Agencies Issue Proposed Rules and Plans

Courtesy of UBA Benefits

October was a busy month in the employee benefits world. President Trump announced a new Acting Secretary for the U.S. Department of Health and Human Services (HHS). Eric Hargan fills the position vacated by Tom Price, who resigned in late September 2017. The U.S. Department of Labor (DOL) issued a proposed rule to delay a disability claims procedure regulation's applicability date and HHS released its proposed rule on benefits and payment parameters for 2019. The U.S. Department of the Treasury (Treasury) issued its Priority Guidance Plan for projects it intends to complete during the first half of 2018.

DOL Proposes Delay to Final Disability Claims Procedures Regulations' Applicability Date

The DOL issued a proposed rule to delay the applicability date of its final rule that amends the claims procedure requirements applicable to ERISA-covered employee benefit plans that provide disability benefits. The DOL's Fact Sheet contains a summary of the final rule's requirements.

The DOL is delaying the applicability date from January 1, 2018, to April 1, 2018, to consider whether to rescind, modify, or retain the regulations and to give the public an additional opportunity to submit comments and data concerning the final rule's potential impact.

CMS Releases 2019 Benefits Payment and Parameters Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule and fact sheet for the 2019 Benefit Payment and Parameters. The proposed rule is intended to increase individual market flexibility, improve program integrity, and reduce regulatory burdens associated with the Patient Protection and Affordable Care Act (ACA) in many ways, including updates and annual provisions to:

  • Essential health benefits
  • Small Business Health Options Program (SHOP)
  • Special enrollment periods (SEPs)
  • Exemptions
  • Termination effective dates
  • Medical loss ratio (MLR)

CMS usually finalizes the Benefit Payment and Parameters rule in the first quarter of the year following the proposed rule's release. November 27, 2017, is the due date for public comments on the proposed rule.

Almost all the topics addressed in the proposed rule would affect the individual market and the Exchanges, particularly the Small Business Health Options Program (SHOP) Exchanges.

Of interest to small group health plans, CMS proposes to change how states will select essential health benefits benchmark plans. If CMS keeps this change in its final rule, then it will affect non-grandfathered small group health plans for benefit years 2019 and beyond.

Treasury Issues its Priority Guidance Plan

The Treasury issued its 2017-2018 Priority Guidance Plan that lists projects that it intends to complete by June 30, 2018, including:

  • Guidance on issues related to the employer shared responsibility provisions
  • Regulations regarding the excise tax on high cost employer-provided coverage ("Cadillac tax")
  • Guidance on Qualified Small Employer Health Reimbursement Arrangements (QSE HRAs)

By Danielle Capilla, Senior VP of Compliance and Operations, United Benefit Advisors

The Perk of Pets

Courtesy of UBA Benefits

Companies on the leading edge of employee benefits, especially those that want to stand out within an industry, will offer such pet-friendly perks in order to attract top talent. But what exactly are these benefits?

According to an article titled, “Pet-Friendly Perks” in Human Resource Executive Online, employers are offering benefits such as pet insurance, paid pet bereavement leave, pet parental leave, paid leave to take care of a new pet, an on-site dog park, and the ever-popular bring your pet to work day. Most of these would have been unheard of even a few years ago.

On the website of Workforce, their infographic titled, “By The Numbers: Pet-friendly Workplaces,” shows how the popularity of these benefits has skyrocketed, as evidenced by the fact that one in three Fortune 500 companies offer pet insurance. So, why are pet-related perks so popular now?

As mentioned in the Human Resource Executive Online article, the bond between pets and humans appears to be stronger these days. Individuals are placing a greater amount of importance on their pets and spending a significant amount of their disposable income on them. Employers have taken notice of this and even acknowledged that pets can have a positive impact in the workplace.

The Workforce infographic shows that seven out of 10 people say that pets make a positive impact on office dynamics and morale, and bringing a dog to work is preferred three to one over table tennis and foosball tables. Yet, even with those strong statistics, only seven percent of employers allow pets in the workplace.

Obviously, while some job candidates are thrilled with pet-related benefits, others may cringe at the thought of working side-by-side with someone’s dog or cat. They may have allergies, a fear of animals, or some other issue that makes them pet averse.

Employers need to find a balance if they decide to implement a pet-friendly work policy that takes into account everyone’s opinions. Details need to be set in clear language and managers should be made aware of what is and is not allowed. If this trend continues, you may be lucky enough to have a furry, four-legged co-worker sitting next to you.

By Geoff Mukhtar, Communications Manager at United Benefit Advisors

Contraception Mandate Rolled Back for Employers

Courtesy of UBA Benefits

Two tri-agency (Internal Revenue Service, Employee Benefits Security Administration, and Centers for Medicare and Medicaid Services) Interim Final Rules were released and became effective on October 6, 2017, and will be published on October 31, 2017, allowing a greater number of employers to opt out of providing contraception to employees at no cost through their employer-sponsored health plan. The expanded exemption encompasses all non-governmental plan sponsors that object based on sincerely held religious beliefs, and institutions of higher education in their arrangement of student health plans. The exemption also now encompasses employers who object to providing contraception coverage on the basis of sincerely held moral objections and institutions of higher education in their arrangement of student health plans. Furthermore, if an issuer of health coverage (an insurance company) had sincere religious beliefs or moral objections, it would be exempt from having to sell coverage that provides contraception. The exemptions apply to both non-profit and for-profit entities.

