Many employers are in the final stages of designing their 2016 health benefit programs, contribution strategies, vendor terms, and employee communications. To assist in this effort, Mercer has recently published the top 10 compliance-related issues employers should address in health benefit planning for the upcoming year. Referring to this list will assist employers in keeping pace with the latest Affordable Care Act (ACA) and other developments impacting health plans:
1. Employer shared-responsibility (ESR) strategy. Ensure the intended goal of avoiding or paying ESR assessments for 2016 coverage is supported by coverage offers, administrative and recordkeeping processes, and benefit documents.
2. ESR reporting. Arrange data sources, systems, and administrative processes to collect all information about enrollees with minimum essential coverage (MEC), full-time employees, and coverage offers needed for reporting on 2016 coverage. Create a process for correcting any erroneous IRS filings and personal statements.
3. Preventive care. Ensure “non-grandfathered” group health plans comply with the final ACA rules and recent guidance on cost-free preventive services.
4. Other ACA reporting and disclosure requirements. Review delivery operations for summaries of benefits and coverage (SBCs) and watch for revised SBC templates. Prepare for round two of online submission and payment of ACA’s reinsurance fee.
5. Midyear changes to cafeteria plan elections. Decide whether to permit midyear changes to cafeteria plan elections for either or both of the status-change events in IRS Notice 2014-55.
6. ACA’s out-of-pocket maximum. Verify that self-only and other (e.g., family) coverage tiers in “non-grandfathered” plans meet ACA’s 2016 out-of-pocket (OOP) limits for in-network care. Confirm that family coverage also satisfies ACA’s self-only OOP limit for each enrollee.
7. Same-sex marriages and domestic partnerships. Assess how the US Supreme Court’s Obergefell v. Hodges ruling that legalizes same-sex marriage nationwide affects your benefit programs and employment policies. Also consider the decision’s indirect implications for domestic partner coverage.
8. Mental health parity. Check that plan designs and operations provide parity between medical/surgical and mental health/substance use disorder (MH/SUD) coverage. Federal audits of health plans now evaluate compliance with the final Mental Health Parity and Addiction Equity Act (MHPAEA) rules that took effect in 2015. In addition, state legislative activity and litigation around parity issues continue.
9. Wellness. Review employee wellness programs against the proposed Equal Employment Opportunity Commission (EEOC) rules requiring voluntary participation and restricting incentives for completing health risk assessments and/or biomedical screenings. Be prepared to make changes after EEOC finalizes these rules for nondiscriminatory wellness plans under the Americans with Disabilities Act.
10. Fixed-indemnity and supplemental health insurance. Review fixed-indemnity and supplemental health insurance policies to ensure they qualify as excepted benefits under the ACA and the Health Insurance Portability and Accountability Act (HIPAA).