On July 2, 2013, the U.S. Treasury Department delayed enforcement of the employer “play or pay” mandate penalties and reporting requirements by one year to 2015. Removing the penalties for noncompliance and the requirement to report compliance or noncompliance essentially allows large employers one more year to prepare for implementation of the play or pay provisions.
There has been some confusion, however, on the healthcare reform changes taking effect in 2014 regarding what was and was not postponed. Still taking effect in 2014 are the State Exchanges (and the October 1, 2013 employer’s notice of Exchange requirement), the individual mandate to obtain minimum essential coverage, federal premium assistance, the 90-day limit on waiting periods, the termination of all pre-existing condition limitations for all participants, the removal of annual limits on essential health benefits and the optional increase in wellness program incentives from 20% to 30% (50% if tobacco related).
Please contact our office for more information on Health Care Reform and how it will impact your business.
If your company offered either a Health Reimbursement Account (HRA) or Medical Expense Reimbursement Plan (MERP) as part of your employee benefits package in 2012, you must report and pay the PCORI fee for your 2012 plan year no later than July 31, 2013. Please note that the penalty for not filing can be as high as $10,000 per month.
You must use the IRS Form 720 to report and pay the PCORI fee.
If you used a third party administrator to handle the administration of your HRA or MERP plan, they should have provided you with the necessary information to complete Form 720 as they are not permitted to file this with the IRS on your behalf.
Please let us know if you have any questions.
It is time to take your winter treadmill routine outdoors to the parks. Summer is here and you are prepared to sweat! But before you lace up your running shoes, read these eight tips to help you keep cool during the summer months.
Safety tips
Heat-related illness is serious, but that does not mean you are doomed to spending summer indoors in the air-conditioned gym. Review these safety tips before you step out into the sun:
Recognize Warning Signs of Heat Illness
The heat can take its toll on your body and make you sick. Heat-related illness can even be life threatening. Learn how to spot signals of heat-related illness. They range from cramps to muscle spasms to more serious signs like dizziness or fainting. If possible, move to a cool place to help cool the body down and drink fluids .
Heat exhaustion is a warning sign that your body cannot keep itself cool. Stop exercising right away. Heat exhaustion is dangerous and may lead to heat stroke. Symptoms include:
Heat stroke is life-threatening. Stop exercising right away and call 911 for any of the following symptoms:
Heat illness is more likely to occur in people who:
How Will This Change Effect Me?
There will be NO CHANGE to a member’s current prescription benefit coverage as a result of the move to OptumRx.
Members will receive a new UHC ID card in the mail with the new OptumRx information on it. The new card will not be effective until September 1st. Members will also receive communication direct from UHC to help inform them about this change also.
Members will still have access to over 64,000 network retail pharmacies, including all large national chains, and many local community pharmacies.
Most current mail service prescriptions that have remaining refills will automatically transfer over to OptumRx. Prescriptions for certain medications, like painkillers, will not transfer. In this instance, members will receive a letter from UHC letting them know their current prescription will not transfer over to OptumRx and they will need to obtain a new mail order prescription from their doctor.
Please contact our office for more information on this transition.
Our topic for this month focuses on performing an HR Tune Up of current policies and procedures to ensure you are up-to-date and compliant.
Areas covered include:
Contact us today for more information on this topic.
The Obama administration recently kicked off the Health Insurance Marketplace education effort with a new, consumer focused HealthCare.gov website paired with a 24-hours a day consumer call center to help Americans prepare for open enrollment and sign up for private health insurance. The new tools will help Americans understand their choices and select the coverage that best suits their needs when open enrollment for the Exchange begins October 1, with coverage beginning January 1, 2014.
The website will continue to add functionality over the summer months so that, by October, consumers will be able to create accounts, complete an online application, and shop for qualified health plans. For Spanish speaking consumers, CuidadoDeSalud.gov, will also be updated to match HealthCare.gov’s new consumer focus.
Key features of the website include integration of social media, sharable content, and engagement destinations for consumers to get more information. The site will also launch with web chat functionality to support additional consumer inquiries.
Between now and the start of open enrollment, the Marketplace call center will provide educational information and, beginning October 1, 2013, will assist consumers will application completion and plan selection. In addition to English and Spanish, the call center provides assistance in more than 150 languages through an interpretation and translation service. Customer service representatives are available for assistance via a toll-free number at 1-800-318-2596 and hearing impaired callers using TTY/TDD technology can dial 1-855-889-4325 for assistance.
The U.S. Administration announced on July 2, 2013, that it will not require employers to provide health insurance for full time workers under the Health Care Reform Employer Mandate (also known as Pay or Play) until 2015. This move will cause a delay in a key provision of Health Care Reform that was scheduled to go into effect in 2014. The delay represents the administration’s response to widespread complaints about the reporting requirements for employers who are subject to the mandate.
