Employee Benefits-Size Matters


Regardless of the size of your practice or business, the ever-increasing cost of your Group Health Plan(s) is typically the second or third largest item of your expenses, next to salaries or, in certain circumstances, malpractice insurance. But this is just the “transparent” cost of being an owner.

Knowing (or NOT knowing) more about the “invisible” and multitudinous regulations that you, the employer, are responsible for can be dizzying and expensive if you are not informed. Adding or Terminating Employees from your Plan(s) is critical. If you fail to enroll an eligible employee who has satisfied the Plan(s) waiting period, the carrier has no obligation to accept that individual until your Plan(s) renewal, barring a “Qualifying Life Event”. If an individual is terminating for any reason, they “MUST” be removed from your plan and offered the opportunity to continue and pay for their own coverage, unless or until they return to work at some future date. Typically, the terminated employee would be permitted to continue their coverage for 18 months, but there are some extenuating circumstances that could allow for an extension. You are also responsible for notifying and removing your terminated employee upon the expiration of the allowable extended coverage and we recommend the implementation of Certified Mail to avoid being sued from a disgruntled employee who may make a claim of having never been notified.

Here’s just a few places where size matters:

  • Small Groups of 2-19 are mandated by State Continuation, Large Groups by Federal COBRA
  • Small Groups of 2-99 for Group Health, Large Groups are 100+ by Federal Law but the law allows states to modify that number and NJ and PA have chosen 2-49 for Small Group and 50+ for Large Group, while NY has elected to use 2-99 as Small Group and 100+ as Large Group.
  • Under the ACA, many of the penalties applicable to Large Groups are avoided if you are utilizing Level Funded* or Self-Funded Plans*, which are now available to both Large and Small Groups.

Large Groups will require:

  • ACA Compliance & Reporting                               · Forms 1094-1095 B and C
  • Form 6055                                                               · ERISA 5500 Compliance
  • ERISA SPD & Wrap Reporting                              · COBRA Continuation and Notification

The following are just a few of the many services or plans that can save you and/or your employees money and enhance your renewal experience:

  • Health Savings Accounts (HSAs)                           · Health Reimbursement Arrangements (HRAs)
  • Flexible Spending Accounts (FSAs)                       · Dependent Care FSAs
  • Self-Funded/TPA Plans*                                         · Group Life
  • Short & Long Term Disability                                · Retirement Plans
  • Transit & Parking Plans                                          · COBRA
  • Employee Wellness Programs                                · Voluntary Benefits
  • Employee Handbook                                              · Online Portals, Compliance and Reporting Tools


We would invite you to visit our Employee Benefits web site at www.kirwanbenefits.com and would be privileged to receive your questions or calls.

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