Compliance Recap June 2024

Compliance Recap June 2024

by | Jul 23, 2024 | Compliance

ACA PREVENTIVE CARE MANDATE REMAINS IN PLACE WITH AN EXCEPTION

In a recent decision, the U.S. 5th Circuit Court of Appeals upheld a key provision of the Affordable Care Act (ACA) that mandates private insurance cover preventive services without cost to patients. However, the court also ruled that the plaintiffs are exempt from complying with this mandate, setting the stage for potential future challenges. The appellate panel emphasized that the task force responsible for determining which preventive services should be covered must receive congressional confirmation, raising questions about the authority of groups making recommendations on contraception and vaccines.

The case stemmed from a lawsuit by Texas-based Christian companies Braidwood Management and Kelley Orthodontics, arguing that the ACA’s requirement to cover preventive care such as contraception, HPV vaccines, and HIV prevention drugs violated their religious beliefs. Initially, a district court sided with the employers, prompting an appeal by the Biden administration.

While the 5th Circuit overturned the lower court’s nationwide nullification of the preventive services mandate, it acknowledged concerns over the constitutional authority of the U.S. Preventive Services Task Force (USPSTF) to issue binding recommendations. The court’s decision requires USPSTF members to undergo presidential nomination and Senate confirmation moving forward.

The ruling’s implications are significant for the approximately 164 million Americans receiving employer-based health insurance, as it preserves access to vital preventive care services. Despite this immediate relief, advocacy groups caution that the decision could pave the way for future legal challenges that may threaten broader access to these essential health benefits.

EMPLOYER CONSIDERATIONS

Employers must ensure that their health plans continue to comply with the ACA’s preventive care mandate, which requires coverage of certain preventive services without cost-sharing for employees. This includes staying updated on the latest guidelines from the U.S. Preventive Services Task Force (USPSTF) and other relevant regulatory bodies to ensure that all mandated services are covered.

HIPAA PRIVACY RULE TO SUPPORT REPRODUCTIVE HEALTH CARE PRIVACY

The Biden administration’s new rule aimed at safeguarding the privacy of protected health information related to lawful reproductive health care went into effect in June. Under the HIPAA Privacy Rule to Support Reproductive Health Care Privacy, healthcare providers are now barred from disclosing sensitive information such as contraception use, pregnancy-related care, and infertility treatments to law enforcement without patient consent.

Effective June 25, with compliance required by December 23, 2024, the rule addresses concerns that arose following the overturning of Roe v. Wade in June 2022. This decision prompted concern that patients seeking lawful reproductive health services across state lines could face unwarranted scrutiny, compromising their privacy and potentially exposing them to legal repercussions.

The rule mandates that HIPAA-covered entities must now obtain a signed attestation that the request is not for prohibited purposes before disclosing protected health information (PHI) for specific purposes like health oversight, judicial proceedings, and law enforcement inquiries.

In the coming months, the Office for Civil Rights plans to release a standardized attestation form to facilitate compliance with the new regulations. This measure aims to ensure that individuals can confidently access reproductive health care without fear of their private medical information being misused or exploited.

EMPLOYER CONSIDERATIONS

Healthcare providers, health plans, and healthcare clearinghouses regulated under the Final Rule must update their Notice of Privacy Practices (NPPs) to align with the requirements for safeguarding reproductive healthcare privacy.

Employers should update HIPAA policies and procedures to ensure they specify when an attestation is required to disclose PHI and train employees on the new rules.

ENFORCEMENT OF PREGNANT WORKERS FAIRNESS ACT BEGINS

Effective June 18, 2024, the Equal Employment Opportunity Commission (EEOC) will enforce the final rule on the Pregnant Workers Fairness Act (PWFA), which mandates that employers provide reasonable accommodations to employees affected by pregnancy, childbirth, or related medical conditions. This applies to all employers with 15 or more employees, encompassing both public and private sectors. Employees are eligible for accommodation regardless of their tenure with the company.

Under the PWFA, employees can request accommodations akin to those permitted under the Americans with Disabilities Act (ADA). These include adjustments such as breaks, modified schedules, remote work, and changes to work environments, among others. Unlike the ADA, the PWFA stipulates four accommodations that employers are generally expected to grant without extensive documentation, such as access to water, restroom breaks, modified seating, and breaks for eating.

Notably, the PWFA requires employers to provide accommodation even if an employee is temporarily unable to perform essential job functions due to pregnancy-related conditions, provided the employee can resume these functions in the near future. Employers cannot mandate specific healthcare providers for medical certification unless certain conditions are met, ensuring flexibility for employees in documenting their accommodation needs.

