HR Professionals

Regulatory Compliance Assistance

Fulfilling regulatory obligations is critical to controlling overall benefit costs. By combining regulatory knowledge, administrative expertise and state-of-the-art computer technology, we currently help many employers comply with the requirements of HIPAA, COBRA and other government mandates. Just a few of our compliance services include the following:

HIPAA Coverage Certification Assistance

Under the Health Insurance Portability and Accountability Act of 1996, as long as covered employees meet certain requirements with regard to waiting periods, they are assured of insurability when they leave their job and move to another employer. This "promise of continuation of insurability" places additional obligations on the shoulders of both employers.

The former employer must track coverage "credits" and issue a certification of coverage as participants leave the plan. The new employer must accept such certification and apply it to the plan's pre-existing condition provisions.

Compliance With These Provisions Requires

• - Knowledge of the regulations, as well as the specific plan design
• - Technology to track eligibility, waiting periods and coverage credits
• - Strategies to ease the notification process and required employee communications

We have the systems and the expertise required to assist your organization with compliance in this area of employment law.

Easing COBRA Compliance

Virtually all U.S. employers with 20 or more full or part time employees, who offer these employees a health care benefit plan, are subject to COBRA. This law, originally passed in 1985 as the Consolidated Omnibus Budget Reconciliation Act, was updated by Congress through passage of HIPAA in 1996.

Under COBRA, employers are required to let certain persons, known as "qualified beneficiaries," continue their health care coverage at the group rate for a specified period of 18, 29, or 36 months, depending upon the "qualifying event" involved. For this reason, we assist employers in complying with the requirements of the law. Our specific COBRA services include

Tracking Time Limits

We assist by maintaining employee and dependent data and generating timely notices as needed.

Notifying Eligible Employees

We can assist in notifying all covered employees and spouses of their rights under COBRA and as "qualifying events" take place. We will also implement coverage as qualified beneficiaries elect continuation coverage.

Calculating Costs

Charges for continuation coverage cannot exceed 102% of the applicable premium for the coverage period. In a self-funded plan, the premium must be calculated on an actuarial basis or by determining the premium for a like-situated beneficiary for the preceding determination period, with proper cost of living adjustments.

Regardless of your funding strategy, our administrative experts will calculate premiums and generate all required written notices. Premium payments will be processed in accordance with strict control procedures and disbursed promptly.

Assembling Plan Information

As professional administrators, we routinely assemble plan information for inclusion in the Plan's 5500 Form, which is the annual report form required of all self-funded health benefit plans by ERISA. These forms are designed to facilitate in reporting fees, commissions or compensation received by service providers associated with the Plan. If needed, we can assist with preparation of the 5500 Form as well.

Another standard part of our compliance assistance program is helping to prepare technically accurate Plan Documents and Summary Plan Descriptions. In this process, we follow up to assure that all notifications required by COBRA and HIPAA are contained in the Summary Plan Description issued to participating employees.

Get The Help You Need To Ease The Burden

From ERISA to HIPAA, COBRA to Family and Medical Leave... it has been said that understanding the regulations that impact employee benefits is just slightly more complicated than interpreting a blueprint for New York City. And if that isn't intimidating enough, consider the cost of failing to comply!

That's why administrative expertise, regulatory knowledge and information technology must be an important part of your employee benefit strategy.