Dealing With Marketplace Notices and Employer Action Points

The Health Insurance Marketplace has begun sending notices to employers where at least one employee enrolled in the Exchange/Marketplace and who was determined to be eligible for an advance premium tax credit (APTC) or cost sharing reduction (CSR). This employee has reported to the Marketplace that they were NOT offered minimum affordable coverage by their employer.

If you are an applicable large employer and find yourself in this situation, you may have recently received a Health Insurance Marketplace letter stating that the employee was determined eligible for subsidized Marketplace coverage.

If you believe the employee was offered appropriate coverage, there is time to appeal.
Employers have 90 days from the date of the notice to file an appeal. This appeal will NOT determine if your organization has to pay the Employer Shared Responsibility Payment. Only the Internal Revenue Service (IRS) can determine which employers are subject to the Employer Shared Responsibility Payment as stated under section 4980H of the Internal Revenue Code.

IMPORTANT: For 2015, the Employer Shared Responsibility Payment will generally apply to employers with 100 or more full-time equivalent (FTE) employees, and may apply to certain employers with 50 or more FTE employees. Starting in 2016, the Employer Shared Responsibility Payment will apply to employers with 50 or more FTE employees.

Employer Action Points:

1. If appealing a Marketplace determination, it is recommended to provide the least amount of detail required to respond.

2. It is important to remember that any retaliation or discrimination against an employee because he/she received subsidized Marketplace coverage is prohibited.

3. Create a policy surrounding Marketplace notices and which members of your Human Resources team should review and respond. Consider creating a firewall between those responding to notices and those making employment decisions.

4. Train your managers on your policy regarding the Marketplace letters and the rules surrounding retaliation and discrimination in the Affordable Care Act to limit potential missteps.

$47,476 Wage and Hour Changes

Yesterday, the Department of Labor published the much anticipated changes to the Overtime Rule.  They have posted a wealth of information for employers.  The link below is a good place to start — the DOL offers a quick overview and a video.

Employers have six months to analyze the impact and make strategic decisions prior to the December 1, 2016 implementation date.

The DOL’s 3-page overview and summary is available here.

New Summary of Benefits and Coverage Template Posted

On Wednesday, the Department of Labor and the Centers for Medicare and Medicaid (CMS) posted the new and improved Summary of Benefits and Coverage form.  The SBC was designed to help employees compare benefit provisions and make educated decisions when shopping for a medical plan. However, employers provided feedback indicating confusion among SBC recipients.

The CMS press release explains “The SBC includes coverage examples that demonstrate the cost sharing amounts an individual might be responsible for in three common medical situations.  In addition to the current coverage examples that address diabetes care and childbirth, the updated template has a new coverage example that addresses coverage for a foot fracture so that a consumer understands what a plan covers in an emergency scenario.

Changes have also been made to the SBC to improve readability for consumers. The new templates include more information about cost sharing, such as enhanced language to explain deductibles and a requirement that plans address individual and overall out-of-pocket limits in the SBC.”

These enhancements, including hyperlinks to the definitions section in electronic versions, should make reading the SBC a bit easier come open enrollment time.

Most employers will begin to use this new template on the first day of the first open enrollment period that begins on or after April 1, 2017.

To access the existing SBC template, or to review the new one, visit the DOL website via the link below.

1/1 Renewal? Medicare D Reminder…

All group health plans that provide prescription drug coverage to Medicare Part D eligible individuals (whether actively working, retired, or disabled) are required to notify CMS whether or not the Rx coverage offered by the employer is “creditable” within 60 days of the start of the plan year.

For plan sponsors that renew January 1, disclosure are due to CMS by March.

This disclosure is required whether the coverage is primary or secondary to Medicare. Employers must file their Disclosure Notice through the CMS website.  It only takes a few minutes to complete the disclosure and remain in compliance.