--- title: R&R Insurance Blog | Pete Frittitta description: R&R Insurance, Wisconsin's largest independent insurance agency, is a great place to work for many reasons. 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[Tweet](https://twitter.com/share) ![Employee Benefits - 2024-09-12T091521.422](https://www.myknowledgebroker.com/hs-fs/hubfs/Employee%20Benefits%20-%202024-09-12T091521.422.png?width=324&height=182&name=Employee%20Benefits%20-%202024-09-12T091521.422.png) Earlier this year, a U.S. District Court dismissed  a class-action lawsuit filed against Johnson & Johnson (J&J), which alleged that the company breached its fiduciary duties under the Employee Retirement Income Security Act (ERISA). So, it must have been a “nothingburger” and there’s no sense to talk about it anymore, right? Wrong! Why? It was thrown out on a legal technicality. In dismissing the two fiduciary breach claims, the court ruled that the plaintiff (an employee of J&J) lacked standing to bring a lawsuit. The J&J case should serve as a reminder to employers of the importance of adhering to their ERISA fiduciary duties when managing their health plans.  The court found the plaintiff’s first claim, that she paid more in premiums due to the defendants’ purported breach of fiduciary duty during the plans’ negotiation process, did not sufficiently show evidence of an injury and was “at best, speculative and hypothetical.” Further, the outcome of the lawsuit would not affect the plaintiff’s future benefit payments, and the plaintiff failed to show that the defendants’ specific conduct resulted in higher premiums. Interestingly, regarding the plaintiff’s second claim that she paid higher prices for drugs under the plans and thus paid more out of pocket, **the court acknowledged that she suffered an injury that was traceable to the defendants’ alleged ERISA violations**. However, the plaintiff lacked standing based on this injury because a favorable decision would not be able to compensate her for the money she already paid, given that she had reached her prescription drug cap for each year asserted in the complaint. The court reasoned that, even if the defendants were to reimburse her out-of-pocket costs on a given drug, that money “*would be owed to her insurance carrier to reimburse it for its expenditures on other drugs that same year.”* After the J&J lawsuit was filed, similar fiduciary litigation involving the management of prescription drug benefits followed. These cases are still making their way through the court system as scrutiny of the PBM industry intensifies. **The important fact remains that, under ERISA’s strict fiduciary standards, employers must prudently select and monitor their third-party service providers, including pharmacy benefit managers (PBMs).** ERISA includes standards of conduct for those who manage an employee benefit plan and its assets, who are called “fiduciaries.” This [Compliance Overview](https://www.myknowledgebroker.com/hubfs/Employee%20Benefits/Client%20Compliance%20Documents/119432%20ERISA%20Compliance%20FAQs%20-%20Fiduciary%20Responsibilities%201.30.25.pdf) includes a set of frequently asked questions (FAQs) to help employers understand the basic fiduciary responsibilities applicable to group health plans under ERISA. Click [here](https://www.myknowledgebroker.com/hubfs/Employee%20Benefits/Client%20Compliance%20Documents/119432%20ERISA%20Compliance%20FAQs%20-%20Fiduciary%20Responsibilities%201.30.25.pdf) to read more.  If you want to know more about what you should be doing to be in compliance, contact one of our Knowledge Brokers – we know!   Topics: [ERISA](https://www.myknowledgebroker.com/blog/topic/erisa), [Compliance](https://www.myknowledgebroker.com/blog/topic/compliance) ## [What Employers Should Know About Seasonal Employment](https://www.myknowledgebroker.com/blog/what-employers-should-know-about-seasonal-employment) Posted by [Pete Frittitta](https://www.myknowledgebroker.com/blog/author/pete-frittitta) - [Tweet](https://twitter.com/share) ![Employee Benefits - 2024-09-12T091521.422](https://www.myknowledgebroker.com/hs-fs/hubfs/Employee%20Benefits%20-%202024-09-12T091521.422.png?width=324&height=182&name=Employee%20Benefits%20-%202024-09-12T091521.422.png) Many organizations rely on seasonal workers