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R&R Insurance Blog

Pete Frittitta

Recent Posts

COVID-19 Vaccination – A Work Requirement?

Posted by Pete Frittitta

coronavirus vaccineOn 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 in the client advisory made available from von Briesen & Roper.

Please visit our COVID-19: Business Recovery Resources 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 for future updates and resources.

Please contact your R&R representative with any questions.

Families First Coronavirus Response Act

Posted by Pete Frittitta

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


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.


  • 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


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.


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



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


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.

For more information and resources, visit MyKnowledgeBroker.com/Coronavirus-Resources-for-Businesses


Publish date: 3/20/20 - updated: 4/7/20

Is Your Company At Risk Of An IRS Penalty?

Posted by Pete Frittitta

IRSDid 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.

For more information regarding Letter 226-J, you can refer to our previous blog here.

For more information regarding Letter 5699, you can refer to our previous blog here.

[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

IRS Issues Letter 5699 to Employers that are Non-compliant with ACA Reporting

Posted by Pete Frittitta

reportingThe 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.

To learn more about Letter 226-J, you can refer to our previous blog here.

Source: Zywave

Topics: Compliance

ACA Affordability Percentages Will Increase for 2019

Posted by Pete Frittitta

ACA Affordability Percentages will IncreaseThe IRS recently issued a Revenue Procedure 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.

Topics: Affordable Care Act

Wisconsin's ACA Section 1332 Waiver Application Is Officially Complete

Posted by Pete Frittitta

On May 9, 2018, the Departments of Health and Human Service and the Treasury notified officials in Wisconsin that their application for a state innovation waiver under Section 1332 of the Affordable Care Act (ACA) was complete. The Departments will accept public comment on the waiver application until June 8, 2018 and approve or deny the application within 180 days.

Wisconsin proposes to develop and implement a state-based reinsurance program—the Wisconsin Healthcare Stability Plan (WIHSP)—for its individual insurance market. WIHSP, if approved, would begin in the 2019 plan year and reduce premiums by 10.6 percent (relative to what premiums would have been in the absence of the waiver). Wisconsin estimates a federal pass-through rate of 83 percent. Of the overall $200 million program, the federal government is expected to contribute about $166 million and state funds are expected to account for about $34 million.

Stay tuned as developments progress.

Topics: Compliance

What You Need to Know About Premium Refund Checks

Posted by Pete Frittitta

erisa advisoryYou have the opportunity to earn a premium refund on your level-funded plan but do you know what to do with it once you get it? Or maybe you’ve already received one - did you know that there are compliance rules to follow to disburse any employee share of that refund within 90 days?

In most simple terms, if employees pay a portion of health care premiums, then they are entitled to a prorated share of the premium refund. Additionally, you must distribute the appropriate funds within 90 days of receiving the refund check.

There are some interpretations being expressed in the consulting community that would suggest a very simple option exists such as “give every employee the same amount.” We strongly discourage this as it relies on comments from the U.S. Department of Labor (DOL) that contradict other guidance by the DOL. It clearly is not supported.

An employer can apply the entire refund check amount toward reducing employee contributions. However, this only eliminates the need to calculate the “split” between the employees and the employer. Unless the employer has paid 100% of the premiums, employers will still need to calculate the appropriate share of the refund for each employee prorated according to the amount they contributed.

There are basically three compliance options available to employers. If you are not familiar with the compliance options that are available to you, contact an R&R Benefits Knowledge Broker to learn more.

Topics: Employee Benefits, Compliance

An Important Health Care Reform Update

Posted by Pete Frittitta

alarm clockLast Saturday, the U.S. Senate passed their version of a tax reform bill, the Tax Cuts & Jobs Act. The bill is not yet finalized. While the Senate and the House have passed similar tax reform plans, negotiators from both chambers need to develop agreement on a single piece of legislation that both chambers must approve before it is sent to the President for his signature.

One component of the Senate Bill that is not in the House Bill is regarding the Individual Shared Responsibility Payment (aka “Individual Mandate”) provision of the Affordable Care Act (ACA). If the Senate Bill provision makes its way into the final version of a tax reform bill, the Individual Mandate Tax would be set to zero dollars. However, all other ACA-related taxes would remain intact including the “Employer Mandate” (discussed here later).

While any other legislative actions to repeal/replace/repair the ACA remain to be seen, the Trump Administration has been busy focusing on what it can do via the rule-making agencies, namely, the Treasury (IRS), the Department of Labor (DOL) and the Department of Health and Human Services (HHS). Following is a summary of key updates, changes, and proposed changes:


  • It’s that time of year again. ACA Employer Reporting (IRS Forms 1094-C and 1095-C) is still required. For what it’s worth, none of the discussions involving ACA repeal/replacement/repair mentioned the elimination of reporting. This required reporting will be alive and well for some time.

