by admin | Oct 6, 2017 | ACA, IRS
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-B, 1095-B, 1094-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.
By Danielle Capilla
Originally Published By United Benefit Advisors
by admin | Oct 4, 2017 | Financial Planning, Hot Topics, Retirement
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
Originally Published By United Benefit Advisors
by admin | Sep 29, 2017 | ACA, Compliance, IRS
In spite of the recent efforts by Congress to change or repeal the ACA, its provisions are still in effect. The IRS has issued continuing guidance on the affordability rate for coverage, the employer shared responsibility provisions and reporting, and the individual mandate provision.
IRS Released the 2018 Affordability Rate
The Internal Revenue Service released its Revenue Procedure 2017-36, which sets the affordability percentage at 9.56 percent for 2018. Under the Patient Protection and Affordable Care Act (ACA), an applicable large employer may be liable for a penalty if a full-time employee’s share of premium for the lowest cost self-only option offered by the employer is not affordable (for 2018, if it’s more than 9.56 percent of the employee’s household income) and the employee gets a premium tax credit for Marketplace coverage.
Because the 2018 affordability rate is lower than the 2017 affordability rate, applicable large employers may need to reduce their employees’ share of premium contributions to maintain affordable coverage. Employers should double check their anticipated 2018 premiums now to prevent the need for mid-year changes.
IRS Releases Information Letters
The IRS issued Information Letters 2017-0010, 2017-0011, 2017-0013, and 2017-0017 on the ACA’s employer shared responsibility provisions and individual mandate.
IRS Information Letters 2017-0010 and 2017-0013 explain that the ACA’s employer shared responsibility provisions continue to apply. The letters state, “The [President’s January 20, 2017] Executive Order does not change the law; the legislative provisions of the ACA are still in force until changed by the Congress, and taxpayers remain required to follow the law and pay what they may owe.” Further, the letters indicate that there are no waivers from potential penalties for failing to offer health coverage to full-time employees and their dependents.
IRS Information Letters 2017-0011 and 2017-0017 address the continued application of the ACA’s individual shared responsibility provisions. Letter 2017-0017 states, “The Executive Order does not change the law; the legislative provisions of the ACA are still in force until changed by the Congress, and taxpayers remain required to follow the law, including the requirement to have minimum essential coverage for each month, qualify for a coverage exemption for the month, or make a shared responsibility payment.”
IRS Issues Draft Forms 1094/1095
The IRS issued draft Forms 1094-B, 1095-B, 1094-C, and 1095-C for the 2017 tax year. Coverage providers use Forms 1094-B and 1095-B to report health plan enrollment. Applicable large employers use Forms 1094-C and 1095-C to report information related to their employer shared responsibility provisions under the ACA.
There are no changes to the face of draft Forms 1094-B, 1095-B, or 1095-C. The IRS made one substantive change to draft Form 1094-C. The IRS removed the line 22 box “Section 4980H Transition Relief” which was applicable to the 2015 plan year only.
By Danielle Capilla
Originally Published By United Benefit Advisors
by admin | Sep 27, 2017 | Benefit Plan Tips, Tricks and Traps, Employee Benefits, Human Resources
We’ve all been there – once or twice (or more)—when a child, spouse or family member has had to gain access to healthcare quickly. Whether a fall that requires stitches; a sprained or broken bone; or something more serious, it can be difficult to identify which avenue to take when it comes to walk-in care. With the recent boom in stand-alone ERs (Emergency Care Clinics or ECCs), as well as, Urgent Care Clinics (UCCs) it’s easy to see why almost 50% of diagnoses could have been treated for less money and time with the latter.
It’s key to educate yourself and your employees on the difference between the two so as not to get pummeled by high medical costs.
- Most Emergency Care facilities are open 24 hours a day; whereas Urgent Care may be open a maximum of 12 hours, extending into late evening. Both are staffed with a physician, nurse practitioners, and physician assistants, however, stand alone ECCs specialize in life-threatening conditions and injuries that require more advanced technology and highly trained medical personnel to diagnose and treat than a traditional Urgent Care clinic.
- Most individual ERs charge a higher price for the visit – generally 3-5 times higher than a normal Urgent Care visit would cost. The American Board of Emergency Medicine (ABEM) physicians’ bill at a higher rate than typical Family-Medicine trained Urgent Care physicians do (American Board of Family Medicine (ABFM). These bill rates are based on insurance CPT codes. For example, a trip to the neighborhood ER for strep throat may cost you more than a visit to a UC facility. Your co-insurance fee for a sprain or strain at the same location may cost you $150 in lieu of $40 at a traditional Urgent Care facility.
- Stand alone ER facilities may often be covered under your plan, but some of the “ancillary” services (just like visit rates) may be billed higher than Urgent Care facilities. At times, this has caused many “financial sticker shock” when they first see those medical bills. The New England Journal of Medicine indicates 1 of every 5 patients experience this sticker shock. In fact, 22% of the patients who went to an ECC covered by their insurance plan later found certain ancillary services were not covered, or covered for less. These services were out-of-network, therefore charged a higher fee for the same services offered in both facilities.
So, what can you and your employees do to make sure you don’t get duped into additional costs?
- Identify the difference between when you need urgent or emergency care.
- Know your insurance policy. Review the definition of terms and what portion your policy covers with regard to deductibles and co-pays for each of these facilities.
- Pay attention to detail. Understand key terms that define the difference between these two walk-in clinics. Most Emergency Care facilities operate as stand-alone ERs, which can further confuse patients when they need immediate care. If these centers, or their paperwork, has the word “emergency”, “emergency” or anything related to it, they’ll operate and bill like an ER with their services. Watch for clinics that offer both services in one place. Often, it’s very easy to disguise their practices as an Urgent Care facility, but again due to CPT codes and the medical boards they have the right to charge more. Read the fine print.
It’s beneficial as an employer to educate your employees on this difference, as the more they know – the lower the cost will be for the employer and employee come renewal time.
by admin | Sep 22, 2017 | Employee Benefits, Health & Wellness
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
Originally Published By United Benefit Advisors