to supplement their regular workforce during peak times. Your immediate thought upon reading this might be that this is about determining benefits eligibility under the Affordable Care Act (ACA). Well, that’s only part of the challenge; there is so much more to consider! The ACA addresses implications related to group medical benefits. What about other benefits? What about worker classification? Wage and hour laws? While similarities exist, there are important differences between seasonal and regular employment. Due to these differences, hiring and reliance on seasonal workers can present significant and unexpected challenges for employers. This [HR Compliance Overview](https://www.myknowledgebroker.com/hubfs/Employee%20Benefits/Client%20Compliance%20Documents/What%20Employers%20Should%20Know%20About%20Seasonal%20Employment.pdf) provides employers with a broad overview of seasonal employment and compliance strategies for employers. If you want to know more about what you should be doing to be in compliance, contact one of our Knowledge Brokers – we know!   Topics: [Compliance](https://www.myknowledgebroker.com/blog/topic/compliance) ## [It’s That Time of Year Again – Do You Know How to Be Compliant in Handling Your MLR Rebate?](https://www.myknowledgebroker.com/blog/mlr-rebate) Posted by [Pete Frittitta](https://www.myknowledgebroker.com/blog/author/pete-frittitta) - [Tweet](https://twitter.com/share) ![Employee Benefits - 2024-09-12T091521.422](https://www.myknowledgebroker.com/hs-fs/hubfs/Employee%20Benefits%20-%202024-09-12T091521.422.png?width=324&height=182&name=Employee%20Benefits%20-%202024-09-12T091521.422.png) Employers with insured group health plans may soon receive a medical loss ratio (MLR) rebate from their health insurance issuers. Issuers who did not meet the applicable MLR percentage for the last calendar year must provide rebates to plan sponsors by **September 30th**. These rebates may be in the form of a premium credit or a lump-sum payment. Most group health plans sponsored by employers in the private sector are subject to ERISA. Employers with ERISA plans should not assume they can simply retain an MLR rebate. In general, unless an employer pays the entire cost of health coverage without any employee contribution, at least a portion of the rebate will be a plan asset under ERISA. **Any rebate amount that qualifies as a plan asset must be used for the exclusive benefit of the plan’s participants and beneficiaries. The question is: do you know how to determine that? Furthermore, once you have determined that, do you know how to distribute the assets appropriately?** R&R Insurance has assisted our benefits clients with this challenge every year, providing them with the proper guidance and proprietary tools to help them conduct the proper analysis. If you’re feeling lost and don’t know what you should be doing to be in compliance with your ERISA Fiduciary requirements, contact one of our Knowledge Brokers – we know!   Footnote: The Affordable Care Act (ACA) includes a provision known as the Medical Loss Ratio (MLR) which requires insurance companies to review their overall plan performance by market segments (small group and large group) to determine if they must return a portion of the premiums collected. For the small employer market segment, the insurance carriers must demonstrate that they spent $0.80 of every $1 collected in premium (80% medical loss ratio or greater) for all of their small group plans in a specific State directly on claims and health promotion for the covered members. For the large group market, the threshold is 85%. This review is conducted by calendar year and reported to the Centers for Medicare and Medicaid Services (CMS) by the following August. If a carrier’s MLR is less than the applicable 80% or 85% level for the prior calendar year, they are then required to rebate a portion of the premium back to the policyholders. Topics: [Compliance](https://www.myknowledgebroker.com/blog/topic/compliance) ## [HR Software You're Using Might Be Violating the ADA](https://www.myknowledgebroker.com/blog/hr-software-violating-ada) Posted by [Pete