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.
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”.
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.
- May 2, 2016 – Updates from the IRS, DOL and HHS – 2017 HSA Limits and More. Agencies Provide Guidance on Preventive Services, Rescissions, Mental Health Parity, and More
- July 10, 2014 – Effective Dates Have Arrived! Your Wellness Plan and Mental Health Coverages Must Comply
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 firstname.lastname@example.org. 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.
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.
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:
- ACA – Limits (OOPMax Changes 2018 vs. 2019, Affordability Changes 2018 vs. 2019)
- ACA – Cadillac Tax
- EEOC – Wellness Litigation (AARP vs. EEOC)
- HCR – AHPs (Association Health Plans)
- HIPAA – Reminders: BAAs with Vendors & Carriers
- HIPAA – NPP: Notice of Privacy Practices (and an actual policy)
- IRS – IRS Relief 1094/1095
- IRS – Notice 2018-6
- IRS – IRS Q&A
- IRS – HSA Limits Lowered – COLA
- IRS – Vasectomies & HDHP-HSAs
- IRS – Cafeteria Plans: Section 125 Status Changes – Reminders & Best Practices
- IRS – HDHP: HSA Potpourri (a. Medicare, b. Clinics, c. Virtual Doctors, d. AFLAC/VOYA/Indemnity Plans, e. Limits)
- 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
Posted April 13, 2018 by Megan DiMartino
ACA Affordability Threshold – Adjustments 2014 through 2019
- 2014 Affordability 9.5%
- 2015 Affordability 9.56%
- 2016 Affordability 9.66%
- 2017 Affordability 9.69%
- 2018 Affordability 9.56%
- This is the first time since the implementation of the ACA rules that the affordability contribution percentages have been reduced.
- Guidance: https://www.apbenefitadvisors.com/2017/06/12/irs-reduces-2018-affordability-percentages/
- 2019 Affordability percentage – 9.86% (see IRS Rev. Procedure 2018-34).
The Department of Health and Human Services (HHS) issued final regulations on April 9, 2018, related to guidance on the Affordable Care Act (ACA) provisions which include Essential Health Benefits (EHBs), Out-of-Pocket (OOP) Maximums, and Marketplace updates and reforms. These final regulations are generally effective for plans and plan years beginning on and after January 1, 2019.
Final rule improvements include:
- greater flexibility to states for determining EHBs,
- reduction to some regulatory requirements in the individual and small group markets, and
- provides annual benefit provision updates.
These final regulations are primarily focused on individual and small group Marketplace updates and reforms, but the EHB benchmark plan changes will have some effect on large group health plans as well.
Essential Health Benefits (EHBs)
For plan years beginning on and after January 1, 2020, states can either follow their current rules and maintain the 2017 benchmark plans or they may select a new EHB benchmark plan annually from one of the following:
- Choose another state’s 2017 benchmark plan – allows states to select another state’s 2017 benchmark plan and implement the plan benefits and limits to their own EHB standards, such as changing benefits with dollar limits to non-dollar limits.
- Replace one or more of the 10 required EHB categories of benefits under its current 2017 benchmark plan with the same categories from another state’s 2017 benchmark plan – giving states the ability to make precise changes to their 2017 benchmark plans at the coverage detail level.
- Otherwise, select a new set of benefits to become its benchmark plan – provided the plan meets other specified requirements.
These three options are also subject to additional requirements, including two scope of benefits conditions which confirms that their new/modified benchmark plans provide:
- scope of benefits that is equal to, or greater than, the scope of benefits provided under a “typical employer plan,” and
- no more generous than the most generous of a set of comparison plans.
HHS’s final guidance can be found here. States have until July 2, 2018 to submit their 2020 EHB benchmark plan to the Centers for Medicare and Medicaid Services (CMS).
