Expanding HRA Options Effective 2020

hra

On June 13, 2019, The Departments of Health and Human Services, Labor, and Treasury issued the final rule expanding health reimbursement accounts (HRAs) which allows employers greater flexibility in the breadth and scope of HRAs available for their employees.

Background:

Since 2013, regulations have prohibited employers from paying for an employee’s individual health insurance policy and required that HRAs offered to employees be integrated with a group health plan. In 2016, Qualified Small Employer HRAs (QSEHRA) were developed to allow small employers (under 50 lives) to offer an HRA with IRS defined annual limits (in 2019 $5,150/individual and $10,450/family) to be used to pay for individual health premiums of minimum essential coverage when the employer does not offer a group health plan. In October of 2017, President Trump issued an Executive Order that in part directed the agencies to end rules that prohibited employers from paying for individual health insurance premiums through an HRA.

Two New HRA Options arising out of the Executive Order effective January 1, 2020 are:

  1. Individual Coverage HRA
  2. Excepted Benefit HRA

Individual Coverage HRA:

This HRA would allow employers to provide tax-free funding to an employee’s HRA account that could be used to purchase individual health insurance policies. This differs from the QSEHRA in that there is no requirement around the size of the employer.

  • Employers cannot offer both a traditional group health plan and an Individual Coverage HRA to similarly situated employees. However, they can choose a group of employees to offer either the group health plan or the HRA based on a specific class:
        • Full-Time Employees*
        • Part-Time Employees*
        • Seasonal Employees
        • Employees covered by a collective bargaining agreement
        • Employees who have not satisfied a waiting period for coverage
        • Non-Resident aliens with no US-based income
        • Employees whose primary site of employment is in the same rating area*
        • Salaried Employees*
        • Non-Salaried Employees*
        • Temporary Employees of staffing firms
        • Combination of 2 or more of the above*
          *Minimum class size requirements will apply depending upon the classes defined (those with asterisk), whether some classes have a group health plan offered, and the size of the employer. (For example, the minimum class size is 10 for employers with 100 or less employees and 20 employees for an employer with 200 or more employees. The minimum class size for mid-sized employers (between 100 to 200) is 10 percent of the total number of employees.)
  • The HRA must be offered on the same terms and conditions to all similarly situated employees. Dollar amounts, however, can vary based on age and number of dependents;
  • Employees must have the ability to opt out of the HRA and waive future HRA reimbursements at least annually;
  • HRA sponsors must be able to vary their HRA terms to account for different effective dates for individual coverage which can vary based on enrollment;
  • If an employee stops being enrolled in an individual policy, they forfeit the HRA prospectively;
  • Loss of the HRA for reasons other than failing to maintain individual coverage may qualify the HRA for COBRA;
  • Individuals covered by the HRA must attest to being enrolled in an individual policy providing minimum essential coverage. Employers can rely on their employees attestation statement as accurate. No further verification is required;
  • Individual coverage can be purchased on or off the exchange. It also includes student health coverage;
  • Employers can specify reimbursements – premiums only, non-premium cost shares, or particular medical expenses per existing HRA rules. An Individual Coverage HRA that reimburses solely for premiums would not disqualify contributions to an HSA if the individual otherwise meets the requirements (enrollment in a HDHP);
  • Under some circumstances, an Individual Coverage HRA may reimburse for Medicare premiums;
  • Employers must provide a notice to participants which outlines the terms and conditions of the HRA at least 90 days before the start of the plan year;
  • Individual Coverage HRAs are not considered ERISA plans;
  • Individual Coverage HRAs are considered an offer of minimum essential coverage for 4980H(a) employer shared responsibility provision. If the Individual Coverage HRA is also deemed affordable, the offer would also satisfy the 4980H(b) employer shared responsibility provision;
  • Employees being offered an affordable Individual Coverage HRA will not be eligible for a premium tax credit from the exchange (also must be stated clearly in the employee notice);
  • Affordability means that health insurance for the employee should cost no more than 9.86% (indexed annually) of the employee’s household income, using the lowest cost silver plan for self only coverage on the local exchange and incorporating the employer’s contributions. Because this would be a logistical impossibility for most employers, the final notice includes 3 safe harbors to determine affordability:
        • Location: This safe harbor allows employers to use the lowest cost silver plan where the employer’s primary site of employment is located as the standard for affordability calculations;
        • Calendar Year: Employers who implement an individual coverage HRA for the following calendar year could use the existing year’s estimates as a baseline for affordability;
        •  Affordability: Since it is unlikely that employers know their employee’s household income, they can use the already established affordability safe harbors of W-2, rate of pay or federal poverty line.

