Employers with over 50 employees must pay attention to FMLA. With some employers, we are finding that concerns about abuse are growing.
While FMLA is designed to help employees that are in a tough spot, the prepared employer can head off abuses by having good processes in place and have access to the right information. In some cases, we have found the employees abusing FMLA are actually the experts!
Here is some FMLA info you may find useful – FMLA Rights for Nontraditional Families.
If you need assistance on FMLA resources, we can help.
Perhaps this is early but you can file it.
IRS Announces HSA-HDHP Limits for 2018
Who knows where the federal healthcare regulations are going, but if the Republicans (and the President) pass anything it will likely affect the group market by:
- Removing the cost share regulations
- Reduce the reporting requirements
- Allow carriers to create more types of plans
We will report on those types of things when/if the Senate releases their proposed version of a new healthcare bill .
Medicare can be tricky when it is coordinating with Group Health Coverage.
This is especially true when Medicare enrollees WAIVE Part B coverage, thinking that they don’t need it because they have Group Health Coverage.
Our message to those people is BE CAREFUL. You must be certain that if you waive Part B coverage that you are not opening yourself up to claims exposure.
Never assume that a Group Health Plan will step in and cover claims.
Since CMS clearly states that the INDIVIDUAL is responsible to know (not the employer nor the insurance company) the Medicare coordination with other coverage, it is critical to be careful and do the research.
Here are some examples where things get tricky:
- When an employer has fewer than 20 employees, Medicare is primary. With some insurance companies they do not even pay claims if Medicare does not approve. If one does not enroll in Part B, that means NOTHING is approved by Medicare. Translation: Costs that would have gone to Part B are not approved by Medicare and not approved by the insurance company. This is a big problem.
- When an employer has fewer than 100 employees, Medicare that is DUE TO DISABILITY is primary. The same rules apply.
- When someone is on COBRA and Medicare, Medicare is primary no matter how many employees the employer has. If the member on COBRA waives Part B, they face potential liability. People could easily assume that the rules would be the same as when they were active on the plan (vs COBRA), but that would be a mistake.
While we at BBG will help our clients get the right answer and try to fix things if someone has assumed the wrong thing, we urge everyone who is Medicare eligible to engage to find the right answers. We are not responsible for errors in Medicare enrollment, but we can be a resource for assistance.
No one should assume that waiving Medicare Part B coverage will be just fine. Getting the right answers and keeping the documentation is critical if you waive Part B.
What do we see?
Our opinion was that if Hillary Clinton had won, ACA would have gotten the heavy lift it would have needed to advance. The difficult regulations would have been imposed (vs delayed further) and the money would have been allocated from general funds to stabilize the market.
Without the heavy lift, big trouble for ACA would be on the horizon.
The horizon is here. What we see initially is that the regulations will start to go away (changed or ignored) and cash infusion will not happen. What remains to be seen is what the party in power will do to replace the law. Doing nothing will almost be a replacement, but to what? The Republicans do have various plans, but which course they will follow remains to be scene.
Our job will be to let you know how this will affect you and your people. As of today, we just hold the course. The taxes and reporting requirements are still in place. The plans on the market have not changed. We will keep you aware as things change. If things hit your radar or you have questions on what you read or hear, please let us know and we will dig in.
For more on the latest: ACA Compliance Bulletin — Congress Clears Path for ACA Repeal
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- Mike Barrett
- January 25, 2017
- ACA, affordable, affordable care act, confusion, cost, costs, coverage, employees, employers, exchange, federal, health plans, healthcare, healthcare reform, insurance, mandate, medical, Obamacare, ruling
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