More and more small and medium enterprises are the transition from off the insurance group and self-insured medical reimbursement plans the means to employees free of tax refund for individual health insurance. This article examines ERISA rules for this type of premium reimbursement plans.
What kind of control Preferred Premium Refund plan?
In a preferred control premium refund plan, the employer provides a limited self-insured medical reimbursement plan as healthcare reimbursement commonly referred Plan (HRP) or § 105 Medical Reimbursement Plan.
, the plan is structured so employees to reimburse for eligible health insurance premiums up to a certain monthly health allowance, and b asic preventive health services without any cost sharing.
What is ERISA?
most private sector group health plans are the Covered Employee Retirement Income Security Act (ERISA). Among other ERISA provides protection for participants and beneficiaries in benefit plans (participants rights), including access to the provision of information to plan. these individuals also need to manage the plans (and other trustees) meet the requirements in the law certain standards of conduct in the context of fiduciary duties.
self-insured medical reimbursement plan health plan is a type of group. As such, it must be observed with ERISA required.
Key ERISA rules for premium reimbursement plans
There are two key, ERISA rules must follow premium reimbursement plans.
1. Summary Plan Description
self-insured medical reimbursement plans are employee pension plans under ERISA. ERISA requires every [welfare] plan to have a Summary Plan Description (SPD) and deliver it to each participant copies.
The SPD is the primary vehicle for the participants and to inform beneficiaries about their rights and benefits under their pension plans.
. Tip: a premium refund software vendors Use custom and accurate summary plan descriptions (EPD) to produce, which can be easily updated and distributed with schedule changes
2. ERISA compliance
the US federal government has the employer-specific regulations must be observed in order to reimburse employees for individual health insurance premiums without this ERISA plan status for the individual health insurance.
For example, the employer must be no direct support for individual health insurance or pay directly for them
. Tip: Do not get involved in the purchase or selection of staff of the individual health insurance. Policy
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Pay Other rules control preferred premium reimbursement plans must follow
In addition to ERISA rules tax preferred premium reimbursement plans need these rules and regulations to follow:
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IRS (see: IRS rules for premium reimbursement plans)
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HIPAA Medical Privacy
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COBRA
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Affordable Care Act (ACA)
In future articles we discuss each of these topics in detail. For a complete list of rules and regulations, download the new eBook "101 Compliance".
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