Excepted Benefits HRA:

Currently, only HRAs classified as an excepted benefit HRA (reimburses only limited expenses, such as vision or dental) can be stand-alone/not integrated with the medical plan. The new Excepted Benefit HRA would allow a stand-alone HRA to also reimburse cost sharing expenses and still qualify as an excepted benefit if it meets certain requirements:

  • The maximum benefit cannot exceed $1,800 for the plan year (indexed annually);
  • Must be offered alongside a traditional group health plan although employees do not have to be enrolled in the traditional plan;
  • The HRA must be available on the same terms for all similarly situated individuals regardless of health factor. Similarly situated means job classification, such as full-time, part-time, different geographic locations, union, non-union, and different occupations or even dates of hire or length of service ;
  • Reimburses cost sharing expenses as well as premiums for excepted benefits (such as vision, dental, std), short-term medical plans, and COBRA premiums (individual or group premiums, Medicare premiums are not eligible);
  • No employer size requirement;
  • Can permit rollover of unused amounts;
  • Subject to Section 105(h) nondiscrimination rules.

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Who says wellness isn’t worthwhile?

Business woman posing with exercise mat

Experience shows that worksite wellness is a big part of every high-quality health plan.

We take exception with a recent JAMA study that said wellness simply isn’t working. While we could point out many reasons why their assessment is short-sighted, our main objection is that their viewpoint was based on the assumption that all wellness programs are the same. Not true!

Corporate Fitness & Health, our worksite wellness subsidiary, has designed, implemented and maintained customized corporate wellness programs for businesses since 1985 – long before worksite wellness became a common part of the employee benefits landscape.

After serving as a consulting resource for clients around the country, CF&H knows that like health plans, there are no cookie-cutter solutions to worksite wellness. Our experience in both the fully-insured and self-funded markets helps CF&H design programs that work because they target the risks driving healthcare costs.

One thing we will concede is that short-term returns from wellness are tough to come by. Health is complex and you simply cannot influence behavior overnight. Yet, CF&H generates 80% participation in the corporate wellness programs it manages and 61% say their program has lowered healthcare costs.

Fostering a culture of wellness within an organization does take time. But when long-term health and well-being, employee attraction and retention and developing a sense of community within the work space are at stake, the investment is more than worthwhile.

Tell Us How You Feel!

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MA Paid Family and Medical Leave – Delay of Payroll Tax Deduction

Compliance

The Massachusetts Paid Family and Medical Leave law (effective in 2021) requires employers to start making financial contributions to support the paid leave program starting on July 1, 2019. The law allows employers to deduct a part of the required contribution from each employee’s wages (along with an employer contribution*) to fund the program. The initial contributions are set at 0.63% of each employee’s wages.

On June 12th, the Governor, Charlie Baker, announced a three-month delay to the start of the payroll tax which would have begun July 1st. The delay is to help clarify the provisions of the program and to give employers adequate time to adjust and implement the program. The goal is to have the new tax in place by the fall. This delay comes in part due to the May 20th request from Associated Industries of Massachusetts (AIM) and various labor groups requesting the delay, as well as fixes to the policy that better align the law with the federal Family and Medical Leave Act.

*Employers with fewer than 25 employees do not have to pay the employer share of the cost. 

Diversified Group will stay up-to-date on this issue and pass along any further developments.

Diversified Group State Mandate Update: New Jersey

Pre-Tax Transportation Fringe Benefits:

On March 1, 2019, New Jersey becomes the first state to require employers to offer pre-tax transportation benefits to employees. A pre-tax transportation fringe benefit is a benefit that allows an employee to set aside wages on a pre-tax basis, which is then only made available to the employee for the purchase of certain eligible transportation services, including transit passes and commuter highway vehicle travel (vanpooling).

