2022 Open Enrollment Checklist

2022 Open Enrollment Checklist

2022 Open Enrollment Checklist

To download this entire document as a PDF, click here: Open Enrollment eBook

This Compliance Overview is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice.  Readers should contact legal counsel for legal advice. 

In preparation for open enrollment, Employers should review their plan documents in light of changes for the plan year beginning Jan 1, 2021. Below is an Employer 2 Open Enrollment Checklist including some administrative items to prepare for in 2020. 

Health plan sponsors should also confirm that their open enrollment materials contain certain required participant notices, when applicable—for example, the summary of benefits and coverage (SBC). There are also some participant notices that must be provided annually or upon initial enrollment. To minimize costs and streamline administration, employers should consider including these notices in their open enrollment materials.

PLAN DESIGN CHANGES

Out-of-pocket Maximum

Effective for plan years beginning on or after Jan. 1, 2014, non-grandfathered health plans are subject to limits on cost-sharing for essential health benefits (EHB). The ACA’s out-of-pocket maximum applies to all non-grandfathered group health plans, including self-insured health plans and insured plans.

  • $8,700 for self-only coverage and $17,400 for family coverage out-of-pocket maximum.
  •  $7,050 for self-only coverage and $14,100 for family coverage HSA Maximum. For 2021 plan years, the out-of-pocket maximum limit for HDHPs is $7,000 for self-only coverage and $14,000 for family coverage. 

Preventive Care Benefits 

The ACA requires non-grandfathered health plans to cover certain preventive health services without imposing cost-sharing requirements (that is, deductibles, copayments or coinsurance) for the services. Health plans are required to adjust their first-dollar coverage of preventive care services based on the latest preventive care recommendations. If you have a non-grandfathered plan, you should confirm that your plan covers the latest recommended preventive care services without imposing any cost-sharing.  

More information on the recommended preventive care services is available through the U.S. Preventive Services Task Force and www.HealthCare.gov.

Health FSA Contributions

The ACA imposes a dollar limit on employees’ salary reduction contributions to a health flexible spending account (FSA) offered under a cafeteria plan. An employer may impose its own dollar limit on employees’ salary reduction contributions to a health FSA, as long as the employer’s limit does not exceed the ACA’s maximum limit in effect for the plan year. 

The ACA set the health FSA contribution limit at $2,500. For years after 2013, the dollar limit is indexed for cost-of-living adjustments. For 2022 plan years, the health FSA limit is $2,850. The DFSA Rollover Maximum is $570. 

  • Communicate the health FSA limit to employees as part of the open enrollment process.

HDHP and HSA Limits for 2022

If you offer an HDHP to your employees that is compatible with an HSA, you should confirm that the HDHP’s minimum deductible and out-of-pocket maximum comply with the 2020 limits. The IRS limits for HSA contributions and HDHP cost-sharing increase for 2022. The HSA contribution limits will increase effective Jan. 1, 2022, while the HDHP limits will increase effective for plan years beginning on or after Jan. 1, 2022.

  • Check whether your HDHP’s cost-sharing limits need to be adjusted for the 2022 limits.
  • If you communicate the HSA contribution limits to employees as part of the enrollment process, these enrollment materials should be updated to reflect the increased limits that apply for 2022.

The following table contains the HDHP and HSA limits for 2022 as compared to 2021. It also includes the catch-up contribution limit that applies to HSA-eligible individuals who are age 55 or older, which is not adjusted for inflation and stays the same from year to year.

Type of Limit20212022Change
HSA Contribution LimitSelf-only$3,600$3,650Up $50
Family$7,200$7,300Up $100
HSA Catch-up Contributions (not subject to adjustment for inflation)Age 55 or older$1,000$1,000No change
HDHP Minimum DeductibleSelf-only$1,400$1,400No change
Family$2,800$2,800No change
HDHP Maximum Out-of-pocket Expense Limit (deductibles, copayments and other amounts, but not premiums)Self-only$7,000$7,050Up $50
Family$14,000$14,100Up $100

 

ACA EMPLOYER MANDATE AND OTHER REQUIREMENTS 

 

Applicable Large Employer Status (ALE)

Under the ACA’s employer penalty rules, applicable large employers (ALEs) that do not offer health coverage to their full-time employees (and dependent children) that is affordable and provides minimum value will be subject to penalties if any full-time employee receives a government subsidy for health coverage through an Exchange.

To qualify as an ALE, an employer must employ, on average, at least 50 full-time employees, including full-time equivalent employees (FTEs), on business days during the preceding calendar year. All employers that employ at least 50 full-time employees, including FTEs, are subject to the ACA’s pay or play rules.

  • Determine your ALE status for 2022
  • Calculate the number of full-time employees for all 12 calendar months of 2020. A full-time employee is an employee who is employed on average for at least 30 hours of service per week.
  • Calculate the number of FTEs for all 12 calendar months of 2021 by calculating the aggregate number of hours of service (but not more than 120 hours of service for any employee) for all employees who were not full-time employees for that month and dividing the total hours of service by 120.
  • Add the number of full-time employees and FTEs (including fractions) calculated above for all 12 calendar months of 2021.
  • Add up the monthly numbers from the preceding step and divide the sum by 12. Disregard fractions.
  • If your result is 50 or more, you are likely an ALE for 2022.

Identify Full-time Employees

All full-time employees must be offered affordable minimum value coverage.  A full-time employee is an employee who was employed on average at least 30 hours of service per week. The final regulations generally treat 130 hours of service in a calendar month as the monthly equivalent of 30 hours of service per week. The IRS has provided two methods for determining full-time employee status—the monthly measurement method and the look-back measurement method.

  • Determine which method you are going to use to determine full-time status
  • The monthly measurement method involves a month-to-month analysis where full-time employees are identified based on their hours of service for each month. This method is not based on averaging hours of service over a prior measurement method. Month-to-month measuring may cause practical difficulties for employers, particularly if there are employees with varying hours or employment schedules, and could result in employees moving in and out of employer coverage on a monthly
  • The look-back measurement method allows an employer to determine full-time status based on average hours worked by an employee in a prior period. This method involves a measurement period for counting/averaging hours of service, an administrative period that allows time for enrollment and disenrollment, and a stability period when coverage may need to be provided, depending on an employee’s average hours of service during the measurement 

Audit FTEs for FMLA Compliance

Audit your FTEs to determine if you have reached or exceeded 50 employees and are required to comply with the Family Medical Leave Act (FMLA) in 2022. Employers covered by the FMLA are obligated to provide their employees with certain important FMLA notices, so both employees and the employer have a shared understanding of the terms of the FMLA leave. Note that FMLA compliance requirements are different from ACA compliance. 

