Compliance
Keeping you and your company compliant
Below you can find information and guidance released from our Compliance Center of Excellence about current legislation and issues that impact employers.
All our clients receive regular e-newsletter alerts. From the recently passed Families First Coronavirus Response Act to ERISA to the Affordable Care Act, annual reminders, and new Paid Family Leave legislation, our subject matter experts and attorneys help keep you up to date and compliant.
April 1, 2024
MMA’s Guide to 2023 RxDC Reporting
February 28, 2024
The Illinois Consumer Coverage Disclosure Act: An Updated Review
November 13, 2023
A summary of 2024 health and welfare plan limits and other annual adjustments
October 19, 2023
Update for machine-readable files transparency requirement
October 19, 2023
2023 Employer Update: Massachusetts Minimum Creditable Coverage
September 20, 2023
Annual reminder: Medicare Part D (Creditable Coverage) Notices due to individuals
September 19, 2023
Agencies release long-awaited mental health parity guidance
September 1, 2023
The ACA’s affordability safe harbor percentage plummets for 2024
August 17, 2023
Return to sender: What to do with insurance premium refunds and discounts
August 8, 2023
CMS encourages group health plans to extend the special enrollment period during Medicaid unwinding
On July 20, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a letter to employers, plan sponsors, and insurance issuers encouraging them to extend the special enrollment period for a loss of Medicaid or CHIP coverage under their group health plans beyond the required minimum 60-day special enrollment period for individuals losing coverage due to the expiration of the Medicaid continuous enrollment provision.
July 12, 2023
IRS ending COVID-19 relief for HDHPs/HSAs
The Internal Revenue Service (IRS) published IRS Notice 2023-37 on June 23, 2023, which revokes the existing COVID-19 relief that allows HDHPs to provide first dollar coverage for COVID-19 testing and treatment without affecting the ability to contribute to HSAs. This will affect calendar and non-calendar year HDHPs at different times.
June 8, 2023
Annual PCORI fee is due July 31st
The Affordable Care Act created the Patient Centered Outcome Research Initiative (PCORI) to evaluate and compare health outcomes. The annual PCORI fee partially funds this initiative. The fee applies to all health plans that provide coverage to employees, including church and government plans.
May 31, 2023
Roundup of selected state health developments, first-quarter 2023
Statehouses across the United States stayed busy in the first quarter of 2023, tackling issues like leave, health insurance and prescription drug pricing. New laws in Arkansas and Tennessee allow for family leave insurance. Illinois now requires all workers to earn paid leave they can use for any reason, starting in 2024. A recent San Francisco ordinance institutes paid military leave, while changes to existing paid leave laws occurred in Puerto Rico and two Minnesota cities. A new Seattle ordinance provides paid sick and safe leave benefits to gig workers. COVID-19 leave mandates expired in several California localities. Telehealth access gained traction in several states, including Idaho, Utah, Vermont, Washington and Wyoming. More than a half dozen states passed prescription drug laws, including ones capping insulin cost sharing in Washington and West Virginia. Illinois and New York were among states issuing insurance coverage mandates. North Carolina expanded its Medicaid program, as allowed under the Affordable Care Act (ACA).
May 18, 2023
A summary of certain 2024 health and welfare benefit plan limits
The IRS released Rev. Proc. 2023-23 on May 16, 2023, containing the 2024 high deductible health plan, HSA, and excepted benefits HRA annual limits. The U.S. Department of Health & Human Services previously released the 2024 annual out-of-pocket maximum limits for non-grandfathered medical plans subject to the Affordable Care Act. The plan limits apply to plan years beginning during the 2024 calendar year. The HSA annual contribution limits apply to the 2024 calendar year.
May 5, 2023
IRS lowers mandatory e-filing threshold
On February 23, 2023, the IRS issued final regulations lowering the mandatory electronic filing threshold from 250 forms down to 10 for many tax and information returns filed by businesses with the IRS beginning in 2024. Although the new requirement will not take effect until next year, it has the potential to cause substantial disruption—especially for small employers who were more likely to file using paper forms.
May 5, 2023
Federal judge rules against ACA’s preventive care requirements
Since its creation, the Affordable Care Act (ACA) has been subject to numerous legal challenges in state and federal courts. In the latest, Braidwood Management Inc. v. Becerra, a Texas federal district court judge ruled that a portion of the ACA’s preventive care requirement is unconstitutional. The judge issued this ruling on March 30, 2023, striking down the mandate to provide certain preventive care effective immediately on a nationwide basis.
April 21, 2023
The end in sight: The COVID-19 public health emergency and outbreak periods ending soon
Federal, state, and local governments implemented a wide range of provisions affecting employers and, where applicable, their benefit plans during the COVID-19 pandemic. President Biden signed a joint Congressional resolution ending the national emergency on April 10, 2023. Many of the COVID-19 mandates and related relief are tied – directly or indirectly – to this national emergency. Its end sets in motion a return to a pre-pandemic normal, although changes will occur at different times. The federal agencies administering and enforcing this relief exercised their discretionary authority to use May 11, 2023 as the end date for certain relief and the beginning of a countdown to end other relief. We will address this in more detail in this Guide.
March 30, 2023
Roundup of Selected State Developments, Fourth-Quarter 2022.
March 28, 2023
IRS Appears Set to Enforce Gaps in Telemedicine Relief for HDHPs/HSAs.
Beginning in 2020, the federal government enacted the first of three laws creating a patchwork of temporary relief excluding telemedicine as disqualifying other health coverage when provided in conjunction with a high deductible health plan (HDHP) and affecting eligibility for HSA contributions:
- The Coronavirus Aid, Relief and Economic Security Act;
- The Consolidated Appropriations Act, 2022; and
- The Consolidated Appropriations Act, 2023.
