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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...

CalChoice Health Savings Account (HSA) Options – Q4 2016

As the majority of group renewals are fast approaching, I wanted to outline the different HSA options available to CaliforniaChoice clients.  For the fourth quarter of 2016, there are twelve different HSA eligible medical policies from five different carriers. (Listed Below – Please note that not all plans are available in all 19 regions) Note that there are not any PPO HSA options available to CaliforniaChoice clients at the moment.  You may assume that Anthem’s EPO policy would be a close fit, but beware the limited network without any out-of-network coverage, aside from emergencies.   While the private exchange offers employees the flexibility to choose various plans without the need for employers to meet specific participation requirements, the only way to offer a PPO HSA currently is outside of CaliforniaChoice.  For employers that wish to concurrently offer a PPO alongside Kaiser, you must have a minimum of 5 non-Kaiser employees that wish to enroll, which make up at least 25% of eligible enrollees. While the state’s public exchange, Covered CA, has setup a mirrored network of health plans that offer the same participation flexibility as CaliforniaChoice, they are only offering six HMO HSA policies from three carriers: Kaiser, Sharp, and Western Health. As premiums continue to increase, and plans become more limited and standardized, small group shoppers are losing their flexibility within private exchanges.  We can only hope that the insurance carriers and partners will loosen the reins in 2017. Deductible – A specified amount of money that you must pay before an insurance company will contribute towards a claim. Out of Pocket Max – The most you will have to...

(HSA) Health Savings Account – Eligible Medical Policies

As insurance premiums continue to rise, you may find yourself exploring coverage options you may not have considered in the past.  One of which is an HSA eligible policy that has risen in popularity over the years for multiple reasons.    Health Savings Accounts are associated with high deductible health plans – a plan with an annual deductible no less than $1,300, and an annual out-of-pocket maximum not to exceed $6,550; the overall cost of an HSA eligible policy can be less than other plans, while it still provides you with the same catastrophic coverage. Health Savings Accounts allows the account holder to pay for current health care expenses and save for those in the future.  Payments towards qualified medical expenses are withdrawn tax-free, and interest earned on deposits also accrue tax deferred.  Funds roll-over each year, and the account belongs to the individual and follows the individual throughout his/her career.  An HSA eligible policy can be purchased on both the individual and group marketplace, providing full flexibility. Contributions are tax-deductible or are deducted directly from payroll pre-tax. Employers may also offer to contribute towards an HSA, and contributions are excludable from an employee’s income and are not subject to federal income tax, Social Security or Medicare taxes.  In addition, employer contributions are deductible as a business expense to the company.  Employers may choose to contribute a set amount or make ‘matching’ contributions.  The IRS sets annual limits on the amounts that may be contributed to the HSA.  If funded from both the employer and employee, it is important to ensure that the total contributions remain within the annual IRS...

Due to difficulties with the Covered California website, I thought I was never going to get healthcare coverage. I saw the website for Shop CA Brokers and the contact information. I connected with Bryan Bedrosian and now have health care. He sent me the application form for coverage and walked me through the entire process. He kept me up todate, along with giving me step by step instructions on the process. He was patient and informative. I highly recommend Ryan if you need any assistance!

Jane M.

San Francisco, CA

I spent a whole week trying to figure out how Obamacare actually worked through the Covered CA website. Just when I thought I had it all figured out with my subsidy and the plan I was going to choose, I DID NOT QUALIFY!  I couldn’t believe it, I spent at least 8 hours on the computer this past week doing everything I was requested to do, and in the end all it did was frustrate the living heck out of me.  I was about to give up and just go without insurance as I have in the past, but my wife randomly found the phone number to Benefit Agents and I was connect with Arman.  In 2 minutes he knew exactly what was wrong with my application and was able to walk me though the process of designating him as my agent.  He was then able to view my application through his computer and made the necessary fixes and got my wife and I enrolled.  5 minutes compared to 8 hours.  These guys deserve a lot more praise than any agent I’ve spoken to in the past.  5 star service, I highly recommend them to anyone.

Alex M.

Los Angeles, CA

I needed to have covered California insurance for my daughter and her family inasmuch is my son-in-law does not have the time to make the necessary inquiries due his work schedule. Ryan Bedrosian name came up on the computer screen and fortunately for me because he was able to facilitate the application to be submitted for covered California. Needless to say it was truly gut wrenching experience trying to contact covered California,however, we were able to resolve everything to my satisfaction. What I liked most was his willingness to accept all my phone calls, as busy as he is.

Martin C.

Palm Desert, CA

I submitted a new application on CoverCa website and was waiting for more than 3 weeks without any news or progress.