Offer of Coverage 

An ALE may be liable for a penalty under the pay or play rules if it does not offer coverage to “substantially all” (95%) full-time employees (and dependents) and any one of its full-time employees receives a premium tax credit or cost-sharing reduction for coverage purchased through an Exchange. For employees who are offered health coverage that is affordable and provides minimum value are generally not eligible for these Exchange subsidies.  The IRS lowered the 2022 employer health plan affordability threshold, or cost-sharing limit, to 9.61% of an employee’s income. The threshold in 2021 was 9.83%. 

  • Offer minimum essential coverage to all full-time employees
  • Ensure that at least one of those plans provides minimum value (60% actuarial value)
  • Ensure that the minimum value plan offered is affordable to all full-time employees by ensuring that the employee contribution for the lowest cost single minimum value plan does not exceed 78% of an employee’s earnings based on the employee’s W-2 wages, the employee’s rate of pay, or the federal poverty level for a single individual.

Reporting of Coverage

The ACA requires ALEs to report information to the IRS and to employees regarding the employer-sponsored health coverage on Form 1095-C. The IRS will use the information that ALEs report to verify employer-sponsored coverage and to administer the employer shared responsibility provisions (Code Section 6056).

In addition, the ACA requires every health insurance issuer, sponsor of a self-insured health plan, a government agency that administers government-sponsored health insurance programs and any other entity that provides minimum essential coverage (MEC) to file an annual return with the IRS and individuals reporting information for each individual who is provided with this coverage (Code Section 6055). 

  • Determine which reporting requirements apply to you and your health plans
  • Determine the information you will need for reporting and coordinate internal and external resources to help compile the required data for the   1094-C and 1095-C
  • Complete the appropriate forms for the 2020 reporting year. Furnish statements to individuals on or before January 31, 2021 has been extended to March 2, 2021 IRS Notice 2020-76., and file returns with the IRS on or before February 28, 2020 (March 31, 2020, if filing electronically).
ACA RequirementDeadline
1095 forms delivered to employeesJan. 31 (extended to March 2)
Paper filing with IRS*Feb. 28
Electronic filing with IRSMarch 31

Comparative Effectiveness Research Fee (PCORI)

Sponsors of self-funded plans and health insurance issuers of fully insured plans are required to pay a fee each year, by July 31st, to fund comparative effectiveness research. Fees will increase to $2.45 per covered life in 2020 and are next due July 31, 2021.

W-2 Reporting

Healthcare Reform requires employers to report the aggregate cost of employer-sponsored group health plan coverage on their employees’ Forms W-2. This reporting requirement was originally effective for the 2011 tax year. However, the IRS later made reporting optional for 2011 for all employers.

The IRS further delayed the reporting requirement for small employers (those that file fewer than 250 Forms W-2) by making it optional for these employers until further guidance is issued. For the larger employers, the reporting requirement was mandatory for the 2012 Forms W-2 and continues.

ACA DISCLOSURE REQUIREMENTS

Summary of Benefits and Coverage 

The ACA requires health plans and health insurance issuers to provide an SBC to applicants and enrollees to help them understand their coverage and make coverage decisions. Plans and issuers must provide the SBC to participants and beneficiaries who enroll or re-enroll during an open enrollment period. The SBC also must be provided to participants and beneficiaries who enroll other than through an open enrollment period (including those who are newly eligible for coverage and special enrollees).

The SBC template and related materials are available from the Department of Labor (DOL).

  • In connection with a plan’s 2020 open enrollment period, the SBC should be included with the plan’s application materials. If coverage automatically renews for current participants, the SBC must generally be provided no later than 30 days before the beginning of the new plan year.
  • For self-funded plans, the plan administrator is responsible for providing the SBC. For insured plans, both the plan and the issuer are obligated to provide the SBC, although this obligation is satisfied for both parties if either one provides the SBC. Thus, if you have an insured plan, you should confirm that your health insurance issuer will assume responsibility for providing the SBCs.

Grandfathered Plan Notice

If you have a grandfathered plan, make sure to include information about the plan’s grandfathered status in plan materials describing the coverage under the plan, such as SPDs and open enrollment materials. Model language is available from the DOL. 

Notice of Patient Protections

Under the ACA, non-grandfathered group health plans and issuers that require designation of a participating primary care provider must permit each participant, beneficiary and enrollee to designate any available participating primary care provider (including a pediatrician for children). Also, plans and issuers that provide obstetrical/gynecological care and require a designation of a participating primary care provider may not require preauthorization or referral for obstetrical/gynecological care.

If a non-grandfathered plan requires participants to designate a participating primary care provider, the plan or issuer must provide a notice of these patient protections whenever the SPD or similar description of benefits is provided to a participant. If your plan is subject to this notice requirement, you should confirm that it is included in the plan’s open enrollment materials. Model language is available from the DOL.

 

OTHER NOTICES 

Group health plan sponsors should consider including the following enrollment and annual notices with the plan’s open enrollment materials. 

  • Initial COBRA Notice 

The Consolidated Omnibus Budget Reconciliation Act (COBRA) applies to employers with 20 or more employees that sponsor group health plans.  Plan administrators must provide an initial COBRA notice to new participants and certain dependents within 90 days after plan coverage begins. The initial COBRA notice may be incorporated into the plan’s SPD.  A model initial COBRA notice is available from the DOL.

  • Notice of HIPAA Special Enrollment Rights

At or prior to the time of enrollment, a group health plan must provide each eligible employee with a notice of his or her special enrollment rights under HIPAA.  This notice may be included in the plan’s SPD.   Model language for this disclosure is available on the DOL’s website.

  • Annual CHIPRA Notice

Group health plans covering residents in a state that provides a premium subsidy to low-income children and their families to help pay for employer-sponsored coverage must send an annual  notice about the available assistance to all employees residing in that state. The DOL has provided a model notice.

