ACA
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The Pay or Play Percentage Increase for 2025
The Affordable Care Act (ACA) requires large employers to offer affordable health insurance coverage to their full-time employees or face a penalty known as the “Pay or Play” tax. This tax is based on the employer’s average monthly wage (AMW) and the number of full-time employees. The affordability rate for employer-sponsored health coverage will increase from 8.39%…
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Medical Loss Ratio (MLR) Rebates: A Timely Reminder
The Affordable Care Act (ACA) introduced the Medical Loss Ratio (MLR) to ensure that health insurance companies spend a significant portion of premiums on medical care and quality improvement activities rather than administrative costs and profits. When insurers fail to meet the MLR threshold, they are required to issue rebates to plan sponsors. Understanding MLR…
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PCORI Fee Filing Deadline
The Patient-Centered Outcomes Research Trust Fund fee, often referred to as the PCORI fee, can be a source of confusion for employers offering health insurance plans. This article aims to simplify what the PCORI fee is, why it exists, and how it impacts your business. What is the PCORI Fee? The PCORI fee is an…
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Compliance Recap May 2024
PREPARE NOW TO PAY THE PCORI FEE The Patient-Centered Outcomes Research Institute (PCORI) fee funds research that evaluates and compares health outcomes, clinical effectiveness, and the risks and benefits of medical treatments and services. Effective through 2029, the IRS treats this fee like an excise tax, applied to all covered lives, including employees, retirees, spouses,…
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Benefits Buzz May 2024
Prescription Drug Report Is Due by June 1, 2024 Group health plans must annually submit detailed information on prescription drug and health care spending to the federal government. This reporting is referred to as the “prescription drug data collection,” or the “RxDC report.” The next RxDC report is due by Saturday, June 1, 2024, covering…
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Benefits Check-up: 6 Compliance Issues Affecting Your Clients’ Health
A health plan is more than a product or service; it’s a relationship. All productive and healthy relationships—especially in the benefits space—rely on trust. When an employer extends trust in a broker or insurance carrier to purchase something as critical as healthcare—for people as critical as their workers and families—we’re obligated to raise all factors…
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Benefits Buzz February 2024
ACA Reporting Deadlines Are Approaching Employers subject to Affordable Care Act (ACA) reporting under Internal Revenue Code Sections 6055 or 6056 should prepare to comply with upcoming reporting deadlines. For the 2023 calendar year, covered employers must: Furnish statements to individuals by March 1, 2024 (an alternative method of furnishing statements to covered individuals is…
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Compliance Recap January 2024
NEW EMPLOYEE CLASSIFICATION RULE In January, the Department of Labor (DOL) Wage and Hour Division introduced a rule that changes the way workers are classified under the Fair Labor Standards Act (FLSA). This Final Rule, effective March 11, 2024, offers a more comprehensive test to determine a worker’s status, potentially making it more challenging to classify…
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Compliance Recap December 2023
WORKPLACE POSTERS The U.S. Department of Labor (DOL) enforces the posting of employee notices in the workplace to comply with various DOL statues. The posters are available for free in multiple languages. To determine which posters are needed for your business, the DOL FirstStep Poster Advisor can help. Employers can download and print the posters directly from…
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Benefits Buzz December 2023
IRS Announces Employee Benefit Plan Limits for 2024 Many employee benefits are subject to annual dollar limits that are updated for inflation before the beginning of each calendar year. Most of these annual dollar limits will increase in 2024. Note that some benefit limits are not adjusted for inflation, such as the contribution limit for…
