The Seminar Series Copyright 2007 Infinisource, Inc. Presented by: Karen L. Kirkpatrick America’s Leading Employee Benefit Administration.
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The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Presented by:
Karen L. Kirkpatrick
America’s Leading Employee Benefit Administration and Compliance Specialist
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Goals of Proper COBRA Administration
• KEEP the IRS out of your business
• KEEP your business out of court
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Intent of COBRA
COST SHIFTING
Private employersFederal government Expense
TO
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Compliance with COBRA
RequiredEmployers with
20 or moreemployees
Church plans[Under IRC 414 (e)]
Federal government
NotRequired
Manual Page 1
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Manual Page 2
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Employee Count (cont.)
• Common ownership- Manual Page 3
• Foreign employees• Multi/multiple employer plan- Manual Page 4 and 5
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Established criteria for IRS auditing of
COBRA compliance program
TAMRA 1988Technical and Miscellaneous Revenue Act
Manual Page 7
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Manual Page 8
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Manual Page 10
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Manual Page 11
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Qualified BeneficiariesCovered Employee
Covered Spouse
Covered DependentCovered Dependent
Child born to, or adopted by, covered employee
Manual Page 14
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Manual Page 16
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Manual Page 17
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Manual Page 19
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Manual Page 23, 24
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
COBRA Coverage
Manual Page 29
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Manual Page 36
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Time Frames
Manual Page 53
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
45-Day Retroactive Premium Payment
Loss ofcoverage date
Date ofelection
All retroactivepremiums due
March 31
May 29
July 13
Manual Page 57
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
COBRA Expires: At the end of the maximum coverage period18 months* for 36 months* for
*29 months with a Social Security disability
determination
* Under the Medicare entitlement
Manual Page 63
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
COBRA Terminates
*Insignificant premium payment
Failure to make
TIMELY
payment*
Manual Page 64
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
COBRA Terminates
Manual Page 64
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
COBRA Terminates
Manual Page 64
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
COBRA Terminates
Manual Page 64
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
COBRA Terminates
Applies within the 11-month extension ONLYManual Page 65
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
COBRA Terminates
Manual Page 65
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Premiums
*If disabled Qualified Beneficiary is part of the extension Manual Page 67
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
If your goal is to …
•KEEP the IRS out of your business
•KEEP your business out of court
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
COBRA Compliance Checklist• Documentation of TAMRA
• Notices
• Elections and premiums
• Documentation systems
=100% ComplianceManual Page 80
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
HIPAA Portability
• New notices – General Notice– Individual Notice
• Certificates of Creditable Coverage
• Special Enrollment– What is and isn’t a SE event
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
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
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Key Privacy/Security Rules (cont.)
• 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
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Recent and Current Developments
• HIPAA criminal actions• Notable security breaches• Recent guidance on remote devices
• April 14, 2007 deadline for HIPAA Notice of Privacy Practices
The Seminar Series
www.benefitsolved.comCopyright 2007 Infinisource, Inc.
Contact Infinisource
For information on employee benefits administration and compliance issues, visit
www.benefitsolved.com or call 800-300-3838.
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