Regarding undue hardship, employers must assess accommodations based on factors like those used under the ADA, considering the impact on business operations and resources. Accommodations that impose significant costs, disruptions, or alter the fundamental nature of business operations may qualify as undue hardship.

EMPLOYER CONSIDERATIONS

Employers are advised to update their policies and informational materials to reflect PWFA requirements, including handbook updates and the display of updated federal anti-discrimination posters. They should be prepared to accommodate reasonable requests promptly and without unnecessary bureaucratic hurdles, ensuring compliance with both federal and applicable state laws that offer greater protection to pregnant employees.

SUPREME COURT RULES ON MEDICATION ABORTION

The Supreme Court issued a unanimous decision in upholding the FDA’s current protocol for mifepristone, a drug used in medication abortions. The ruling dismissed a challenge based on procedural grounds, asserting that the challengers lacked standing to contest the FDA’s regulations. Despite this decision, the Court left open the possibility of future challenges related to access to the drug.

This ruling holds significant implications, as medication abortion, which includes mifepristone and misoprostol, accounts for a substantial majority of abortions in the United States. The Court’s decision preserves existing access to medication abortion amid rising restrictions on reproductive healthcare.

Currently, coverage for abortion, including medication abortion, varies widely among employers due to state laws and individual plan provisions. While some states mandate coverage, others prohibit it, creating a complex landscape for employers to navigate. Additionally, access to mifepristone can be challenging, as distribution is limited to certified providers, impacting both in-person and mail-order availability.

EMPLOYER CONSIDERATIONS

Employers should review their medical and pharmacy plans to ensure coverage of mifepristone and assess participant access to certified providers.

PREPARATION FOR FILING FORM 5500 FOR CALENDAR YEAR PLANS

ERISA plans with 100 or more plan participants as of the first day of the plan year are required to file IRS Form 5500 by the last day of the seventh month following the end of the plan year. See the IRS Form 5500 Corner for information.

Employers may obtain an automatic extension to file Form 5500, Form 5500-SF, Form 5500-EZ, Form 8955-SSA, or Form 5330 by filing IRS Form 5558. The extension will allow return/reports to be filed up to the 15th day of the third month after the normal due date.

Due to administrative issues within the IRS, electronic filing of Form 5558 through EFAST2 will be postponed until Jan. 1, 2025. Plan sponsors and administrators should continue to use a paper Form 5558 to request a one-time extension of time to file a Form 5500 series or Form 8955-SSA (up to 2½ months after the normal due date for Form 5500s or Form 8955-SSA).

QUESTION OF THE MONTH

Q: For small group clients that do not have to offer medical plans, should we discourage the use of a cafeteria plan for pre-tax premiums if they want to allow employees to drop the medical plan mid-year if they cannot afford it?

A: If you avoid using a cafeteria plan to allow employees to pay for medical premiums, the downside is that the employees must pay for the premiums on an after-tax basis. The upside is you avoid all of the Section 125 rules that generally require elections be irrevocable for the year, unless there is a qualifying life event (and insurance being too expensive is not a qualifying life event). So a good solution for employers that want to offer employees maximum flexibility is to allow them to pay premiums on an after-tax basis.

If giving employees the choice between pre-tax (through a cafeteria plan) or after-tax premiums is too confusing or administratively complex, the employer could choose NOT to offer a cafeteria plan and make all premiums be paid on an after-tax basis. Of course, if the employer does not think the financial hardship issue will occur too frequently, offering a cafeteria plan makes the most financial sense for the employees and the employer.

©2024 United Benefit Advisors

HSAs Made Easy: Learn the Essentials & Protect Your Savings from Mistakes

HSAs Made Easy: Learn the Essentials & Protect Your Savings from Mistakes

by | Jul 15, 2024 | Employee Benefits

Health savings accounts (HSAs) have become a vital part of many employers’ benefits packages, offering employees a powerful tool to manage healthcare expenses while benefiting from tax advantages. However, managing HSAs goes beyond just facilitating contributions. It also involves understanding and addressing mistakes with distributions that employees might encounter.

This article delves into the basics of HSAs, common distribution mistakes, and discusses how employers can assist employees in correcting these errors.

HSA Overview

HSAs are tax-advantaged savings accounts available to individuals enrolled in High Deductible Health Plans (HDHPs). They allow employees to set aside pre-tax dollars to cover qualified medical expenses, providing a triple tax benefit: contributions are tax-deductible, earnings grow tax-free, and withdrawals for qualified medical expenses are tax-free. Contributions to HSAs can come from both employees and employers, with annual contribution limits for individual and family coverage set by the IRS.

