PBGC Amends Special Financial Assistance Regulation to Add a Withdrawal Liability Condition Exception
CAA Pharmacy Benefit and Healthcare Spending Reporting Deadline Approaching
Under the CAA, Section 204, insured and self-insured group health plans are required to report significant information regarding prescription drug and healthcare spending to the government. The 2020 and 2021 calendar year data submissions are due by December 27, 2022. However, under recently announced relief, a submission grace period is available to employers who make a good faith submission of the 2020 and 2021 data on or before January 31, 2023.
The data must be submitted to the Health Insurance Oversight System (HIOS) in files and formats specified by CMS. As applicable, employers should work closely with their carriers, third-party administrators, pharmacy benefit managers and other vendors to ensure the required information is timely and accurately provided. In some cases, employers that sponsor self-insured plans may need to submit data directly to HIOS.
Detailed information regarding the reporting requirements, including instructions, FAQs and a HIOS portal user guide, is available on the CMS website.
Employers should also keep in mind that the reporting of 2022 data is due by June 1, 2023. Employers should respond timely to any requests from carriers and service providers for necessary data, such as the average monthly premium paid by employers and employees. Employers should confirm in writing that the carrier or service provider will submit the June filing for the plan.
Upcoming ACA Reporting Deadlines for Forms 1094/1095
Annual ACA reporting deadlines for employers that sponsored group health plans in 2022 are approaching.
Applicable large employers (ALEs) with 50 or more full-time employees (FTEs), including full-time equivalent employees, in the prior year who sponsored group health plans (whether insured or self-insured) must comply with IRC Section 6056 reporting in early 2023. Specifically, ALEs must complete and distribute Form 1095-C to full-time employees by March 2, 2023. The form should detail whether the employee was offered minimum value, affordable coverage during 2022. The forms may be mailed, electronically delivered or delivered by hand (although proof of delivery in some manner is recommended).
Employers who sponsored a self-insured plan during 2022 must comply with Section 6055 reporting in 2023. Self-insured employers with 50 or more FTEs must complete Section III of Form 1095-C detailing which months the employee (and any applicable spouse and dependents) had coverage under the employer’s plan. If the self-insured employer has fewer than 50 FTEs, it must complete and distribute a Form 1095-B with such information. Again, the forms must be delivered to employees by March 2, 2023.
If the self-insured employer has fewer than 50 FTEs, an alternative is available to distributing Form 1095-B to individuals. Such a small employer is permitted to post a clear and conspicuous notice on their website of the availability of the document and the necessary contact information to request it. Any such request must be fulfilled within 30 days. No such alternative is available for Form 1095-C.
Employers must also file the forms with the IRS by February 28, 2023, if filing by paper, and March 31, 2023, if filing electronically. The filing must include the transmittal Form 1094-C (if filing Forms 1095-C) or Form 1094-B (if filing Forms 1095-B).
2022 Instructions for Forms 1094/1095-B »
2022 Instructions for Forms 1094/1095-C »
2022 Form 1094-B »
2022 Form 1095-B »
2022 Form 1094-C »
2022 Form 1095-C »
New San Francisco Ordinance Requiring Employers to Provide Supplemental Pay for Military Leave
January 31, 2023
On January 20, 2023, San Francisco Mayor London Breed signed into law the Military Leave Pay Protection Act (MLPPA), which will require private employers with 100 or more employees to provide supplemental paid leave during a qualifying military leave for a maximum of 30 days in a calendar year. The MLPPA becomes effective on February 19, 2023, and will make San Francisco the first major city to require private employers to provide paid military leave.
Below are the key highlights of the MLPPA:
Employers with 100 or more employees, regardless of where they work.
Employees who work within the geographic boundaries of San Francisco and are a member of the reserve corps of the United States Armed Forces, National Guard, or other US uniformed service organization.
The MLPPA also applies to part-time and temporary employees.
Covered Employers’ Supplemental Compensation Requirement
Covered employers are required to pay covered employees the difference between the amount of the employee’s gross military pay and the amount of gross pay the employee would have received from the employer had the employee worked the employee’s regular work schedule (excluding overtime unless regularly scheduled as part of the employee’s regular work schedule). Leave for military duty with supplemental compensation can be taken in daily increments for up to 30 days in any calendar year.
The MLPPA provides that the San Francisco Office of Labor Standards and Enforcement (OLSE) will issue regulations that are expected to provide additional guidance on the application and enforcement of this Ordinance.
Employers with at least one employee working in San Francisco and at least 100 employees nationwide should be aware of this new update.
NH PFML Employer Toolkit Released
January 31, 2023
On January 26, 2023, New Hampshire released a Paid Family and Medical Leave (NH PFML) Employer Toolkit available at Employer Toolkit | NH Paid Family Medical Leave (see the November 10, 2022, Compliance Corner article for a description of the NH PFML program). The Toolkit is intended to serve as a roadmap for employers to understand, design and implement NH PFML for their workforce. Employers with employees in New Hampshire should review the new guidance.
2023 HCRA Covered-Live Assessment Rates Posted
January 31, 2023
The Department of Health posted the 2023 covered-lives assessment (CLA) rates for professional education under the Health Care Reform Act (HCRA). These rates are applicable to health claim payers (including self-insured plans) that elect to pay the assessment directly to the state rather than facing higher surcharges for in-state hospital expenses. The annual amount owed by the payer is calculated based on the number of covered individuals residing in the state.
The HCRA was enacted to provide financial assistance to hospitals through special taxes on health plans and medical services. The CLA is intended to support the funding of graduate medical education. CLA rates (or alternative surcharges) vary by state region. Accordingly, the applicable charge is based on where the covered individual resides or receives in-state care.
The CLA rates are in addition to the indigent care surcharge on services at state hospitals, diagnostic and treatment centers, and ambulatory surgery centers. The indigent care surcharge is payable regardless of the residency of the covered individual or group health plan sponsor. The current rate, which remains in effect through December 31, 2023, is 9.63% for payers electing to pay the amount directly to the state Public Good Pool and an additional 28.27% for non-electing payers that pay the surcharge to healthcare providers.
Group health plan sponsors should be aware of the 2023 HCRA rates and surcharges applicable to medical and dental services provided at HCRA-designated facilities. Sponsors should consult with their carriers or third-party administrators, as applicable, for additional information regarding the rates, surcharges, elections and related reporting requirements.
2023 Regional Covered Lives Assessment Rates and Surcharges »
Indigent Care Surcharges by Payor »
This material was created by PPI Benefit Solutions to provide accurate and reliable information on the subjects covered but should not be regarded as a complete analysis of these subjects. It is not intended to provide specific legal, tax or other professional advice. The service of an appropriate professional should be sought regarding your individual situation. PPI does not offer tax or legal advice. "PPI®" is a service mark of Professional Pensions, Inc., a subsidiary of NFP Corp. (NFP). All rights reserved.