Compliance Recap April 2018

April was a busy month in the employee benefits world.

The Internal Revenue Service (IRS) modified the 2018 health savings account (HSA) family contribution limit back to $6,900. The U.S. Department of Labor (DOL), U.S. Department of Health and Human Services (HHS), and the Treasury released proposed frequently asked questions regarding mental health parity. The Centers for Medicare and Medicaid Services (CMS) released the 2019 parameters for the Medicare Part D prescription drug benefit, a 2019 Benefit and Payment Parameters final rule, a transitional policy extension for non-grandfathered coverage in the small group and individual health insurance markets, and an assignment schedule for new Medicare beneficiary identifiers. The IRS released frequently asked questions on the employer credit for paid family medical leave. The Congressional Research Service (CRS) published a summary of federal requirements that apply to the private health insurance market.

 

UBA Updates
UBA released one new advisor: 2019 Benefit and Payment Parameters Final Rule
UBA updated existing guidance: Sample Open Enrollment Notices Packet

 

IRS Changes 2018 HSA Family Contribution Limit
The Internal Revenue Service (IRS) recently released Revenue Procedure 2018-27 to modify the 2018 health savings account (HSA) family contribution limit back to $6,900. This is the second, and likely final, change in limit during 2018. As background, in May 2017, the IRS released Revenue Procedure 2017-37 that set the 2018 HSA family contribution limit at $6,900.

However, in March 2018, the IRS released Revenue Procedure 2018-10 that adjusted the annual inflation factor for some tax-related formulas from the Consumer Price Index (CPI) to a new factor called a “chained CPI.” As a result, the 2018 HSA family contribution limit was lowered to $6,850 from $6,900, retroactively effective to January 1, 2018. Stakeholders informed the IRS that the lower HSA contribution limit would impose many unanticipated administrative and financial burdens. In response and in the best interest of sound and efficient tax administration, the IRS will allow taxpayers to treat the originally published $6,900 limit as the 2018 HSA family contribution limit.

Excess Contribution Tax Treatment if Employee Received Distribution Based on Earlier Limit

DOL, HHS, and Treasury Release Proposed FAQs on Mental Health Parity
The U.S. Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively,
the “Departments”) released proposed FAQs About Mental Health and Substance Use Disorder Parity

Implementation and the 21st Century Cures Act Part XX.
The Departments respond to FAQs as part of implementing the Paul Wellstone and Pete Domenici
Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

Generally, the MHPAEA requires that the financial requirements (for example, coinsurance and copays)
and treatment limitations (for example, visit limits) imposed on mental health or substance abuse disorder
(MH/SUD) benefits cannot be more restrictive than the predominant financial requirements and treatment
limitations that apply to substantially all medical/surgical benefits in a class.

Similarly, a group health plan or issuer cannot impose a nonquantitative treatment limitation (NQTL) on
MH/SUD benefits that is more stringent than a comparable limitation that is applied to medical/surgical
benefits.

The MHPAEA regulations include express disclosure requirements. For example, if a participant requests
the criteria for medical necessity determinations regarding MH/SUD benefits, then the plan administrator
must make the information available to the participant.

To assist plan sponsors with disclosure requests, DOL released a revised draft Mental Health and
Substance Use Disorder Parity Disclosure Request that plan sponsors may provide to individuals who
request information from an employer-sponsored health plan regarding treatment limitations.

To assist plan sponsors in determining whether a group health plan complies with MHPAEA, the DOL
released its Self-Compliance Tool for the Mental Health Parity and Addiction Equity Act.

 

CMS Releases 2019 Parameters for Medicare Part D Prescription Drug Benefit
The Centers for Medicare and Medicaid Services (CMS) released the following parameters for the defined
standard Medicare Part D prescription drug benefit for 2019:


Generally, group health plan sponsors must disclose to Part D eligibility individuals whether the
prescription drug coverage offered by the employer is creditable. Coverage is creditable if it, on average,
pays out at least as much as coverage available through the defined standard Medicare Part D
prescription drug plan.

