Getting Prepared for a Department of Labor ACA Compliance Audit – Best Practices

The Department of Labor is stepping up its enforcement activities when it comes to the Affordable Care Act. Now that businesses have had since 2010 to anticipate and adjust to requirements, and they’ve had a year to work out teething problems since the employer mandate became effective in 2015, the Administration is serious about ensuring that employers fulfill their responsibilities under the Act.

Penalties for failure to comply with the ACA’s requirements are severe and potentially devastating to small businesses, with fines amounting to as high as $250 for missing returns or documents per incident, up to $3 million.

While the topic is extremely broad, here are some of the subjects you need to be prepared to discuss and show documentation to prove compliance when the audit takes place.

 

Plan communication requirements

  • Have a complete summary plan description on file.
  • Show proof that you have adequately communicated your employees’ right to extend benefits to qualified adult children up to age 26.
  • Show proof that you have communicated women’s health care rights under the Affordable Care Act.
  • Provide copies of employee enrollment applications.
  • Provide copies of documents describing both worker and employer responsibilities regarding payment of premiums.

 

Best practices

  • Appoint a health care czar internally – an experienced manager with a strong background or interest in HR and benefits management to be your company’s subject matter expert (SME) regarding health plan administration and requirements.
  • Appoint an experienced administrator or manager with responsibility for tracking audit requirements and compliance status. This could be the same person as the SME mentioned above, or it could be a staffer who reports to him or her within your human resources office. Either way, ensure that there is specific accountability for ACA compliance requirements, and that the persons responsible know what their jobs are regarding ACA compliance.
  • Consult official IRS and Department of Labor sources, beginning with IRS Publication 5196 – Understanding Employer Requirements of the Health Care Law.
  • Have a solid handle on the IRS criteria for full-time employees, and know exactly who they are at all times. You don’t want to be blindsided when the auditors look at actual hours worked and tell you that a long-time worker whom you thought was part-time is actually a full-time worker.
  • Have employees sign for all key health care plan documents, or email them with return receipts requested. You may duplicate the effort by mailing certified letters to employees’ addresses.
  • Provide this individual with adequate time, resources and staff to accomplish his or her tasks. Ensure he or she receives the cross departmental cooperation needed to ensure your company is prepared for the audit. Audit yourself. Don’t wait for an audit notice from the Department of Labor to get the ball rolling. Have a practice audit internally, and ensure managers follow up and correct deficiencies. Do this regularly, using a quality checklist, and you will have little to fear from the Department of Labor inspectors. Here is the official Department of Labor Self-Audit Checklist pertaining to ACA and the health care components of the Employee Retirement Income Security Act (ERISA).
  • Invest in the education your staff needs to be effective in your compliance effort, ahead of time. This may mean sending staff to in-service training, webinars, seminars and workshops with other HR professionals or vendors.
  • Outsource your compliance effort to specialists and outside vendors, where appropriate, but ensure those vendors are doing their jobs. After all, if the vendor drops the ball, you are still responsible for any fines and penalties.
  • Notify your benefits broker or agent as soon as you receive notice that you are slated for an audit. Many times, these brokers or their home offices have resources, tips and tools to help you manage your compliance effort.
  • Cooperate fully with Department of Labor officials during the audit. Don’t attempt to ‘stonewall.’ Stay in their good graces, and you will often find you can correct small deficiencies on the spot rather than be charged with violations and fines.

Why Did Your Car Get Recalled and What Should You Do About It?

Statistics show that cars today are getting safer. The number of traffic fatalities has fallen since 2006, though they increased in 2015. However, even with improved design, vehicle components sometimes fail and require replacement or repair. In these situations, regulators require car manufacturers to recall the vehicles.

The National Highway Traffic Safety Administration requires  recalls when vehicles have safety-related defects or when they fail to meet Federal safety standards. Safety defects can include problems such as:

  • Accelerator controls that may break or stick
  • Faulty windshield wiper assemblies
  • Air bags that deploy when they are not supposed to
  • Fuel system components that may leak after a collision
  • Wiring systems that may ignite fires or cause the lights to fail

Not every defect is subject to a recall. For example, a malfunctioning stereo system would not spur a recall.

Often, carmakers initiate recalls voluntarily; other times, recalls occur following NHTSA investigations or orders. Carmakers must notify the NHTSA and vehicle owners, distributors and dealers when they learn of safety defects. They must then correct the defect free of charge to the vehicle’s owner.

Car manufacturers have three options when they recall vehicles: Repair the problem, replace the vehicle or component, or refund the owner’s money. The manufacturer will inform the owner of which options are available at the time they give notice of the recall. When a car owner receives a recall notice and an offer of a free repair, he should make an appointment as to have it serviced by an authorized dealer as soon as possible. Before the appointment, he should follow any safety guidance the manufacturer may provide.

