Employee Benefits Compliance Resource Center

Our employee benefits compliance experts regularly examine state & federal insurance regulations to keep our clients from incurring costly fees or penalties. The Employee Benefits Compliance Resource Center is a repository of new laws/regulations, expert guidance and insightful news articles, where HR & Finance professionals gain actionable information for their benefit programs.

8.7.2020 | Compliance Alert!

Court Eliminates Key Provisions of COVID-19 Leave Regulation​
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View the Recorded Live Update from 03.18

8.7.2020 | Compliance Alert!

Court Eliminates Key Provisions of COVID-19 Leave Regulation​
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Coronavirus Employer Insurance ResourcesCOVID-19 Compliance Guidance, Insurance Carrier Notices & Infographics
The Health & Welfare Compliance Forum (HAWC)An Exclusive LinkedIn Group


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Below are our compliance resource postings over the last 6 months. For your convenience the sections are color-coded in chronological order. Orange Compliance Alerts discuss new guidance interpreted by our staff ERISA attorney and team. U.S. Policy postings represent new state and Federal laws and In the News articles convey current commentary from reputable news outlets.

Compliance Alert
Supreme Court Upholds Religious and Moral Exemptions to ACA Contraceptive Mandate ​

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Agencies Issue Guidance on COVID-19 Testing and Treatment​

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Agencies Issue Plan Limits and other New ACA Rules for 2021 and Future Plan Years​

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HHS Removes ACA Rules Prohibiting Gender Identity Discrimination; Supreme Court Concludes That Title VII Prohibits Discrimination Against LGBTQ Employees​

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Insurers Issue Refunds Due to COVID-19

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The PCOR Fee Continues: IRS Issues Long-awaited PCOR Fee Update​

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Reminder: PCOR Fees for Non-calendar Year Plans are Due July 31, 2020 ​

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Internal Revenue Service Issues 2021 HSA Limits​

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IRS Guidance Gives Cafeteria Plans Flexibility During COVID-19 Pandemic​

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DOL Issues New COBRA Model Notices and FAQ Guidance​

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Agencies Issue COV​​ID-19-Rela​​ted Compliance Relief for Benefit Plans​​​

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President Signs Coronavirus Stimulus Package into Law​

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President Signs Coronavirus Stimulus Package into Law​

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Senate Approves Coronavirus Bill; Now Under Review by the House​

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DOL Guidance Clarifies Coronavirus Paid Leave Requirements​

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Important State & Federal Reporting and Enrollment Extensions

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Agencies Issue Guidance on Coronavirus Paid Leave Tax Credits

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Agencies Issue Guidance Relaxing Enforcement of Benefits Compliance Rules During Coronavirus Health Emergency

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Coronavirus Bill Requiring Paid Leave and Other Benefits Signed Into Law

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House Coronavirus Bill Awaits Senate Approval​

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COVID-19 Compliance Guidance, Insurance Carrier Notices & Infographics for Employees

Visit Coronavirus Resource Page →

State "Individual Mandate" Law Impose New Compliance Requirements on Employers and Employees

2.20.2020 revised from 11.18.2019
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New Budget Law repeals ACA "Cadillac Tax"; Makes Significant Changes to the ACA and other Employee Benefits Laws​

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IRS Extends Deadline for Distributing 2019 Forms 1095-C; Provides New Penalty Relief for Coverage Providers​

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IRS' Draft Instructions for 2019 ACA Information Reporting are Nearly the Same as 2018​

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State "Individual Mandate" Laws Impose New Compliance Requirements on Employers and Employees​

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UPDATE: Massachusetts Health Insurance reporting Form Must Be Filed by December 15​​​​
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IRS Announces Health FSA and Other 2020 Limits​

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IRS and Treasury Issue Proposed Regulation on New "ICHRAs" Available in 2020

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Reminder: 2nd Year of Massachusetts Health Insurance Reporting Form Due November 30​

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New York Paid Family Leave Contributions and Benefits Set to Increase January 1, 2020​​​

