Agenda. Annual Enrollment in the Era of. Healthcare Reform COMPLIANCE CONSULTING AUGUST 2015

Transcription

1 Annual Enrollment in the Era of Healthcare Reform COMPLIANCE CONSULTING AUGUST 2015 Agenda New for 2016 under PPACA Same Sex Marriage Enrollment Communications Administration Additional Resources 2 1

2 NEW IN New in 2016 Employer Shared Responsibility Began for some employers in 2015 Begins for other employers in

3 New in 2016 Change in threshold for Employer Shared Responsibility penalty Employers must offer coverage to at least 95% of their full time employees in order to avoid a 4980H(a) Employer Shared Responsibility Penalty Headcount penalty reduction is 30 employees in 2016 (instead of 80 employees allowed for 2015) 5 New in 2016 Sections 6055 and 6056 reporting Dependent Social Security Numbers are key for Section 6055 reporting Verify mailing addresses Or, obtain consent to provide Forms 1095 B or 1095 C electronically Documentation for conditional offers of coverage to spouses For 2016 and beyond, employers will be able to use two new additional codes that will indicate that the employer s offer to the spouse is a conditional offer (e.g., spouses are only eligible if not eligible for other employer sponsored coverage) For more details, refer to AJG s Sections 6055 and 6056 Reporting Toolkit here. 6 3

4 New in 2016 Penalties for Section 6055 and 6056 reporting failures rise in 2016 Failure Previous Penalty Amount Increased Penalty Amount Failure to file return with IRS or furnish statement to applicable individual in a timely manner or completely Annual maximum penalty on all failures to file or furnish in a timely manner or completely during a calendar year $100 per return $250 per return $1,500,000 $3,000,000 Annual maximum penalty for failure by entity with $5,000,000 or less gross receipts $500,000 $1,000,000 Failures corrected within 30 days $30 per return $50 per return Maximum penalty on failures corrected within 30 days $250,000 $500,000 Maximum penalty on failures corrected within 30 days by entity with $5,000,000 or less gross receipts $75,000 $175,000 Failure corrected within 30 days, but before August 1 of the calendar year $60 per return $100 per return Maximum penalty on failures corrected after 30 days, but before August 1 of the calendar year Maximum penalty on failures corrected after 30 days, but before August 1 of the calendar year by entity with $5,000,000 or less gross receipts $500,000 $1,500,000 $200,000 $500,000 Failure due to intentional disregard; no maximum penalty cap applies $250 per return $500 per return 7 New in 2016 Section 4111 Assessments Waivers of coverage NEW Best practices: Get written or electronic waiver Include information related to whether lowest cost plan has minimum value and is affordable» Affordability statement may either be generic if based upon federal poverty safe harbor, or include dollar amount if using Form W 2 or rate of pay safe harbor 8 4

5 New in 2016 Use of look back method will likely impact plan eligibility language Adopt language for definitions Full time employee Part time employee Variable Hour employee Seasonal employee Measurement period Administrative period Stability period Clear communication about new rules necessary 9 New in 2016 Dependent eligibility An offer of coverage includes an offer of minimum essential coverage to employee s dependent children Dependent children include natural children, children placed for adoption, and adopted children Employers are not required to offer coverage to stepchildren and foster children in order to meet the offer of coverage standard, but if those children are covered, the coverage is subject to the coverage for dependents to age 26 rule 10 5

6 New in 2016 If plan does not have minimum value and meet federal poverty line safe harbor for affordability, employees must have an annual opportunity to accept or waive coverage Minimum value = 60% value FPL safe harbor The official amount is based upon the federal poverty line for a single individual based on the rates in effect six months prior to the beginning of the plan year A plan with a January 1 plan year would use the federal poverty line in effect in July 2015 That amount is currently $11, % of that figure is $1, Dividing that number by 12 results in a monthly amount of just over $93 per month 11 New in 2015 Plan years beginning on or after January 1, 2016 (except as noted) Changes apply to: Non grandfathered health plans Special rules for certain health plans 12 6

7 New in 2016 Plans losing grandfathered status, older PPACA requirements that will apply: Preventive care at 100% (includes contraceptives) Patient protections selection of PCP, access to routine OB/GYN care, emergency room coverage Claims and appeals including external appeal using IRO Coverage for routine costs associated with clinical trials 13 New in 2016 Highlighted additional preventive services Plan years beginning on or after May 1, 2015 Screening for hepatitis B virus (HBV) infection in persons at high risk for infection Plan years beginning on or after September 1, 2015 Low dose aspirin (81mg/d) as preventive medication after 12 weeks of gestation in women who are at high risk for preeclampsia 14 7

