News Brief: Heart Disease Is Now Second Costliest Ailment for U.S. Employers
A new report by independent stop-loss provider Sun Life revealed that cardiovascular disease rose to second place on the list of highest stop-loss claim reimbursements during 2020-23. This rise is significant, as the condition surpassed blood cancers for the first time in 12 years since the report began.
Sun Life’s annual report analyzed 60,000 stop-loss claims from a member database of 6 million people. Nearly three-quarters(72%) of all stop-loss claims came from the top 10 conditions, and 37% of claim reimbursements came from the top three conditions.
Career Elevator: Understanding the Difference Between Upskilling and Reskilling (June)
In today’s rapidly evolving job market, the terms “upskilling” and “reskilling” are becoming increasingly common. While they both involve enhancing one’s skills, they serve different purposes and require distinct approaches. For employees navigating their career paths, understanding the difference between upskilling and reskilling is crucial for making informed decisions about professional development.
Legal Update: ERISA Penalties Awarded for Failing to Respond to Request for Information on Mental Health Benefits
The U.S. District Court for the District of Montana recently awarded over $32,000 in penalties against an employer’s self-insured health plan and its third party administrator (TPA) for failing to provide information to a plan participant upon request. This case, which involved a dispute over payment for mental health benefits, highlights the importance of promptly responding to participants’ requests for plan-related information.
If these documents are not provided within 30 days of receiving the written request, the participant or beneficiary may file a lawsuit under ERISA, and a court may impose monetary penalties of up to $110 per day, beginning on the date of the failure.
News Brief: U.S. Employers to Spend $1.3 Trillion on Health Benefits in 2024
Health care spending in the United States has been trending upward for decades, and analysts at the Centers for Medicare and Medicaid Services (CMS) predict that total employer spending this year will increase by 5.8% to $1.3 trillion.
Furthermore, spending per participant will increase by 6% to $7,459. However, due to increased health care expenses and cost of living, enrollment is projected to decrease by 0.2%, down to 178 million.
Legal Update: Federal Court Rules ERISA Preempts Oklahoma State PBM Legislation
On Aug. 15, 2023, the 10th U.S. Circuit Court of Appeals ruled in Pharmaceutical Care Management Association (PCMA) v. Glen Mulready that ERISA preempts certain provisions of an Oklahoma law aimed at regulating pharmacy benefit managers (PBMs). The ruling contrasts with the U.S. Supreme Court’s 2020 rulingin PCMA v. Rutledge, which held that ERISA did not preempt an Arkansas PBM regulation. The Oklahoma Insurance Commissioner has stated their intention to appeal, although the state has not yet filed a petition with the U.S. Supreme Court for review.
Legal Update: EEOC Announces July 9 Failure to File Deadline for 2023 EEO-1 Reports
On June 5, 2024, the U.S. Equal Employment Opportunity Commission (EEOC) announced
that it had entered the “Failure to File” phase for EEO-1 reporting, as described in the agency’s recently updated EEO-1 Reporting Instruction Booklet.The EEOC offers a fact sheet regarding the failure to file deadline.
This announcement means that if an employer failed to submit a required EEO-1 Report by the “Published Due Date” of June 4, 2024, the EEOC will send it a Notice of Failure to File letter requesting that it complete the submission as soon as possible but no later than
July 9, 2024.
ACA Information Reporting Penalties Increased for Returns Filed in 2025
Now that the reporting deadlines for the 2023 calendar year, which took place in 2024, have passed, it
is time to focus on next year’s filing deadlines and penalties. IRS Revenue Procedure 2023-34 includes
the updated penalty amounts that may apply to reporting entities that fail to comply with the Affordable Care Act’s (ACA) requirements under Internal Revenue Code Sections 6055 and 6056.
Click here to learn more and download the latest ACA Compliance Bulletin.
In the Loop (June)
Health Panel Drops Breast Cancer Screening Age to 40
On April 30, 2024, the U.S. Preventive Services Task Force (USPSTF) recommended that women
get a mammogram every other year starting at age 40 and continuing until they are 74. Nearly one year after this screening guidance was drafted in May 2023, the health panel’s recommendations have been finalized without major changes.
News Brief: Over 80% of Employers Will Add or Improve Benefits in the Next Year
A new report by health care benefits company Lively found that 81% of organizations plan to add or improve employee benefits in the next year to better recruit and retain employees. Furthermore, the report showed that employee experience, feedback and ease of use matter the most when benefits leaders decide to select or renew with benefits providers.
“Employee benefits are a critical decision for companies and impact their goals and bottom line. They go far beyond health insurance, as the right package of flexible benefits enables employees to afford everyday expenses, plan for the future and counter financial stress.”
-Alex Cyriac, co-founder and CEO of Lively
ACA Compliance Overview – Electronic Filing of ACA Returns
The Affordable Care Act (ACA) created reporting requirements under Internal Revenue Code (Code) Sections 6055 and 6056. Under these rules, certain employers must provide information to the IRS about the health plan coverage they offer (or do not offer) to their employees.
Under the original rules, any reporting entity that was required to file at least 250 individual statements under Sections 6055 or 6056 had to file electronically. However, in 2023 the IRS released a final rule implementing a law change by the Taxpayer First Act of 2019, which lowers the 250-return
threshold for mandatory electronic reporting to 10 returns. As a result, most reporting entities are now required to complete their ACA reporting electronically.
Click here to learn more and download the latest ACA Compliance Bulletin.
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.
