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Current benefit plans have given more purchasing and decision-making power to the members with higher out-of-pocket responsibilities. Members do not always understand what their benefit plans cover, and the costs associated to that coverage, which can cause a lot of confusion and frustration. 
We at Fall River Employee Benefits understand that benefit plans can be an intimidating and confusing subject. We want to empower and educate our client’s employees to be their own best health advocates and make informed decisions regarding their health care. 
We love helping our clients create year-round campaigns to teach their employees to be better consumers of health care. There are many topics to cover, so we’ll likely do several articles in this area. 
Published in Best Practices
Monday, 16 April 2018 15:08

HIPAA Compliance Made Easy

HIPAA is an important guideline for employers, health care practitioners, and insurance companies to follow. Since the fines for non-compliance can be in the tens of thousands of dollars, it’s imperative that employers pay attention to their obligations in keeping employees’ information private.

Published in Compliance
Wednesday, 25 January 2017 20:13

Update on ACA Repeal and Replace Strategy

It was no secret before President Trump signed the executive order that he wanted the Affordable Care Act (ACA) repealed, and now he has made his intentions clear. His first signed executive order requires federal agencies to ease the economic burden of the ACA “to the maximum extent permitted by law” until it is repealed. Although the executive order doesn’t grant the administration any powers that it didn’t already have, it does signal to the public that change is coming. 

Published in Healthcare Reform
Wednesday, 18 January 2017 13:56

On Wellness, One Size Fits ONE

Guest Article by Brad Cooper, CEO of US Corporate Wellness


The research is in, and it warrants an exclamation point!  An effective employee wellness program will provide a 125-600% ROI or more through decreased health care, sick time and disability costs, as well as improved recruitment, retention and employee engagement (and that doesn’t take into account the personal enhancements participants experience in their own lives!).  The result of this research has been a two-fold increase in the number of organizations that have launched wellness programs for their employees in recent years.  Only one problem – the first word in the phrase “Effective Employee Wellness Program.”


There are many approaches to employee wellness.  Common entry level approaches include holding an internal “biggest loser”-like contest or providing paid memberships at the local health club. 

Published in Wellness

The 21st Century Cures Act was signed into law on December 13, 2016 by then President Obama. The bulk of the Cures Act covers areas such as medical research and drug and device approvals. This new law also revokes a ban in effect since 2014 on small employer pre-tax funding of individual health insurance premiums. Beginning in 2017, this new act will allow small employers to create “Qualified Small Employer Health Reimbursement Arrangements” or “QSEHRAs.” 

Published in Healthcare Reform

The annual Kaiser Family Foundation/Health Research & Education Trust Employer Survey is always a great source of information about the trends in employer-sponsored health coverage.  This year’s big conclusion is that while final premium increases were not that high, the average was markedly reduced by even more movement to cost-saving High Deductible Health Plans (HDHPs), which means employees likely have less rich benefits than before.

Published in Industry Trends
Wednesday, 13 July 2016 14:32

Fall River Inspiration Scholars Announced

We are so excited to share that we have chosen the winners of our annual Fall River Inspiration Scholarship. Each year, employees of Fall River clients, as well as their children/grandchildren, are eligible to apply. We had an outstanding pool of applicants this year (in both quantity and quality of applications) and have decided to increase the number of scholarships we gave. We are awarding two $1,000 scholarships as well as three $250 book stipends.
Published in Fall River News
Monday, 07 April 2014 12:00

Final Colorado Exchange Enrollment

Now that the deadline for Open Enrollment on the Exchange Marketplace has passed, we’d like to update you on some of the enrollment figures.
Colorado has an Exchange site of its own, Connect for Health Colorado, as do about a dozen other states, separate from the federally-run enrollment website, hhs.gov.
In Colorado alone, the Connect for Health Colorado site was visited by 1,260,008 people.  Of that number there were 277,149 who signed up for health insurance.  This total reflects two distinct categories of insurance.  In the category of private health insurance (through Connect for Health Colorado) there were 118,628 new subscribers.  The vast majority of this enrollment is in individual plans, with a small percentage in the small business plans through the SHOP Exchange.
The rest of the enrollments were individuals who qualified for coverage under Medicaid.
For additional information and metrics, please visit http://connectforhealthco.com/news-events/metrics .
The figures on a national level have not been finalized at this time.


