Welcome to the December 2024 edition of Benefits Buzz ! In this issue, we dive into the latest topics related to employee benefits, wellness programs and ever-evolving workplace dynamics. Stay informed and gain insights that help you make the most of your benefits package.  This month's highlights  Topic #1: A brief breakdown of IRS employee benefit plan limits for 2025.  Topic #2: Federal agencies seek to expand coverage for OTC contraceptives under Notice 2024-75, which could impact high-deductible health plans and issuers.   [Download the Full Story PDF]   Stay informed, stay empowered and make the most of your benefits with Benefits Buzz! Be sure to follow us on LinkedIn for monthly updates and never miss out on the latest in benefits news.  Questions?  If you have questions, contact TruePlan . Our team of advisors can help you with questions within the scope of employee benefits .    Read our last Benefits Buzz on ACA reportin...

Welcome to the November 2024 edition of Benefits Buzz! This month, we dive into the latest topics related to Affordable Care Act (ACA) reporting for 2024 and updates on the IRS. Stay informed and gain insights that help you navigate new regulations and changes.  This month's highlights  Topic #1: ACA final forms and instructions for 2024 are now available.  Topic #2: IRS releases health FSA limits for 2025.  Download the full story  For an in-depth look at this month's topics, download the PDF below. Don't miss out on valuable insights regarding important 2024 forms and 2025 increases.  [Download the Full Story PDF]   Stay informed, stay empowered and make the most of your benefits with Benefits Buzz! Be sure to follow us on LinkedIn for monthly updates and never miss out on the latest in benefits news.  Have questions?  If you have questions, feel free to contact TruePlan . Our team of advisors can help you with questions within the scope ...

Welcome to the October 2024 edition of Benefits Buzz! In this blog post, we dive into the latest topics related to the IRS and the Affordable Care Act (ACA). We also examine the Mental Health Parity and Addiction Equity Act (MHPAEA) final rule.  This month's highlights  Highlight #1: On Sept. 6, the IRS released the affordability percentage threshold for 2025 plan years under the Affordable Care Act’s (ACA) pay-or-play rules.  Highlight #2: On Sept. 9, DOL, Health and Human Services and the Treasury Departments released a final rule to strengthen the requirements of the Mental Health Parity and Addiction Equity Act (MHPAEA).  Download the full story  For an in-depth look at this month's highlights, download the PDF below.   [Download the full story]   Stay informed, stay empowered and make the most of your benefits with Benefits Buzz! Be sure to follow us on LinkedIn for monthly updates and never miss out on the latest in benefits news.   ...

The U.S. Department of Labor (DOL) released a new model employer Children’s Health Insurance Program (CHIP) notice with information that is current as of July 31 .   Under the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), employers maintaining group health plans in states that provide premium assistance subsidies under a Medicaid plan or a CHIP plan must send employees an annual notice.   An employer can choose to provide the notice on their own or concurrent with the furnishing of:   materials notifying the employee of health plan eligibility;  open enrollment materials; and  the summary plan description.  An employer is subject to this annual notice requirement if their group health plan covers participants who reside in a state that provides a premium assistance subsidy, regardless of the employer’s location.   Employers may use the DOL’s model notice for this disclosure. DOL updates the model notice periodicall...

The 5th U.S. Circuit Court of Appeals recently  ruled  that a key component of the Affordable Care Act’s (ACA) preventive care mandate is unconstitutional. However, in a decision it referred to as a “mixed bag,” the 5th Circuit limited its ruling to the plaintiffs in the case, a small group of individuals and businesses from Texas.  The ACA requires non-grandfathered health plans and issuers to cover a set of recommended preventive services without imposing cost-sharing requirements, such as deductibles, copayments or coinsurance, when the services are provided by in-network providers.  5th U.S. Circuit Court of Appeals decisions  In March 2023, the U.S. District Court for the Northern District of Texas struck down a key component of the ACA’s preventive care mandate as unconstitutional and issued a nationwide injunction against its enforcement. This decision involved a wide range of preventive care services, such as cancer screenings and medications for chronic...

HSA/HDHP limits will increase for 2025  On May 9, the IRS released Revenue Procedure 2024-25 to provide the inflation-adjusted limits for health savings accounts and high-deductible health plans for 2025. The IRS is required to publish HSA/HDHP limits by June 1 each year. These limits include:  the maximum HSA contribution limit;  the minimum deductible amount for HDHPs; and  the maximum out-of-pocket expense limit for HDHPs.  These limits vary based on whether an individual has self-only or family coverage under an HDHP.  Eligible individuals with self-only HDHP coverage will be able to contribute $4,300 to their HSAs in 2025, up from $4,150 in 2024. Eligible individuals with family HDHP coverage will be able to contribute $8,550 to their HSAs in 2025, up from $8,300 in 2024. Individuals age 55 or older may make an additional $1,000 “catch-up” contribution to their HSAs.  The minimum deductible amount for HDHPs increases to $1,650 for self-only cover...

DOL releases ERISA enforcement results for 2023  The U.S. Department of Labor released the results of the Employee Benefits Security Administration’s enforcement actions for fiscal year 2023.  Through its enforcement of ERISA, EBSA oversees approximately 2.8 million health plans, 765,000 pension plans and 619,000 other welfare benefit plans. According to the audit, these plans cover 153 million workers, retirees and dependents.  In FY 2023, EBSA recovered over $1.4 billion for plans, participants and beneficiaries. Other key enforcement results include:  EBSA closed 731 civil investigations. Of these, 69% resulted in monetary results for plans or other corrective actions.  EBSA referred 50 cases for civil litigation and closed 196 criminal investigations.  EBSA’s criminal investigations led to the indictment of 60 individuals for offenses related to employee benefit plans. This included plan officials, corporate officers and service providers.  EBSA’s...