  • WHCRA Notice

Plans and issuers must provide notice of participants’ rights to mastectomy-related benefits under the Women’s Health and Cancer Rights Act (WHCRA) at the time of enrollment and on an annual basis.  Model language for this disclosure is available on the DOL’s website.

  • NMHPA Notice

Plan administrators must include a statement within the Summary Plan Description (SPD) timeframe describing requirements relating to any hospital length of stay in connection with childbirth for a mother or newborn child under the Newborns’ and Mothers’ Health Protections Act. Model language for this disclosure is available on the DOL’s website.

  • Medicare Part D Notices

Group health plan sponsors must provide a notice of creditable or non-creditable prescription drug coverage to Medicare Part D eligible individuals who are covered by, or who apply for, prescription drug coverage under the health plan. This creditable coverage notice alerts the individuals as to whether or not their prescription drug coverage is at least as good as the Medicare Part D coverage. The notice generally must be provided at various times, including when an individual enrolls in the plan and each year before Oct. 15th (when the Medicare annual open enrollment period begins).  Model notices are available on the Centers for Medicare and Medicaid Services’ website.

  • HIPAA Privacy Notice

The HIPAA Privacy Rule requires covered entities (including group health plans and issuers) to provide a Notice of Privacy Practices (or Privacy Notice) to each individual who is the subject of protected health information (PHI). Health plans are required to send the Privacy Notice at certain times, including to new enrollees at the time of enrollment. Also, at least once every three years, health plans must either redistribute the Privacy Notice or notify participants that the Privacy Notice is available and explain how to obtain a copy.

Self-insured health plans are required to maintain and provide their own Privacy Notices. Special rules, however, apply for fully insured plans. Under these rules, the health insurance issuer, and not the health plan itself, is primarily responsible for the Privacy Notice.

Model Privacy Notices are available through the Department of Health and Human Services

  • Summary Plan Description (SPD)

Plan administrators must provide an SPD to new participants within 90 days after plan coverage begins. Any changes that are made to the plan should be reflected in an updated SPD booklet or described to participants through a summary of material modifications (SMM).

Also, an updated SPD must be furnished every five years if changes are made to SPD information or the plan is amended. Otherwise, a new SPD must be provided every 10 years. 

Summary Annual Report

Plan administrators that are required to file a Form 5500 (> 100 participants in plan) must provide participants with a narrative summary of the information in the Form 5500, called a summary annual report (SAR). The plan administrator generally must provide the SAR within nine months of the close of the plan year. If an extension of time to file the Form 5500 is obtained, the plan administrator must furnish the SAR within two months after the close of the extension period.

Wellness Program Notices 

Group health plans that include wellness programs may be required to provide certain notices regarding the program’s design. As a general rule, these notices should be provided when the wellness program is communicated to employees and before employees provide any health-related information or undergo medical examinations.

  • HIPAA Wellness Program Notice—HIPAA imposes a notice requirement on health-contingent wellness programs that are offered under group health plans. Health-contingent wellness plans require individuals to satisfy standards related to health factors (for example, not smoking) in order to obtain rewards. The notice must disclose the availability of a reasonable alternative standard to qualify for the reward (and, if applicable, the possibility of waiver of the otherwise applicable standard) in all plan materials describing the terms of a health-contingent wellness program. Final regulations provide sample language that can be used to satisfy this requirement.
  • ADA Wellness Program Notice—Employers with 15 or more employees are subject to the Americans with Disabilities Act (ADA). Wellness programs that include health-related questions or medical examinations must comply with the ADA’s requirements, including an employee notice requirement. Employers must give participating employees a notice that tells them what information will be collected as part of the wellness program, with whom it will be shared and for what purpose, the limits on disclosure and the way information will be kept confidential. The Equal Employment Opportunity Commission (EEOC) has provided a sample notice to help employers comply with this ADA requirement.

 

 

 

Enhance Your Employee Benefits Package.  A competitive benefits package is key to keeping and attracting top talent.  Assess your current benefits package and consider making necessary adjustments to include options, such as expanded mental health support, for example. 

GENERAL HR  

Review Employee Records.  The fourth quarter is a good time to review your employee records and check record retention guidelines. Don’t forget to dispose of outdated termination and outdated job applications properly. With W2s around the corner, make sure all addresses and information are updated.

Develop and Distribute Your 2022 Calendar.  Create and distribute a calendar outlining important dates, vacation time, pay dates, and company-observed holidays for 2022. 

Review and Update Employee Handbook. Review your employee handbook to make sure it is up-to-date and addresses areas, such as employment law mandates, new COVID-related policies, guidelines for remote working, privacy policies, compensation and performance reviews, social media policies, attendance, and time-off, break periods, benefits, and procedures for termination, discipline, workplace safety, and emergency procedures.

PLEASE NOTE: This information is for general reference purposes only. Because laws, regulations, and filing deadlines are likely to change, please check with the appropriate organizations or government agencies for the latest information and consult your employment attorney and/or benefits advisor regarding your responsibilities. In addition, your business may be exempt from certain requirements and/or be subject to different requirements under the laws of your state. (Updated Oct. 3, 2021)

Contact us at (855) 667-4621 or email us at info@medicalsolutionscorp.com

 

Learn more about

 Liability Protection        •        Employee Benefits       •        HR Consulting

 

PEO Pros and Cons

PEO Pros and Cons

When choosing the right PEO, especially when it comes to human resource management, you should ensure that they offer basic HR services like benefits, payroll, and compliance.

Pros of PEO

1. Flexible, scalable:

Bundled HR solution covers you as you grow.  i.e. Compliance changes based on # of employees. The HR Platform can handle 10 as well as 200 employees. The benefits scale up as you do. You are able to include value-added services as you grow.

2. Access to “Big-Company” infrastructure and benefits

  • More health care benefit options for employees and their families mean:
    • Attract high caliber talent in your industry
    • Retain your best employees
  • 401(k) and retirement planning 
  • Top-rated voluntary benefits and discount programs
  • HR technology platform for administering benefit plans

3.  Access to HR expertise

  • Support for payroll and employee needs.
  • HR and Human Capital consultants.
    • Benefits administration
    • Employee issues
    • Strategic HR planning:  Interview Traning and Permanence Management Reviews, etc. 
  • Ensure HR compliance with local, state and federal laws.

