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Individual and Group Health Insurance

Benefit Agents is a privately owned agency focused on providing a broad array of services related to health insurance. We have employee benefit and insurance expertise for close to four decades. Located in San Francisco, California we focus on providing group and individual clients direct access to every insurance carrier. We are licensed and contracted with all of the major medical, dental, vision, life, disability and long term care providers to assist individuals and businesses on their behalf. We provide small businesses access to a consortium carrier – California Choice; in addition to California’s Health Benefit Exchange – Covered California. As health insurance experts, Benefit Agents focus is to provide the most competitive individual and employee benefit plans in California. We will provide you with a comparison between Covered California SHOP, California Choice and direct carrier rates. Benefit Agents will let you know if you are eligible for any government subsidies, saving you time and ensuring your eligibility. Call or contact us for a consultation today, as our service is provided without a fee.

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Recent News

Common ERISA Penalties by the DOL – 2017

The Department of Labor recently released their inflation-adjusted penalties for ERISA, the Family Medical Leave Act, and the Genetic Information Nondiscrimination Act. The chart below shows some of the more common penalties assessed from DOL audits. Failure to provide a summary of benefits and coverage$1,105 per employeeFailure to inform employees of CHIP coverage opportunities$112 per employee per day Failure to comply with FMLA notice requirements$166 per employee per dayFailure to comply with certain GINA requirements$112 per employee per day Failure to provide an SPD or plan document$110 per employee per dayFailure to provide documents to the DOL upon request$149 per day, not to exceed $1,496 per request Failure to file an annual 5500 form$2,097 per day The new ERISA penalties serve as important reminders to employers who sponsor benefit plans.  Many employers either think they are too small to be audited (not true), or that the medical carriers adhere to all the rules and furnish employees with what is required (not true).  It is for this reason that we have taken on the responsibility to protect our clients by providing them with the proper notices and instructions to maintain...

Withdraw Dependent Coverage – COBRA Rules and the Pay or Play Provision

With healthcare premiums continuously increasing year over year, many employers are searching for options to help reduce their benefit costs. A seemingly quick fix would be to eliminate dependent coverage, but you may want to consider eliminating dependent contribution rather than not offering coverage at all. First and foremost, the circumstances are different for Small Groups in comparison to Applicable Large Employers. If you are considered an ALE, with 51 or more full time equivalent employees, then you are required to offer dependent coverage by law, or you may face an employer shared responsibility penalty. Please note that the definition for Small Group plans has been expanded to include up to 100 employees, so it is possible to be an Applicable Large Employer and still offer Small Group plans (51-100 employee size). Per the Affordable Care Act, and the ‘pay or play’ provision, the definition of ‘dependent’ only applies to children under the age of 26. Spouses are not considered dependents, nor are step children or foster children. There are two types of penalties you may face if you do not offer proper coverage as an ALE. If you DO NOT offer minimum essential coverage to at least 95% of your full time equivalent employees and their dependents then you may face a penalty if at least one of your employees obtains premium assistance from the public marketplace (Covered CA). If just one of your employees receives premium assistance, then you are liable for a $2,000 penalty for each employee, after the first 30 employees. [Total employees – 30, multiplied by $2,000] If you DO offer minimum essential coverage...

SPD Requirements – Erisa Wrap Compliance

The Employee Retirement Income Security Act (ERISA) oversees group benefit plans, and with the onset of the Affordable Care Act, the ERISA Summary Plan Description (SPD) requirements are in the spotlight.  More often than not, a plan administrator assumes that a Certificate of Insurance qualifies as an SPD, and that either the insurance company or their broker is responsible for preparing and delivering SPD’s.  In this instance, the employer (plan administrator) is solely responsible for ERISA compliance. An employer must have a written SPD, which serves as the main vehicle for communicating plan rights and obligations to participants and beneficiaries.  An SPD that includes the plan’s terms and conditions, such as a Certificate of Coverage, and includes (or ‘wraps’) it with the specific ERISA disclosure language is considered a ‘Wrap SPD.’  One step further would be to produce a mega-wrap document which would encompass all benefit lines into one document, which is HIPAA compliant as long as none of the benefits are self-funded. ERISA requires that a SPD be distributed to enrolled participants within 90 days of coverage, or 120 days of a new plan being established.  If an SPD has not changed, an employer is required to furnish another copy to all participants every five years. An example of some of the information required in an SPD: Plan name Employer’s name and address Employer’s EIN Plan Administrator’s name, address, and phone number Type of plan and description of benefits Effective and End Dates of the plan Eligibility terms How refunds are allocated to plan participants Claims procedures ERISA legal disclosure of participants’ rights Sources of plan contributions Details...