resources

Compliance Recap | September 2018

September was a relatively busy month in the employee benefits world. The Internal Revenue Service (IRS) released draft 2018 instructions for Forms 1094-B, 1095-B, 1094-C, and 1095-C. The IRS also issued an information letter regarding health flexible spending accounts and guidance on the ...

Federal Tax Credit for Employer-Provided Paid Family & Medical Leave (updated)

Updated September 24, 2018 In December 2017, the Tax Cuts and Jobs Act (Act) included a new federal tax credit for employers that provide paid family and medical leave (FML) to their employees. To be clear, the Act does not require employers to provide paid leave. However, eligible employers ...

Compliance Recap | August 2018

August was a relatively quiet month in the employee benefits world. The Internal Revenue Service (IRS), the Department of Health and Human Services (HHS), and the Department of Labor (DOL) published a final rule that amends the definition of short-term, limited-duration insurance. HHS also ...

11/11-11/14 | Texas PRIMA Annual Conference

Advocacy in Action | Claims Investigation

A member contacted her Patient Advocate to request an audit of delivery bills for her newborn baby. The PA reviewed the EOB’s and discovered that the insurance carrier had over-applied her deductible. It appeared that the member had met her deductible and out of pocket expenses of $3,125.00 on ...

Compliance Recap | July 2018

July was a quiet month in the employee benefits world. The Internal Revenue Service (IRS) released draft Forms 1094-B, 1095-B, 1094-C, and 1095-C. The IRS also released an information letter on the employer shared responsibility provisions. IRS Releases Draft Forms 1094-B, 1095-B, 1094-C, and ...

Final Regulations Regarding Short-Term Limited-Duration Insurance, Excepted Benefits, and Lifetime/Annual Limits

On October 31, 2016, the U.S. Department of the Treasury, Department of Labor (DOL), and Department of Health and Human Services (HHS) (collectively the Departments) issued final regulations regarding the definition of short-term, limited-duration insurance, standards for travel insurance and ...

What Group Plan Sponsors Need to Know about ERISA

The Employee Retirement Income Security Act (ERISA) was signed in 1974. The U.S. Department of Labor (DOL) is the agency responsible for administering and enforcing this law. For many years, most of ERISA’s requirements applied to pension plans. However, in recent years that has changed and ...

Advocacy in Action | Unexpected Bill

A member received a bill from the lab for $2,152.89. The member did not understand why she was receiving the bill and mentioned the issue to her co-worker. Her co-worker mentioned her Patient Advocate had helped her resolve a similar issue. The member called her Patient Advocate about the lab ...

Frequently Asked Questions about Tracking Full Time Employees under Play or Pay

Q1: Must full time employees be tracked under the Patient Protection and Affordable Care Act’s (PPACA) play or pay rules? A1: All common-law employees must be tracked under play or pay rules, including ongoing full time employees. Q2: Why would you track employees that you know are full time? ...
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