4. Shifting and sharing of liability

  • Workplace safety
  • Sexual Harassment
  • Employer Practices Liability Insurance
  • Affordable Care Act compliance
  • COVID and New regulations

5. Value

  • Time Saver:  You get back valuable time from doing redundancies. The average PEO client saves 10 hrs/month. 
  • Benefits Savings:  The average client saves 15-40% on medical benefits alone.   The national networks and robust benefits are also value-added. 
  • Savings on Workmans Comp. 
    • PEO’s are pay as you go WC. This means if you downsized in light of COVID you receive an adjusted lower rate the following month and not end of the year. 
    • PEO’s may be able to place hard to write Workmans Comp. Ex: Construction Industry
  • State Unemployment:  Since you are sharing in a larger company’s SUTA rate the rates are generally lower with lower fluctuations. If during COVID a company had high turnover their SUTA rate can jump much higher than a PEO. 

PEO Cons

1. Wrong PEO Selecting a PEO for the wrong reason(s): should be considered a long-term strategy, not a short-term fix.  Some PEOs may charge a percentage of salary instead of a clear per employee per month cost.  

2. Employers fear the loss of controEven though you will still be running your small business and making day to day decisions, the PEO will become the co-employer of your staff.  PEOs do NOT have control over your salary. You control who you hire/fire.  You decide on benefits eligibility waiting periods, plan selections, and employer contributions. The PEOs deal with HR responsibilities and risks, saving you countless hours and many headaches, but do not take away your independence.

3  System limitations   Because the PEO is a business as well, and has to meet it’s own deadlines, they may request certain payments upfront. This may mean a fundamental shift in your cash flow because there will be consequences for being a week late with your payroll taxes.

4. It is NOT for every small business depending on your industry and demographics you may or may not be the right for a PEO. While the vast majority of clients are indeed enjoying benefits savings for some groups the costs may be even higher than small group health insurance. Addiotnaly, some companies can develop above-average very high risk and become too much of a liability burden for the PEO and the client can be moved to a higher risk category. The very advantage of a PEO can make it a disadvantage – they can underwrite.  

Summary

Before you consider hiring a Professional Employment Organization, you should first find out what is a PEO so that you can know exactly what to expect from it. With the right PEO, you will be able to manage your businesses’ demand for growth and your employees as well. 

If you are looking for an insurance solution for your business, go to our website and check out our business insurance solutions. Do not hesitate to contact us for more information.

 RESOURCE:

PEO What are the Stats?

What is a PEO?

 

 

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Get In Touch

For more information on PEOs or a custiomized quote please submit your contact. We will be in touch ASAP. 

2022 Open Enrollment Checklist

2021 Open Enrollment Checklist

2021 Open Enrollment Checklist

To download this entire document as a PDF, click here: Open Enrollment eBook

This Compliance Overview is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice.  Readers should contact legal counsel for legal advice. 

In preparation for open enrollment, Employers should review their plan documents in light of changes for the plan year beginning Jan 1, 2021. Below is an Employer 2 Open Enrollment Checklist including some administrative items to prepare for in 2020. 

Health plan sponsors should also confirm that their open enrollment materials contain certain required participant notices, when applicable—for example, the summary of benefits and coverage (SBC). There are also some participant notices that must be provided annually or upon initial enrollment. To minimize costs and streamline administration, employers should consider including these notices in their open enrollment materials.

PLAN DESIGN CHANGES

 

Out-of-pocket Maximum

Effective for plan years beginning on or after Jan. 1, 2014, non-grandfathered health plans are subject to limits on cost-sharing for essential health benefits (EHB). The ACA’s out-of-pocket maximum applies to all non-grandfathered group health plans, including self-insured health plans and insured plans.

  • $8,550 for self-only coverage and $17,100 for family coverage  out-of-pocket maximum.
  •  $7,000 for self-only coverage and $14,000 for family coverage HSA Maximum. For 2021 plan years, the out-of-pocket maximum limit for HDHPs is $7,000 for self-only coverage and $14,000 for family coverage. 

Preventive Care Benefits 

The ACA requires non-grandfathered health plans to cover certain preventive health services without imposing cost-sharing requirements (that is, deductibles, copayments or coinsurance) for the services. Health plans are required to adjust their first-dollar coverage of preventive care services based on the latest preventive care recommendations. If you have a non-grandfathered plan, you should confirm that your plan covers the latest recommended preventive care services without imposing any cost-sharing.  

More information on the recommended preventive care services is available through the U.S. Preventive Services Task Force and www.HealthCare.gov.

Health FSA Contributions

The ACA imposes a dollar limit on employees’ salary reduction contributions to a health flexible spending account (FSA) offered under a cafeteria plan. An employer may impose its own dollar limit on employees’ salary reduction contributions to a health FSA, as long as the employer’s limit does not exceed the ACA’s maximum limit in effect for the plan year. 

The ACA set the health FSA contribution limit at $2,500. For years after 2013, the dollar limit is indexed for cost-of-living adjustments. For 2021 plan years, the health FSA limit is $2,750. 

  • Communicate the health FSA limit to employees as part of the open enrollment process.

HDHP and HSA Limits for 2021

If you offer an HDHP to your employees that is compatible with an HSA, you should confirm that the HDHP’s minimum deductible and out-of-pocket maximum comply with the 2020 limits. The IRS limits for HSA contributions and HDHP cost-sharing increase for 2020. The HSA contribution limits will increase effective Jan. 1, 2020, while the HDHP limits will increase effective for plan years beginning on or after Jan. 1, 2020.

  • Check whether your HDHP’s cost-sharing limits need to be adjusted for the 2020 limits.
  • If you communicate the HSA contribution limits to employees as part of the enrollment process, these enrollment materials should be updated to reflect the increased limits that apply for 2020.

The following table contains the HDHP and HSA limits for 2020 as compared to 2019. It also includes the catch-up contribution limit that applies to HSA-eligible individuals who are age 55 or older, which is not adjusted for inflation and stays the same from year to year.