  • Every employer in the State of New Jersey that employs at least 20 employees is required to offer transit benefits to all employees who are not currently covered by a collective bargaining agreement (however employers with collectively bargained employees will be required to offer this benefit to them once the bargaining agreement in effect as of March 1, 2019 expires);
  • An employee is identified as anyone hired or employed by the employer and who reports to the employer’s work location. This mirrors the definition used in New Jersey’s unemployment compensation law;
  • There is no exception for non-profits or state and local governmental employers;
  • If an employer has less than 20 employees, there is no requirement to offer the benefit at this time;
  • Employers must provide pre-tax election transportation benefits that provide commuter highway vehicle and transit benefits at the maximum benefit level allowed under federal law (Section 132(f)(2)). For 2019, the maximum benefit level is $265/month for commuter highway benefits and any transit pass combined, as well as $265/month for qualified parking;
  • The law is effective 3/1/19 but penalties for non-compliance will not be assessed until the earlier of March 1, 2020 or the effective date of any implementing rules and regulations;
  • Non-compliance, when enforced, will be a penalty of not less than $100 and not more than $250 for the first violation of failure to offer transit benefits. The employer will then have 90 days to offer the employees the benefit if a penalty is imposed;
  • Associated program costs are not deductible from federal corporate income tax. Employers will need to discuss any New Jersey tax-favored status with their tax advisers.

For now, employers should monitor developments and news regarding the program. The New Jersey Transit Corporation, in conjunction with the New Jersey Turnpike Authority and the South Jersey Transportation Authority will be conducting public awareness campaigns encouraging the public to contact employers about the benefit. Additionally, employers may want to start talking to third party administrators who can administer the transportation fringe benefit program.

Diversified Group can assist you in the administration of Section 132 Parking and Transportation benefits. Please call Jamie Fazio for a quote at 800-322-2524 Ext. 391.

Health Insurance Mandate:

In 2018, New Jersey Governor, Phil Murphy signed into law The New Jersey Health Insurance Market Preservation Act. This law requires all New Jersey residents to have health insurance or pay a penalty. Lawmakers in New Jersey drafted this legislation in response to the decision to eliminate the ACA individual mandate with the passage of the Tax Cuts and Jobs Act of 2017. Although the law focuses primarily on the individual market, there will be reporting requirements on employers that provide health insurance coverage to New Jersey residents staring for the 2019 tax year. Visit www.nj.gov for instructions on reporting (anticipated to be posted by mid-2019).

Individual penalties will mirror the ACA individual mandate penalties; the greater of 2.5% of an individual’s income or $695. The penalty will be capped at the average annual premium for bronze level plans in New Jersey (currently $3,012 per year). Revenue collected (estimated to be between $90M and $100M annually) will be used to fund New Jersey’s reinsurance pool.

The New Jersey law will require certain entities—employers that offer job-based coverage, insurers, and the New Jersey Department of Human Services—to comply with new reporting standards. Under the law, entities that provide MEC to a New Jersey resident will be required to submit a return to the state treasurer. Employers must provide the same information (Form 1094-C and Form 1095-C or Form 1094-B and Form 1095-B) for New Jersey that they currently provide to taxpayers and the IRS. Employers who already use Forms 1094-C or B, and Forms 1095-C or B, to report health coverage information federally, will be required to remit copies of these documents to the New Jersey Division of Taxation on or before February 15th following the close of each calendar year, beginning in 2020.

Out-of-State Employers of New Jersey Residents
Out-of-State employers that withhold and remit New Jersey Gross Income Tax for New Jersey residents have the same filing requirements as businesses located in New Jersey.

Adult Children
Under the federal Affordable Care Act, adult children up to the age of 26 may be covered by their parents’ health plan. New Jersey does not require Forms 1095-B or 1095-C be provided separately to children who are covered by their parents’ health plans, regardless of their residency, beyond the current requirement under 26 U.S.C. s.6055, as that section was in effect and interpreted on December 15, 2017. It is recommended employers advise employees to provide a copy of any Form 1095-B or 1095-C containing coverage information to their children residing in New Jersey.

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2019 PCOR Fee Increase

For 2019, the annual fee to fund the federal Patient-Centered Outcomes Research Institute (PCORI), paid by employers that sponsor self-insured health plans and by commercial group health insurance providers, will go up by about .06 cents per employee or dependent enrolled in the health plan. The fees are due by July 31. The chart below shows the fees to be paid in 2019, which rose slightly from the fees owed in 2018.

Plan Year Ending in 2018 Fee per Plan Enrollee for
July 31, 2019, Payment
Plan year ending on or after Oct. 1, 2018, through Dec. 31, 2018, including calendar-year plans.

