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Brown & Brown — Conference Presentation (February 2023)
38 slides from Brown & Brown's conference presentation, February 2023
Slide 1: This Webinar Will Start Momentarily
This Webinar Will Start Momentarily. Thank you for joining us.
Slide 2: Status Changes and HIPAA Special Enrollments
Status Changes and HIPAA Special Enrollments Presented By: Presented by the Regulatory and Michael Beech and Daniel Brady Legislative Strategy Group
Slide 3: Disclaimer
DISCLAIMER Brown & Brown, Inc. and all its affiliates, do not provide legal, regulatory or tax guidance, or advice. If legal advice counsel or representation is needed, the services of a legal professional should be sought. The information in this document is intended to provide a general overview o
Slide 4: HIPAA Special Enrollments
HIPAA Special Enrollments A Coverage Issue
Slide 5: HIPAA Special Enrollments
HIPAA Special Enrollments A HIPAA Special Enrollment Special Enrollment does not apply to: event allows an individual to • Stand-alone dental and vision plans require a group health plan to • Retiree-only plans provide coverage. “Excepted • Insured specific disease policies Benefits” • Most health F
Slide 6: Loss of Other Coverage
Loss of Other Coverage Loss of Coverage Under Another Group Health Plan • The employee, spouse or dependent’s other • The employee, spouse or dependent was coverage was terminated because: covered under the other group health plan when the employer’s plan was first offered, » COBRA has been exhauste
Slide 7: Coverage: Who Is Eligible to Enroll
Coverage: Who Is Eligible to Enroll • Employee may elect coverage for themselves, their spouse and their children » Employee may elect coverage just for the employee only and not cover any dependents » Employee who covered themselves but not their spouse and children may elect coverage for spouse an
Slide 8: Other Special Enrollments
Other Special Enrollments • Marriage • Birth, adoption, placement for adoption or foster care • Must allow at least 30 days for individual to request enrollment • Who can be covered? » Employee, spouse and any newly- acquired dependents may be enrolled » Plans may allow tag-along of other existing d
Slide 9: Additional Special Enrollments
Additional Special Enrollments • Loss of eligibility in the individual market • Loss of eligibility for Medicaid or CHIP coverage • Gaining eligibility under Medicaid or CHIP subsidy for employer-provided coverage » Individual must request enrollment within 60 days of becoming eligible » Plan must a
Slide 10: When Must Coverage Begin?
When Must Coverage Begin? Birth, adoption, placement for adoption or foster care Marriage or loss of other coverage The date of the event No later than the first of the month following the date of the request BROWN & BROWN | 10
Slide 11: What Coverage Can Be Elected?
What Coverage Can Be Elected? • For HIPAA Special Enrollments, coverage HIPAA Special Enrollments do option change may be made by the not allow employees to drop participant for any benefit package offered to coverage (unless there is an participants at open enrollment intervening status change). BR
Slide 12: Cafeteria Plan Status Changes
Cafeteria Plan Status Changes
Slide 13: Cafeteria Plans – IRC 125
Cafeteria Plans – IRC 125 • Must be in writing • Must offer a choice between a qualified benefit or taxable cash » Qualified benefit = health plan, dependent care FSA, health FSA, etc. » Taxable cash = the employee's regular, non-reduced taxable wages • Annual elections are made before the benefit b
Slide 14: Election Rules
Election Rules • Benefit elections are irrevocable except for a change in status • Only the employee is allowed to make, revoke or change elections • Elections are not required to be on paper documents - electronic media may be used BROWN & BROWN | 14
Slide 15: Status Changes: The General Rules
Status Changes: The General Rules • A plan is not required to allow any pre-tax • Plan terms can require election changes be election change, or a plan may be selective made within a specified period in which changes are allowed » The 31-day status quo is not mandated • Status changes must be prospe
Slide 16: Status Changes: The General Rules
Status Changes: The General Rules Tag-Along Rule • The preamble to the final regulations indicates that dependents directly affected by the status change event plus other dependents may be added on a pre-tax basis, if allowed under the terms of the applicable benefit plan • Remember HIPAA Special En
Slide 17: Status Changes: The General Rules
Status Changes: The General Rules • The status changes affecting group health plans generally apply to the medical, dental and vision plan » These all provide coverage for medical issues per IRC 213(d) Remember: Status Changes • HIPAA Special Enrollments generally apply are all about changing pre-ta
Slide 18: Special Election Rule for New Employees
Special Election Rule for New Employees • A cafeteria plan may provide new employees 30 days after their hire date to make an election » The election is effective as of hire date » However, salary reduction amounts used to pay for such an election must be from compensation not yet currently availabl
Slide 19: Status Changes: The General Rules
Status Changes: The General Rules HIPAA Special Enrollments • Loss of other coverage » Loss of eligibility; exhaustion of COBRA; employer ceases contributions Special Enrollments provide the right to • Gaining eligibility under Medicaid or CHIP subsidy mid-year coverage for employer-provided coverag
Slide 20: The Status Changes
The Status Changes Change in Marital Status Change in Number of Dependents • Events that change an employee’s • Events that change an employee’s marital status including: number of dependents, including: » Marriage » Birth » Death of a spouse » Death » Divorce, legal separation or » Adoption and pla
Slide 21: The Status Changes
