Benefits Compliance Resources

ACA Employer Reporting Guide

Certain employers, plan sponsors, and insurers are required to report medical plan and participant coverage data to the IRS on an annual basis. The IRS uses this information to administer and enforce multiple aspects of the Affordable Care Act (ACA), including the Section 4980H employer shared responsibility provision and an individual’s eligibility for a premium tax credit when purchasing health insurance through a public Marketplace. The following is a practical guide to understanding the complex ACA reporting requirements that apply to employers under Sections 6055 and 6056 of the Internal Revenue Code.

 

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Updated October 2023

State Individual Mandate Reporting Guide

In 2006, Massachusetts was the first state to implement a health care reform law that required the commonwealth’s residents to have health coverage, else pay a penalty tax. Subsequently, after Congress eliminated the federal individual mandate to maintain health coverage in 2017, a handful of U.S. states and the District of Columbia responded by adopting their own individual mandates for their residents to have health coverage or face a state tax penalty.  Among that patchwork of state laws are reporting obligations for certain employers. This compliance guide outlines the key aspects of those state reporting requirements and directs you to relevant resources to help you understand your organization’s responsibilities.

 

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Updated January 2024

HSA Guide

High deductible health plans (HDHPs) have become ubiquitous over the last two decades. Health savings accounts (HSAs) are a logical companion benefit to HDHPs, as they are individually owned accounts that can be used for reimbursement of medical expenses on a tax-favored basis without some of the restrictions and risk that accompany more traditional account-based medical expense reimbursement accounts. However, the IRS sets forth various rules that govern HSAs, including regulations that define who is eligible to contribute to an HSA; what elements must be present under a HDHP to be compatible with an HSA; how much tax-exempt funds may be contributed to an HSA; and which medical expenses are reimbursable by such accounts. A failure comply with such requirements could result in the loss of the tax-favored treatment, excise taxes, and adverse consequences to employers and their plan participants alike. This Employee Benefits Compliance Guide offers a detailed review of the multiple IRS and other agency rules that govern HSAs.

 

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Updated August 2023

Cafeteria Plan Election Change Guide

Most employers maintain cafeteria plans that, a basic level, give their employees the choice between receiving their full salary in taxable cash or reducing their salary on a pre-tax basis to purchase qualified benefits (such as health coverage). When participants make an election to receive benefits in exchange for a reduction in pay under such a cafeteria plan, the broad, underlying IRS rule is that the election must remain unchanged (i.e., is “irrevocable”) for the duration of the cafeteria plan year. However, IRS regulations do allow for some exceptions to the general irrevocability rule in the event of a limited list of circumstances, provided the plan sponsor has drafted its cafeteria plan to recognize all or some of those IRS-sanctioned events. The purpose of this Employee Benefits Compliance Guide is to outline these exceptions in more detail and provide guidance to employers concerning: 1) the circumstances under which mid-year election changes may be permitted; and 2) exactly what changes to employees’ cafeteria plan elections are permissible under the IRS rules.

 

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Updated December 2023

ERISA Health & Welfare Plan Disclosure and Reporting Guide

The Employee Retirement Income Security Act of 1974 (ERISA) holds plans subject to the law to numerous disclosure and reporting requirements. Those ERISA plan responsibilities include adopting formal plan documents; preparing and providing various participant disclosures (e.g., Summary Plan Descriptions, Summaries of Benefits and Coverage, claims notices, Summaries of Material Modification, among others); and reporting certain information to the government’s enforcement agencies (e.g., Form 5500s). This Employee Benefits Compliance Guide provides a comprehensive review of the primary disclosure and reporting requirements that apply to group health plans subject to ERISA. This guide summarizes the purpose, content and timing of each disclosure or report, the acceptable forms of distribution for all participant disclosures, and the potential consequences of compliance failures.

 

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Mental Health Parity Guide

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires group health plans offering mental health (MH) or substance abuse (SA) benefits to provide such benefits “in parity” with (i.e., at a level equal to or better than) the medical/surgical coverage available under the group health plan. The MHPAEA does not require group health plans to provide MH or SA benefits, but if a plan offers such benefits beyond what is considered preventive under the Affordable Care Act (ACA), the law’s parity standards apply. This Employee Benefits Compliance Guide walks you through the various elements of the MHPAEA, including health plan design; the related testing, documentation, and disclosure requirements; and consequences of noncompliance.

 

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Updated June 2023

Compliance Toolkit: Gag Clause Attestation

The prohibition on gag clauses went into effect on December 27, 2020. As a result, virtually all group health plans and insurers must annually submit an electronic attestation of compliance to the Department of Health and Human Services (HHS). The first attestation is due December 31, 2023, with an annual requirement applying every calendar year thereafter. Many employers who sponsor group health plans will be responsible for submitting the attestation without the help of their insurer, plan administrator, or other health plan service providers.  This Gag Clause Attestation Toolkit describes which plans must comply, how to determine which party should attest to HHS, and walks through each of the steps necessary to successfully submit the compliance attestation to HHS.

 

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QMCSO Guide

Under multiple federal laws, all group health plans are required to comply with medical child support orders.  In many instances, such orders are originally issued in the form of a National Medical Support Notice (NMSN), which when completed, must be recognized as Qualified Medical Child Support Order (QMSCO). This Employee Benefits Compliance Guide explains NMSN and QMCSOs along with their implications under ERISA, walks you through the multiple steps that an employer must follow to comply with these orders, and provides sample written QMSCO procedures.

 

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Updated September 2023