An employee who opted not to be on our medical plan is about to have a baby. Would this event allow the employee and their newborn child to enroll in our plan?
It would, yes. the birth of a child is a HIPAA special enrollment right, meaning the employee, their spouse, and their newborn child may enroll in the medical plan midyear. However, it’s a somewhat common misconception to assume the employee can also enroll their other children, if they have any, at the same time.
Marketplace Subsidies will be expanded until 2025This is great news for individuals and families who are currently enrolled in a marketplace plan and was needing to continue their coverage into 2023.
If you are not currently enrolled and are interested in viewing quotes, now is the perfect time to take advantage of this opportunity for increased premium subsidies that will help offset the cost of medical insurance.
Read HERE for more on this and contact us today!MLR Rebates Reminder for Employers
Insurance Carriers are required to send out Medical Loss Ratio (MLR) payments to employers by September 30th.
When an employer receives one of these MLR checks from the insurance carrier, they’ll need to carefully consider how the funds must be spent – they should not just keep it. This is because any portion of the rebate that is considered “plan assets” has to be used in a very specific manner. In other words, if employees paid any portion of the total premium, then that portion related to the MLR rebate check is considered plan assets and can only be used to benefit those participants, not the employer.
For instance, if employees paid 20% of total premiums last year and the employer contributed 80%, then 20% of the rebate check is considered “plan assets” and should only be used for the benefit of plan participants.
There are 3 basic methods an employer may use to spend this portion on participants: 1) Pay out a taxable cash refund, 2) Offer a premium holiday for the amount of the rebate, or 3) Provide some type of benefit enhancement.
There is no de minimis (minimum) amount for distribution of any portion that’s considered plan assets under the rules. The only leeway given relates to the cost of including former participants in the rebate distribution. In other words, even if the rebate is a very small amount and dividing it up between participants results in a few dollars, any portion related to plan assets still has to be given back to current participants and possibly to former employees (such as COBRA qualified beneficiaries and retirees).