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The IRS has released the updated inflation-adjusted limits for health savings accounts (HSAs) and high deductible health plans (HDHPs) for 2026. Annual contribution limits, minimum deductibles for HDHPs, and maximum out-of-pocket expenses will see an increase. However, the additional catch-up contribution limit for individuals aged 55 and older will remain unchanged.

If you have any questions, please reach out to your Relationship Manager at Rose Street Advisors, or email info@rosestreetadvisors.com.

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Understanding Non-FMLA Leave and Health Coverage: Employer Responsibilities

When an employee takes leave that is not covered under the Family and Medical Leave Act (FMLA), employers often have questions about how to handle health insurance coverage. Unlike FMLA leave, which mandates continued health benefits, non-FMLA leave operates under different rules. Employers must navigate federal and state laws, company policies, and benefit plan provisions to ensure compliance. Here's what you need to know. 

Can an Employer Terminate Health Coverage During Non-FMLA Leave?  

Yes, in some cases an employer may terminate health coverage during non-FLMA leave, but this depends on several factors:

    • Employer Policies: If company policies specify that health coverage continues during leave, the employer must follow its own           policies. 

    • Insurance Plan Rules: Some group health insurance policies have specific provisions about continued coverage during                    unpaid leave. Employers should review their plan documents to determine eligibility requirements. 

    • Americans with Disabilities Act (ADA) and Other Regulations: If the leave qualifies as a reasonable accommodations under          the ADA, the employer may be required to maintain health coverage 

Employers should be consistent in applying their policies to avoid discrimination claims. 

 

What Notices Need to Be Provided?  

If an employer decides to terminate or modify health coverage during non-FMLA leave, proper notice must be given to the employee. Notices may include: 

    • Plan Documents & SPD (Summary Plan Description): Employees should already have received details about health coverage        continuation in their SPD. 

    • COBRA Notification: If coverage is terminated and the employer has 20 or more employees, COBRA (Consolidated Omnibus           Budget Reconciliation Act) requires that the employee be notified of their right to continue health coverage at their own expense. 

    • State-Specific Notices: Some states have mini-COBRA laws that apply to smaller employers or provide additional protections. 

    • Internal Communication: Employers should send a written notification outlining the impact of the leave on benefits, deadlines        for premium payments, and any available options for continuation. 

How Can Employers Collect Premiums During Non-FMLA Leave?  

If an employer chooses to continue health benefits while an employee is on non-FMLA leave, they need a clear process for collecting premiums. Options Include: 

    1.  Prepayment Before Leave: Employees can pay their portion of premiums in advance before going on leave.

    2.  Payroll Deductions Upon Return: Employers may allow employees to catch up on missed premium payments through payroll          deductions once they return 

    3.  Direct Billing During Leave: Employers can set up a system where employees pay premiums directly to the company or the            insurer during their leave.  

    4. COBRA Enrollment: If an employee loses coverage due to non-payment or termination of benefits, they may elect                              COBRA to continue coverage.  

 

Should Employers Address This in Their Employee Handbook? 

Absolutely. A well-drafted employee handbook should include: 

    • Eligibility for Leave and Benefits: Clearly outline which types of leave are covered and how they impact benefits. 

    • Premium Payment Policies: specify how employees are expected to pay for their health coverage during unpaid leave.

    • COBRA and Continuation Coverage: Explain what happens if health coverage is terminated and how employees can                         maintain benefits. 

    •State-Specific Regulations: If applicable, include any state-mandated provisions for health benefits continuation. 

By having a clear and consistently applied policy, employers can ensure compliance and help employees understand their rights and responsibilities. 

Conclusion

Navigating health coverage during non-FMLA leave requires careful attention to company policies, insurance plan provisions, and legal requirements. Employers should provide clear notices, establish a fair premium collection process, and document policies in their handbook to prevent misunderstandings. By proactively addressing theses issues, employers can maintain compliance while supporting employees during their time away from work. If you have questions about your responsibilities or need assistance with non-FLMA leave, consult your Rose Street Advisors team for assistance. If you are not a current client of Rose Street Advisors, please feel free to contact us at 269-552-3200 or contact@rosestreetadvisors.com to speak to someone. 

