November and December can be a whirlwind of holidays, vacations, and distracted workweeks. Still, as the year draws to a close, it's important for employers to take stock of their employee benefits compliance obligations.
By staying organized and current on the latest rules and regulations, employers can avoid costly penalties and ensure that their employees have access to the benefits they need.
“As we come to the end of the year, it is a good time for employers with January 1st health plan renewals to review their plan documents and get ready for open enrollment,” writes Schwabe, Williamson & Wyatt PC for JD Supra.
So, in addition to spreading Yuletide cheer and planning company get-togethers, employers will want to have this end-of-the-year employee benefits compliance checklist handy:
The Affordable Care Act (ACA) has brought about significant changes to employee benefits compliance. Employers should be aware of the following requirements:
The ACA also sets limits on maximum deductibles and out-of-pocket costs for certain health plans. Employers should review their plans to ensure that they comply with these limits.
The ACA has been amended to provide certain COVID-19-related provisions, such as coverage for COVID-19 testing and treatment. Employers should review these provisions to ensure that they are compliant.
“The federally declared public health emergency has ended (for now), which means health plans are no longer required to cover diagnostic tests and related services without cost sharing. This may come as an unwelcome surprise to employees when they visit a healthcare provider for a PCR test in early 2024. Employers may want to clarify their insurer’s COVID testing policy and communicate it during open enrollment,” wrote Schwabe, Williamson & Wyatt PC.
o Influenza
o Meningitis
o Tetanus
o HPV
o Hepatitis A and B
o Measles
o Mumps
o Rubella
o Varicella
o COVID-19
“Going forward, any COVID-19 vaccine recommended by ACIP, including updated boosters, will continue to be fully covered for people enrolled in non-grandfathered plans starting 15 days after the vaccine is recommended by ACIP, irrespective of whether the vaccine is under an emergency use authorization or fully approved by the FDA,” says KFF.
FSAs allow employees to save pre-tax money for certain eligible expenses, such as medical, dental, and vision care. Employers should review their FSA plans to ensure that they comply with the latest rules and regulations.
“Employees should be reminded about new strict substantiation requirements for FSA reimbursements. Administrators are no longer allowed to rely on self-certification, waiver of substantiation of claims from favored providers, or not having to verify expenses below certain dollar amounts,” said JD Supra. “Plans that fail to substantiate all claims may be disqualified by the IRS, resulting in adverse tax consequences for the employer and all participating employees.”
Employers are required to provide certain annual notices to their employees, such as a summary of benefits and coverage (SBC) and a Marketplace Notice. These notices must be provided by certain deadlines each year.
JD Supra says employers should pay attention to the following annual notices:
Staying organized and compliant with employee benefits regulations is important for several reasons:
Navigating the complexities of employee benefits compliance can be a daunting task, but it is essential for employers to protect their business and their employees.
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