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California Requires New FSA Notices in 2020​​​

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REVISED IRS Allows New Expenses for Chronic Conditions to Be Treated as Preventative Care under HSA Rules​​

9.20.2019 revised from 07.22.2019
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IRS Lowers ACA Affordability Percentage for 2020; Applies New Method for Determining Annual Percentage Adjustment

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New Jersey Issues Guidance on its Individual Mandate Reporting Requirements; Extends Reporting Deadline​

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Agencies Directed to Issue Rules on Healthcare Price and Quality Transparency​​
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Agencies Issue Final Regulation Expanding HRA Uses and Availability​
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U.S. Policy

IRS Guidance Clarifies that ACA Tax Liability is Forever
2.21.2020 — The IRS has stated that because there is no actual return filed reporting ACA taxes owed by Applicable Large Employers (ALEs) under Code Section 4980H, the statute of limitations on the IRS’s ability to collect the taxes never begins to run. Even though ALEs file Form 1094-C transmittal forms with IRS each year, they remain potentially liable for Code Section 4980H excise taxes for an indefinite period.
IRS Memorandum »

DOL Issues Updated Model Notice for Premium Assistance under Medicaid & CHIP
2.13.2020 (effective 1.31.2020) — The following states updated their contact information on the annual Model CHIP Notice: CA, IA, KS, KY, LA, MN, PA, VA and WA.
New Model CHIP Notice (English) »
New Model CHIP Notice (Spanish) »

Supreme Court Denies Democrats’ Effort to Expedite ACA Challenge
1.28.2020 — The U.S. Supreme Court rejected an effort by Democrats to expedite a challenge to a court’s decision holding that the individual mandate of the Affordable Care Act is unconstitutional. The decision significantly decreases the likelihood that the Supreme Court will take up the case in 2020.
The Hill »

U.S. Department of Labor Updates Form 5500 Search Tool
1.28.2020 — The Department of Labor Employee Benefits Security Administration released an enhanced search tool for Form 5500 filings. In addition to searching for specific filings, users can now search for filings using new filters that include plan type, plan asset value, number of participants, employer plan types, business codes, and form years and locations.
Updated DOL Search Tool »

New Jersey Passes Law Mandating Severance Pay for Layoffs
1.27.2020 — New Jersey became the first state in the country to enact a law that guarantees severance pay for mass layoffs. The legislation ensures that businesses with 100 or more full-time employees will pay workers one week of severance pay for each year of service when a widespread downsizing or plant closure affects 50 or more employees.
New Jersey Statute on Severance Pay »

Tax Exempt/Non-Profit Employers Can Claim TCJA Refund
1.21.2020 — Tax-exempt/non-profit employers can claim a refund of the Tax Cuts and Jobs Act (TCJA) tax that they previously paid for qualified transportation benefits, including parking benefits. The IRS provides instructions for applicable employers to claim the refund.
IRS: Instructions for Claiming a TCJA Refund »

Supreme Court to Consider Limits on Contraception Coverage
1.21.2020 — The Supreme Court has agreed to hear a case that will decide whether employers with religious objections must offer free contraceptive coverage under the Affordable Care Act.
New York Times »

ERISA Preemption Case to Go to the U.S. Supreme Court
1.13.2020 — The Supreme Court will hear a decision by the U.S. Court of Appeals for the Eighth Circuit, which previously ruled that ERISA superseded an Arkansas law that sought to regulate PBMs. The case concerns an Arkansas law that created a process for pharmacies to challenge below-cost reimbursements for dispensing generic drugs. The Eighth Circuit held that the Arkansas law was preempted by ERISA because it is “relate[d] to and has a connection with employee benefit plans.” The Court’s decision to hear the case is important because the majority of U.S. states have enacted laws that attempt to regulate PBMs; ERISA preemption would leave a significant portion of the U.S. population outside the reach of those laws.
Eighth Circuit’s Rutledge Opinion »