The currently-in-place accommodation is also maintained as an optional process for exempt employers, and will provide contraceptive availability for persons covered by the plans of entities that use it (a legitimate program purpose). These rules leave in place the government's discretion to continue to require contraceptive and sterilization coverage where no such objection exists. These interim final rules also maintain the existence of an accommodation process, but consistent with expansion of the exemption, the process is optional for eligible organizations. Effectively this removes a prior requirement that an employer be a "closely held for-profit" employer to utilize the exemption.

Employers that object to providing contraception on the basis of sincerely held religious beliefs or moral objections, who were previously required to offer contraceptive coverage at no cost, and that wish to remove the benefit from their medical plan are still subject (as applicable) to ERISA, its plan document and SPD requirements, notice requirements, and disclosure requirements relating to a reduction in covered services or benefits. These employers would be obligated to update their plan documents, SBCs, and other reference materials accordingly, and provide notice as required.

Employers are also now permitted to offer group or individual health coverage, separate from the current group health plans, that omits contraception coverage for employees who object to coverage or payment for contraceptive services, if that employee has sincerely held religious beliefs relating to contraception. All other requirements regarding coverage offered to employees would remain in place. Practically speaking, employers should be cautious in issuing individual policies until further guidance is issued, due to other regulations and prohibitions that exist.

For comprehensive background on the contraception mandate as well as information on who could object and how, please view UBA’s ACA Advisor, “Contraception Mandate Rolled Back for Employers”.

By Danielle Capilla, Chief Compliance Officer at United Benefit Advisors

Benefit Plan Design: Charging Employees Different Premiums

Courtesy of UBA Benefits

Employers who are designing a health and welfare benefit plan for their employees often wonder about the rules relating to setting premiums for employees. Employers generally have significant flexibility in this part of their plan's design. Common structures contemplated by employers include, but are not limited to:

  • Charging all employees a flat amount for their health plan
  • Charging employees a percentage of the premium for the health plan, with the percentage changing as employees move between tiers (self, self plus one, self plus family)
  • Giving employees a set dollar amount that they can use to offset the cost of whatever plan and plan tier they enroll in

Employers are also interested in setting different contribution structures for different groups of employees. Sometimes this is due to a geographic difference between employees, job types, staff versus management, and more. Employers may wish to give lower-paid employees more employer-provided money; sometimes employers wish to give managers or executive staff more employer-provided money.

Employers should be aware that there are different nondiscrimination requirements to consider.

Generally, under HIPAA non-discrimination rules, employers have discretion when structuring their benefits plans and may make distinctions among employee populations regarding access to and the level of benefits offered. Plans may differ among employees only on "bona fide employment-based classifications" consistent with the employer's usual business practice. Examples that would satisfy this requirement include salaried, hourly, full-time, part-time, type of job, geographic location, date of hire, division, subsidiary, business unit, and profit center distinctions.

If an employer's proposed structure meets these basic HIPAA requirements, then the employer needs to review the applicable nondiscrimination requirements under Internal Revenue Code Section 125 (for cafeteria plans) and Section 105(h) (for self-funded plans). If the employer's plan is subject to these rules, at a most basic level, the plan cannot favor highly compensated individuals. Sometimes an innocent plan design can lead to an employer failing the nondiscrimination requirements under Section 125 or 105(h) without the employer intentionally favoring the highly compensated employees. Many employers also erroneously assume that none of their employees fall into the "highly compensated" category, so the rules do not apply to them. As a best practice, any time an employer has a plan design with different levels of employer contributions, the employer should run the applicable testing to ensure its plan is compliant.

Under Section 125, benefit plans cannot discriminate in favor of highly compensated individuals or key employees. For definitions of highly compensated and key employees, as well as the consequences of violating HIPAA nondiscrimination rules and failing section 125 or 105(h) nondiscrimination tests, request UBA’s Compliance Advisor, “Benefit Plan Design: Charging Employees Different Premiums”.

By Danielle Capilla, Chief Compliance Officer at United Benefit Advisors

President Trump Ends ACA Cost Sharing Reductions

Courtesy of UBA Benefits

On the evening of October 12, 2017, President Trump announcedthat cost sharing reductions for low income Americans in relation to the Patient Protection and Affordable Care Act (ACA) would be stopped. The Department of Health and Human Services (HHS) has confirmed that payments will be stopped immediately. While there is no direct impact to employers at this time, UBA will continue to educate employers about changes in the law and its Health Plan Survey will continue to track group health plan rates over time as insurance companies potentially seek to recoup lost revenue. It is anticipated at least some state attorneys general will file lawsuits to block the ending of the subsidy payments, with California Attorney General Xavier Becerra stating he is prepared to file a lawsuit to protect the subsidies.