Justine Dickens

EMPLOYEE BENEFITS ADVISOR

Justine is a devoted and meticulous team member with a passion to educate and support business partners and their employees. Since 2013, Justine’s commitment to her clients has allowed her to instill confidence and stability in the benefits packages offered to their employees. Her strengths allow her to communicate efficiently, focus on customization and understand the complexities of an ever changing industry. She is a Dale Carnegie Graduate and has her NAHU Self-Funded Certification.

When she is not working, Justine is busy running her son and daughter to their practices and games and volunteering in the community. She enjoys playing golf, hiking and spending time with her family and friends.

Interested in more?

Let's Talk Proactive HR

What is RxDC Reporting? 

RxDC (Prescription Drug Data Collection) reporting is a requirement under the Consolidated Appropriations Act (CAA) of 2021. The purpose of this reporting is to provide the Centers for Medicare & Medicaid Services (CMS) with data on prescription drug costs and health care spending. The information collected helps federal agencies analyze trends in drug pricing, understand how prescription costs impact premiums, and promote transparency in the healthcare market. 

Employers sponsoring health plans—whether fully insured, level-funded, or self-funded—must ensure compliance with RxDC reporting requirements. Understanding your responsibilities based on the type of plan you offer is crucial for compliance and avoiding potential penalties. 

Employer Responsibilities by Plan Type 

Fully Insured Health Plans 

Employers with fully insured health plans generally have limited responsibilities regarding RxDC reporting. The health insurance carrier is responsible for submitting the required data to CMS. However, employers should: 

    •Confirm with their insurer that the reporting will be completed on their behalf. 

    •Request documentation from the insurer confirming submission. 

    •Retain records of compliance in case of future audits or inquiries. 

Level-Funded Health Plans 

Level-funded plans are a hybrid between fully insured and self-funded plans, where the employer pays a set monthly amount but retains some financial risk. The reporting responsibilities for level-funded plans can vary depending on the insurer’s role. Employers should: 

    •Determine whether their carrier will handle the RxDC reporting. 

    •If the insurer does not report on their behalf, coordinate with third-party administrators (TPAs) or pharmacy benefit managers       (PBMs) to ensure data submission. 

    •Maintain documentation of the reporting process and ensure compliance deadlines are met. 

Self-Funded Health Plans 

For self-funded plans, the employer holds the primary responsibility for RxDC reporting. However, third-party administrators (TPAs) or pharmacy benefit managers (PBMs) may assist with the process. Employers should: 

    •Confirm if their TPA or PBM will submit the RxDC report. 

    •If the TPA or PBM does not handle submission, ensure data collection and timely reporting to CMS. 

    •Keep records of the submission process for compliance verification. 

Key Deadlines and Compliance Considerations 

RxDC reporting is due annually, typically by June 1st for data from the previous calendar year. Employers should: 

    •Start discussions with insurers, TPAs, or PBMs well in advance of the deadline. 

    •Ensure all required data—including total health care spending, prescription drug costs, and premium information—is                          accurately compiled. 

    •Monitor regulatory updates, as reporting requirements may evolve over time. 

Final Thoughts 

RxDC reporting is an essential compliance requirement for employer-sponsored health plans. While fully insured employers have minimal direct responsibilities, those with level-funded and self-funded plans must take a proactive approach to ensure timely and accurate reporting. By working closely with insurers, TPAs, and PBMs, employers can fulfill their obligations, avoid compliance risks, and contribute to greater transparency in healthcare costs. 

If you have questions about your responsibilities or need assistance with RxDC reporting, consult your Rose Street Advisors team for assistance. If you are not a current client of Rose Street Advisors, please feel free to contact us at 269-552-3200 or contact@rosestreetadvisors.com to speak to someone.  

Justine Dickens

EMPLOYEE BENEFITS ADVISOR

Justine is a devoted and meticulous team member with a passion to educate and support business partners and their employees. Since 2013, Justine’s commitment to her clients has allowed her to instill confidence and stability in the benefits packages offered to their employees. Her strengths allow her to communicate efficiently, focus on customization and understand the complexities of an ever changing industry. She is a Dale Carnegie Graduate and has her NAHU Self-Funded Certification.

