Benefits Open Enrollment 2019: What You Need to Know

From ChamberChoice

Open enrollment can be a complicated process, especially if decisions surrounding the employee benefits plan selections are delayed. To make matters more interesting, there are legal changes affecting the design and administration of benefits for plan years beginning on or after Jan. 1, 2019, says Aaron Ochs, managing consultant at JRG Advisors.

In addition, if any changes are made to your company’s health plan benefits for the 2019 plan year, those changes should be communicated to plan participants through an updated Summary Plan Description or a Summary of Material Modifications. Employers should confirm that open enrollment materials contain the required participant notices, when applicable. Some participant notices also must be provided annually or upon initial enrollment.

With the assistance of a knowledgeable benefits professional, employers should thoroughly review plan documents to confirm they include any required changes in adherence to the Affordable Care Act (ACA).

Smart Business spoke with Ochs about a few important plan design considerations to carefully review at open enrollment.

What’s important to understand about grandfathered status, the ACA affordability standard and out-of-pocket maximums?

Grandfathered plan status — If an employer has a grandfathered plan, it needs to determine whether it will maintain its grandfathered status for the 2019 plan year. A grandfathered plan’s status affects its ACA compliance obligations from year to year. If an employer’s plan will maintain its grandfathered status, then the Notice of Grandfathered Status should be provided in the open enrollment materials. If the plan is losing its grandfathered status, the employer should confirm that the plan includes all of the additional patient rights and benefits required by the ACA.

ACA affordability standard — Currently under the ACA, an applicable large employer’s health coverage is considered affordable if the employees’ required contribution does not exceed 9.5 percent of their household income for the taxable year. For plan years that begin on or after Jan. 1, 2019, the affordability percentage is 9.86 percent. Employers should ensure that at least one of the health plans offered satisfies the ACA’s affordability standard. Since the percentage increases from 2018, employers could have additional flexibility to increase the employee share of the premium while still avoiding a penalty under the pay or play rules.

Out-of-pocket maximum — Employers should review the out-of-pocket maximum of their health plan to ensure that it complies with the ACA’s limits for the 2019 plan year. The limits for 2019 are $7,900 for self-only coverage and $15,800 for family coverage.

It is important to remember that a high deductible health plan (HDHP) must be compatible with a health savings account (HSA), and the out-of-pocket maximum must be lower than the ACA’s limit. The out-of-pocket maximum for HDHPs beginning in 2019 is $6,750 for self-only coverage and $13,500 for family coverage.

If the employer’s plan utilizes multiple service providers to administer benefits, it should ensure that the plan coordinates all claims for essential health benefits across the plan’s service providers, or that the plan divides the out-of-pocket maximum across the categories of benefits, with a combined limit that does not exceed the maximum for 2019.

How are the HDHP and HSA limits changing?

The IRS limits for HSA contributions and HDHP cost sharing are increasing for 2019. The HSA contribution limit increases from $3,450 to $3,500 effective Jan. 1, 2019. Effective for plan years beginning on or after Jan. 1, 2019, the HDHP maximum out-of-pocket limit increases from $6,650 to $6,750 for self-only coverage and from $13,300 to $13,500 for family coverage. Employers should review their HDHP’s cost sharing limits and determine if an adjustment is required to meet the 2019 limits

If an employer communicates HSA contribution limits to its employees as part of the open enrollment process, the enrollment materials should be updated to reflect the increased limits that apply for 2019.

Workers’ Comp Fix Signed Into Law

From PA Chamber of Business & Industry

In welcome news for the state’s business community, one of the PA Chamber’s top priorities this session – legislation that will save employers hundreds of millions of dollars a year – was signed by Gov. Tom Wolf last week.

Act 111 of 2018 (formerly H.B. 1840) addresses last year’s financially detrimental state Supreme Court decision in the Protz v. Workers’ Compensation Appeals Board case.  In Protz, the PA Supreme Court removed Impairment Rating Evaluations from the law, which for more than 20 years has provided a structured process for state-designated physicians to determine a patient’s level of impairment and how long wage-loss benefits should be paid. As a result of the ruling, the Pennsylvania Compensation Rating Bureau took the unprecedented action of filing for a mid-year loss cost increase, which industry experts are conservatively estimating is costing employers upwards of $300 million each year.

