Protecting Your Business In 2017 & Beyond Employee Benefits Compliance. Suzannah Gill, J.D. Carl Pilger, Esq. EPIC Insurance Brokers & Consultants

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1 Protecting Your Business In 2017 & Beyond Employee Benefits Compliance Suzannah Gill, J.D. Carl Pilger, Esq. EPIC Insurance Brokers & Consultants 1

2 Do your ever-increasing benefit compliance obligations seem like MADNESS? GAME ON! We ve got a winning game plan to lead you through it. 2

Game Plan 1 st Half: ACA Repeal & Replacement Half-Time: Strategizing for the Rest of 2017 2 nd Half: Foul Time Common

3 Game Plan 1 st Half: ACA Repeal & Replacement Half-Time: Strategizing for the Rest of nd Half: Foul Time Common Compliance Mistakes Final Minute: Free Throws to the Finish Compliance Best Practices Post Game Press Conference: Q&A 3

4 BRACKET BUSTER 4

5 FULL COURT PRESS AGAINST THE ACA Repeal & Replace Timeline Draft Legislation Executive Orders 5

6 Full Court Press Against the ACA Repeal and Replace Timeline January 12 January 13 January 20 January 20 January 30 Senate votes, 51-48, to approve budget measure to repeal ACA House votes, , to approve budget measure to repeal ACA President signs Executive Order signaling Administration s intent to repeal ACA President signs Executive Order freezing agency regulation President signs Executive Order to limit agency regulation Two-for-one provision Zero-cost provision 6

7 Full Court Press Against the ACA Repeal and Replace Timeline February 16 February 24 February 28 March 6 March 13 Policy brief issued by Republicans describing approach for replacing the ACA GOP draft budget reconciliation bill leaked to the media outlining concepts described in policy brief President Trump s speech to Congress reiterates intent to repeal and replace the ACA Committees release American Health Care Act (AHCA) proposal Congressional Budget Office scores AHCA March 24 AHCA pulled from House Floor prior to vote 7

8 Full Court Press Against the ACA The American Health Care Act (AHCA) Goal: Repeal and replace the ACA But: Certain reforms were to have remained intact Dependent child coverage up to age Prohibition on pre-existing condition exclusions Pulled at 11 th hour in last-ditch effort to gain support For now, ACA s compliance requirements remain intact...so employers should continue to comply 8

9 The Dream Team Starting Line-Up Tom Price (R-GA) Seema Verma 9

10 TIME OUT STRATEGY TIP For now the game plan remains unchanged The ACA s compliance requirements remain intact, so employers should continue to comply 10

11 REBOUND CMS Proposed Rules To Help Stabilize Insurance Marketplace 11

12 CMS Proposes Marketplace Changes Purpose: Stabilize public Marketplace New 2018 Open Enrollment Period November 1 - December 15, 2017 Expanded Pre-enrollment Verification New consumers enrolling in Marketplace during a special enrollment period (SEP) via HealthCare.gov must complete expanded pre-enrollment verification Begins July 1,

13 CMA Proposes Marketplace Changes Tighter SEP eligibility requirements for specific individuals: History of nonpayment of premiums Move to new geography documentation required Marriage More rigorous test for future uses of the exceptional circumstances SEPs New deference to state reviews for network adequacy Applies to states in which a federally facilitated Marketplace operates Only if state demonstrates it has authority and means to assess issuer network adequacy 13

14 Expanded Fiduciary Duty Under Attack Presidential memo directs the Department of Labor to review the Fiduciary rule Fiduciary Rule Established that insurance brokers who help employers set up Health Savings Accounts (HSA) in conjunction with sale and service of high-deductible health plans (HDHP) may have fiduciary responsibility Set to be effective January 1, 2018 Delay likely for 180 days for new round of public comments Judiciary Involvement: Federal court judge recently ruled in favor of the government in U.S. Chamber of Commerce v. DOL, which sought to overturn the rule 14

15 Strategizing for the Rest of

16 NEW GAME OUTLINE Updated Summary of Benefits and Coverage (SBC) Template 16

17 Updated SBC Template Effective Date What Who Who Produces By When Distribution DETAILS New Game Outline: SBC Template Effective for plans on or after April 1, 2017 Key plan information presented in a standardized format to facilitate easy comparison Each health plan or health benefit package Insured Plans: Insurer Self-Funded: Plan Sponsor First Day of Open Enrollment Paper or electronic, subject to distribution rules 17

18 SBC Template: Revised Information Introductory Paragraph Important Questions Yes or No Disclosures Minimum Essential Coverage Minimum Value Coverage Examples 18

