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2015 Benefit University: Employee Benefit Legal Update

Tanya Gonzalez
Tanya Gonzalez

HUB International's Chief Compliance Officer, Sibyl Bogardus, delivers a comprehensive review of Health Care Reform & Benefit changes that are coming and what employers need to do to be prepared.

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2015 Benefit University: Employee Benefit Legal Update
2 Watch for upcoming resources
Cyber Liability: How to protect your employees and minimize the threat to your company March 3
Corporate Insurance Overview: What Every Forward-Thinking CFO & HR VP Need to Know March 31 Webinar
Save The Date May 27th 2015 La Costa Resort & Spa
Ultimate Rewards A Results-Driven Approach to Total Rewards: Executive and broad-based compensation Sales compensation and incentive plan designs Compensation and performance management outsourcing Ultimate Rewards quick view and assessment Temporary assignments and permanent placement
7 Thank You To Our Sponsors!
Sibyl Bogardus provides compliance and consulting advice regarding employee benefits. Areas of expertise include federal healthcare reform, HIPAA, ADA, wellness, labor laws, COBRA, ERISA, FMLA, and compliance with tax requirements. Sibyl has been named as one of the 100 Leading Women in insurance by Business Insurance and one of the 25 Most Influential Business Women by the St. Louis Business Journal. She is a nationally recognized speaker on healthcare reform, medical plan design trends, state and federal laws, and human resources issues. A widely-published author on healthcare reform, employee benefits, tax, and labor law issues, Sibyl publishes articles each month in Health Reform Magazine. She is on the Editorial Advisory Board of Benefits Quarterly, a publication of the International Society of Certified Employee Benefit Specialists. She has given interviews for radio, magazines, and newspapers. Sibyl Bogardus Chief Compliance Advisor, Attorney
Click to edit Master title styleEmployee Benefits Legal Update: Your Guide to Avoiding Legal Landmines and Pitfalls in 2015 HUB International Sibyl Bogardus Chief Compliance Officer 息 All Rights Reserved 2015
10 Agenda Tough - and valuable - lessons from 1/1/15 enrollments and rollout of group health reform Will technology catch up to legal requirements? Effects of individual exchange enrollment, subsidies, and premium payments The Supreme Court case - key dates and likely outcomes A Republican Congress - what we expect in 2015 & later Increased DOL & IRS audit activity impact on you Dealing with 2015's top five expected developments
11 So, How Did THAT Feel? Tough & valuable lessons from 1/1/15 enrollments & rollout of group health reform Communications o Benefit guide re-alignment o Enrollment meetings (It lasted how long?) o Typical employee questions and concerns Enrollment percentages & changes o Traditional core health plans o Minimum value skinny
12 So, How Did THAT Feel? (cont.) Tough & valuable lessons from 1/1/15 enrollments & rollout of group health reform Nontraditional plans o ELAP (Medicare plus a percentage) o Supplements o Skeletons? o No hospitalizationRIP Renewals / rate changes o Large group o Small group o Fixed costs for self-funded plans
13 Key C-Suite Goal: No Surprises on Additional Costs Opportunities to minimize financial and administrative impacts o The challenge: Migraine inducing, right? o One answer: Technology, but who is ready? Standards for compliance in 2015/2016 o Budget for the offer 70% moving to 95% Individual penalty impact o Good faith on reporting Making a business case o Who will be your internal partner? External?
14 Advance Planning Remains Crucial Why and how to create a 3-5 year strategic plan for healthcare reform The grid to guide you Work in flexibility o Ongoing changes with agency interpretations o Cadillac tax o Need for fallback strategies Financial analysis for self-funding Monitor new benchmarks and approaches
15 Are Your Systems Ready? Tracking o Hours worked, PTO, FMLA, Military Leave, jury duty o Changes in position or job status Gathering date & reporting to employees & IRS o Draft forms o Impact as enforcement tool Premium adjustments and other nuances Will technology catch up to legal requirements?
16 Staying on Top of Practical Issues Variable hour and seasonal classifications o Practical implications of premium collection o Changing status of an employee: Change to full-time (new hire or other?) Change to part-time (variable hour or full-time?) Wasnt there another rule on? o Leaves of absence o PTO accruals o Rate of pay changes o Changing measurement periods Remember 70%! And remember toBreathe!
17 Your employees are asking What is happening?! Effects of individual exchange enrollment, subsidies, and premium payments Inappropriate subsidies Unique perspective of state exchanges Pitfalls for the unwitting o Uncoordinated & inadequate information o Claw backs Beware unions & staffing/temp/ PEO firms Help me with $, information/advice, tax forms
18 Keep Employee Engagement Facilitate human capital management in the midst of these changes Cultural considerations Matching processes internally Avoid the Siren Song of public exchanges Education -- re-focus and emergence of "new" tools
19 What will the Court Say? The Supreme Court case o Subsidies for citizens in state exchange (not federal?) o Current # of state exchanges Key dates o Arguments in March o Decision before July 4th Possible outcomes o Subsidies in any exchange o Subsidies only in state exchanges Then what? Likely outcomewait for itwait for it.