Background

Individuals with household modified adjusted gross incomes (AGI) in excess of 100 percent but not exceeding 400 percent of the federal poverty level (FPL) may be eligible for cost-sharing reductions for coverage purchased through health insurance exchanges if they meet a variety of criteria. Cost-sharing reductions are limited to coverage months for which the individual is allowed a premium tax credit. Eligibility for cost-sharing reductions is based on the tax year for which advanced eligibility determinations are made by HHS, rather than the tax year for which premium credits are allowed. In 2015, cost-sharing subsides reduced out-of-pocket (OOP) limits:

  • Less than 100 percent but not exceeding 200 percent of FPL: OOP limits reduced by two-thirds
  • Greater than 200 percent but not exceeding 300 percent of FPL: OOP limits reduced by one-half
  • Greater than 300 percent but not exceeding 400 percent of FPL: OOP limits reduced by one-third

After 2015, the base percentages were shifted based on a percentage of average per capita health insurance premium increases. The cost-sharing reduction is paid directly to the insurer, and is automatically applied when eligible individuals enroll in a silver plan on the Marketplace or Exchange.

The cost-sharing reduction is not the same as the "advance premium tax credit" which is also available to individuals with household modified AGIs of at least 100 percent and not exceeding 400 percent of the FPL.

By Danielle Capilla, Chief Compliance Officer at United Benefit Advisors

Executive Order on Healthcare

Courtesy of UBA Benefits

On October 12, 2017, the White House released an Executive Order, signed by President Trump, titled "Promoting Healthcare Choice and Competition Across the United States."

It is important to note that the Executive Order (EO) does not implement any new laws or regulations, but instead directs various federal agencies to explore options relating to association health plans, short term limited-duration coverage (STLDI), and health reimbursement arrangements (HRAs), within the next 60 to 120 days.

The Department of Labor is ordered to explore expansion of association health plans (AHPs) by broadening the scope of ERISA to allow employers within the same line of business across the country to join together in a group health plan. The EO notes employers will not be permitted to exclude employees from an AHP or develop premiums based on health conditions. The Secretary of Labor has 60 days to consider proposing regulations or revising guidance.

Practically speaking, this type of expansion would require considerable effort with all state departments of insurance and key stakeholders across the industry. Employers should not wait to make group health plan decisions based on the EO, as it will take time for even proposed regulations to be developed.

The Department of the Treasury, Department of Labor, and Department of Health and Human Services (the agencies) are directed to consider expanding coverage options from STLDI, which are often much less expensive than Marketplace plans or employer plans. These plans are popular with individuals who are in and outside of the country or who are between jobs. The Secretaries of these agencies have 60 days to consider proposing regulations or revising guidance.

Finally, the EO directs the same three agencies to review and consider changing regulations for HRAs so employers have more flexibility when implementing them for employees. This could lead to an expanded use of HRA dollars for employees, such as for premiums. However, employers should not make any changes to existing HRAs until regulations are issued at a later date. The Secretaries have 120 days to consider proposing regulations or revising guidance.

To benchmark your current HRA plan with other employers, request UBA’s special report: How Health Savings Accounts Measure Up or download our Fast Facts on HSAs vs. HRAs.

By Danielle Capilla, Chief Compliance Officer at United Benefit Advisors

Employee's Financial Health

Courtesy of UBA Benefits

The importance of health and wellness in the workplace is more apparent than ever. It’s obvious why healthy individuals make better employees and the positive impact this has on your bottom line. When thinking about building a program to improve the well-being of your employees, don’t forget about the importance of their financial health.

In recent years, studies show that employees have a wide range of financial concerns that affect their work. Some financial issues are widespread, impacting a large number of employees, while others may be more unique based on an employee’s specific circumstances.

Financial stress in the workplace influences productivity, absenteeism, physical health, emotional well-being, and the overall happiness of employees. Nearly 25 percent of employees confirm personal finance issues are a distraction at work and 39 percent say they spend three hours or more each week at work dealing with personal financial issues.1

Some of the biggest financial stressors impacting employees today include:

  • Student loan debt – 2 million Americans collectively owe $1.3 trillion in student loans – that’s more than credit card and auto loan debt, and second only to mortgage debt 2
  • Retirement savings – 56 percent of Americans have less than $10,000 in retirement savings 3
  • Emergency funds – 46 percent are unable to cover a $400 emergency 4
  • Other debt – 48 percent of Americans have more credit card debt than savings 5

Unfortunately, financial stress can go unnoticed because it is usually not as openly discussed or addressed. Discussing personal finance with co-workers and even family members is still considered difficult for many. This makes it even more important to have a program in place to educate and empower your employees to make positive financial decisions.

There are a wide variety of financial wellness programs and services available. When developing a program, be sure that you include both educational resources and tools that support behavioral change.