 

CMS Issues 2019 Benefit and Payment Parameters Final Rule
The Centers for Medicare and Medicaid Services (CMS) published its 2019 Benefit and Payment
Parameters final rule. The rule primarily affects the individual health insurance market inside and outside
of the Exchange, the small group health insurance market, issuers, and the states.

Within the rule, three items most directly affect employers and their group health plans:
• Maximum annual out-of-pocket limit on cost sharing for 2019
• New methods for changing state EHB-benchmark plans
• New requirements for employers and issuers participating in the Small Business Health Options
Program (SHOP) Marketplace

 

CMS Issues Transitional Policy Extension
The Centers for Medicare and Medicaid Services (CMS) issued a bulletin extending its transitional policy.

As background, in November 2013, CMS announced a transitional policy for non-grandfathered coverage
in the small group and individual health insurance markets. Under its policy, health insurance issuers may
choose to continue certain coverage that would otherwise be cancelled because of noncompliance with
Patient Protection and Affordable Care Act (ACA) and Public Health Service Act (PHS Act). Further,
affected small businesses and individuals may choose to re-enroll in such coverage.

Under its policy, non-grandfathered health insurance coverage in the small group and individual health
insurance markets will not be considered to be out of compliance with the following ACA and PHS Act
market reforms if certain criteria are met:
• Fair health insurance premiums
• Guaranteed availability of coverage
• Guaranteed renewability of coverage
• Prohibition of pre-existing condition exclusions or other discrimination based on health status,
with respect to adults, except with respect to group coverage
• Prohibition of discrimination against individual participants and beneficiaries based on health
status), except with respect to group coverage
• Non-discrimination in health care
• Coverage for individuals participating in approved clinical trials
• Single risk pool requirement

Under CMS’ transitional policy, states may permit issuers that have renewed policies under the
transitional policy continually since 2014 to renew such coverage for a policy year starting on or before
October 1, 2019. However, any policies renewed under this transitional policy must not extend past
December 31, 2019.

 

CMS Starts Assigning New Medicare Beneficiary Identifiers
The Centers for Medicare and Medicaid Services (CMS) started issuing new Medicare cards with a
Medicare Beneficiary Identifier (MBI) or Medicare number. The MBI will replace the Social Security
number-based Health Insurance Claim Number (HICN) for Medicare transactions such as billing, eligibility
status, and claim status.

New enrollees will be among the first to get these new cards. Current Medicare beneficiaries will get their
new cards on a rolling basis over the next few months.

Employers who are currently capturing the HICN for their active employee or retirees should update their
systems to accept the new MBIs.

 

IRS Releases FAQ on Employer Credit for Paid Family Medical Leave
The IRS released an FAQ that primarily reiterates the Tax Cuts an Jobs Act’s provisions that provide a
new federal credit for employers that provide paid family and medical leave to their employees.

The IRS explains that an employer must reduce its deduction for wages or salaries paid or incurred by the
amount determined as a credit. Also, any wages taken into account in determining any other general
business credit may not be used in determining this credit.

The IRS adds this definition of “paid family and medical leave” that, for purposes of the credit, includes
time off for:
• Birth of an employee’s child and to care for the child.
• Placement of a child with the employee for adoption or foster care
• To care for the employee’s spouse, child, or parent who has a serious health condition
• A serious health condition that makes the employee unable to perform the functions of his or
her position
• Any qualifying exigency due to an employee’s spouse, child, or parent being on covered active
duty (or having been notified of an impending call or order to covered active duty) in the Armed
Forces.
• To care for a service member who is the employee’s spouse, child, parent, or next of kin

The FAQ also explains that, in the future, the IRS intends to address:
• When the written policy must be in place
• How paid “family and medical leave” relates to an employer’s other paid leave
• How to determine whether an employee has been employed for “one year or more”
• The impact of state and local leave requirements
• Whether members of a controlled group of corporations and businesses under common control
are treated as a single taxpayer in determining the credit

 

CRS Publishes Federal Requirements on Private Health Insurance Plans
The Congressional Research Service (CRS) published Federal Requirements on Private Health
Insurance Plans, which summarizes federal requirements that apply to the private health insurance
market, including a table that indicates whether a particular federal requirement applies to a fully-insured
large group plan, fully-insured small group plan, self-funded plan, or individual coverage.