While the three laws generally provide relief for HDHP plan years from 2020 – 2024, there are certain gaps in the relief that potentially affect the annual HSA maximum contribution limit for many HDHP participants. Until recently, it was not clear if the IRS would enforce the gaps in the telemedicine relief, but the IRS now appears set to do so. This Alert addresses why telemedicine can interfere with HSA contributions, the temporary relief intended to address this, the gaps in that relief, and the potential effects on employees.
March 27, 2023
Prohibition on Gag Clauses and the Attestation Requirement.
On February 23, 2023, the Departments of Labor, Health and Human Services, and Treasury prepared Frequently Asked Questions related to the prohibition on gag clauses, including guidance and methods for submitting annual attestations of compliance with the anti-gag clause requirements. The first “Gag Clause Prohibition Compliance Attestation” is due no later than December 31, 2023, which covers the period beginning December 27, 2020 (or the effective date of the group health plan or health insurance coverage, if later), through the attestation date.
February 21, 2023
The Illinois Consumer Coverage Disclosure Act: An Updated Review.
The Illinois Consumer Coverage Disclosure Act (the “Act”) became law on August 27, 2021, and is an addition to Illinois employment law under the jurisdiction of the Illinois Department of Labor (IDOL). The Act requires an employer to compare its medical coverage against Illinois’ list of essential health insurance benefits and disclose this information to its Illinois workforce. The disclosure’s purpose is to help employees make informed decisions about whether coverage through their employer or the individual market will best meet their needs.
February 9, 2023
Opt-Out Right for Self-Insured Non-Federal Governmental Plans Under the Parity Rules Eliminated.
On December 29, 2022, President Biden signed the Consolidated Appropriations Act, 2023 (“CAA 2023”) into law. The CAA 2023 eliminated the ability of large state and local governmental employers sponsoring self-insured medical plans to opt out of compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA or “parity rules”). This means all of their plans will ultimately have to comply with the parity rules, if they were not already.
January 31, 2023
Annual CMS Medicare Part D Disclosure Due for Calendar Year Plans.
As part of the annual notification requirements under the Medicare Modernization Act, employer-sponsored group health plans that provide prescription drug coverage are required to disclose the plan’s creditable or non-creditable coverage status to the Centers for Medicare & Medicaid Services (CMS). This online disclosure is due 60 days after the first day of each plan year, which is March 2, 2023 for 2023 calendar year plans.
This Alert provides a summary of the disclosure requirements, including a review of:
- The employers subject to disclosure;
- The timing of the disclosure;
- The general contents of the disclosure; and
- Available CMS guidance and instructions.
January 4, 2023
Telemedicine Relief for HDHPs/HSA Extended.
President Biden recently signed the Consolidated Appropriations Act, 2023 (“CAA 2023”) into law. The CAA 2023 includes an extension of the exclusion of telemedicine as disqualifying other health coverage when provided in conjunction with a high deductible health plan (HDHP) for HDHP plan years that begin in 2023 and 2024. This extends the existing telemedicine relief that was set to expire on December 31, 2022.
November 30, 2022
Guide to Health Plan Spending Accounts.
This Guide to Health Plan Spending Accounts (the “Guide”) provides an overview and comparison of Health Savings Accounts (HSAs), Health Reimbursement Arrangements (HRAs), and Health Care Flexible Spending Accounts (HCFSAs), and includes:
- A comparison of design and eligibility, contributions and distributions, and applicable federal laws to each;
- A summary of the applicable annual limits; and
- A set of frequently asked questions with examples for HSAs, HRAs, and HCFSAs.
November 17, 2022
IRS Fixes the “Family Glitch” for Marketplace Subsidy Eligibility.
On October 13, 2022, the Internal Revenue Service (IRS) unveiled its long awaited final regulations to fix the Affordable Care Act’s “family glitch” rule.
November 11, 2022
Massachusetts Minimum Creditable Coverage.
Massachusetts requires its citizens to maintain what it considers a minimum level of health coverage or face a state individual mandate penalty. Massachusetts taxpayers must indicate if they maintained Minimum Creditable Coverage (MCC) as required by the Massachusetts Health Care Reform Law when completing their Massachusetts personal income tax returns using Schedule HC. Massachusetts taxpayers who do not maintain MCC for themselves and their dependents throughout the year and who do not qualify for an exception are subject to state income tax penalties.
October 24, 2022
A Summary of 2023 Health and Welfare Plan Limits and Other Annual Adjustments.
The Internal Revenue Service released Revenue Procedure 2022-38 on October 18, 2022, which contains the 2023 inflation adjustments for various employee benefit plans, including health care flexible spending accounts, qualified transportation fringe benefits, and adoption assistance programs.
September 15, 2022
Medicare Part D Notice Reminder.
Employer group health plans that include prescription drug coverage must provide a notice each year to all Medicare-eligible employees and dependents before the annual October 15th Medicare Part D enrollment period. The notice describes whether the employer’s prescription drug coverage is at least as good as Medicare’s prescription drug coverage (i.e., creditable coverage). If an employer’s coverage is not considered creditable, Medicare eligible individuals can incur a late enrollment penalty for failing to timely enroll in Medicare Part D, so the notice can help them make an informed enrollment decision.
August 25, 2022
Philadelphia’s New Commuter Transit Ordinance that Benefits Commuters – Update.
As anticipated, the Employee Commuter Transit Benefit Programs legislation passed by the Philadelphia City Council has been signed into law by Mayor Jim Kenney. This ordinance requires certain Philadelphia employers to provide a tax-advantaged commuter transit benefit program to their employees working in the City of Philadelphia.
July 21, 2022
Supreme Court Rules against DaVita in Battle over Group Health Plan Dialysis Coverage.