2019 Out-of-Pocket (OOP) Maximums (applied to all non-grandfathered plans, regardless of size or funding type)
- Individual Coverage – $7,900
- Family Coverage – $15,800
Marketplace provisions, effective January 1, 2019:
- Deferring the network adequacy reviews for qualified health plan (QHP) certification to the states
- Loosening the audit process for agents, brokers and issuers who participate in the direct enrollment process
- Updating the risk adjustment model for insurers with high-cost enrollees
- Modifying the requirements for Marketplaces to verify eligibility for, and enrollment in, qualifying employer-sponsored coverage
- Not specifying 2019 standardized plan options (know as simple choice plans)
- Updating special enrollment period (SEP) rules for coverage effective dates specific to SEPs that allow adding or changing dependents
- Adding a new SEP for pregnant women who were receiving coverage through the Children’s Health Insurance Program (CHIP) but lose that access
- Allowing Marketplaces to determine individual affordability exemptions based on affordability of the lowest-cost metal level plan available
- Allowing enrollees to request same-day termination of coverage
- Removing several Small Business Health Options Program (SHOP) requirements for online enrollment
Other Market Reforms
- Streamlining the rate review process for states and issuers, including when rates are posted by the states, increasing the threshold at which rate increases require review from 10% to 15%, and establishing a process for states to request a higher threshold.
- Modifying the Medical Loss Ratio (MLR) rules, including simplifying quality improvement activity reporting requirements for issuers and establishing a process for states to use to request adjustments to the 80% MLR standard in the individual market.
Expanded Individual Mandate Hardships
New hardship exemptions include people who:
- Live in a county, borough, or parish in which no QHP is offered
- Live in a county, borough, or parish in which there is only one issuer offering coverage and can show that the lack of choice resulted in them failing to obtain coverage under a QHP
Cigna Health Care Reform Alert: Final Regulations – 2019 Notice of Benefit and Payment Parameters
HHS Final Guidance
HHS Fact Sheet
Posted March 23, 2018 by Megan DiMartino
In our March 7th blog we made the exciting announcement that we have changed our name to AP Benefit Advisors, LLC. We can’t thank you enough for all of your support and understanding during this transition!
Over the weekend we will be transitioning our old website, www.crawfordadvisors.com, to our new website, www.apbenefitadvisors.com. This means that over the next couple days the redirect may not be working yet, so the best way to visit us is by going directly to www.apbenefitadvisors.com.
Please contact us if you have any questions or comments regarding our new site.
Again, thank you tremendously for your patience, understanding and support!
AssuredPartners’ HRCI & SHRM Pre-Approved Webinar | Onboarding: The Day that Matters Most for Retention and Engagement
Posted March 13, 2018 by Megan DiMartino
Please join AssuredPartners and change communication expert, Kip Soteres, for an HRCI* and SHRM** pre-approved webinar addressing how your onboarding process can improve employee retention and appreciation for your company and its benefits beginning on Day 1.
Employees recruited into your company have often been shown the best and brightest face – they are likely excited to be starting a new job and have been sold on the best features of your organization. Day 1 orientation and ensuing onboarding efforts can either continue that momentum or kill it. Twenty percent of employee turnover happens in the first 45 days of employment; effectively communicating benefits in a sustained way can make a significant positive difference in the way new employees view their job and the way they define their relationship with their employer. Please join our webinar to receive information and training on how to communicate information on your company and benefits effectively during the onboarding process to obtain the best results.
This training will provide:
- Suggestions for revamping Day 1 orientation content for enhanced impact and better emotional engagement for employees
- A plan template for a 6-month new hire launch campaign for new hires that will keep them engaged and aware of the total rewards of working for your company
- Sample communications that can be tailored for your benefit needs and tips for auto-distributing those communications to new hires
- Tips for creating communities and forums for new hires and how to plug them into the full-value proposition of working for your company
- Wednesday, March 21, 2018 – 2-3pm EDT
- No cost to attend
- This webinar is open to all HR and Finance Professionals – but not to brokers, agents, TPAs and PEOs
**AP Benefit Advisors is recognized by SHRM to offer Professional Development Credit (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.
