In an effort to make health coverage more affordable and accessible, the Affordable Care Act (ACA) implemented parameters to the premium rating methodologies used by insurers in the individual and small group markets. Insurers in these markets can vary premium based on age so long as the insurers adhere to the proper age band rating procedure. This procedure has remained unchanged since 2014, but pursuant to a rule issued by the Department of Health and Human Services (HHS), the rating methodology will change come 2018.
In California yesterday, Governor Brown signed into law two bills, SB 63 and AB 168, that will significantly impact California employers come January 1, 2018:
Conversion is an important feature in employer-sponsored life insurance plans that can allow an employee to maintain coverage after experiencing a loss of eligibility by converting group coverage to an individual policy. Critically, though, the responsibility to adequately inform the employee about the conversion option falls upon the employer rather than the insurer. This duty is underscored in a recent decision by a U.S. District Court, Erwood v. Life Insurance Company of North America (Erwood).
***Please note, some of the information in this article may be outdated. It is being left in place for continuity reasons. ****
Domestic partner coverage under a group health plan can be a complex issue for employers, particularly in light of the U.S. Supreme Court's 2015 ruling that legalized same-sex marriage nationwide (Obergefell v. Hodges). California law continues to require domestic partner coverage of some employer-sponsored plans, while others are faced with the decision. But important considerations exist for all employers with respect to domestic partner coverage.
On Monday, May 16, the U.S. Equal Employment Opportunity Commission (EEOC) issued two final rules related to employer wellness programs.
The two rules explain how the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA) apply to employer-sponsored wellness programs that collect health information from employees and spouses. These rules take effect in January 2017 and address important issues related to program incentives, design, and confidentiality.
What is the difference between fully funded, self-funded and partially funded?
Employers provide health insurance benefits to their employees and families because they want to be competitive with other employers, retain their workforce; and maybe, as a result of the employer mandate portion of the Affordable Care Act, are required to offer health insurance to avoid penalties.
The Employee Retirement Income Security Act of 1974 (ERISA) is federal law that regulates employer-sponsored health and welfare plans of all sizes – both fully-insured and self-funded. To ensure group health plan compliance, federal agencies such as the Department of Labor and the IRS are tasked with enforcing ERISA and its related laws, including HIPAA, COBRA, and now the ACA. Despite the complexity of these laws, employers can take steps to prevent the costly consequences of noncompliance. An ERISA gap assessment can serve as the first line of defense by identifying areas of weakness and addressing vulnerabilities.
The expansion of the definition of a small group plan from 50 employees to 100 employees is a transition that we’ve all been tackling. Most impacted are employers in the 50-99 employee range who currently participate in the large group market but face a potential squeeze into the small group market – and small group rates – come 2016. Fortunately, we now have a bit more clarity on how employer size will be determined in California for purposes of small group market eligibility.