News - Essential StaffCARE

Important Reminder: PCORI Fees Due By July 31st, 2018

The Patient-Centered Outcomes Research Institute (PCORI) trust fund fee was established by the Affordable Care Act and is assessed for each plan year ending after September 30, 2012 and before October 1^st, 2019. The fee is applicable on sponsors of self-insured plans and is intended to help fund medical research.

Essential StaffCARE has prepared a helpful guide to understanding and calculating PCORI fees.

Please review the guide here.

Avoiding ACA Reporting Pitfalls: How to Stay in Compliance

Reporting of Offers of Health Insurance Coverage by Employers (Forms 1094/1095) is well under way. As such, employers are no doubt scrambling to complete the forms in a timely and accurate way in order to avoid costly IRS penalties.

To help get through the reporting season, the following are a few things to keep in mind as you proceed through the often daunting and confusing reporting process.

It is important to remember that, in the eyes of the IRS, reporting is ultimately the responsibility of the employer. Employers working with reporting vendors still bear the responsibility and liability for their submissions to be timely and accurate. Thus, if an employer is deemed to owe penalties under the reporting rules, it is the employer, and not the vendor, who will be responsible for those payments.

Under the Affordable Care Act, applicable large employers (ALEs)—generally those with at least 50 full-time employees, including full-time equivalent employees, in the preceding calendar year—must report certain information to their full-time employees and the IRS about the health care coverage they have offered (if any).

With deadlines for 2017 reporting just a couple of months away, ALEs should begin thinking about the following reporting facts:

ALEs are required to furnish Form 1095-C to each of its full-time employees by March 2, 2018 (new extended deadline).
ALEs must file Forms 1095-C, accompanied by the transmittal Form 1094-C, with the IRS no later than February 28, 2018 (or April 2, 2018, if filing electronically).
Self-insured ALEs must also report via Forms 1094-C and 1095-C.
ALEs that file 250 or more Forms 1095-C must file them electronically.

ALEs can find a complete list of resources and the latest news at the IRS’s Applicable Large Employer Information Center.

Lessons Learned from the 2015 Reporting Filings

After having reviewed the IRS 226J letters (https://www.irs.gov/individuals/understanding-your-letter-226-j) that were sent to employers who were assessed a penalty under the Employer Shared Responsibility provisions for reporting year 2015, and having discussed such reasons with reporting industry experts, here are some of the reasons for the penalties:

Employers who have utilized reporting companies who do not interact with the accounting or data management personnel of the employer, have seen a greater instance of errors due to incorrect or incomplete data being submitted.
Reporting vendors who do work closely with their clients to assess and determine information being submitted for 1094/1095 forms are less likely to have inaccuracies on their forms and indicator codes. This greatly decreases the likelihood of penalties being levied against the employer.
Line 21 and 22 of form 1094-C was often checked incorrectly or simply left blank. This occurred due to missteps by both employers and vendors alike. These mistakes often triggered the (A) tax penalty for employers.
Another common error related to line 22 (A) was whether or not an employer could utilize the “Qualifying Offer Method”(QOM). In order to be eligible for the less burdensome reporting reserved for the QOM, the below criteria is needed. https://www.irs.gov/affordable-care-act/employers/questions-and-answers-about-information-reporting-by-employers-on-form-1094-c-and-form-1095-c
- A “Qualifying Offer” is an offer that satisfies all of the following criteria:
  - It is an offer of minimum essential coverage that provides minimum value;
  - The employee cost for employee-only coverage for each month does not exceed 9.5% (as adjusted) of the mainland single federal poverty line divided by 12; and
  - An offer of minimum essential coverage is also made to the employee’s spouse and dependents (if any).
Line 22 (D) was also a frequent mistake, incorrectly indicated by employers or vendors. Line 22 (D) deals with the 98% Offer Method, which allows an employer to forego tracking or counting employees full or part-time status, as long as they offered qualified coverage to at least 98% of their employees.
Part III of the 1094-C form had reporting problems related to whether minimum essential coverage was offered or not, and what months the offers were made. Many employers used the wrong indicator codes and were penalized, even when they had made correct offers of coverage.
Not all penalties that were incurred by employers were the fault of the employer, but by the IRS themselves. The IRS sent many employers 226J letters with penalties for not offering Minimum Essential Coverage (MEC), when in fact the employer had properly offered MEC.