Type of Limit20202021Change
HSA Contribution LimitSelf-only$3,500$3,600Up $50
Family$7,100$7,200Up $100
HSA Catch-up Contributions (not subject to adjustment for inflation)Age 55 or older$1,000$1,000No change
HDHP Minimum DeductibleSelf-only$1,400$1,400No change
Family$2,800$2,800No change
HDHP Maximum Out-of-pocket Expense Limit (deductibles, copayments and other amounts, but not premiums)Self-only$6,900$7,000Up $100
Family$13,800$14,000Up $200

 

ACA EMPLOYER MANDATE AND OTHER REQUIREMENTS 

 

Applicable Large Employer Status (ALE)

Under the ACA’s employer penalty rules, applicable large employers (ALEs) that do not offer health coverage to their full-time employees (and dependent children) that is affordable and provides minimum value will be subject to penalties if any full-time employee receives a government subsidy for health coverage through an Exchange.

To qualify as an ALE, an employer must employ, on average, at least 50 full-time employees, including full-time equivalent employees (FTEs), on business days during the preceding calendar year. All employers that employ at least 50 full-time employees, including FTEs, are subject to the ACA’s pay or play rules.

  • Determine your ALE status for 2021
  • Calculate the number of full-time employees for all 12 calendar months of 2020. A full-time employee is an employee who is employed on average for at least 30 hours of service per week.
  • Calculate the number of FTEs for all 12 calendar months of 2020 by calculating the aggregate number of hours of service (but not more than 120 hours of service for any employee) for all employees who were not full-time employees for that month and dividing the total hours of service by 120.
  • Add the number of full-time employees and FTEs (including fractions) calculated above for all 12 calendar months of 2020.
  • Add up the monthly numbers from the preceding step and divide the sum by 12. Disregard fractions.
  • If your result is 50 or more, you are likely an ALE for 2021.

Identify Full-time Employees

All full-time employees must be offered affordable minimum value coverage.  A full-time employee is an employee who was employed on average at least 30 hours of service per week. The final regulations generally treat 130 hours of service in a calendar month as the monthly equivalent of 30 hours of service per week. The IRS has provided two methods for determining full-time employee status—the monthly measurement method and the look-back measurement method.

  • Determine which method you are going to use to determine full-time status
  • Monthly measurement method involves a month-to-month analysis where full-time employees are identified based on their hours of service for each month. This method is not based on averaging hours of service over a prior measurement method. Month-to-month measuring may cause practical difficulties for employers, particularly if there are employees with varying hours or employment schedules, and could result in employees moving in and out of employer coverage on a monthly
  • Look-back measurement method allows an employer to determine full-time status based on average hours worked by an employee in a prior period. This method involves a measurement period for counting/averaging hours of service, an administrative period that allows time for enrollment and disenrollment, and a stability period when coverage may need to be provided, depending on an employee’s average hours of service during the measurement 

Offer of Coverage 

An ALE may be liable for a penalty under the pay or play rules if it does not offer coverage to “substantially all” (95%) full-time employees (and dependents) and any one of its full-time employees receives a premium tax credit or cost-sharing reduction for coverage purchased through an Exchange. Employees who are offered health coverage that is affordable and provides minimum value are generally not eligible for these Exchange subsidies.

  • Offer minimum essential coverage to all full-time employees
  • Ensure that at least one of those plans provides minimum value (60% actuarial value)
  • Ensure that the minimum value plan offered is affordable to all full-time employees by ensuring that the employee contribution for the lowest cost single minimum value plan does not exceed 78% of an employee’s earnings based on the employee’s W-2 wages, the employee’s rate of pay, or the federal poverty level for a single individual.

Reporting of Coverage

The ACA requires ALEs to report information to the IRS and to employees regarding the employer-sponsored health coverage on Form 1095-C. The IRS will use the information that ALEs report to verify employer-sponsored coverage and to administer the employer shared responsibility provisions (Code Section 6056).

In addition, the ACA requires every health insurance issuer, sponsor of a self-insured health plan, a government agency that administers government-sponsored health insurance programs and any other entity that provides minimum essential coverage (MEC) to file an annual return with the IRS and individuals reporting information for each individual who is provided with this coverage (Code Section 6055). 

  • Determine which reporting requirements apply to you and your health plans
  • Determine the information you will need for reporting and coordinate internal and external resources to help compile the required data for the   1094-C and 1095-C
  • Complete the appropriate forms for the 2020 reporting year. Furnish statements to individuals on or before January 31, 2021 has been extended to March 2, 2021 IRS Notice 2020-76., and file returns with the IRS on or before February 28, 2020 (March 31, 2020, if filing electronically).
ACA RequirementDeadline
1095 forms delivered to employeesJan. 31 (extended to March 2)
Paper filing with IRS*Feb. 28
Electronic filing with IRSMarch 31

Comparative Effectiveness Research Fee (PCORI)

Sponsors of self-funded plans and health insurance issuers of fully insured plans are required to pay a fee each year, by July 31st, to fund comparative effectiveness research. Fees will increase to $2.45 per covered life in 2020 and are next due July 31, 2021.

W-2 Reporting

Healthcare Reform requires employers to report the aggregate cost of employer-sponsored group health plan coverage on their employees’ Forms W-2. This reporting requirement was originally effective for the 2011 tax year. However, the IRS later made reporting optional for 2011 for all employers.

The IRS further delayed the reporting requirement for small employers (those that file fewer than 250 Forms W-2) by making it optional for these employers until further guidance is issued. For the larger employers, the reporting requirement was mandatory for the 2012 Forms W-2 and continues.

ACA DISCLOSURE REQUIREMENTS

Summary of Benefits and Coverage 

The ACA requires health plans and health insurance issuers to provide an SBC to applicants and enrollees to help them understand their coverage and make coverage decisions. Plans and issuers must provide the SBC to participants and beneficiaries who enroll or re-enroll during an open enrollment period. The SBC also must be provided to participants and beneficiaries who enroll other than through an open enrollment period (including those who are newly eligible for coverage and special enrollees).

The SBC template and related materials are available from the Department of Labor (DOL).

  • In connection with a plan’s 2020 open enrollment period, the SBC should be included with the plan’s application materials. If coverage automatically renews for current participants, the SBC must generally be provided no later than 30 days before the beginning of the new plan year.
  • For self-funded plans, the plan administrator is responsible for providing the SBC. For insured plans, both the plan and the issuer are obligated to provide the SBC, although this obligation is satisfied for both parties if either one provides the SBC. Thus, if you have an insured plan, you should confirm that your health insurance issuer will assume responsibility for providing the SBCs.

