Harvard Pilgrim Gain Life Wellness Program

Through 2018, Harvard Pilgrim is offering online weight management and healthy eating programs with Gain Life for all fully insured accounts.

The programs are available to self-insured accounts for a fee.

Gain Life’s 16-week programs are personalized by gender and lifestyle, and they are available via smartphone, tablet or computer

See below for the employer and employee flyers, and contact your NEEBCo representative with additional questions.

HPHC Gain Life Employer Flyer

HPHC Gain Life Member Flyer

Tufts Health Freedom Plan Passes Pharmacy Rebates to Members

In many cases, when a prescription is purchased by a patient the prescription drug manufacturer pays a rebate to the pharmacy benefit manager (PBM), who then shares a portion of the rebate with the health insurer.

Effective January 1, 2019 Tufts Health Freedom Plan will pass pharmacy rebates directly to fully insured members on the high deductible Saver plan at the point of sale.

For self funded members, the rebates will be available as an option for the employer’s consideration.

The rebates will apply at the 60,000+ pharmacies in the CVS network.

Contact your NEEBCo representative with questions.

DOL Finalizes Rule to Expand Association Health Plans

On June 19, 2018, the Department of Labor (DOL) released a final rule that gives small businesses more freedom to join together as a single group to purchase health insurance in the large group market or to self-insure. These benefit arrangements are called association health plans (AHPs). AHPs have been available to small employers, but the Final Rule offers new options.

AHPs are a type of multiple employer welfare arrangement (MEWA). Because AHPs are regulated at the federal and state level, the availability of these plans will also depend on a state’s regulatory approach. ERISA allows states to regulate MEWAs under their own insurance laws and regulations. For example, to guard against fraud and abuse, a number of states provide that self-insured MEWAs must be licensed, registered, have a minimum number of participating employers, obtain an actuarial opinion that the MEWA can meet promised benefits and keep a minimum level of reserves. Several states prohibit self-insured MEWAs altogether.

The final rule allows fully insured plans to begin operating under the new rule on Sept. 1, 2018. Existing self-insured AHPs can begin operating under the new rule on Jan. 1, 2019, and new self-insured AHPs can begin on April 1, 2019.

Refer to the below Compliance Bulletin and Fact Sheet for details and contact your NEEBCo representative with questions.

DOL Finalizes Rule to Expand Association Health Plans

AHP Fact Sheet

New Hampshire Insurance Department Commissioner

As of June 11, 2018, John Elias began his five year term as the new Commissioner of the New Hampshire Insurance Department, replacing Robert Sevigny after 16 years in the post. Commissioner Elias was nominated by Governor Chris T. Sununu and unanimously approved by the New Hampshire Executive Council in May.

“I am honored to be trusted with this responsibility,” said Commissioner John Elias. “I am excited to get started working in this new role on behalf of New Hampshire.”

Elias’s priorities as commissioner include regulatory modernization, operational efficiency and effectiveness in the pursuit of regulatory value, and the use of data to promote market transparency and to improve regulatory accountability and success in the reduction of public harms.

For the full press release, click here.

New Jersey Individual Mandate

New Jersey became the second state to enact its own individual mandate penalty. On May 30, 2018, New Jersey Gov. Phil Murphy signed two bills into law that are designed to stabilize and reduce health insurance premiums in the individual market.

These new laws are among the first state laws passed in response to changes made to the federal ACA. New Jersey is only the second state to enact its own health insurance individual mandate.

To help administer the individual mandate penalty, the New Jersey Health Insurance Market Preservation Act imposes a reporting requirement on every entity that provides MEC to an individual during a calendar year, similar to the ACA’s reporting requirement under Internal Revenue Code Section 6055.

Refer to the below bulletin for additional information and contact your NEEBCo representative with questions.

New Jersey Enacts State Individual Mandate and Reinsurance Program

Model FMLA Forms Expire in 2018

Every three years, the DOL must submit its model FMLA forms to the federal Office of Management and Budget (OMB) for approval for continued use. The OMB’s approval for the current FMLA forms expires in 2018. This expiration date is included on the model forms in the upper right corner.

The DOL has requested that the OMB reauthorize the model FMLA forms for another three-year period, until 2021, without proposing any substantive changes to the forms.

Employers may continue to use the DOL’s current model forms until new ones are released. The updated model forms are expected to be the same as the current forms, except they will have a 2021 expiration date in the upper right corner.

Employers that use the model FMLA forms can monitor the DOL’s FMLA webpage for updated model forms.

Refer to the below Compliance Bulletin for additional information and contact your NEEBCo representative with questions.

DOL’s FMLA Forms Expire in 2018

2019 ACA Affordability Percentages

For plan years beginning in 2019, employer-sponsored coverage will be considered affordable if the employee’s required contribution for self-only coverage does not exceed:

  • 9.86% of the employee’s household income for the year, for purposes of both the pay or play rules and premium tax credit eligibility; and
  • 8.3% of the employee’s household income for the year, for purposes of an individual mandate exemption (adjusted under separate guidance).

These updated affordability percentages are effective for taxable years and plan years beginning Jan. 1, 2019. This is an increase from the affordability contribution percentages for 2018. As a result, some employers may have additional flexibility with respect to their employee contributions for 2019 to meet the adjusted percentage.

Refer to the below Compliance Bulletin for details and contact your NEEBCo representative with questions.

Affordability Percentages Will Increase for 2019

2019 HSA Limits

On May 10, 2018, the IRS released Revenue Procedure 2018-30 to announce the inflation-adjusted limits for health savings accounts (HSAs) and high deductible health plans (HDHPs) for 2019.

The adjusted contribution limits for HSAs take effect as of Jan. 1, 2019. The adjusted HDHP cost-sharing limits (minimum deductible and maximum out-of-pocket) take effect for the plan year beginning on or after Jan. 1, 2019.

The following chart shows the HSA and HDHP limits for 2019 as compared to 2018. It also includes the catch-up contribution limit that applies to HSA-eligible individuals who are age 55 or older, which is not adjusted for inflation and stays the same from year to year.

Contact your NEEBCo representative with questions.

IRS Announces HSA Limits for 2019

 

2018 HSA Family Limit

Earlier this year, a tax law change for 2018 reduced the HSA contribution limit for individuals with family HDHP coverage from $6,900 to $6,850. After this change was announced, the IRS received complaints that the $50 reduction would be difficult and costly to implement.

The IRS has now decided to allow taxpayers with family HDHP coverage to use the original $6,900 limit for HSA contributions for 2018, without facing excess contribution penalties.

Refer to the below Compliance Bulletin for details and contact your NEEBCo representative with questions.

IRS Allows Taxpayers with Family Coverage To Use $6,900 HSA Limit for 2018

PCORI Fees due by July 31st

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, 2018, for plan years ending in 2017. 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:

  • $2.26 for plan years ending on or after Oct. 1, 2016, and before Oct. 1, 2017
  • $2.39 for plan years ending on or after Oct. 1, 2017, and before Oct. 1, 2018

If your HRA plan originated in 2017 but does not end until 2018, no fee is due until July 31, 2019.

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