IRS releases ACA pay –or play penalties for 2025  The IRS recently updated  “pay or play” penalty amounts for 2025 related to the Affordable Care Act’s employer shared responsibility rules.   For calendar year 2025, the annually adjusted $2,000 penalty amount is $2,900 and the adjusted $3,000 penalty amount is $4,350 . This is a decrease from the penalty amounts for the 2024 calendar year, which are $2,970 and $4,460, respectively.  Under the 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 Section 4980H(a) penalty or the Section 4980H(b) penalty:  Under Section 4980H(a) an applicable large employer will be subject to a penalty if it does ...

Approaching ACA reporting deadlines for 2024   Employers subject to Affordable Care Act reporting under Internal Revenue Code Sections 6055 or 6056 should prepare to comply with the upcoming ACA 2024 reporting deadlines. For the 2023 calendar year, covered employers must: furnish paper statements to individuals by March 1, 2024; and file paper returns with the IRS by Feb. 28, or April 1 if filing electronically. Beginning in 2024, employers who file at least 10 returns during the calendar year must file electronically. Penalties may apply if employers are subject to ACA reporting and fail to file returns and furnish statements by the applicable deadlines. The following employers are subject to ACA reporting under Sections 6055 and 6056: employers with self-insured health plans (Section 6055 reporting); and applicable large employers with either fully insured or self-insured health plans (Section 6056 reporting). ALEs are employers with 50 or more full-time employees (includin...

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...

The IRS released the final 2023 forms and instructions for reporting under Internal Revenue Code Sections 6055 and 6056: 2023 Forms 1094-B and 1095-B (and instructions ) will be used by those offering minimum essential coverage, including self-insured plan sponsors that are not applicable to large employers, to report under Section 6055. 2023 Forms 1094-C and 1095-C (and instructions ) will be used by applicable large employers to report under Section 6056, as well as for combined Section 6055 and 6056 reporting by ALEs that sponsor self-insured plans. No major substantive changes were made to the final forms and instructions for 2023 reporting. However, the 2023 instructions include information on the new electronic filing threshold for information returns required to be filed on or after Jan. 1, 2024, which has been decreased to 10 or more returns (originally, the threshold was 250 or more returns). Employers should become familiar with these forms and instructions for 2023 calen...

Deadline for Medicare Part D notices is Oct. 15 Each year, Medicare Part D requires group health plan sponsors to disclose whether the health plan’s prescription drug coverage is creditable to eligible individuals. Plan sponsors must provide the annual disclosure notice to Medicare-eligible individuals before Oct. 15 — the start date of the annual enrollment period for Medicare Part D. The Centers for Medicare and Medicaid Services has provided model disclosure notices for employers to use. Notice requirement Medicare beneficiaries will likely pay higher premiums if they enroll at a later date if they: do not have creditable prescription drug coverage; and do not enroll in Medicare Part D when first eligible. Although no specific penalties are associated with the notice requirement, failing to provide the notice may be detrimental to employees. Employers should confirm whether their health plans’ prescription drug coverage is creditable or non-creditable and prepare to send their Medi...

2024 Open Enrollment: 3 Preparation Strategies With the 2024 open enrollment season fast approaching, employers have an opportunity to develop attractive benefits offerings and proactively communicate with employees. Early preparation can help show employees they’re valued, convince top performers to stay in their current positions and attract new talent. Consider these three strategies to prepare for 2024 open enrollment: 1. Tailor benefits offerings Benefits offerings are one of the top reasons employees join companies and stay at their jobs. That’s why it’s critical for employers to speak with employees about which perks provide the most value. Adding or tweaking a few benefits options could be the difference between retaining and losing top performers. 2. Determine key messaging Benefits communications should account for employees’ desire to feel safe. Thus, key messaging should demonstrate how workplace offerings can protect employees. Outlining different benefits offerings can he...

  FDA approves OTC daily oral contraceptive; IRS issues draft forms for ACA reporting FDA approves first over-the-counter daily oral contraceptive On July 13, the U.S. Food and Drug Administration approved the first nonprescription daily oral contraceptive to prevent pregnancy. This drug is expected to become available to consumers without a prescription from stores and online retailers in early 2024. Insurance coverage The Affordable Care Act requires most group health plans and health insurance issuers to provide first-dollar coverage of certain specified preventive services for women, including all FDA-approved contraceptives, as prescribed by a healthcare provider. The ACA’s contraceptive coverage mandate does not cover over-the-counter oral contraceptives that are obtained without a prescription. It is possible that the Biden administration or Congress will take action to expand insurance coverage of over-the-counter oral contraceptives. In the meantime, employers should revi...

The 5th U.S. Circuit Court of Appeals has issued a stay of enforcement of a lower court’s ruling in  Braidwood Management Inc. v. Beccara . In  Braidwood , the lower court vacated a key portion of the Affordable Care Act’s preventive care coverage requirement.  In this issue, let’s get into what the court’s reinstatement of the ACA’s preventive care mandate means. We’ll also look at another ACA insurance-related topic: Patient-Centered Outcomes Research Institute fees. The ACA Preventive Care Mandate Explained  The ACA requires most health plans and health insurance issuers to cover a set of preventive services without imposing cost-sharing requirements when the services are provided by in-network providers. Among these are evidence-based items or services that have a rating of A or B in the current recommendations of the U.S. Preventive Services Task Force. In  Braidwood , the lower court ruled that preventive care coverage requirements based on an A or B ratin...