  • Educational resources – Education is the backbone to any financial wellness program. Remember, financial issues can impact anyone in your company and not everyone learns the same way. Offer a variety of resources including workshops, seminars, books, online courses and access to financial consultations. It’s important to assure employees that they are in a safe environment where they can learn and feel comfortable asking questions and seeking more information.
  • Empowering behavioral change – Financial wellness doesn’t stop with education. Worksheets, budgeting tools, financial consultants, loan repayment plans and retirement savings plans are all tools that aid employees in making long-term behavioral changes that improve their financial health. Celebrating the small successes early on will help employees commit to making more long-term changes. Be sure to have programs in place that offer the tools and resources needed for employees to set goals, change their behavior and celebrate their success.

Consult with your Employee Assistance Program about resources they may have to help you develop a financial wellness program and empower your employees to get on the path to financial health.

1 PricewaterhouseCoopers, “Employee Financial Wellness Survey,” 2014, page 11

2  Friedman, Zack, “Student Loan Debt in 2017: A $1.3 Trillion Crisis,” Forbes.com, February, 21, 2017, https://www.forbes.com/sites/zackfriedman/2017/02/21/student-loan-debt-statistics-2017/#6d7983a05dab

3 GOBankingRates, “How Much Americans Have Saved for Retirement Survey,” 2016

4 Board of Governors of the Federal Reserve System, “Report on the Economic Well-Being of U.S. Households in 2015,” May 2016, p. 22.

5 Bankrate, “Bankrate Financial Security Index,” 2017

By Nancy Cannon, LCSW, LMHP, CEAP, EAP Manager, Workplace Solutions
Mutual of Omaha Insurance Company, a UBA Strategic Partner

 

ACA Reporting - Draft Forms and Instructions for 2017

Courtesy of UBA Benefits

Under the Patient Protection and Affordable Care Act (ACA), individuals are required to have health insurance while applicable large employers (ALEs) are required to offer health benefits to their full-time employees.

Reporting is required by employers with 50 or more full-time (or full-time equivalent) employees, insurers, or sponsors of self-funded health plans, on health coverage that is offered in order for the Internal Revenue Service (IRS) to verify that:

  • Individuals have the required minimum essential coverage,
  • Individuals who request premium tax credits are entitled to them, and
  • ALEs are meeting their shared responsibility (play or pay) obligations.

2017 Draft Forms and Instructions

Draft instructions for both the 1094-B and 1095-B and the 1094-C and 1095-C were released, as were the draft forms for 1094-B1095-B1094-C, and 1095-C. There are no substantive changes in the forms or instructions between 2016 and 2017, beyond the further removal of now-expired forms of transition relief.

In past years the IRS provided relief to employers who make a good faith effort to comply with the information reporting requirements and determined that they will not be subject to penalties for failure to correctly or completely file. This did not apply to employers that fail to timely file or furnish a statement. For 2017, the IRS has unofficially indicated that the “good faith compliance efforts” relating to reporting requirements will not be extended. Employers should be ready to fully meet the reporting requirements in early 2018 with a high degree of accuracy. There is however relief for de minimis errors on Line 15 of the 1095-C.

The IRS also confirmed there is no code for the Form 1095-C, Line 16 to indicate an individual waived an offer of coverage. The IRS also kept the “plan start month” box as an optional item for 2017 reporting.

Employers must remember to provide all printed forms in landscape, not portrait.

When? Which Employers?

Reporting will be due early in 2018, based on coverage in 2017.

For calendar year 2017, Forms 1094-C, 1095-C, 1094-B, and 1095-B must be filed by February 28, 2018, or April 2, 2018, if filing electronically. Statements to employees must be furnished by January 31, 2018. In late 2016, a filing deadline was provided for forms due in early 2017, however it is unknown if that extension will be provided for forms due in early 2018. Until employers are told otherwise, they should plan on meeting the current deadlines.

All reporting will be for the 2017 calendar year, even for non-calendar year plans. The reporting requirements are in Sections 6055 and 6056 of the ACA.

For an at-a-glance chart of all reporting requirements, as well as information on penalties for failure to file, 6055 requirements and instructions for certain boxes/lines on 1095C, request UBA’s ACA Advisor, “IRS Releases Draft Forms and Instructions for 2017 ACA Reporting."

By Danielle Capilla, Chief Compliance Officer at United Benefit Advisors

 

Wellness Programs Update

Courtesy of UBA Benefits

On August 22, 2017, the United States District Court for the District of Columbia held that the U.S. Equal Employment Opportunity Commission (EEOC) failed to provide a reasoned explanation for its decision to adopt 30 percent incentive levels for employer-sponsored wellness programs under both the Americans with Disabilities Act (ADA) rules and Genetic Information Nondiscrimination Act (GINA) rules.

The court declined to vacate the EEOC's rules because of the significant disruptive effect it would have. However, the court remanded the rules to the EEOC for reconsideration.

Based on the recent court decision to require the EEOC to reconsider its wellness program rules, does this mean that the EEOC rules no longer apply to employer wellness programs? No. For now, the current EEOC rules apply to employer wellness programs. However, employers should stay informed on the status of the EEOC's reconsideration of the wellness program rules so that employers can change their wellness programs' design, if necessary, to comply with new EEOC rules.