Common Mistakes in HSA Distributions

Despite the best intentions, mistakes in HSA distributions can occur. Common errors include:

  • Using funds for nonqualified expenses: Employees may inadvertently use HSA funds for expenses that do not qualify as medical expenses under IRS guidelines.
  • Overdrawing funds: Employees may withdraw more than necessary from their HSAs, leading to unintended tax consequences.
  • Exceeding contribution limits: Employees may contribute more than the IRS annual maximum, resulting in tax consequences.
  • Inadequate recordkeeping: Poor recordkeeping can make it difficult for employees to track HSA transactions and verify the eligibility of expenses.

Supporting Employees in Correcting Distributions

As an employer, you can support employees in correcting mistaken HSA distributions in several ways:

  • Educate employees: Provide comprehensive education and training on HSA rules and regulations, including eligible expenses, contribution limits, and the consequences of nonqualified distributions. Offer resources such as workshops, webinars, and informational materials to help employees understand how to use their HSAs effectively.
  • Encourage recordkeeping: Emphasize the importance of keeping detailed records of HSA transactions and medical expenses. Encourage employees to save receipts and documentation for all qualified medical expenses, as well as records of HSA contributions and distributions.
  • Offer guidance and resources: Ensure employees know where to turn for help if they have questions or need assistance with their HSAs. Provide access to knowledgeable benefits administrators, financial advisors, or tax professionals who can offer guidance on correcting mistaken distributions and navigating HSA rules.
  • Communicate proactively: Regularly communicate with employees about HSA-related updates, such as contribution limit adjustments, changes to regulations, and reminders about best practices for managing their accounts. Use multiple channels—email, intranet, and employee meetings—to ensure that information reaches all employees.

Conclusion

HSAs provide employees with a valuable opportunity to save for healthcare expenses and offer significant tax benefits. As an employer, it’s essential to support employees in understanding and managing their HSAs effectively. By providing education, resources, and guidance on correcting mistaken distributions, employers can help their workers maximize their HSA benefits while minimizing potential pitfalls. Together, employers and employees can navigate the complexities of HSAs and achieve greater financial wellness.

PCORI Fee Filing Deadline

PCORI Fee Filing Deadline

by | Jul 9, 2024 | ACA, Compliance

The Patient-Centered Outcomes Research Trust Fund fee, often referred to as the PCORI fee, can be a source of confusion for employers offering health insurance plans. This article aims to simplify what the PCORI fee is, why it exists, and how it impacts your business.

What is the PCORI Fee?

The PCORI fee is an annual charge levied on most health insurance plans and self-funded employer health plans. It was established by the Affordable Care Act (ACA) to fund the Patient-Centered Outcomes Research Institute (PCORI).

What Does PCORI Do?

PCORI is an independent, non-profit organization dedicated to conducting research on the effectiveness of different medical treatments and approaches. Their research helps patients, caregivers, and healthcare providers make more informed decisions about treatment options.

The IRS offers useful resources, including a chart that explains how the fees apply to different types of health coverage and arrangements.

How Much is the PCORI Fee?

The PCORI fee is calculated based on the average number of lives covered under a plan during the policy year. The fee amount is adjusted annually based on inflation in National Health Expenditures. Here’s a quick breakdown:

  • For plans ending after September 30, 2023 and before October 1, 2024: The applicable dollar amount is $3.22 per covered life.
  • For plans ending after September 30, 2022 and before October 1, 2023: The applicable dollar amount is $3.00 per covered life.

Who Pays the PCORI Fee?

The PCORI fee is generally paid by the issuer of a health insurance plan or the plan sponsor of a self-funded health plan. Employers offering group health plans will typically see the PCORI fee reflected in their health insurance premium statements.

When is the PCORI Fee Due?

The PCORI fee is typically due on July 31st of the year following the last day of the plan year.

Are There Any Exemptions?

Certain types of health plans are exempt from the PCORI fee, including:

  • Health Reimbursement Arrangements (HRAs)
  • Certain government-funded plans (Medicare, Medicaid)
  • Some limited-flexibility plans

The Bottom Line:

The PCORI fee is a relatively small annual cost that helps fund valuable research in patient-centered outcomes. Understanding the purpose and calculation of the PCORI fee can help employers better manage their health insurance expenses and contribute to the advancement of healthcare knowledge.

Additional Resources:

Benefits 101: What Is an HDHP?

Benefits 101: What Is an HDHP?

by | Jul 1, 2024 | Health Insurance

In today’s world of complex health insurance options, High Deductible Health Plans (HDHPs) have become increasingly popular. But with a name like “high deductible,” it’s natural to have questions. Let’s break down the basics of HDHPs:

What is an HDHP?