When she is not working, Justine is busy running her son and daughter to their practices and games and volunteering in the community. She enjoys playing golf, hiking and spending time with her family and friends.

Interested in more?


Let's Talk

Proactive HR

Employers looking for more predictability in their costs, more equity in their contributions and perhaps even more flexibility for their employees are increasingly exploring the idea of Defined Contribution strategies for their employee benefit plans. 

Defined Contribution (or DC) plans come in various different forms.  When I started my career many years ago, DC plans were often called “Full Flexible” or “Cafeteria” Benefit Plans.  Today, they might be as simple as a set dollar amount contribution towards the purchase of several medical plan options or as complicated as a “benefits bank” utilizing an online platform from which employees can spend those dollars on the benefits that are most important to them (like a throwback to the Full Flexible Benefit Plan days!).

The predictability comes in when an employer can determine their costs right from the start. For example, rather than an employer paying 80% of the premium, regardless of which medical plan an employee chooses, the employer may instead set a specific dollar amount they’re willing to pay.  An employee can then choose to buy up or down from that dollar amount for the plan that best fits them.  Why should an employer pay more just because an employee chooses a more expensive plan?  From an equity standpoint, why should one employee receive a higher employer subsidy (i.e. pay) simply because they chose a more expensive benefit?  The employer also gets to determine the level of increase each year to their contribution, rather than being tied to the benefit renewal increase.

There can also be greater flexibility for employees if the plans and contributions are well designed.  For example, public employers in Michigan are required to either share medical plan premium costs with employees through a 80%/20% split or they must utilize the “Hard Cap” (a state mandated maximum for employee only, dual, and family coverage).  This “Hard Cap” is one form of a Defined Contribution strategy.  Many public employers who utilize the Hard Cap oftentimes have plan options that cost the employee more than the Hard Cap. In this case, the employee pays the difference. Additionally, plan options like HDHP/Health Savings Account (HSA) plans tend to cost less than the Hard Cap.  In these scenarios where the premium cost is less than the Hard Cap, employees pay nothing out of their paycheck for premium contributions AND employers may fund contributions into an employee’s HSA on their behalf – up to that Hard Cap or Defined Contribution limit.  This gives employees much more flexibility and financial incentive to choose the most appropriate plan for them.

This is a very abbreviated explanation of a Defined Contribution strategy.  To determine what kind of strategy is right for your organization and employees, talk to your Rose Street Advisors Relationship Manager!

Ben Cohen

CEBS | EMPLOYEE BENEFITS RELATIONSHIP MANAGER

Ben Cohen, CEBS, is one of our large group Employee Benefits Relationship Managers. Following graduation from Central Michigan University (Fire Up Chips!) with a degree in Human Resources, Ben spent 18 years as a benefits consultant with Kushner & Company before joining RSA in 2014. Ben’s daily focus is working with clients to offer benefit options that help recruit and retain a productive workforce in a compliant and cost-effective manner designed specifically for each employer. He also enjoys educating employees about their benefits in a fun and informative manner.

Outside of work, Ben is passionate about community involvement and volunteering. Ben also loves spending time at home and at their cottage in South Haven with his wife, Jen, and their dogs. He loves travel, cars, reading on the front porch, golf, and sailing (on friends’ boats!).

Interested in more?

Let's Talk Proactive HR

Top 4 Reasons Healthcare
Costs are Rising for 2025

We all know healthcare costs increase annually. Medical trend increases are based on higher costs for prescription drugs, advancement in medical technologies, reinsurance costs and regulatory changes. So, what are the reasons for the higher than normal premium rates as we approach 2025? The aftereffects of COVID are creeping into the system. 

Following is a few of the consequences of the pandemic:

1. Many of the experienced nurses who shouldered the responsibility of caring for COVID patients were burned out. 

These brave medical personnel, who normally would have continued to work in the industry longer; left the field of nursing, which created a shortage. Higher wages, bonuses and hiring traveling nurses were the only way to keep facilities staffed to take care of patients. This increased expenses at all hospitals.