Frittitta](https://www.myknowledgebroker.com/blog/author/pete-frittitta) - [Tweet](https://twitter.com/share) [![christin-hume-hBuwVLcYTnA-unsplash](https://www.myknowledgebroker.com/hs-fs/hubfs/christin-hume-hBuwVLcYTnA-unsplash.jpg?width=279&height=186&name=christin-hume-hBuwVLcYTnA-unsplash.jpg)](https://unsplash.com/photos/person-using-macbook-hBuwVLcYTnA?utm_content=creditShareLink&utm_medium=referral&utm_source=unsplash) Recently, the Equal Employment Opportunity Commission (EEOC) and U.S. Department of Justice (DOJ) each issued new technical assistance documents about how employers’ use of artificial intelligence (AI) and other software tools to make employment decisions may result in unlawful disability discrimination under the Americans with Disabilities Act (ADA). Employers increasingly use software tools to help select new employees, monitor performance, determine pay or promotions, and administer or score tests. Without safeguards, this use may result in ADA violations. The ADA requires employers with 15 or more employees to provide reasonable accommodations and have other processes in place to ensure that their software tools do not unfairly rate or screen out qualified individuals with disabilities. EEOC Guidance The [EEOC’s new guidance](https://www.eeoc.gov/laws/guidance/americans-disabilities-act-and-use-software-algorithms-and-artificial-intelligence?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=) focuses on the following three ways an employer’s use of software tools for employment decisions may violate the ADA: - The employer does not provide a reasonable accommodation necessary for an individual to be rated fairly and accurately by the software; - The software “screens out” an individual with a disability, even though the individual is able to do the job with a reasonable accommodation; and - The software makes disability-related inquiries or includes medical examinations. The EEOC also provides best practices to help employers avoid these violations. DOJ Guidance The [DOJ’s new guidance](https://beta.ada.gov/ai-guidance/?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=) provides a broad overview of rights and responsibilities under the ADA. It also provides examples of the types of software tools employers use, clarifies that employers must consider various disabilities when designing or choosing their software, and explains when an employer must provide a reasonable accommodation when using software tools. Employer Takeaway Several factors have led these agencies to address this topic. One is the ongoing unemployment challenge for workers with disabilities. The Bureau of Labor Statistics’ [April data](https://www.bls.gov/news.release/pdf/empsit.pdf) revealed a labor force participation rate of 23.1% for people with a disability, compared with 67.5% for those without. Employers should review this guidance and assess their employment technology and processes to ensure they are not at risk for ADA violations. You can read the EEOC’s new guidance [here](https://www.eeoc.gov/laws/guidance/americans-disabilities-act-and-use-software-algorithms-and-artificial-intelligence?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=) and the DOJ’s new guidance [here](https://beta.ada.gov/ai-guidance/?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=). Source: Zywave, Inc. Topics: [Employee Benefits](https://www.myknowledgebroker.com/blog/topic/employee-benefits), [Compliance](https://www.myknowledgebroker.com/blog/topic/compliance) ## [Federal Court Reinstates OSHA Vaccination Mandate for Private Employers With 100 or More Employees](https://www.myknowledgebroker.com/blog/federal-court-reinstates-osha-vaccination-mandate) Posted by [Pete Frittitta](https://www.myknowledgebroker.com/blog/author/pete-frittitta) - [Tweet](https://twitter.com/share) ![legalupdate](https://www.myknowledgebroker.com/hs-fs/hubfs/legalupdate.jpg?width=300&name=legalupdate.jpg) The Occupational Safety and Health Administration's (OSHA's) vaccine-or-testing Emergency Temporary Standard (ETS) is back on again.  On Friday, December 17th, the Sixth Circuit Court of Appeals lifted the stay of OSHA's emergency temporary standard (ETS) requiring private sector employers with at least 100 employees to ensure workers are either vaccinated or tested weekly and wear masks. **With the stay lifted, employers must comply with the requirements outlined in the ETS.