PCORI Fees are Due Soon

Posted June 12, 2018 by Megan DiMartino

Applies to: Self-Insured Health Plans, including HRAs & FSAs

Employers who sponsor self-insured health plans must pay their annual Patient-Centered Outcomes Research Institute (PCORI) fees by July 31st!

PCORI fees are reported and paid annually using IRS Form 720 (Quarterly Federal Excise Tax Return). The applicable PCORI fee you pay this year, by July 31, 2018, is based on your plan year end date in 2017:

As a reminder, the PCORI fees are based on the average number of covered lives under the plan or policy. This ordinarily includes employees and their enrolled spouses and dependents. Individuals who are receiving continuation coverage (such as COBRA coverage) must also be included in the number of covered lives under the plan in calculating the fee. Plan sponsors of self-insured health plans must use one of the following three methods to determine the average number of lives covered under a plan for the plan year:
  1. Actual Count Method: A plan sponsor may determine the average number of lives covered under a plan for a plan year by adding the totals of lives covered for each day of the plan year and dividing that total by the total number of days in the plan year.
  2. Snapshot Method: A plan sponsor may determine the average number of lives covered under an applicable self-insured health plan for a plan year based on the total number of lives covered on one date (or more dates, if an equal number of dates is used in each quarter) during the first, second or third month of each quarter, and dividing that total by the number of dates on which a count was made.
  3. Form 5500 Method: An eligible plan sponsor may determine the average number of lives covered under a plan for a plan year based on the number of participants reported on the Form 5500, Annual Return/Report of Employee Benefit Plan, or the Form 5500-SF, Short Form Annual Return/Report of Small Employee Benefit Plan.
HRAs and Health FSAs
Health Reimbursement Arrangements (HRAs) and health Flexible Spending Accounts (FSAs) are not completely excluded from the obligation to pay PCORI fees. However, two special rules apply for plan sponsors that provide an HRA or health FSA. Under these special rules:
  1. If a plan sponsor maintains only an HRA or health FSA (and no other applicable self-insured health plan), the plan sponsor may treat each participant’s account as covering a single life. This means that the plan sponsor is not required to count spouses or other dependents.
  2. An HRA is not subject to a separate research fee if it is integrated with another self-insured plan providing major medical coverage, provided the HRA and the plan are established and maintained by the same plan sponsor and have the same plan year. This rule allows the sponsor to pay the PCORI fee only once with respect to each life covered under the HRA and other plan. However, if an HRA is integrated with an insured group health plan, the plan sponsor of the HRA and the issuer of the insured plan will both be subject to the research fees, even though the HRA and insured group health plan are maintained by the same plan sponsor.

The same analysis applies to health FSAs that do not qualify as excepted benefits.

Please contact your AssuredPartners’ Sales Executive or Account Manager for any further questions or assistance.


For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

AP Benefit Advisors Webinar Series | HRCI & SHRM Pre-Approved – Total Rewards Strategies: Getting the Most from Your Rewards Dollars

Posted June 8, 2018 by Megan DiMartino

Total rewards is an approach and framework for managing the elements of the employment interface between the organization and its workforce. As a strategy, it provides a vehicle for:

  • Identifying value-added employment-related factors;
  • Prioritizing the organization’s human resource investment;
  • Rationalizing different components of the employment interface; and
  • Communicating the alignment between rewards and business strategy.

Please join us for this HRCI* and SHRM** pre-approved, complimentary, one-hour webinar as Dan Ripberger, Managing Director of RSC Advisory Group, discusses total rewards in the context of business strategy and employment value proposition. RSC Advisory Group is a management advisory and consulting firm specializing in pay performance. The RSC team has worked with clients in a multitude of market sectors and geographic areas. Their work has spanned start ups, high-performing organizations and those going through re-invention – all who need advice and guidance specific to their situation.

Participants will learn a top-down approach to developing a reward framework that is aligned with short- and long-term business and mission needs. After participating in this webinar, participants will be able to:

  • Define the difference between and integration of employment value proposition and total rewards strategy;
  • Understand how business drivers influence total reward strategy; and
  • Begin to determine which reward elements have the greatest impact on specific people and reward objectives.

Webinar Details:

  • Thursday, June 21, 2018
  • 2:00pm – 3:00pm EDT
  • No cost to attend
  • This webinar is open to all HR and Finance Professionals – but not to brokers, agents, TPAs and PEOs

For more information contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.


*The use of this seal confirms that this activity has met HR Certification Institute’s® (HRCI®) criteria for recertification credit pre-approval.
**AP Benefit Advisors, LLC is recognized by SHRM to offer Professional Development Credits (PDCs) for SHRM-CP or SHRM-SCP. This program is valid for 1 PDC for the SHRM-CP or SHRM-SCP. For more information about certification or recertification, please visit shrmcertification.org.