Question of the Month
Q. What are the penalties for failing to comply with Section 125 requirements, such as failing to follow a
cafeteria plan document’s terms?

A. An operational failure occurs when a plan fails to follow its cafeteria plan document’s terms. There are
several potential penalties for operational failures, including:
• Cafeteria plan disqualification
• Requiring the cafeteria plan to comply with Section 125 and its regulations, including reversing
transactions that caused noncompliance
• Imposing employment tax withholding liability and penalties on the employer regarding pre-tax
salary reductions and elective employer contributions
• Imposing employment and income tax liability and penalties on employees regarding pre-tax
salary reductions and elective employer contributions

5/15/2018

Download the full recap here.


Bettering Health Plan Management Through Modern Healthcare Technology

Taking advantage of modern technology is part of the reason why Hierl excels in providing the best results for our clients. In this installment of CenterStage, we asked our Executive Vice President, Scott Smeaton, to give an in-depth overview of how we use our technological resources to create customized, high-quality, low-cost health plans for our clients.

Technology and Data

There are three steps to developing plans for our clients, when using technology and data. The first step is to identify the client’s cost drivers within their health program(s). For example, we may look at a client’s claims data and find their highest dollar claims are musculoskeletal – such as hip and knee replacements – identifying whether health plan members are going to the higher cost, lower quality provider. These are becoming much more prevalent and are among most plans top cost drivers. With the technology at Hierl, we can import our client’s data – medical and prescription claims and health screening results from wellness – and aggregate it into one technology platform. Doing so, will help keep our clients’ members updated on physician requests and advice.

Competitive Advantage

The second step beyond identifying our client’s cost drivers is to implement management programs and plan designs to address their health plan issues. This kind of technology is newer to the healthcare industry. It can be a great resource and tool that larger employers can use to their advantage. Think about Netflix. They analyze their viewer’s behaviors and apply predictive modeling in a way that they know what their viewers like to watch and when they want to watch it, incorporating those preferences into the ads their customers see. That kind of technology is coming to healthcare, allowing us to look at all claims and behaviors and predict where the next large claim will come from. This helps plan administrators fully understand what’s driving their health plan costs and do something about it through plan design changes, provider relations and contracting, member incentives, and member education and engagement.

Employee Betterment

After identifying areas that can be improved upon and creating a plan to address these cost drivers as discussed above, our third and final step is to create a communication program that will engage and educate employees. Our goal is to help employees understand that, within a healthcare system, there are some providers who perform better than others and cost less. When we give employees the tools and resources they need to be better healthcare consumers, everyone wins. Employer sponsored health plans have lower overall costs. This means their employees and their families lower their out-of-pocket costs, save healthcare dollars for the future, and have better outcomes. Not to mention that a happier, healthier employee is also a more productive employee at work and in the community. Hierl accomplishes this with our “Why Matters” program, which is a custom designed, year-round member education and communication program using a variety of mediums to reach our clients’ members. Through Why Matters, Hierl builds a custom (intranet) and mobile app for our clients to access basic information about their benefits 24/7. Think of it as a homepage to one of your favorite websites that you bookmark in your browser. This is where your members go to research, make decisions, educate themselves on your benefit offerings and how to be a better healthcare consumer. Based on the cost drivers identified through the process above we build out a 12-month calendar of communication materials specifically addressing the areas we’ve identified as a concern and can be delivered via paper, email, mobile app, etc.

Hierl strives to bring our clients the best possible solutions that result in high-quality, low-cost benefits. If you think your company needs to take this step toward improvement, please contact Scott Smeaton at 920.921.5921 or send him an email at ssmeaton@hierl.com.


