Compliance Services

Protect your business against liability claims and litigation.

Federal laws, commonly known as HIPAA and COBRA, are in place to protect the rights of employees who elect to change jobs or are in jeopardy of losing group health insurance benefits for other reasons.

As an employer, it is mandatory to comply with the specific regulations of the law, and it's also a sound strategy to protect your business from liability claims or other litigation.

Our Employee Benefits Consultants can assist in this area to make sure employers are in compliance with the following Federal and State regulations.

COBRA Highlights

As an employer with 20 or more employees, you are obligated by law to offer COBRA coverage to employees and covered dependents when meeting the following qualifying events:

Job termination or voluntary resignation
Work hours reduction
Employee's Medicare entitlement
Divorce or legal separation
Death of employee
Loss of "dependent child" status

Health plans subject to COBRA are:

Medical plans
Dental, vision and prescription drug plans
Drug and alcohol treatment programs
Employee Assistance Plans (EAPs) that provide medical care such as counseling or psychological treatment
On-site health care (including discounted or free medical services)
Section 125 spending arrangements ("cafeteria plans") including unreimbursed medical expense and dependent care expense accounts, under certain circumstances

Benefits NOT subject to COBRA are:

Wellness programs
Life, disability and long term care insurance plans
EAPs that do not provide medical care

While any of the qualifying events may well require a long period of adjustment and recovery time, it's important to note that COBRA coverage is not indefinite. COBRA coverage ends when:

The employee or other qualified individual reaches the last day of maximum coverage
Premiums are not paid on a timely basis
You as an employer cease to maintain any group health plan
You as an employer go out of business

Health Insurance Portability and Accountability Act of 1996 (HIPAA) Highlights

Every employer group health plan that has at least two participants cannot deny an application for coverage based solely on health status.
HIPAA also limits exclusions for pre-existing waiting periods that can be imposed when applying for new health care coverage.
HIPAA makes it easier for new employees to get health insurance, however, there is no guarantee they will be provided the same level of benefits, deductibles and claim limits they had previously.
HIPAA does allow employers or health plans to impose a waiting period (typically 1-3 months) before allowing a new employee to enroll for coverage under the plan.
Employee coverage under HIPAA, including any waiting periods, is determined by their coverage history and the number of continuous months they have maintained health insurance (this is known as "creditable coverage").
Creditable coverage is accrued through an employee's participation in any of the following health plans:
- A group health plan
- Medicare
- Medicaid
- Tri-Care (Military Sponsored Health Care program)
- A State high-risk pool plan
- Federal Employees Health Benefit Program
- A Public Health Plan sponsored or maintained by a State or local government
  Peace Corp Health plan

Our Employee Benefit Consultants can also provide assistance with information on other employment related regulations such as:

Employee Manual
EEOC/Discrimination & Wrongful Termination
I-9 Forms "IRCA"
Sexual Harassment;
Workers' Compensation Claims Review;
Records Retention

Contact us today for a comprehensive review of business insurance needs.