Making You Look Good in the World of Healthcare Reform Compliance

Transcription

1 Making You Look Good in the World of Healthcare Reform Compliance

2 ABOUT THE PRESENTER: KRISTIN KAHLE Certified Health Care Reform Specialist (CHRS) Nationally recognized leader in Health Care Reform Currently finishing her PhD dissertation on Health Care Reform National speaker and educator Benefits strategist and broker with 20+ years of experience As a chief compliance officer, Kristin has tackled the regulations and impact of the Patient Protection Affordable Care Act (PPACA) on behalf of employers. Utilizing this knowledge and strategic planning, inspired Kristin to develop a compliance solution for brokers to deploy to their clients.

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5 Towers Watson Survey 19 th Annual Employers Focus on Key Levers Redefined Financial Commitment Program Redesign Network Optimization Consumerism

6 Benefits communication straddles an unusual line: Between the ever-changing requirements of government regulations Increasing need for clear, concise and understandable content Changing preferences for how to receive and send information

7 Summary Plan Document Crisis Plan document is typically written in very legal language, as it serves as a manual for administering the plan. ERISA states that the SPD be written in a manner calculated to be understood by the average plan participant. 56% of respondents on the High Road compliance survey stated they are using their SPD as a plan document. 67% percent of respondents of that same survey, stated that they had a wrap plan document. High roads also noted that employers are migrating to electronic distribution, as a preferred method.

8 SOCIAL MEDIA Social Media is gaining more acceptance as a tool for communicating with active employees and retirees about their benefits 45% of respondents indicated that they are using or plan to use Twitter and/or Facebook. Employers still don t know what percentage of their employees are using smartphones and other mobile devices for work (69%).

9 THE HARSH REALITIES OF REFORM Chaos and Confusion- Have you read the new laws? Do you understand the delays? Time Theft- Who on your team will take the responsibility for the implementation of reform? Potential Severe Penalties- What is the risk of non-compliance? Greater Compliance Administration- Are you prepared to wrap your arms around all the new compliance requirements? New Costs- Brace yourself!!!! Difficult Decisions- What should you do and when should you do it?

10 DO I REALLY NEED TO BE CONCERNED? What some of your clients are saying.. We are a small business, we will ignore this stuff!! I m not aware of any businesses that ever got fined for compliance My broker will tell me what to do Lack of timely information may result in missed opportunities Indecision may cost your business money The rules have changed!!

11 COMPLIANCE COMPONENTS Build your toolbox!!! Websites Blasts Resource Binders Seminar and Webinars Monthly communications Electronic delivery tools

12 Be Compliant with Health Care Reform and Other Key Regulations ERISA- 7 Parts of ERISA Part 1: Reporting and Disclosure Part 4: Fiduciary Responsibilities Part 5: Administration and Enforcement Part 6: COBRA Part 7: Group Health Requirements Mandated Coverage QMCSO Dependents Mental Health Financial Accounting Standards Board (FASB) Requirement Statement 106 Statement 112 Statement 158 Other Federal Laws Medicare Part D etc. 8 others Employment Law Affecting Group Health Plans 7 items Key State Regulations

13 How are you building your compliance toolbox? Legal Database or access to information blasts Compliance players Creating it yourself Looking for private label firms Integration with renewal Additional staff members

14 COMPLIANCE CHECKLIST Estimate whether the mandate is likely to be enforced for the group in 2015 Look into any common control issues Determine a six-month measurement period for 2014 Review eligibility for transition relief for non-calendar year plans Review ERISA plan documents Review plan to see who is offered coverage now and the types of coverage offered and if changes need to be made for 2016 to avoid penalties Determine if you need to track variable hour workers and utilize measurement periods and stability periods and how best to use them to your advantage Make decisions as to whom to offer health care coverage Determine what coverage to offer Take steps to minimize penalties and cost of providing health care

15 Employer Reporting Rules Expected By Spring 2014

16 OTHER EMPLOYER RESPONSIBILITIES: IT S NOT JUST THE MANDATE Employers are also responsible for maintaining a PPACA-compliant plan, which includes adherence to market reform requirements, notice requirements, etc. Employers are also responsible for maintaining a PPACA-compliant plan, which includes adherence to market reform requirements, notice requirements, etc. The Department of Labor has enforcement authority. Primary enforcement means is audits, and significant resources and funds have been dedicated for audits in 2014 and on forward. Top audit trigger--employee complaints! Others include IRS memorandum of understanding, third party vendors and form 5500 filings. Fines can be heavy! Up to $100 per day per violation for each impacted beneficiary.

17 @EasyHCR Navigatehcr.com Kristin Kahle, CEO and Founder of NavigateHCR.com. NavigateHCR provides software solutions to small to mid sized companies. Our software deliveries 42 notices on a calendar basis to employees directly, with a acknowledgement of receipt. Our software can also be customized, to add additional notices and additional information, like 401k and Workers Compensation. How to reach Kristin Kahle: kristin@navigatehcr.com or