Susan Henderson's Slow Cooker Chicken & Dumplings

For this month’s Dish, Susan Henderson has given us her Dine In and Dine Out choices. Check them out below!

Dine In

Susan’s favorite Dine In recipe to enjoy with her family is Slow Cooker Chicken and Dumplings. She loves it for its pure simplicity and nostalgia. “It’s ALMOST what my Grandmother’s recipe!”

You can get the full recipe and directions here.

Dine Out

Susan has two favorite Dine Out choices. First is Gardina’s Wine Bar and Cafe, and second is The Ruby Owl Tap Room.

448 N Main St, Oshkosh, WI 54901
421 N Main St, Oshkosh, WI 54901

Thanks for joining us for this month’s Dish! If you try a recipe or restaurant, be sure to let us know. Don’t forget to come back next month for more yummy favorites!


April 2018 Safety Matters: Elevator Best Practices

Elevator Best Practices

Millions of employees use elevators each day at work. While elevators are considered one of the safest forms of transportation, it is important to follow best practices and safety precautions when using an elevator.

Boarding the Elevator

Take note of the following procedures for entering an elevator:

  • Make sure you are aware of the risks associated with riding the elevator prior to boarding, such as falls and accidents.
  • Allow all passengers to fully exit the elevator before you begin boarding.
  • Watch your step when entering the elevator, as it may not be exactly level to the floor.
  • Steer clear of the doors once you enter the elevator. Keep all clothes, carry-ons and body parts within the car. Never attempt to stop a closing door.
  • Pay attention to the elevator’s capacity limit. Do not attempt to board an elevator that has reached capacity.

Riding the Elevator

Keep in mind the following procedures for riding an elevator:

  • Stand as close to the elevator wall as possible. Be sure to leave as much room as possible for others.
  • Pay close attention to floor indications and transitions to ensure you are able to exit at the right time.
  • Press the “door open” button in the event of the elevator stopping on a floor without opening its doors.
  • Be courteous of other passengers on the elevator. Do not push other riders in front of you when exiting and be sure to move out of the way of passengers when they exit the elevator.

Watch your step as you exit to avoid tripping on uneven ground.

In Case of Emergency

Although rare, elevator accidents and malfunctions do happen. Keep in mind the following procedures in the event of an elevator emergency:

  • Never use an elevator in the event of a fire. Always take the stairs.
  • Remain calm at all times. If you are in a stalled elevator, utilize the alarm button or phone button to contact emergency services.
  • Reassure those who are panicked in the situation. Remind everyone that they are safe inside the elevator.
  • Do not engage in horseplay.
  • Do not try to exit the elevator or pry open the doors. Always wait for trained professionals to arrive.

While elevators are considered one of the safest forms of transportation, it is important to encourage best practices and safety precautions to all employees or building occupants that frequent the elevator.

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RISK INSIGHTS: April 2018

The #MeToo movement.

The #MeToo movement has spread across the globe since gaining traction in Hollywood, and small business owners should see it as a wake-up call for preventing sexual harassment in the workplace.

Small Businesses Most Vulnerable to Sexual Harassment Claims

In wake of the #MeToo movement, awareness of sexual harassment has increased, but not necessarily at small businesses. Unlike their larger counterparts, small businesses are more vulnerable to sexual harassment claims because they’re less likely to have formal workplace policies in place.

According to the CNBC/SurveyMonkey Small Business Survey of more than 2,000 small business owners, only half of businesses with 5-49 employees had formal sexual harassment policies in place. That number decreased to 39 percent at businesses with less than five employees. That’s a stark contrast to businesses with 50 or more employees, as 85 percent said they had formal sexual harassment policies in place.

Eleven percent of the businesses surveyed said they issued companywide reminders of their sexual harassment policies and reporting procedures as a result of the #MeToo movement and other high-profile sexual harassment accusations. Nine percent said they’ve reviewed policies regarding diversity and gender equality. Seven percent have required new or additional training, and 4 percent have issued new reporting procedures. However, 61 percent of all businesses surveyed did not take any of the above precautions.