20 Impact of Politics? Republican Congress o 2/3 Upcoming Presidential election What we expect in 2015 & later o Hours adjustment to 40? o Penalty elimination o Mandate elimination o Repeal? Or repeal & replace? o The big fix in July, August, later
21 Implementation & Changing of the Guard in 2016 Expect a push & prepare for disruptive changes Want to get involved? o Deal with facts: Regulatory agenda o Federal requests for input Comment if an issue is important to you o Example: k-12 substitute teachers Dual path -- compliance + advocacy
22 An Audit How will that feel? Increased DOL & IRS audit activity o Foreshadowing! Triggers o Complaints o Reporting o Timing Immediate impact on you Fallout o Cross-referrals o Vendor impact o The follow-through
23 Staying Out of Trouble How to avoid the scams and shams the IRS will be targeting in audits Individual policy payments or reimbursements Unearthing skeletons in your benefits closet Defined contribution software Payroll tax avoidance schemes More war stories And dont forget the DOL Employee communication o Fiduciary responsibilities Building your Fiduciary File
24 Staying Ahead of the Curve What works, what doesnt, and how to avoid the wrong path Consider pros & cons Strong Trend: Collaboration Using influence the solution solution Sample considerations for Cadillac Tax o Supplemental benefits o Eliminating the health plan o Skinny plan options not for everyone o Self-funding o Budgeting
25 Sweat (& Document) the Small Stuff Example: Affordability safe harbors Three possible safe harbors o W-2, Rate of Pay, Federal Poverty Practical application What about non-safe harbors? Memorialize the path you have taken Similar issues: waiting period, non-health eligibility, measurement and coverage rules, transition relief for effective date or delay, class outs, etc.
26 Sweat (& Document) the Small Stuff Example: Employee Categories Variable hour, seasonal, and full-time Elimination of other categories for health benefits How to establish status o With employees o In HR documentation Addressing other benefits Memorialize the path you have taken
27 Top 5 Expected Developments in 2015 1. Discrimination rules for insured plans 2. Final Forms 1095-C and related forms and instructions for employee & IRS 3. Small employer guidance Effective dates Other like required notices? 4. Automatic enrollment (200+ employees plus) 5. Cadillac Tax Perhaps as request for input
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2015 Benefit University: Employee Benefit Legal Update

  • 3. Cyber Liability: How to protect your employees and minimize the threat to your company March 3
  • 4. Corporate Insurance Overview: What Every Forward-Thinking CFO & HR VP Need to Know March 31 Webinar
  • 5. Save The Date May 27th 2015 La Costa Resort & Spa
  • 6. Ultimate Rewards A Results-Driven Approach to Total Rewards: Executive and broad-based compensation Sales compensation and incentive plan designs Compensation and performance management outsourcing Ultimate Rewards quick view and assessment Temporary assignments and permanent placement
  • 7. 7 Thank You To Our Sponsors!
  • 8. Sibyl Bogardus provides compliance and consulting advice regarding employee benefits. Areas of expertise include federal healthcare reform, HIPAA, ADA, wellness, labor laws, COBRA, ERISA, FMLA, and compliance with tax requirements. Sibyl has been named as one of the 100 Leading Women in insurance by Business Insurance and one of the 25 Most Influential Business Women by the St. Louis Business Journal. She is a nationally recognized speaker on healthcare reform, medical plan design trends, state and federal laws, and human resources issues. A widely-published author on healthcare reform, employee benefits, tax, and labor law issues, Sibyl publishes articles each month in Health Reform Magazine. She is on the Editorial Advisory Board of Benefits Quarterly, a publication of the International Society of Certified Employee Benefit Specialists. She has given interviews for radio, magazines, and newspapers. Sibyl Bogardus Chief Compliance Advisor, Attorney
  • 9. Click to edit Master title styleEmployee Benefits Legal Update: Your Guide to Avoiding Legal Landmines and Pitfalls in 2015 HUB International Sibyl Bogardus Chief Compliance Officer 息 All Rights Reserved 2015
  • 10. 10 Agenda Tough - and valuable - lessons from 1/1/15 enrollments and rollout of group health reform Will technology catch up to legal requirements? Effects of individual exchange enrollment, subsidies, and premium payments The Supreme Court case - key dates and likely outcomes A Republican Congress - what we expect in 2015 & later Increased DOL & IRS audit activity impact on you Dealing with 2015's top five expected developments
  • 11. 11 So, How Did THAT Feel? Tough & valuable lessons from 1/1/15 enrollments & rollout of group health reform Communications o Benefit guide re-alignment o Enrollment meetings (It lasted how long?) o Typical employee questions and concerns Enrollment percentages & changes o Traditional core health plans o Minimum value skinny
  • 12. 12 So, How Did THAT Feel? (cont.) Tough & valuable lessons from 1/1/15 enrollments & rollout of group health reform Nontraditional plans o ELAP (Medicare plus a percentage) o Supplements o Skeletons? o No hospitalizationRIP Renewals / rate changes o Large group o Small group o Fixed costs for self-funded plans
  • 13. 13 Key C-Suite Goal: No Surprises on Additional Costs Opportunities to minimize financial and administrative impacts o The challenge: Migraine inducing, right? o One answer: Technology, but who is ready? Standards for compliance in 2015/2016 o Budget for the offer 70% moving to 95% Individual penalty impact o Good faith on reporting Making a business case o Who will be your internal partner? External?