2. Beginning in 2021 through 2023, inflation has more than doubled compared to the previous 20 years. 

 This has not only impacted interest rates but also the cost of goods and services provided by health care organizations.

3. Health insurance companies were previously locked into 3-5 year reimbursement contracts with hospitals that would not let the hospitals receive more money for their services.

As the contracts come to term, hospitals are looking to recoup their losses and want insurance carriers to pay more for services.

4. We are still seeing an increased use of healthcare post-pandemic by those who delayed treatment and are either catching up on their treatments or have a chronic condition that has progressed which has placed them in a worse state. 

The list above highlights some of the key reasons why we anticipate you will see higher than normal rate increases than in the past. If you have any questions or would like to have a conversation, please reach out to us at Rose Street Advisors.

Chris Werme

LIC | Employee Benefits Advisor

As an advisor, Chris partners with clients to develop benefit strategies that meet organizational goals, budgets and company culture. From his background in accounting, he has a talent in picking out trends arising from claims data, reviewing analytics and negotiating renewal pricing with underwriters that serve his client’s well. He is an advocate in the healthcare world for his clients and their employees. On a personal note, Chris enjoys family and friends, especially while traveling, playing golf or boating. He is also a ‘Proud Papa’ to three grandsons!.

Interested in more?

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PCORI Fees - What are They and When Do I Pay Them?

One of the many requirements in the Affordable Care Act (ACA) is the Patient-Centered Outcomes Research Institute (PCORI) fee, an often overlooked but essential aspect of compliance. The PCORI fee is a charge imposed on issuers of specified health insurance policies and plan sponsors of applicable self-insured health plans. It was established to fund the Patient-Centered Outcomes Research Institute, an organization tasked with improving the quality and relevance of evidence available to help patients, caregivers, and healthcare providers make informed health decisions.

 

Who Needs to Pay the PCORI Fee? 

The fee applies to:  •  Health Insurance Providers: Issuers of specified, fully insured health insurance policies. For fully insured health plans, the insurance carrier pays the PCORI fee on your behalf. No action is required of the employer. • Self-Insured Plan Sponsors: Employers or plan sponsors of applicable self-insured health plans, including Health Reimbursement Arrangements (HRAs). The employer is responsible for the PCORI fee for self-insured health plans and HRAs.

 

How Much is The PCORI Fee? 

The PCORI fee amount is adjusted annually and is based on the average number of lives covered under the policy or plan. As of the most recent update, the fee is: •  $3.00 per covered life for plan years ending on or after October 1, 2022, and before October 1, 2023.  •  $3.22 per covered life for plan years ending on or after October 1, 2023, and before October 1, 2024.  The fee increases slightly each year based on the projected increases in national health expenditures. 

 

Calculating the PCORI Fee

Calculating the PCORI fee involves determining the average number of lives (employee, spouse and dependents) covered under the policy or plan during the plan year. Please note that for HRA plans, an employer pays the PCORI fee only on the number of participating employees, not including covered spouses and dependents. There are several methods for this calculation: 1. Actual Count Method: Count the total number of covered lives for each day of the plan year and divide by the number of days in the year.  2. Snapshot Method: Add the total number of lives covered on one date (or more dates, if using the "more dates" variation) in each quarter of the plan year and divide by the number of dates used. 3. Form 5500 Method: Use the participant counts reported on the Form 5500 for the plan year, if filed. Plan sponsors can choose the method that best fits their reporting capabilities, but they must use the same method consistently within a given plan year. 

 

Reporting and Payment 

To report and pay the PCORI fee, issuers and plan sponsors must file Form 720 (Quarterly Federal Excise Tax Return) annually, by July 31 of the year following the last day of the plan year. The fee is reported in Part II of the form under "Patient-Centered Outcomes Research Fee". The latest version of Form 720 can be found here: https://www.irs.gov/pub/irs-pdf/f720.pdf (see Part II, IRS No. 133). Ensuring compliance with PCORI fee requirements is critical to avoid penalties. Failure to pay the fee or report it accurately can result in interest and penalties imposed by the IRS. For more detailed information, refer to the IRS instructions for Form 720 or reach out to your Rose Street Advisors team for assistance.