On June 21, 2022, the Supreme Court of the United States (SCOTUS) ruled against DaVita Inc. in the battle over dialysis coverage for participants with End Stage Renal Disease (ESRD). In its 7-2 decision, SCOTUS ruled that plans can limit dialysis coverage under the Medicare Secondary Payer (MSP) rules so long as benefits aren’t differentiated between those offered to other participants without ESRD.
July 15, 2022
After Roe v. Wade: A Guide to Employer Coverage for Abortion-Related Services.
As you all know, the U.S. Supreme Court (SCOTUS) ruling in Dobbs v. Jackson Women’s Health Organization on June 24, 2022 overturned its 1973 Roe v. Wade decision that established a legal right to abortion services under the U.S. Constitution.1 This decision will affect the availability of abortion services throughout the country. Employers are expressing interest in providing affected employees with assistance to access these services, but they are understandably concerned about potential risks
June 21, 2022
Guide to annual/recurring federal health and welfare plan participant notices and disclosures.
June 6, 2022
Annual PCORI Fee is Due July 31st. Time to File and Submit Payment for the PCORI Fee.
The Affordable Care Act (ACA) created the Patient Centered Outcome Research Initiative (PCORI) to evaluate and compare health outcomes. The annual PCORI fee partially funds this initiative. The fee applies to all health plans that provide coverage to employees, including church and government plans.
May 13, 2022
A Summary of Certain 2023 Health and Welfare Benefit Plans Limits. Limited Adjusted for the Upcoming Year.
The IRS released Rev. Proc. 2022-24 on April 29, 2022, containing the 2023 high deductible health plan (HDHP) and health savings account (HSA) annual limits. The U.S. Department of Health & Human Services also previously released the 2023 annual limits for non-grandfathered medical plans subject to the Affordable Care Act (ACA).
April 26, 2022
Limited Telemedicine Relief for HDHPs/HSAs Reappears.
President Biden signed the Consolidated Appropriations Act, 2022 (“CAA 2022”) into law. The CAA 2022 includes limited prospective relief excluding telemedicine as disqualifying other health coverage for high deductible health plan (“HDHP”) purposes. However, this relief leaves compliance gaps for many employer-sponsored HDHPs, affecting employee eligibility for health savings account (“HSA”) contributions during the gap periods.
March 31, 2022
The Agencies Adddress MHPAEA Enforcement Priorities in Report to Congress.
On January 25, 2022, the U.S. Departments of Labor (DOL), Health and Human Services (HHS), and Treasury (IRS), published the 2022 MHPAEA Report to Congress (the “Report”). We will refer to the DOL, HHS, and IRS collectively as the “Agencies” in this Alert. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires the Agencies to submit an annual report to Congress highlighting MHPAEA enforcement efforts and priorities, dedicated resources to support these efforts, findings, and noncompliance trends.
March 18, 2022
No Surprises Act: Federal Agencies Issue Prescription Drug and Health Care Spending Transparency Rule
The Consolidated Appropriations Act, 2021(CAA) required certain federal agencies to issue rules providing for cost transparency and related protections for health coverage under the No Surprises Act portion of the CAA. On November 23, 2021, the Department of Health and Human Services (HHS), together with the Department of Labor (DOL) and the Department of the Treasury (collectively, the Agencies), published an interim final rule entitled Prescription Drug and Health Care Spending.
January 14, 2022
U.S Supreme Court Acts on OSHA and CMS Healthcare Worker Vaccination Mandates.
On January 13, 2022, the U.S. Supreme Court (the “Supreme Court” or “Court”) issued its long-awaited decisions for the following two federal vaccination mandates:
- The Occupational Safety and Health Administration (OSHA) Emergency Temporary Standard for COVID-19 Vaccination and Testing (the “OSHA ETS”) for employers with 100 or more employees, which became effective in part on January 10, 2022; and
- The Medicare and Medicaid Programs; Omnibus COVID–19 Health Care Staff Vaccination interim final rule (the “CMS Healthcare Worker Vaccination Mandate”).
January 13, 2022
New Required Health Plan Coverage for Over-the-Counter COVID-19 Testing
August 16, 2021
The American Rescue Plan Act of 2021: COBRA Subsidy Guide
We’ve updated our COBRA Subsidy Guide for the recent additional IRS guidance. The update includes the following significant revisions (in the order they appear in the guide):
- Comparable state continuation coverage includes state continuation coverage that is only available for limited groups such as state/local governmental employees.
- Individuals who did not exercise rights to extend their original period of continuation coverage may still be able to do so retroactively and qualify for the subsidy if certain conditions are met. It appears this must result in an uninterrupted period of continuation coverage leading into the subsidy period and does not allow for the use of the subsidy’s extended election right to “skip ahead” and resume coverage during the subsidy period by leaving a gap behind.
- Gaining eligibility for group medical coverage or Medicare wipes out subsidy eligibility for all benefits.
June 30, 2021
Grandfathered Plans Get a Refresh
The Affordable Care Act (ACA) became law on March 23, 2010, subjecting both group and individual medical coverage to a variety of plan design mandates. Group health plans already in effect as of that date qualified for “grandfathered” status and could avoid meeting some of the mandates required by the new law.
June 30, 2021
U.S. Supreme Court Upholds ACA (Again)
On June 17, 2021, the U.S. Supreme Court (the “Supreme Court” or “Court”) delivered its long awaited ruling in California v. Texas, No. 19-840 (US June 17, 2021). In a 7-2 decision, the Court rejected the constitutional challenge on a procedural issue, upholding the Affordable Care Act (ACA) in its entirety. This Alert summarizes the Court’s ruling and impact on group health plans.
May 26, 2021
IRS Issues Update for Increase to 2021 Dependent Care FSA Reimbursement Limit
The American Rescue Plan Act of 2021 (the “ARPA”) became law on March 11, 2021, and it provides economic and other relief related to the COVID-19 pandemic as well as spending for other programs. One of the ARPA’s relief provisions for health and welfare benefits is an optional temporary increase to the taxfree dependent care flexible spending account (DCFSA) reimbursable limit from $5,000 ($2,500 for married couples filing separate tax returns) to $10,500 ($5,250 for married couples filing separate tax returns) for the 2021 calendar year.