What to Watch for in Reporting Filings for 2017 and Beyond

If utilizing a reporting vendor it is important for employers to work closely with their vendors to ensure that the data the vendor has is accurate and that the boxes on the forms are being marked correctly. If an employer is doing their own reporting, it is highly recommended that they seek the assistance of a tax professional or other reputable reporting vendor.

We also highly recommend that employers maintain all the documentation from previous years used in their reporting, including all forms and transmission reports, so in the event of an Appeal with the IRS, they can offset incorrect penalties in a timely manner.

ESC is committed to helping its clients remain in compliance with all of their responsibilities and duties under the ACA and other regulatory obligations. If you would like assistance on your reporting, we suggest that you contact a reporting specialist. If you decide that you need an outside reporting resource, we recommend our integrated partner, StaffACA https://staffaca.com/.

ESC and its affiliates do not provide reporting, tax, legal or accounting advice. This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for reporting, tax, legal or accounting advice. You should consult your own reporting, tax, legal and accounting advisors to ensure you are in compliance with all the regulatory and legal issues that govern your business.

Health Networks Pull Out of Plans Leaving Clients Potentially Exposed

Essential StaffCARE has been contacted by several staffing companies reporting they have received unexpected mid-year termination notices from their Voluntary Employee Beneficiary Association (VEBA) Trust/Captive plan. These notices made reference to their networks pulling out of the plans.

The possibility of VEBA Trust/Captive plan promoters putting their clients at risk was predicted by Essential StaffCARE in our October 2015 Industry Alert.

The U.S. Department of Labor has issued a temporary restraining order to protect enrollees and beneficiaries who had been participating in this plan, and has filed a Cease and Desist order to prevent further marketing of the failed fund.

The abrupt failure of these VEBA Trust/Captive self-funded plans leaves their clients potentially exposed to ACA penalties and employee claims that are not being paid.

Continue to Exercise Caution

Staffing companies that offer major medical healthcare benefits through alternative plan funding scenarios should remember to exercise caution and diligence. Group plans structured under VEBA Trusts, Captive insurance scenarios or those designated as ERISA-exempt are likely to draw attention from industry regulators, and for good reason.

Unregulated Operation

VEBA Trusts and captive off-shore organizations such as these are not regulated by state law, the way a licensed health insurance company would be. The plans they offer are often appealing because of their perceived low pricing, tax advantage and self-operated structure. Their status as exempt, however, can open the door to a host of operational and financial pitfalls if not managed with proper oversight.

The Federation Of Regulatory Counsel (FORC) – a national association of attorneys specialized in the arena of insurance regulatory law – saw this coming as ACA legislation was being enacted. In 2010, they quickly warned, “Some unauthorized insurance promoters, wary of the administrative burden and cost of insurance regulation, seek to avoid state regulation of these products as insurance. They do so by cloaking these programs as “exempt” from regulation by flawed reference to federal law, such as the Internal Revenue Code or the Employee Retirement Income Security Act (ERISA).”

Employers May Be Responsible for Unpaid Claims

It is important to not only understand the inherent risks involved with unlicensed insurance scenarios, but also the liability of cost should the claims fund become insufficient. In self-funded scenarios, the employer is ultimately responsible.

Essential StaffCARE urges any staffing company currently participating in a VEBA Trust/Captive scenario or other ERISA-exempt plan to evaluate the financial stability, managerial acumen and funding equilibrium behind their plan.

If you have recently received an unexpected termination letter from your VEBA Trust/Captive self funded plan, or have any questions surrounding this industry issue, ESC can assist.