Grandfathered Plan Notice

If you have a grandfathered plan, make sure to include information about the plan’s grandfathered status in plan materials describing the coverage under the plan, such as SPDs and open enrollment materials. Model language is available from the DOL. 

Notice of Patient Protections

Under the ACA, non-grandfathered group health plans and issuers that require designation of a participating primary care provider must permit each participant, beneficiary and enrollee to designate any available participating primary care provider (including a pediatrician for children). Also, plans and issuers that provide obstetrical/gynecological care and require a designation of a participating primary care provider may not require preauthorization or referral for obstetrical/gynecological care.

If a non-grandfathered plan requires participants to designate a participating primary care provider, the plan or issuer must provide a notice of these patient protections whenever the SPD or similar description of benefits is provided to a participant. If your plan is subject to this notice requirement, you should confirm that it is included in the plan’s open enrollment materials. Model language is available from the DOL.

OTHER NOTICES 

Group health plan sponsors should consider including the following enrollment and annual notices with the plan’s open enrollment materials. 

  • Initial COBRA Notice 

The Consolidated Omnibus Budget Reconciliation Act (COBRA) applies to employers with 20 or more employees that sponsor group health plans.  Plan administrators must provide an initial COBRA notice to new participants and certain dependents within 90 days after plan coverage begins. The initial COBRA notice may be incorporated into the plan’s SPD.  A model initial COBRA notice is available from the DOL.

  • Notice of HIPAA Special Enrollment Rights

At or prior to the time of enrollment, a group health plan must provide each eligible employee with a notice of his or her special enrollment rights under HIPAA.  This notice may be included in the plan’s SPD.   Model language for this disclosure is available on the DOL’s website.

  • Annual CHIPRA Notice

Group health plans covering residents in a state that provides a premium subsidy to low-income children and their families to help pay for employer-sponsored coverage must send an annual  notice about the available assistance to all employees residing in that state. The DOL has provided a model notice.

  • WHCRA Notice

Plans and issuers must provide notice of participants’ rights to mastectomy-related benefits under the Women’s Health and Cancer Rights Act (WHCRA) at the time of enrollment and on an annual basis.  Model language for this disclosure is available on the DOL’s website.

  • NMHPA Notice

Plan administrators must include a statement within the Summary Plan Description (SPD) timeframe describing requirements relating to any hospital length of stay in connection with childbirth for a mother or newborn child under the Newborns’ and Mothers’ Health Protections Act. Model language for this disclosure is available on the DOL’s website.

  • Medicare Part D Notices

Group health plan sponsors must provide a notice of creditable or non-creditable prescription drug coverage to Medicare Part D eligible individuals who are covered by, or who apply for, prescription drug coverage under the health plan. This creditable coverage notice alerts the individuals as to whether or not their prescription drug coverage is at least as good as the Medicare Part D coverage. The notice generally must be provided at various times, including when an individual enrolls in the plan and each year before Oct. 15th (when the Medicare annual open enrollment period begins).  Model notices are available on the Centers for Medicare and Medicaid Services’ website.

  • HIPAA Privacy Notice

The HIPAA Privacy Rule requires covered entities (including group health plans and issuers) to provide a Notice of Privacy Practices (or Privacy Notice) to each individual who is the subject of protected health information (PHI). Health plans are required to send the Privacy Notice at certain times, including to new enrollees at the time of enrollment. Also, at least once every three years, health plans must either redistribute the Privacy Notice or notify participants that the Privacy Notice is available and explain how to obtain a copy.

Self-insured health plans are required to maintain and provide their own Privacy Notices. Special rules, however, apply for fully insured plans. Under these rules, the health insurance issuer, and not the health plan itself, is primarily responsible for the Privacy Notice.

Model Privacy Notices are available through the Department of Health and Human Services

  • Summary Plan Description (SPD)

Plan administrators must provide an SPD to new participants within 90 days after plan coverage begins. Any changes that are made to the plan should be reflected in an updated SPD booklet or described to participants through a summary of material modifications (SMM).

Also, an updated SPD must be furnished every five years if changes are made to SPD information or the plan is amended. Otherwise, a new SPD must be provided every 10 years. 

Summary Annual Report

Plan administrators that are required to file a Form 5500 (> 100 participants in plan) must provide participants with a narrative summary of the information in the Form 5500, called a summary annual report (SAR). The plan administrator generally must provide the SAR within nine months of the close of the plan year. If an extension of time to file the Form 5500 is obtained, the plan administrator must furnish the SAR within two months after the close of the extension period.

Wellness Program Notices 

Group health plans that include wellness programs may be required to provide certain notices regarding the program’s design. As a general rule, these notices should be provided when the wellness program is communicated to employees and before employees provide any health-related information or undergo medical examinations.

  • HIPAA Wellness Program Notice—HIPAA imposes a notice requirement on health-contingent wellness programs that are offered under group health plans. Health-contingent wellness plans require individuals to satisfy standards related to health factors (for example, not smoking) in order to obtain rewards. The notice must disclose the availability of a reasonable alternative standard to qualify for the reward (and, if applicable, the possibility of waiver of the otherwise applicable standard) in all plan materials describing the terms of a health-contingent wellness program. Final regulations provide sample language that can be used to satisfy this requirement.
  • ADA Wellness Program Notice—Employers with 15 or more employees are subject to the Americans with Disabilities Act (ADA). Wellness programs that include health-related questions or medical examinations must comply with the ADA’s requirements, including an employee notice requirement. Employers must give participating employees a notice that tells them what information will be collected as part of the wellness program, with whom it will be shared and for what purpose, the limits on disclosure and the way information will be kept confidential. The Equal Employment Opportunity Commission (EEOC) has provided a sample notice to help employers comply with this ADA requirement.

 

 

 

Contact us at (855) 667-4621 or email us at info@medicalsolutionscorp.com

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(855) 667-4621 or email us at info@medicalsolutionscorp.com

2021 Dollar Limits

2021 Dollar Limits

 

The IRS & SSA announced the 2021 dollar limits for various benefits and compensation levels for retirement plans and IRAs. There are incremental changes but nonetheless worth bookmarking.

 

The contributions and retirement benefits for qualified retirement plans and individuals. Retirement Arrangements (IRAs) are subject to certain limits that are adjusted by the Secretary of the Treasury annually subject to cost-of-living. Highlighted below are the various 2020 and 2021 limits that impact IRA and retirement plans.

 

Compensation Limits

 

 

 

2020

2021

Compensation Limit

285,000$$290,000

Defined Benefit §415 Limit

$230,000

$230,000

Defined Contribution §415 Limit

$57,000$57,000

Key Employee Officer

$185,000$185,000

Highly Compensated Employee

$130,000$130,000

Governmental. Plan Compensation

Limit

$425,000$435,000

ESOP §409(o) Limits

$1,150,000

$230,000

$1,165,000

$230,000

 

 

 

Deferral and Catch-up Contribution Limits

 

 

2020

2021

401(k), 403(b), 457(b) Nan Deferral. Limi

$19,500$19,500

401(k), 403(b), Governmental. 457(b) Catch-up Limi

$6,500

$6,500

SIMPLE Plan Deferral Limi

$13,500$13,500

Key Employee Officer

$185,000$185,000

SIMPLE Plan Catch-up Limit

$3,000$3,000

 


IRA Limits

 

The limit on contributions to a traditional. or Roth IRA will remain unchanged in 2021 at $6,000. The limit that applies to IRA catch-up contributions (contributions for individuals age 50 and older) remains at $1,000.

 

Social Security

 

The Social. Security Administration (SSA) announced an increase in the taxable wage base (TWB) for 2021 to $142,800 (was $137,700 in 2020). Workers pay Social. Security tax on wages up to the TWB and some retirement plans use the TWB when allocating contributions or calculating benefits.

 

HSA Contribution Limits

 

Although not a formal. retirement plan, health savings accounts (HSA) often factor into retirement savings. The IRS announced the following 2021 limits. These apply to individuals under a high-deductible-health-plan (HDHP). The minimum deductibles and maximum out-of-pocket expenses the IRS uses to define HDHPs are outlined below, as well.

 

HSA Contribution Limits

 

LimitIndividualFamily

 

 

2020

2021

2020

2021

HSA Contribution Limits

$19,500$19,500$7,100$7,200

Minimum Deductible for HDHPs

$6,500

$6,500

$2,800

$2,800

Maximum Out-of-Pocket Expense

$6,500$6,500$2,800$2,800

 

Resource:

 

 

 

 

Is your HSA compliant?  Which pre-tax qualified HSAFSAHRA spending card is right for you? Please contact our team at Millennium Medical Solutions Corp (855)667-4621 for immediate answers.  Stay tuned for updates as more information gets released.  Sign up for the latest news updates.

 

The subject matter in this communication is educational only and not rendering legal, accounting, investment advice, or tax advice. You should consult with appropriate counsel or other professionals on all matters pertaining to legal, tax, investment, or accounting obligations and requirements.

 

 

 

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Moving to Paperless Benefits Admin System

Moving to Paperless Benefits Admin System

Moving to Paperless Benefits Admin System

As COVID-19 has challenged the status quo and disrupted the way we’ve always done things. Working from home have ushered in a new reality for benefits, and one of the more tangible questions right now is: “We’ve always held an in-person benefits fair, so what should we do now?” And the answer: “Let’s just move the benefits fair online.”

 Things To Consider Before You Open

1.What’s Your Strategy for Going Paperless?

The best recommendation for most offices is to switch to paperless going forward. Decide how you’re going to organize your electronic files (tip: making it match your paper filing will make the transition easiest on your staff). Then put a scanning policy in place and stick to it … going forward. Baby steps! Once your staff has gotten comfortable with the new system, they can feel free to pull in old material as it’s needed.

2Replace paper forms with digital ones 

US companies spend more than $120 billion a year printing paper forms alone. That’s a staggering, unnecessary amount of money that can be saved by using online forms instead. With online forms, you’ll also see faster response times, with the submission data stored neatly in the cloud

3. Accuracy 

Automated processes reportedly make far fewer errors than those performed by humans. All data errors should be corrected when discovered for recordkeeping compliance purposes. But documents with errors in paper-generating systems must be corrected and re-printed.

4. Cost

key benefits of taking your HR paperless is simply the fact that you will be reducing overall waste while saving time and money. Paper reams may not be the most expensive commodity your business is using, but it may be the most easily upgraded. With our partnerships we are able to deploy a basic online beneeifts admin ssytem at no cost to our clients

 

5. Time

Employers do not spend as much time on insurance forms. In fact, for a group of 50 employees, employers decrease the time they spend on forms by 84%. This is because we map employee information directly to carrier forms and is rules-based, which validates data entered to avoid incorrect and missing information. This means that when an employee completes an insurance form, plenty of their information is auto-populated and fields cannot be left incomplete. If a signature is required, the employee can e-sign forms in Ease using their mouse or finger. Additionally, all data can be securely stored online

6. Recruiting Millenials  

You can enable new employees to enroll in benefits online. They can see the cost per pay period for each plan they are eligible for, as well as view side-by-side comparisons, informational videos, and digital brochures about plans they are considering. Additionally, they can log into our portal from anywhere, at any time, and view a detailed benefits summary. An iOS and Android mobile app allows employees to quickly access plan information, details, and policy numbers from any location.  online mobile open enrollment

Employers can use Ease to initiate pre-boarding activities the second an offer is made. Through the Offer Letter feature, employers can send applicants offer letters with custom details like salary, company policies, start date, and eligible benefits. This enables applicants to view all of the components of their offer in one go. If they do accept, the employer can prompt them to begin onboarding and benefits enrollment right away.

7.  Mid-Year and Annual Renewal Changes

How many times have come accross Clinets who simply dont want to be bothered with changes.  On Average 12% of costs are attributed to inertia.  With our paperless benefts system SMB can easily add and manage voluntary coverage. Employers can work  to choose which voluntary benefits are best suited for their employees and their benefit offering, and employees can enroll in these plans at the same time as their medical plans. They’ll even see the cost per pay period per voluntary plan and, in many cases, instantly view their eligibility.

Each employee has a real-time historical record. Any qualifying life event, like a divorce or a new dependent, can be made in their real-time historical record. The employee or employer can make this change and deployed  to the insurance carrier.

8. Payroll integrations

Several integrated payroll companies charge $20-$50 per employee per month dependizng n the size of the SMB. Ease enables employers to easily keep track of payroll deductions with its Consolidated Billing report. This report calculates and populates new employee payroll deductions into payroll. Employers can export the report as an excel file and upload it to their payroll provider.

