Employers depend heavily on their third-party administrators (TPAs) for much of the information and assistance they need to stay in compliance with regulatory reporting requirements. The good news is that some of the COVID-related requirements are ending. Other requirements are resuming or are new to the industry.
Pharmacy and Health Care Spending Updates
As required under the Consolidated Appropriations Act (CAA), all employer groups who offer health plans, along with insurers and pharmacy benefit managers, must submit information on pharmacy and health care spending to the Departments of Health and Human Services (HHS), Labor (DOL) and Treasury. HHS will use the information to compile an annual report beginning in 2023 on the impact these costs have on premiums and consumer out-of-pocket costs. Deadline for submission to HHS is initially December 27, 2022, and then by June 1st each year thereafter.
PCORI Fee Change
For plan years that end on or after October 1, 2021 and before October 1, 2022, the new PCORI fee is $2.79 per covered life. The resulting payments are due on or before July 31, 2022.
ACA Safe Harbor Reporting Requirement Updates
The IRS has decreased the affordability percentage index for eligible employee affordable health care options from 9.81% to 9.61% for 2022. (A slight increase to 9.7% is projected for 2023.)
As reported in BenefitsPRO, “For employers who use the Federal Poverty Level (FPL) Safe Harbor method, coverage is deemed affordable if the employee’s required monthly contribution for the lowest-cost, self-only, ACA-compliant coverage does not exceed the FPL for a single individual. Eligible employees must not be required to pay more than $103.15 per month for plans beginning July 11, 2021, to December 31, 2022.”
Good Faith ACA Reporting Error Change
Good faith relief from ACA Reporting errors has ended. Employers need to review forms 1094-B or C and 1095-C carefully each year before they are submitted to the IRS, but the annual deadline for reporting requirements has been moved permanently to March 2. Employer penalties have increased to $280 per employee for failure to provide form 1095-B or C plus $280 per employee for failure to file with the IRS, for potential employer penalties of up to $560 per employee.