According to UBA’s free special report, “How Employers Use Wellness Programs,” 67.7 percent of employers who offer wellness programs have incentives built into the program, an increase of 8.5 percent from four years ago. Incentives are the most prevalent in the Central U.S. (76.1 percent), among employers with 500 to 999 employees (83.2 percent), and in the finance, insurance, and real estate industries (74.7 percent). The West offers the fewest incentives, with only 48.3 percent of their plans having rewards.

Across all employers, slightly more (45.4 percent) prefer wellness incentives in the form of cash toward premiums, 401(k)s, flexible spending accounts (FSAs), etc., versus health club dues and gift cards (40 percent). But among larger employers (500 to 1,000+ employees) cash incentives are more heavily preferred (63.2 percent) over gift certificates and health club dues (33.7 percent). Conversely, smaller employers (1 to 99 employees) prefer health club-related incentives (nearly 40 percent) versus cash (25 percent).

Download our free (no form!) special report, “How Employers Use Wellness Programs,” for more information on regional, industry and group size based trends surrounding prevalence of wellness programs, carrier vs. independent providers, and wellness program components.

For comprehensive information on designing wellness programs that create lasting change, download UBA’s whitepaper: “Wellness Programs — Good for You & Good for Your Organization”.

To understand legal requirements for wellness programs, request UBA’s ACA Advisor, “Understanding Wellness Programs and Their Legal Requirements,” which reviews the five most critical questions that wellness program sponsors should ask and work through to determine the obligations of their wellness program under the ACA, HIPAA, ADA, GINA, and ERISA, as well as considerations for wellness programs that involve tobacco use in any way.

By Danielle Capilla, Chief Compliance Officer at United Benefit Advisors

 

The Killjoy of Office Culture

Courtesy of UBA Benefits

One of the latest things trending right now in business is the importance of office culture. When everyone in the office is working well together, productivity rises and efficiency increases. Naturally, the opposite is true when employees do not work well together and the corporate culture suffers. So, what are these barriers and what can you do to avoid them?

According to an article titled, “8 ways to ruin an office culture,” in Employee Benefit News, the ways to kill corporate culture may seem intuitive, but that doesn’t mean they still don’t happen. Here’s what organizations should do to improve their corporate culture.

Provide positive employee feedback. While it’s easy to criticize, and pointing out employees’ mistakes can often help them learn to not repeat them, it’s just as important to recognize success and praise an employee for a job well done. An “attaboy/attagirl” can really boost someone’s spirits and let them know their work is appreciated.

Give credit where credit is due. If an assistant had the bright idea, if a subordinate did all the work, or if a consultant discovered the solution to a problem, then he or she should be publicly acknowledged for it. It doesn’t matter who supervised these people, to the victor go the spoils. If someone had the guts to speak up, then he or she should get the glory. Theft is wrong, and it’s just as wrong when you take someone’s idea, or hard work, and claim it as your own.

Similarly, listen to all ideas from all levels within the company. Every employee, regardless of their position on the corporate ladder, likes to feel that their contributions matter. From the C-suite, all the way down to the interns, a genuinely good idea is always worth investigating regardless of whether the person who submitted the idea has an Ivy League degree or not. Furthermore, sometimes it takes a different perspective – like one from an employee on a different management/subordinate level – to see the best way to resolve an issue.

Foster teamwork because many hands make light work. Or, as I like to say, competition breeds contempt. You compete to get your job, you compete externally against other companies, and you may even compete against your peers for an award. You shouldn’t have to compete with your own co-workers. The winner of that competition may not necessarily be the best person and it will often have negative consequences in terms of trust.

Get rid of unproductive employees. One way to stifle innovation and hurt morale is by having an employee who doesn’t do any work while everyone else is either picking up the slack, or covering for that person’s duties. Sometimes it’s necessary to prune the branches.

Let employees have their privacy – especially on social media. As long as an employee isn’t conducting personal business on company time, there shouldn’t be anything wrong with an employee updating their social media accounts when they’re “off the clock.” In addition, as long as employees aren’t divulging company secrets, or providing other corporate commentary that runs afoul of local, state, or federal laws, then there’s no reason to monitor what they post.

Promote a healthy work-life balance. Yes, employees have families, they get sick, or they just need time away from the workplace to de-stress. And while there will always be times when extra hours are needed to finish a project, it shouldn’t be standard operating procedure at a company to insist that employees sacrifice their time.

By Geoff Mukhtar, Communications Manager at United Benefit Advisors

 

What You Need to Know about Dependent Care Flexible Spending Accounts

Courtesy of UBA Benefits

A dependent care flexible spending account (DCFSA) is a pre-tax benefit account used to pay for eligible dependent care services. The IRS determines which expenses are eligible for reimbursement and these expenses are defined by Internal Revenue Code §129 and the employer's plan. Eligible DCFSA expenses include: adult day care center, before/after school programs, child care, nanny, preschool, and summer day camp. Day nursing care, nursing home care, tuition for kindergarten and above, food expenses, and overnight camp are ineligible expenses.