Alicia Ball

STRATEGIC OPERATIONS ADVISOR

As Strategic Operations Advisor, Alicia has the opportunity to lead the Employee Benefits Department every day. The focus of her role is to ensure the Department is operating at maximum efficiency, which allows us to ensure that our client’s needs and expectations are consistently exceeded. She accomplishes this efficiency through her strong communication, ability to maximize resources and staying true to Rose Street’s core values. Alicia’s tenure with Rose Street began in 2016 as our Maxwell Health Champion. She then spent time as a Employee Benefit Advisor where she built long lasting relationships with her clients that remain in place today even with her role change. In her spare time, Alicia tries to keep up with her very busy son, volunteers as a Big Sister for the Big Brother, Big Sister organization, and makes sure to spend as much time outside as she possibly can.

Interested in more?

Let's Talk Proactive HR

Spousal Incentive Opt-Out HRA Plans

What is a Spousal Incentive Opt-Out HRA Plan? While many organizations have a taxable cash opt-out or waiver incentive that is offered to employees who are covered by health insurance coverage elsewhere, a spousal incentive opt-out HRA (sometimes called a spousal HRA, etc.) provides an opportunity to offer a larger, tax-free incentive to employees at similar (tax deductible) cost to employers.  A spousal incentive opt-out HRA plan is an arrangement where employers offer financial incentives to employees whose spouses have access to health insurance through their own employer and choose to opt-out of the company’s health plan in favor of the spouse’s plan. Instead of covering the family under the company’s plan, the employer provides a tax-free HRA incentive to the employee, which can be used to reimburse eligible medical expenses. How Does It Work?  Here's a simplified breakdown of how these plans typically work:  1. Eligibility: The employee’s spouse must have access to their own employer-sponsored health plan, and the family must enroll in that coverage after opting out of the company’s plan.  The employee must prove this enrollment. 2. Incentive/Usage: The employer provides an HRA as an incentive, which is usually a set amount of money that can be used for qualifying medical expenses, including deductibles, copayments, and other out-of-pocket healthcare costs.  The exact amount and the types of eligible expenses are determined by the employer.  The HRA funds are tax-free and can be used throughout the year for various medical expenses. 3. Administration: While HRAs can be administered by an employer, they are typically administered by a separate TPA, similar to the work done for Flexible Spending Accounts (FSAs). Benefits for Employers  1. Cost Savings: Employers save on the premiums they would otherwise pay to cover the spouse under the company plan. 2. Risk Management: By encouraging spouses to use their own employer’s plan to cover the entire family, the overall risk pool for the company’s health plan can become more stable and predictable. 3. Employee Satisfaction: Offering an HRA as an incentive provides a valuable benefit to employees, showing that the company cares about providing flexible and supportive options for their healthcare needs.  The HRA also provides a much greater potential benefit to employees vs a traditional, taxable cash incentive. Benefits for Employees 1. Financial Incentive: Employees receive a financial benefit for opting out of the company plan for their spouse’s coverage, which can help offset the employee’s healthcare costs.  As stated above, the financial benefit in an HRA is usually significantly higher than the taxable cash incentive. 2. Flexibility: The HRA funds can be used for a wide range of medical expenses, as determined by the employer, offering flexibility and financial support. 3. Simplified Coverage: For some families, having all family members on the same health plan can simplify coverage and coordination of benefits. Considerations While spousal incentive opt-out HRA plans offer numerous benefits, there are a few things to consider: • Spousal Carveout or Surcharge:  Spousal incentive opt-out HRAs are often paired with programs that either exclude a spouse’s enrollment in the company’s health plan if they have coverage available to them at their employer (carveout) or may simply add a surcharge to employees who cover their spouse on the company’s health plan when they have coverage available to them at their employer. • Eligibility:  An employer may limit the availability of the HRA incentive to those with spousal coverage available vs a parent’s coverage available. • Group Health Plan Integration: It is imperative that the spouse has comprehensive health coverage available to entire family, and that the family enrolls in that coverage.  The HRA must be integrated with the spouse’s group health plan to avoid healthcare reform issues. • Health Savings Accounts (HSAs):  In order for someone to contribute to or receive contributions to an HSA, they must not be enrolled in any non-high deductible health plan (HDHP) coverage.  A spousal incentive opt-out HRA would constitute a non-HDHP coverage.  Therefore, if an employee accepts the HRA incentive, the spouse could NOT contribute to an HSA.  For some people, the HRA may offset the lack of an HSA.  For others, they may wish to continue to fund their HSA and may wish to either forgo the HRA incentive OR you can offer a lower, taxable cash opt-out incentive alongside the HRA incentive OR offer as a limited purpose HRA for dental and vision expenses only. • COBRA Continuation:  The spousal incentive opt-out HRA is a COBRA qualified benefit.  This means that employees could elect to continue their HRA after a COBRA qualifying event. • Communication: Clear communication with employees about how the HRA works, the rules above and what expenses are eligible is crucial. • Compliance:  The design of the spousal incentive opt-out HRA must maintain compliance with the ACA, HIPAA nondiscrimination rules, §125 nondiscrimination rules, Medicare Secondary Payer (MSP) rules, etc. Conclusion Spousal incentive opt-out HRA plans can be a win-win for both employers and employees, offering cost savings, flexibility, and valuable benefits. By understanding how these plans work and implementing them thoughtfully, companies can enhance their benefits offerings and support their employees' diverse needs. Is your company ready to explore the potential of spousal incentive opt-out HRA plans? Reach out to your Rose Street Advisors’ Relationship Manager or contact us at info@rosestreetadvisors.com to learn more and see if this innovative option is right for you.

