PCORI Fees Last Installment

Posted November 6, 2018 by Patrick Haynes

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 each July is based on when your plan year ended.

  • $2.26 for plan years ending between January 1, 2017 – September 30, 2017
  • $2.39 for plan years ending between October 1, 2017 – December 31, 2017
  • $2.45 for plan years ending on/after October 1, 2018 but before October 1, 2019
  • Please see our multi-year reference chart, here.
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.


Please see the following IRS resources for more information on the ACA’s PCORI Fees:
IRS Notice 2018-85 (released 11/05/2018)
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.

HRA Expansion – New Regulations to Expand HRA Use

Posted October 31, 2018 by Patrick Haynes

The Departments (IRS, DOL, and HHS) have jointly proposed regulations in response to President Trump’s executive order directing the agencies to consider regulations or guidance that would expand the availability and permitted use of HRAs (Health Reimbursement Arrangements), allowing HRAs to to be used in conjunction with nongroup coverage.  Most experts see this as a non-starter, since post-ACA all non-retiree-HRAs have to be bundled with a major medical plan to pass the stringent ACA-requirements.

Let’s review the highlights associated with these new regulations.

HRAs Funding Individual Health Insurance. The proposed regulations would allow HRAs to be integrated with, and to reimburse premiums for, individual health insurance coverage if certain conditions are met. For this regulation, individual health insurance coverage is defined as coverage offered in the individual market as well as fully insured student health insurance. Employees and dependents covered by the HRA would have to be enrolled in individual coverage (other than coverage that consists solely of excepted benefits), and an attestation or other verification of enrollment would be required when participation commences and when expenses are reimbursed. Also, the HRA sponsor could not offer a “traditional” group health plan (one that is neither account-based nor limited to excepted benefits) to the same class of employees.  The HRA would have to be offered on the same terms and conditions to all employees within a class, except that the HRA benefit amount could increase by age or family size. The regulations offer several permitted classifications, including full-time, part-time, seasonal, and collectively bargained employees.  Employees would have to be able to opt out and waive future HRA reimbursements at least annually and would have to receive timely written notices with specified HRA information.

Excepted Benefit HRAs. The proposal would allow employers to offer qualified non-integrated HRAs that may be used to pay premiums for excepted benefits, short-term plans, and COBRA premiums (and thus are not subject to the PHSA mandates, and, by extension, ACA mandates) if they meet the following requirements:

(1) The employer makes other non-excepted, non-account-based group health plan coverage available to the HRA participants (enrollment is not required);

(2) no more than $1,800 (indexed after 2020) is newly available to each participant for each plan year (carryovers permitted under the arrangement would be disregarded);

(3) the HRA does not reimburse premiums for individual health coverage, non-COBRA group coverage, or Medicare Parts B or D (premiums for coverage consisting solely of excepted benefits could be reimbursed); and

(4) the HRA is made available under the same terms and conditions to all similarly situated individuals. An excepted benefit HRA could not be offered to employees who are also offered an HRA that is integrated with individual health insurance.

Highlights.

  • Cafeteria Plan Salary Reductions. The preamble clarifies that employers with HRAs that are integrated with individual health insurance could allow employees to use pre-tax cafeteria plan salary reductions to pay any portion of their individual insurance premiums not covered by the HRA. (Presumably, salary reductions would not be available for individual policies offered through an Exchange, due to restrictions under the cafeteria plan rules.) If offered, salary reductions would have to be made available on the same terms and conditions to all employees within a class.
  • Premium Tax Credit Guidance. A proposed IRS regulation would provide guidance regarding the premium tax credit consequences for individuals who are offered or covered by an HRA that is integrated with individual health insurance.
  • ERISA Plan Status of Individual Health Coverage. Under a proposed DOL regulation, the terms “employee welfare benefit plan” and “welfare plan” as used in ERISA would not include individual health insurance funded by an HRA if certain requirements are met. Among other things, the purchase of the insurance must be completely voluntary for participants and beneficiaries; the employer or other plan sponsor must not select or endorse any particular insurer or coverage; and participants must be notified annually that the individual coverage is not subject to ERISA.
  • Exchange Special Enrollments Periods. Proposed HHS regulation would establish an Exchange special enrollment period for employees and their dependents who gain access to an HRA that is integrated with individual health insurance coverage or are provided with a QSEHRA, allowing them to enroll in individual insurance coverage or change from one individual coverage plan to another.
  • Applicability Date; No Reliance. The changes are proposed to apply for plan and taxable years beginning on or after January 1, 2020, and may not be relied on before they are final.

If these regulations are finalized, as they have been proposed, there will be significant changes brought to that nature and scope of HRAs.  Unlike QSEHRAs (Qualified Small Employer HRAs—for sub-50 life groups that aren’t subject to ACA and don’t offer medical/rx coverage) these changes would apply to groups of all sizes.  However, the likelihood of adoption remains small given that many employers already offer cafeteria plans and would not be able to circumvent the non-discrimination rules under IRC Sections 105 and 125.