Agencies Issue Proposed Rules to Allow Importation of Certain Rx Drugs
12.18.2019 — The U.S. Department of Health and Human Services and the U.S. Food and Drug Administration have issued a notice of proposed rulemaking that would allow for the importation of certain prescription drugs from Canada. In addition, the agencies have released new draft guidance describing procedures that drug manufacturers can follow to facilitate importation of prescription drugs that are FDA-approved, manufactured abroad, authorized for sale in any foreign country, and originally intended for sale in that foreign country.
Read the HHS News Release »

5th Circuit Court Rules ACA’s Individual Mandate as Unconstitutional
12.18.2019 — The 5th Circuit Court of Appeals ruled in Texas v. U.S. that the ACA’s Individual Mandate is unconstitutional, but punted on the “severability” decision (whether the rest of the ACA can survive without it). This decision was remanded back to the Texas District Court to re-decide on severability which could still make its way back up to the Supreme Court. Since the Individual Mandate penalty was already reduced to $0, there is nothing for employers/plan sponsors to do at this time. From here, the case will likely proceed down 2 paths:

  1. The States that defended the ACA are likely to ask the Supreme Court to put an end to this lawsuit, or at least request that it does not extend beyond the 5th Circuit’s ruling.

  2. The Texas District Court judge will get another shot to make a decision on the severability analysis which could again be appealed to the 5th Circuit. If they then decide that any other parts of the ACA need to be struck down, then the Supreme Court will likely take up the case.
Read the Case »
Kaiser Family Foundation Analysis »

Congress Passes Spending Bill
12.17.2019 — Likely to be signed into law by the President “as is,” the spending bill passed by both houses of Congress includes 3 repeals: the Cadillac Tax, the ACA’s Health Insurers’ (HIT) Tax and the ACA’s Medical Device Tax. Also included are re-authorizations of the Terrorism Risk Insurance program and the National Flood Insurance program. Stalled and not included in this Bill are the recent “Surprise Medical Billing” law and Rx price-reducing rule initiatives.
Read the Legislation »

UPDATE: Agencies Release Transparency In Coverage Model Notice
12.5.2019  — This model notice satisfies the notice requirements under the proposed rules with respect to prerequisites and the limitations of the cost-sharing information. See our earlier announcement on Transparency in Coverage, below.
Read Instructions for the Transparency in Coverage Model Notice »

CMS Issues Final Rule on Hospital Price Transparency
11.15.2019  — CMS has issued a final rule, “CY 2020 Hospital Outpatient PPS Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates: Price Transparency Requirements for Hospitals to Make Standard Charges Public.” This rule requires U.S. hospitals to establish, update and make public standard charges for services. The action is designed to promote price transparency and public access to hospital charges.
Read the Final Rule »

Agencies Issue Proposed Rule to Increase Group Health Insurance Cost Transparency
11.15.2019  — CMS, HHS, DOL and IRS issued a proposed rule, “Transparency in Coverage,” to establish requirements for group health plans and health insurance issuers in the individual and group markets to disclose cost-sharing information upon request to a participant, beneficiary, enrollee or representative. The rule would require an estimate of an individual’s cost-sharing liability for covered provider items or services . This rule is intended to help insurance users to easily obtain an estimate and understanding of their out-of-pocket expenses while shopping for medical items and services.
Read Transparency in Coverage »

New York Law on Reproductive Health Discrimination NY Labor Law Prohibits Discrimination Based on Reproductive Health
11.8.2019 — Governor Andrew Cuomo signed a law that protects employees against discrimination on the basis of their reproductive health decision-making. The law, which mirrors a bill passed by New York City lawmakers, also requires that employers in the state provide notice of the law in their employee handbooks/manuals. The law defines reproductive health decisions as including, but not limited to, the decision to use or access a particular drug, device, or medical service.
Read New York State Assembly Bill A584 »
Read New York State Bans Discrimination Based on Reproductive Health Decisions »

