Mid-Year Compliance Review

From ChamberChoice

Late June begins the start of summer and thoughts turn to those lazy-hazy days of just relaxing. When it comes to the matter of compliance though, 2017 is not the time to “just kick back” and see what happens. In July, many employers will start to review their past compliance efforts and begin to look forward to the new employee benefit plan year. The following discusses some of the issues that employers should continue to monitor for the rest of the year.


Affordable Care Act

Under the Affordable Care Act (ACA) an Applicable Large Employer (ALE) is required to offer minimum essential coverage that is affordable and provides minimum value. Known as the employer mandate, an employer could be penalized if the employer fails to offer any coverage – whether “affordable” or not – to at least 95% of its full-time employees, (and their dependents) and at least one full-time employee enrolls in subsidized coverage on the Exchange. The penalty for 2017 is $2,260 (annualized) or $183.33 monthly multiplied for every full-time employee in the employer’s company, reduced by the first thirty full-time employees.

On the other hand, if an ALE does offer coverage to at least 95% of its full-time employees (and dependents), but the coverage is not affordable, then the employer will be subject to a penalty of $3,390 (annualized) or $282.50 monthly multiplied by just the number of those specific full-time employees to whom affordable coverage was not offered and who are receiving subsidized coverage on the Exchange during that month.

The affordability percentage is indexed and, as such, has gradually increased reaching 9.69% in 2017. However, 2018’s limit will decrease to 9.56%.

To assist with the enforcement of the employer mandate, ALEs are required to report offers of health coverage and enrollment in health coverage for their employees. Forms 1094-C and 1095-C are used by ALEs to report this information to the IRS. The “C” forms assist the IRS in determining an ALE’s compliance with the employer mandate and the eligibility of employees for the premium tax credit.

Upon the inauguration of President Trump and his signing of two Executive Orders, many employers erroneously believe that the ACA is no longer applicable. The IRS has given no indication that it is planning to not enforce the employer mandate, so an employer should proceed as if penalties for noncompliance will be issued.

The ACA is still in effect and actions need to be taken accordingly. Unless and until any legislation is finalized, stay the current course, and continue to comply with ACA employer mandate and reporting requirements as if nothing has changed.

To that end, employers should review their compliance with the Affordable Care Act:
• Determine whether the employer is or is not an Applicable Large Employer by reviewing to see if they had 50 or more full-time or full-time equivalent employees in 2016.
• If an ALE, ensure that in 2017 affordable, minimum value coverage is being offered to full-time employees and dependents (a full-time employee is one who works on average 30 hours a week).
• Continue to gather data as to what full-time employees have been offered coverage, accepted or waived it and whether coverage was affordable for the purpose of 1095-C and 1094- C reporting.

As a final note, in late June the Senate proposed its efforts to repeal and replace significant provisions of the Affordable Care Act, released a draft of the Better Care Reconciliation Act of 2017 (BCRA). Although the BCRA does not repeal the individual and employer mandate, they would be effectively eliminated by making the penalties $0 for tax years starting after December 31, 2015. But as already noted, until there is a new Act in place the ACA remains effective.


Equal Employment Opportunity Commission (EEOC)

EEO-1 Report
The EEOC collects workforce data from all employers with 100 or more employees through an annual EEO-1 Report. The report, in its current form, collects data about gender, race, and ethnicity of employees by 10 different job groupings. In 2016 the EEOC revised the form in order to begin requiring employers to provide employee pay data.

This new information must be provided in the 2017 form, and to give employers time to collect that data, the deadline for 2017 will be extended by six months to March 31, 2018.

The EEOC’s goal in gathering this additional data is to identify businesses that may have pay gaps, and then target those employers who are discriminating on the account of gender—and possibly race or ethnicity—through enforcement actions. The EEOC plans to publish reports using aggregated data and to train its investigators to identify potential indicators of discrimination warranting additional investigation.

Thus, it would be in the best interest of those applicable employers to take the following action steps:
• Review pay practices to address and correct any areas of pay disparity based on gender or race/ethnicity before reporting to the EEOC;
• Review and if necessary revise job descriptions in order to determine which of the EEO-1 job categories each position should be reported under;
• Consider any time requirements and costs for data collection in order to generate the necessary reports; and
• Ensure proper understanding of how employees earn overtimes, bonuses, commissions and other W-2 box 1 wages.