** **[Click here to download ](https://www.myknowledgebroker.com/hubfs/Court%20Reinstates%20OSHA%20Vaccination%20Mandate%20for%20Private%20Employers%2012.20.2021.pdf)**R&R Insurance's summary of reinstatement with important dates for employers. In response, [OSHA stated](https://www.dol.gov/newsroom/releases/osha/osha20211218) that it “will not issue citations for noncompliance with any requirements of the ETS before January 10 and will not issue citations for noncompliance with the standard’s testing requirements before February 9, so long as an employer is exercising reasonable, good faith efforts to come into compliance with the standard. OSHA will work closely with the regulated community to provide compliance assistance.”  **KEY TAKEAWAY ON THIS CHANGE: Affected employers now have until January 10th, 2022 to comply with the requirements that were initially slated to begin on December 6th, 2021. Also, weekly testing requirements for unvaccinated employees with an original deadline of January 4th, 2022 is now delayed until February 9th, 2022.** ETS opponents have already filed an appeal with the U.S. Supreme Court challenging the Sixth Circuit’s decision. R&R will continue to monitor developments and provide you with updates and resources that pertain to these compliance requirements as they occur. For more information and resources, click [here](https://www.myknowledgebroker.com/vaccine-mandate?hsCtaTracking=11b71066-e21d-4f65-a85c-51e49af9eea1%7C34d508b2-cc50-4144-8879-d281b3832b1f) to navigate to our dedicated *OSHA Vaccine Mandate Compliance* webpage. [Click here](https://www.opn.ca6.uscourts.gov/opinions.pdf/21a0287p-06.pdf) to view the full Sixth Circuit Court of Appeals opinion to dissolve the stay order as well the dissenting opinion. Topics: [OSHA Compliance](https://www.myknowledgebroker.com/blog/topic/osha-compliance), [OSHA](https://www.myknowledgebroker.com/blog/topic/osha), [regulations](https://www.myknowledgebroker.com/blog/topic/regulations) ## [COVID-19 Vaccination – A Work Requirement?](https://www.myknowledgebroker.com/blog/covid-19-vaccination-a-work-requirement) Posted by [Pete Frittitta](https://www.myknowledgebroker.com/blog/author/pete-frittitta) - [Tweet](https://twitter.com/share) [![daniel-schludi-mAGZNECMcUg-unsplash](https://www.myknowledgebroker.com/hs-fs/hubfs/daniel-schludi-mAGZNECMcUg-unsplash.jpg?width=300&height=375&name=daniel-schludi-mAGZNECMcUg-unsplash.jpg)](https://unsplash.com/photos/blue-and-white-plastic-bottle-mAGZNECMcUg?utm_content=creditShareLink&utm_medium=referral&utm_source=unsplash)On December 8, 2020, the United Kingdom became the first Western nation to vaccinate patients against COVID-19. Additionally, the Food and Drug Administration concluded in a detailed analysis that the first COVID-19 vaccine being considered for U.S. distribution “met the prescribed success criteria” in a clinical study, paving the way for the agency to green-light distribution as early as this weekend. While the vaccine will not be available generally for citizens until 2021, employers have begun to raise the **question of mandatory vaccination as a work requirement** or condition of employment. **At present, no law, regulation, or other guidance directly addresses whether employers may require their employees to get a COVID-19 vaccination.** The idea is not new; many healthcare workers are currently required to receive certain vaccinations as a condition of their employment. The EEOC updated its Pandemic Preparedness in the Workplace guidance on March 19, 2020 to address the COVID-19 pandemic advising employers to **“follow guidance from the CDC as well as state/local public health authorities.”** Notably, the CDC has issued guidance recommending influenza vaccination for critical industries during a pandemic. **It is likely that the EEOC will issue updated guidance to address the issue of COVID-19 vaccinations in the workplace in the near future.** Additionally, there are currently discussions within State government concerning how to address this issue within the State law context. **Until some action is taken, it appears that employers may require employees to receive vaccinations when available, subject to the restrictions identified by the EEOC and OSHA.