To smoothly reimburse employees for premiums Medicare, employers often choose to use a health care reimbursement plan (HRP) . With HRP, employers can customize a plan that meets the needs of their business while ensuring compliance with federal requirements. However, we are often asked, "Can we do it ourselves?" The answer is, technically yes. However, the compliance requirements for the reimbursement of health insurance can be difficult to navigate and cause unnecessary administrative burdens .
If a company chooses to "Do It Yourself" and self-administer the reimbursement of health insurance, health reimbursement software provides assurance in the following areas.
design plan
When designing an advantageous tax rebate plan, it must comply with the Internal Revenue code while satisfying the affordable care Act "market reforms." This is how a HRP design plan responds:
Internal Revenue code
Designed under Internal Revenue code (IRC) § 105, an HRP allows employers to reimburse employees for qualified medical expenses, as defined by IRC § 213 (d). This includes health insurance premiums and some preventive services.
Affordable Care Act
The implementation of the Affordable Care Act (ACA ) provided additional requirements for group health plans, including § 105 plan templates. These requirements, known as the "market reforms," prohibit both the lifetime and annual limits on essential health benefits and require some preventive services to be covered without cost sharing. A HRP meets these requirements by only allowing reimbursement of insurance premiums (not essential health benefits), and some preventive services (without cost sharing).
Administration
When administering a repayment plan, considerations must be taken to ensure compliance with certain requirements of ACA, ERISA, HIPAA and COBRA. using HRP software like ZaneHealth allows administrative compliance without extensive training or dedicated time requirements Here are some ways that the use of software accounts for these administrative requirements.
Affordable Care Act
in addition to the market reforms on plan design, ACA requirements provide group health plans with administrative guidelines. To ensure administrative compliance with the ACA, an HRP provides:
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The waiting periods for new employees, up to 0 days
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Mid-Year Plan changes with a Notice provided 60 days of Contents modification
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internal and external claims appeal process
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eligibility load until the child reaches the age of 26
ERISA
the security of retirement income Officers Act (ERISA) establishes the fair and equitable treatment requirements for benefit plans social employees. HRP supports them, including ERISA requirements, preventing discrimination among groups of individuals in the same situation.
HIPAA
repayment plans are generally governed by the HIPAA privacy rules. During verification of the proof of payment of eligible medical expenses of an employee, the person or refund of the processing entity will be exposed to the protected health information (PHI) to be kept confidential under HIPAA. To comply, the HRP software handles all claims so that the employer is not exposed to PHI.
COBRA
repayment plans with more than 20 participants are generally subject to COBRA. These employers must give dismissed employees the opportunity to continue their participation in the repayment plan for a period after the employment has ended. HRP software provides easy access to all notices required COBRA.
Plan Documents
Finally, the design of the plan discussed and administrative considerations must be borne by the formal plan documents. The respective documents are required by the Internal Revenue Service (IRS), ERISA and ACA. These are intended to describe the terms and conditions related to the operation and administration of the repayment plan. HRP software provides employers with a personalized document plan HRP Summary of Benefits and Coverage (SBC) and the summary plan description (SPD). Without these documents, the employer may operate the dreaded Shot employer payment .
Conclusion
As you can see by the long sampling requirements, using a DIY software a rebate program can be a wise decision. Although technically possible to administer themselves, compliance requirements are complex and difficult to navigate, resulting in unnecessary administrative time and burden.
What questions do you have on the administration of reimbursement of health? Leave a comment below.
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