The application was stuck at Eligibility check stage. At that time I was desperate for help and called the CoverCa tool free number and waited over 1 hr and still cannot go thru. The same goes for their website’s chat that has 150 to 200 people waiting and would eventually kick you out of their system.

According to CoverCA health cost estimate tool, our family of 4 should be getting a few hundreds dollars of subsidies per month but after I went thru the whole online enrollment process at CoverCA, the system quoted me a ZERO subsidies per month!!!

So, thru. Google Ads, I found Bardia Farhadian from Benefit Agents. With my permission, he was able to see my case on his computer. He then step thru. all the info I have previously submitted and made a few minor but “critical” corrections.

Finally he performed the “M A G I C     T O U C H” by calling the broker’s dedicated support team / specialist inside of CoverCA and I got a call the next day with a Cover CA case number.

We were very happy that we also received the correct amount of subsidies and this alone is a great deal of money, over $4500 per year!!!

With this case number, I was told to wait about 5 days and call BlueCross for enrollment. I am now enrolled and have the peace of mind…

Overall, the process was very smooth, Mr. Farhadian was very professional and patient and informative. Thanks so much for your professional service!!!

p/s: He also saved me $400 (per year) plus for Auto Insurance!!!

I seldom give review but thru Yelp I was able to get very valuable consumer advises and save time filtering out the GOOD companies to do business with. Benefit Agents is definitely one of the good companies out there and one that will get the job done and save you a lot of $$$$ and time.

Joe A.

Rowland Heights, CA

If you have questions about Covered CA, the private insurance market or are thinking about making a change to your existing policy, then you need to call Ryan at SHOP CA Brokers.   He knows all the little details about Covered CA and the private insurance market that other agents won’t disclose to you or just do not know. I called at least five different San Francisco insurance agencies before I found Ryan. He streamlined the process in less than 15 minutes by asking if I qualified for subsidies through Covered CA. I am in between jobs at the moment and could still be unemployed in January 2014. At least I have the comfort of knowing that the government will help pay my premium if I cannot find work but then. In the meantime, Ryan helped me find a Blue Shield high-deductible HSA plan that is $130/month that will allow me to see all of my current doctors. Then toward the end of the year I will re-evaluate my situation. I am excited to have a new medical plan and wonderful new broker that will be there for me when my situation changes.

Also, it is important to note that Ryan did not try to push me off the phone when I kept asking questions.  I still email him from time to time to get his take on certain policy provisions and he still responds quickly (in less than an hour).  A+++++ Service.

Gwen O.

Oakland, CA

I’m so glad I selected Ryan to steer me through the process of signing my wife up for Obama Care via Covered CA. Even though the online enrollment process is FUBAR for both the federal and state sites I finally had success thanks to Ryan’s guidance.

Just as an example Covered CA asked for additional documentation regarding household income and citizenship for my wife who is Canadian. The site gave 3 methods  for providing this documentation: 1- Download to the site but the site does not have any provision to do so; 2- Snail mail (which wouldn’t work because the deadline for them receiving it was only 2 days from the date I received the request), and; 3- FAX it (but I have no access to a FAX machine since I am currently in Mexico)
Ryan’s solution to this dilemma was for me to send him the documents as an attachment to an email to him which is what I did. In turn he Faxed all 6 pages to Covered CA before the deadline and Kaiser was able to accept the first payment and my wife is now a member there.

Bob D.

Chula Vista, CA

Platinum 90


Gold 80


Silver 70

Silver 70

Bronze HSA


Bronze 60


Enhanced Silver 73 Policy

Silver 73

Enhanced Silver 87 Policy

Silver 87

Enhanced Silver 94 Policy

Silver 94

Eligibility Chart

Your FPL must be between 138%-400% to qualify.

FPL chart 2016

Your FPL must be between 138% -400% to qualify.

FPL chart 2016

Qualifying Life Events

A Qualifying Life Event would be considered:

  • Marriage, having a baby, adopting a child or placing a child for adoption or foster care, moving outside your
    insurer’s coverage area, gaining citizenship, leaving incarceration.
  • Gaining status as member of an Indian tribe. Members of federally recognized Indian tribes can sign up for or
    change plans once per month throughout the year.
  • For people already enrolled in Marketplace coverage: Having a change in income or household status that affects
    eligibility for premium tax credits or cost-sharing reductions.
  • Losing other health coverage—due to losing job-based coverage, divorce, the end of an individual policy plan year
    in 2014, COBRA expiration, aging off a parent’s plan, losing eligibility for Medicaid or CHIP, and similar
    circumstances. Important: Voluntarily ending coverage doesn’t qualify you for