The Affordable Care Act requires all employers with more than 50 full time workers to provide affordable health insurance or face a fine as much as $3000 per employee. The policy has raised concerns that companies would downsize their workforce or cut workers’ hours in order to dodge the new mandate.
The Obama Administration has announced that this provision was delayed so officials could simplify reporting requirements and give employers ample time to adjust their health care coverage.
The postponement does not affect other central provisions of the law, including the individual mandate or the establishment of the health insurance marketplaces, known as Exchanges, which are both still set to go into effect in January 2014.
Formal guidance is expected to be released this week. The Obama Administration has said that once the formal guidance is release they will work with employers to encourage them to voluntarily implement this information in 2014 to allow for a smoother transition into 2015.
Beginning in 2014, large employers (those with 50 or more employees) that do not provide “qualifying” coverage and who have employees who receive a subsidy for Exchange coverage may be subject to certain tax penalties, as high a $3000 per year per employee, under Health Care Reform. We can show you a lower-cost alternative to traditional major medical that will help you avoid these penalties. The cost ranges from $105-$125 per month for employee only coverage and the premium is tax deductible to the employer.
For employers who choose to not offer an ACA compliant plan in 2014, the penalty is an excise tax, therefore not deductible.
This could be the perfect solution for large employers who are looking for an alternative to the high cost of traditional major medical coverage while avoiding the potential penalties of ACA.
Please contact our office if you would like more information about this program and your options as an employer in 2014 with Health Care Reform.
The DOL’s Employee Benefits Security Administration (EBSA) has made available Spanish language versions of model notices to employees of health coverage options. The Affordable Care Act (ACA) requires employers to provide employees with a notice of their health insurance coverage options available through the future health insurance exchanges no later than October 1, 2013. The English version of these model notices were released in May 2013.
Please contact our office for copies of the model notice(s) in English and/or Spanish.
On June 26, 2013, the US Supreme Court declared the Defense of Marriage Act (DOMA) as unconstitutional. DOMA had previously established the federal definition of marriage as a legal union only between one man and one woman. The extinction of DOMA already has HR departments thinking how this will impact the future of the Family and Medical Leave Act (FMLA) as well as other benefits.
How FMLA is Impacted
As we know, the FMLA allows otherwise eligible employees to take leave to care for a family member with a serious health condition. “Family member” includes the employee’s spouse, which, under the FMLA regulations, is defined as:
a husband or wife as defined or recognized under State law for purposes of marriage in the State where the employee resides, including common law marriage in States where it is recognized. 29 C.F.R. 825.102
Initially, this seems to suggest that the DOL would look to state law to define “spouse”…but not so fast. According to a 1998 Department of Labor opinion letter, the DOL acknowledged that the FMLA was bound by DOMA’s definition that “spouse” could only be a person of the opposite sex who is a husband or wife. Thus, the DOL has taken the position that only DOMA’s definitions could be recognized for FMLA leave purposes. As a result, FMLA leave has not been made available to same-sex spouses.
That changes yesterday, at least in part.
What’s Clear about FMLA After the Ruling
In striking down a significant part of DOMA, the Supreme Court cleared the way for each state to decide its own definition of “spouse”. Thus, if an employee is married to a same-sex partner and lives in a state that recognizes same-sex marriage, the employee will be entitled to take FMLA leave to care for his/her spouse who is suffering from a serious health condition, for military caregiver leave, or to take leave for a qualifying exigency when a same-sex spouse is called to active duty in a foreign country while in the military.
What’s Unclear about FMLA After the Ruling
But what about employees who live in a state that does not recognize same-sex marriage? Are they entitled to FMLA leave to care for their spouses?
As an initial matter, the regulations look to the employee’s “place of domicile” (aka state of primary residence) to determine whether a person is a spouse for purposes of FMLA. Therefore, even if the employee formerly lived or was married in a state that recognized the same-sex marriage, he/she is unlikely to be considered a spouse in the “new” state for purposes of FMLA if the state does not recognize the marriage. This is no small issue, since 30+ states currently do not recognize same-sex marriage and some don’t go all the way (e.g. Illinois, which recognizes same-sex unions, not marriages).
Surely, some might argue that the U.S. Constitution requires other states to recognize the marriage; however, this issue is far from settled. Clearly employers need some help from the DOL. It is speculated that the DOL may draft regulations on how employers can administer FMLA in situations where the employee’s spouse is not recognized under state law. This would give life to concepts such as a “State of Celebration” rule, in which a spousal status is determined based on the law of the State where the employee was married and not where they reside. However, without more guidance, it is still too early to tell how the DOL will handle this.
Other Key Benefits Affected by the DOMA Decision
FMLA is not the only federal law impacted by the fall of DOMA. If federal regulations follow through, some of the notable federal laws and benefits impacted may include: