Florida Business Innovation - Florida Business Insurance
How Biometrics Change the Way Business Decisions Are Made
May 28, 2019
How Businesses are Using Digital Identities to Enhance Customer Personalization
June 10, 2019

Employee Benefits Compliance Checklist for Small and Large Employers

Florida Workplace Wellness

There have been many significant changes to group health plans in the years since the Affordable Care Act (ACA) was signed into law in 2010. Certain changes to ACA requirements have taken effect in 2019 for employers sponsoring group health plans. The ACA applies to health plans and health insurance issuers, with few exceptions. There is not an exception for small employers.

Below you’ll find an ACA Compliance Checklist to help small employers (defined as fewer than 50 FTEs) and applicable large employers (ALEs), generally those with 50 or more full-time equivalents, manage the changes and stay on top of the benefits compliance rules most employers will need to follow.

  1. Plan Design Changes
  • Grandfathered Plan Status
    • Review grandfather status
    • Confirm plan has all patient rights if past plan is no longer grandfathered in
    • Provide Notification of Grandfathered Status if benefits will remain grandfathered in under the law
  • Cost-sharing limits
    • Review plans out-of-pocket maximum
    • Check out-of-pocket maximum for HSA-compatible HDHP
    • Confirm plan will coordinate all claims for EHBs across the plan’s service providers or will divide out-of-pocket maximum across the categories of benefits
    • Confirm the plan applies the self-only maximum to each individual in the plan
  • Health FSA Contributions
    • Work with advisors to monitor IRS guidance on the health FSA limit
    • If 2019 limit is announced too late for open enrollment, use the 2018 limit to ensure compliance
    • Communicate the health FSA limit to employees
  1. Summary of Benefits and Coverage (SBC)
  • Ensure you are using the appropriate SBC template for the 2019 plan year
  • For self-funded plans, plan administrator is responsible for creating and providing the SBC OR
  • For insured plans, the issuer is required to provide the SBC to the plan sponsor. Confirm whether your health insurance issuer will supply the SBC.
  1. HIPAA Certification
  • Confirm that your health plan is in compliance with any applicable EDI rules
  • Monitor whether any additional guidance is issued by HHS on the HIPAA certification requirement.
  1. Employer Shared Responsibility Rules
  • Applicable Large Employer Status
    • For each calendar month in 2018, calculate the number of full-time. A full-time employee is an employee who is employed, on average, at least 30 hours of service per week or 130 hours for the calendar month.
    • For each calendar month in 2018, calculate the number of FTEs.
    • Add the number of full-time employees and FTEs (including fractions) for each month in 2018. Add up these monthly numbers and divide by 12. Discard any fractions – if your result is 50 or more, you are likely an ALE for 2019.
    • Does my organization qualify for the special exception for employers with seasonal workers?
    • Use the monthly measurement or look-back method to confirm health coverage will be offered to all full-time employees and their dependents.
    • To use the look-back method, select your measurement, administrative and stability periods.
  • Applicable Penalties
    • Review the cost of your health plan coverage to determine affordability for employees using one or more of the affordability safe harbors
    • Determine whether the plan provides metal levels (MVs) by using one of the four available methods
    • Determine whether any penalties apply under these rules.
  1. Reporting of Coverage
  • Forms Used for Reporting
  • ALEs that sponsor self-insured plans must report under Section 6055 about MEC provided health insurance issuers
  • ALEs that sponsor self-insured plans must supply information under Section 6056 about offers of health coverage
  • ALEs that sponsor insured plans bust report information under Section 6056 but not under 6055.
  • Non-ALEs that sponsor self-insured plans must report information under 6055 but not under 6056.
  • Non-ALEs that sponsor insured plans are not required to report under 6055 or 6056.
  • Under both sections 6055 and 6056, a separate statement for each individual and a single transmittal form must be filed.
  • Under Section 6055, one Form 1094-B and a separate Form 1095 must be filed for each responsible individual with the IRS.
  • Under Section 6055, a copy of Form 1095-B must be furnished to each individual, and a copy of Form 1094-B and Form 1095-C must be filed for each full-time employee with the IRS.
  • Under Section 6056 a copy of Form 1095-C must be furnished to each individual.
  • For both Sections 6055 and 6056, one Form 1094-C and 1095 for each full-time employee and responsible individual must be filed with the IRS.
  • For both Sections 6055 and 6056 a copy of Form 1095-C must be furnished to each individual.
  • Electronic Reporting
    • Any employer required to file at least 250 returns under Section 6055 or 6056 must file electronically
  • Penalties
    • A reporting entity that fails to comply with Section 6055 or 6056 may be subject to penalties.
    • Identify which reporting requirements apply to you and your health plans.
    • Determine the information you will need for reporting and coordinate internal and external resource to help compile the data.
    • Complete the appropriate forms.
  1. Employee Notice of Exchange
  • Ensure the Exchange notice is provided to all new hires at the time of hiring.
  • Customize the appropriate model Exchange notice.
  • Verify that the customized notice has been provided to all current employees.
  • Verify that the customized notice has been given to all new employees when hired.

Please contact Lanier Upshaw here for assistance if you have questions about Affordable Care Act changes for 2019.