Ben Cohen

EMPLOYEE BENEFITS RELATIONSHIP MANAGER

Ben Cohen, CEBS, is one of our large group Employee Benefits Relationship Managers.  Following graduation from Central Michigan University (Fire Up Chips!) with a degree in Human Resources, Ben spent 18 years as a benefits consultant with Kushner & Company before joining RSA in 2014.  Ben’s daily focus is working with clients to offer benefit options that help recruit and retain a productive workforce in a compliant and cost-effective manner designed specifically for each employer.  He also enjoys educating employees about their benefits in a fun and informative manner.  Outside of work, Ben is passionate about community involvement and volunteering.  Ben also loves spending time at home and at their cottage in South Haven with his wife, Jen, and their dogs.  He loves travel, cars, reading on the front porch, golf, and sailing (on friends’ boats!).

Interested in more?

Let's Talk Proactive HR

employer Guide: navigating aca compliance as an applicable large employer

In today’s dynamic employment landscape, staying compliant with healthcare regulations is crucial for employers. The Affordable Care Act (ACA), signed into law in 2010, brought significant changes to the healthcare system, including requirements for employers to offer health insurance to eligible employees. As an Applicable Large Employer (ALE) under the ACA certain responsibilities and compliance requirements now apply to your organization. Here’s what you need to know and steps you can take to navigator ACA compliance effectively: Understanding ALE Status  1. Definition of ALE: An ALE is an employer with 50 or more full-time equivalent employees (FTEs) during the previous calendar year. Full-time employees are those who work, on average, at least 30 hours per week or 130 hours per month. 2. Determining FTE Count: Calculate your FTE count by combining the total hours worked by all employees (including part-time employees) in a month and dividing by 120. This will help determine if you meet the threshold for ALE status.  ACA Compliance Steps for ALEs:  1. Offering Minimum Essential Coverage (MEC):  • ALEs must offer Minimum Essential Coverage to at least 95% of full-time employees and their dependents to avoid potential penalties. • The coverage offered must meet affordability and minimum value standards set by the ACA. 2. Employer Shared Responsibility (ESR) Provision:  • Ensure compliance with the ESR provision, also known as the “employer mandate”, which requires ALEs to offer affordable health insurance that provides minimum value to eligible employees. • Track and monitor employee hours to determine full-time status and eligibility for coverage. 3. Reporting Requirements:  • File Forms 1094-C and 1085-C annually with the IRS. • These forms provide detailed information about the health insurance coverage offered to full-time employees and are used to assess compliance with the ACA employer mandate. • Stay up to date about ACA Reporting deadlines. Typically, these occur early in the years (i.e. January 31st for distributing Form 1095-C to employees and February 28th/March 31st for filing forms with the IRS)  Tips for Ensuring ACA Compliance: 1. Consult With Experts: Consider seeking guidance from your RSA Team and/or legal advisors to ensure accurate interpretation and implementation of ACA regulations. 2. Invest in HR Technology: Implement robust HR and payroll systems that can accurately track employee hours, manage benefits enrollment, and generate required ACA reports.  • IMPORTANT - Don't forget to ask your RSA Team how Employee Navigator can help you.  3. Educate Employees: Provide clear and transparent communication to employees about their health insurance options, enrollment process, and rights under the ACA. 4. Stay Updated: Regularly monitor updates and changes to the ACA regulations issued by the IRS and other governing bodies to stay compliant with evolving requirements. Becoming an ALE signifies growth and success for your organization but also brings added responsibilities in terms of ACA compliance. By understanding your obligations, taking proactive steps, and leveraging available resources, you can navigate ACA compliance effectively while supporting the well-being of your workforce. If you have any questions or need further assistance with ACA compliance, please contact your Relationship Manager to discuss your needs in greater detail. If your are not a current client of Rose Street Advisors, please feel free to contact us at 269-552-3200 or contact@rosestreetadvisors.com to speak with someone.

