Premium Reimbursement Arrangements are an alternative to traditional employer-sponsored health benefits, allowing companies to reimburse employees for individual health insurance. Employers use a Premium Reimbursement Administration Software to stay compliant, and to make administration easy.
While this first feature isn’t entirely a "software" feature, it is one of the most important considerations of offering a Premium Reimbursement Arrangement: employee education and company on-boarding. The Premium Reimbursement Administration Software should provide you a toolkit to help your company:
Understand the benefit (What is premium reimbursement? How does it work?)
Understand the benefits of individual health insurance
Learn how to request reimbursement and use their participant portal
The Premium Reimbursement Administration Software should allow you to give employees allowances monthly or at any time on an exception basis—with automatic monitoring of HIPAA and ERISA discrimination compliance rules. Deferred allowances (a waiting period) should be possible for new hires, and suspended allowances should be allowed for former employees that employers hope to re-hire on a seasonal basis.
Employees should be able to submit requests for reimbursement online, by fax, or by mail, and immediately receive an email acknowledging their request and providing an online link to monitor status. Documentation should be permanently available online for convenient access by employees.
The Premium Reimbursement Software Administration provider should process requests within 24 hours and employees should be able to inquire about their request via online chat, email, fax, mail, or telephone. No request should be rejected for improper or incomplete submission without multiple contacts. All employee contact should leave clear audit trails and meet appropriate regulatory guidelines (e.g. ACA, IRS, HIPAA, ERISA, and SAS 70). Look for software that provides “real-time” tracking of requests, available online 24/7.
Employees should receive email notification when their request is approved and again confirming when (and how) it is reimbursed. Reimbursement should be administered individually or on a periodic batch basis via check, payroll addition, or direct deposit leaving a clear and permanently-available audit trail.
All employees should have access to an online ledger showing their current balance, allowance, requests, and reimbursements including permanent storage of receipts, relevant tax information, Plan Documents, and the ability to save or export their own medical information via the administration platform.
The Plan Document, Summary of Benefits and Coverage (SBC), and SPD (Summary Plan Description) should be electronically created, readily accessible online, and signatures should be collected electronically. Employers should be able to administer a change to benefits for any specific Class of Employees at any time and the electronic documents should automatically change and, where required, new electronic signatures should be collected when the employee is next online.
Employers should be able to instantly create unlimited different Classes of employees with each Class receiving different benefits by employee family status.
Employers should be able to instantly enroll or remove employees in real-time on an individual or batch basis, with automatic printing of employee welcome kits and other appropriate plan administration information.
Employers should be able to completely set up and/or change both their premium reimbursement Health Plan and their Plan Documents simultaneously online.
Employers should be able to view all reimbursements by employee or by Class of employees, and monitor in real-time claim information for each Class of employees. Employees should be able to see 3-5 prior years of history.
All information for required administration reporting (e.g. 5500 for employers with more than 100 employees) should be available online in real time, and non-eligible plan participants (e.g. independent contractors, owners of Sub S companies) should receive appropriate 1099 information.
Premium Reimbursement Software should automatically provide the employer’s health insurance broker a CRM (Customer Relationship Manager) to best serve their employees—including automatic notification to the broker when an employee’s premium reimbursement plan status changes due to family additions, promotions, etc.
The employer should be automatically protected and the plan administration made HIPAA Compliant through technology rather than the training of administering employees. For example, employers should not be able to view HIPAA-protected employee information, and should automatically follow Department of Labor, HIPAA, and ERISA guidelines for employers allowing insurers’ access to their employees.