United Benefit Advisors Insight and Analysis Blog

So you’re being audited by the DOL. Are you ready?

Posted by: Bill Olson    Jun 11, 2015 12:00:00 PM

Are you ready?As our recent press release addressed, DOL audits are on the rise. Not many things incite more fear than receiving a notice that you’re about to have an audit, especially from the DOL. The Department of Labor (DOL) is a cabinet-level department of the U.S. federal government responsible for occupational safety, wage and hour standards, unemployment insurance benefits, re-employment services, and some economic statistics. It is headed by the U.S. Secretary of Labor.

Read More

Topics: Department of Labor, white papers, LHD Benefit Advisors, Jeff Hadden, Michael Cramer, Audit, Don't Roll the Dice on Department of Labor Audits, Deanna Johnson, Beneflex Insurance Services, Benefit Insurance Marketing

Preventive Service Requirement FAQ

Posted by: Danielle Capilla    Jun 4, 2015 12:00:00 PM

Preventive CareOn May 11, 2015, the Department of Labor (DOL) along with other federal agencies issued an FAQ regarding the implementation of the Patient Protection and Affordable Care Act (PPACA) that focused on coverage of preventive services. Non-grandfathered group health plans and health insurance offered in the individual or group markets must provide certain listed benefits with no cost-sharing to the beneficiary. The FAQ provided information on some commonly confusing or ambiguous requirements.

Read More

Topics: PPACA Affordable Care Act, contraception, Department of Labor, anesthesia, preventive services, well-woman care, colonoscopy, Danielle Capilla, BRCA testing, preventive screening

It’s Not a Matter of “If,” But “When” You Get Audited By the U.S. Department of Labor

Posted by: Bill Olson    Jun 2, 2015 5:44:00 PM

Department of Labor AuditAs the saying goes, an ounce of prevention is worth a pound of cure, and that’s definitely the case when it comes to a health plan audit by the U.S. Department of Labor (DOL). And prevention is certainly warranted, according to Jeff Hadden, Partner at LHD Benefit Advisors (a UBA Partner Firm), because it’s not a matter of “if” you’re getting audited, but “when” you get a letter from the DOL that your company is being audited.

Read More

Topics: DOL, Department of Labor, white papers, Jeff Hadden, Michael Cramer, Audit

Reference-Based Pricing and Cost-Sharing Limits

Posted by: Linda Rowings    Nov 11, 2014 10:19:00 AM

The Department of Labor (DOL), the IRS, and the Department of Health and Human Services (HHS) have jointly issued a FAQ that addresses how "reference-based pricing" works with the Patient Protection and Affordable Care Act's (PPACA) restrictions on out-of-pocket maximums. PPACA limits the out-of-pocket maximum a non-grandfathered plan may impose, and generally requires that co-pays, coinsurance, and deductibles be counted toward this limit. However, premiums, balance billed amounts for non-network providers, and non-covered services do not need to be applied to the out-of-pocket limit. (For 2015, the limits are $6,600 per individual or $13,200 per family.) The new FAQ explains how the out-of-pocket limit applies to plans that use reference-based pricing--i.e., a design under which the plan pays a fixed amount for a particular procedure (such as a knee replacement), which certain providers have agreed to accept as full payment.

Read More

Topics: Linda Rowings, IRS, HHS, Reference-Based, Pricing, Cost-Sharing, Limits, Department of Labor, Department of Health and Human Services, DOL