At the time of the Protz decision, the PA Chamber warned its members that the cost increase would be coming while also advocating for legislation to address the Court’s concerns.  Act 111 updates IRE-related language in the law to address the issues raised by the Supreme Court and requires the PCRB to file a loss cost decrease, which will spare employers from being forced into paying significantly higher insurance costs.

After the governor signed the bill, PA Chamber President Gene Barr issued a statement applauding his action. “This measure will go a long way to reining in future excessive workers’ comp costs related to the Supreme Court’s decision last year,” Barr said.  “We also commend the General Assembly – particularly House Labor and Industry Committee Chair Rob Kauffman and Senate Labor and Industry Committee Chair Kim Ward – for working in quick order to find a legislative solution to address the Court’s concerns.”  

Pursuing Health Insurance Options for Members

Gene Barr, President of the PA Chamber of Business & Industry; Bob Carl, Jr. , Chair of the Pennsylvania Association of Chamber Professionals; and Maggie Sheely, Manager, Great Lakes Region, U.S. Chamber of Commerce, discussed opportunities for offering association health plans in Pennsylvania at a statewide chamber conference held in mid-October in Schuylkill County.

In June, the U.S. Department of Labor (DOL) issued a rule that allowed small businesses to once again band together for health insurance. However, Pennsylvania was one of 12 states that has thrown a bucket of cold water on the opportunity for chambers, and other associations, to offer lower-cost options for members. Organizations at the state and federal levels are working together to challenge these states in implementing association health plans.

The DOL tweaked the ERISA definition of “employer” to include “employer association.” This allows a group of small businesses to be treated as a single, large group in pursuing health insurance options that are more flexible than marketplace plans that must comply with the Affordable Care Act. In anticipation of this rule change, the Chamber’s benefits partner, ChamberChoice, had been in discussions with several health insurance providers about again offering health insurance options.

Attorneys general from eleven states and the District of Columbia filed suit against the DOL claiming the rule violated federal procedure. Pennsylvania Insurance Commissioner Jessica Altman also sought clarification from the Federal government on states’ ability to regulate health insurance and expressed concern over “sham” health insurance offerings. As DOL confirmed that states retain the right to regulate insurance, Altman maintains that Pennsylvania’s regulations, which closely mirror the Affordable Care Act, provide necessary protection for individuals. Most health insurance companies have not pursued association health plan discussions following the state’s positioning.

While Pennsylvania’s position on association health plans could change with a new governor, state and federal associations are not sitting on their hands. The Pennsylvania Chamber of Business and Industry and national associations are attempting to demonstrate to state policymakers that association health plans had been offered responsibly and are seeking flexibility in plan requirements. The Columbia Montour Chamber is supporting these efforts with the goal of offering cost-effective health insurance options for members.

Are You Ready For ACA Reporting? Prepare Now For January 2019 Deadline

Last year saw multiple frantic efforts in Congress to change or eliminate many provisions of the Affordable Care Act. The results were mixed.

Individual mandate to expire in 2019.
Beginning January 1, 2019, there will no longer be a penalty on individuals who fail to maintain “minimum essential coverage.”

Employer mandate remains in force.
Applicable large employers (generally speaking, that means a single employer or group of related employers with over 50 employees between them during the previous year) are still required to offer qualifying coverage to their full-time employees in 2018 and beyond, or pay significant penalties.

The “A” Penalty. Applicable large employers who fail to offer coverage to at least 95% of their full-time employees will pay a penalty in 2018, calculated based on the total number of full-time employees (minus a 30 employee allowance) multiplied by $2,320.

The “B” Penalty. A separate penalty applies to applicable large employers who offer coverage, but that coverage is not affordable or does not provide minimum value. This penalty is assessed at $290 per month for each employee who receives a premium tax credit (or other Marketplace subsidies) and is not offered affordable coverage providing minimum value.

