4 Point Compass: Winter 2021

Chicago rookery building
COVID-19 Vaccines are Here! – Now that the vaccines have arrived (thankfully) and each state is executing its vaccine distribution strategy, the government and insurance companies have begun to explain how the vaccine will be covered.  The CARES Act requires that all plans (except those with “grandfathered” status) will cover the FDA-authorized vaccines with no cost sharing to the patient during the “national public health emergency period”.  Many employers are asking if they can make it mandatory for employees to get inoculated, and considerations must be made under the Americans with Disabilities Act, National Labor Relations Act and more.  Early commentary suggests that employers will be able to require employees to be vaccinated – unless an employee’s disability, pregnancy, or religious belief prevents them from being vaccinated.  Employers should seek legal advice about making the vaccine mandatory, and counsel may want to wait for more clear guidance from the government before proceeding.

  Insurance Rebates & Premium Credits – Since 2011, fully-insured medical carriers/plans have been subject to the Medical Loss Ratio (MLR) rules – and some have been required to deliver rebates to customers, resulting in employers determining if/how much of the rebates need to be reimbursed back to plan participants.  Similar to these MLR rebates, in response to the financial hardship of COVID-19 in 2020, some carriers (including many Medical, Dental, Vision, Life, and Disability carriers) issue premium credits to employers.  Remember, ERISA law does require employers to utilize “returned plan assets” (i.e. these rebates and/or premium credits) for the benefit of the welfare benefit plan.  In other words, the employer can retain the portion of the rebate/credit equal to the percentage they funded, while issuing the remaining portion to plan participants.

What’s your Group Size? – Over many years, the Employee Benefits industry and Labor & Health insurance laws have created a number of “company size thresholds”, which should be monitored by employers and, in most cases, reported to their insurance carriers (as well as State & Federal governments).  The specific size thresholds for many of these laws/requirements vary and the measurement/calculation of these thresholds can vary, so an employer needs to follow the “count methodology” for each law/requirement.  The most common employee thresholds (and applicable laws) to monitor:
15 employees – American with Disabilities Act, Pregnancy -Discrimination Act, Genetic Information Nondiscrimination Act
20 employees – Medicare coordination, COBRA, Age Discrimination in Employment Act
50 employees – Family Medical Leave Act, ACA ALE 1095 Filing (see below), health plan “Community rating” vs. “Experience rating” for certain states
100 employees –  Medicare coordination, EEO-1 reporting, 5500 filing, health plan “Community rating” vs. “Experience rating” for certain states

At the end of each year, and/or prior to their health insurance anniversary date, Employers (both stand-alone, and those aggregated with other employers under common control) should maintain an accurate monthly headcount of full-time & part-time employees, determine if any threshold has been crossed, and prepare to alert the insurance companies and/or employees of any changes. 

1095 Information & DIY Online Solution – The Affordable Care Act requires Applicable Large Employers (i.e. employers with 50 or more full-time + “full-time equivalent” employees in 2019, including members of an aggregated group or under common control) to provide a 2020 1095-C to all medical eligible employees no later than March 2nd, 2021.  While this deadline was extended by the IRS, the deadline for filing the forms with the IRS has not been extended, so employers must submit their forms to the IRS by February 28, 2021 (or electronically by March 31st, 2021).  A quick reminder that Stumm Insurance offers you a “Do-It-Yourself” (DIY) 1095-C online solution at no cost to you.  For more information please watch an introductory video at this link https://millsonjames.wistia.com/medias/v1vc4ep6bx and contact your SI service team as soon as possible if you would like to discuss this solution.  Should you have any further questions, please feel free to contact your Stumm Client Service Team.