New Jersey Becomes the 2nd State to Enact an Individual Health Insurance Mandate Tax

Posted June 7, 2018 by Patrick Haynes

On Wednesday, May 30th, NJ Governor, Phil Murphy, signed into law a bill that will require all New Jersey residents to have health coverage or pay a tax (penalty), making NJ the second state to enact an individual health insurance mandate.

Massachusetts, the first state to enact such a mandate, began taxing its citizens in 2006, and their approach served as a model for PPACA (aka “The Affordable Care Act”).  Massachusetts reports, as of the end of 2016, that 97% of its residents were insured for that year, and they had the lowest percentage of uninsured in the United States.  By contrast, the US Census reflects that 92% of NJ residents were insured in 2016.

Meanwhile, NJ Democratic lawmakers drafted the bill, NJ A3380 (18R), in response to Congress’ decision to repeal the federal mandate established under the Affordable Care Act (ACA). The repeal, the New Jersey lawmakers feared, would drive healthier people out of the state’s Healthcare.gov marketplace and cause premiums to spike.

“The individual market would descend into a death spiral if not for this legislation,” said State Sen. Joe Vitale (D-Middlesex), the prime sponsor. “This helps to keep people insured and keeps that market healthier.”

Will Vermont join their ranks?

Vermont Gov. Phil Scott, a Republican, signed a bill on May 28th that would establish an individual mandate, but the details, including the financial penalty and enforcement mechanisms, will be determined during the 2019 legislative session. The Vermont mandate won’t go into effect until January 1, 2020.

When will this new tax (NJ Mandate) take effect?  And, how much will it be?

The Mandate is really a tax and it closely mirrors the federal ACA tax structure.  So, when a NJ resident files his/her state income tax return, the resident will owe a penalty for themselves, their spouse and each of their dependent children that is uninsured (or has coverage that doesn’t meet federal MEC (Minimum Essential Coverage) guidelines).

The tax will be the greater of:

  • $695 per adult, and half of that ($347.50) per child; OR
  • 2.5% of the taxpayer’s income

New Jersey’s mandate is scheduled to take effect January 1, 2019, which gives state officials seven months to get the word out to residents about the new requirement.

 


For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

AssuredPartners Webinar | SHRM Pre-Approved – Substance Abuse Treatment: Fraud, Abuses, and Other Barriers to Effective Care

Posted May 18, 2018 by Megan DiMartino

The ACA, Mental Health Parity and opioid epidemic have created a “perfect storm” in the substance abuse treatment field. Prior to these legislative changes, many plans had very low financial exposure, limiting the number of treatment days/visits available per year, or even in a lifetime. Today’s reality is that substance abuse treatment facilities are growing rapidly with more direct to consumer marketing of their “luxury, resort-like” amenities. With treatment episodes exceeding six figures, substance abuse is no longer an area of low risk exposure.

Please join AssuredPartners and our speaker, Judi Braswell, LPC, CEAP, GBS, Vice President, Business Development at Behavioral Health Systems, for this SHRM* pre-approved, complimentary, one-hour webinar as she shares insights into the legal landscape related to fraud and abuse and what employers can do to protect their employees. Specifically, this webinar will provide the following:

  1. Overview of fraud/abuse/low value care
    • Substance abuse treatment
    • Drug testing
  2. Claims analysis insights
  3. Key elements in effective treatment
  4. Employer strategies/plan design for improving outcomes/ROI

Webinar Details:

  • Thursday, May 31, 2018
  • 2:00pm – 3:00pm EDT
  • No cost to attend
  • This webinar is open to all HR and Finance Professionals – but not to brokers, agents, TPAs and PEOs

For more information contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.


*AP Benefit Advisors, LLC is recognized by SHRM to offer Professional Development Credits (PDCs) for SHRM-CP or SHRM-SCP. This program is valid for 1 PDC for the SHRM-CP or SHRM-SCP. For more information about certification or recertification, please visit shrmcertification.org.

IRS Increases Some HSA Limits for 2019

Posted May 14, 2018 by Patrick Haynes

With IRS Rev. Proc. 2018-30, the IRS provided several new increases to various categories that Individuals and Families may elect into a Health Savings Account (HSA) if they have a compatible HDHP (High Deductible Health Plan).

For 2019, the annual contribution limitation for a person with self-only coverage under a high-deductible health plan is $3,500, up from $3,450 in calendar year 2018.

The annual limit on deductible contributions for a person with family coverage under a high-deductible health plan will increase by $100 – from $6,900 in 2018 to $7,000 in 2019.