    The Individual statements for 2017 must be furnished by January 31, 2018. IRS returns for 2017 must be filed by February 28, 2018 (April 2, 2018, if filed electronically, since March 31, 2018, is a Sunday). R&R has updated our Employer Reporting Tool for 2017 which will generate the required forms in PDF format (paper filing allowed by IRS for less than 250 forms).
  • Check your mailbox. The IRS recently released an outline of the processes and form letters that it will use to enforce assessment of ESRPs (Employer Shared Responsibility Penalties, aka the “employer mandate”). These are penalties that apply to large employers (with 50 or more full-time equivalent employees) to offer a medical plan (to at least 95% of its full-time employees) that is of a “minimum value” and is “affordable.”

    The IRS began to issue assessment letters last week informing employers of their liability for 2015 calendar year penalties. These letters will have a response deadline of 30 days from the date the letter was written. Timely response is crucial to maintain your appeal rights. Read more here regarding sample letters and the processes involved.
  • No more “Reinsurance Fees.” The ACA’s “Reinsurance Fees” were imposed for 2014, 2015, and 2016 only. The 2nd (last) installment payment for 2016 was to be made by November 15, 2017.
  • One more round. The PCORI fees continue to apply but are scheduled to sunset. The PCORI fees will no longer apply beginning with plan years ending on or after October 1, 2019.
  • “HIT” Restart. The ACA’s Health Insurance Tax (HIT) is a permanent, annual fee on health insurers that began in 2014. It was suspended for 2017 as part of the 2015 Budget Act but will restart for 2018 collection and payment. The traditional insurance market continues to be further challenged by innovative self-funding and level-funding arrangements which also have the advantage of being exempt from the ACA’s “HIT” (3.5% - 5% of premium).
  • Where did they park that Cadillac? Although it has been delayed until 2020, the ACA’s “Cadillac Tax,” if it is ever implemented, would put pressure on employers to reduce benefits to avoid/minimize paying a 40% excise tax. By its design, it is not a question of “if” an employer will be subject to the “Cadillac Tax” but “when.”


  • Simplified…almost. On October 6, 2017, the DOL, HHS and the IRS issued two interim final rules expanding certain exemptions from the ACA’s contraceptive coverage mandate. As a result, objecting employers are no longer required to choose between direct compliance and compliance through the accommodation. A plan sponsor, issuer and plan covered by these exemptions will not be penalized for failing to include contraceptive coverage in the plan’s benefits. Note that fully-insured policies will most likely need to file policy riders as appropriate once the rule is final.
  • Going up! On October 27, 2017, the Department of Health and Human Services (HHS) released its Proposed Notice of Benefit and Payment Parameters for 2019. Following are the current and proposed out-of-pocket maximums:
    • For 2017, the out-of-pocket maximum is $7,150 for self-only coverage and $14,300 for family coverage.
    • For 2018, the out-of-pocket maximum is $7,350 for self-only coverage and $14,700 for family coverage.
    • Under the proposed rule, the out-of-pocket maximum would increase for 2019 to $7,900 for self-only coverage and $15,800 for family coverage.
  • Who doesn’t want more flexibility? The same proposed rules would allow states more flexibility in their options to select a new EHB-benchmark (Essential Health Benefits) plan on an annual basis beginning in 2019. This would provide more plan design choices for the small group market (less than 50 employees in Wisconsin).
  • Off the table for now. The HIPAA certification requirement is delayed indefinitely, pending guidance from HHS as on October 4, 2017, HHS withdrew its proposed rule in order to reexamine the issues and explore options and alternatives to comply with the HIPAA certification requirement. This would apply to all self-funded plans including medical reimbursement HRAs.
  • Back to the drawing board. The EEOC’s (Equal Employment Opportunity Commission) “final rule” regarding “voluntary” wellness incentives turns out to be not so final after all as it has been challenged by the courts to revisit its position regarding the definition of “voluntary.” The current rules were not “vacated” by the courts so the EEOC guidance should still be complied with. Stay tuned.
  • That’s an order!  Several weeks ago, President Donald Trump signed “Presidential Executive Order Promoting Healthcare Choice and Competition Across the United States.” The executive order directs federal agencies to expand access to MEWAs (Multiple Employer Welfare Arrangement), HRAs and short-term, limited-duration insurance. More will follow on this as the agencies’ deadline to draft proposed regulations is December 11, 2017.
  • Coming home? Even without a “repair” or “replacement” of the ACA, it is anticipated that there will be a number of states that will apply for Section 1332 State Innovation Waivers. This has been discussed recently for consideration in Wisconsin by the Office of the Commissioner of Insurance.
The disruption and turbulence in the employee benefits market will continue. For now, the Affordable Care Act remains the “law of the land” and requires much in the way of compliance for which we have the knowledge, resources and experience in helping our clients. R&R continues to monitor discussions at the federal and state levels with respect to legislative changes that will impact employee benefits. As always, do not hesitate to contact your R&R Benefits Consultant with any questions or concerns.

