Broad Reach Benefits

Plan Design and Considerations Based on Section 1557 of the ACA and the Civil Rights Act of 1964

Employers that sponsor group health plans have many regulations to consider in their plan design choices, including nondiscrimination regulations. One of the newest sources of nondiscrimination rules is Section 1557 of the Patient Protection and Affordable Care Act (ACA). Employers also have to consider overarching laws and regulations that impact both their employment practices and their group health plans, such as the Civil Rights Act of 1964.

In recent years disparate treatment on the basis of sex, particularly gender identity and sexual orientation, has been a hotbed of discussion and litigation. Adding additional confusion has been shifts in interpretations and enforcement of Section 1557 between the last three presidential administrations.

Employers should be sure to consider the impact of both Section 1557, and the Civil Rights Act of 1964 as they make benefit plan design choices, as well as in developing overall employment practices.

Civil Rights Act of 1964 and Bostock v. Clayton County

The Civil Rights Act of 1964 is an important law that is both a civil rights and labor law and on its basic level outlaws discrimination on the basis or race, color, religion, sex, or national origin. More specifically under Title VII, which governs equal employment opportunity, it is unlawful for an employer to fail or refuse to hire or to discharge any individual, or otherwise to discriminate against any individual with respect to his compensation, terms, conditions, or privileges of employment for any of the basis of race, color, religion, sex, or national origin.

The heart of the most recent Supreme Court ruling on Title VII in Bostock v. Clayton County was an employee’s “sex” included an employee’s sexual orientation or gender identity, therefore, protecting an employee from […]

By |May 14th, 2021|Broad Reach Benefits, Compliance, Employee Benefits, Health Care Reform, Human Resources, Legislation, Medical|Comments Off on Plan Design and Considerations Based on Section 1557 of the ACA and the Civil Rights Act of 1964

DOL Releases Model Notices and Other Resources Related to COBRA Premium Assistance

On April 7, 2021, the U.S. Department of Labor (DOL) released a link to its webpage dedicated to the COBRA premium assistance authorized under the American Rescue Plan Act, 2021 (ARPA), the third COVID-19 stimulus bill.  The webpage includes model notices, frequently asked questions, and related information.  With the exception of the model notices, the guidance appears targeted towards impacted workers, leaving many employer-related questions unanswered.  This alert summarizes the recent guidance and model notices.

What does ARPA Provide and Who is an Assistance Eligible Individual?

Among other things, the ARPA provides a 100% subsidy for COBRA premiums for group health plans (other than health FSAs) from April 1, 2021 through September 30, 2021 for assistance eligible individuals (AEIs).  AEIs are employees and their family members who are:

  • eligible for, and enroll in, COBRA (or state mini-COBRA) due to a reduction in hours or involuntary termination of employment;
  • not eligible for other group health plan coverage or Medicare; and
  • still within their maximum COBRA continuation coverage period (generally, 18 months).

AEIs include individuals newly eligible for COBRA between April 1, 2021 and September 30, 2021, individuals who were in their COBRA election period as of April 1, 2021, and individuals who would be AEIs but whose COBRA coverage lapsed due to non-payment prior to April 1, 2021.  AEIs also include any qualified beneficiaries, such as family members, who did not elect COBRA continuation coverage when first eligible.  Generally, this means an employee (and their qualified beneficiaries) with a COBRA start date on or after November 1, 2019, would have one or more months of eligibility for the COBRA subsidy.  Therefore, employers should identify any employees involuntarily terminated or whose hours were reduced on or after […]

By |April 8th, 2021|Broad Reach Benefits, Employee Benefits, Employee Benefits Adviser, Employee Communications, Health Care Reform, Human Resources, Medical, Private Health Care Exchange, U.S. Department of Labor, Voluntary Benefits, Wellness|Comments Off on DOL Releases Model Notices and Other Resources Related to COBRA Premium Assistance

Health Plan Rules—Treating Employees Differently

Some employers may want to be selective and treat employees differently for purposes of group health plan benefits. For example, employers may consider implementing the following plan designs:

-A health plan “carve-out” that insures only select groups of employees (for example, a management carve-out);

– Different levels of benefits for groups of employees; or
– Varied employer contribution rates based on employee group.

In general, employers may treat employees differently, as long as they are not violating federal rules that prohibit discrimination in favor of highly compensated employees. These rules currently apply to self-insured health plans and arrangements that allow employees to pay their premiums on a pre-tax basis. The nondiscrimination requirements for fully insured health plans have been delayed indefinitely.

