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Question: Can an employee change a pretax plan election after the employer’s open enrollment window has closed but before the plan year has begun? Are there any potential downsides for allowing this?

Answer: Yes, an employee may make a change to his or her benefit election after open enrollment has ended but before the plan year begins. However, there are potential downsides for allowing such a practice.

In general, open enrollment is a period of time set by the employer for employees to enroll, terminate, and/or make changes to their existing benefit elections for the following plan year. The purpose of the deadline is to ensure timely and accurate administration of such elections, and to treat employees similarly.

In deciding how to handle this situation, the employer would want to consider:

  • Does the insurance carrier or the group policy have specific requirements?
  • If an exception is made, other employees must also be allowed to change their elections after the open enrollment deadline. Employees must be treated similarly; the employer cannot make an exception for one person.
  • How clear were the open enrollment written communications in stating changes could not be made after the deadline (except in connection with a qualifying event)? Employers must make sure their communications clearly state when and how changes may be made after the deadline.

Allowing changes after the deadline typically involves more work on behalf of the administrator, subjects employees to coverage and claims errors, and leaves employees with the understanding that exceptions will be allowed. Employers should review their policies carefully and make sure they are clearly communicated.

This article originally appeared on ThinkHR.com

Fall.  With it comes cooler temperatures’, falling leaves, warm seasonal scents like turkey and pumpkin pie, and Open Enrollment.  It goes without saying; employees who understand the effectiveness of their benefits are much more pleased with those packages, happier with their employers, and more engaged in their work. So, as your company gears up for a new year of navigating Open Enrollment, here are a few points to keep in mind to make the process smoother for both employees and your benefits department. Bonus: it will lighten the load for both parties alike during an already stress-induced season.

Communicate Open Enrollment Using a Variety of Mediums

Advertise 2018 benefit changes to employees by using a variety of mediums. The more reminders and explanation of benefits staff members have using more than one mode of media, the more likely employees will go into Open Enrollment with more knowledge of your company’s benefit options and when they need to have these options completed for the new year.

  • Consider explainer videos to simplify the amount of emails and paperwork individuals need to review come Open Enrollment time. These videos can increase the bottom line as well, eliminating the high cost of print material.
  • Opt for placards placed throughout your high-traffic areas. Communicate benefit options and remind employees of Open Enrollment dates for the new year by posting in such areas as the lobby, break room and bathroom stalls.
  • Choose SMS texting. Today, over 97% of individuals use text. Ninety-eight percent of those that use text open messages within the first three minutes of receiving them; 6-8 times higher than the engagement rate for email. Delivering a concise message to employees’ mobile devices creates more touch points along the Open Enrollment journey. The key, however, is making it quick so as to entice your employees to take action.
  • Promote apps and in-app tools. Push notifications and apps like Remind 101 can help drive employee engagement during Open Enrollment season simply by providing short messages reminding them to enroll. Notifications like these can also be tailored to unique employee groups based on location, job level, eligibility status and more.

Utilize Mobile Apps and Web Portals for Open Enrollment

Now that your company has communication down pat for Open Enrollment, simplify the arduous task employees have of enrolling for the coming year by going paperless. Utilize web portals through benefit brokers and companies like ADP to eliminate the hassle of employees having to fill out paperwork both at renewal, and at the time of hire.  With nearly three quarters of individuals in the United States checking their phone once an hour and 90% percent of this time is spent using one app or another as a main source of communication, mobile apps can make benefits engagement much easier due to the anywhere/anytime accessibility they offer.

The personal perks for employees are great too! Staff members with a major lifestyle event can make benefit adjustments quickly with the ease of mobile apps.  Employees recognize this valuable and time-saving trend and enjoy having this information at their fingertips.

Open Enrollment season can be a stressful time but hopefully these tips will help for a smoother transition into the next year for your business. Simple things like using explainer videos, placing reminders in high traffic areas and utilizing mobile apps and text messaging can save time and stress in the long run for your employees and benefit department.

It’s not surprising that 2017 stands to be the year many will have an experience to share using a Telemedicine or a Virtual Doctor service. With current market trends, government regulations, and changing economic demands, it’s fast becoming a more popular alternative to traditional healthcare visits.  And, as healthcare costs continue to rise and there are more strategic pricing options and digital models available to users, the appeal for consumers, self-insured employers, health systems and health plans to jump on board is significant.

In a recent study conducted by the Aloft Group on the state of Telemedicine, 47.7% of respondents weren’t sure about what Telemedicine meant, but it’s possible they may have experienced it, as 52.4% have had interaction with a physician or clinician via email or text. Further, 78.5% of respondents indicated they would be comfortable talking with a physician using an online method.

