Open enrollment for individual and family healthcare plans for 2017 is rapidly approaching. It begins on November 1, and many employers choose a similar timeline when allowing workers to sign up for, or make changes to, their participation in the company’s benefits offerings. As such, now is a vital time to review your benefits package and ensure your plans are in compliance with all government regulations before you roll them out to your workers during the open enrollment period.
In April, the U.S. Department of Labor (DOL), issued a final rule to address conflicts of interest in retirement advice. This fiduciary standard applies to anyone who provides investment advice to sponsors and participants in workplace retirement plans and individual retirement accounts including 401(k)s and IRAs, and is expected to impact compliance issues and costs for employers who offer employer-sponsored retirement plans as part of their benefits package.
In essence, the definition of ‘fiduciary’ has been expanded by the new rule, and many vendors who service employer-sponsored retirement plans who were not formerly considered fiduciaries now will be. This includes broker-dealers and mutual-fund representatives. Experts recommend that employers carefully evaluate all of their retirement plan advisors and services and cut ties with those who do not want to comply with the new fiduciary standard.
The Department of Health and Human Services continues to update regulations that can have direct effects on the healthcare benefit employers offer. Before you roll out your non-grandfathered 2017 healthcare insurance selections to your workforce, you’ll want to makes sure each one covers all essential health benefits including:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Behavioral health treatment for mental health and substance use disorders
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventative and wellness services (including chronic disease management)
- Pediatric services (including dental and vision care)
The medical options offered must also meet established minimum value, minimum essential coverage and affordability standards. For example, in order to avoid making employer shared responsibility payments to the IRS, your employer-sponsored plan must cover at least 60 percent of the total allowed cost of benefits that are expected to be incurred under the plan.
Finally, you must make sure that the healthcare plans you’re offering—and the insurers who back them—meet the final Department of Health and Human Services (HHS) regulations under the Patient Protection and Affordable Care Act (ACA, section 1557) which prohibit any discrimination on the basis of race, color, national origin, sex, age or disability when offering or providing health coverage. This includes denying or limiting coverage for health services provided to transgender individuals, categorically excluding all coverage for health services related to gender transition, or denying or limiting coverage for specific health services related to gender transition.
If your employee wellness program includes a health risk assessment, biometric screening, asks for a spouse’s information, or includes a financial incentive for participants, you’ll want to ensure it meets new Equal Employment Opportunity Commission (EEOC) rules.
While the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA) generally prohibit employers from asking for information about their workers’ health conditions or the health conditions of their family members, they do not prevent employers from asking health-related questions or conducting certain medical examinations to determine risk factors as part of a voluntary wellness program.
Under the Health Insurance Portability and Accountability Act (HIPAA) as amended by the ACA, wellness programs are only considered voluntary if they offer incentives that are 30 percent or less than the cost of an individual’s health insurance premium. The maximum incentive for spouse participants is also limited to 30 percent. No additional incentives are allowed in exchange for specific genetic information (such as family history or genetic test results) of an employee, employee’s spouse, or employee’s children. Smoking cessation programs can offer an incentive up to 50 percent of the cost of individual healthcare coverage.
The Bottom Line
Benefits plan compliance has always been complicated and has only become more so in recent years. If you’re uncertain that your 2017 offerings meet government standards and regulations, contact your benefits professional for a review and assistance.