Benefits Compliance & ACA Strategic Planning for

Transcription

1 Benefits Compliance & ACA Strategic Planning for Producer Trip Grove Park Inn Jason Cogdill Benefits Attorney

2 Strategic Items Play-or-Pay compliance New IRS Reporting Requirements ERISA compliance Creative solutions, including private exchange model (defined contribution)

3 Employer Mandate Refresher Two parts: (1) penalties & (2) reporting requirements Potential Penalties under 4980H(a) or 4980H(b) Effective beginning 1/1/15 for employers with 100 or more FT + FTE (measured during 2014*) Effective beginning 1/1/16 for employers with FT + FTE (measured during 2015) Reporting Requirements Apply for 2015 calendar year for all employers with 50 or more FT + FTE (measured during 2014*) 3

4 Employer Mandate: 100+ Groups 2015 items for 100+ employers Ensure that all 30+ hour employees have been identified If no plan or a carve-out plan for any months during 2015, understand application of penalty reduction number (80) Any 4980H(a) penalty ( sledgehammer ) assessed for 2015 would be: # of full-time employees in each month, minus80, times $167/month If offering skinny plan ( MEC ) or MVP plan, assess all scenarios Affordability analysis (9.56%) & applicable safe harbors Consider whether 3-month grace period rule for first year of Applicable Large Employer status may help 4

5 Employer Mandate: Groups 2016 items for employers Confirm effective date of Play-or-Pay 1/1/16 or non-calendar renewal date if transition rule met Ensure that all 30+ hour employees have been identified If no plan or a carve-out plan for any months during 2016, understand application of penalty reduction number (30) Any 4980H(a) penalty ( sledgehammer ) assessed for 2016 would be: # of full-time employees in each month, minus30, times $167/month If considering skinny plan ( MEC ) or MVP plan, assess all scenarios Affordability analysis & applicable safe harbors 5

6 New Reporting Requirements IRS Code 6055/6056 reporting Required for all Applicable Large Employers for 2015 Includes FT + FTE groups exempt from penalties in 2015 First reports due in early 2016 for 2015 calendar year Timelines & submission methods track W-2 rules 6055: Insurer or self-funded plan sponsor reporting 6056*: Plan sponsor reporting, including Form 1095-C to full-time employees & 1094-C to IRS Employer data items: list of 9 categories Forms & instructions have been finalized for 2014 (informational only) but not More guidance to come. Keys for employers right now: (1) assess data tracking requirements; (2) examine need/options for outsourcing 6

7 Overview By Employer Size & Plan Type <50 fully insured plan No reporting required 50+ fully insured plan Carrier: Form 1094-B; 1095-B Employer: Form 1094-C to IRS Form 1095-C to F/T EEs <50 self-funded plan Employer: Form 1094-B to IRS Form 1095-B to F/T EEs 50+ self-funded plan Employer: Form 1094-C to IRS Form 1095-C to F/T EEs Current (2014) forms are available with instructions Even if reporting is outsourced, data from employer will be required in process Examples: Month-by-month EE counts for 1094-C; monthly coverage & enrollment codes for employee 1095-Cs 7

8 Under 50 groups What Must Be Filed? Small employer with fully insured plan No reporting required as long as prior year employee count remains under 50 FT + FTE Small employer with self-funded plan Employer must submit Form 1095-B to all covered individuals by 3/31/16 Employer must submit Form 1094-B to IRS by 2/29/16 (or by 3/31/16 if submitted electronically) Note: the small employer is still exempt from the employer mandate penalties this is simply a legal requirement due to self-funded status 8

9 50+ fully insured plan What Must Be Filed? Carrier is required to submit Form 1095-B to all covered individuals by 1/31/16, & Form 1094-B to IRS by 2/29/16 Employer must submit: Form 1095-C to each employee that was full-time for at least one month during 2015 (due by 1/31/16) Form 1094-C to IRS by 2/29/16, or 3/31/16if filed electronically 1094-C is transmittal form sent to IRS with copies of all Cs sent to full-time employees 9

10 50+ self-funded plans Employer must submit: What Must Be Filed? Form 1095-C to each employee that was full-time for at least one month during 2015 (due by 1/31/16) This single form will cover requirements of both 1095-B & 1095-C. Employer will be required to complete Part III info for all covered individuals (spouses & dependents included) Form 1094-C to IRS by 2/29/16, or 3/31/16if filed electronically 1094-C is a transmittal forms sent to IRS with copies of all 1095-Cs sent to employees. Note: Rules allow a 3rd party (TPA or carrier) to submit forms on behalf of employer. However, legal responsibility is the employer s as self-funded plan sponsor. 10

11 Strategic summary ERISA Compliance Requirements have not changed; there is simply additional attention as part of Compliance Era ERISA rules apply equally to all employers other than government entities & church-related entities; however, practical analysis different for 100+ than <100 Primary keys: (1) SPDs; & (2) Form 5500 reporting SPDs: Every ERISA plan requires a compliant SPD Wrap SPDs or Consolidated Wrap SPDs needed in many cases Form 5500s: Required for every health/welfare benefit with 100+ employee participants on 1 st day of plan year 11

12 Private Exchange Model Defined contribution method is available to all employers; full range of non-taxable & taxable benefit options Built as part of employer s Section 125 plan as a flex credit (cafeteria plan credit) design Many options, including which specific benefits are available, how credits are ordered/allotted, & any cashout provision Keys: Method of enrollment & communication Specific program design Compliance: (1) Section 125 SPD w/ credit details (2) Tax analysis

13 Other Hot Topics Viability of MEC/MVP plans for groups subject to Playor-Pay in 2015 or 2016 Employer reimbursement of individual or Marketplace premiums no longer allowed (taxable or non-taxable) Limited transition relief: IRS Notice Small group premiums Small group definition will be uniform 100 (FT + FTE) for 2016 Age-banded community rating applies outside of keep your plan exception Employers may convert to composite rates, but considerations apply Spousal health coverage exclusions Employers have 4 options for spousal coverage Considerations exist for employers seeking to exclude

14 Additional Resources Your team at The Cason Group Contact us for further details on any ACA or compliance topic ACA website & LinkedIn page Customized content available contact your sales rep 2015 Benefits Compliance Checklist; 2015 ACA Checklist; Summary of New IRS Reporting Requirements; Play-or-Pay summaries for 2015 or 2016 Further sessions in 2015 Monthly webinars resume April 28 Employer seminar/workshop options: IRS reporting, Identifying 30+ hour Employees, Play-or-Pay for 2016, ERISA compliance Jason Cogdill: Partner benefits attorney Benefits, ERISA, & ACA advising ProBenefits: Section 125 design, documents, & admin 14