Employers should also confirm that any health plan rules do not violate other federal laws that prohibit discrimination. In addition, employers with insured plans should confirm that carve-out designs comply with any minimum participation rules imposed by the carrier.

Health Plan Design—General Rules

Nondiscrimination Tests

In general, a health plan will not have problems passing any applicable nondiscrimination test when the employer treats all of its employees the same for purposes of health plan coverage (for example, all employees are eligible for the health plan, and the plan’s eligibility rules and benefits are the same for all employees). However, treating employees differently may make it more difficult for a health plan to pass the applicable nondiscrimination tests. Examples of plan designs that may cause problems with nondiscrimination testing include:

  • Only certain groups of employees are eligible to participate in the health plan (for example, only salaried or management employees);
  • The health plan has different employment requirements for plan eligibility (for example, waiting periods and entry dates) for different employee groups;
  • Plan […]

How Many Years Is A One Year Extension? DOL Clarifies its Disaster Relief Guidance

The Department of Labor (DOL) has released Notice 2021-01, which clarifies the end date for the relief provided in April 2020 under Notice 2020-01. Per the latest guidance, individuals (and plans) are granted relief based on their own fact-specific timeframes and, therefore, may still take advantage of the relief beyond February 28, 2021 until the earlier of (a) 1 year from the date they were first eligible for relief, or (b) 60 days after the announced end of the COVID-19 National Emergency.

As background, in April 2020 the DOL announced that certain deadlines under ERISA were suspended starting March 1, 2020 until 60 days after the announced end of the COVID-19 National Emergency or such other date determined by the agencies (the “Outbreak Period”). The following deadlines applicable to participants and beneficiaries are tolled (paused) during the Outbreak Period:

  • The 30-day period (or 60-day period, if applicable) to request a HIPAA special enrollment;
  • The 60-day period for electing COBRA continuation coverage;
  • The date/deadline for making COBRA premium payments;
  • The deadline for individuals to notify the plan of a COBRA qualifying event or determination of disability;
  • The deadline within which employees can file a benefit claim, or a claimant can appeal an adverse benefit determination, under the group health plan or disability plan claims procedures described in the plan;
  • The deadline for claimants to file a request for an external review after receipt of an adverse benefit determination or final internal adverse benefit determination; and
  • The deadline for a claimant to file information to perfect a request for external review upon finding that the request was not complete.

Certain deadlines impacting employers/plan sponsors were also extended, such as the deadline to provide a COBRA election […]

By |March 1st, 2021|Broad Reach Benefits, Compliance, Employee Benefits, Human Resources, Legislation, Medical, Private Health Care Exchange, U.S. Department of Labor|Comments Off on How Many Years Is A One Year Extension? DOL Clarifies its Disaster Relief Guidance

Alera Group Employees Relieve $1.35M of Medical Debt Across NJ

Alera Group, Inc. employees announced their alleviation of $1.35 million of medical debt for families located across the state of New Jersey through two of its New Jersey based divisions, CRISP and Broad Reach Benefits. This gift is part of approximately $19 million in healthcare debt being relieved by Alera Group employees for struggling households across the country, an effort that began during the 2020 holiday season and remains open for contributions today. Alera is one of the youngest and fastest growing privately held, national insurance brokerage firms in the country.

Alera employees worked directly with the debt-forgiveness nonprofit, RIP Medical Debt, to identify individuals and families with outstanding healthcare-related bills in more than 200 cities located in 35 counties across the country. Founded by two former debt collectors, RIP is able to purchase medical debts for those most in need in bundled portfolios for a fraction of their face value.

“The global pandemic has impacted the lives of millions of people across the country, with so many families struggling to pay off soaring medical bills associated with getting sick in this environment,” stated David Russo, a partner at CRISP. “Giving back to the local communities in which we live is at the heart of what Alera Group stands for, and we are proud to be part of such an incredible initiative that is easing the worries of families across New Jersey during these challenging times.” 

Rather than waking up to the knocking of a debt collector, thousands of Americans will receive letters of forgiveness to alert them of the gift from Alera employees. These letters will be delivered by March 2021 and beyond, targeting individual and families living below 200% of the poverty […]

By |February 16th, 2021|Broad Reach Benefits, Employee Benefits Adviser, Employee Communications, Medical, Uncategorized|Comments Off on Alera Group Employees Relieve $1.35M of Medical Debt Across NJ