8 New in 2016 Religious Affiliated Nonprofit Employers ( eligible organizations ) e.g. hospitals, universities nongrandfathered Accommodation for contraceptive coverage Four criteria to qualify Carrier must provide if insured TPA must arrange if self insured In addition, non grandfathered plans must comply with new claims and appeals requirements. Accommodation extended to closely held for profit employers Religious employers (e.g., houses of worship) exempt. 15 New in 2016 Newer requirements for non grandfathered plans Compliance with annual out of pocket limitations Limits for 2016:» Self only coverage: $6,850 *» Family coverage: $13,700» Embedded out of pocket of $6,850 Coverage of Essential Health Benefits (only small employers) Nondiscrimination based upon health status *$6,550 and $13,100 maximum out of pocket for HSA compatible HDHP 16 8

9 New in 2016 Expansion of definition of small employer Until 2016, the state definition of small employer applies That s typically 1 50 full time employees In 2016, the definition of small employer automatically changes to for all states for PPACA purposes Key issue is that plans offered in the small group market must cover Essential Health Benefits Employer with employees May have expanded coverage that should be communicated 17 SAME-SEX MARRIAGE 18 9

10 Same-Sex Marriage Supreme Court Decision On June 26th, in the case of Obergefell v. Hodges, the United States Supreme Court ruled, in a 5 4 decision, that based on language in the United States Constitution, a state cannot refuse marriage licenses to same sex couples and must recognize same sex marriages that have been legally performed in another state See GBS Technical Bulletin and our July 9 recorded webinar United States Supreme Court Decision in Obergefell v. Hodges. 19 Same-Sex Marriage Supreme Court Decision As a result of the Obergefell decision, state laws that define marriage or spouse as referring to oppositesex couples only must be revised to include same sex marriages and same sex spouses Ruling impacts employer sponsored health and welfare plans If plan covers same sex spouses, may require changes to enrollment forms Examine plan language and applicable law Common law marriage requirements should be examined too 20 10

11 Same-Sex Marriage Requesting marriage certificate Treat the same as opposite sex spouses Imputed income Windsor removed requirement to impute income for federal income tax purposes Should no longer have to impute income for state tax purposes May require alteration to forms New step children 21 Same-Sex Marriage If previously covered domestic partners, but wish to phase out coverage, consider impact on annual enrollment Will existing domestic partners be grandfathered? If eliminating, must provide Summary of Material Reduction Must provide within 60 days of date of making decision to eliminate domestic partner coverage No COBRA continuation, but may offer a type of continuation coverage if approved by insurer or stop loss carrier 22 11

12 ENROLLMENT RULES 23 Enrollment New Permitted Status Change Events Marketplace special enrollment Marketplace open enrollment 11/1/15 1/31/16 Reduction in hours below 30 Employee questions Enrollment rules: Marketplaces have enrollment rules Employer enrollment rules still apply Employee reminder may be helpful 24 12

13 Enrollment Important element in design Annually review & communicate Three sets of rules: Federal Insurer Employer Automatic enrollment still delayed pending regulations. 25 COMMUNICATIONS 26 13

14 Communications Active employees Modified enrollment materials for: COBRA qualified beneficiaries QMCSO(NMSN)* alternate recipients Employees on leave (e.g., FMLA) Beneficiaries (e.g., spouse and children) for SBC if a different address than the employee *Qualified Medical Child Support Order (National Medical Support Notice) 27 Communications Required Communications All Plans Some Plans Optional Reminders 28 14

15 Communications All Health Plans Summary of Benefits & Coverage (SBC) Content and format specified by regulations Be sure to use the current year template Must include statement that plan does/does not provide minimum value (MV) Must include statement that plan is/is not minimum essential coverage (MEC) May use cover letter for MV and MEC statement 29 Communications All Health Plans Description of changes in eligibility, benefits, cost, insurer or TPA COBRA Initial Notices Newly enrolled employees Newly enrolled spouses DOL model notices* *Reinstatement of Health Care Tax Credit ( HCTC ) may affect election notice for some employers 30 15

16 Communications All Health Plans Annually Required Notices Women s Health & Cancer Rights Act CHIPRA notice current model May 2, 2014 Creditable/noncreditable drug coverage (Part D) most recent model April 4,2011 HIPAA Notice of Privacy Practices availability* * Every 3 years, consider annual notice 31 Communications Some Health Plans Annual HIPAA Portability waivers Self insured non federal governmental plans Notice to CMS and employees Must be online notice to CMS using HIOS Grandfather status If losing grandfathered status, don t forget to remove the grandfathered language from plan materials

17 Communications Some Health Plans GINA language in Health Risk Assessment Michelle s Law notice (if needed) HIPAA wellness program alternative standard EEOC Proposed Wellness Regulations 33 Communications Optional Reminders Review beneficiary designation Update dependent status (eligibility) Imputed income reminders GTL over $50k Taxable income for covered non dependents Health FSA ineligible expenses reminder Insurer rules for life and disability (e.g., evidence of good health, actively at work) 34 17