May 25, 2021
Annual PCORI Fee is Due July 31st
The Affordable Care Act (ACA) created the Patient Centered Outcome Research Initiative (PCORI) to evaluate and compare health outcomes. The annual PCORI fee partially funds this initiative. The fee applies to all health plans, including church and government plans, which provide coverage to employees.
May 17, 2021
A Summary of Certain 2022 Health and Welfare Benefit Plan Limits
The IRS released Rev. Proc. 2021-25 on May 10, 2021, containing the 2022 high deductible health plan (HDHP) and health savings account (HSA) annual limits. The U.S. Department of Health & Human Services also recently released its Notice of Benefit and Payment Parameters for 2022, which include the 2022 annual limits for non-grandfathered medical plans subject to the Affordable Care Act (ACA). The limits for 2021 and 2022 are below for comparison purposes.
April 20, 2021
Agencies Issue Guidance on Updated Mental Health Parity Rules
On April 2, 2021 the U.S. Departments of Labor (DOL), Health and Human Services (HHS), and Treasury (IRS), published FAQs about the Mental Health and Substance Use Disorder Parity Implementation and the Consolidated Appropriations Act, 2021 Part 45 (FAQs). The Agencies’ guidance clarifies the new self assessment requirement added by the Consolidated Appropriations Act, 2021 (the “Act”) to the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
April 20, 2021
2021-04 COBRA Subsidy DOL Update
In March, we published an Alert providing a general overview of the COBRA subsidy created by the American Rescue Plan Act of 2021 (the “ARPA”). By itself, the ARPA is just an outline of the COBRA subsidy, and certain federal agencies need to provide the details to enable its actual administration. We expect this guidance will appear over time in the form of one or more technical notices and waves of frequently asked questions.
April 5, 2021
The Rise of State Individual Mandates v.5
As of 2019, the Tax Cut and Jobs Act of 2017 reduced the ACA’s individual mandate penalty to $0. In reaction, several states and the District of Columbia have enacted their own ACA-style individual mandates requiring taxpayers to provide proof of health coverage to avoid financial penalties.1 This Alert focuses on the obligations for employers sponsoring group medical coverage and summarizes what we know so far.
March 18, 2021
The American Rescue Plan Act of 2021
President Biden signed the American Rescue Plan Act of 2021 (the “ARPA”) into law on March 11, 2021. The ARPA is a $1.9 trillion omnibus federal spending package intended to provide economic and other relief related to the COVID-19 pandemic as well as spending for other programs.
March 18, 2021
IRS Issues Guidance Addressing Flexible Spending Account and Other Relief
The Consolidated Appropriations Act, 2021 (the “Act”) was signed into law on December 27, 2020. The Act includes flexible spending account plan relief, although it fell short of the relief participants wanted most. The Act did not permit flexible spendings.
February 16, 2021
COVID-19 Plan Administrative Guidance and FSA Relief Guide v1
The Compliance COE has released a COVID-19 Administrative Guidance Overview guide to reference in regards to issued dates, effective dates, end dates and whether the guidance is optional or mandatory.
January 27, 2021
The Rise of State Individual Mandates
As of 2019, the Tax Cut and Jobs Act of 2017 reduced the ACA’s individual mandate penalty to $0. In reaction, several states and the District of Columbia have enacted their own ACA-style individual mandates requiring taxpayers to provide proof of health coverage to avoid financial penalties.1 This Alert focuses on the obligations for employers sponsoring group medical coverage and summarizes what we know so far.
January 20, 2021
Summary of Benefits Provisions in the 2021 Consolidated Appropriations Act – Part 2
The Consolidated Appropriations Act, 2021 (the “Act”) was signed into law on December 27, 2020. The Act combines the $1.4 trillion omnibus federal spending package for the 2021 fiscal year and a $900 billion COVID-19 stimulus package. We addressed the Act’s limited relief for flexible spending account plans, the optional limited extension to emergency paid sick leave and public health emergency leave, student loan repayment assistance, and a high level overview of surprise billing legislation in our earlier Alert.
This Alert summarizes the Act’s additions to the Mental Health Parity and Addiction Equity Act (MHPAEA), which require group health plans to self-assess compliance with the MHPAEA’s parity rules for nonquantitative treatment limitations. Group health plans must provide this self-assessment to an appropriate federal and/or state agency upon request.
January 20, 2021
Annual CMS Medicare Part D Disclosure Due for Calendar-Year Plans
As part of the annual notification requirements under the Medicare Modernization Act (MMA), employersponsored
group health plans that provide prescription drug coverage are required to disclose the plan’s
creditable or non-creditable coverage status to the Centers for Medicare & Medicaid Services (CMS). This
online disclosure is due sixty (60) days after the first day of each plan year, and for calendar year plans it
should be made by March 2, 2021 (but see Timing of the Disclosure to CMS Form below).
This alert provides a summary of the Medicare Part D disclosure requirements, including a review of:
- The employers subject to Medicare Part D disclosure,
- The timing of the Disclosure to CMS Form
- The general contents of the Disclosure to CMS Form, and
- Available CMS guidance and instructions.
If you have any questions or need further details about the creditable coverage disclosure requirements,
please contact your client service team.
January 4, 2021
A Bitter Pill to Swallow: Supreme Court Denies ERISA Pre-Emption for Arkansas Law Affecting Pharmacy Benefit Managers
In a unanimous decision issued on December 10, 2020, the U.S. Supreme Court ruled that Arkansas Act 900 (“Act 900”), a state law regulating Pharmacy Benefit Managers (PBMs), is not pre-empted by ERISA. The Rutledge v Pharmaceutical Care Management Association decision may not appear to be relevant outside of the state of Arkansas, but it could have broader effects if other states enact their own controls over the amounts insurance carriers and third party administrators (TPAs, including PBMs) pay for prescription drugs and/or other medical care.
