Employee Benefits Compliance Checklist for Large Employers

Legislative BriefMany employee benefits laws apply to all group health plans, regardless of the size of the sponsoring employer. However, there are a few compliance requirements that only apply to large employers, such as the ACA’s employer shared responsibility rules. This Employee Benefit Compliance Checklist for Large Employers Legislative Brief provides a compliance checklist for large employers.

© 2015 Zywave, Inc. All rights reserved.

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Workplace Wellness Plan Design – Legal Issues

Legislative BriefWellness plans must be carefully structured to comply with federal laws. This Workplace Wellness Plan Design Legal Issues Legislative Brief provides an overview of the requirements for wellness plans under HIPAA (as amended by the ACA), the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA). It also includes a chart that compares key wellness plan requirements under these three laws.

© 2015 Zywave, Inc. All rights reserved.

Annual Compliance Deadlines for Health Plans

Legislative BriefEmployers that provide group health plan coverage are subject to numerous compliance requirements throughout the year, such as requirements for reporting, participant disclosure and certain fee payments. This Annual Compliance Deadlines for Health Plans Legislative Brief provides a high-level overview of the various compliance requirements and associated deadlines that health plan sponsors should be aware of throughout the year.

© 2015 Zywave, Inc. All rights reserved.

Health Savings Account (HSA) Contribution Rules

Legislative BriefMany employers offer high deductible health plans (HDHPs) to control premium costs and pair this coverage with health savings accounts (HSAs) to help employees with their health care expenses.

An HSA is a tax-favored trust or account that can be contributed to by, or on behalf of, an eligible individual for the purpose of paying qualified medical expenses. For example, individuals can use their HSAs to pay for expenses covered under their HDHPs until their deductibles have been met, or they can use their HSAs to pay for qualified medical expenses not covered by their HDHPs, such as dental or vision expenses.

HSAs provide a triple tax advantage—contributions, investment earnings and amounts distributed for qualified medical expenses are all exempt from federal income tax, Social Security/Medicare tax and most state income taxes. Due to an HSA’s potential tax savings, federal tax law includes strict rules for HSA contributions.

Read this HSA Contribution Rules legislative brief to learn who can contribute, how much can be contributed and more.

© 2015 Zywave, Inc. All rights reserved.

Year-end Checklist for 2015 Compliance

Health Care Reform Legislative Brief

The Affordable Care Act (ACA) has made a number of significant changes to group health plans since the law was enacted over four years ago. Many of these key reforms became effective in 2014, including health plan design changes, increased wellness program incentives and reinsurance fees.

Additional reforms take effect in 2015 for employers sponsoring group health plans. In 2015, the most significant ACA development impacting employers is the shared responsibility penalty and related reporting requirements for applicable large employers.

This Year end Checklist for 2015 Compliance Legislative Brief provides a short checklist of the ACA’s key reforms that will take effect in 2015. As 2014 draws to a close, employers should review this checklist to help confirm they are ready to comply with the ACA’s 2015 reforms. Please contact The Noble Group if you would like more information about the ACA’s reforms.

HIPAA Certificates No Longer Required in 2015

Health Care Reform Legislative Brief

Effective for plan years beginning on or after Jan. 1, 2014, the Affordable Care Act (ACA) prohibits group health plans and issuers from imposing pre-existing condition exclusions (PCEs) on any enrollees. Prior to 2014 plan years, the ACA prohibited PCEs for enrollees under 19 years of age. The ACA’s restrictions on PCEs apply to both grandfathered and non-grandfathered plans.

On Feb. 24, 2014, the Departments of Health and Human Services, Labor and the Treasury (Departments) issued a final rule that addresses how the ACA’s prohibition on PCEs affects the requirement to provide HIPAA Certificates of Creditable Coverage (HIPAA Certificates).

The final rule eliminates the requirement to provide HIPAA Certificates, beginning Dec. 31, 2014.

HIPAA PCE RESTRICTIONS (PLAN YEARS BEGINNING BEFORE JAN. 1, 2014)
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) includes rules regarding portability of health coverage, which are designed to help individuals transition from one source of health coverage to another. HIPAA’s portability provisions limit exclusions for preexisting conditions, prohibit discrimination based on health status and provide for special enrollment opportunities.

