United Benefit Advisors Insight and Analysis Blog

Reporting Minimum Essential Coverage

Posted by: Danielle Capilla    Oct 6, 2016 10:30:00 AM

Minimum essential coverage (MEC) is the type of coverage that an individual must have under the Patient Protection and Affordable Care Act (ACA). Employers that are subject to the ACA’s shared responsibility provisions (often called “play or pay”) must offer MEC coverage that is affordable and provides minimum value.

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Topics: minimum essential coverage, MEC, ACA, Affordable Care Act, employer shared responsibility, Danielle Capilla

HIPAA Phase 1 Audits

Posted by: Danielle Capilla    Aug 26, 2016 10:30:00 AM

The Health Insurance Portability and Accountability Act (HIPAA) established national standards to secure and protect the privacy of health information. The Health Information Technology for Economic and Clinical Health Act (HITECH) requires the Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) to conduct audits of covered entities and business associates in order to ensure compliance with the HIPAA Privacy, Security, and Breach Notification Rules.

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Topics: HIPAA, HIPAA audit, Danielle Capilla, compliance, business associates, covered entities

How to Complete the IRS/SSA/CMS Data Match Report

Posted by: Danielle Capilla    Jul 26, 2016 10:30:00 AM

Data Match is a program coordinated by the Internal Revenue Service (IRS), Centers for Medicare & Medicaid Services (CMS), and the Social Security Administration (SSA) to identify Medicare beneficiaries who received Medicare benefits with Medicare as the primary payer when Medicare should have been the secondary payer. We recently covered background on this program in a previous blog posting. Employers are required to complete the Data Match report within 30 days of receipt of the Data Match Personal Identification Number (PIN), unless an extension has been requested and approved. The letter directs employers to the Data Match Secure Website, where the questionnaire can be accessed after entering the employer identification number and PIN.

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Topics: IRS-SSA-CMS Data Match Program, Medicare, compliance, Danielle Capilla

ALE Employers Ask: Should Benefits Be Offered to Variable Hour Employees?

Posted by: Danielle Capilla    Jul 12, 2016 10:30:00 AM

UBA’s compliance team leverages the collective expertise of its independent partner firms to advise 36,000 employers and their 5 million employees. Lately, a common question from employers is: How does an ALE determine whether or not a newly hired variable hour employee should be offered benefits?

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Topics: applicable large employers, variable-hour employee, group health insurance, Danielle Capilla, benefits compliance

What Employers Need to Know about the IRS-SSA-CMS Data Match Program

Posted by: Danielle Capilla    Jun 14, 2016 10:30:00 AM

Beginning in early 2016, many employers received letters from the IRS-SSA-CMS Data Match program. These letters are addressed to the employer and begin by stating that "Medicare needs your cooperation." Employers are directed to report information on the IRS/SSA/CMS Data Match Secure Web Site (https://www.cob.cms.hhs.gov/DataMatch/). The data being requested is often extensive, and can cover a number of years.

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Topics: Centers for Medicare and Medicaid Services, Group health plans, Danielle Capilla, IRS-SSA-CMS Data Match Program

DOL Issues 31st FAQ on ACA Implementation

Posted by: Danielle Capilla    May 17, 2016 10:00:00 AM

The U.S. Department of Labor (DOL) has issued its 31st FAQ on the implementation of the Patient Protection and Affordable Care Act (ACA), dedicated to coverage of preventive services, rescissions of coverage, out-of-network emergency services, clinical trial coverage, cost-sharing limitations, the Mental Health Parity Act, and the Women's Health and Cancer Rights Act. Some highlights are provided below.

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Topics: ACA, PPACA, preventive services, Danielle Capilla, Affordable Care Act, rescissions of coverage, out-of-network services, cost-sharing limitations

Employers Ask: What Prevents Me from Reimbursing Individual Health Insurance Policies?

Posted by: Danielle Capilla    May 10, 2016 10:00:00 AM

In serving 36,000 employers and 5 million employees, our UBA Partners get this question frequently: What federal guidance prohibits employers from reimbursing individual health insurance policies?

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Topics: ACA, PPACA, employer payment plans, premium reimbursement, Danielle Capilla, individual health plans

ACA Regulations Roundup (and Free Resources)

Posted by: Danielle Capilla    May 5, 2016 10:00:00 AM

The government was busy recently, issuing the massive Benefit Payment and Parameters rule in addition to numerous other updates. Our recent blog reviews the updates to the Benefit Payment and Parameters rule; for more detailed information as it relates to standardized plans, small employer definition, reinsurance fees, rating areas, guaranteed availability, exemptions, and more, download UBA’s ACA Advisor, “Benefit and Payment Parameters Rule and HIP FAQ”.

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Topics: ACA, PPACA, Danielle Capilla, Affordable Care Act, Benefit Payment and Parameters rule, HIPAA audit

Employers Ask: What happens to benefits eligibility during an unpaid leave of absence?

Posted by: Danielle Capilla    Mar 8, 2016 12:00:00 PM

Question: If an employee of an applicable large employer takes an unpaid leave of absence (not Family and Medical Leave Act), what happens to their benefit eligibility during that time?

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Topics: FMLA, leave of absence, Danielle Capilla, counting employees

Proposed Summary of Benefits and Coverage Template and Updates

Posted by: Danielle Capilla    Mar 3, 2016 12:00:00 PM

Insurance document summaryA Summary of Benefits and Coverage (SBC) is four-page (double-sided) communication required by the federal government. It must contain specific information, in a specific order and with a minimum size type, about a group health benefit’s coverage and limitations. Recently, the Department of Labor (DOL) issued proposed revisions to the template and related materials.

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Topics: summary of benefits and coverage, SBC, Group health plans, Danielle Capilla