For more information contact email@example.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.
Posted March 8, 2018 by Patrick Haynes
With IRS Notice 2018-12, the IRS has clarified that health plans covering male sterilization or male contraceptives without a deductible, or with a deductible below the statutory minimum deductible for high-deductible health plans (HDHPs), are not HDHPs under current IRS guidance regarding requirements for health savings accounts (HSAs). As background, individuals who wish to make or receive HSA contributions must be covered by a qualifying HDHP and have no impermissible coverage. An HDHP is an insured or self-insured health plan that meets certain requirements, including minimum annual deductible and maximum out-of-pocket expense limits, although HDHPs may provide preventive care benefits without a deductible or with a deductible below the statutory minimum.
To qualify as preventive care, a benefit must be defined as such under the Social Security Act (SSA) or in IRS or Treasury Department guidance. These standards govern whether benefits that a state law requires insurance policies to provide on a no-deductible or low-deductible basis will qualify as “preventive care”. The IRS has also confirmed that preventive services that must be provided without cost-sharing under health care reform (the ACA) will qualify as preventive care for HDHP purposes.
Why now? Why this change and guidance?
The guidance notes that some states have recently adopted laws requiring health insurance policies to cover male sterilization or male contraceptives without cost-sharing—they cite Illinois, Maryland, Oregon, and Vermont as examples. These benefits are not preventive care under the SSA or under IRS or Treasury Department guidance, nor are they preventive services that must be provided without cost-sharing under health care reform. Therefore, plans that provide these benefits before the HDHP minimum deductible is satisfied are not HDHPs, even if the benefits are required under state law, and an individual who is covered under such a plan is not eligible to make or receive HSA contributions.
However, the IRS has provided transition relief for periods before 2020. Under the relief, individuals will not be treated as failing to qualify as HSA-eligible merely because they are or were covered by an insurance policy that is not an HDHP solely because it covers male sterilization or male contraceptives without a deductible, or with a deductible below the HDHP minimum deductible.
As you may recall from our December 2017 guidance, many concerned employers and plan sponsors with HSA programs worried about this issue, and were concerned that state legislators were not moving fast enough to exempt HDHPs from their mandates. With this new guidance and transitional relief state legislators will have additional time to correct the oversight that “free vasectomies” were not intended to cause.
Should you have any questions or concerns, please contact your Account Manger or Sales Executive. Thank you.
- Background reading, The Uncertain Future for HSAs in Maryland, 12/19/2017
- IRS Notice 2018-12
Posted March 8, 2018 by Patrick Haynes
We are very excited to announce that we are changing our name to AP Benefit Advisors, LLC.
As you may recall, in 2014, we were acquired by AssuredPartners, Inc. and our business of developing long lasting relationships and continuing to find the new and innovative solutions to fulfill the specific needs of our clients has strengthened. We are proud to share our name and to be able to offer new tools, new products, and new lines of insurance coverage to help our clients manage more of their risk (property, casualty, aviation, marine, etc.).
You will continue to work with the same leadership team, professional staff and systems that you have enjoyed in the past, and you can expect to see additional tools, resources, products and services in the future.
Our old email address, @crawfordadvisors.com, will continue to work, but you will begin seeing replies from your service team coming from an @assuredpartners.com email address. Our telephone and fax numbers will not be changing.
AssuredPartners, Inc. is headquartered in Lake Mary, Florida, and invests in property and casualty and employee benefits brokerage businesses across the country. Through access to partner agency resources nationally, we continue increasing our leverage and negotiation power with our carrier-partners as a result of an increase to our overall book of business.
Please contact us if you have any questions or comments about our name change. Thank you again for the opportunity to serve you. We sincerely appreciate the confidence you have placed in us as your partner in providing employee benefits services to your employees and co-workers.