December 29, 2020
A Summary of Benefit Provisions in the 2021 Consolidated Appropriations Act
The Consolidated Appropriations Act, 2021 (the “Act”) was signed into law on December 27, 2020. The Act combines the $1.4 trillion omnibus federal spending package for the 2021 fiscal year and a $900 billion COVID-19 stimulus package.
The Act includes certain provisions affecting health and welfare benefits, including:
- Limited relief for flexible spending account plans;
- An optional limited extension to emergency paid sick leave (EPSL) and public health emergency leave under the emergency Family and Medical Leave expansion act (this leave is referred to as “EFMLEA” in this Alert);
- Student loan repayment assistance; and Surprise billing legislation.
This Alert summarizes these provisions based on the language of the Act and attempts to identify issues federal agencies should address in later guidance. No additional guidance was available as of this Alert’s publication date. We will also briefly touch on limited relief for qualified transportation fringe benefit plans
unrelated to the Act. This Alert does not address the Act’s amendments to the Paycheck Protection Program.
December 23, 2020
A Coronavirus Update for Employers
Remaining calm is easier said than done given the relentless stream of news about the spread of novel coronavirus (“COVID-19”) across the globe. This guide summarizes actions taken by both the federal and
state governments affecting employer-provided health benefits as well as certain other related issues.
November 20, 2020
2020-11 Final Transparency Rules
The Department of Health and Human Services (HHS), the Department of Labor, and the Department of Treasury (the “Agencies”) issued final rules for Transparency in Coverage on October 29, 2020. HHS also posted a fact sheet summarizing these rules that were drafted in response to President Trump’s June 2019 Executive Order on Improving Price and Quality Transparency in American Healthcare to PutPatients First.
The rules will provide health plan participants with greater access to health care cost information than is generally available or required today, but they impose a significant burden on insurance carriers and the sponsors of employer-provided medical plans. The rules also allow insurance carriers to affect their medical loss ratio calculations by using certain shared savings programs, but we will not address this in this Alert.
October 30, 2020
A Summary of 2021 Health and Welfare Plan Limits and Other Annual Adjustments
The Internal Revenue Service (IRS) released Revenue Procedure 2020-45 on October 26, 2020, which contains the 2021 inflation adjustments for various employee benefit plans, including health care flexible spending accounts, qualified transportation fringe benefits, and adoption assistance programs. This Alert also summarizes other health and welfare benefit plan limits announced earlier this year, and provides a brief summary of changes to the employer shared responsibility penalties under the Affordable Care Act (ACA).
If you have any questions or need further details about the tax limits and how they will affect your employee benefit programs, please contact your account team.
October 21, 2020
Final 2020 IRS Forms 1094/1095 Published
On October 16, 2020, the Internal Revenue Service (IRS) published the final versions of Forms 1094/1095-B and 1094/1095-C (collectively, the “Forms”) along with instructions for completing them to report information about employer-sponsored health coverage for the 2020 calendar year.
October 8, 2020
Affordable Care Act Reporting Relief Extended for 2020
The Internal Revenue Service (IRS) released Notice 2020-76 (the “Notice”), which extends the deadline for 2020 Affordable Care Act (ACA) Form 1095 reporting to individuals and the good faith compliance
defense for reporting errors consistent with the relief that has been available each reporting year since 2015.
Relief Notes
– Delivery of Forms 1095 to Individuals – The deadline to provide the 2020 Forms 1095 (B or C) to individuals is extended to March 2, 2021. No additional extension is available.
– Filing Forms 1094/1095 with IRS – The deadline to file the 2020 Forms 1094/1095 with the IRS has not been extended.
o Electronic filers – The deadline for entities filing electronically is March 31, 2021. Entities filing 250 or more forms must file electronically.
o Paper filers – The deadline for entities filing by paper is February 28, 2021. An automatic 30-day extension of the deadline to file with the IRS is available using IRS Form 8809.
– Good faith relief extended – The IRS will not assess penalties for missing or inaccurate information if the 2020 forms are completed and filed in good faith. Entities who fail to provide and/or file forms altogether are not eligible for this relief.
Note: The Notice indicates that 2020 will be the final year this good faith relief is available.
– Form 1095 Delivery Relief – The IRS also repeated delivery relief first granted in 2019 for Forms 1095-B and 1095-C (see immediately below).
October 8, 2020
Michigan Revises No-Fault Auto Insurance
A Change to Michigan’s Personal Injury Protection Requirement Likely Affects Many Medical Plans
In May 2019, Governor Whitmer signed legislation revising Michigan’s o-fault auto insurance law. The changes are substantial, and employees will likely ask about health plan coverage related to auto accidents. The changes affect auto insurance carriers and health insurance carriers as they adopt administrative changes related to no-fault auto insurance policies issued or renewed after July 1, 2020.
This Alert reviews auto personal injury protection (PIP) coverage and employer-sponsored health plans, and the increased potential liability to employees. The changes will take place as each employee’s auto policy renews, so the need for information will occur over time.
September 21, 2020
A Coronavirus Update for Employers –
Trying to Remain Calm in Troubled Times
Remaining calm is easier said than done given the relentless stream of news about the spread of novel coronavirus (“COVID-19”) across the globe. This article summarizes recent articles taken by both the federal and state governments affecting employer-provided health benefits as well as certain other related issues.
This article covers the following:
Families First Coronavirus Response Act
States are Addressing Coverage for COVID-19
High Deductible Health Plans
Spending Account Plans
Other Coverage Options for Employees
Potential Increase in Appeals?
