especially considering the extremely time-sensitive nature of the required notifications. Keeping it all properly documented to protect your company in the event of an audit is also an absolute necessity.
At PGP, we understand the challenges employers face in this day and age to prevent legal ramifications, which can be devastating to the bottom-line if noncompliance penalties are incurred. That’s why we have solidified a partnership with TASC to ease the burden of benefits administration and give you and your clients peace of mind. TASC teams are trained to thoroughly understand legislative regulations and mandates so you and your clients don’t have to worry. We will work with you and them to make sure your clients plans are in legal compliance every step of the way.
Another viable option that today’s savvy employers are utilizing so they can alleviate the burden of compliance and human resources management is a Professional Employer Organization (PEO). Click here to learn how a PEO can help you and your clients with not only compliance issues but also efficiency, profitability, and productivity.
- ERISA Defined
The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans.
ERISA requires plans to provide participants with plan information including important information about plan features and funding; provides fiduciary responsibilities for those who manage and control plan assets; requires plans to establish a grievance and appeals process for participants to get benefits from their plans; and gives participants the right to sue for benefits and breaches of fiduciary duty.
There have been a number of amendments to ERISA, expanding the protections available to health benefit plan participants and beneficiaries. Some of these amendments include COBRA, HIPAA, Newborns’ and Mothers’ Health Protection Act, the Mental Health Parity Act, and the Women’s Health and Cancer Rights Act.
- COBRA Defined
The Consolidated Omnibus Budget Reconciliation Act (COBRA), one important amendment to ERISA, gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan.
COBRA generally requires that group health plans sponsored by employers with 20 or more employees in the prior year offer employees and their families the opportunity for a temporary extension of health coverage (called continuation coverage) in certain instances where coverage under the plan would otherwise end.
COBRA outlines how employees and family members may elect continuation coverage. It also requires employers and plans to provide notice.
- HIPAA Defined
Another amendment to ERISA is the Health Insurance Portability and Accountability Act (HIPAA) which includes protections for coverage under group health plans that limit exclusions for preexisting conditions; prohibit discrimination against employees and dependents based on their health status; and allow a special opportunity to enroll in a new plan to individuals in certain circumstances. HIPAA may also give employees a right to purchase individual coverage if they have no group health plan coverage available, and have exhausted COBRA or other continuation coverage.
- Healthcare Reform Review and Analysis
Click here to learn how our healthcare reform review and analysis can help you and your clients stay compliant and avoid penalties.