18 Communications Communication materials SBC SMM/SMR/SPD Communication methods Electronic DOL rules apply Online enrollment Mail Hand delivery 35 ADMINISTRATION 36 18

19 Administration Employer Forms Cafeteria plan election form Waiver form(s) Medical special enrollment Optional coverage life or disability HRA waiver FSA waiver of carryover Insurer Forms Enrollment Beneficiary designation Evidence of insurability (non health coverage) 37 Administration Insurer evidence of good health (life, disability) Insurer forms Additional medical information/exam (if req d) Effective date: Insurer specifies in approval Begin payroll deduction after approval received Retroactive = post tax 38 19

20 Administration Tax Forms Older child (after year of 26th birthday) Domestic partner, civil union partner Other Forms (if required) Birth certificates/adoption papers Student status (after 26th birthday) Michelle s Law (if applicable) Marriage certificates 39 Administration Data for Section 6055 Reporting to the IRS Name, address and EIN of the employer Name and telephone number for the contact person Calendar year for which the return is being filed Name, address and Social Security Numbers for everyone covered under the employer s health plan Months of coverage (by person) Includes individuals who are not current employees such as retirees and COBRA qualified beneficiaries 40 20

21 Administration Data for Section 6056 Reporting to the IRS Employers name, address, and EIN Name and phone number for contact person Calendar year for which the report is being filed Certification whether employer offered MEC to full time employees for each month Months during which coverage was offered The number of full time employees for each month during the calendar year Each full time employee s share of the lowest required contribution for self only coverage, by month Name, address and Social Security Number of each full time employee during the year and if the employee was covered 41 Administration Employer coverage tool Part of Marketplace application Employer may want to pre populate some of the information (list on next slide) 42 21

22 Administration Employer Coverage Tool Employer info name, EIN, address, phone, e mail and contact General plan info: Employee, spouse, dependents eligible Minimum value Employee contribution for lowest cost option Anticipated plan changes (if any) Start/stop offering health coverage Change in contributions Date of change 43 Administration Employer Coverage Tool (cont d) Employee specific information Name SS# Eligible now Eligible within next 3 months 44 22

23 Administration Data Collection: Drug plan reporting CMS website within 60 days after plan year begins Information for Form W 2 reporting of health coverage cost Dependent SS#s for CMS reporting (insurer or TPA reports to CMS) and IRS reporting Full time employee status 45 Administration Data Collection to consider: Other coverage Availability of other employer sponsored coverage (usually spouse) Actual coverage under another plan (e.g. spouse s plan) Child(ren) information even if not covered Same sex spouse Information on same sex spouse and any children May have new spouses in states that did not previously recognize same sex marriage New recognition of existing marriage performed in a state that recognized same sex marriages before June 2015 New marriages in states that will recognize as a result of the Supreme Court s June 2015 decision 46 23

24 Administration Update Plan Document & SPD plan changes Notices COBRA general (initial notice) COBRA election notice Models available on DOL website* Forms Procedures *HCTC language may need to be added to model notice for some employers 47 ADDITIONAL RESOURCES 48 24

25 GBS Resources 49 GBS Resources Webinars (registration) A Practical Review of Election Changes html Sections 6055 and 6056 Reporting to the IRS html Supreme Court Decision King v. Burwell n.html Supreme Court Decision Obergefell v. Hodges tion.html 50 25

26 GBS Resources Technical Bulletins EEOC Issues Proposed Rule on Employer Sponsored Wellness Programs Supreme Court Rules in Favor of Marriage Equality Website Healthcare Reform Page Healthcare Reform Update Newsletters Employer Toolkits 51 Governmental Resources HIPAA Nonfederal governmental plan opt out ns_ html Drug Plan Reporting to CMS Drug Coverage/CreditableCoverage/CCDisclosure.html Certificates of Creditable/Noncreditable Coverage (drug) (main) isclosurenotice pdf (creditable coverage notice) agedisclosurenotice pdf (noncreditable coverage notice) 52 26

27 Additional Resources CHIPRA Model Notice COBRA Notices (main) EBSA s Interactive Advisor for Health Plans Summary of Benefits and Coverage (SBC) DOL website efits.html CLAS information Sheets and FAQs/Downloads/ CLAS County Data_ _clean_508.pdf 53 HRCI Approval Pending This program is being submitted for recertification credit through the HR Certification Institute. The approval process takes approximately 4 weeks. To obtain the program ID number for this program, which you can include on your recertification application form, please send an request to GBS.CEcredits@ajg.com. Under HRCI rules, only those individuals who attend the webinar and whose attendance we can verify will receive the program ID. Once your attendance has been verified and the program has been approved, you will receive an e- mail with the program ID number. As such, if a group attends the webinar, the program ID can only be given to the individual whose information was used to register

28 THANK YOU 55 28