by admin | 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
by admin | Jan 24, 2018 | Hot Topics, Human Resources, IRS
WHD Revises Test for Unpaid Internships
On January 5, 2018, the U.S. Department of Labor’s Wage and Hour Division (WHD) released a Field Assistance Bulletin (FAB No. 2018-2) establishing that the primary beneficiary test, rather than the six-point test, will determine whether interns at for-profit employers are employees under the federal Fair Labor Standards Act (FLSA).
The primary beneficiary test requires an examination of the economic reality of the intern-employer relationship to determine which party is the primary beneficiary of the relationship. The following seven factors are part of this test:
- The extent to which the intern and the employer clearly understand that there is no expectation of compensation. Any promise of compensation, express or implied, suggests that the intern is an employee — and vice versa.
- The extent to which the internship provides training that would be similar to that which would be given in an educational environment, including the clinical and other hands-on training provided by educational institutions.
- The extent to which the internship is tied to the intern’s formal education program by integrated coursework or the receipt of academic credit.
- The extent to which the internship accommodates the intern’s academic commitments by corresponding to the academic calendar.
- The extent to which the internship’s duration is limited to the period in which the internship provides the intern with beneficial learning.
- The extent to which the intern’s work complements, rather than displaces, the work of paid employees while providing significant educational benefits to the intern.
- The extent to which the intern and the employer understand that the internship is conducted without entitlement to a paid job after the internship.
According to the WHD, under the primary beneficiary test, no one factor is dispositive and every factor is not required to be fulfilled to conclude that the intern is not an employee entitled to the minimum wage. The primary beneficiary test is a distinct shift in analysis because per the six-part test every intern and trainee would be an employee under the FLSA unless his or her job satisfied each of six independent criteria. Courts have held that the primary beneficiary test is an inherently “flexible” test and whether an intern or trainee is an employee under the FLSA necessarily depends on the unique circumstances of each case.
The WHD announced it will conform to the federal court of appeals’ determinations and use the same court-adopted test to determine whether interns or students are employees under the FLSA.
Read the field bulletin
Increased Penalties for Federal Violations
On January 2, 2018, the U.S. Department of Labor (DOL) announced in the Federal Register that penalties for violations of the following federal laws have increased for 2018:
- Black Lung Benefits Act.
- Contract Work Hours and Safety Standards Act.
- Employee Polygraph Protection Act.
- Employee Retirement Income Security Act.
- Fair Labor Standards Act (child labor and home worker).
- Family and Medical Leave Act.
- Immigration and Nationality Act.
- Longshore and Harbor Workers’ Compensation Act.
- Migrant and Seasonal Agricultural Worker Protection Act.
- Occupational Safety and Health Act.
- Walsh-Healey Public Contracts Act.
These increases are due to the requirements of the Inflation Adjustment Act, which requires the DOL to annually adjust its civil money penalty levels for inflation by no later than January 15.
These increased rates are effective January 2, 2018.
Read the Federal Register
OSHA Penalties Increased
On January 2, 2018, the U.S. Department of Labor announced in the Federal Register that Occupational Safety and Health Administration (OSHA) penalties will increase for 2018 as follows:
- Other-than-Serious: $12,934
- Serious: $12,934
- Repeat: $129,336
- Willful: $129,336
- Posting Requirement Violation: $12,934
- Failure to Abate: $12,934
These increases apply to states with federal OSHA programs; rates for states with OSHA-approved State Plans will increase to these amounts as well; State Plans are required to increase their penalties in alignment with OSHA’s to maintain at least as effective penalty levels.
These new penalty increases are effective as of January 2, 2018 and apply to any citations issued on that day and thereafter.
Read the Federal Register
Agencies Release Advance Copies of Form 5500 for Filing in 2018
The Employee Benefits Security Administration (EBSA) the Internal Revenue Service (IRS), and the Pension Benefit Guaranty Corporation (PBGC) released the advance informational copies of the 2017 Form 5500 and related instructions. For small employee benefit plan reports, advance short form copies of 2017 Form 5500-Short Form (SF) and 2017 Instructions for Form 5500-SF were also released with supplemental materials including schedules and attachments.
Read about and download the Form 5500 Series
Originally Published By ThinkHR.com
by admin | Jul 20, 2017 | Benefit Management, ERISA
UBA’s compliance team leverages the collective expertise of its independent partner firms to advise 36,000 employers and their 5 million employees. Lately, a common question from employers is: If a health and welfare benefit plan has fewer than 100 participants, then does it need to file a Form 5500?
If a plan is self-funded and uses a trust, then it is required to file a Form 5500, no matter how many participants it has.