Data Privacy Concerns
Certain Labor & Employment Issues
The Affordable Care Act and the Employer Mandate
The WARN Act
Additional Resources
Please contact your MMA Marsh McLennan Agency representative directly with any questions or concerns.
September 21, 2020
Medicare Part D Notice Reminder
The Annual October 14th Deadline is Fast Approaching
Employer group health plans that include prescription drug coverage must provide a Medicare Part D creditable and/or non-creditable coverage notice (“Notice”), as applicable, each year to all Medicare-eligible employees and dependents before the annual October 15th Medicare Part D enrollment period. The purpose of this annual Notice is to notify Medicare beneficiaries whether or not their employer’s prescription drug coverage is at least as good as Medicare’s prescription drug coverage, in order to help them decide whether to enroll in Medicare Part D.
Click here to read full article
If you have any questions or need further details, please contact your client service team.
September 17, 2020
Return to Sender
What to do with Insurance Premium Refunds and Discounts
Insurance carriers will soon issue 2019 Medical Loss Ratio (MLR) rebates as mandated by the Affordable Care Act (ACA). In addition to this recurring refund, insurance carriers have been offering – and continue to offer – employers premium refunds and discounts on fully insured health coverage due to lower-than-expected claims experience during 2020. While money back is useful for employers, there are rules affecting what employers may be able to do with it resulting in another headache for beleaguered HR personnel to sort out. This Alert distinguishes between refunds and discounts, and it addresses what employers can do with them.
Click here to read full article
If you have any questions or need further details, please contact your client service team.
September 14, 2020
Transportation Fringe Benefits Update
Proposed Qualified Transportation Fringe Benefit Regulations
Provide a New Roadmap
On June 23, 2020, the IRS issued proposed regulations providing guidance regarding employee taxability and employer deductibility for qualified transportation fringe (QTF) benefits. The Tax Cuts and Jobs Act of 2017 (TCJA) eliminated most employer deductions for QTF benefits provided to employees while preserving the pre-tax treatment of those benefits for employees.
Click here to read full article
If you have any questions or need further details, please contact your client service team.
August 14, 2020
The Empire State Strikes Back
New York Federal Court Strikes Down Certain FFCRA Paid Leave Provisions
The Families First Coronavirus Response Act (FFCRA) became law on March 18, 2020. Among many other provisions, FFCRA created a pair of COVID-19-related paid leaves effective beginning April 1, 2020 through December 31, 2020:
1. Emergency paid sick leave (EPSL); and
2. Public health emergency leave under the Emergency Family and Medical Leave Expansion Act
(EFMLEA).
Click here to read the full article
If you have any questions or need further details, please contact your client service team.
July 22, 2020
The Rise of State Individual Mandates
Restoring an Affordable Care Act (ACA) Requirement
As of 2019, the Tax Cut and Jobs Act of 2017 reduced the ACA’s individual mandate penalty to $0. In reaction, several states and the District of Columbia have enacted their own ACA-style individual mandates requiring taxpayers to provide proof of health coverage to avoid financial penalties. 1 This article focuses on the obligations for employers sponsoring group medical coverage and summarizes what we know so far.
If you have any questions or need further details, please contact your client service team.
July 22, 2020
The Rise of State Individual Mandates
Restoring an Affordable Care Act (ACA) Requirement
As of 2019, the Tax Cut and Jobs Act of 2017 reduced the ACA’s individual mandate penalty to $0. In reaction, several states and the District of Columbia have enacted their own ACA-style individual mandates requiring taxpayers to provide proof of health coverage to avoid financial penalties. 1 This article focuses on the obligations for employers sponsoring group medical coverage and summarizes what we know so far.
If you have any questions or need further details, please contact your client service team.
Compliance Alert – July 8, 2020
IRS Addresses Direct Primary Care and Health Care Sharing Ministries
Payments for Direct Primary Care and Health Care Sharing Ministries can be Qualified Medical Expenses. On June 8, 2020, the Internal Revenue Service (IRS) issued proposed regulations addressing when amounts paid for direct primary care arrangements and health care sharing ministry expenses are “qualified medical expenses” under Internal Revenue Code (the “Code”) Section 213(d). A 2019 Presidential Executive Order directed the Treasury Department to “propose regulations to treat expenses related to certain types of arrangements, potentially including direct primary care arrangements and health care sharing ministries, as eligible medical expenses under [Code] Section 213(d).”
When, Exactly?
For now, the proposed regulations operate as a safe harbor. Final regulations will ultimately specify an effective date applicable to tax years that end on or after their publication date. We believe this is unlikely to occur before spring 2021 at the earliest.
Click here to read the full alert
If you have any questions or need further details, please contact your client service team.
The following communication is a consolidation of several compliance updates from our Compliance Center of Excellence. Please reach out to your dedicated MMA Marsh McLennan Agency representative for any questions regarding the impact this may have on your health plans or business practices.
A Tale of Two IRS Notices: IRS Provides Relief for Mid-Year Election Changes and Flexible Spending Accounts
On May 12, 2020, the IRS issued two notices (collectively referred to as the “Notices”):
- IRS Notice 2020-29 gives employers additional flexibility to allow mid-year benefit electionchanges, permits employers to provide flexible spending account (FSA) participants anextended grace period to use their 2019 FSA plan year funds, and addresses someprevious loose ends.
- IRS Notice 2020-33 increases the carryover limit for unused health care FSA (HCFSA)funds and indexes it for inflation.
Click here to read the full alert
2021 Plan Limits and Final Coupon Guidance Released
Now that the U.S. Department of Health & Human Services (HHS) has released its Notice of Benefit and Payment Parameters for 2021 and the IRS has released Rev. Proc. 2020-32, we know the 2021 cost-of-living adjustments for non-grandfathered plans subject to the Affordable Care Act (ACA), high-deductible health plans (HDHPs), and health savings accounts (HSAs).