Qualifying Individuals

Only qualifying individuals are eligible for dependent care expenses. A qualifying individual is an individual who spends at least eight hours in the participant's home.

Dependent care includes care for a child who is under the age of 13 and in the participant's custody for more than half the year. Dependent care also includes care for a spouse or relative who is physically or mentally incapable of self-care and lives in the participant's home.

If parents are divorced, then the child is a qualified dependent of the custodial parent. A non-custodial parent cannot be reimbursed under a DCFSA even if the parent claims the child as a tax dependent.

Contributing to a DCFSA

The election is the participant's contribution amount, which is the amount the participant puts into a DCFSA at enrollment. Participants may change the amount of money to be withheld within a 31-day window after a qualifying event, such as marriage, birth or adoption of a child, dependent death, divorce, or change in employment. Participants may enroll in or renew their election in a DCFSA during open enrollment. Participation is not automatic. Participants must re-enroll every year by the enrollment date.

The employer determines the minimum election amount and the IRS determines the maximum election amount. The IRS sets the following annual contribution limits for a DCFSA:

  • $2,500 per year for a married employee who files a separate tax return
  • $5,000 per year for a married employee who files a joint tax return
  • $5,000 per year for the head of household
  • $5,000 per year for a single employee

Even though a different maximum contribution limit may apply depending on the employer's plan, the maximum contribution cannot exceed the following earned income limitations:

  • If you are single, the earned income limit is your salary, excluding contributions to your DCFSA.
  • If you are married, the earned income limit is the lesser of: your salary, excluding contributions to your DCFSA, or your spouse's salary.

All DCFSA contributions are subject to IRS use-it-or-lose-it rules, which means that unused funds within the plan year will be forfeited to the employer unless the employer's plan offers a grace period extension. Some plans include a two-and-a-half-month grace period.

Participants must report their DCFSA contributions on their federal tax return along with the name, address, and Social Security number (if applicable) of the dependent care service provider.

Reimbursement Requests

A valid DCFSA claim will either have the dependent care provider certify the service by signing the claim form or have the participant provide an itemized statement from the dependent care provider that includes the following: service dates, dependent's name, type of service, amount billed, and the provider's name and address along with a completed claim form.

Participants should save supporting documentation related to their DCFSA expenses and claims because the IRS may request itemized receipts to verify the eligibility of their expenses.

For information on related topics such as Health FSAs, visit UBA’s compliance library.

By Danielle Capilla, Chief Compliance Officer at United Benefit Advisors

 

What You Need to Know about Health Flexible Spending Accounts

Courtesy of UBA Benefits

A health flexible spending account (FSA) is a pre-tax account used to pay for out-of-pocket health care costs for a participant as well as a participant's spouse and eligible dependents. Health FSAs are employer-established benefit plans and may be offered with other employer-provided benefits as part of a cafeteria plan. Self-employed individuals are not eligible for FSAs.

Even though a health FSA may be extended to any employee, employers should design their health FSAs so that participation is offered only to employees who are eligible to participate in the employer's major medical plan. Generally, health FSAs must qualify as excepted benefits, which means other nonexcepted group health plan coverage must be available to the health FSA's participants for the year through their employment. If a health FSA fails to qualify as an excepted benefit, then this could result in excise taxes of $100 per participant per day or other penalties.

Contributing to an FSA

Money is set aside from the employee's paycheck before taxes are taken out and the employee may use the money to pay for eligible health care expenses during the plan year. The employer owns the account, but the employee contributes to the account and decides which medical expenses to pay with it.

At the beginning of the plan year, a participant must designate how much to contribute so the employer can deduct an amount every pay day in accordance with the annual election. A participant may contribute with a salary reduction agreement, which is a participant election to have an amount voluntarily withheld by the employer. A participant may change or revoke an election only if there is a change in employment or family status that is specified by the plan.

Per the Patient Protection and Affordable Care Act (ACA), FSAs are capped at $2,600 per year per employee. However, since a plan may have a lower annual limit threshold, employees are encouraged to review their Summary Plan Description (SPD) to find out the annual limit of their plan. A participant's spouse can put $2,600 in an FSA with the spouse's own employer. This applies even if both spouses participate in the same health FSA plan sponsored by the same employer.

Generally, employees must use the money in an FSA within the plan year or they lose the money left in the FSA account. However, employers may offer either a grace period of up to two and a half months following the plan year to use the money in the FSA account or allow a carryover of up to $500 per year to use in the following year.

For additional information on covered expenses and reimbursement rules under FSAs, request UBA’s Compliance Advisor, “What You Need to Know about Health Flexible Spending Accounts”.

By Danielle Capilla, Chief Compliance Officer at United Benefit Advisors

 

5 Key Steps to a Successful Open Enrollment

Courtesy of UBA Benefits

In previous posts, I have talked about several aspects of strategic benefits communication. Now it’s time to put those strategies into action. As we approach enrollment season, let’s look at five key steps to ensuring this year’s open enrollment is successful for you and your employees.