What is minimum value? Minimum value means that the coverage is actuarially valued to provide at least 60% of the total cost of medical services to a population.

Large employers still required to submit Forms 1094-C and 1095-C.
Along with the mandate to offer coverage, applicable large employers also need to continue filing the 1094-C and 1095-C reports to the IRS. These employers also need to provide the 1095-C to full-time employees. The deadlines for these reports are:

• Jan. 31 to mail the 1095-C to employees (although a 30-day extension has been granted in prior years)
• Feb. 28 to file the 1094-C and 1095-C forms (if mailing paper returns)
• March 31 to file 1094-C and 1095-C forms (if filing electronically).

Failure to meet these reporting deadlines can result in penalties of $260 per failure to file, and another $260 for failure to mail the report to full-time employees. So employers could pay up to $520 per full-time employee if they do not mail and file the forms as required.

What About Small Employers?
The “employer mandate” to offer coverage only applies to applicable large employers. However, smaller employers who provide self-funded medical coverage (including level-funded plans) also need to file form 1094-C and 1095-C for each covered individual on the plan, and mail a 1095-C report to each covered individual.

Is the IRS Enforcing Penalties?
Beginning last fall, the IRS started issuing penalty notices (known as Letter 226J) to employers whose 1094-C and 1095-C reports showed they owe either the “A” or “B” penalty under the tax code. Employers who receive a 226J letter must respond within 30 days in order to disagree with the penalty, or they will receive a tax bill for the full amount. Other letters have been sent to employers who were required to file, but failed to file, the 1094-C and 1095-C form.

What Should I Do Now?
All employers should be able to answer the following questions:

1. Is our organization an applicable large employer or part of a group of employers that together qualify as an ALE?
2. If so, do we offer affordable coverage to all full-time employees and does that coverage provide minimum value?
3. Are we correctly reporting these offers of coverage on the 1094-C and 1095-C forms and issuing the 1095-C forms to all full-time employees?
4. For small employers, are we offering self-funded (or level funded) medical benefits and if so, are we correctly and timely filing the 1094-B and 1095-B forms and issuing the 1095-B to all covered individuals?

If you are not sure of the answer to any of these questions, please contact your JRG employee benefit advisor for more information! We will be happy to help answer your questions and help you come up with a plan to make sure you are in compliance with the ACA.


Listening Sessions to Gauge Public Input About Regional Transportation Services

Transportation planners from the SEDA-COG and Williamsport Metropolitan Planning Organization (MPO) areas will be holding three listening sessions this fall to hear from the public about transit and transportation service needs and issues.

These sessions are an opportunity for residents who do not drive or who rely on transportation services to speak directly with planners about service gaps, scheduling issues, delays, reliability, affordability issues and other concerns. When one or more of these issues gets in the way of reaching jobs, medical appointments, food stores, pharmacies and other services, our region falls short.

Understanding who is affected—whether seniors, minorities, low-income individuals, people with disabilities, individuals with limited English language skills or even the general public—will help quantify needs and prioritize areas of improvement.

Three sessions have been scheduled to hear from residents in Clinton, Columbia, Juniata, Lycoming, Mifflin, Montour, Northumberland, Snyder and Union counties. 


Session #1:         Tuesday, Oct. 30, 2018, 1pm – 4pm  
Union-Snyder Community Action Agency
713 Bridge Street, Suite #10, Selinsgrove, PA 17870

Session #2:         Thursday, Nov. 1, 2018, 2pm – 5pm
River Valley Trade and Transit Center II
144 W 3rd Street, Williamsport, PA 17701

Session #3:         Monday, Nov. 5, 2018, 1pm – 4pm
Geisinger’s Justin Drive Office Building #2 (behind outpatient center)
35 Justin Drive, Danville, PA, 17821         

Each three-hour session is designed for people to drop in and stay as long as they prefer to share their needs and concerns about transportation services. Each facility is accessible and has convenient parking. Caregivers, advocates and service agencies are also welcome to attend.

Those not able to attend a listening session in person are encouraged to participate in an online survey by Oct. 29.