Dr. Tony Yuan, an experienced ER doctor in San Diego, who also consults for Doctor on Demand, provides insight into this increasing trend during a recent Q and A session. Currently, over half of the patients he sees in his ER could utilize a digital healthcare model. In fact, 90% of patients who head to the ER for minor illnesses can be treated through this service. So, the next sinus, ear infection, or other minor health issue just may provide you and your family the chance to try what will become the new standard in minor healthcare.

Here are few benefits TeleMedicine has to offer:

It’s Fast and Simple

There’s no question apps are available for everything to make our lives easier—and TeleMed is no exception. Within minutes, standard first time users can set up an account, complete a few medical profile questions, then create and save a session. Having the ability to log on with a board-certified physician or clinician 24/7/365, using any PC, smart device, and even phone in some cases, saves time and money. Many services, like Teledoc and MDLive, will connect you with a licensed doctor or clinician online in just a few minutes – no scheduling or wait required. Once on, you can discuss your healthcare needs confidentially. After the visit, the doctor will update his/her records, notify your primary care physician of the call, and send an electronic prescription to the pharmacy of your choice, if necessary—all in the time it takes for a lunch break.


It’s Flexible

The ability to connect with a professional whether you are at home, work, or traveling makes getting the care you need invaluable. How often have you experienced the symptoms—or the full blown-effect—of getting sick while traveling? Many, no doubt, have had to adjust flight/travel plans to get the help needed from their PCP, in order to avoid getting worse.  By using an app or online service from your smart phone or laptop, you’re able to get the antibiotics you need quicker without cutting trips short or missing work to do so.


In addition, patients in smaller communities without the resources available of classically- trained, emergency-med physicians, see the benefit and flexibility of tapping into these online doctor services. Not only is it a plus for the patient to access more advanced care if needed, doctors in these rural areas value this as well. These digital healthcare models provide immediate, life-saving tools for both doctors and their patients who may not have access to higher, acute facilities.


It’s Affordable

Many TeleMedicine services now accept insurance, making a patient’s visit free, or at minimum the same as most deductible or co-insurance amounts for office visits; around $40. For those on a high-deductible plan, paying $40 for an online doctor service is a much cheaper alternative than paying $150 or more for an Urgent Care visit, or over $1200 for a trip to the ER. For employers, group options are low cost and can be a clear asset when creating solutions EEs will value.


It’s Beneficial to Employers

Today, 3 of 5 corporations, or 59% of employers provide digital healthcare benefits to their employees. As an employer, the benefits are straightforward. First, employees can participate in professional consultations for their family members or themselves without taking away from productivity. Second, when employers incorporate these services into their benefit plans, non-emergency care is redirected from expensive ER visits, ultimately saving thousands of dollars or more to the bottom line. Additionally, TeleHealth services offer frequent monitoring from clinicians for those employees who may need regular support due to more chronic issues, reducing trips to the hospital. Reducing these costs have a direct ROI for the employer and relieves the stress on the employee’s pocketbook. Third, many companies are now adding this digital benefit to their packages as a way to recruit new talent.


There’s no doubt 2017 will see a greater opportunity for all to experience the increasing trend of Telemed. Creating a clear communication strategy to make sure employees know how to find, access and utilize this service to the highest potential is key.

A fixed indemnity health plan pays a specific amount of cash for certain health-related events (for example, $40 per office visit or $100 per hospital day). The amount paid is neither related to the medical expense incurred, nor coordinated with other health coverage. Further, a fixed indemnity health plan is considered an “excepted benefit.”

Under HIPAA, fixed dollar indemnity policies are excepted benefits if they are offered as “independent, non-coordinated benefits.” Under the Patient Protection and Affordable Care Act (ACA), excepted benefits are not subject to the ACA’s health insurance requirements or prohibitions (for example, annual and lifetime dollar limits, out-of-pocket limits, requiring individual and small-group policies to cover ten essential health benefits, etc.). This means that excepted benefit policies can exclude preexisting conditions, can have dollar limits, and do not legally have to guarantee renewal when the coverage is cancelled.

Further, under the ACA, excepted benefits are not minimum essential coverage so a large employer cannot comply with its employer shared responsibility obligations by offering only fixed indemnity coverage to its full-time employees.

Some examples of fixed indemnity health plans are AFLAC or similar coverage, or cancer insurance policies.

Recently, the IRS released a Memorandum on the tax treatment of benefits paid by fixed indemnity health plans that addresses two questions:

  1. Are payments to an employee under an employer-provided fixed indemnity health plan excludible from the employee’s income under Internal Revenue Code §105?
  2. Are payments to an employee under an employer-provided fixed indemnity health plan excludible from the employee’s income under Internal Revenue Code §105 if the payments are made by salary reduction through a §125 cafeteria plan?