** As the pandemic vaccine situation develops and evolves, R&R Insurance will continue to monitor new laws and guidance from federal and state authorities and continue to keep you informed. Employers should weigh the legal exposure and other risks associated with any mandatory vaccination program, and assess whether the alternative of voluntary vaccination may be a better option based on the nature and needs of their businesses. You can [read more](https://www.myknowledgebroker.com/hubfs/Employee%20Benefits/Mandatory%20COVID-19%20Vaccination%20In%20Employment%20_%20von%20Briesen%20%26%20Roper.pdf) in the client advisory made available from von Briesen & Roper. Please visit our [COVID-19: Business Recovery Resources](https://www.myknowledgebroker.com/coronavirus-resources-back-in-business?hsCtaTracking=a0b7970c-df14-424e-a1dc-faa547ab6f80%7Cecab8154-e6ef-456f-b2af-9a8a4cffb90a) webpage for the latest information and quick references on a variety of industries with guidelines and considerations for getting back to full operation.  And visit our [R&R Coronavirus Resources webpage](https://www.myknowledgebroker.com/coronavirus-resources-for-businesses) for future updates and resources. Please contact your R&R representative with any questions. ## [Families First Coronavirus Response Act](https://www.myknowledgebroker.com/blog/families-first-coronavirus-response-act) Posted by [Pete Frittitta](https://www.myknowledgebroker.com/blog/author/pete-frittitta) - [Tweet](https://twitter.com/share) President Trump signed into law on March 18, 2020 the Families First Coronavirus Response Act requiring employers with 500 or fewer employees to provide emergency paid sick leave and family leave to employees dealing with the impact of COVID-19. Below is a high-level summary of these two components of the Act, which become effective as of April 1, 2020: |   | **Emergency Paid Sick Leave Act** | **Emergency Family and Medical Leave Expansion Act (EFMLEA)** | | --- | --- | --- | | **What it Does** | Applicable employers will be required to provide full-time employees with 10 days (80 hours) of paid sick leave when the employee cannot work or telework for reasons related to COVID-19. Part-time employees are also entitled to this benefit based on the average hours worked over a 2-week period.  Below are the allowable leave reasons: - Employee is subject to a federal, state or local quarantine or isolation order related to COVID-19 - Employee has been advised by a health care provider to self-quarantine due to concerns related to COVID-19 - Employee is experiencing symptoms of COVID-19 and seeking a medical diagnosis - Employee is caring for an individual subject to quarantine or isolation order, or who has been advised by a health care provider to self-quarantine. - Employee is caring for their own child whose school or place of care has closed due to COVID-19 concerns - Employee is experiencing any other substantially similar condition specified by the Secretary of Health and Humana Services in consultation with the Secretary of the Treasury and the Secretary of Labor. | Applicable employers will be required to provide up to 12 weeks of job-protected family leave for employees who have been employed for at least 30 days and are unable to work or telework due to a need for leave to care for their child if schools are closed or their daycares are unavailable resulting from COVID-19. The first 10 days are unpaid and thereafter the benefit must replace at least two-thirds of the employee’s wages up to a maximum of $200 per day.   Employers are also required to restore employees to their same or equivalent position, and if not available, have ongoing obligation for 1-year to contact impacted employee if such position becomes available (exception for employers with less than 25 employees).     | | **Who is Covered** | Applies to employers with fewer than 500 employees | Applies to employers with fewer than 500 employees | | **Eligibility** | All employees, regardless of length of employment are eligible for the leave. | This leave benefit covers employees who have been working for at least 30 calendar days. | | **Rate of Pay** | Employers must pay employees their regular rate of pay if the employee is taking leave for a reason related to their own symptoms of, or exposure to, COVID-19. Employees who are taking leave to care for family members are only entitled to be paid at two-thirds of their regular rate.   