Published in Healthcare Reform


The Employee Retirement Income Security Act of 1974 (ERISA) was enacted to protect the interests of individuals who participate in an employer-sponsored group health, pension, and benefits plan. To ensure that these interests are upheld, certain requirements are in place for all plan sponsors and administrators to follow in order to meet their ERISA obligations.
It is a common misnomer that ERISA only applies to self-funded plans. ERISA applies to all employee benefit plans, self-insured and fully insured, regardless of size. This is why it is essential for plan administrators to understand the importance of ERISA, and take the necessary steps to stay in compliance to avoid possible penalties by the Department of Labor (DOL).  See the More Info Section below to see to which types of plans ERISA applies, and which employers are exempt.
What are the ERISA requirements for an Employer-sponsored Health Plan?
  • Written Plan Document – insurer certificates are not sufficient; a wrap document is often     required
  • Summary Plan Descriptions (SPDs)
  • Summary of Material Modification (SMM) for off-anniversary changes
  • Form 5500 and Summary Annual Report (SAR), for those with 100+ participants
  • Numerous required notices throughout the year – note that these changed recently
  • COBRA compliance
  • HIPAA and HITECH compliance – including the latest privacy regulations effective 9/23/13
  • Medicare Part D notifications to members and CMS if any beneficiaries could be Medicare eligible; note that even some non-ERISA plans such as churches and governments are also subject to this requirement
Once you have the above pieces in place (the Fall River ERISA Toolkit can help), we recommend an annual checkup where once a year you:
  • Collect and review all benefit  plan documents
  • Identify plan changes and initiate corrections
  • Mark calendar for the dates required forms are due and deadlines for reporting
  • Review and update required notices for employee distribution
Fall River understands the complexity of ERISA and feels it is important for employers big and small to know the “who, what and when” of ERISA compliance. If this is an area where you need some help getting fully into compliance, just This email address is being protected from spambots. You need JavaScript enabled to view it. or give us a call at (303) 369-3200!
The information provided only gives a brief summary and general guidance, and should not be considered legal advice. We always recommend you contact your ERISA attorney regarding the laws and regulations that interpret your health plan.
What plans are subject to ERISA?
  • Group Medical (PPO, HDHP, HMO, POS, etc.)
  • Dental
  • Vision
  • Group Life & AD&D
  • Disability
  • Prescription Drug Plans
  • FSA
  • HRA
  • Wellness programs (if medical care is offered)
  • Employee Assistance Programs (if counseling is provided)
What types of employers and plans are NOT subject to ERISA?
  • Government Plans (federal, state, city, county, public school districts)
  • Church
  • Health Savings Accounts themselves (though the underlying HDHP plans are)
  • Section 125 - Premium Only Plans
  • Payroll Practices
  • Voluntary Plans
Published in Best Practices


Many Affordable Care Act (ACA) compliance deadlines have already been delayed, mostly surrounding the Large Group Employer Mandate, now postponed until 2015 and 2016, depending on group size. The most recent extension has created confusion surrounding whether groups can keep their current plans beyond their 2014 renewal date. We all remember hearing during the ACA rollout that “If you like your plan, you can keep your plan.”  However, groups are finding out with their 2014 renewals that this is not the case, that their current plans are being discontinued, and therefore they must choose new plans that are ACA-compliant.
Perhaps in response to negative reactions from the public, in November of 2013 the federal government announced a one-year transition relief period, during which groups could continue offering their current non-compliant plans.  The March 5, 2014, an announcement extended that relief to 2 years.  So now that groups have another 2 years to transition to ACA-compliant plans, your current plans are fine, right?
Unfortunately, it’s not that simple.
At the time of the initial delay back in November, CMS provided guidance that at the option of each state, health insurance carriers could continue to offer non-compliant policies through October 1, 2016.  However, only about half the states opted to grant extensions for offering non-compliant policies.
The Colorado Division of Insurance was quick to say that they would not elect the extension, and therefore plan renewals in 2014 would have to be transitioned over to ACA-compliant coverage as planned. The reason is likely due to the large time and effort already spent by the DOI and carriers to create benefits and pricing for their new ACA-compliant plans.  The carriers hadn’t planned on being able to offer non-compliant plans any longer, so they did not calculate pricing for them.  It didn’t make sense to the DOI to put aside all the work they had already done, and focus back on plans that will eventually be obsolete.
As a result, in Colorado and many other states, the delay has no impact. The plans available when first moving to a new carrier, as well as your renewals, will include only ACA-compliant plans.
Published in Healthcare Reform
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