19 TIME OUT STRATEGY TIP Teamwork: Confirm usage of new template with Insurance Carrier or Third Party Administrator 19

20 FOUL! Increased Department of Labor (DOL) Penalties 20

21 Increased DOL Penalties REQUIREMENT Failure To: OLD PENALTY Up To: NEW PENALTY Up To: Beginning January 2017, penalties are now annually adjusted for inflation File Form 5500 annually with DOL (unless exemption applies) MEWA: File Form M-1 annually with DOL $2,063 / day $2,097 / day $1,502 / day $1,527 / day Furnish plan-related information requested by DOL $147 / day Not to exceed $1,472 / request $149 / day Not to exceed $1,496 / request 21

22 Increased DOL Penalties REQUIREMENT Failure To: OLD PENALTY Up To: NEW PENALTY Up To: Provide SBC $1,087 / failure $1,105 / failure Provide annual notice regarding CHIP coverage opportunities Timely disclose information regarding group health plan coverage of Medicaid or CHIP plan participant $110 / day / failure * $112 / day / failure* $110 / day** $112 / day** * Each employee is a separate violation ** Each participant/beneficiary is a separate violation 22

23 Increased DOL Penalties REQUIREMENT Failure To: Comply with the requirements of the Genetic Information Nondiscrimination Act (GINA) for health plans OLD PENALTY Up To: $110 per participant (P) or beneficiary (B) / day De Minimis: Min. of $2,745 / P or B Not De Minimis: Min. of $16,473 / P or B Unintentional: $549,095 cap NEW PENALTY Up To: $112 per participant (P) or beneficiary (B) / day De Minimis: Min. of $2,790 / P or B Not De Minimis: Min. of $16,742 / P or B Unintentional: $558,078 cap 23

24 2017/2018 Federal Plan Limits Plan Self-Only Family Health Savings Accounts (HSA) 2017 Maximum Contribution High Deductible Health Plan (HDHP) 2017 Minimum Deductible HDHP Out-of-Pocket (OOP) 2017 Maximum Essential Health Benefits (EHB) 2017 OOP Maximum $3,400 $6,750 $1,300 $2,600 $6,550 $13,100 (embed selfonly limits) $7,150 $14,300 EHB 2018 OOP Maximum $7,350 $14,700 OOP Maximum Includes: Deductible, Co-Pays, Coinsurance 24

25 2 nd Half Foul Time: Common Compliance Mistakes 25

26 Foul: Distributing Carrier Plan Materials As ERISA Plan Documents ERISA requires: Written Plan Document: sets out terms of the plan Summary Plan Description (SPD) that summarizes benefits available under plan in a specific format Carriers policies & contracts plan documents Carrier certificates & evidence of coverage SPDs 26

27 TIME OUT BEST PRACTICE TIP Create a wrap plan document and SPD to satisfy both ERISA requirements 27

28 FOUL: HIPAA Applies to Me?? 28

29 HIPAA HIPAA = Health Insurance Portability and Accountability Act of 1996 Protects the Privacy and Security of Health Information Fully-Insured Plans: Insurers have primary responsibility for HIPAA compliance Self-funded Health Plans: Plan sponsors have primary responsibility for HIPAA compliance **Health FSAs are self-funded plans** 29

30 HIPAA: Hands Off Employer Hands Off All health plans are fully-insured Does NOT offer a health FSA Responsibilities: If participant requests assistance with claim dispute, obtain participant s authorization before receiving health information from insurance carrier Train affected workforce on this policy 30

31 HIPAA: Hands On Employer Hands On Sponsors a Self-funded medical plan or Offers a health FSA Responsibilities (include, but not limited to): Maintain HIPAA policies & procedures Conduct IT assessment Appoint Privacy/Security Official Distribute notice Routinely train affected employees Document processes Maintain Business Associate Agreements, as necessary 31

32 TIME OUT BEST PRACTICE TIP If you are a hands on plan sponsor, conduct a HIPAA assessment to better understand obligations and establish appropriate practices 32

33 FINAL MINUTE: FREE THROWS TO THE FINISH Compliance Best Practices 33

34 Compliance Best Practices Conduct an annual compliance review Maintain a compliance calendar to stay abreast of upcoming deadlines Establish clear roles/responsibilities within team Lean on your benefits consultant/broker to provide relevant timely updates and be willing to pivot as necessary Document, document, document 34

35 POST-GAME PRESS CONFERENCE Questions? 35

Understanding & Addressing Your 2019 Health and Welfare Benefits Compliance Obligations

Understanding & Addressing Your 2019 Health and Welfare Benefits Compliance Obligations NOVEMBER 15, 2018 PRESENTERS Carl Pilger, Esq. Director, National Employee Benefit Compliance Services EPIC Insurance