By Danielle Capilla, Originally Published By United Benefit Advisors

On October 3, 2016, federal officials posted the 2016 Transitional Reinsurance Program Annual Enrollment Contributions Form that health insurers and self-funded plan sponsors (employers) will use to make required payments under the Transitional Reinsurance Program (TRP). The 2016 report is due no later than November 15, 2016.


The Affordable Care Act (ACA) prohibits insurers from rejecting applicants based on their health status or pre-existing conditions. To spread the financial risk of this change across insurance markets, the ACA also established the Transitional Reinsurance Program (TRP). The program raises revenue to help fund high-risk insurance pools by imposing a mandatory contribution on health insurers and employers with self-funded health plans (contributing entities). Contributions are collected annually for each calendar year from 2014 through 2016.

For 2016, the reinsurance contribution amount is $27 per plan enrollee per year. (The 2014 amount was $63 and the 2015 amount was $44.)

Self-Funded Health Plans

Insurers and health maintenance organizations (HMOs) are responsible for reporting and paying the reinsurance contribution for insured plans. The employer policyholder does not have any duties under the TRP for any group insurance plans.

For self-funded health plans, however, the plan sponsor (employer) is responsible for reporting its enrollment count and paying the appropriate contribution. Although a third-party administrator may handle duties on behalf of the self-funded plan, the employer as plan sponsor remains responsible for accuracy and timeliness.

The reinsurance contribution applies only to health plans that provide minimum value. To confirm whether a particular plan provides minimum value, refer to the plan’s Summary of Benefits and Coverage (SBC). Minimum value plans typically are major medical and HMO plans that provide benefits covering at least 60 percent of allowable costs.

The reinsurance contribution does not apply to the following plans:

  • Stand-alone dental and/or vision plans.
  • Carve-out prescription drug plans.
  • Health flexible spending accounts (FSAs).
  • Integrated health reimbursement arrangements (HRAs).
  • Health savings accounts (HSAs).

Exception for Certain Self-Funded Self-Administered Plans

For 2015 and 2016 only, group health plans that are both self-funded and self-administered are exempt from the reinsurance contribution requirement. Plans that do not use a third-party administrator for “core administrative functions,” such as claims processing or adjudication or plan enrollment, may qualify for the exception. The majority of self-funded, self-administered plans are union trust plans, so this exception is not widely available outside of the multi-employer plan environment.

Enrollment and Contribution Submission Form

Contributing entities must register on www.pay.gov. (Entities that created a Pay.gov account for earlier years may use the account this year.) Once registered, the contributing entity will use the online form to enter their identifying information and 2016 enrollment counts.(If reporting for four or more entities, supporting documentation also is required.) Access the 2016 form directly at 2016 Transitional Reinsurance Program Annual Enrollment Contributions Form or by going to www.pay.gov, then searching for “2016 ACA Transitional Reinsurance.”

The form automatically calculates the plan’s required annual reinsurance contribution based on the enrollment count. To complete the form, entities also must enter payment information (e.g., bank account info) and schedule their payment dates(s). The two payment schedule options are to pay the total contribution by January 17, 2017, or to pay in two installments by January 17, 2017 and November 15, 2017.

Several different methods are allowed to determine the plan’s enrollment count:

  • Actual count method.
  • Snapshot method.
  • Form 5500 method.

These three methods are similar to the methods used to determine the Patient-Centered Outcomes Research Institute (PCORI) fee. For the reinsurance contribution, however, the actual count and snapshot count methods are based on enrollment in the first nine months of the calendar year, regardless of when the health plan year begins and ends.

Employers may use Employee Retirement Income Security Act (ERISA) plan assets (e.g., employee contributions) to pay some or all of the plan’s reinsurance contribution.

Key Dates for 2016 Reinsurance Contribution

  • By November 15, 2016, submit enrollment count and schedule payment date(s).
  • By January 17, 2017, remit 2016 contribution:
    • If paying 2016 amount in single installment: $27 per covered life.
    • If paying in two installments: $21.60 per covered life.
  • By November 15, 2017, remit 2016 contribution (second installment, if any): $5.40 per covered life.

More Information

For step-by-step instructions to complete the 2016 Form, register on the CMS REGTAP page, and then search for “2016 Reinsurance Contributions.”. This web-based training was developed by the Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for the TRP, to assist contributing entities. CMS also will respond to specific questions sent to ReinsuranceContributions@cms.hhs.gov.

Entities are encouraged to allow enough time to review the training site and understand the requirements. Entities that made reinsurance contributions for 2015 are familiar with the process. Entities that are responsible for the first time this year should not wait until November to begin preparing their submission. Also, if reporting for four or more entities, supporting documentation will be required and must be submitted using specific file formats.

Employers, brokers, and other interested parties may access the web-based training site at https://www.regtap.info/index.php.

The deadline for contributing entities to complete the 2016 form is November 15, 2016.

Originally published by www.thinkhr.com

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