$2.45

Plan year ending on or after Jan. 1, 2018, through Sept. 30, 2018

$2.39

For self-funded plans, the self-insured employer is responsible for submitting the fee and accompanying paperwork to the IRS. PCOR fees are reported on IRS Form 720, Quarterly Federal Excise Tax Return. On page two of Form 720, under Part II, the employer needs to designate the average number of covered lives under its applicable self-insured plan. Although the fee is paid annually, employers should indicate on the Payment Voucher (720-V)—located at the end of Form 720—that the tax period for the fee is the second quarter of the year. Failure to properly designate ‘2nd Quarter’ on the voucher will result in the IRS’s software generating a tardy filing notice.

Sponsors of self-insured health plans will pay their last PCOR fee by July 31, 2019 (for calendar-year plans) or by July 31, 2020 (for certain non-calendar year plans). The PCOR fee will no longer apply for policy and plan years ending on or after Oct. 1, 2019. The final filing for a calendar year plan will be July 31, 2019, with respect to the 2018 plan year.

Clients who have elected to have Diversified Group assist with the PCOR fee calculation can expect an email in June which will include a copy of the completed Form 720 and a PCOR calculation worksheet with supporting documentation. Clients will need to file the Form 720 by July 31, 2019.

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Hospitals charge employers 240% more than Medicare

Researchers hope the study will give private payors a better grasp of what health care costs are, and allow them to compare prices within a state and across states. (Photo: Shutterstock)

This article was published on May 13, 2019 on BenefitsPro written by Scott Wooldridge.

Prices range from 150 percent of Medicare prices at the low end to 400 percent at the high end.

A new study by RAND and the Employers’ Forum of Indiana (EFI) finds that hospital prices are much higher for employer-based health plans than for Medicare.

The study gathered data from hospitals in 25 states, finding a wide variation in what hospitals charged health plans. The researchers looked at claims data for more than 4 million people, with information coming from self-insured employers, state databases and records from participating health insurance plans.

Depending on the state, prices rose and fell in the period between 2015 and 2017, the data showed, but on average, private insurers were charged 240 percent more than Medicare. Prices also varied widely among hospital systems, ranging from 150 percent of Medicare prices at the low end to 400 percent of Medicare prices at the high end. The cost of outpatient care from hospitals was higher than the average inpatient costs, averaging 293 percent of what Medicare would pay.

“The widely varying prices among hospitals suggests that employers have opportunities to redesign their health plans to better align hospital prices with the value of care provided,” said Chapin White, the study’s lead author and an adjunct senior policy researcher at RAND, a nonprofit research organization. “Employers can exert pressure on their health plans and hospitals to shift from current pricing system to one that is based on a multiple of Medicare or another similar benchmark.”

The American Hospital Association has put out a statement taking issue with the report, in part because of its sample size–utilizing data from 1,598 hospitals in 25 states. In addition, wrote AHA in a statement, “Medicare payment rates, which reimburse below the cost of care, should not be held as a standard benchmark for hospital prices. Simply shifting to prices based on artificially low Medicare payment rates would strip vital resources from already strapped communities, seriously impeding access to care.”

Different payors, different rules

EFI officials noted that private health insurance contracting for hospitals is done on a discounted-charge basis, negotiated between insurance carriers and hospitals. Medicare, on the other hand, issues a fee schedule that determines the price it will pay for each service, with adjustments for inflation, hospital location, the severity of a patient’s illness, and other factors.

According to Gloria Sachdev, president and CEO of EFI, the new study will give private payors—such as employer-based plans—a better grasp of what health care costs are, and allow them to compare prices within a state and across states.

“The purpose of this hospital price transparency study is to enable employers to be better shoppers of health care on behalf of their employees,” Sachdev said. “We all want to know which hospitals provide the best value (best quality at best cost). Numerous studies have found that rising health care costs are due to high prices, not because we are using more health care services.”

RAND recommendations

The research group issued a list of recommendations with the study. Some of the recommendations are in line with the recent movement toward direct contracting, as employers seek to negotiate directly with high-quality, lower-cost facilities.

The study’s recommendations included:

  • Employers can exert pressure on their health plans and hospitals to shift from discounted charge contracts to contracts based on a multiple of Medicare or some other prospective case rates.
  • Employers can use networks and benefit designs to move patient volume away from high-priced, low-value hospitals and hospital systems.
  • Employers can encourage expanded price transparency by participating in existing state-based all-payer claims databases and promoting development of new ones.

Transparency by itself is likely insufficient to reduce hospital prices; employers may need state or federal policy interventions to rebalance negotiating leverage between hospitals and employer health plans.