The Status Changes Change in Employment Status that Affects Eligibility for the Plan or Benefit: • Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual’s eligibility under a cafeteria plan including: » Commencement or loss of employment »
Slide 22: The Status Changes
The Status Changes Gain or Loss of Dependent Status • Event causing an employee’s dependent to satisfy or cease to satisfy the eligibility requirements for coverage • An increase or decrease in the number of family members or dependents who may benefit from coverage under the plan BROWN & BROWN | 22
Slide 23: The Status Changes
The Status Changes A change in the place of residence of the employee, spouse or dependent • Example: Moving out of an HMO service area affecting eligibility Adoption • Commencement or termination of an adoption proceeding may be recognized as a status change Judgment, decree or order • Changes may
Slide 24: The Status Changes
The Status Changes COBRA Qualifying Events • If an employee, spouse, or dependent becomes eligible for COBRA continuation coverage under the group health plan of the employee's employer or any similar state law » Cafeteria plan may permit the employee to elect to increase payments in order to pay fo
Slide 25: The Status Changes
The Status Changes Medicare and Medicaid • A change in entitlement of employee, employee’s spouse or employee’s dependent will allow the employee to change health coverage » Loss of entitlement allows employee to add coverage » New entitlement allows employee to cancel or reduce coverage Other Gover
Slide 26: The Status Changes
The Status Changes Cost Changes • Do not apply to health FSA • Automatic cost increase • What is “significant?” Significant Curtailment of Coverage • A plan may permit an Eligible Employee to add coverage for the employee, spouse or dependent, if the Eligible Employee, spouse or dependent loses cove
Slide 27: The Status Changes
The Status Changes Addition or Improvement of a Benefit Package Option • The plan may permit all Eligible Employees to elect coverage under the new or improved option » This includes Eligible Employees who had not previously made an election under the Plan BROWN & BROWN | 27
Slide 28: The Status Changes
The Status Changes Change in Coverage Under Another Employer-Sponsored Plan • The plan may permit Eligible Employees to make an election change on account of, and corresponding with, a change made under another employer plan (including a plan of the same employer or another employer) if the other pl
Slide 29: The Status Changes
The Status Changes Open Enrollment Period of a Different Plan • An Eligible Employee can make a mid-year election change corresponding with an open enrollment period change made by a spouse or dependent when the plan of that individual’s employer has a different period of coverage than the employee’
Slide 30: The Status Changes
The Status Changes Special Rule for Group-Term Life Insurance and Disability Coverage • Participants may be allowed to increase or decrease group-term life insurance and disability coverage due to any status change » Note: Unless permitted under the master group policy, increases in coverage will li
Slide 31: The Status Changes
The Status Changes Health Savings Account (HSA) • If pre-tax contributions to an HSA are included under the cafeteria plan, participants may prospectively change HSA contribution elections on a monthly basis » Not subject to status change rules but must be noted in the plan document » If the partici
Slide 32: The Status Changes
The Status Changes Termination and Resumption of Employment (30-Day Rule) < > • Employee is rehired less than 30 days after • Employee is rehired more than 30 days after termination of employment, then: termination of employment, then: » Employer must reinstate prior election » Reinstate prior elect
Slide 33: The Status Changes
The Status Changes For Employees in Stability Period, Employee May Prospectively Revoke Election If: • Reasonably expected to average less than 130 hours per month because of a change in employment status; and • The employee intends to enroll in other MEC with an effective date no later than the fir
Slide 34: The Status Changes
The Status Changes Employee May Prospectively Revoke Election If: • Employee is eligible for special enrollment in an Exchange plan OR the employee wants to enroll in an Exchange plan during the Exchange’s annual open enrollment • The employee’s revocation of election is due to their intended enroll
Slide 35: New for 2023 – Employee's Spouse/Dependent(s) Enrolls in Exchange
The Status Changes New for 2023 – Employee’s Spouse/Dependent(s) Enrolls in Exchange • Part of the “Family Glitch” fix, outlined in Notice 2022-41 • Election of family coverage under group health plan (not including health FSA) may be revoked when: » One or more related individuals are eligible for
Slide 36: New for 2023 – Employee's Spouse/Dependent(s) Enrolls in Exchange
The Status Changes New for 2023 – Employee’s Spouse/Dependent(s) Enrolls in Exchange • This new exception only applies to election changes on or after 1/1/23 • Plan sponsor may rely on the reasonable representation of an employee that the employee and/or related individuals have enrolled or intend t
Slide 37: HRCI and SHRM Credits
HRCI and SHRM Credits This Program, ID No. 617873, has been approved for 1.00 HR (General) recertification credit hours toward aPHR™, aPHRi™, PHR®, PHRca®, SPHR®, GPHR®, PHRi™ and SPHRi™ recertification through HR Certification Institute® (HRCI®). Brown & Brown is recognized by SHRM to offer Profess
Slide 38: Find your solution at BBrown.com
Find your solution at BBrown.com DISCLAIMER: Brown & Brown, Inc. and all its affiliates, do not provide legal, regulatory or tax guidance, or advice. If legal advice counsel or representation is needed, the services of a legal professional should be sought. The information in this document is intend
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