Concerned vehicle owners can also report safety issues to the NHTSA. The agency has a web site, safercar.gov, where owners can file complaints about their cars. If the agency receives enough similar complaints from a large number of car owners, it may open an investigation into the issue. An investigation may lead to the agency ordering a recall.

Any vehicle owner can easily find out if there are outstanding recalls on his car. Car manufacturer web sites should list all recalls. Owners can also visit safercar.gov and do searches on their vehicles through the vehicle identification number (VIN) and the search results will indicate whether that particular vehicle has been recalled.

Another government web site, www.recalls.gov, provides information about car recalls in addition to recalls of vehicle equipment, tires, and child safety seats. The site also enables users to sign up for email alerts when recalls for any of these are announced. Safercar.gov also offers a free smartphone app to notify vehicle owners about recalls and to enable them to easily submit complaints.

A visit to safercar.gov shows dozens of vehicle recalls for things such as transmissions that shift into neutral without warning, misrouted fuel lines, and leaky transmission hoses. Car owners should act on these recalls without delay. Prompt repair of these problems will help ensure that drivers and passengers will get to their destinations safely.

The 10 Most Costly Property Damage Catastrophes in U.S. History

Natural disasters, fires, explosions, terrorist incidents – these all cause horrendous loss of life and injuries. They also cause huge amounts of property damage, leaving the property owners to clean up the ruins, try to put their lives and businesses back together, and rebuild. Their insurance companies bear much of the cost.

For property owners, the events on the following list were the ten worst catastrophes in the United States as of June 2016. The dollar amounts are insured property losses, adjusted for inflation to reflect 2014 prices, and not including losses paid by the National Flood Insurance Program.

10. In April 2011, 355 tornadoes swept through large portions of the U.S. and southern Canada. The cities of Tuscaloosa and Birmingham, Alabama were especially hard hit. In all, 348 people died and insured property damages totaled $7.652 billion.

9. Hurricane Ivan caused insured damage to the tune of $8.639 billion when it hit Florida and Texas in September 2004.  54 Americans were killed. More damages and fatalities occurred in Carribean and South American countries.

8. A month before Ivan, Hurricane Charley did more than $9 billion in damage in Florida and the Carolinas. 80 percent of the buildings in Charlotte County, Florida were destroyed, include one-third of the schools.

7. Hurricane Wilma in October 2005 would have been the worst storm in any other year. It hit Florida late that month and caused $12.125 billion in damage.

6. Hurricane Ike in September 2008 left $13.6 billion in damage in Texas and Louisiana. Fatalities totaled 112. The emergency closure of Texas oil refineries also caused a jump in fuel prices.

5. A massive earthquake struck the greater Los Angeles area in January 1994. The 6.7 magnitude quake killed 57, injured more than 8,000, and caused $18.3 billion in damage.

4. Hurricane Sandy hit the eastern U.S. days before Halloween 2012. When it was over, 160 people were dead, thousands were homeless, and millions were without electrical power. Insured damages were $19.3 billion.

3. Hurricane Andrew devastated Florida and Louisiana in August 1992. It destroyed more than 25,000 homes in Miami-Dade County, Florida alone; another 100,000 suffered severe damage. At $23.8 billion in damage, it held the title as the most costly catastrophe in U.S. history. For nine years.

2. On September 11, 2001, terrorists seized control of four jetliners. Two aircraft struck and destroyed the towers of the World Trade Center in New York City, one struck the Pentagon near Washington, D.C., and the other crashed in a field in rural Pennsylvania. The worst terrorist attack on the U.S. mainland left nearly 3,000 dead, more than 6,000 wounded, and $24.3 billion in damage.

1. The most costly catastrophe in U.S. history was Hurricane Katrina in August 2005. The killer storm wrecked the Gulf Coast and also caused damage in Georgia, Kentucky and Ohio. More than 80 percent of New Orleans was flooded. Over 1,800 people died. Total insured property damage was $48.4 billion, double the cost of the September 11 attacks.

 

Reviewing Life Insurance Every Year Is A Must

Since life circumstances change over time, life insurance policies must be updated to reflect those changes. As a rule, it is best to review coverage at least once per year. When doing this, spend some time pinpointing major life changes over the past year. Meet with a personal agent to go over a list of events to ensure adequate updates. To evaluate current coverage, ask these self-assessment questions:

  • Did marriage status change this year?
  • Were any babies or adopted children added to the family?
  • Did a spouse, child or other dependent family member die?
  • Did personal debt amounts change?
  • Have interest rates changed since the policy was started?
  • Did working or retirement status change?
  • Was there a change in income?
  • Was there a partnership or ownership change in a business?
  • Was a new key employee added to a personal business?
  • Was any money inherited recently?
  • Do parents require financial help?
  • Were there any major health status changes?
  • Did smoking status change?