Additionally,  with different payroll etablished exchnage connections that makes it easy to:

  1. Add new employees in one system, either the payroll provider.
  2. Process benefit changes, since changes flow from the payroll provide or vice versa.
  3. Keep employee records up to date with automated data syncs.

9.  Tracking Employees’ Time-Off & Performance

Ease’s suite of HR tools, EaseHR, was built to help employers manage growth. The software uses the same login and employee information from benefits enrollment, making setup simpler. The different tools included in HRIS by Ease are:

  1. PTO Policies: Employers can set up holidays and manage custom PTO policies. Employees can view hours remaining per policy, such as PTO, sick leave, and FMLA.
  2. Time-Off Tracking: Employees can request time-off and managers can approve those requests on the go.
  3. Metrics: Visualized HR stats including employee growth, company diversity, and organization charts.
  4. Employee Events & Company Directory: Employees can connect at any time with a repository of employee contact information. Managers can keep track of birthdays and work anniversaries.
  5. Ease iOS and Android Mobile App: Access all time-off tracking features and your company directory from anywhere at any time.

10. Hassle of Switching   

With most leading paperless payroll and Thrid Party HR and COBRA providers already integrated this becomes more organic.  You are not alone.  We help with group set-up and deployment.  The Client serves as a QB but are not required to become the power-user of the system.  Each employee has a unique login, allowing them to enroll in benefits themselves. They can reach out to the employer if they have questions, but also have the ability to explore the software themselves.

 

Resource:

Goodbye Paper, Hello Ease Simplified Benefits and HR– Click Above

EASE Ben Admin EmployerOverviewOne-Pager_16SEP19_V2-AM

Why a Private Exchange?

Private Exchange Made Simple

Your employees shop online for everything else, why not benefits?

Each year, Ease surveys tens of thousands of employees who chose benefits through our online benefits marketplaces to find out what they think of the experience. Overwhelmingly, the data point to employees being more satisfied with their experience overall, compared to traditional benefits offerings: 

Weekly Demo Tuesday’s @ 1PM RSVP Here

The information provided on this website is intended for informational purposes only.  Millennium Medical Solutions Corp. does not offer legal or medical guidance.  Those with legal or medical questions should seek appropriate assistance from a licensed professional.  Stay up to date by signing up for Newsletter and Coronavirus Dashboard below. Please connect for a one-on-one-demo at info@medicalsolutionscorp.com or 855-667-4621

Learn how our PEO Partnership can help your group please contact us at info@360peo.com or (855)667-4621.

Put You & Your Employees in Good Hands

Get In Touch

For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.

6 Advantages of a PEO during COVID-19

6 Advantages of a PEO during COVID-19

6 Advantages of a PEO during COVID-19

As COVID-19 unfolds, the importance of a PEO for a Small Business becomes evident. How can you protect your employees while also managing costs?  Here are examples of how our PEO clients have benefited.

 1. Rapid Law Changes

With recent CARES Act and FFCRA(Families First Coronavirus Response Act) to help struggling businesses, overwhelming info and regulations have mounted for the small business owner. Who is eligible for benefits? Tax credits? Furloughs and COBRA? Is their business Essential? Paid Sick Leave eligibility and additional tax credit entitlement?

PEOs provide a full team of experts who anxiously awaited the legislation, final rulings, and updates on all the Acts. They spend countless hours diving into legal jargon to answer business owners’ questions. Then, PEOs work alongside organizations to implement processes that assist in keeping the business compliant. They also help employees through the difficult time, with the livelihood of the business always in mind.

2. PEOs help with Paycheck Protection Program (PPP) loans through the CARES Act

Lenders are asking for historical payroll data and tax reports quickly produced by a PEO’s HRIS System. Many small businesses without HR help find these systems financially draining. Example: Needed 940/941 reporting is issued which can be sent to SBA Lender.  Also, several leading  PEO’s have supported clients with NYS Shared Loans Program.

Working with clients to understand options.

 3. Payroll Burden

Payroll administration is now a nightmare. Tracking the FFCRA emergency sick leave and expanded FMLA separately from regular sick and FMLA leave has thrown a wrench in many payroll processors’ systems. Add on any furloughed or terminated employee reporting and tracking, and now the job has doubled.

Instead, our PEO Clients are spending their time on mission-critical work that could make or break the business. Additionally, their payroll is processed by professionals who have the time and expertise to know the nuances of payroll and payroll tax laws with back up teams of professionals in place.

 4. Staffing Needs – On-Boarding and Terminations 

A minimum 75% of PPP loans must be spent on staffing costs.  Companies that had previously furloughed or terminated employees find they need to hire employees back. This comes with additional paperwork and many employee questions, such as whether benefits wait periods start over. 

Conversely, when businesses do need to furlough or terminate employees, the PEO is a great guide for compliance. The layoff process, COBRA,  paperwork including government reporting are supported. 

5. HR Excellence

Partnering with a PEO is much like gaining access to a full-service HR division, with a team of HR experts who are up-to-date with new and changing employment laws and able to identify ways to streamline your HR.

According to a report conducted by the National Association of Professional Employer Organizations (NAPEO), PEOs provide access to more HR services at a cost that is close to $450 lower per employee, compared to companies that manage their HR services in-house. 

 Studies show that businesses in a PEO arrangement grow 7-9 percent faster, have 10-14 percent lower turnover, and are 50 percent less likely to go out of business.

 6. Affordable and Better Benefits

By joining a large group risk-pool a a PEO can help employers gain access to high quality employee benefits, such as health insurance options with stable and affordable rates. Due to costs, small businesses often find high-quality employee benefits out of reach.  The savings on health insurance alone can pay for the PEO itself.  

If you’re interested in hearing more about the advantages of partnering with a PEO, we’d love to talk to you. Fill out the form below or email info@medicalsolutionscorp.com for a FREE Consultation Today!

The information provided on this website is intended for informational purposes only.  Millennium Medical Solutions Corp. does not offer legal or medical guidance.  Those with legal or medical questions should seek appropriate assistance from a licensed professional.  Stay up to date by signing up for Newsletter and Coronavirus Dashboard below.

Learn how our PEO Partnership can help your group please contact us at info@360peo.com or (855)667-4621.

Put You & Your Employees in Good Hands

Get In Touch

For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.