Is Your Group Plan Certified?

With the plethora of unending new legislation arriving daily, coding and electronic reporting issues becoming an impediment to your reimbursements, as well as your practice/business, we now have yet another issue to present, Employer Certification.

The carriers have always reserved the right to request an annual certification, which is a detailed census of “all employees”, regardless of hours worked, in an effort to be assured that not only are you including all eligible employees, but to be certain that you are meeting the requisite 75% participation test.

Prior to this year, this request has been sporadic but the screws are now tightening and most all of the carriers are not only requesting but scrutinizing your Employer Certification and here’s what you will need to provide:

  • Complete Census consisting of name, position, dob, salary, hire date and hours
  • WR-30-used to substantiate your census
  • Completed/Signed Waivers for all those not accepting coverage
    Note: A valid waiver would be spousal coverage, not, “I can’t afford it”.
  • 75% Participation is required, which would include the aforementioned categories
  • Employer must pay at least 10% of the Single rate
  • New for 2011-Only 1 carrier (Ex: Horizon, Aetna etc.) per group

Due to the more intense scrutiny by the carriers, we have expanded our services to include the review of our clients Employee Benefit structure, wherein, we are now analyzing several key areas where we have found our clients to be lacking and/or vulnerable:

  • POP (Premium Only Plan) – Payroll Deduction is the method of choice and allows your Employees to pay for their share of monthly premiums on a “Pre-Tax” basis, saving them at least 20% on their tax bill, while equally providing for about a 10%-14% tax savings to the Employer.

    However:
    1. You will be required to have a properly completed Section 125 document in order to take advantage of this tax break, as well as a,
    2. Signed acknowledgement of consent by your employee/participant

    Note: If HSA contributions are being made through payroll deduction, your document will be required to have additional qualifying language to permit this deduction.

  • FSA (Flexible Spending Accounts) is another popular method to allow your employees to take advantage of Pre-Tax” payment of excess and/or non-covered medical, dental or vision expenses.

    These plans require annual testing and you should maintain a copy of both the respective documents and test results in your office in the event of an audit and to confirm that they are up-to-date.

    Please check the current rules of eligibility pertaining to owners/stockholders or contact our office and we will provide you with a free office audit if you indicate your membership with the Morris County Medical Society.

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