For plan years beginning before Jan. 1, 2014, HIPAA allowed plans and issuers to exclude pre-existing conditions from coverage, but placed significant limitations on those exclusions. For example, under HIPAA, PCEs could be imposed only for a maximum period of 12 months for regular and special enrollees and 18 months for late enrollees.

In addition, HIPAA required that the plan or issuer reduce any PCE by the amount of creditable coverage the individual had prior to his or her enrollment in the plan.

To allow an individual to establish prior creditable coverage for purposes of reducing or eliminating any PCE imposed by a group health plan, HIPAA’s rules require plans and issuers to provide HIPAA Certificates. Plans and issuers are required to provide HIPAA Certificates to individuals:
• Automatically when they lose coverage under the plan; and
• Upon request for a period of 24 months following termination of coverage.

EFFECT ON HIPAA CERTIFICATES
The ACA’s prohibition on PCEs for plan years beginning on or after Jan. 1, 2014, makes HIPAA Certificates unnecessary. Recognizing this fact, the Departments’ final rule eliminates the requirement to provide HIPAA Certificates, beginning Dec. 31, 2014. Thus, group health plans and issuers are not required to provide HIPAA Certificates during 2015 and later years.

This Legislative Brief is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers
should contact legal counsel for legal advice. © 2014 Zywave, Inc. All rights reserved. EM 11/14

ERISA Compliance FAQs: What is an ERISA Plan?

Legislative BriefThe Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for employee benefit plans maintained by private-sector employers. ERISA includes requirements for both retirement plans (for example, 401(k) plans) and welfare benefit plans (for example, group health plans). ERISA has been amended many times over the years, expanding the protections available to welfare benefit plan participants and beneficiaries.

The Department of Labor (DOL), through its Employee Benefits Security Administration (EBSA), enforces most of ERISA’s provisions. Violating ERISA can have serious and costly consequences for employers that sponsor welfare benefit plans, either through DOL enforcement actions and penalty assessments or through participant lawsuits.

This Legislative Brief ERISA Compliance FAQs What Is an ERISA Plan includes a set of frequently asked questions (FAQs) to help employers determine whether their employee benefits plans are subject to ERISA.

ERISA Compliance FAQs: Reporting and Disclosure Rules

Legislative BriefThe Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for employee benefit plans maintained by private-sector employers. ERISA includes requirements for both retirement plans (for example, 401(k) plans) and welfare benefit plans (for example, group health plans). ERISA has been amended many times over the years, expanding the protections available to welfare benefit plan participants and beneficiaries.

The Department of Labor (DOL), through its Employee Benefits Security Administration (EBSA), enforces most of ERISA’s provisions. Violating ERISA can have serious and costly consequences for employers that sponsor welfare benefit plans, either through DOL enforcement actions and penalty assessments or through participant lawsuits.

This legislative brief, ERISA Compliance FAQs Reporting and Disclosure Rules includes a set of frequently asked questions (FAQs) to help employers understand ERISA’s requirements for reporting and disclosure.

Pay or Play Penalties—Look-back Measurement Method Examples

Health Care Reform Legislative BriefThe Affordable Care Act (ACA) imposes a penalty on applicable large employers (ALEs) that do not offer health insurance coverage to substantially all full-time employees and dependents. Penalties may also be imposed if coverage is offered, but is unaffordable or does not provide minimum value. The ACA’s employer penalty rules are often referred to as “employer shared responsibility” or “pay or play” rules.

On Feb. 12, 2014, the IRS published final regulations on the ACA’s employer shared responsibility rules. The final regulations provide an optional safe harbor method that employers can use for determining full-time status, called the look-back measurement method. The look-back measurement method involves a measurement period for counting hours of service, a stability period when coverage may need to be provided, depending on an employee’s average hours of service during the measurement period, and an administrative period that allows time for enrollment and disenrollment.

This Pay or Play Penalties – Look-back Measurement Method Examples Legislative Brief provides examples of potential measurement, administrative and stability periods for plan years beginning in each month throughout the 2015 and 2016 calendar years. These examples assume that the employer will be using a 12-month standard measurement period, a two-month administrative period and a 12-month stability period.

© 2014 Zywave, Inc. All rights reserved.