DOL and HHS Issue Revised SBC Template for 2021
11.7.2019  — DOL and HHS issued a revised Summary of Benefits and Coverage (SBC) template for use in plan years beginning on or after January 1, 2021. The SBC template’s provisions regarding minimum essential coverage (MEC) and minimum value (MV) reflect the reduction of the ACA’s Individual Mandate penalty to $0, and additional coverage examples have been added.
See the Revised Summary of Benefits »

IRS Issues New Contribution Limits For Health FSAs and Other Plans
11.6.2019  — For 2020, employees can contribute $2,750 to health FSAs, up from $2,700 in 2019. The same increase applies to limited-purpose FSAs (i.e., dental and vision), which can be stacked with health savings accounts. The IRS has also increased monthly exclusion amounts for Commuter Benefits to $270 in 2020 (up from $265 in 2019) and for Adoption Assistance to $14,300 in 2020 (up from $14,080 last year).
IRS Rev. Proc. 2019-44 »

HHS Rescinds HIPAA Health Plan Identifier Rules
10.20.2019  — In final regulations, the Department of Health and Human Services has rescinded earlier rules governing health plan identifiers (and their related implementation specifications and requirements), which were intended for use in standard electronic transactions under HIPAA. The final regulations are effective December 27, 2019.
Thomson Reuters »

Proposed Rules Released For 2 New Types of HRAs—ICHRAs and EBHRAs
09.27.2019 — Complying with the ACA Employer Mandate requirements and Internal Revenue Code nondiscrimination requirements, the Rules propose that the cost of an affordable plan at an employee’s primary site of employment is a reasonable proxy for the cost of an affordable plan at the employee’s residence. So, an employer may use the lowest cost silver plan for employee self-only coverage, where the employee’s primary site of employment is located, for determining whether an offer of an ICHRA to a full-time employee is affordable.
Federal Register »

CA Notification of Deadline to Withdraw Funds from FSAs
8.30.2019 — Effective January 1, 2020 a new labor law requires employers with workers in California to notify their flexible spending account (FSA) participants about any deadline to withdraw funds from the FSA (whether a health FSA, dependent care FSA (or DCAP) or an adoption assistance FSA) before the end of the plan year. The law requires that the employer provide the notice through 2 different channels, which can include postal mail, emails, texts, phone calls and in-person notification.
California Legislative Information »

Washington, D.C. Issues Information Reporting Guidance on Its Individual Mandate Law
08.09.2019 — The law generally requires employers that covered at least 50 full-time employees, including at least one employee who was a D.C. resident, to file returns with the city.
D.C. Individual Mandate Guidance »

Three Updates on State Individual Mandate Healthcare Laws:
07.19.2019  New Jersey Issues Guidance on Individual Mandate Reporting Rules/Requirements
NJ.gov »

07.12.2019  Rhode Island Passes Requirement for Residents to Have Health Insurance
Taxnews.ey.com »

06.27.2019  California Legislature Passes Health Insurance Individual Mandate Penalty
ca.gov »
Californiaglobe.com »

IRS Lowers ACA Affordability Percentage for 2020
07.25.2019 — Employer-sponsored health coverage will satisfy the ACA’s affordability requirement if the lowest-cost, self-only coverage option available to employees does not exceed 9.78% of household income.
IRS Revenue Procedure »

IRS Expands Preventive Care Benefits List for HSA Participants
07.17.2019 — The Internal Revenue Service has added care for a range of chronic conditions to the list of preventive care benefits that may be provided by a high deductible health plan (HDHP). Notice 2019-45 (PDF), posted on IRS.gov, lists the new types of medical care that may be treated as preventive care for this purpose.
IRS.gov »

Final Rule on HRAs Could Shake Up Markets
06.20.2019 — A new rule that expands the use of health reimbursement arrangements (HRAs) changes the health insurance landscape with potential implications for employers, insurers and patients.
Health Affairs »
Final Rule »