State Individual Mandate Reminder – May 8, 2020
Restoring an Affordable Care Act (ACA) Requirement
As of 2019, the Tax Cut and Jobs Act of 2017 reduced the ACA’s individual mandate penalty to $0. In reaction, several states and the District of Columbia have enacted their own ACA-style individual mandates requiring taxpayers to provide proof of health coverage to avoid financial penalties. This article focuses on the obligations for employers sponsoring group medical coverage and summarizes what we know so far. This is an update to our earlier release.
Click here to read the full alert
If you have any questions or need further details, please contact your client service team.
EBSA Notice and Final Rule – May 8, 2020
COVID-19 Plan Administration Relief: The Good, the Bad, and the Ugly
On April 28, 2020, the U.S. Department of Labor (DOL) and U.S. Department of the Treasury (“Treasury”)1 coordinated the release of the following guidance in response to the COVID-19 National Emergency:
- EBSA Disaster Relief Notice 2020-01 (the “EBSA Notice”) – The EBSA Notice provides limited relief for certain plan filings, broad relief for the delivery of plan notices and disclosures, and relaxes the rules for electronic delivery.
- Extension of Certain Timeframes for Employee Benefit Plans, Participants, and Beneficiaries Affected by the COVID–19 Outbreak Final Rule (the “Final Rule”) – The Final Rule suspends various plan administration deadlines. Most of this relief gives employees/participants more time to enroll when certain events occur, file claims for benefits or appeal denied claims, and elect and pay for COBRA. Group health plans must administer these employee/participant rights but get limited consolation in the form of COBRA election notice relief.
- COVID-19 FAQs for Participants and Beneficiaries (the “COVID-19 FAQs”) – The COVID- 19 FAQs are intended to help employees and participants understand how the EBSA Notice and Final Rule may affect them.
This Alert solely addresses the guidance applicable to group health plans, and it does not cover any guidance for retirement plans (e.g. 401(k) plans, pension plans, etc.). The U.S. Department of Health and Human Services indicated in both the EBSA Notice and Final Rule that it intends to adopt similar relief through the Public Health Services Act (PHSA), which will affect non-federal governmental and church plans.
Click here to read the full alert
If you have any questions or need further details, please contact your client service team.
IRS and DOL Extend Filing Deadlines Due to COVID-19 – May 8, 2020
IRS Notice 2020-23 Gives Limited Relief for Certain Plan Filings The Internal Revenue Service (IRS) issued IRS Notice 2020-23 (the “Notice”) on April 6, 2020, which automatically delays the filing date for tax returns and payments that were due on or after April 1, 2020 through July 14, 2020 (the “Automatic Relief Window”) until July 15, 2020.
Most of the items covered by the Notice are beyond the scope of this Alert. The Notice does not directly mention anything related to health and welfare benefits, but it incorporates Revenue Procedure 2018-582 by reference which includes Forms 5500 and 990.
Click here to read the full alert
If you have any questions or need further details, please contact your client service team.
CARES Act – April 10, 2020
This alert from our Compliance Center of Excellence provides an overview of the recently signed CARES Act and its effect on health and welfare programs.
Provisions Affecting Health and Welfare Plans
Congress worked overtime to pass a stimulus bill intended to assist employers and the economy during the COVID-19 pandemic, and the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) was signed into law on March 27, 2020. While most of the CARES Act provisions involve economic relief for employers and employees that are beyond the scope of this Alert, there were several changes affecting group health plans. Some of these changes are permanent while others are of limited duration to address the COVID-19 pandemic period.
Our overview includes details on the mandate to cover testing (and vaccination) for COVID-19, the changes for Spending Account Plans, telemedicine and HSAs, and student loan repayment assistance.
Click here to read the full alert
If you have any questions or need further details, please contact your client service team.
IRS Notice 2020-23 Gives Limited Relief for Certain Plan Filings – April 2020
The IRS issued IRS Notice 2020-23 (the “Notice”) on April 6, 2020, which automatically delays the filing date for tax returns and payments that were due on or after April 1, 2020 through July 14, 2020 (the “Automatic Relief Window”) until July 15, 2020.
Most of the items covered by the Notice are beyond the scope of this Alert. The Notice does not directly mention anything related to health and welfare benefits, but it incorporates Revenue Procedure 2018-582 by reference which includes Forms 5500 and 990.
Click here to read the details related to Form 5500 and Form 990
If you have any questions or need further details, please contact your client service team.
Update: The Rise of State Individual Mandates – March 24, 2020
As a follow up to our special alert on the State of New Jersey announcement that postponed their 1094/1095 filing deadline, the original Compliance Alert on The Rise of State Individual Mandates has been updated and is now available. This article, released in February, provided an overview of states and the District of Columbia who have enacted their own ACA-style individual mandates requiring taxpayers to provide proof of health coverage to avoid financial penalties. The alert focuses on the obligations for employers sponsoring group medical coverage and summarizes what we know so far.
Note: We intend to continue to update this article as new or additional state individual mandate guidance becomes available.
Click here to read the Updated State Individual Mandate Guide
If you have any questions or need further details, please contact your client service team.
New Jersey Postpones Filing Deadline for Form 1094/1095 – March 20, 2020
This is a follow up to the MMA Compliance Alert on Individual State Mandates released on Friday, February 14, 2020. The State of New Jersey has postponed the deadline for their new filing 1094/1095 requirement from March 31, 2020 to May 15, 2020. As a reminder, this requirement applies to all covered individuals who are residents of the state of New Jersey and is required of all applicable large employers (ALE’s) and self-insured small groups regardless of where the company is located. The State will not accept paper filings, for information on how to file electronically from New Jersey State click here.
Click here to read the full alert
If you have any questions or need further details, please contact your client service team.