Some of these criteria such as being a smoker will affect life insurance pricing on the insurer’s end and on the policyholder’s end. Major life events and income or debt changes are good reasons to increase a coverage amount. This is not required by the insurer. However, it is important to leave enough money to cover debts, final expenses and some living expenses for heirs. If there was a significant income increase, a person may want to add more money to a life insurance policy for a child’s future college fund or for an elderly parent’s skilled care.

Also, another topic commonly overlooked by consumers is insuring a spouse who is a stay-at-home caregiver. Men and women who stay home to take care of the house and the children make vital contributions. If they die, the main breadwinner is left with the expense of finding someone to care for the children and the home. Paying for child care and a housekeeper can be expensive. It is important for stay-at-home caregivers to have life insurance as well.

Policy Expiration

Term life insurance is a popular choice. People purchase it for a specific amount of time such as 30 years. If the policy’s term expires without it being renewed, the policyholder is no longer covered. There are other types of policies that do not expire, and the payout and premium remain the same regardless of health or age changes.

A person who buys a term life insurance policy at age 30 for a term of 30 years would pay much less at that point than he or she would pay to renew it at age 60. If the individual started smoking and had multiple health problems, the cost to stay insured would be significantly higher. When choosing life insurance or updating it, always keep a long-term plan in mind. People with term life insurance policies can convert them into permanent policies before they expire.

The right policy choice for each person depends on personal circumstances, health status, age and budget allowances. Although universal life insurance may be a better option than term life insurance, it is more expensive. However, having an affordable term life insurance policy is better than going without life insurance. To learn more about life insurance options and how much coverage to purchase for individual circumstances, discuss concerns with an agent.

Workplace HSA Plans Exploding Due To Cost Savings, Efficiency

Health care costs are stubbornly continuing to rise – and employers are looking for ways to protect themselves and find savings when it comes to providing health insurance for their workers.

Consider: According to the Kaiser Family Foundation, average employer health insurance premiums in 2015 totaled $17,545 per employee – a 61 percent increase over the prior ten years. Employer costs increased from $8,167 to $12,591, while the portion paid by employees increased from $2,713 to $4,955 over the same period.

If left unchecked, these escalating costs will prove devastating to hundreds of thousands of employers. And so they are increasingly turning to high deductible health plans, combined with tax-advantaged health savings accounts that let workers save money tax free for future medical expenses.

Why? Simple: They save money over conventional indemnity plans. The total premium outlay for both workers and employers was $17,545, on average, for family plans, and $6,281 for individuals, for all plan types. But for those workers enrolled in HDHPs, the annual total costs were $15,970 for individual plans, and $5,567 for individual plans, according to the Kaiser Family Foundation.

As a result, interest in high deductible health plans as a cornerstone of the employee health plan has exploded over the last ten years, with the percentage of workers with an HDHP rising from 4 percent in 2015 to 24 percent in 2015. The popularity of these plans – and the increased responsibility they place on plan participants to control costs – has been a key factor in reducing runaway price increases in employee health insurance costs in recent years.

Their popularity is expected to continue to grow: According to the Kaiser Family Foundation’s 2015 Employer Health Benefits Survey, 40 percent of all employers are considering offering only HDHP/HSAs to their work forces over the next three years.

How HDHPs Work

To qualify as an HDHP, the policy must have a minimum annual deductible of $1,300 for individual policies, and $2,600 for family plans, as well as maximum out of pocket limits of $6,550 for individuals and $13,100 for family plans. If one or more plan participants reaches age 55 during the year and at any time thereafter, the maximum contribution is $1,000 higher.

Workers covered by an HDHP who meet certain other eligibility requirements can contribute up to $3,350 to a health savings account, while families can contribute up to $6,750 per year. These contributions are pre-tax, and the money in those accounts is invested tax-deferred until the employee withdraws it. Withdrawals for qualified medical expenses are tax-free. Otherwise the money is taxed as income upon distribution. Participants under age 65 who make a non-qualified withdrawal from an HSA must pay a penalty of 20 percent.

Employers may make pre-tax contributions to worker HSAs provided they have a cafeteria plan in place providing for such contributions. Employer HSA contributions are not subject to income tax withholding, nor are they subject to FICA, FUTA or the Railroad Retirement Act.

Matching contributions won’t work, due to comparability testing rules (unless made via a section 125 cafeteria plan). Employers are not responsible for reviewing medical expenses paid for via the HAS. That’s the employee’s responsibility.

Or more information, or to start a HDHP/HSA workplace program for your company, speak to your insurance or employee benefits professional today.

Why Everyone Needs Life Insurance

People who are considering life insurance usually debate whether they need it or not. If anyone will suffer financially after a person’s death, that person should have life insurance. This death benefit is meant to help surviving family members or dependents cope with the financial difficulties of losing the deceased’s income and paying for final expenses. Life insurance isn’t subject to federal income tax.