Topics: Affordable Care Act, ACA

House of Representatives Passes the American Health Care Act

Posted by Pete Frittitta

Capital BuildingOn May 4, 2017, members of the U.S. House of Representatives voted along party lines to pass an amended version of the American Health Care Act - proposed legislation to repeal and replace the ACA. The AHCA will now move on to be considered by the Senate.

ACA Provisions Not Impacted

The majority of the ACA would not be affected by the AHCA. The MacArthur amendments specifically maintain most of the ACA’s market reforms. For example, the following key ACA provisions would remain in place:

  • Cost-sharing limits on essential health benefits (EHBs) for non-grandfathered plans (currently $7,150 for self-only coverage and $14,300 for family coverage)
  • Prohibition on lifetime and annual limits for EHBs
  • Requirements to cover pre-existing conditions
  • Coverage for adult children up to age 26
  • Guaranteed availability and renewability of coverage
  • Nondiscrimination rules (on the basis of race, nationality, disability, age or sex)
  • Prohibition on health status underwriting

Click here to download the ACA Compliance Bulletin - which provides an overview of the proposed legislation and its potential impact going forward.


Topics: ObamaCare, ACA

What You Need to Know | Impact of Trump Election on Employee Benefits Regulations

Posted by Pete Frittitta

Trump-Election.jpgIt has often been said that “the only thing that is constant is change” and certainly the recent political election results translate into more change. In that vein, we at R&R Insurance Services remain “constant” in our dedication to keeping our Benefits Practice clients informed of these changes…to be your knowledgebroker.

Of course, the biggest change we have seen in the world of benefits has been the Patient Protection and Affordable Care Act (aka ACA, aka Obamacare). One of the main platforms of President-Elect Trump has been to “repeal and replace Obamacare.” In this current post-election and pre-inaugural stage, there are many prognostications about what the future may be. So, what about “repeal and replace?” We would like to share some thoughts with you as best we can and at this point in time to address questions you may have:
  1. Soon after President-Elect Trump is inaugurated on January 20th, Congress could “repeal” Obamacare through “reconciliation” (only requiring a vote of 51 in the Senate). Among the challenges will be addressing the 19 million+ individuals who would lose coverage through the Exchanges with approximately 85% of them currently receiving federal assistance. Another major issue that will need to be addressed is that Medicaid expansion goes away with repeal in 31 states where enrollment increased by 16 million.
  2. “Replacement” cannot be accomplished through the “reconciliation” process unless additional spending cuts are made in the budget. Therefore, “replacement” could most likely occur in a second legislative stage. How long this will take is a question.
  3. Through the “reconciliation” process that would “repeal” the ACA, the reduction of funds for Medicaid and Exchange subsidies could be delayed for some time (6 – 18 months?) in order to avoid the problems mentioned above in #1.
  4. The Republicans will need to have bipartisan support in the Senate to get to 60 votes. Some Democrats might be motivated to collaborate as the 2018 mid-term election will have 25 Democrat seats up for re-election in the Senate.
  5. As for what “replacement” might involve, there are numerous considerations. The Trump platform has consistently promoted expansion of HSA-based coverage and selling of insurance across state lines. Additionally, President-Elect Trump himself stated that he would like to see certain parts of Obamacare retained such as coverage of pre-existing conditions and coverage of adult children to age 26. If there are any individual tax credits that might be introduced for individual medical coverage, we may see, as the “Cadillac Tax” is repealed along with the rest of the ACA, a limitation or cap on the amount that an employer can deduct for health and welfare expense to provide a revenue stream.

We recently hosted a Benefits Client Monthly Compliance Webinar - “How Will the Election Impact Employee Benefits Regulations & a Look Forward to 2017.” If you weren’t able to attend, please note that all of our webinars are recorded and archived at https://www.myknowledgebroker.com/health-care-webinar-archives where they are available 24/7.

In addition,
Terry Frett from R&R Insurance discussed the “re-tooling” of the Affordable Care Act on WISN 1130AM Radio shortly after the election.  In addition to ObamaCare Open Enrollment 2017, he shared his thoughts on what repeal could look like in the individual and employer group markets.  

The changes ahead will involve more than the future of the ACA. We can reasonably expect to see regulatory changes from the Department of Labor, the Treasury Department and the Department of Health and Human Services. As we monitor and study these developments, we will keep you informed in a variety of ways –timely Legislative Briefs posted to your MyWave Connect© client portal, special client alert emails, monthly compliance webinars, account management communications and client consultation.

We look forward to continuing to serve you as your knowledgebroker. If you have any questions, please contact your R&R Benefits Consultant.

Topics: Employee Benefits, Healthcare, health care benefits, presidential election