IRS Notice 2020-15 – March 11, 2020
This is a follow up to the MMA Marsh McLennan Agency Special Alert on Coronavirus Testing Benefit Considerations released on Tuesday, March 10, 2020. The Department of Treasury and the Internal Revenue Service (IRS) issued guidance through IRS Notice 2020-15 that allows the coverage of COVID-19 on a first dollar basis without rendering a qualified high deductible health plan (HDHP) ineligible for use with a Health Savings Account (HSA). The full notice is available at: https://www.irs.gov/pub/irs-drop/n-20-15.pdf
Click here to read the full alert
If you have any questions or need further details, please contact your client service team.
Coronavirus Testing Benefit Considerations – March 10, 2020
As we continue to monitor COVID-19 and its impact throughout the world and within the U.S. there are several issues impacting employee benefits that employers need to consider quickly. While information is changing rapidly we wanted to provide some immediate updates based on what we know as of right now, so you can make decisions on how you would like to proceed.
COVID-19 Testing
Last Thursday, The US Centers for Disease Control and Prevention (CDC) expanded its testing guidelines for COVID-19 to be covered as a preventive benefit. Lab Corp. announced last Thursday, that it was immediately offering testing for COVID-19, while Quest Diagnostics said it will start testing specimens this week. It is important to note that there continues to be a testing supply issue so while these labs may be able to complete the testing they may not have the supplies to do so. Members cannot just request testing, a physician’s prescription is required, and will be ordered based on CDC guidelines after completion of an overall risk assessment that will review symptoms and potential for exposure based on travel, interaction with those having potential or presumptive diagnosis in the area, etc. If you have any questions or need further details, please contact your client service team.
Federal Agencies Issue Proposed Rules Addressing Transparency in Coverage – March 9, 2020
The proposed rules on Transparency in Coverage were published by the Department of Health and Human Services, the Department of Labor and the Department of Treasury (the “Agencies”) on November 27, 2019. These rules were generated in response to President Trump’s June 2019 Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First. If enacted as written, the rules will provide health plan participants with greater access to health care cost information than is generally available or required today.
Click here to read the full alert
If you have any questions or need further details, please contact your client service team.
Annual CMS Medicare Part D Disclosure Due for Calendar-Year Plans – February 14, 2020
Reporting Creditable or Non-Creditable Status to CMS
As part of the annual notification requirements under the Medicare Modernization Act (MMA), employer-sponsored group health plans that provide prescription drug coverage are required to disclose the plan’s creditable or non-creditable coverage status to the Centers for Medicare & Medicaid Services (CMS). This online disclosure is due sixty (60) days after the first day of each plan year, and for calendar year plans it should be made by February 29, 2020 (but see Timing of the Disclosure to CMS Form below).
This alert provides a summary of the Medicare Part D disclosure requirements including a review of:
- The employers subject to Medicare Part D disclosure,
- The timing of the Disclosure to CMS Form,
- The general contents of the Disclosure to CMS Form, and
- Available CMS guidance and instructions.
If you have any questions or need further details about the creditable coverage disclosure requirements, please contact your client service team.
Guide to the State Individual Mandates – February 10, 2020
The Rise of State Individual Mandates
Restoring an Affordable Care Act (ACA) Requirement
As of 2019, the Tax Cut and Jobs Act of 2017 reduced the ACA’s individual mandate penalty to $0. In reaction, several states and the District of Columbia have enacted their own ACA-style individual mandates requiring taxpayers to provide proof of health coverage to avoid financial penalties. This article focuses on the obligations for employers sponsoring group medical coverage and summarizes what we know so far.
Note: We intend to update this article as new or additional state individual mandate guidance becomes available. This article is current as of the publication date appearing at the top of this page.
ACA Mandate Part 4 – January 23, 2020
2020 Spending Package and 5th Circuit ACA
2019 ACA Reporting Relief
IRS Releases Draft 2019 Instructions for Forms 1094/1095
IRS Releases 2020 FSA Limits
Compliance Center of Excellence Newsletter – Volume 7
New Health Reimbursement Arrangements Allowed Under Final Rules-September 30, 2019
Compliance Center of Excellence Newsletter – Volume 6
Medicare Part D Notice – September 23, 2019
AHP Update – August 13, 2019
read more
Expanding Preventive Care for HDHPs
Exec Order on Price and Quality Transparency – June 28, 2019
New HRAs Allowed Under Final Rules – June 18, 2019
Compliance Center of Excellence Newsletter – Volume 4
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Compliance Center of Excellence Newsletter – Volume 3
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DOL Releases Proposed Overtime Rule
Compliance Center of Excellence Newsletter – Volume 2
Compliance Center of Excellence Newsletter – February 2019
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February Reminder – Annual CMS Disclosure
Texas Federal Court Rules ACA Unconstitutional…But Please Sit Tight
Compliance Center of Excellence Newsletter – December 2018
Massachusetts Employers Must File HIRD Form by November 30
Compliance Center of Excellence Newsletter – November 2018
Compliance Center of Excellence Newsletter – October 2018
Reminder: Medicare Part D Creditable Coverage Notice Deadline is October 14, 2018
Federal Agencies Release Final Regulations for Short-Term Limited Duration Insurance Coverage
Agencies Issue Guidance on Mental Health Parity Issues, Signal Enhanced Enforcement
IRS Grants Relief for Reduction to 2018 HSA Tax Limits
IRS Announces Reductions to 2018 HSA and Adoption Credit Tax Limits
Reminder: Annual CMS Medicare Part D Disclosure
DOL Announces April 1 Applicability of Final Disability Plan Claims Procedure Regulations
New HRAs Allowed Under Final Rules – June 18, 2019
Compliance Center of Excellence Newsletter – Volume 4
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Compliance Center of Excellence Newsletter – Volume 3
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