Wellness Programs
Generally a “wellness program” refers to a program or activity to encourage employees to improve their health, thereby reducing overall healthcare costs. Programs run the spectrum of encouraging healthier lifestyles, such as exercising daily or stop smoking to obtaining medical information through the completion of health risk assessments or screenings for health risk factors. Financial incentives generally are offered to employees who participate or achieve certain health outcomes.

In 2016, the Equal Employment Opportunity Commission (EEOC) issued final rules applicable to employer-sponsored wellness programs as they relate to the American with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA). These final rules are applicable to employer plan years beginning on or after January 1, 2017.

Besides the ADA and GINA, employer-sponsored wellness programs can be subject to other federal laws, including the Employee Retirement Income Security Act (ERISA) and the Health Insurance Portability and Accountability Act (HIPAA). It should be noted that compliance with one law does not guarantee compliance with other laws.

Any wellness program that includes a disability-related inquiry and/or medical exam is subject to this rule. The ADA rule provides the extent to which an employer may use incentives to encourage participation in wellness programs that require a response to a disability related inquiry or to undergo a medical examination. These inquiries or medical examinations include medical questionnaires, health risk assessments (HRAs), and biometric screenings. The incentive limits imposed by the ADA final rule are applicable to all wellness programs regardless of whether offered only to employees enrolled in the employer sponsored health plan, all employees regardless of enrollment in the group health plan, or offered as a stand-alone benefit without any group health plan coverage.

An employer’s wellness program is required to be voluntary. Voluntary means an employer cannot:
• Require an employee to participate in the program;
• Deny coverage under the employer’s group health plan or limit coverage under the plan for employees not participating in the wellness program; and
• Take any adverse action, retaliate against, or coerce employees who choose not to participant.

The regulations provide a notice requirement to employees and guidelines on incentive limitations under both the ADA and GINA, and were effective for plan years beginning on or after January 1, 2017.

Employers should take the time to review their benefit programs and identify any wellness program it may be offering in 2017. It could be an employer is inadvertently offering a wellness program that is included as part of a benefits option offered by its insurer. Thus, employers should take the following into consideration:
• Is the wellness program reasonably designed to promote health or prevent disease?
• Are employees required to answer any disability related questions or have medical examinations to which the ADA would apply?
• Is it ensured that participation in any wellness program is voluntary?
• Has the confidentiality of any medical condition or history information been maintained?
• Do provided incentives meet the limitations imposed by the ADA, GINA and HIPAA?
• Are reasonable accommodations being offered to disabled employees as to participation in any wellness program?
• Does any smoking cessation program require testing, such that it comes within the EEOC limitations for incentives?


JRG Advisors, which manages the ChamberChoice program, is available on a consultative basis to help assist Chamber members with compliance related issues. For more information, call 1-800-377-3539. 


Montour County Readdressing Update

The first round of readdressing notifications for the Danville zip code were mailed the week of July 3, one week later than previously expected. The second round is anticipated for the week of July 24, pending final approval by the U.S. Postal Service. All properties in Montour County as well as Rush Township and Riverside Borough in Northumberland County will receive address confirmation information. Information on the process is available at montourco.org. Specific questions can be directed to the Columbia County GIS office at 570-387-4930.

Hamilton Dental Care Holds Ribbon Cutting at New Office Building












The Columbia Montour Chamber was on hand yesterday, July 6, to help Hamilton Dental Care cut the ribbon on its new office building at 2 Audubon Court in Bloomsburg. The event included Drs. David and Joel Hamilton and members of their families; fellow Chamber member First Columbia Bank & Trust, which financed the project and ArchCentral Architects, Inc., which drew up the plans for the building; as well as representatives from Hamilton Dental’s dental supplies distributor, cabinetry contractor, builders of the facility and Scott Township. 

Following the ribbon cutting (immediately below), Dr. David Hamilton made some remarks in which he thanked all of the individuals and organizations that helped make this project possible (second video), and then led a tour of the new building for the attendees.

Members of the public can see the new facility at an Open House next Thursday, July 13, from 4:30-8 p.m. The event will feature food, prizes, as well as face painting and balloons for children. 

Risk analysis: How to identify health conditions and costs within your workforce

From ChamberChoice and Smart Business Pittsburgh Magazine

Today’s health care environment is riddled with complex plan designs and rigorous government regulations, leaving many employers to feel as though their hands are tied when it comes to unique, innovative and cost-saving solutions. There is a new strategy and technology, however, that enables small employers to identify risk, influence behavior and ultimately control costs.

