Benefits Buzz – IRS Changes Family Coverage Affordability Rules
On Oct. 11, 2022, the IRS released a final rule that changed the premium tax credit (PTC) eligibility rules for family members. This change is effective for taxable years beginning after Dec. 31, 2022.
The PTC is available to eligible individuals who purchase health insurance coverage through an Exchange. Individuals are not eligible for the PTC if they have access to employer-sponsored health coverage that is affordable and provides minimum value.
Effective for 2023, the final rule changes the PTC rules for determining whether employer-sponsored coverage is affordable for family members. Currently, this determination is based on the lowest-cost self-only coverage available to the employee. Under the final rule, an employer-sponsored plan is affordable for family members if the portion of the annual premium the employee must pay for family coverage (the employee’s required contribution) does not exceed 9.5% (as adjusted annually) of household income.
Benefits Buzz – Medicare Part D Notices Due Before Oct. 15, 2022
Each year, Medicare Part D requires group health plan sponsors to disclose whether the health plan’s prescription drug coverage is creditable to individuals eligible for Medicare Part D and the Centers for Medicare and Medicaid Services (CMS).
Plan sponsors must provide the annual disclosure notice to Medicare-eligible individuals before Oct. 15, 2022—the start date of the annual enrollment period for Medicare Part D. CMS has provided model disclosure notices for employers to use.
Medicare beneficiaries who do not have creditable prescription drug coverage and do not enroll in Medicare Part D when first eligible will likely pay higher premiums if they enroll at a later date. Although no specific penalties are associated with the notice requirement, failing to provide the notice may be detrimental to employees.
Benefits Buzz – ACA Pay or Play Penalties Increase for 2023
On Aug. 16, 2022, the IRS updated its FAQs on the Affordable Care Act’s (ACA) employer shared responsibility (pay or play) rules to include updated penalty amounts for 2023. The adjusted $2,000 penalty amount is $2,880 and the adjusted $3,000 penalty amount is $4,320.
Pay or Play Penalty Calculations
An applicable large employer (ALE) 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 subsidies.
Benefits Buzz – Federal Guidance on Reproductive Health Care
In the wake of the Supreme Court’s ruling allowing states to regulate abortion, federal agencies have been issuing new guidance focused on reproductive health care.
HIPAA Guidance
New guidance addresses covered entities’ obligation under the HIPAA Privacy Rule to safeguard patients’ protected health information (PHI) related to reproductive health care, including abortions. It focuses on health care providers but refers to covered entities, including health plans.
Benefits Buzz – DOL Guidance on FMLA and Mental Health Conditions
The Department of Labor’s (DOL) Wage and Hour Division has released new resources on workers’ rights to leave for mental health conditions under the Family and Medical Leave Act (FMLA). The DOL said it published the new guidance in recognition of Mental Health Awareness Month.
- New DOL Fact Sheet and FAQs
- Mental Health as a Serious Health Condition
- HIPAA Guidance on Audio-only Telehealth
Benefits Buzz – HSA/HDHP Limits Increase for 2023
On April 29, 2022, the IRS released Revenue Procedure 2022-24 to provide the inflation-adjusted limits for health savings accounts (HSAs) and high deductible health plans (HDHPs) for 2023. The IRS is required to publish these limits by June 1 of 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.
Benefits Buzz – IRS Suspends Notices to Delinquent Filers of Some Returns
On March 22, 2022, the IRS announced it will temporarily stop sending written notices to certain entities that fall behind on filing obligations related to Forms 5500, 990 and others. The IRS usually mails these notices to tax-exempt or governmental entities in case of a delinquent return. The suspension does not relieve entities of any filing deadlines or obligations.
Affected Notices
The suspension applies to these notices:
- Reminder Notice About Your Form 5500-EZ or 5500-SF Filing Requirement
- Form 940 Not Required—Federal, State and Local Government Agencies
- First Taxpayer Delinquency Investigation Notice—Forms 990/990EZ/990N, 990PF, 990T, 5227, 1120-POL and 990/990EZ
- First Delinquency Notice—Forms 5500 and 5500-SF
- Second Delinquency Notice—Form 5500
Client and Employee Resources
The more your employees understand your benefit plans the more they become educated, empowered consumers. The programs you provide will also gain an enhanced value.
As your strategic partners in employee benefits, we can provide multiple avenues of ongoing support, including:
- Employee Meetings (English and Spanish)
- Webcasts
- Payroll Stuffers
- Poster Campaigns
- Newsletters
Carrier Directories
E-Verify is a web-based system that allows enrolled employers to confirm the eligibility of their employees to work in the United States. Click the image below to begin.