In The News

Supreme Court Agrees to Hear Case on the Constitutionality of the ACA
3.2.2020 — The U.S. Supreme Court will hear the case of Texas v. U.S., a decision on the constitutionality of the Affordable Care Act. The 5th Circuit Court of Appeals had ruled that part of the law, the Individual Mandate, was unconstitutional and raised questions about whether the law in its entirety must fall. The Supreme Court will likely hear the case in October 2020.
Washington Post »

Lawsuit Alleges FL State Health Plans Discriminate Based on Gender Identity
1.14.2020 — Two transgender employees are suing the state of Florida, alleging sex discrimination in their health insurance coverage. The suit alleges that excluding gender-affirming care, including treatment for gender dysphoria, from a state health plan is sex discrimination and violates Title VII of the Civil Rights Act and the Equal Protection Clause of the Fourteenth Amendment. While this lawsuit does not allege any violation of Section 1557 of the ACA, in June 2019, new proposed regulations under Section 1557 were issued by HHS that eliminated its prohibition of discrimination on the basis of “gender identity,” as well as specific health insurance coverage protections for transgender individuals.
TampaBay.com »

Record High Medical Loss Ratio (MLR) Rebates
09.26.2019 — Many more or our clients are getting MLR rebates this year, and they’re for much larger sums of money than we’ve seen. This is likely happening now due to the high profitability of insurance companies, particularly in the individual insurance markets.
Kaiser Family Foundation »
Kaiser Family Foundation Individual Insurance Market Performance in 2018 »

Here are the Democrats’ Three Key Disputes About Medicare for All
07.31.2019 — During the Democratic presidential debate, the party’s moderates worked to undermine the liberals’ plan for a national health insurance system.
Washington Post »

Trump Administration Plans to Allow Some Imported Rx Drugs from Canada
07.31.2019 — The administration is outlining two possible ways certain drugs that were intended for foreign markets could be imported to the U.S.
NPR Health »

HHS Announces New Plan for Safe Rx Importation
07.31.2019 — The HHS and FDA are publishing a Safe Importation Action Plan laying the foundation for the safe importation of certain prescription drugs.
HHS Press Release »
Safe Importation Action Plan » (.pdf)

Medicare for All Tax Impact Gets Attention at Democratic Debate
07.30.2019 — One particular aspect of Bernie Sanders’ Medicare for All plan got special scrutiny: whether candidates would raise taxes and whether families’ total healthcare bills would go up. 
NPR Health »

Proposed Regulation Would Require Hospitals to Publish Rates Negotiated with Insurers 07.29.2019 — The Centers for Medicare & Medicaid Services (CMS) proposed new regulations designed to improve healthcare price and quality transparency. 
CMS News Release »
Proposed Regulation »

AARP Foundation Sues Yale University Over Employee Wellness Program
07.17.2019 — The class action suit alleges that the program, which involves workers undergoing certain medical examinations and divulging health info in lieu of a weekly fine, is a violation of the American with Genetic Information Nondiscrimination Act.
Yale’s Wellness Program Plan Guide »
The Complaint »
Med City News »

House Passes Bill to Repeal the Cadillac Tax 07.17.2019 — The U.S. House of Representatives approved the “Middle Class Health Benefits Tax Repeal Act of 2019,” which would fully repeal the “Cadillac Tax.” The strong bipartisan vote of 419 to 6 underscores both the importance and urgency of full repeal.
Washington Post »
Read the Bill here.

Injunction Against Contraceptive Regulation Upheld
07.16.2019 — On July 12th the Third Circuit Court of Appeals upheld a preliminary nationwide injunction against two rules to dramatically expand exemptions to the ACA’s contraceptive mandate based on religious or moral objections.
Health Affairs »
Read the Court’s decision here.

House is Set to Vote on Healthcare Cadillac Tax Repeal
07.15.2019 — On Wednesday, July 17, 2019, the House plans to vote on legislation that would roll back the Affordable Care Act’s Cadillac tax. The 40% surcharge tax applies to certain high-cost employer healthcare plans.
Roll Call »

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