According to the IRS, a HDHP (High-Deductible Health Plan) is defined under Section 223(c)(2)(A) as a health plan with an annual deductible that is “not less than $1,350 for self-only coverage or $2,700 for family coverage.”  Those amounts remain unchanged from 2018’s minimum levels.

Annual out-of-pocket expenses (OOPMAXes) – such as deductibles, copayments, and other amounts that do not include premiums – will have a maximum limit of $6,750 for individuals and $13,500 for families, which also increased from 2018’s limits.

Links:

 

 

 

 

Reference Charts for ACA-Healthcare Reform, HSAs, FSAs and PCORI/CERF Fees

Posted May 7, 2018 by Megan DiMartino

Healthcare Reform Timeline – Perpetual timeline of all healthcare reform updates from 2010 to 2020 (and 2022-when the Cadillac Tax is scheduled to “begin”).

Consumer-Driven Healthcare Options – Medical Savings Account (MSA), Health Savings Account (HSA), Flexible Savings Account (FSA) and Health Reimbursement Arrangement (HRA) – descriptions, details, pros and cons of each plan type, annual account minimums and maximums, etc.

Consumer-Driven Healthcare Options Chart – Comparison chart between HSAs, MSAs, HRAs and FSAs – same as above, but a single-page reference chart.

PCORI/CERF Fees Schedule – Patient-Centered Outcomes Research Institute (PCORI) Fees and Comparative Effectiveness Research Fees (CERF) schedule through 2020.  These fees are due/payable each July via IRS Form 720.  For additional background details, please read this.  (e.g., Do I owe $2.26 per covered life or $2.39?).

If you have any questions or concerns, please contact your Account Manager or Sales Executive.

 

 

 


For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

Mental Health Parity Updated Guidance from DOL, HHS & Treasury

Posted May 2, 2018 by Patrick Haynes

Mental Health Parity and Addiction Equity Act Guidance Issued by Departments

In an effort to encourage compliance with the MHPAEA (Mental Health Parity and Addiction Equity Act), the departments (DOL, HHS and Treasury) released a regulatory package that includes examples of mental health parity violations, as well as a new disclosure template used to request documentation from an employer-sponsored health plan or an insurer regarding treatment limitations. They are also enforcing civil monetary penalties for parity violations.

Background

The Mental Health Parity and Addiction Equity Act of 2008 prevents group health plans from providing mental health and substance use disorder (MH/SUD) benefits, financial requirements, or nonquantitative treatment limitations (NQTL) that are more limiting or not as favorable than those benefits, financial requirements, or NQTLs provided for medical/surgical benefits.  (Simple violations can occur when you have a $30 copay on an MH/SUD treatment, but a medical/surgical visit has a $20 copay.  Or, when a pre-authoriziation requirement is applied to MH/SUD benefits and not to similar medical/surgical benefits).

Disclosure requirements were set in regulations published in 2013, and were intended to help participants and beneficiaries evaluate MH/SUD parity. In 2016, the Departments of Labor, Treasury, and Health and Human Services (the departments) thought to develop template forms for participants and beneficiaries to use to request information on NQTLs. In 2017, the departments made clear that treatment for eating disorders is classified as a mental health benefits, and requested comments on the disclosures.

According to current regulations, no civil monetary penalties are given for MHPAEA violations, but penalties do include requiring reimbursement or coverage of the inappropriately denied claim, called “equitable relief”.

New Guidance

A new package of guidance was released by the departments on April 23, 2018, and included tools such as FAQs , Pathways to Full Parity (DOL’s 2018 report to Congress), a self-compliance tool, disclosure template, and an action plan from the HHS and fact sheet to help enforce the regulations. The package explains the departments’ ideas that to enforce the MHPAEA more successfully, civil enforcement penalties should be implemented.

The proposed FAQs include examples of specific treatments that the plan cannot deny. For example, the plan could not deny experimental Applied Behavior Analysis therapy claims for a child with Autism Spectrum Disorder that is a professionally recognized treatment, while approving professionally recognized medical/surgical treatments. The plan could also not deny out-of-network inpatient treatment for eating disorders when it would cover a similar treatment for medical/surgical conditions with proper physician authorization.

The Pathways to Full Parity report describes the implementation and enforcement of the MHPAEA, as well as some pilot programs designed by the DOL such as the Regional Opioid Investigative Task Force and Specialized MHPAEA teams (see page 15 of the report here), whose purpose is to further enforce the Act.

The Self-Compliance Tool gives group health plans, plan sponsors, plan administrators, and insurers information to allow them to determine whether a group health plan or insurer complies with the act, and encourages the focus on strategies for compliance rather than the overall result.

