Transcript Infinisource, Inc Consumer Driven Health Care

The Seminar Series
Presented by:
Karen L. Kirkpatrick
America’s Leading Employee Benefit
Administration and Compliance Specialist
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The Seminar Series
Goals of Proper COBRA
Administration
• KEEP the IRS out of your business
• KEEP your business out of court
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The Seminar Series
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The Seminar Series
Intent of COBRA
COST SHIFTING
TO
Federal government Expense
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Private employers
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Compliance with COBRA
Required
Employers with
20 or more
employees
Not
Required
Church plans
[Under IRC 414 (e)]
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Federal government
Manual Page 1
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The Seminar Series
Manual Page 2
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The Seminar Series
Employee Count (cont.)
• Common ownership- Manual Page 3
• Foreign employees
• Multi/multiple employer plan- Manual Page 4 and 5
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TAMRA 1988
Technical and Miscellaneous
Revenue Act
Manual Page 7
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Established criteria for IRS auditing of
COBRA compliance program
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Manual Page 8
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Manual Page 10
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Manual Page 11
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Qualified Beneficiaries
Covered Employee
Covered Spouse
Covered Dependent
Covered Dependent
Child born to, or adopted by, covered employee
Manual Page 14
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Manual Page 16
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Manual Page 17
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Manual Page 19
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Manual Page 23, 24
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COBRA Coverage
Manual Page 29
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Manual Page 36
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Time Frames
Manual Page 53
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45-Day Retroactive
Premium Payment
Loss of
coverage date
Date of
election
All retroactive
premiums due
March 31
May 29
July 13
Manual Page 57
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COBRA Expires:
At the end of the maximum coverage period
18 months* for
*29 months with a Social Security
disability determination
36 months* for
* Under the Medicare entitlement
Manual Page 63
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COBRA Terminates
Failure to make
TIMELY
payment*
*Insignificant premium payment
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Manual Page 64
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The Seminar Series
COBRA Terminates
Manual Page 64
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The Seminar Series
COBRA Terminates
Manual Page 64
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The Seminar Series
COBRA Terminates
Manual Page 64
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COBRA Terminates
Applies within the 11-month extension ONLY
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Manual Page 65
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COBRA Terminates
Manual Page 65
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Premiums
*If disabled Qualified Beneficiary is part of the extension
Manual Page 67
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The Seminar Series
If your goal is to …
• KEEP the IRS out of your business
• KEEP your business out of court
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The Seminar Series
COBRA Compliance Checklist
• Documentation of TAMRA
• Notices
• Elections and premiums
• Documentation systems
=100% Compliance
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Manual Page 80
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HIPAA Portability
• New notices
– General Notice
– Individual Notice
• Certificates of Creditable Coverage
• Special Enrollment
– What is and isn’t a SE event
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Key Privacy/Security Rules
• PHI and EPHI: What are they?
• Who has PHI and EPHI at your facility?
• Disclosure of PHI in three major circumstances:
– Treatment
– Payment
– Health care operations
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Key Privacy/Security Rules
(cont.)
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Security Concerns: Reporting form
Limited access to facilities
Protection from malicious software
Need for unique user IDs and passwords
Access to EPHI on need-to-know basis
Encryption and Password protection of EPHI
Business Associate Agreements
Security Reminders
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Recent and Current
Developments
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HIPAA criminal actions
Notable security breaches
Recent guidance on remote devices
April 14, 2007 deadline for HIPAA Notice of
Privacy Practices
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The Seminar Series
Contact Infinisource
For information on employee benefits
administration and compliance issues, visit
www.benefitsolved.com or call 800-300-3838.
Copyright 2007 Infinisource, Inc.
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