  • 14. 14 Advance Planning Remains Crucial Why and how to create a 3-5 year strategic plan for healthcare reform The grid to guide you Work in flexibility o Ongoing changes with agency interpretations o Cadillac tax o Need for fallback strategies Financial analysis for self-funding Monitor new benchmarks and approaches
  • 15. 15 Are Your Systems Ready? Tracking o Hours worked, PTO, FMLA, Military Leave, jury duty o Changes in position or job status Gathering date & reporting to employees & IRS o Draft forms o Impact as enforcement tool Premium adjustments and other nuances Will technology catch up to legal requirements?
  • 16. 16 Staying on Top of Practical Issues Variable hour and seasonal classifications o Practical implications of premium collection o Changing status of an employee: Change to full-time (new hire or other?) Change to part-time (variable hour or full-time?) Wasnt there another rule on? o Leaves of absence o PTO accruals o Rate of pay changes o Changing measurement periods Remember 70%! And remember toBreathe!
  • 17. 17 Your employees are asking What is happening?! Effects of individual exchange enrollment, subsidies, and premium payments Inappropriate subsidies Unique perspective of state exchanges Pitfalls for the unwitting o Uncoordinated & inadequate information o Claw backs Beware unions & staffing/temp/ PEO firms Help me with $, information/advice, tax forms
  • 18. 18 Keep Employee Engagement Facilitate human capital management in the midst of these changes Cultural considerations Matching processes internally Avoid the Siren Song of public exchanges Education -- re-focus and emergence of "new" tools
  • 19. 19 What will the Court Say? The Supreme Court case o Subsidies for citizens in state exchange (not federal?) o Current # of state exchanges Key dates o Arguments in March o Decision before July 4th Possible outcomes o Subsidies in any exchange o Subsidies only in state exchanges Then what? Likely outcomewait for itwait for it.
  • 20. 20 Impact of Politics? Republican Congress o 2/3 Upcoming Presidential election What we expect in 2015 & later o Hours adjustment to 40? o Penalty elimination o Mandate elimination o Repeal? Or repeal & replace? o The big fix in July, August, later
  • 21. 21 Implementation & Changing of the Guard in 2016 Expect a push & prepare for disruptive changes Want to get involved? o Deal with facts: Regulatory agenda o Federal requests for input Comment if an issue is important to you o Example: k-12 substitute teachers Dual path -- compliance + advocacy
  • 22. 22 An Audit How will that feel? Increased DOL & IRS audit activity o Foreshadowing! Triggers o Complaints o Reporting o Timing Immediate impact on you Fallout o Cross-referrals o Vendor impact o The follow-through
  • 23. 23 Staying Out of Trouble How to avoid the scams and shams the IRS will be targeting in audits Individual policy payments or reimbursements Unearthing skeletons in your benefits closet Defined contribution software Payroll tax avoidance schemes More war stories And dont forget the DOL Employee communication o Fiduciary responsibilities Building your Fiduciary File
  • 24. 24 Staying Ahead of the Curve What works, what doesnt, and how to avoid the wrong path Consider pros & cons Strong Trend: Collaboration Using influence the solution solution Sample considerations for Cadillac Tax o Supplemental benefits o Eliminating the health plan o Skinny plan options not for everyone o Self-funding o Budgeting
  • 25. 25 Sweat (& Document) the Small Stuff Example: Affordability safe harbors Three possible safe harbors o W-2, Rate of Pay, Federal Poverty Practical application What about non-safe harbors? Memorialize the path you have taken Similar issues: waiting period, non-health eligibility, measurement and coverage rules, transition relief for effective date or delay, class outs, etc.
  • 26. 26 Sweat (& Document) the Small Stuff Example: Employee Categories Variable hour, seasonal, and full-time Elimination of other categories for health benefits How to establish status o With employees o In HR documentation Addressing other benefits Memorialize the path you have taken
  • 27. 27 Top 5 Expected Developments in 2015 1. Discrimination rules for insured plans 2. Final Forms 1095-C and related forms and instructions for employee & IRS 3. Small employer guidance Effective dates Other like required notices? 4. Automatic enrollment (200+ employees plus) 5. Cadillac Tax Perhaps as request for input
  • 28. Q & A
  • 30. Click to edit Master title styleThank You!