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.

12.30.2019 | Compliance Alert!

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

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.

U.S. Policy

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 In addition, the agencies have released new draft guidance describing procedures that drug manufacturers can follow to facilitate importation of prescription drugs that are FDA-approved, manufactured abroad, authorized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 »

U.S. Policy

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 »

Compliance Alert

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

11.15.2019
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Compliance Alert

UPDATE: Massachusetts Health Insurance reporting Form Must Be Filed by December 15​​​​
11.14.19
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Compliance Alert

IRS Announces Health FSA and Other 2020 Limits​

11.11.2019
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U.S./State Policy

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 »

Compliance Alert

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

10.15.2019
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Compliance Alert

California Requires New FSA Notices in 2020​​​

10.11.2019
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In The News

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 »

U.S. Policy

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 »

In The News

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 »

In The News

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 »

U.S. Policy

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.
SHRM »
IRS Revenue Procedure »

In The 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.

In The News

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 »

U.S. Policy

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 »

U.S. Policy

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 »

U.S. Policy

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 »

U.S. Policy

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 »

U.S. Policy

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 »

Compliance Alert

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
Download eAlert →

In The News

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 »

In The News

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)

Compliance Alert

IRS Lowers ACA Affordability Percentage for 2020; Applies New Method for Determining Annual Percentage Adjustment

07.29.2019
Download eAlert →

In The News

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 »

U.S. Policy

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 »

U.S. Policy

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 »

U.S. Policy

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 »

Compliance Alert

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

12.3.2019
Download eAlert →

Compliance Alert

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

11.19.2019
Download eAlert →

U.S. Policy

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 »

U.S. Policy

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 »

Compliance Alert

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

10.23.2019
Download eAlert →

Compliance Alert

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

10.23.2019
Download eAlert →

U.S. Policy

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 »

U.S. Policy

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 »

In The News

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 »

Compliance Alert

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

07.29.2019
Download eAlert →

U.S. Policy

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 »

In The News

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.

Compliance Alert

Agencies Directed to Issue Rules on Healthcare Price and Quality Transparency​​
07.01.2019
Download eAlert →

U.S. Policy

Trump Administration Issues Executive Order on Healthcare Price Transparency
06.25.2019 — The Executive Order instructs the DOL, HHS and Treasury to issue guidance on surprise medical bills, high-deductible health plans, health savings accounts, and expenses related to direct primary care arrangements and healthcare sharing ministries. Health Affairs »

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