Justine Dickens

EMPLOYEE BENEFITS ADVISOR

Justine is a devoted and meticulous team member with a passion to educate and support business partners and their employees. Since 2013, Justine’s commitment to her clients has allowed her to instill confidence and stability in the benefits packages offered to their employees. Her strengths allow her to communicate efficiently, focus on customization and understand the complexities of an ever changing industry. She is a Dale Carnegie Graduate and has her NAHU Self-Funded Certification. When she is not working, Justine is busy running her son and daughter to their practices and games and volunteering in the community. She enjoys playing golf, hiking and spending time with her family and friends.

Interested in more?

Let's Talk Proactive HR

Top 3 reasons you need (and want) a summary plan description (spd)

Employee benefits are a critical component of talent retention, and providing clear information about these benefits is a legal requirement for employers. The Summary Plan Description (SPD) serves as a crucial document in this communication process. In 2024, the landscape is evolving, with an increased focus on compliance through audits. In this blog post, we will explore the top reasons you need (and want) an SPD and the essential requirements for creating an effective and compliant SPD.

1.       Creating and maintaining a compliant Summary Plan Description is a legal obligation (if you’re an employer that is subject to ERISA).

2.       In the face of expected increased audits in 2024, staying informed about regulatory requirements, regularly reviewing and updating SPDs, and ensuring accurate and timely distribution will be essential for organizations aiming to navigate the evolving landscape successfully.

3.       SPDs are a great way to concisely communicate all of the legal and informational benefit details to employees. 

Now that we have the top reasons for having an SPD, what are the key pieces of information that need to be in an SPD. What is required information in the SPD?    a. Plan Name and Identification    b. Plan Administrator Information    c. Plan Year and Amendment Information    d. Eligibility and Participation    e. Benefit Accruals and Vesting    f. Benefit Calculations    g. Funding Information    h. Claims Procedures    i. ERISA Rights    j. COBRA Rights    k. HIPAA Privacy Information    l. Legal Compliance What are SPD distribution requirements and accessibility rules? Employers must distribute the SPD within specific timeframes, and given the increased scrutiny, adherence to these timelines is crucial. New employees should receive the SPD within 90 days of joining the plan, and existing participants should receive updated SPDs every five years. Employers should also provide a summary of material modifications (SMM) when there are significant changes to the plan. Providing the SPD in various formats, including paper and electronic, ensures accessibility. This is vital to guarantee that all eligible employees have access to the information, especially in the context of audits. This is meant as a very high-level description of Plan Documents and SPDs.  If you are a current client of Rose Street Advisors, please contact your Relationship Manager to discuss your needs in greater detail.  If you are not a current client of Rose Street Advisors, please feel free to contact us at 269-552-3200 or contact@rosestreetadvisors.com to speak to someone.