An HDHP is a health insurance plan with a higher deductible than traditional plans. This means you pay more out of pocket for covered medical services before your insurance kicks in and starts sharing the costs. However, HDHPs often come with lower monthly premiums.

Here’s a breakdown of the key features:

  • Higher deductible: This is the amount you’re responsible for paying before your insurance starts covering costs. HDHP deductibles are typically in the range of $1,600 for individuals and $3,200 for families (as of 2024).
  • Lower monthly premiums: Since you’re shouldering more upfront costs, the monthly premium for an HDHP is usually lower than a traditional plan.
  • Possible Health Savings Account (HSA) compatibility: Many HDHPs allow you to open a Health Savings Account (HSA). HSAs are tax-advantaged accounts where you can save money specifically for qualified medical expenses. You contribute pre-tax dollars to the HSA, which reduces your taxable income, and the funds grow tax-free. You can then use the HSA funds to pay for deductibles, copays, and other qualified medical expenses, tax-free.

Pros of HDHPs:

  • Lower monthly premiums: This can be a significant advantage, especially for young and healthy individuals who don’t anticipate needing frequent medical care.
  • Tax advantages of HSAs: HSAs offer a triple tax benefit – contributions are tax-deductible, funds grow tax-free, and qualified withdrawals for medical expenses are tax-free.
  • Potential for cost savings: If you’re generally healthy and have good budgeting skills, an HDHP can lead to overall lower healthcare costs by combining lower premiums and tax-advantaged savings in an HSA.

Cons of HDHPs:

  • Higher out-of-pocket costs: With a high deductible, you’ll be responsible for a larger chunk of medical bills before your insurance kicks in. This can be a burden if you have unexpected medical needs.
  • Not suitable for everyone: If you have chronic health conditions or anticipate needing frequent medical care, an HDHP might not be the best choice due to the high out-of-pocket costs.
  • Requires financial discipline: To truly benefit from an HSA, you need to be able to contribute and save money on a regular basis.

Is an HDHP Right for You?

There’s no one-size-fits-all answer. Consider these factors:

  • Your overall health: If you’re generally healthy and have a low risk of needing frequent medical care, an HDHP could be a good option.
  • Your budget: Can you comfortably afford to pay a higher deductible if needed?
  • Your financial discipline: Are you comfortable managing and contributing to an HSA?
  • Your future health needs: Do you anticipate needing frequent medical care in the future?

Make an informed decision before enrolling in an HDHP to ensure that it’s the right choice for you, your family and your medical needs.  But remember, you can always re-evaluate your health insurance plan during open enrollment periods.

Investing in Health Prevention and Wellness: A Smart Bet

Investing in Health Prevention and Wellness: A Smart Bet

by | Jun 24, 2024 | Health & Wellness

The old adage “an ounce of prevention is worth a pound of cure” rings truer than ever in today’s world. While reactive healthcare plays a crucial role in treating illness, a growing emphasis is being placed on the power of health prevention and wellness.

Investing in preventive measures and promoting overall well-being isn’t just about individual health; it’s a strategic decision with far-reaching benefits for individuals and communities. Here’s why:

Reduced Healthcare Costs:

Reactive healthcare, focused on treating existing conditions, can be incredibly expensive. Chronic diseases like heart disease, diabetes, and cancer often require ongoing treatment and management, placing a significant strain on healthcare systems and individuals’ finances.

Investing in preventive measures like healthy eating, regular exercise, and preventive screenings can significantly reduce the risk of developing these chronic conditions, leading to substantial cost savings in the long run.

Improved Quality of Life:

Health prevention isn’t just about avoiding illness; it’s about promoting overall well-being. By prioritizing healthy habits, individuals experience increased energy levels, improved mental clarity, and a greater sense of vitality. This leads to a higher quality of life, allowing individuals to be more productive, engaged, and fulfilled in all aspects of their lives.

Enhanced Productivity and Economic Growth:

A healthy workforce is a productive workforce. When individuals are free from chronic illness and experience better overall health, they are more likely to be present at work, focused on their tasks, and less prone to absenteeism due to health issues. This translates to increased productivity and economic growth for both individuals and organizations.

Strategies for Investing in Health Prevention:

Investing in health prevention can take various forms, both at an individual and community level:

  • Individual Level: Prioritizing healthy eating habits, regular exercise, adequate sleep, and preventive screenings are essential steps individuals can take to safeguard their health.
  • Community Level: Promoting access to healthy food options, safe parks and recreational facilities, and community-based wellness programs can significantly impact population health.

Investing in health prevention and wellness is a wise decision with far-reaching benefits. By prioritizing proactive measures and promoting overall well-being, individuals, communities, and societies can reap the rewards of a healthier, happier, and more productive future.