Employer Health Plans Team
Our Knowledge in Employer Health Plans Team
Businesses spend between 7-15% of their annual revenues on health care for their employees, and this percentage has been increasing annually. We provide the advice employers need to develop a health care coverage strategy that considers the employer’s budget, employee benefit objectives, and applicable law. Our team does not replace the valuable services provided by insurance brokers and other consultants, rather the services we provide complement their work. We help to ensure that our clients comply with the myriad of laws applicable to their health and welfare benefits. We keep current on the sometimes daily changes in the regulations that affect employers and provide an unbiased review of an employer’s health care plans and options.
The following are some examples of the services we provide to our clients.
- The ACA (pay or play, reporting and disclosure) and monitor anticipated changes;
- HIPAA, HIPAA privacy, and HIPAA HITECH;
- Tax laws applicable to health and welfare benefits;
- COBRA and state law coverage continuation requirements;
- ERISA, including reporting and disclosure and fiduciary requirements;
- Mandated benefit requirements, such as the Mental Health Parity Act;
- The ADA and other labor laws as applied to health and wellness programs; and
- The Medicare secondary payor rules.
Review and Assess:
- Cybersecurity issues in employer health programs and service provider arrangements;
- Health plan coverage provisions of employment and severance agreements, including the special tax issues for self-funded health plans and other potential tax issues (e.g., Code section 409A);
- Implications of judicial and regulatory guidance, such as gender identity issues under Title VII and the ACA;
- The tax implications of sick leave and other PTO conversion plans and design options;
- ERISA fiduciary concerns in pharmacy benefit manager (“PBM”) and other administrative services contracts;
- Religious rights under the Religious Freedom Restoration Act and other laws.
Design and Maintain:
- Self-funded and insured health and welfare plans;
- Wellness programs;
- Health reimbursement account (“HRA”) and health savings account (“HSA”) programs;
- Health plan funding vehicles, such as VEBAs under Code section 501(c)(9);
- Post-employment and retiree medical programs; and
- Cafeteria plans and flexible spending accounts (“FSAs”).
Timothy C. McDonald
Employer Health Plans Team Professionals
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