However, the agencies are accepting comments and are open to suggestions—those comments must be received by December 28, 2018.

In conclusion, if this guidance is finalized, we will have five different types of HRAs:

  1. HRAs that are integrated with other group health plan coverage (that complies with the ACA/PHSA/etc.).
  2. Premium reimbursement HRAs.
  3. Excepted benefit (vision or dental) HRAs.
  4. QSEHRAs (although it remains to be seen what value QSEHRAs would offer in light of the flexibility provided by the proposed regulations).
  5. In addition, retiree-only HRAs will continue to be allowed as well.

Should you have additional questions or comments, please contact your Sales Executive or Account Manager.  Thank you.

Links:

NY Sexual Harassment Prevention Laws

Posted October 23, 2018 by Megan DiMartino

Effective on October 9, 2018, New York State and New York City legislators passed a number of new initiatives for sexual harassment prevention laws in response to the #MeToo Movement and increased allegations of sexual harassment in the workplace. The new laws require various provisions for employee communications, training and several dates for compliance. Overlap exists between both laws, so employers are encouraged to review and consider all requirements when establishing new policies, training programs and employee communications. The New York City Act addresses 11 separate bills and is categorized as being one of the strictest anti-sexual harassment laws in the United States.

Summaries of the New York State and New York City compliance requirements are outlined below:

New York State

  • Law effective October 9, 2018 – Employers must implement sexual harassment training
  • Training must be completed by October 1, 2019
    • Employee training requirements apply to all employers, regardless of size
    • All employees must be trained, including transient
    • Training must be provided on an annual basis
  • New-hire training is to be completed as quickly as possible, but employer may be liable for employees’ actions immediately upon hire
  • Adoption of a written policy must be distributed to all employees and posted at work sites
  • Policy must include:
    • Statement prohibiting sexual harassment, including examples of what constitutes sexual harassment
    • Information regarding Federal and State sexual harassment laws and remedies available to victims
    • Standardized compliant form
    • Procedures addressing timeliness and confidentiality of compliant investigations
    • Outline of employee rights of redress and forums for bringing forward complaints
    • Statement to communicate sexual harassment is a form of employee misconduct and subject to corrective action
    • Statement to communicate retaliation is unlawful and not tolerated

New York City

  • Law effective April 1, 2019
  • Training is to be completed by April 1, 2020
  • Applies to all employers with 15 or more employees (including interns)
  • Applies to all employees working more than 80 hours per calendar year
  • Training must be provided within 90 days of hire date
  • Annual employee training is required
  • Poster requirements should be displayed in prominent locations and be available in both English and Spanish
  • An informational fact sheet should be provided to every new hire
  • Training records (including signed employee acknowledgment forms) must be maintained for 3 years

Tips for Compliance

  • Employers with comprehensive policies and training should review new laws and adjust policy and training content, accordingly
  • Development of policies, training, procedures, and forms should be customized based on company requirements
  • Consult with your attorney or HR Consultant for specialized assistance

More information can be found at:
New York State Department of Labor
Combating Sexual Harassment in the Workplace | The State of New York


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.

3rd Quarter Compliance Newsletter

Posted October 1, 2018 by Megan DiMartino

In this quarter’s Compliance Newsletter:

  • Medicare Part D Notices
  • Summary Annual Reports Due
  • ACA Reporting
  • Affordable Health Plans in 2019 & 2019 Affordability Percentage
  • Exchange Model Notice
  • New Model FMLA Forms
  • Health FSA Carryovers
  • Employers Not Required to Provide Specific Requested Reasonable Accommodations
  • MLR Rebates
  • Federal Court Approves $115 Million Settlement
  • Save American Workers Act of 2018

Please contact your AssuredPartner’s 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.

Are Remote Workers Eligible for FMLA?

Posted September 25, 2018 by Megan DiMartino

With the ever-growing population of telecommuting employees comes the question if they’re eligible for FMLA (Family and Medical Leave Act). Most believe that telecommuters can’t qualify for FMLA because they are usually not within proximity of 49 other company employees within a 75-mile radius of a company worksite. But Section 825.111(a)(2) of the FMLA regulations clears up how to determine whether 50 employees are employed within a 75-mile radius of a worksite:
  • An employee’s personal residence is not a worksite in the case of employees, such as salespersons, who travel a sales territory and who generally leave to work and return from work to their personal residence, or employees who work at home, as under the concept of flexiplace or telecommuting. Rather, their worksite is the office to which they report and from which assignments are made.

For example, a company based out of Harrisburg, PA has 49 employees and also has an at-home employee who works from Chicago, IL. The at-home employee still gets their assignments from the main headquarters in Harrisburg,so under FMLA, their worksite is Harrisburg and qualifies them for FMLA.

