Consultant offers guidance to employers on new health care guidelines

Petula Workman

New regulations and health care reform mean new guidelines for business owners. And, on Tuesday, the Victoria Chamber of Commerce's Building Better Businesses series was there to clear those guidelines up.

Petula Workman, compliance consultant with Arthur J. Gallagher & Co., spoke with about 30 people in the University of Houston-Victoria Multi-Purpose Room about what those changes were, and what they meant to employers.

Here is a list of 12 "hot spots" business owners should be aware of in the coming months.

ERISA reporting and disclosure:

Most employer-sponsored plans must meet certain requirements, such as filing Form 5500s and distributing numerous notices. Fines can total $1,100 per day for those who fail to file Form 5500s and up to $100 per day for other notices. The United States Department of Labor has upped its auditing practices, so it pays to be prepared.

HIPAA privacy:

HIPAA deals with protection of employees' health information and a new audit program began in November. Although they are meant to be educational, rather than to generate non-tax revenue, auditors want to see written privacy policies, procedures and the like. You are more likely to run into trouble if you're rude to an auditor or you show breaches in safeguards, such as laptops without encryption.

Cafeteria plan administration:

Such plans allow employees to pay for contributions on a pre-tax basis, but there are strict guidelines regarding when elections can be changed. As an employer, see what your cafeteria plan says and make sure it meshes with your medical plan.

Family and Medical Leave Act administration:

This act provides protection to employees who must take leave for medical conditions or other qualifying circumstances. Extending such leave for those who are ineligible may lead to a denial in coverage by insurance companies and more. A recent regulation change also means the most recent forms aren't up-to-date, so take note of updates.

Americans with Disabilities Act and wellness programs:

Most wellness programs, such as those that evaluate employees' cholesterol and so on, are also considered medical exams under the Americans with Disabilities Act. Some organizations consider it a violation. If you have a wellness program or do health risk assessments, check with your attorneys to make sure you're in the clear.

Americans with Disabilities Act and unpaid leaves of absence as a reasonable accommodation:

Be clear with your company's approach to different types of leave. There are times, for instance, where an employee does not qualify for Family and Medical Leave Act leave but needs a few weeks to get used to a prosthetic device. Have written policies in place to address such situations.

New summary of benefits and coverage requirements:

Beginning with the first open enrollment period after Sept. 23, employers and insurance carriers must issue summaries of benefits coverage to every participant and beneficiary eligible to participate in the group health plan. This is in addition to existing requirements.

New limits on employee contributions to flexible spending accounts:

Beginning Jan. 1, employee contributions to health care flexible spending accounts will be limited to $2,500. Start getting word out to employees now about the coming change and why it's happening.

New W-2 reporting requirements:

The Affordable Care Act requires employers to report the aggregate cost of employer-sponsored coverage on W-2 forms. Additional information is available from the IRS to make sure employers know what they need to do. Look over the information and know how the changes will affect your practices.

Self-reporting excise taxes include PPACA violations:

Since Jan. 1, 2010, employers have been required to self-impose excise taxes for COBRA violations, sending out late election notices and the like. Avoid violating the laws, however, and you don't have to worry about such penalties.

Patient-centered outcomes research fees:

The Affordable Care Act established the Patient-Centered Outcomes Research Institute to better evaluate various medical practices and the like. Health insurance issuers and those who sponsor self-insured plans must pay fees starting for the plan year that began Jan. 1. Fees are $1 per covered individual the first year and $2 per covered individual afterward.

New external appeals requirements for non-grandfathered health plans:

Beginning Jan. 1, non-grandfathered health plans must meet new review standards for denied claims that involve medical judgment or rescinded coverage. If a plan doesn't meet those standards, individuals can take the issue to court.