Compliance Update | September 2, 2015 | McGohan Brabender

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TeleDoc Continues to Grow

One way to help control costs and save time is telemedicine.  That is, when the person calls the doctor rather than actually going to the physician’s office.  A telemedicine visit is usually cheaper and, in the case of an employee, the person does not have to leave work.

http://onforb.es/1Q3opxn

TeleDoc, a large telemedicine company, went public this year and reported a 78% increase in revenue.  You may want to look into offering telemedicine as an employee benefit.

Don’t Forget About Pregnancy Discrimination Laws

Employers continue to embrace wellness programs and the government continues to issue guidance.  For example, the EEOC is taking an active role in this area.  One popular tool is a health risk assessment where the person is asked to complete a health questionnaire.

http://bit.ly/1JGEBDT

Employers cannot discriminate based on pregnancy and one employer ran afoul of the rules for firing an employee after the employer found out she was pregnant.  The employer said it was justified because she lied at the job interview.  However, the EEOC said she only had to disclose the fact if she anticipates a need for special accommodation.

Tax-Free Identify Theft Protection

As a general proposition, anything the employer provides an employee is taxable compensation unless specifically excluded from taxable income under the Internal Revenue Code.  A prime example of a tax-free benefit is health benefits.

http://1.usa.gov/1JwoYNN

There have been a number of security breaches and many employers are offering identity theft protection.  The IRS has issued a ruling saying this protection is now a tax-free benefit.  That is, the employer need not include the value of this coverage on the employees’ W-2 forms.

Maximum Out of Pocket Ruling Gets Congressional Attention 

We have reported in several previous articles the Department of Health and Human Services issued a “clarification” that health care reform requires that all non-grandfathered health plans must adopt an embedded maximum out of pocket for in-network providers when it comes to essential health benefits.

http://bit.ly/1EsS8yn

This article talks about essential health benefits.  Although there are 10 broad categories of essential health benefits the specific definition varies from state to state.

http://bit.ly/1hrqWFH

The chairs of the House Ways and Means, Education and the Workforce and Energy and Commerce committees expressed concerns about this clarification and have asked the Department of Health and Human Services to justify this “clarification.”  Note that the embedded maximum out of pocket rules have not yet been repealed but it is being subject to scrutiny at this point.  Stay tuned!!!

HRAs and Reporting Requirements

Small employers (i.e. those with fewer than 50 full-time and full-time equivalents) with fully insured health plans do not need to complete IRS Forms 1094 and 1095.  However, small employers with self-funded health plans do need to complete IRS Forms 1094-B and 1095-B.  The IRS now says a small employer with a fully insured group health plan and an HRA must complete the forms.  Large employers with fully insured health plans would have to complete Part III of Form 1095-C.

http://bit.ly/1Unhxvh

According to the IRS an HRA is a self-funded health plan so it is subject to the reporting requirements.  Also, see next article regarding the penalties for not complying with the reporting requirements.

Increased Penalties for Reporting Failures

We have had numerous articles and seminars on the new reporting requirements (i.e. IRS Forms 1094 and 1095) under health care reform.  The government has increased the potential penalties for failing to comply.

http://xerox.bz/1MXsK59

The government has indicated no penalties will be assessed for the 2015 forms, which are due early next year, if the employer makes a good faith compliance effort.  However, this means relief will be provided for incorrect or incomplete information reported on the return or statement, including Social Security numbers, but not for failing to file timely an information return or statement.  So it is critical the forms be filed on time.

More Disclosure Rules on the Horizon

  

Insurance companies that sell products on the health care exchanges or marketplaces have to disclose information regarding out-of-network liability and balance billing; enrollee claim submission; claims and denials, etc.

http://bit.ly/1fR4K6H

Non-grandfathered group health plans and insurers offering group or individual coverage outside an exchange will soon have to collect, display and submit similar transparency data to HHS, state commissioners and the public (upon request).

IRS Guidance on ALEs

Different health care reform rules apply to applicable large employers or ALEs.  An ALE is an employer with 50 or more full-time and full-time equivalent employees during the previous calendar year.  The count is based on a control group basis where related employers are considered a single employer.

http://1.usa.gov/1zBwR2Z

This control concept has been around for years and the IRS has issued guidance on how it applies in the context of health care reform.

Get Those Social Security Numbers

Employers with self-funded group health plans have to report the Social Security number of everyone covered under the plan.  That is not going to be much of an issue for employees but it may be challenging to get the Social Security numbers of the spouses and children.

http://bit.ly/1Evurpp

The employer has to make a good faith attempt to get the numbers, and this article explains what that means.  If the employer is unable to get the numbers, the employer can use the person’s birthdate but only after making a good faith attempt to get the Social Security number.

More Rules on Preventive Services

Health care reform requires non-grandfathered health plans to provide first dollar coverage for preventive care.  The government released new rules on this requirement.

http://bit.ly/1KWXxux

If you sponsor a fully insured plan the carrier will ensure compliance, and if you sponsor a self-funded health plan you should make sure your plan is updated before next year.

Health Care Reform Here to Stay But Needs Fixes

The U.S. Supreme has again approved the Affordable Care Act so it looks like the court challenges are over and the statute is here to stay, at least under the current administration.

http://bit.ly/1JGNIjr

This article talks about several provisions of the statute that need to be tweaked so that the law becomes more workable.

Retiree Health Coverage and HRAs

Employers providing retiree health coverage have a new option under health care reform.  That is, the health care exchange or marketplaces may be a viable option for retirees not yet eligible for Medicare.  Some employers are helping these individuals by establishing HRAs for retirees.

http://xerox.bz/1Q3kj8q

HRAs for retirees only (i.e. no active employees are covered under the HRA) are exempt from health care reform for the most part.  However, the HRA may preclude the retiree from getting a premium subsidy through the exchange or marketplace.  This article talks about those rules.

You May be Buying a Cadillac Whether You Like It or Not

The Cadillac tax is scheduled to kick in January 1, 2018, and it is expected to hit a large number of employers.

http://bit.ly/1JvStAP

This study says the unpopular tax could impact up to 42% of employers by 2028.  A lot of people are upset with the tax but health care reform has to be funded one way or another.  So if the Cadillac tax is repealed, something will have to replace it to pay for health care reform.

http://bit.ly/1JrKiln

This is a nice overview of the Cadillac tax.  The government continues to issue guidance and ask for comments on the tax.

The Shift Continues

As health care costs continue to grow, employers continue to look for ways to reduce their health care expenses.  One way has been to shift more of the cost to the employees.

http://bit.ly/1LNK0eu

This article talks about that trend and how employers are taking health care reform (e.g. the employer mandate or play or pay rules) into account.

Be Sure to Get a Bang for Your Buck

Employee benefits are becoming more expensive every day and many employers are missing a branding opportunity when it comes to employee benefits.

http://bit.ly/1NSa4EL

This article is talking about tying the company’s branding and culture to the employee benefit program.

Bigger May Not Mean Better

This article says that the largest issuers in the health care exchanges or marketplaces increased premiums more than the other carriers.

http://bit.ly/1MDslGu

On average, the largest issuers raised rates by 23.9%, while the other issuers only raised rates by 13.7%.  Since these were the largest carriers the increase impacted more individuals.