Workplace investigations are crucial when it comes to establishing a safe and welcoming work environment. However, these investigations are often complex and can involve navigating sensitive topics and disputes. More than ever before, companies face irreversible reputational damage and negative publicity if they mishandle workplace investigations.
Employers are expected to take investigations and employee concerns seriously in order to foster a supportive workplace culture. In fact, organizations that fail to conduct proper investigations may face legal action if they mishandle a workplace investigation. In recent cases, companies that did not respond properly to investigation requests faced legal action and six-figure settlements.
Refer to the below review of best practices for workplace investigations and contact your NEEBCo representative with questions.
Best Practices for Conducting Workplace Investigations
As a result of a recent Georgia court order, the New Hampshire Insurance Department is advising consumers that Aliera, a company that markets itself as a health care sharing ministry, may be operating illegally in New Hampshire.
In the past, Aliera acted as a plan administrator to Unity Healthshare, which is a qualified health care sharing ministry.
The Georgia court found that “the evidence shows that Aliera has taken actions to misappropriate [Unity’s] assets; namely by unilaterally attempting to transition the Unity HCSM plans to Trinity.” The court also found that the company misrepresented itself to state insurance regulators, and that “Timothy Moses, who exercises substantial control over Aliera, was convicted of felony securities fraud and perjury in federal court.”
Refer to the attached press release for details and contact your NEEBCo representative with any questions you may have.
NH DOI Press Release Aliera Health Care Sharing Ministry
Beginning in May of last year, the Trump administration began searching for ways to curb out-of-control prescription drug costs—referring to the initiative as American Patients First. This effort is finally seeing some traction, with the administration publishing its first final rule on the matter.
Drug companies will now be “… required to disclose to patients the list price for prescription drugs in TV ads,” according to the Department of Health and Human Services (HHS).
This rule won’t take effect until 60 days after its publication, so employers should expect to see action starting in July.
Refer to the attached new brief for detail and contact your NEEBCo representative with questions.
News Brief – HHS Drug Transparency
The Affordable Care Act (ACA) requires health insurance issuers and sponsors of self-insured health plans (including qualified Health Reimbursement Arrangements/HRA) to pay Patient-Centered Outcomes Research Institute fees (PCORI fees).
The PCORI fees generally apply to insurance policies providing accident and health coverage and self-insured group health plans. The fees are reported and paid annually using IRS Form 720 (Quarterly Federal Excise Tax Return).
The entity that is responsible for paying the PCORI fees depends on whether the plan is insured or self-insured.
- For insured health plans, the issuer (insurance carrier) of the health insurance policy is required to pay the research fees.
- For self-insured health plans (including HRAs) the research fees are to be paid by the plan sponsor (employer).
PCORI fees will be due by July 31, 2019, for plan years ending in 2018. IRS instructions for filing form 720 include information on reporting and paying the PCORI fees.
Using Part II, Number 133 of Form 720, issuers and plan sponsors will be required to report the average number of lives covered under the plan separately for specified health insurance policies and applicable self-insured health plans. That number is then multiplied by the applicable rate for that tax year, as follows:
- $2.39 for plan years ending on or after Oct. 1, 2017, and before Oct. 1, 2018
- $2.45 for plan years ending on or after Oct. 1, 2018, and before Oct. 1, 2019
As the fee applies to plan years ending before Oct. 1, 2019, 2018 is the final assessed year for employers with calendar year plans, and the July 2019 payment will be the final payment. For non-calendar year plans, 2020 will be the final payment.
Health insurance issuers have the following options for determining the average number of covered lives:
- The Actual Count Method—This method involves calculating the sum of lives covered for each day of the plan year and dividing that sum by the number of days in the plan year.
- The Snapshot Method—This method involves adding the total number of lives covered on a date in each quarter of the plan year, or an equal number of dates for each quarter, and dividing the total by the number of dates on which a count was made.
- The Form Method—As an alternative to determining the average number of lives covered under each individual policy for its respective plan year, this method involves determining the average number of lives covered under all policies in effect for a calendar year based on the data included in the National Association of Insurance Commissioners Supplemental Health Care Exhibit (Exhibit) that some issuers are required to file (called the member months method). For issuers that are not required to file an Exhibit, there is a similar available method that uses data from equivalent state insurance filings (called the state form method).
Sponsors of self-insured plans (including HRAs) may determine the average number of covered lives by using the actual count method or the snapshot method.
For additional information please refer to the attached compliance bulletin and contact your NEEBCo representative.
FAQs on the PCORI Fee
On May 9, 2019, President Donald Trump delivered a speech criticizing the practice of surprise medical billing. The president’s speech aligned with this administration’s American Patients First initiative—a blueprint for lowering consumer health costs. Here are the four main regulatory aspects called out by the president, suggesting that they might be tackled first:
1) In emergency situations, patients shouldn’t have to “bear the burden” of out-of-network costs.