In order to determine how much life insurance to buy, it’s important to consider what surviving loved ones would need if death occurred suddenly. Be sure to consider monthly living expenses, debts and final expenses when calculating costs. These are the essentials. There are also several more considerations. For example, college money for surviving children is a beneficial addition to a life insurance funding plan. Long-term financial goals, a surviving spouse’s retirement and several other factors must also be considered. It’s best to speak with a qualified agent to discuss individual needs and determine what amount is sufficient. There are several aspects to consider with purchasing life insurance.

Married Individuals Many couples who get married don’t think they need to purchase life insurance coverage until they have children. However, it’s important to know that the debts of one spouse must be paid by the surviving spouse in most situations. For example, if one of the individuals earns the sole income and has sufficient debt, the surviving spouse with the lesser income would face many serious struggles by inheriting such debt.

Parents With Young Children Whether parents are single or married, it’s important to have enough life insurance to cover the costs of child care and care. If one spouse stays at home and cares for the children, it’s important to be sure that they will all have enough money to live on. It’s also important to have life insurance for the spouse who stays at home to care for the children. Without that spouse in the picture, the cost of transporting and caring for the children will be an issue. It may also be necessary to pay for housekeeping services. Single parents should always make sure that their children will have enough money to survive on. If possible, it’s best to leave extra money to contribute toward their college education.

Parents With Grown Children It’s best for parents with grown children to make sure they leave enough money that their children will be able to pay their final expenses. Married parents with grown children must still consider the needs of their spouses.

Single Individuals Although many singles think they don’t need life insurance, this coverage is beneficial to have. Surviving parents, siblings or other acquaintances may benefit from the money. Aging parents may need extra money for health care. For example, parents who inherit this benefit may be able to afford a private room instead of a shared room in a nursing home.

There are several reasons for any person to purchase life insurance. Even those who have no family members and few friends still have values that are important to them. In these cases, it’s helpful and satisfying to set up a life insurance benefit amount to go to a preferred charity. To learn more about life insurance and what options are best, speak with an agent.

Supply Chain Interruption Insurance Can Help Your Business Survive Another Business’s Disaster

On April 16, 2016, a 7.8 magnitude earthquake struck western Ecuador, killing more than 600 people, injuring another 27,000, and causing $3 billion in damage. At around the same time, two quakes shook Japan, leaving 49 people dead, 3,000 injured and billions of dollars in damage.

In addition to the human and economic cost in these two countries, the disasters impacted businesses around the world. Ecuador exports more bananas and plantains than any other country, shipping them to more than 50 countries. The Japanese quakes suspended production of camera chips, image sensors, motorcycles, cars, electronic display devices, and steel. Businesses in the U.S. rely on imports of these products to meet the needs of their customers. When disasters like these occur, businesses around the world feel the effects.

In addition to making advance arrangements for alternate suppliers, businesses can protect themselves by purchasing two types of insurance: Contingent business interruption and supply chain insurance.

Contingent business interruption, also called business income from dependent properties, pays for a business’s lost profit plus continuing expenses when it must slow or stop operations because of damage to another business’s property. These other businesses can be customers or suppliers. For example, if a motorcycle dealership was left with no bikes to sell because its supplier in Japan suffered a fire, this insurance would make up part of the lost income.

The damage must be caused by a cause of loss that the insurance policy covers, such as fire or a hurricane. This is important because standard property insurance policies do not cover losses caused by catastrophes such as floods and earthquakes.

Supply chain insurance takes contingent business interruption a step further. It covers income lost because of damage to a supplier’s or customer’s property. However, it also covers losses resulting from events that do not cause physical damage. These may include: 

•                Labor disruptions

•                Production process problems

•                Trade disputes

•                Wars

•                Political turmoil

•                Closed roads, bridges, railroads and shipping channels

•                Public health crises

•                Actions by regulators

•                Financial difficulties

 

Businesses often have different tiers of suppliers, with key suppliers in the top tier and less important ones in the lower tiers. It is common for them to insure only the top tier. However, insurers are increasingly offering multi-tier coverage. This applies to the business’s entire supply chain. Multi-tier coverage provides a more comprehensive solution for the business while also spreading out the insurer’s risk.

Some insurers offer options. One lets policyholders choose between measuring losses in terms of gross earnings or number of units from the supplier. Some also offer agreed value coverage, which eliminates penalties for buying amounts of insurance less than the amounts of value at risk.

Businesses should determine where they are vulnerable to supply chain losses and develop backup plans for dealing with unexpected disruptions. These could include reserves of the needed supplies and contracts with alternate suppliers. Insurance can help the business recover from a supply chain loss after the fact. Advance planning can help make that loss as small as possible.