Category: Compliance
Gag Clause Attestation Deadline
As the year comes to an end, a crucial compliance deadline looms for employers with health plans. Under the Consolidated Appropriations Act (CAA), health plans and insurance issuers must submit a Gag Clause Compliance Attestation by December 31, 2024. Since its enactment in 2020, this regulation prohibits health plans from including gag clauses—provisions that limit…
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% to…
Compliance Recap | Sept. 2024
SUMMARY ANNUAL REPORT DUE The Summary Annual Report (SAR) is a disclosure requirement under ERISA. The SAR acts as a narrative of the Form 5500 for employee benefit plans. It includes financial statements, funding requirements, and participants’ rights. The SAR must be provided to participants and enrolled beneficiaries within nine months after the end of the plan…
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…
Compliance Recap August 2024
FEDERAL COURT BLOCKS FTC NON-COMPETE BAN NATIONWIDE: IMPORTANT INSIGHTS FOR EMPLOYERS On August 20, 2024, the U.S. District Court for the Northern District of Texas delivered a crucial ruling, effectively halting the Federal Trade Commission’s (FTC) Rule prohibiting most non-compete agreements. The Rule, which was set to go into effect on September 4, 2024, was…
Empowering Gen Z: Building a Competitive Benefits Package
Get ready for a new wave of talent! Gen Z (born between 1997 and 2012), or Zoomers, is the youngest generation entering the workforce, and they’re bringing fresh perspectives and priorities. Unlike previous generations, Gen Z isn’t just punching a clock. They crave opportunities for personal and professional growth, a workplace that prioritizes mental well-being,…
Compliance Recap July 2024
FORM 5500 FILING FOR HEALTH AND WELFARE PLANS The Form 5500 series is a component of the Employee Retirement Income Security Act’s (ERISA) reporting and disclosure framework. The Form is used to report information on the qualification of the plan, its financial condition, investments, and its operations. It also guarantees that participants, beneficiaries, and regulators have access…
Compliance Recap | June 2024
ACA PREVENTIVE CARE MANDATE REMAINS IN PLACE WITH AN EXCEPTION In a recent decision, the U.S. 5th Circuit Court of Appeals upheld a key provision of the Affordable Care Act (ACA) that mandates private insurance cover preventive services without cost to patients. However, the court also ruled that the plaintiffs are exempt from complying with this mandate,…
Form 5500: What You Need To Know
Attention Employers: Don’t Miss Your Form 5500 Deadline! Here’s a simplified breakdown of what you need to know about filing your employee benefit plan report: Who Needs to File? Employers subject to ERISA (Employee Retirement Income Security Act) with employee benefit plans, unless exempt. What to File? Form 5500 (annual report) for each employee benefit…
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…