Daily and total maximum limits apply see “Appendix A” for details. Special calculation rules apply for part-time employees.   | A qualifying employee will not be eligible for pay from the employer for the first ten (10) days unless the employee has available accrued vacation, personal or sick leave which can be substituted for the otherwise unpaid time. An employer is **not permitted** to require the substitution of accrued paid leave which the employee may have for the 10 unpaid period. After the 10 day period, the employee will be eligible for pay from the employer equal to two-thirds of the employee’s regular rate of pay for the remainder of the available leave up to a maximum of $200 per day, or $10,000 total. Special calculation rules apply to part-time employees. | | **Employer Notice** | Employers are required to post model notice of rights which the Department of Labor will be issuing by  March 25th, 2020. | None specified yet at this time. | | **Tax Credits** | Each quarter, employers subject to the requirement are entitled to a fully refundable tax credit equal to 100 percent of the qualified paid sick leave wages paid by the employer | Each quarter, employers subject to the requirement are entitled to a fully refundable tax credit equal to 100 percent of the qualified paid Family and Medical Leave Act (FMLA) wages paid by the employer. | | **Exemptions** | - Employers of employees who are healthcare providers or emergency responders may elect to exclude such employees from eligibility for paid leave. - Small businesses with fewer than 50 employees may qualify for exemption from the requirement to provide leave due to school closings or child care unavailability if the leave requirements would jeopardize the viability of the business as a going concern. An authorized officer of the business must determine that at least one of the three conditions described in the DOL’s FAQ is satisfied. Small businesses must still comply with all other allowable leave reasons stated above. | - Employers of employees who are healthcare providers or emergency responders may elect to exclude such employees from eligibility for paid leave. - Small businesses with fewer than 50 employees may qualify for exemption from the requirement to provide leave due to school closings or child care unavailability if the leave requirements would jeopardize the viability of the business as a going concern. An authorized officer of the business must determine that at least one of the three conditions described in the DOL’s FAQ is satisfied. | | **Effective Date** | Goes into effect April 1, 2020 and will expire on December 31, 2020 | Goes into effect April 1, 2020 and will expire on December 31, 2020 | | **Enforcement** | Eligible employers who violate the new paid sick leave law will be subject to penalties under the federal Fair Labor Standards Act. | The Department of Labor will enforce the new requirement to provide Public Health Emergency Leave under the FMLA Expansion Act. | | **Comments** | For employers with existing leave policies, the paid sick leave allotment provided for under this act is **in addition to** whatever sick leave is already offered by employers.     | As with other FMLA leave, Public Health Emergency Leave is job-protected leave. Employees have the right to return to their positions when their leave expires. However, that right to return is limited when covered employers with fewer than 25 employees must eliminate the position due to economic circumstances caused by the COVID-19 pandemic and there is no equivalent position available. |   ## **Compensation under the new paid sick leave law** Under the new paid sick leave law, employers must pay employees their regular rate of pay if the employee is taking leave for a reason related to their own symptoms of, or exposure to, COVID-19. Employees who are taking leave to care for family members are only entitled to be paid at two-thirds of their regular rate. Daily and total maximum limits apply, per the chart below: | **Reason for leave** | **Daily pay rate/cap** | **Total pay cap** | | --- | --- | --- | | Quarantine or isolation order | Regular rate of pay