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Showing posts from January, 2024

January 2024 Benefits Buzz: Group Health Plans and ACA Reporting

Group health plans must expand price comparison tool for 2024 Beginning this year, group health plans and health insurance issuers must expand the online price comparison tool they make available to participants, beneficiaries and enrollees so that it includes all covered items, services and drugs. This tool provides consumers with real-time estimates of their cost-sharing liability from different providers for covered items and services, so they can shop and compare prices before receiving care. For plan years beginning on or after Jan. 1, 2023, health plans and issuers were required to make price comparison information available for 500 shoppable items, services and drugs. For plan years beginning on or after Jan. 1, 2024, price comparison information must be available for all covered items, services and drugs. Most employers rely on their issuers or third-party administrators to develop and maintain the price comparison tool. Employers should confirm that their issuers and TPAs wil

Section 125 – Cafeteria Plans Overview

A Section 125 plan, or cafeteria plan , allows employees to pay for certain benefits on a pre-tax basis. Employers use these plans to provide their employees with a choice between cash and certain qualified benefits without adverse tax consequences. Paying for benefits on a pre-tax basis reduces the employee’s taxable income and, therefore, reduces both the employee’s and the employer’s tax liability. To receive these tax advantages, a cafeteria plan must comply with the rules of Section 125 of the Internal Revenue Code and related IRS regulations. Under these rules, a Section 125 plan must have a written plan document and can only offer certain qualified benefits on a tax-favored basis. Once an employee makes a Section 125 plan election, they may not change that election until the next plan year, unless the employee experiences a permitted election change event. Also, for highly compensated employees to receive the tax advantages associated with a Section 125 plan, the plan must pass

Wrap Documents for Welfare Benefit Plans

As an employer, you may be asking yourself, “What is a wrap document, and why is it important?” Before we get into the full definition, let’s review the history behind wrap documents to better understand how they originated and why they’re important. The federal Employee Retirement Income Security Act of 1974 set minimum standards for employee benefit plans maintained by private-sector employers. Under ERISA, employer-sponsored welfare benefit plans, such as group health plans, must be described in a written plan document. In addition, employers must explain the plans’ terms to participants by providing them with a summary plan description. The insurance certificate or benefit booklet provided by an insurance carrier or other third party for a welfare benefit plan typically does not satisfy ERISA’s content requirements for plan documents and summary plan descriptions. However, employers may use wrap documents in conjunction with the insurance certificate or benefit booklet to satisfy E

The 2024 ACA pay or play penalty will increase: What to know

  The IRS has updated penalty amounts for 2024 related to the employer shared responsibility (pay or play) rules under the Affordable Care Act. For calendar year 2024, the adjusted ACA pay or play penalty amounts increased as follows: $2,000 penalty amount is now $2,970; and $3,000 penalty amount is now $4,460. Pay or play penalty calculations Under ACA pay or play rules, an applicable large employer is only liable for a penalty if at least one full-time employee receives a subsidy for exchange coverage. Employees who are offered affordable, minimum value coverage are generally not eligible for these exchange subsidies. Depending on the circumstances, one of two penalties may apply under the pay or play rules: the  4980H(a) penalty  or the  4980H(b) penalty . Under Section 4980H(a), an applicable large employer will be subject to a penalty if it does not offer coverage to “substantially all” (generally, at least 95%) of its full-time employees (and dependents) and any one of its full-t