Posted March 6, 2018 by Patrick Haynes
Late last year, Congress enacted the Tax Cuts and Jobs Billchttps://www.apbenefitadvisors.com/2017/12/20/us-house-senate-pass-tax-cut-jobs-act-2017/ into law. One of the changes affecting health and welfare plans is a change to the way the IRS calculates cost of living increases. Specifically, the Tax Cuts and Jobs Bill legislated that cost of living increases must use “Chained CPI” (a method of calculating inflation that takes into account the fact that as prices increase some consumers switch to lower priced products or substitute products). The aim of using Chained CPI, is to reduce the effects of inflation, and over time, producer lower cost of living increases.
Today, the Internal Revenue Service released Revenue Procedure 2018-18 which recalculates a number of cost of living increases for calendar year 2018, as follows –
- The family HSA contribution for 2018 is reduced from $6,900 to $6,850.
- This change is retroactive to January 1, 2018 therefore previous contribution elections may need to be adjusted and/or excess contributions that have already been deposited for 2018 (e.g., for those who have already contributed the full amount) will need to be returned
- For employer adoption assistance programs, the maximum amount that can be excluded from an employee’s gross income for qualified adoption expenses is reduced from $13,840 to $13,810. Further, the adjusted gross income threshold after which the adoption exclusion begins to phase out is reduced from $207,580 to $207,140.
- Health care FSA, transit and other benefit limits are not impacted.
The above changes apply to the 2018 calendar year. Employees contributing to an HSA should be informed of the reduced maximum limit, and adjustments in contributions for the remainder of 2018 may be needed. Employees who have already contributed the maximum amount for 2018, such as a one-time HSA contribution from a beginning of the year bonus payment, will need to receive a refund of the excess contribution.
Please contact your Account Manager or Sales Executive with any questions you may have.
- Internal Revenue Bulletin 2018-10 is here.
- Details about the change to CPI can be found throughout, but HSA interested readers should review pages 1 and 17 of the 43 page PDF.
Posted February 13, 2018 by Megan DiMartino
As we head into the last few weeks of February, we want to take this opportunity to remind employers about the following upcoming annual filing deadlines:
- Annual Prescription Drug Notice
Group health plans must notify the Centers for Medicare and Medicaid Services (CMS) each year regarding whether the group health plan’s prescription drug coverage offered to Medicare Part D-eligible individuals is “creditable” or “non-creditable.” This notice must be done electronically by completing the online registration and disclosure form on the CMS website. CMS has also published, on its website, guidance regarding the notice and the information required for the filing.The compliance date(s) for this annual disclosure is: (a) within 60 days after the beginning of the plan year (e.g., for a calendar year plan year, by March 1, 2018); (b) within 30 days after the termination of the plan’s prescription drug coverage; and (c) within 30 days of any change in the creditable coverage status of the prescription drug plan.
- HIPAA Breach Report
HIPAA-covered benefit plans are required to report any breach during a calendar year involving less than 500 individuals to the Department of Health and Human Services (HHS) on an annual basis. Any such breach that occurred during the year must be reported to HHS by completing the disclosure form on the HHS website.The compliance date for this annual disclosure is within 60 days after the end of the calendar year (i.e., by March 1, 2018).
- ACA Reporting Deadlines
Pursuant to the ACA, Applicable Large Employers (ALEs) and employers that self-insured their medical benefits must file information returns with the IRS and distribute health coverage information forms to their employees, via Form 1095-C or 1095-B, as applicable.The compliance date(s) for filing 2017 information returns with the IRS is February 28, 2018 for paper filers and April 2, 2018 for electronic filers. Per IRS Notice 2018-06, the deadline for employers to distribute 1095-C or 1095-B forms to their employees was extended 30 days and is now March 2, 2018.
For questions, concerns or additional assistance, please contact your Account Executive or Account Manager.
For more information contact firstname.lastname@example.org. 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.