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Self-Funded Medical for Middle-Market Customers

Traditionally, middle-market employers have used fully-insured funding arrangements to finance their medical insurance costs while self-insurance or “Administrative Services Only” contracts were relegated to the large employer market. Due to rising costs and a lack of transparency of insured arrangements, smaller employers have begun to evaluate self-insurance as an option for controlling costs. This funding mechanism has become much more accepted as the purchase decision now includes the top financial executive level, and vehicles such as lifestyle-based contribution models have become mainstream, allowing the full impact of these strategies to fall directly to the organization …

https://www.epicbrokers.com/insights/self-funded-medical-for-middle-market-customers/

Financial Impact of COVID-19

… in the U.S. While COVID-19 has not run its course, we believe it should be pointed out that mortality is not unlike prior pandemics to date, though is expected to be higher than that of a given flu season. Many of our clients, particularly those in self-funded arrangements (in some cases with little or no aggregate stop-loss protection), have inquired as to whether this pandemic will destroy their healthcare programs with costs exploding higher in response to broad sickness. Our strong belief at this time is that COVID-19 will not have a dramatic impact on …

https://www.epicbrokers.com/insights/financial-impact-of-covid-19/

EPIC Adds Matthew Marmorek as National Practice Leader, Global (Non-US) Employee Benefits

EPIC Insurance Brokers and Consultants, a retail property, casualty insurance brokerage and employee benefits consultant, announced today that Matthew Marmorek has joined the firm as National Practice Leader, Global (Non-U.S.) Employee Benefits. Marmorek has worked in the international employee benefits industry for almost two decades. He specializes in developing innovative solutions to help multinational organizations meet their global employee benefit needs. He has extensive experience guiding clients through the implementation of financing vehicles such as multinational pooling, global underwriting, and captive arrangements, both on and off-shore, including medical, non-medical, and pension coverage. Marmorek brings deep carrier …

https://www.epicbrokers.com/insights/epic-adds-matthew-marmorek-as-national-practice-leader-global-non-us-employee-benefits/

Can ICHRAs Be Used to Make Healthcare a Defined Contribution Benefit?

The Affordable Care Act (ACA) limited employers’ ability to use Health Reimbursement Arrangements (HRAs) to fund individual premiums, except for Qualified Small Employer HRAs which had limited applicability due to legislative restrictions. Legislators were fearful that employers would use these programs to dump bad risk on the individual marketplace, which under ACA now has a pre-existing condition ban. Makes sense – large claims make up a disproportionate share of an organization’s total claims, and an employer would get a windfall if it could remove those individuals from its plan. In 2017, the Trump administration directed the U.S. Treasury …

https://www.epicbrokers.com/insights/can-ichras-be-used-to-make-healthcare-a-defined-contribution-benefit/

The Road Not (Yet) Taken: Surrogacy Benefits

… third party. While an employer plan can elect to extend a host of surrogacy services under its group medical program, it would need to remain cognizant of the cost of these services and ensure the plan is appropriately recognizing those services as taxable components of the program, and that they could give rise to taxable income for the employee. It’s also worth noting that some states have passed laws that expressly prohibit surrogate contract arrangements – including New York – and as such, employers must be careful not to inadvertently transgress any applicable laws by allowing for surrogate coverage or reimbursements.

https://www.epicbrokers.com/insights/the-road-not-yet-taken-surrogacy-benefits/

Compliance Alert: DOL Reveals Higher Health Plan Violation Penalties

… example, employers should make sure they are complying with ERISA’s reporting and disclosure rules, including Form 5500, annual CHIP notice and SBC requirements. ADJUSTMENTS FOR 2020 The increased amounts shown below apply to penalties assessed after January 15, 2020. Edit Requirement2019 Adjusted Penalty Amounts2020 Adjusted Penalty Amounts Failure or refusal to file an annual report (Form 5500) with the DOL (unless a filing exemption applies)Up to $2,194 per dayUp to $2,233 per day Failure of a multiple employer welfare arrangement (MEWA) to file an annual report (Form M-1) with the DOLUp to $1,597 per

https://www.epicbrokers.com/insights/compliance-alert-dol-reveals-higher-health-plan-violation-penalties/

Don’t Let Out-of-Network Balance Billing Happen to Your Team

… a nasty balance-billing surprise, and while some states have protections in place against surprise balance billing, these are limited by federal law. Most of our clients don’t have an issue finding in-network care but it has the potential to be very problematic if gone unaddressed. Typically, alternative arrangements can be made when an in-network provider is not available to an employee, and their provider will be treated as in-network for a service or series of treatments. This applies if the employee truly cannot find a provider – not that they just don’t like any of …

https://www.epicbrokers.com/insights/dont-let-out-of-network-balance-billing-happen-to-your-team/

Compliance Alert: COBRA Series, Part IV: Common Errors and How to Correct Them

… fail to collect COBRA premiums by the due date, extend due dates when premium grace periods apply, or discontinue coverage due to insignificant premium shortfalls. To avoid such failures, procedures should be in place to administer the required grace period and to address underpayment and late issues. FAILURE TO OFFER COBRA COVERAGE FOR ALL HEALTH PLANS Plan administrators should be sure to identify and offer continuation coverage for all health plans subject to COBRA. Some health plans are obvious, such as medical or dental plans, but often overlooked are health flexible spending accounts, health reimbursement arrangements (HRAs), as well as

https://www.epicbrokers.com/insights/compliance-alert-cobra-series-part-iv-common-errors-and-how-to-correct-them/