Whether the plan must file a Form 5500 depends on whether or not the plan is “unfunded” (where the money comes from to pay for the self-funded claims).
Currently, group welfare plans generally must file Form 5500 if:
- The plan is fully insured and had 100 or more participants on the first day of the plan year (dependents are not considered “participants” for this purpose unless they are covered because of a qualified medical child support order).
- The plan is self-funded and it uses a trust, no matter how many participants it has.
- The plan is self-funded and it relies on the Section 125 plan exemption, if it had 100 or more participants on the first day of the plan year.
There are several exemptions to Form 5500 filing. The most notable are:
- Church plans defined under ERISA Section 3(33)
- Governmental plans, including tribal governmental plans
- Top hat plans which are unfunded or insured and benefit only a select group of management or highly compensated employees
- Small insured or unfunded welfare plans. A welfare plan with fewer than 100 participants at the beginning of the plan year is not required to file an annual report if the plan is fully insured, entirely unfunded, or a combination of both.
A plan is considered unfunded if the employer pays the entire cost of the plan from its general accounts. A plan with a trust is considered funded.
For smaller groups that are self-funded or partially self-funded, you’d need to ask them whether the plan is funded or unfunded.
If the employer pays the cost of the plan from general assets, then it is considered unfunded and essentially there is no trust.
If the employer pays the cost of the plan from a specific account (in which plan participant contributions are segregated from general assets), then the plan is considered funded. For example, under ERISA, pre-tax salary reductions under a cafeteria plan are participant contributions and are considered plan assets which must generally be held in trust based on ERISA’s exclusive benefit rule and other fiduciary duty rules.
By Danielle Capilla
Originally Posted By www.ubabenefits.com
by admin | Jan 18, 2017 | ACA, Compliance, ERISA
Proposed regulations for revising and greatly expanding the Department of Labor (DOL) Form 5500 reporting are set to take effect in 2019. Currently, the non-retirement plan reporting is limited to those employers that have more than 100 employees enrolled on their benefit plans, or those in a self-funded trust. The filings must be completed on the DOL EFAST2 system within 210 days following the end of the plan year.
What does this expanded number of businesses required to report look like? According to the 2016 United Benefit Advisors (UBA) Health Plan Survey, less than 18 percent of employers offering medical plans are required to report right now. With the expanded requirements of 5500 reporting, this would require the just over 82 percent of employers not reporting now to comply with the new mandate.
While the information reported is not typically difficult to gather, it is a time-intensive task. In addition to the usual information about the carrier’s name, address, total premium, and payments to an agent or broker, employers will now be required to provide detailed benefit plan information such as deductibles, out-of-pocket maximums, coinsurance and copay amounts, among other items. Currently, insurance carriers and third party administrators must produce information needed on scheduled forms. However, an employer’s plan year as filed in their ERISA Summary Plan Description, might not match up to the renewal year with the insurance carrier. There are times when these schedule forms must be requested repeatedly in order to receive the correct dates of the plan year for filing.
In the early 1990s small employers offering a Section 125 plan were required to fill out a 5500 form with a very simple 5500 schedule form. Most small employers did not know about the filing, so noncompliance ran very high. The small employer filings were stopped mainly because the DOL did not have adequate resources to review or tabulate the information.
While electronic filing makes the process easier to tabulate the information received from companies, is it really needed? Likely not, given the expense it will require in additional compliance costs for small employers. With the current information gathered on the forms, the least expensive service is typically $500 annually for one filing. Employers without an ERISA required summary plan description (SPD) in a wrap-style document, would be required to do a separate filing based on each line of coverage. If an employer offers medical, dental, vision and life insurance, it would need to complete four separate filings. Of course, with the expanded information required if the proposed regulations hold, it is anticipated that those offering Form 5500 filing services would need to increase with the additional amount of information to be entered. In order to compensate for the additional information, those fees could more than double. Of course, that also doesn’t account for the time required to gather all the data and make sure it is correct. It is at the very least, an expensive endeavor for a small business to undertake.
Even though small employers will likely have fewer items required for their filings, it is an especially undue hardship on many already struggling small businesses that have been hit with rising health insurance premiums and other increasing costs. For those employers in the 50-99 category, they have likely paid out high fees to complete the ACA required 1094 and 1095 forms and now will be saddled with yet another reporting cost and time intensive gathering of data.
Given the noncompliance of the 1990s in the small group arena, this is just one area that a new administration could very simply and easily remove this unwelcome burden from small employers.
By Carol Taylor, Originally published by United Benefit Advisors – Read More