1. Determine your key objectives

What do employees need to know this enrollment season? As you review your benefit plan designs, think once again about your key objectives, and for each, how you will make employees aware and keep them engaged. What are the challenges employees face when making their benefits decisions?

  • Are you rolling out new medical plan options? Does this include HDHP options? An HSA? Are there changes in premiums and contribution levels?
  • Are there any changes to other lines of coverage such as dental, life insurance, disability insurance?
  • Are you adding new voluntary plans this year? How do they integrate with your medical plans? Do they plug gaps in high deductibles and out-of-pocket expenses? Are there existing voluntary plans with low participation?
  • Are there other important topics to share with employees, like new wellness programs, or health-driven employee events?

Once you’ve gathered this information, you can develop a communication strategy that will better engage employees in the benefits decision-making process.

2. Perfect your script

What do you know about your employee demographics? Diversity doesn’t refer only to age or gender. It could mean family size, differences in physical demands of the job, income levels, or simply lifestyle. It isn’t a one-size-fits-all world anymore. As you educate employees on benefits, you will want to give examples that fit their lives.

You will also want to keep the explanations as simple as possible. Use as much plain language as you can, as opposed to “insurance speak” and acronyms. Benefit plans are already an overwhelming decision, and as we have seen in our research, employees still don’t fully understand their options.

3. Use a multi-faceted communications strategy

Sun Life research and experience has shown that the most appreciated and effective strategies incorporate multiple methodologies. One helpful tactic is to get a jump-start on enrollment communication. As enrollment season approaches, try dynamic pre-enrollment emails to all employees, using videos or brochures. Once on-site enrollment begins, set up group meetings based on employee demographics. This will arm employees with better knowledge and prepared questions for their one-to-one meeting with a benefits counselor.

Consider hard-to-reach employees as well, and keep your websites updated with helpful links and provide contacts who are available by phone for additional support.

Also, look to open enrollment as a good time to fill any employee data gaps you may have, like beneficiaries, dependents, or emergency contacts.

4. Check your tech!

We have talked in previous posts about leveraging benefits administration technology for effective communications. For open enrollment, especially when you may be introducing new voluntary insurance plans, it is important to check your technology. I recommend this evaluation take place at least 6 to 8 weeks before open enrollment if possible.

Working with your UBA advisor, platform vendor and insurance carriers, some key considerations:

  • Provide voluntary product specifications from your carrier to your platform vendor. It is important to check up front that the platform can handle product rules such as issue age and age band pricing, age reduction, benefit/tier changes and guarantee issue rules. Also, confirm how the system will handle evidence of insurability processing, if needed.
  • Electronic Data Interface (EDI). Confirm with your platform partner as well as insurance carriers that there is an EDI set-up process that includes testing of file feeds. This is a vital step to ensure seamless integration between your benefits administration platform, payroll and the insurance carriers.
  • User Experience. Often benefits administration platforms are very effective at moving data and helping you manage your company’s benefits. As we have discussed, when it comes to your employee’s open enrollment user experience, there can be some challenges. Especially when you are offering voluntary benefits. Confirm with your vendor what, if any, decision support tools are available. Also, check with your voluntary carriers. These could range from benefit calculators, product videos, and even logic-driven presentations.

5. Keep it going

Even when enrollment season is over, ongoing benefits communications are a central tool to keeping employees informed, educated, and engaged. The small window of enrollment season may not be long enough for people to get a full grasp of their benefits needs, and often their decisions are driven by what is easily understood or what they think they need based on other people’s choices. Ongoing communications can be about specific benefits, wellness programs, or other health and benefit related items. This practice will also help new hires who need to make benefits decisions rather quickly.

In summary, work with your UBA consultant to customize benefits and enrollment communications. Leverage resources from your provider, who may, as Sun Life does, offer turnkey services that support communication, engagement, and enrollment. Explore third-party vendors that offer platforms to support the process. The whole thing can seem daunting, but following these steps and considerations will not only make the process easier for you, it will make a world of difference to your employees.

To help employers communicate their plan’s advantages, UBA Partners (li can benchmark your plan against others in your industry, region and groups size. Request your free benchmarking report.

By Kevin D. Seeker, GBA, AVP, Benefit Communication, Sun Life Financial, A UBA Strategic Partner

 

Employer Strategies for Managing Prescription Drug Costs

Courtesy of UBA Benefits

Modern medicines have resulted in longer, more productive lives for many of us. Prescription drugs soothe sore muscles after a strenuous workout or manage the conditions of a chronic disease. Unfortunately, this use of prescriptions drugs can come with a hefty price tag.

Americans are spending more money on prescription drugs than ever before and the United States as a nation spends more per capita on prescription drugs than any other country. With the cost of some drugs exceeding thousands of dollars for a 30-day supply, this can translate into financial hardship for many Americans.

For employers sponsoring a medical plan, managing the cost of these prescription drugs is also becoming a task. Insurance companies and employers struggle with the ability to provide affordable medical plans, and the ever-increasing prescription drug costs are a primary driver of this difficulty. As a result, prescription drug plan designs are changing shape – moving to a model that helps push more of the cost of these drugs to the member along with increasing awareness of the true cost of the prescriptions.