up to a cap of **$511**   | **$5,110** | | Advice from health care provider to self-quarantine | | | | Experiencing symptoms of COVID-19 and seeking a medical diagnosis | | | | Caring for an individual subject to quarantine or isolation order, or who has been advised by a health care provider to self-quarantine | Two-thirds regular rate of pay, up to a cap of **$200** | **$2,000** | | Caring for own child whose school or place of care has closed, or whose care provider is closed or unavailable | | | | Experiencing other substantially similar condition specified by HHS | | |   For an in depth look, [read more here](https://www.myknowledgebroker.com/hubfs/New%20Coronavirus%20Relief%20Law%20Requires%20Paid%20Employee%20Leave.pdf). For more information and resources, visit [MyKnowledgeBroker.com/Coronavirus-Resources-for-Businesses](https://www.myknowledgebroker.com/coronavirus-resources-for-businesses)   *Publish date: 3/20/20 - updated: 4/7/20 * ## [Is Your Company At Risk Of An IRS Penalty?](https://www.myknowledgebroker.com/blog/is-your-company-at-risk-of-an-irs-penalty) Posted by [Pete Frittitta](https://www.myknowledgebroker.com/blog/author/pete-frittitta) - [Tweet](https://twitter.com/share) ![IRS](https://www.myknowledgebroker.com/hs-fs/hubfs/IRS.png?width=231&name=IRS.png)Did you know that $4.5 billion in Affordable Care Act (ACA) employer mandate penalties were assessed by the IRS for the first assessment year alone (2015)? It is expected that by 2026, over $228 billion in penalties will have been assessed. This summer, the IRS began sending Letters 226-J for proposed 2017 ACA employer mandate penalties. Additionally, the IRS is increasing efforts to identify potential non-filers via Letter 5699. **One in every six large employers is currently at risk for compliance action by the IRS regarding the ACA penalties.** This is a reality and the fines can be significant!  R&R Insurance provides evaluations and reconciliations for clients.  However this is a constantly evolving process.  In fact, **we helped one client avoid a $118,213.26 penalty** with our proven process.  [Read more here](https://www.myknowledgebroker.com/hubfs/Dealing%20With%20Compliance%20Realities%20Case%20Study-2.pdf). For more information regarding Letter 226-J, you can refer to our [previous blog here](https://www.myknowledgebroker.com/blog/irs-employer-shared-responsibility-payment-notices). For more information regarding Letter 5699, you can refer to our [previous blog here](https://www.myknowledgebroker.com/blog/page/4). [Note: The ACA requires applicable large employers (ALEs) to offer affordable, minimum value health coverage to their fulltime employees or pay a penalty. This employer mandate provision is also known as the “employer shared responsibility” or “pay or play” rules. An ALE is only liable for a pay or play penalty if one or more of its full-time employees receive a subsidy for coverage through the Marketplace/Exchange.] Topics: [Affordable Care Act](https://www.myknowledgebroker.com/blog/topic/affordable-care-act) ## [IRS Issues Letter 5699 to Employers that are Non-compliant with ACA Reporting](https://www.myknowledgebroker.com/blog/irs-issues-letter-5699-to-employers-that-are-non-compliant-with-aca-reporting) Posted by [Pete Frittitta](https://www.myknowledgebroker.com/blog/author/pete-frittitta) - [Tweet](https://twitter.com/share) [![gabrielle-henderson-HJckKnwCXxQ-unsplash](https://www.myknowledgebroker.com/hs-fs/hubfs/gabrielle-henderson-HJckKnwCXxQ-unsplash.jpg?width=241&height=161&name=gabrielle-henderson-HJckKnwCXxQ-unsplash.jpg)](https://unsplash.com/photos/woman-signing-on-white-printer-paper-beside-woman-about-to-touch-the-documents-HJckKnwCXxQ?utm_content=creditShareLink&utm_medium=referral&utm_source=unsplash)The Internal Revenue Service (IRS) has been sending Letter 5699 to employers that have not complied with their Affordable Care Act (ACA) reporting requirements under Internal Revenue Code Section 6056 for the 2015 calendar year. Letter 5699, *Request for Employer Reporting of Offers of Health Insurance Coverage (Forms 1094-C and 1095-C)*, requests missing information from applicable large employers (ALEs) that were required to report under Section 6056, but failed to file Forms 1094-C and 1095-C with the IRS. The