--- title: R&R Insurance Blog | Compliance description: Compliance | 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) ## [Health Care Flexible Spending Account Limits for 2020](https://www.myknowledgebroker.com/blog/health-care-flexible-spending-account-limits-for-2020) Posted by [the knowledge brokers](https://www.myknowledgebroker.com/blog/author/the-knowledge-brokers) - [Tweet](https://twitter.com/share) [![brano-heYdDdq0cbE-unsplash](https://www.myknowledgebroker.com/hs-fs/hubfs/brano-heYdDdq0cbE-unsplash.jpg?width=300&height=169&name=brano-heYdDdq0cbE-unsplash.jpg)](https://unsplash.com/photos/pink-pig-coin-bank-on-brown-wooden-table-heYdDdq0cbE?utm_content=creditShareLink&utm_medium=referral&utm_source=unsplash)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](https://www.irs.gov/pub/irs-drop/rp-19-44.pdf) 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](https://www.myknowledgebroker.com/hubfs/IRS%20Announces%20Benefit%20Plan%20Limits%20for%202020-1.pdf)! [Contact a Knowledge Broker](https://www.myknowledgebroker.com/about-us/contact-us) for more information. Topics: [Employee Benefits](https://www.myknowledgebroker.com/blog/topic/employee-benefits), [Compliance](https://www.myknowledgebroker.com/blog/topic/compliance) ## [Employee Benefit Plan Limits for 2019](https://www.myknowledgebroker.com/blog/employee-benefit-plan-limits-for-2019) Posted by [the knowledge brokers](https://www.myknowledgebroker.com/blog/author/the-knowledge-brokers) - [Tweet](https://twitter.com/share) ![Compliance](https://www.myknowledgebroker.com/hs-fs/hubfs/Compliance.jpg?width=300&name=Compliance.jpg)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](https://www.myknowledgebroker.com/hubfs/docs/Employee%20Benefit%20Plan%20Limits%20for%202019.pdf) 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](https://www.myknowledgebroker.com/about-us/contact-us) a Knowledge Broker for more information. Topics: [Employee Benefits](https://www.myknowledgebroker.com/blog/topic/employee-benefits), [Compliance](https://www.myknowledgebroker.com/blog/topic/compliance) ## [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) ## [DOL Finalizes Rule to Expand Association Health Plans](https://www.myknowledgebroker.com/blog/dol-finalizes-rule-to-expand-association-health-plans) Posted by [R&R Insurance](https://www.myknowledgebroker.com/blog/author/rr-insurance) - [Tweet](https://twitter.com/share) ![Association Health Plans](https://www.myknowledgebroker.com/hs-fs/hubfs/people%20picture.png?width=150&name=people%20picture.png)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](https://www.myknowledgebroker.com/hubfs/DOL%20Finalizes%20Rule%20to%20Expand%20Association%20Health%20Plans.pdf)). 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](https://www.myknowledgebroker.com/hubfs/DOL%20Finalizes%20Rule%20to%20Expand%20Association%20Health%20Plans.pdf). Topics: [Compliance](https://www.myknowledgebroker.com/blog/topic/compliance), [benefits](https://www.myknowledgebroker.com/blog/topic/benefits) ## [Wisconsin's ACA Section 1332 Waiver Application Is Officially Complete](https://www.myknowledgebroker.com/blog/wisconsins-aca-section-1332-waiver-application-is-officially-complete) Posted by [Pete Frittitta](https://www.myknowledgebroker.com/blog/author/pete-frittitta) - [Tweet](https://twitter.com/share) ![](https://www.myknowledgebroker.com/hubfs/image.png)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](https://www.myknowledgebroker.com/blog/topic/compliance) ## [What You Need to Know About Premium Refund Checks](https://www.myknowledgebroker.com/blog/what-you-need-to-know-about-premium-refund-checks) Posted by [Pete Frittitta](https://www.myknowledgebroker.com/blog/author/pete-frittitta) - [Tweet](https://twitter.com/share) ![erisa advisory](https://www.myknowledgebroker.com/hs-fs/hubfs/erisa%20advisory.jpg?width=227&height=170&name=erisa%20advisory.jpg)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. 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