R&R Insurance Blog

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.

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 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 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 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 and the DOJ’s new guidance here.

Source: Zywave, Inc.

Many employee benefits are subject to annual dollar limits that are periodically updated for inflation, such as HSAs, health FSAs, and transportation fringe benefit plans. The IRS recently released Revenue Procedure 2019-44 revising the Health Care FSA and Limited Purpose FSA maximum for 2020. For tax year 2020:

• The dollar limitation for employee salary reductions for contributions to health flexible spending arrangements is $2,750, up $50 from the limit for 2019.
• The monthly limitation for the qualified transportation fringe benefit is $270, as is the monthly limitation for qualified parking, up from $265 for tax year 2019.

The IRS typically announces the dollar limits that will apply for the next calendar year well in advance of the beginning of that year to give employers time to update their plan designs and make sure their plan administration will be consistent with the new limits. Check out our convenient chart with all of the major IRS benefits limits for 2020!

Contact a Knowledge Broker for more information.

Many employee benefits are subject to annual dollar limits that are periodically updated for inflation, such as HSAs, health FSAs, and transportation fringe benefit plans. This Compliance Overview includes a chart of the inflation-adjusted limits for 2019. Although some of the limits will remain the same, many of the limits increase for 2019.

The IRS typically announces the dollar limits that will apply for the next calendar year well in advance of the beginning of that year to give employers time to update their plan designs and make sure their plan administration will be consistent with the new limits.

Contact a Knowledge Broker for more information.

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.

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

Source: Zywave

On June 19, 2018, the Department of Labor (DOL) released a final rule that gives small businesses more freedom to join together as a single group to purchase health insurance in the large group market or to self-insure. These benefit arrangements are called association health plans (AHPs). The final rule allows working owners without other employees, such as sole proprietors and other self-employed individuals, to join AHPs.

The final rule allows employers to join together to form an AHP that is a single ERISA plan if either of the following requirements is satisfied:

• The employers are in the same trade, industry, line of business or profession; or
• The employers have a principal place of business within a region that does not exceed boundaries of the same state or the same metropolitan area (even if the metropolitan area includes more than one state).

Most AHPs will not be subject to the Affordable Care Act’s requirement to include Essential Health Benefits (EHB), which requires small group plans to cover a core set of 10 major items and services, such as mental health care, maternity and newborn care, prescription drugs and emergency services. Most AHPs will also be exempt from the ACA’s rating restrictions for the small group market, which means that AHPs may base premiums on factors such as age, industry and gender. The final rule requires AHPs to comply with certain consumer protections and anti-discrimination protections that apply to the large group market (learn more).

R&R will continue to keep you informed as we monitor developing guidance regarding AHPs and other benefits matters at the federal and state levels. For a more complete understanding of the new AHP rule, click here to read more.

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.

You 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.

On Monday January 22, 2018, Congress passed HR195 to extend funding for the government through February 8, 2018.  President Trump signed the legislation into law Monday night.  Although this new law was crafted to continue funding the government, it did contain 3 specific items impacting employer sponsored health insurance plans:

• Health Insurance Tax
  • Presently, insured health plans include a premium tax that adds over 2% to the premium rate. This tax is part of the Affordable Care Act.  With the passage of HR195, the Health Insurance Tax will be suspended for 2019.
• Cadillac Tax
  • The Affordable Care Act contained what is often referred to as the “Cadillac Tax”. The tax was originally scheduled to be implemented in 2018.  It would result in a 40% excise tax for health insurance plans with annual costs in excess of $10,200 for single coverage and $27,500 for family coverage.  The tax would be paid by the plan sponsor.  This tax was delayed to 2020 and now, as a result of HR195, it is delayed until 2022.
• Medical Device Tax
  • Manufacturers of medical devices were set to be subjected to a 2.3% tax on their products. Again, this tax was part of the Affordable Care Act.  The passage of HR195 delays the start of this tax for 2 more years.

The new tax law (signed on December 22, 2017) eliminated the individual health insurance mandate penalty starting in 2019.  The employer mandate for Applicable Large Employers (generally companies with 50 or more full-time equivalent employees) and the 1095 reporting continues unchanged.

Employers should be aware of the evolving applicability of existing ACA taxes and fees so that they know how the ACA affects their bottom lines. R&R Insurance Services will continue to keep you informed of changes.

Read here for a more comprehensive list of these current updates. If you have any questions, feel free to contact a Knowledge Broker at 800.566.7007.

Is your organization looking for a way to streamline the audit process for safety and compliance? Do you struggle to create and maintain audits, surveys or questionnaires?

R&R’s Risk Management Center offers an easy-to-use, web-based solution to help manage the audit process from start to finish.

The Audit Track^® provides your organization with the tools you need to proactively manage workplace safety, employee training, IIPP/APP safety program development, and OSHA compliance tracking, reporting and analysis. The tool also allows managers to oversee safety audit, inspection and compliance reporting needs, as well as confirmation that all tasks are assigned, completed and recorded – ensuring your workplace remains safe and compliant.

Completely customizable to your organization, the Audit Track^® allows you to:

• Create custom audits for your organization or department
• Deploy in the field on any major mobile device
• Assign to any employee and track tasks, activities and results
• Access summary and detailed reports based on your criteria
• Track, achieve and demonstrate regulatory compliance
• Target and resolve revealed issues before they become incidents
• Proactively manage your workplace
• Set field audits and surveys to your unique reoccurrence
• Make automated auditing an integral part of your safety strategy
• Keep all Safety Audits, Inspections, Self Assessments and other workplace checklists up-to-date

For more information on R&R’s Risk Management Center and the Audit Track^®, visit www.myknowledgebroker.com/RMC or email Safety@rrins.com.