APC and many employers consider administering a medical reimbursement plan without good health reimbursement Software. APC and employers often give important compliance obligations that put them at financial risk. Failure of the following requirements can be costly. Read on for an overview of why you need consistent Healthcare Reimbursement Software.
Note: In this article, we discuss Article 105 Medical Plans repayment as health care reimbursement plans (HRPS) and health reimbursement arrangements (HRA), which offer tax free reimbursement for eligible medical expenses and / or individual cost of health insurance premiums.
Affordable Care Act (ACA) requirements
The following ACA (health reform federal) provisions applicable to Article 105 Plans medical reimbursement in some cases:
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cover load for adult children up to age 26
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coverage of preventive care without cost sharing
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annual limit rules and life
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Form 720: fees to fund research results patient-centered
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Benefits Summary and coverage (SBC)
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Opinion of 60 days of material changes
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internal and external complaints and appeals process health claims
learn more about the importance of respecting the rules of the ACA.
HIPAA
Article 105 medical reimbursement plan are self-funded health plans, and governed by confidentiality rules of HIPAA. To administer a repayment plan, the application processing entity receives protected health information (PHI) is protected by HIPAA. group of employers who do not comply may be subject to civil penalties of up to $ 100 per violation.
COBRA
Section 105 Medical Plans repayment are health plans subject to COBRA. Under COBRA, employees who experience a qualifying event are entitled to continuation coverage under the employer's plan. An employer who fails to extend COBRA coverage to participants may be subject to substantial fines. Employers can be fined up to $ 110 per day for failure to provide notice or notice initial election. Learn more about COBRA and Section 105 plans.
Medicare reports
Section 105 Medical Plans repayment are group health plans subject to secondary insurance Payer (MSP) provisions. Employers are required to provide coverage information for the Centers for Medicare and Medicaid Services (CMS). The information provided to CMS will allow better coordination of responsibilities between paying the group health plan and Medicare. Failure to comply could result in fines up to $ 1,000 per day.
Plan Documents
Section 105 medical reimbursement plans are defined as level of welfare of employees under ERISA. ERISA requires that each plane [welfare] be established and maintained pursuant to a written instrument. The document of the instrument or written plan serves to define what expenses are eligible for reimbursement, the amount of the employer contribution, and the funds can be rolled over from year to year. Not only enforcement action may be brought against an employer for failing to have a plan document, but it is difficult for the employer to prove the terms of the plan and enforce its provisions. Learn more about Section 105 plan documents.
ERISA-Compliant Repayment of individual health plans
The US federal government has specific regulations that employers must meet in order to reimburse employees for individual health insurance premiums without triggering ERISA plan status for individual policies of insurance. Learn more about ERISA compliant repayment individual policy
Editor's Note :. This post has been updated with the latest information on health insurance. The article was published in June 2014.
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