Flat dollar copay plans have become an expected norm in medical plans for almost a decade. However, insurance companies underwriting fully insured medical plans and employers sponsoring self-funded medical programs now need to make modifications to these plan designs to manage the ever-increasing prescription drug costs. As a result, we are seeing more prescription drug plans combining some aspect of coinsurance along with or in place of the flat dollar copayments.

According to the 2016 UBA Health Plan Survey, copay models are still the most popular, with a three-tier copay structure the most prevalent. Median retail copayments for these three-tier plans are $10 for generic drugs, $35 for preferred brand drugs (drugs on the carrier’s prescription drug list) and $60 for non-preferred brand drugs (drugs not on the carrier’s prescriptions drug list). While 54.5 percent of all prescription plans are copay only, approximately 40 percent of all prescription drug plans have co-insurance along with (or in lieu of) copays--a plan design that is particularly common among four-tier plans.

Coinsurance models have many unique designs. Some plans are a straight percentage of the cost of the drug; some may involve a maximum or minimum dollar copayment combined with the coinsurance. For example, a plan may require 40 percent coinsurance for a preferred brand drug, but there is a minimum copayment of $30 and a maximum copayment of $50. Typically, we see a higher coinsurance percentage for non-preferred brand drugs and specialty drugs. The member cost of the drug is calculated after any negotiated discounts, so members covered by a coinsurance plan are reaping the benefits of any discounts negotiated with the pharmacy by the pharmacy benefit manager (PBM).

Coinsurance plans do provide several advantages to managing prescription drug costs. Under a flat dollar copay plan design, members may not truly understand the full cost of the drug they are purchasing. Pharmacies are now disclosing the full cost of drugs on the purchase receipts. Yet, most consumers do not take note of this disclosure, focusing only on the copayment amount. When a member pays a percentage of the cost of the drug as in a coinsurance model, the true cost of the drug becomes much more apparent.

Another advantage of the coinsurance model is that it automatically increases the member share of the cost as the price of the drug increases. Under the flat dollar copayment model, as the true cost of the drug increases, the member pays a smaller portion of the total cost. When the member’s portion is determined by a coinsurance percentage, the member pays more as the cost of the drug increases.

As the costs of health care overall continue to increase, we all need to become better consumers of our healthcare. Members covered by a prescription drug plan with a coinsurance model will have a better understanding of the true cost of their prescriptions. As members become more aware of the true costs of their care, they make better health care decisions, managing the overall cost of care.

We expect to see prescription drug benefit plans change even more as the cost of health care – especially prescription drugs – escalates. These changes will likely result in more of the cost being pushed to the patient. There are resources available to patients for assistance with some of these out-of-pocket costs. It is vital for the patient to understand their costs and know how to maximize their benefits. In a few weeks, the UBA blog will highlight some of these resources and provide information on how to educate employees on maximizing their benefits and the industry resources available to them.

For all the cost and design trends related to health and prescription drug plan costs by group size, industry and region, download UBA’s Health Plan Survey Executive Summary.

By Mary Drueke-Collins, FSA, Vice President of Employee Benefits for Swartzbaugh-Farber & Associates, Inc.
A UBA Partner Firm

 

ERISA's "Church Plan" Exception

Courtesy of UBA Benefits

The Employee Retirement Income Security Act (ERISA) was signed in 1974. The U.S. Department of Labor (DOL) is the agency responsible for administering and enforcing this law. For many years, most of ERISA's requirements applied to pension plans. However, in recent years that has changed, and group plans (called "welfare benefit plans" by ERISA and the DOL) now must meet a number of requirements. Government and church plans do not need to comply with ERISA.

However, some employers are unsure if they meet ERISA's "church plan" exception. Entities associated with churches such as hospitals, schools, nursing homes, and charities are often unclear about whether they meet the exception. Under ERISA, a church plan is "any employee benefit plan established and maintained by a church or by a convention or association of churches that is exempt from tax under IRS Code Section 501 with respect to which no election has been made under IRS Code Section 410(d). The plan must be established and maintained primarily for benefit of the employees of a church or convention or association of churches. Substantially all the covered individuals under the plan must be employees of the church or the convention or association of churches.

Although this might seem straightforward at first glance, determining whether a church or convention or association of churches exists is dependent on the facts and circumstances of an organization. Organizations may request a DOL opinion letter, or an IRS private letter ruling (although the DOL reserves the right to review IRS determinations via private letter) to determine if they meet the definition. To add another layer of uncertainty, courts are not bound by either DOL or IRS determinations.

For more information on the three-factor test that determines if a plan meets ERISA's "church plan" exception, the related 2017 Supreme Court ruling, and ambiguous areas employers should be aware of, request UBA’s Compliance Advisor, “ERISA's ‘Church Plan’ Exception”.

By Danielle Capilla, Chief Compliance Officer at United Benefit Advisors