Smart Business spoke with Aaron Ochs, managing consultant at JRG Advisors, which manages the ChamberChoice program, about risk analysis.

What is risk analysis?
The ability to anticipate claims or predict claims costs hasn’t been available in the small group market due to the absence of claims data from the insurance companies … until now.

Newly developed technologies include risk analysis and predictive modeling tools that make it possible to take a deeper dive into the health composition and risk factors of an employer’s workforce. For example, companies can proactively identify markers for chronic illness in order to predict health care costs and determine if a fully insured plan or alternative strategy, such as self-funding, is viable.

Why might a self-funded plan work better?
A self-funded plan differs from a fully insured plan in that it offers an employer more control over the plan. In addition, self-funding provides protection against excessive costs in years with high claims, opportunity to keep profits from favorable years and the availability of data, including claims utilization.

While self-funding is not a new concept, it is new to the smaller employer — with many insurance companies now offering level-funded premium options (a form of self-funding) to groups with as few as 10 employees.

How would a risk analysis typically work?
The deeper dive (risk analysis) begins with the collection of employee data that is captured through a custom access portal. The portal is insurance company accepted and an Affordable Care Act and Health Insurance Portability and Accountability Act compliant online benefits application tool specifically designed to reduce the amount of time, cost and paperwork for employers.

Employees are asked to complete an online enrollment interview. Once completed by employees, the employer receives a confidential de-identified aggregate report that includes an overall analysis of the employee population. This expert analysis empowers the consultants to guide the business owner through the benefit decision process with the power of knowledge.

Gaining insight into the composition and health status of the employee population means plan design decisions can be strategic rather than ‘throwing a dart blindfolded’ to find a tolerable solution.

What else do employers need to know about risk analysis?
Often, the same portal technology can reduce or eliminate many administrative burdens by providing the added support of employee enrollment, communication and plan/ election waivers. The solution is a faster and more efficient approach to benefits. This means the employer can essentially build its own health plan, which can lead to generous cost savings, greater transparency, understanding and better overall cost control.

A staggering 50 percent of the average employer’s health care budget is spent on members with preventable conditions. With the strategies and technologies that exist now, even small employers can take control of their health plans.

Talk to an advisor today to learn how risk analysis tools can guide you to the benefits strategy to fit your needs and ultimately reduce cost. JRG Advisors can be reached at 1-800-377-3539. 

Member News – July 5, 2017

Member News


Yard Sale to Benefit Ronald McDonald House of Danville

A yard sale featuring music, food vendors and raffles will benefit the Ronald McDonald House of Danville this Friday, July 7, from 9 a.m. – 5 p.m. at BAYADA Pediatrics, 2041 Columbia Blvd. (Rt. 11), Bloomsburg. It will be held in BAYADA’s front yard. All proceeds from the sale will benefit RMHD. For more information, call 570-389-1568. 


Hamilton Dental Care to Host Open House at New Office Location

Hamilton Dental Care will celebrate the recent opening of its new location at 2 Audubon Court, Bloomsburg, with an Open House on Thursday, July 13 from 4:30-8 p.m. The public is invited to bring the family for a fun night of food and prizes. Attendees can tour the new office and meet the friendly staff. Kids will enjoy face painting and balloons by The Balloon Man, Lanny Lee.  Adults can register to win a variety of prizes and baskets.  All new patients that schedule during this event will receive a 50% savings off their new patient exam.  A door prize of free whitening will also be given away to one lucky winner. 


Bucknell SBDC Hosts First Step Seminar July 12

Have you ever thought about starting your own business, but weren’t quite sure if it would be right for you? Or maybe you want to know what paperwork you need in order to open your doors? These and several other common questions for small businesses will covered at the next First Step Seminar given by the Bucknell University Small Business Development Center next Wednesday, July 12, at noon at the DeWitt Building, 3rd Floor, 416 Market St., Lewisburg. Cost is $25 and pre-registration is required. Register by calling Shelley Gadoury at 570-577-1249, email or online.


First Step Seminar in Bloomsburg July 14

An identical First Step Seminar will also be offered in Bloomsburg by the Wilkes University Small Business Development Center (SBDC) on Friday, July 14, at noon at the Downtown Bloomsburg, Inc. Business Incubator, 151 E. Main St., Bloomsburg. Laura Haden of the SBDC will speak about the different legal structures a business can be, how to write a business plan and create financial projections, and much more. Cost is $15 for the First Step book. Walk-ins are welcome but pre-registration is preferred. Register by calling 570-408-4334, email or online