Viewing posts from: July 2015

AP Benefit Advisors Employee Benefits Broker Checklist Video

Posted July 28, 2015 by Megan DiMartino

Watch this 3 minutes video and compare your current broker resources and enrollment system functionality:

Webinar: Top 15 Must-Do's for 2016 Renewals to Ensure Compliance and Avoid Penalties

Posted July 27, 2015 by Megan DiMartino

2016 Enrollment WebinarJoin AP Benefit Advisors Senior Counsel and VP of Compliance, Patrick Haynes as he reviews the “Top 15 Must-Do’s for Your 2016 Renewal” to ensure compliance and avoid penalties. It’s imperative that HR teams avoid key mistakes in their 2016 open enrollment. With the increased challenges and scrutiny impacting enrollment, employers must avoid these critical, and often overlooked errors. Attorney Haynes will discuss the many nuances of these common errors. Here are a few of the top 15 topics to be analyzed in this complimentary 35 minute webinar:

• Cadillac Tax Updates and Issues
• Minimum Essential Coverage – on SBCs and Forms 1094/1095
• ER Mandate Reporting including 4980H, 6055, 6056 & IRS 8962, 720, 1094, 1095
• Dependent Audits – Value for Validating Spouses and Dependents?
• Wellness Program Compliance Issues (HIPAA, GINA, and PPACA)
• Definition Changes – Spouse, Domestic Partner, Civil Union, etc.
• Health Care FSAs: Grace Periods, Rollover, & Run-Out Periods
• Opt-Out Credit Guidance – Major Impact on PPACA Affordability Testing

Thursday, Aug 20, 2015 12:00 PM – 12:40 PM EDT
Click here to register.

Open to all HR professionals – but not brokers, agents, TPAs, PEOs

Open Enrollment System Checklist – What Systems Should Provide for 2016 Enrollment

Posted July 20, 2015 by Megan DiMartino

US-DeptOfHHS-Seal-3D.svg (1)Open enrollment season is rapidly approaching and your January 1st clients will be looking for an easy-to-use, multi-carrier, multi-product enrollment system. Today, enrollment systems should provide comprehensive services, from pre-enrollment loading of eligibility data to assisting in benefit decisions, and feeding election data to the carriers and vendors. Use the enrollment checklist below to determine if your current enrollment system provides all the services your need:

  • Supports “Rules based” architecture
  • Provides one consolidated bill
  • Electronically feeds all carriers and payroll system
  • Web-based enrollment & eligibility
  • Easy-to-use health benefit accounts (including FSAs, HSAs and HRAs)
  • Automatically aggregates all data
  • Comprehensive ACA compliance reporting & analysis
  • Interactive decision support tool for benefits shopping, enrollment and education.

Our enrollment and administration platform ensures access to a comprehensive and flexible platform. Our implementation team customizes the enrollment system using your company’s plan specifications and eligibility rules to quickly configure, test and implement your open enrollment.

Please contact us at (800) 451-8519 for more information about our comprehensive enrollment and benefit administration system.

Women’s Preventive Services Coverage and Non-Profit Religious Organizations

Posted July 10, 2015 by PHaynes

birth-control-otc-articleThe US Department of Labor, EBSA (Employee Benefits Security Administration) has posted some new information.

Most health plans are required to cover certain recommended preventive services, including certain women’s preventive health services, without charging cost sharing, like a co-pay, co-insurance, or deductible. The independent Institute of Medicine (IOM) provided recommendations to the Department of Health and Human Services (HHS) regarding which preventive services help keep women healthy. The IOM recommendations included covering all FDA-approved contraceptive services for women with child-bearing capacity, as prescribed by a provider, because of the health benefits for women that come from using contraception.  In fact, nearly 99 percent of women in the United States have relied on contraceptive services at some point in their lives, but more than half, between the ages of 18 and 34, have struggled to afford it.  Under Affordable Care Act (ACA) rules, starting in 2012, women enrolled in most  health plans and health insurance policies (non-grandfathered plans and policies) are guaranteed coverage for recommended preventive care, including all FDA-approved contraceptive services prescribed by a health care provider, without cost sharing.

Seeking to end a long-running controversy, federal regulators finalized proposed rules to enable employees of nonprofit religiously affiliated organizations, such as hospitals, and closely held private corporations to obtain coverage for prescription contraceptives, even if their employers object.

Like the earlier rules proposed nearly a year ago by the U.S. Department of Health and Human Services, under the final HHS regulations, religiously affiliated organizations would provide written notification to HHS of their objections to the coverage.

  • For nonprofits with an insured plan, HHS then would notify the insurer, with the insurer becoming responsible for providing the coverage.
  • For self-funded organizations, the U.S. Department of Labor would notify the organization’s third-party health plan administrator, with the TPA then arranging the coverage.
  • The insurers or TPAs would pay for the coverage.







