Ask PIA

Newborn coverage

We have noticed that our health insurance companies have various procedures when it comes to covering newborns. Some require the insured to provide notification, some require notification plus payment of an additional premium, some impose a separate deductible on the child’s coverage. What are the rules governing newborn coverage?

COBRA basics

Which employers are subject to COBRA rules? How long does COBRA entitlement last?

ERISA pre-emption

We are trying to help a client with a health claim. The family is insured under a self-insured health trust based in Pennsylvania, even though they reside in New York state. Do New York’s minimum benefit standards apply?

HIPAA ’eligible individual’ rule

One of our insureds has a New Jersey individual health insurance policy. He has a pre-existing condition. He is considering moving to another state. Does the federal law offer him portability protection?

ACA employee tax notices

I have a client who has 75 employees. What type of tax information does my client have to provide to employees to comply with the requirements of the Affordable Care Act?

New York health insurance continuation

Is New York’s health insurance continuation law the same as COBRA?

Notice of group health plan termination

What notice is an employer required to give to employees, when it terminates its employees’ group health plan?

Health insurance premium rebates

We received a rebate from our health insurance company because they did not meet the 80/20 rule under the federal Affordable Care Act. What can I, as the employer, do with the money?

Minimum notice of cancellation or nonrenewal—group health policies

How much notice must be given to nonrenew or cancel a group health insurance policy in New York state?

Health-care exchanges—broker compensation

Can brokers sell through a health-care exchange? Can they be compensated?

Sharing commission on exchange business

I’m a property/casualty broker who takes care of my clients’ health insurance needs by brokering that business through another person who, in exchange for the referral, shares commission with me. This other broker will be getting certified for the exchange. Do I need to be certified, too, to receive commissions?

Producer health exchange certification

What can you tell me about the interplay between being certified to sell through an exchange, being licensed as a health producer and receiving commissions?

PPACA—Small group renewals

I have a client with a small group policy that renews on Jan. 1, 2014. This client would like to renew the policy on Dec. 1, 2013, so as to avoid the requirements of the Affordable Care Act. Can I do this?

Small business health-care tax-credit eligibility

In order to determine if you qualify for the small business health-care tax credit, you will need to answer a few simple questions:

1. Do you have fewer than 25 full-time employees?
2. Do those employees have an average wage of less than $53,000?