The HHS Action plan describes the plan to identify and take action on improper restrictions and the enforcement of compliance for group health plans.

The revised model disclosure form includes changes based on feedback from stakeholders, such as more examples of the standards used to identify NQTLs. Some examples of those standards are excessive utilization two standard deviation above average, and cost escalation of 10% or more per year for 2 years.

Comments on the FAQs are welcome and are due by June 22, 2018.

If you have any questions specific to your plans, please contact your Account Manager or Sales Executive.  Thank you.

Background links:

New Guidance links (4/23/2018):

Procedure for sharing comments with the Departments:

Please send comments on these disclosure issues to: Office of Information and Regulatory Affairs, Attn: OMB Desk Officer for DOL-EBSA, Office of Management and Budget, Room 10235, 725 17th Street, N.W., Washington, DC 20503; by Fax: 202-395-5806 (this is not a toll-free number); or by email: OIRA_submission@omb.eop.gov. Commenters are encouraged, but not required, to send a courtesy copy of any comments by mail or courier to the U.S. Department of Labor-OASAM, Office of the Chief Information Officer, Attn: Departmental Information Compliance Management Program, Room N1301, 200 Constitution Avenue, N.W., Washington, D.C. 20210; or by email: DOL_PRA_PUBLIC@dol.gov. Commenters should submit their views by June 22, 2018 to ensure consideration. Comments should reference control number 1210-0138.


For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits, or ERISA attorney for legal direction.

IRS Changes Position on HSA Family Limit

Posted April 27, 2018 by Patrick Haynes

The Internal Revenue Service (IRS) has announced relief for taxpayers with family coverage under a High Deductible Health Plan (HDHP) who contribute to a Health Savings Account (HSA). For 2018, taxpayers with family coverage under an HDHP may treat $6,900 as the maximum deductible HSA contribution.

As we announced in early March, as part of the Tax Cuts and Jobs Act, the IRS reduced the maximum deductible HSA contribution for taxpayers with family coverage under an HDHP by $50, to $6,850.

Revenue Procedure 2018-27, released yesterday, announces the relief and allows the $6,900 limitation to remain in effect for 2018. Individuals participating in an HSA generally can change their contribution amounts monthly, therefore anyone who changed their contribution to stay within the reduced $6,850 limit may now want to increase their contributions to reach the higher $6,900 limit for 2018.

For more information about the Tax Cuts and Jobs Act enacted in Dec. 2017, visit the Tax Reform page on IRS.gov.

 

AP Benefit Advisors HRCI* & SHRM** Pre-Approved Webinar: Improve Your 2018 Compliance Outlook with These 13 Lucky Tips & Insights

Posted April 17, 2018 by Megan DiMartino

13 is your lucky number! Join AP Benefit Advisors’ General Counsel and VP of Compliance, Patrick Haynes, for this HRCI* and SHRM** pre-approved, complimentary, one-hour webinar as he counts down these 13 lucky tips and insights to improve your 2018 compliance outlook:

  1. ACA – Limits (OOPMax Changes 2018 vs. 2019, Affordability Changes 2018 vs. 2019)
  2. ACA – Cadillac Tax
  3. EEOC – Wellness Litigation (AARP vs. EEOC)
  4. HCR – AHPs (Association Health Plans)
  5. HIPAA – Reminders: BAAs with Vendors & Carriers
  6. HIPAA – NPP: Notice of Privacy Practices (and an actual policy)
  7. IRS – IRS Relief 1094/1095
  8. IRS – Notice 2018-6
  9. IRS – IRS Q&A
  10. IRS – HSA Limits Lowered – COLA
  11. IRS – Vasectomies & HDHP-HSAs
  12. IRS – Cafeteria Plans: Section 125 Status Changes – Reminders & Best Practices
  13. IRS – HDHP: HSA Potpourri (a. Medicare, b. Clinics, c. Virtual Doctors, d. AFLAC/VOYA/Indemnity Plans, e. Limits)

Webinar Details:

  • Thursday, April 26, 2018
  • 2:00pm – 3:00pm EDT
  • No cost to attend
  • This webinar is open to all HR and Finance Professionals – but not to brokers, agents, TPAs and PEOs
For more information contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.
*The use of this seal confirms that this activity has met HR Certification Institute’s® (HRCI®) criteria for recertification credit pre-approval.
**AP Benefit Advisors, LLC is recognized by SHRM to offer Professional Development Credits (PDCs) for SHRM-CP or SHRM-SCP. This program is valid for 1 PDC for the SHRM-CP or SHRM-SCP. For more information about certification or recertification, please visit shrmcertification.org.