IRS identifies potentially non-compliant ALEs based on their Form W-2 total employee count reported for the 2015 calendar year. The IRS began issuing Letter 226-J to certain ALEs that filed Forms 1094-C and 1095-C to inform them of their potential liability for an employer shared responsibility penalty for the 2015 calendar year. Similarly, the IRS has been issuing Letter 5699 as its enforcement mechanism to identify and assess penalties against ALEs that failed to file Forms 1094-C and 1095-C for the 2015 calendar year. Employers who receive a Letter 5699 should respond to the IRS within the appropriate time frame. When responding to Letter 5699, employers should provide all appropriate information requested by the IRS, including any Forms 1094-C and 1095-C that are due. **Keep in mind that penalties may apply for any failures to file with the IRS by required deadlines.** The IRS will use information provided in response to Letter 5699 to identify non-compliant ALEs and assess any penalties that may be owed. For more information regarding Letter 5699 and related ACA reporting penalties, [click here](https://www.myknowledgebroker.com/hubfs/docs/pdf/IRS%20Issues%20Letter%205699%20to%20Noncompliant%20Employers%209-21-18.pdf). To learn more about Letter 226-J, you can refer to our [previous blog here.](https://www.myknowledgebroker.com/blog/irs-employer-shared-responsibility-payment-notices) Source: Zywave Topics: [Compliance](https://www.myknowledgebroker.com/blog/topic/compliance) ## [ACA Affordability Percentages Will Increase for 2019](https://www.myknowledgebroker.com/blog/aca-affordability-percentages-will-increase-for-2019) Posted by [Pete Frittitta](https://www.myknowledgebroker.com/blog/author/pete-frittitta) - [Tweet](https://twitter.com/share) ![ACA Affordability Percentages will Increase](https://www.myknowledgebroker.com/hs-fs/hubfs/ACA%20Affordability%20Percentages%20will%20Increase.jpg?width=156&name=ACA%20Affordability%20Percentages%20will%20Increase.jpg)The IRS recently issued a [Revenue Procedure](https://www.irs.gov/pub/irs-drop/rp-18-34.pdf) to index the medical insurance premium contribution percentages used to determine the affordability of an employer’s plan under the Affordable Care Act (ACA). These updated affordability percentages are effective for taxable years and plan years beginning Jan. 1, 2019. For plan years beginning in 2019, employer-sponsored coverage will be considered affordable if the employee’s required contribution for self-only coverage does not exceed **9.86 percent** of the employee’s household income for the tax year. This is for purposes of both the “play or pay” rules and premium tax credit eligibility. This represents a significant increase from the affordability contribution percentage for 2018. The 2018 affordability percentage for the “play or pay” rules and premium tax credit eligibility was 9.56 percent. As a result, some employers may have additional flexibility with respect to their employee contributions for 2019 to meet the adjusted percentage. For more guidance on this and other compliance topics, [contact a KnowledgeBroker](https://www.myknowledgebroker.com/about-us/contact-us). Topics: [Affordable Care Act](https://www.myknowledgebroker.com/blog/topic/affordable-care-act) [All posts](https://www.myknowledgebroker.com/blog/all) [Next](https://www.myknowledgebroker.com/blog/author/pete-frittitta/page/2) ### Subscribe to Email Updates ### Recent Posts ### Posts by Topic - [Business Insurance (263)](https://www.myknowledgebroker.com/blog/topic/business-insurance) - [Personal Insurance (129)](https://www.myknowledgebroker.com/blog/topic/personal-insurance) - [Employee Benefits (87)](https://www.myknowledgebroker.com/blog/topic/employee-benefits) - [Wellness (87)](https://www.myknowledgebroker.com/blog/topic/wellness) - [Workers Compensation (62)](https://www.myknowledgebroker.com/blog/topic/workers-compensation) - [Safety (51)](https://www.myknowledgebroker.com/blog/topic/safety) - [Resource Center (42)](https://www.myknowledgebroker.com/blog/topic/resource-center) - [Schools (35)](https://www.myknowledgebroker.com/blog/topic/schools) - [Health Reform (34)](https://www.myknowledgebroker.com/blog/topic/health-reform) - 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