Reporting Requirements: Increased Penalties and New Electronic Filing Steps

Posted July 8, 2015 by Megan DiMartino


The Trade Preferences Extension Act of 2015 (“Act”), signed into law by President Obama on June 29, significantly increases potential penalties for insurers and employers that fail to comply with the new Affordable Care Act (ACA) Minimum Essential Coverage (MEC) and Large Employer reporting requirements first due in 2016.

As a refresher:

  • IRS Code 6055 requires insurers and self-insured plan sponsors to file reports with the IRS to verify whether an individual had MEC during a given calendar year to satisfy the Individual Mandate
  • IRS Code 6056 requires an “applicable large employer” to file reports with the IRS verifying whether it offered minimum value and affordable coverage to full-time employees and their dependents in a given calendar year to satisfy the Employer Mandate

The new penalties are effective for returns and statements required to be filed in 2016 for the 2015 calendar year:

Penalty Old Amount New Amount
Failure to file/furnish an annual IRS return or provide individual statements to all full-time employees $100 $250
Annual cap on penalties $1,500,000 $3,000,000
Failure to file/furnish when corrected within 30 days of the required filing date $30 $50
Annual cap on penalties when corrected within 30 days of required filing date $250,000 $500,000
Failure to file/furnish when corrected by August 1 of the year in which the required filing date occurs $60 $100
Cap on penalties when corrected by August 1 of the year in which the required filing date occurs $500,000 $1,500,000
Lesser cap for entities with gross receipts of not more than $5,000,000 $500,000 $1,000,000
Lesser cap for entities with gross receipts of not more than $5,000,000 when corrected within 30 days of required filing date $75,000 $175,000
Lesser cap for entities with gross receipts of not more than $5,000,000 when corrected by August 1 of the year in which the required filing date occurs $200,000 $500,000
Penalty per filing in case of intentional disregard. No cap applies in this case. $250 $500

Click here to access the Act.

New Electronic Filing Steps

Additionally, this week the IRS provided more information on the process for electronic reporting to the IRS. The electronic filing system known as the ACA Information Return (AIR) system is significantly more complex than simply uploading a PDF file containing the pertinent information. Employers, insurers and third-party fulfillment or filing software developers are required to complete the following steps prior to being able to electronically submit any Reporting Forms:

  1. Register with the IRS’s e-services website, including submission of personal information about the person registering for the Submitting Entity
  2. Obtain an AIR Transmitter Control Code (TCC), a unique identifier authorizing each Submitting Entity to submit the Reporting Forms, and
  3. Pass a series of technical/system tests to ensure that Reporting Forms will be properly submitted when due.

The first two steps can be completed now. The third step is anticipated to become available later this year.

Click here for more information on the AIR program.

Eighth Circuit Reinforces That Plan’s Deadline for Filing Suit Controls

Posted July 1, 2015 by Megan DiMartino

from EBIA

More than two years after receiving a final benefit denial, a participant sued her self-insured multiemployer ERISA health plan. The Eighth Circuit, upholding the trial court, ruled that the lawsuit was time barred because it was not brought within the two-year period required by the plan—rejecting application of a state law providing a longer statute of limitations. (Because ERISA does not specify a limitations period, the deadline for filing an ERISA lawsuit is determined by either the plan’s terms or analogous state law.)

The plan document stated that it was to be construed in accordance first with ERISA and the Internal Revenue Code, and second with Missouri law. The participant argued that this rule of construction required applying Missouri’s ten-year statute of limitations, which also prohibited parties from agreeing to a shorter limitations period. But the court disagreed, citing the U.S. Supreme Court’s ruling in Heimeshoff (see our article), which emphasized the supremacy of an ERISA plan’s written terms. Under Heimeshoff, a plan’s stated limitations period controls unless it is unreasonably short (which this participant did not argue) or conflicts with a controlling statute. The court explained that the state statute was not controlling; the plan’s reference to Missouri law did not make it applicable, as parties may not choose state law to broadly govern an ERISA plan. According to the court, allowing Missouri’s statute of limitations to apply would not only violate the plan’s terms but also risk creating a “national crazy quilt” of ERISA limitations periods, flying in the face of ERISA’s goal (demonstrated by its comprehensive preemption provisions) of administrative uniformity. The participant also argued that the state law was saved from preemption under ERISA § 514(b)(2)(A) (the “savings clause,” which spares most state insurance laws from preemption). But the court noted that even if that argument had traction, ERISA’s “deemer clause” (§ 514(b)(2)(B)) prevents the savings clause from applying to self-insured plans.

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