2) Balanced billing should be prohibited for emergency care.
3) For scheduled non-emergency care, patients should receive an “honest” bill up front—including an itemized list of out-of-pocket expenses the patient must cover.
4) Patients should not receive a surprise bill from out-of-network providers they did not choose themselves.
Refer to the attached news brief for specific information and contact your NEEBCo representative with questions.
News Brief – Surprise Medical Billing
On March 28, 2019, a federal judge ruled that parts of the Trump administration’s 2018 final rule on association health plans (AHPs) were invalid. The court directed the Department of Labor (DOL) to reconsider how the remaining provisions of the final rule are affected.
In its ruling, the court stated that the final rule was an “end-run” around the Affordable Care Act (ACA) and that the DOL exceeded its authority under ERISA.
The court specifically struck down two parts of the rule:
- The provision defining “employer” to include associations of disparate employers; and
- The provision expanding membership in these associations to include working owners without employees.
Employers and business owners without employees that have joined an AHP, or are considering doing so, should review how their plans may be affected by the court’s ruling. These employers can also monitor developments from the DOL on any changes made to the rule.
Refer to the attached compliance bulletin for additional detail and contact your NEEBCo representative with questions
Federal Court Strikes Down Association Health Plan Rules
On Monday, March 4, 2019, major drugmaker Eli Lilly announced that they would begin selling an authorized generic version of their top-selling insulin, Humalog 100, for half the cost. A vial of Humalog 100 costs $275, while a vial of the generic version, Insulin Lispro, will cost $137.35 per vial.
Eli Lilly’s generic insulin offering announcement comes almost one week after top drugmaker CEOs were called before the Senate to undergo questioning about the rising costs of drug prices.
See the attached article for more detail , and contact your NEEBCo representative with questions.
Major Drugmaker to Offer Cheaper, Generic Insulin
This benchmark survey demonstrates how employers across the nation are responding to continually rising health care costs. Survey results indicate that enrollment in a high deductible health plan (HDHP) with a health savings account (HSA) increased, while enrollment in a preferred provider organization (PPO) remained the most popular of plans in terms of employee enrollment.
Employee Benefits Survey Results
The IRS has again determined that some employers, insurers and other providers of Minimum Essential Coverage (MEC) need additional time to gather and analyze the information and prepare the 2018 Forms 1095-B and 1095-C to be furnished to individuals. Therefore, they have provided an additional 32 days for furnishing the 2018 Form 1095-B and Form 1095-C to employees.
This provides employers with an extended due date from Jan. 31, 2019, to March 4, 2019 to provide employees with the 1095 forms.
Notice 2018-94 does not extend the due date for filing forms with the IRS for 2018. The due date for filing with the IRS remains Feb. 28, 2019 (paper filing) or April 1, 2019 (if filing electronically).
Refer to the below bulletin for additional details and contact your NEEBCo representative with any questions.
Furnishing Deadline Delayed for 2018 ACA Reporting
Under the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), employers that offer prescription drug coverage on a group basis are required to provide annual notice to both employees/covered individuals and to the Centers for Medicare & Medicaid Services (CMS) regarding the “creditability” of the prescription coverage offered by the employer (whether or not the prescription coverage is equal to or exceeds the value of prescription coverage through Medicare Part D).
The employee/covered individual notice must be provided at least annually to those Medicare Part D eligible individuals who are covered by, or who apply for, prescription drug coverage under the group health plan. To simplify plan administration, plan sponsors often decide to provide the disclosure notice to all plan participants.
At a minimum, this notice must be provided at the following times:
1. Prior to the Medicare Part D Annual Coordinated Election Period – Oct. 15 through Dec. 7 of each year;
2. Prior to an individual’s Initial Enrollment Period for Part D;
3. Prior to the effective date of coverage for any Medicare eligible individual that joins the plan;
4. When prescription drug coverage ends or changes so that it is no longer creditable or becomes creditable; and
5. Upon a beneficiary’s request.
If the employer provides the notice annually prior to 10/15, items 1 and 2 are considered to be met.
The CMS disclosure notice must be made to CMS on an annual basis, or upon any change that affects whether the coverage is creditable. At a minimum, the notice must be provided at the following times:
1. Within 60 days after the beginning date of the plan year for which the entity is providing the form;
2. Within 30 days after the termination of the prescription drug plan; and
3. Within 30 days after any change in the creditable coverage status of the prescription drug plan.
If you have questions regarding the creditability status of your plan, creating notices specific to your plan, or the notification process, please contact your NEEBCo representative.