Role of HR

Complicating matters for small businesses is that two-thirds of those surveyed lacked an official human resources professional, meaning that the business owner was responsible for handling any harassment claims.

Only 3 percent said it was the job of human resources personnel to handle harassment issues and 10 percent said they had no specified way to handle harassment at all. Without a designated, unbiased person to speak to about harassment, employees may be afraid to report it for fear of retaliation.

Protect Your Business

A lack of a formal policy and procedures for handling sexual harassment in the workplace doesn’t mean that a business owner is exempt from liability. Although federal law exempts small businesses with less than 15 employees from the requirement to have a sexual harassment policy, it’s in their best interest to establish one.

Other than the fact that state laws may have smaller thresholds for requiring a formal policy, the financial and reputational costs are too high to risk running a business without one.

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Commercial Risk Advisor - April 2018

Insurance carriers, courts and regulatory agencies will begin to examine businesses closely to ensure that they take sexual harassment seriously and take steps to protect their employees and customers.

It’s always been important to protect your business and employees from sexual harassment, but recent high-profile cases show the importance of re-examining this topic at your business. Social movements such as the “Me Too” campaign have drawn attention to sexual harassment in the workplace, resulting in a growing number of misconduct allegations. These allegations can result in a wide variety of claims and lead to serious financial and reputational damage.

Insurance carriers, courts and regulatory agencies will begin to examine businesses closely to ensure that they take sexual harassment seriously and act to protect their employees and customers.

3 Questions to Ask When Addressing Sexual Harassment at Your Business:

How do you encourage employees to report inappropriate conduct?

The best way to address sexual harassment allegations is to respond quickly. Employees should be regularly reminded that there won’t be any retaliation for reporting inappropriate behavior. You should also ensure that there are multiple ways for employees to make anonymous reports to management.

Does your employee harassment training address your workplace’s unique traits?

A standard workplace policy is a good starting point for addressing sexual harassment, but you should also think about how your employees interact with co-workers and customers.

Do your insurance policies include exclusions for sexual harassment?

Many commercial general liability policies exclude claims for sexual harassment. Although employment practices liability insurance can provide you with coverage, you also need to ensure that policy periods offer coverage throughout the statute of limitations in your area.

1 in 8 drivers are uninsured and liable for damage and medical bills, according to a new study.

Even if you don't use commercial vehicles, employees who use their personal vehicles for any kind of business-related task can put you at risk:

25% of all vehicles in the United States are used for business in some way.
The average uninsured motorist claim is almost $20,000
Most personal auto policies don't provide coverage for uninsured or underinsured drivers without an endorsement.

Uninsured drivers cause about 1 out of every 8 accidents.

3 Defensive Driving Tips That Could Save Your Life

Many jobs require employees to drive a company vehicle. While most drivers are cautious and attentive, accidents can occur without warning—even if the operator has years of experience.

When accidents happen, it can be incredibly costly for employers. What’s more, just one accident can cost employees their job or lead to serious, debilitating injuries.

One way to stay safe while you’re on the road for a job is through defensive driving. Being a defensive driver means driving to prevent accidents in spite of the actions of others or the presence of adverse driving conditions.

To avoid accidents through the use of defensive driving, do the following:

  • Remain on the lookout for hazards. Think about what may happen as far ahead of you as possible, and never assume that road hazards will resolve themselves before you reach them.
  • Understand the defense. Review potentially hazardous situations in your mind after you see them. This will allow you to formulate a reaction that will prevent an accident.
  • Act quickly. Once you see a hazard and decide upon a defense, you must act immediately. The sooner you act, the more time you will have to avoid a potentially dangerous situation.

Defensive driving requires the knowledge and strict observance of all traffic rules and regulations applicable to the area you are driving in. It also means that you should be alert for illegal actions and driving errors made by others and be willing to make timely adjustments to your own driving to avoid an accident.

Keeping in mind the above tips will not only keep you safe on the job, but in your personal life as well.

Poor indoor air quality can cause chronic headaches, allergies, fatigue and irritation of the lungs, among other symptoms.

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