What Passage of the Health Care Bill Means for Employers

Regardless of your political affiliation, you have to appreciate the magnitude of the moment.

Sweeping health care insurance legislation has passed Congress. (The Senate will still take up  the "reconciliation" part of the bill which will make some additional modifications because the House only approved of the Senate version.)

So, now's the time to ask: What does this mean for employers?

No one really knows. Oh, you've been hearing lots of commentators talk about how lots of jobs will be lost (or saved) as a result of this.  Or they will talk about what this means for our country.   But in truth, it's much like looking at a crystal ball -- you're much more likely to get a distorted picture than a real one.

So rather than guess about what will happen for employers in the future (or speculate about future changes that may or may not be made), let's talk about what we know.   

Employers are not, technically, required to provide health insurance to their workers under the bill that passed.  But if employers with 50 or more employees do not provide health insurance, they will be required to pay a fine of $2000 per worker each year if any worker receives federal subsidies to purchase health insurance. Fines will be applied to entire number of employees minus some allowances (under the formula -- at least in the reconciliation bill -- the first 30 employees are probably not going to be counted).

But again, here's the most important part: If you are an employer will less than 50 employees, you will not be impacted directly from this bill because you will not be penalized if you don't offer health insurance.  

For those employers that do offer coverage, you're not out of the woods just yet. Under the passed bill, if the employee finds the insurance too expensive because it would represent too much a percentage of their income, the employee may purchase insurance on the open market (or at least the marketplace of exchanges that the measure also establishes).  The employer would then be required to provide a voucher to the employee on the percentage that the employer would have kicked in had the employee chose to continue with the employer-sponsored plan.

There is an additional provision for employers of 200 or more employees: If you, as an employer, do offer health insurance to your employees, then you will have to automatically enroll those employees in the plan.  

So, you might be wondering, should I start planning for this? Well, unlike some of the COBRA-subsidy provisions that have gone into effect immediately, this law has a great deal of buffer built in.  In fact, many of these provisions do not start until January 1, 2014 -- or nearly four years from now.

But there are others that go into effect more quickly, including a provision to require employers to extend coverage to include adult children (up to age 26) of employees. 

As you might expect from a 2000 page bill, there are certainly other provisions that might affect employers. Various blogs and publications have begun summarizing some of those provisions including Business Insurance and Washington Employment Law Update.  I expect we'll hear more this week too as everyone starts to analyze it in more detail.

For employers that have low-cost workers, there is no doubt that this measure will have some impact because of the penalties that may be applied if health insurance is not offered. But how much of an impact that will be will have to be determined by each company on a case-by-case basis.

For now, each employer should consider appointing a small group of employees (including those from human resources and finance areas) to figure out what health care reform will mean to that employer.  And stay tuned, I don't expect we've heard about this for the last time.  

Gross Misconduct and COBRA - When Can An Employer Try to Deny Coverage to Terminated Employee

The Employee Benefits blog has a terrific post this week explaining the "Gross Misconduct" rule for COBRA Coverage.

For those unfamiliar with the lingo, The Consolidated Omnibus Budget Reconciliation Act (COBRA) (among other aspects) describes rights that employees have to continue their health insurance after their employment as been terminated (and for some other reasons too).    But there is an exception: When the employee is terminated for "gross misconduct", the benefits cease.  What does that mean? Well, the Act doesn't define it.COBRA - Not cobra kai from Karate Kid

But the Employee Benefit blog shares some insight from one case about what it means. 

Three things are very important about this decision.  First, the court did not find that any “criminal” conduct was required to meet the “gross misconduct” definition.  Gross misconduct can be an intentional, deliberate, extreme and outrageous that “shocks the conscience.”  It can be “reckless or in deliberate indifference to an employer’s interests.”  ...

Second, the employer has the burden of establishing the termination was for “gross misconduct.”  ... It must be the primary reason, not one of many.

Finally, the employee and potential COBRA beneficiaries have to be notified of the determination that COBRA is not being offered because of the termination for gross misconduct.  

So what's an employer to do? The blog suggests some thoughts, but I'll share some general observations as well.

1. Document, document, document.  If an employer is going to claim "gross misconduct", there ought to be ample documentation supporting the decision.

2. Make sure the termination documents reflect the actual reason and the reason amounts to "gross misconduct".  Meeting this standard is difficult and courts will understandably look to any reason to deny it. Having a letter of termination that merely states the employee was let go for "performance" reasons, isn't going to cut it. 

3. Follow policies and COBRA to the letter. The requirements, for example, about notification under COBRA are strict. Missing deadlines or not providing information may provide the escape hatch that might not be available otherwise.

And as always, seek some legal guidance on this. Denying COBRA nowadays is rare; if an employer does try to use that provision, it can be assured that a fight about coverage may not be too far behind.

Employers That Provide Health Insurance Must Post State-Mandated Poster

Recently, a colleague received an e-mail that suggested that all employers must post information that "lists employee's rights to health insurance under Connecticut Law."  When I heard about it, something didn't seem right.  After all, since when do employees have a right to health insurance in Connecticut (and, isn't that a heated topic of the Presidential campaigns?). 

So I started digging.  A peek at the Department of Labor website came back with nothing.

A search on Google for a "Connecticut Healthcare Advocate Poster" provided a link to the website of a company, Progressive Business Compliance, that does, in fact, sell a poster for $12.99 that appears to be on point.  The website page states specifically. "New Poster February 2008! Employers are required to display this poster.  Lists employee's rights to health insurance under Connecticut."  The website allows a viewer to buy this "Healthcare Advocate" poster directly from the site and it has a nice thumbnail picture of what the poster looks like.

Hmm. This seemed strange; still hadn't heard of the law..  But I wondered, why have I seen this poster before? So, I called the Office of the Healthcare Advocate, which is dedicated to serving Connecticut's health insurance consumer. 

And lo and behold, they were extraordinarily helpful.  A poster on rights to health insurance? Never heard of it, they said. But they do have a poster from the Managed Care Ombudsman that lists the services of the Managed Care Ombudsman.  It's required by Conn. Gen. Stat. Sec. 38a-1046.  Oh, and it's not new. It's been around since 1999.  It lists certain items that a health insurance policy must have -- if health insurance is offered.

Ding, ding! We have an answer!  There is no poster listing an employee's rights to  health insurance, only a poster regarding the services of the Managed Care Ombudsman.  And it's been around for a while (which is why it looked so familiar). 

So, I ask the OHA, can I download this poster from the website? Their answer was no but she graciously agreed to e-mail it to me.  (Don't ask me why it isn't on the website in this age of technology.)

And, she did. So, are you curious what it looks like? This is the poster that she e-mailed me. You can compare it to the thumbnail image available for sale on the PBC website and make your own judgment about it. (IMPORTANT DISCLAIMER: As with this entire blog,  I make no representation that this poster does, in fact, comply with the applicable law and readers are strongly cautioned to seek legal advice about whether their postings comply with applicable law.)  If you want your own poster, you can certainly contact the OHA at 1-866-HMO-4446.  Perhaps if enough people call them, they will even post it to the website.

This situation presents a good reminder tor HR professionals and company staff that it is always best to consult with an attorney about their legal obligations, particularly on posters.  And it reminds me of the (seemingly) old adage that just because it is on the Internet, that does not mean it's true.  It is always best to go to the underlying source to resolve any questions you might. And you might save a few bucks by doing so.

(4:30p UPDATE) See comments by Kevin Lembo, from the Office of Healthcare Advocate below regarding the poster.  There will be some further developments in this topic likely tomorrow.  Stay tuned.