There are also special regulations for employees who have no fixed worksite, such as construction workers. In that situation, the worksite is the site to which the employee is assigned as their home base, or from which their work is assigned, or to which they report. FMLA has provided an example for such situation:

  • [I]f a construction company headquartered in New Jersey opened a construction site in Ohio, and set up a mobile trailer on the construction site as the company’s on-site office, the construction site in Ohio would be the worksite for any employees hired locally who report to the mobile trailer/company office daily for work assignments, etc. If that construction company also sent personnel such as job superintendents, foreman, engineers, an office manager, etc., from New Jersey to the job site in Ohio, those workers sent from New Jersey continue to have the headquarters in New Jersey as their worksite. The workers who have New Jersey as their worksite would not be counted in determining eligibility of employees whose home base is the Ohio worksite, but would be counted in determining eligibility of employees whose home base is New Jersey.
There are many intricacies to FMLA and these are just a couple common examples. If you have any other questions or concerns, please feel free to contact your Account Manager or Account Executive at AP Benefit Advisors for further assistance.

Source: Jackson Lewis | The Devil Is in the Detail – FMLA Eligibility and Remote Workers

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.

New FMLA Forms from the DOL

Posted September 17, 2018 by Megan DiMartino

The Department of Labor (DOL) has released new Family and Medical Leave Act (FMLA) Forms – which the only thing that has changed is the expiration date. In the upper-right hand corner of the forms you’ll notice it now reads, “Expires: 8/31/2021.”

Links to the PDF forms:

Now’s a good time to start updating your forms, whether you use the DOL’s or your own, to make sure you stay compliant with FMLA requirements.

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.

HRCI & SHRM Pre-Approved Webinar | J-Codes: Your Healthcare Plan’s Biggest Enemy

Posted September 13, 2018 by Megan DiMartino

“J-Codes” and “medical specialty pharmacy” claims are going to be one of the top two procedure categories in terms of cost within your health plan. Knowing the amount of waste and abuse can give you insight into how you can develop strategies to drive more cost-effective utilization of the plan, and even enhance the benefits to the plan members for that efficient behavior. By identifying these specific issues within your plan and implementing targeted, value-based strategies to address them, you could eliminate tremendous costs without any adverse effects to your population.

Please join us for this HRCI* and SHRM** pre-approved, complimentary, one-hour webinar as our Director of Data Analytics, Scott Mayer, talks about the financial perils and pitfalls of “J-Codes” within an employer-sponsored health plan, and how the power of data can unlock the secrets to managing its spend.

Topics include:

  • What J-Codes are, how they differ from pharmacy claims, and how plans bill for them
  • How providers negotiate reimbursements through the medical benefit and how if differs from the pharmacy benefit
  • The role of channel management, site of care, manufacturer assistance programs and others

Webinar Details:

  • Thursday, September 27, 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.

Employers Not Required to Provide Specific Requested Reasonable Accommodations

Posted August 24, 2018 by Megan DiMartino

The Americans with Disabilities Act (ADA), as well as state and local laws, requires that employers provide reasonable accommodations to employees with disabilities. Employees are able to request specific reasonable accommodations, but employers are not required to provide all requests as they may choose among these reasonable accommodations or provide alternatives (as long as the reasonable accommodation is effective).

In a recent court case, Sessoms v. Trustees of the Univ. of Pennsylvania (June 20, 2018), the Third Circuit Court of Appeals (covering DE, NJ & PA) ruled in favor of the University of Pennsylvania saying they demonstrated good faith in its negotiations on reasonable accommodations for their employee. The employee, who suffered from mental and physical disabilities as well as having difficulties with her supervisor, requested that the University of Pennsylvania allow her to work on a part-time basis, before returning to full-time, after her medical leave and to transfer her to a new, “lower-stress” department under a new supervisor.

The University of Pennsylvania chose to accommodate her request for a part-time schedule but kept her in the same position under the same supervisor. The employee declined this reasonable accommodation and was ultimately terminated. She filed the lawsuit claiming they did not engage in a good-faith effort to reasonably accommodate her requests/disabilities. As already stated, the court ruled in the University of Pennsylvania’s favor and concluded that the employee did not provide evidence of other available positions and that her unwillingness to accept the part-time schedule which included working under the same supervisor was unreasonable.

The Equal Employment Opportunity Commission (EEOC) already stated long before this that an employer is not required to provide the requested reasonable accommodations and can instead consider alternatives, stating that:

“If there are two possible reasonable accommodations, and one costs more or is more burdensome than the other, the employer may choose the less expensive or burdensome accommodation as long as it is effective (i.e., it would remove a workplace barrier, thereby providing the individual with an equal opportunity to apply for a position, to perform the essential functions of a position, or to gain equal access to a benefit or privilege of employment). Similarly, when there are two or more effective accommodations, the employer may choose the one that is easier to provide.”

So, before rejecting an employee’s request for reasonable accommodation, discuss the request and propose effective alternatives, if necessary, with the employee to find a common ground and an acceptable reasonable accommodation that truly meets their needs and capabilities.


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.

Updated/Current Healthcare Reform Timeline

Posted August 15, 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”).

 

 

 

 

 

 

 

 

 

 

HC_Reform_Employers_V19e_05-14-2018

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.