Alicia Ball

STRATEGIC OPERATIONS ADVISOR

As Strategic Operations Advisor, Alicia has the opportunity to lead the Employee Benefits Department every day. The focus of her role is to ensure the Department is operating at maximum efficiency, which allows us to ensure that our client’s needs and expectations are consistently exceeded. She accomplishes this efficiency through her strong communication, ability to maximize resources and staying true to Rose Street’s core values. Alicia’s tenure with Rose Street began in 2016 as our Maxwell Health Champion. She then spent time as a Employee Benefit Advisor where she built long lasting relationships with her clients that remain in place today even with her role change. In her spare time, Alicia tries to keep up with her very busy son, volunteers as a Big Sister for the Big Brother, Big Sister organization, and makes sure to spend as much time outside as she possibly can.

Interested in more?

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Virtual health care in Michigan

In today’s benefits advisor blog, we’ll briefly touch on the types of virtual health care and how each of the primary health insurance carriers in SW Michigan are providing solutions. Virtual health care is primarily provided via internet video visits (and phone to a lesser extent) with health care professionals.  The care can be provided by your personal physician or physician’s office, more like a traditional office visit, just virtually vs. in-person.  It can also be provided through your health insurance carrier or a separate third party.  Virtual health care can be used to treat non-emergency physical issues such as allergies, bites and stings, fever, headache, sore throats, colds, cough and flu, as well as various infections such as eye, ear, pink eye, etc.  More recently, virtual health care can also be used for behavioral, mental health and substance abuse issues such as anxiety, depression, addiction and chronic or acute issues that occur. Many of our employee benefits clients in the Kalamazoo and SW Michigan area use BCBS/BCN, Priority Health or United Healthcare as their insurance carriers.  Below is a little information about the virtual health care solutions from each.  If your health plan is with a different medical carrier or is self-funded, please be sure to ask about the availability and details of virtual health care with your employer. BCBS/BCN:  BCBS (PPO) and BCN (HMO and POS) partnered with Teladoc effective January 1, 2024.  More information here: https://www.bcbsm.com/find-care/virtual-care Priority Health:  Priority Health uses their own Corewell Health providers if seeking services in Michigan.  Outside of Michigan, services are provided by MDWell.  More information here:  https://www.priorityhealth.com/member/getting-care/virtual-care United Healthcare (UHC):  More information here:  https://www.uhc.com/member-resources/health-care-tools/telehealth-virtual-care/virtual-visits The cost of virtual health care is often the same cost, or often lower, than in-person care, and certainly less than an Urgent Care or ER.  Obviously, the details of these programs vary, and you should always check with your employer and/or insurance carrier for the specific details of your plan.  Virtual health care can be a great option to save time and money and is a helpful tool for those needing quick access to physical or mental health care!

Ben Cohen

CEBS | EMPLOYEE BENEFITS RELATIONSHIP MANAGER

Ben Cohen, CEBS, is one of our large group Employee Benefits Relationship Managers.  Following graduation from Central Michigan University (Fire Up Chips!) with a degree in Human Resources, Ben began his career in 1997 as a benefits consultant with Kushner & Company.  After 18 years in that role Ben joined Rose Street Advisors in 2014.  Ben’s daily focus is working with clients to offer benefit options that help recruit and retain a productive workforce in a compliant and cost-effective manner designed specifically for each employer.  He also enjoys educating employees about their benefits in a fun and informative manner.  Outside of work, Ben is passionate about community involvement and volunteering.  He currently donates his time as a board member with the Portage Community Center, volunteers with Hospice Care of Southwest Michigan, and participates with volunteer opportunities through Rose Street Advisors’ SWEET committee.  In the past, his involvement has included the American Red Cross, United Way, Volunteer Kalamazoo, Optimist Club, Jaycees, KHRMA, and the Michigan Maritime Museum.  Ben loves spending time at home and at their cottage in South Haven with his wife, Jen, and their dogs.  He loves travel, cars, golf, sailing, and recently started a group with friends rowing vintage wood shells (42 N’ Rowing).

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