What Employers Need to Know About the New Transparency Rules

Posted on November 22nd, 2019

Proposed Transparency Rule Released

Following President Trump’s Executive Order on Improving Price and Transparency in American Healthcare, one final and one proposed rule was released by HHS and CMS that aim to increase price transparency for hospitals and insurance companies.  These rules would have an impact on employers who sponsor group health plans. 

It is important for employers to remember that the Transparency in Coverage Proposed Rule is only a proposed rule and will not be finalized until after the public comment period if it all. There is also a possibility it may not become a final rule. It is anticipated that many organizations and entities will provide comments on this rule, and there is a likelihood that if finalized in the future, it could be markedly different from the proposed rule. Furthermore, for rules of this magnitude, additional guidance will be required by federal agencies to assist employers, Third-party administrators, insurance carriers, and hospitals, with the specific implementation processes and policies. Employers should look for updates on this rule but should not make decisions or changes based on these proposed rules at this time. 

The final rule for hospitals is the Calendar Year (CY) 2020 Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) Price Transparency Requirements for Hospitals to Make Standard Charges Public Final Rule. This rule will require hospitals to provide, publicly on the internet, standard charges (gross charges, payer-specific negotiated charges, the amount the hospital will accept in cash from a patient, and the minimum and maximum negotiated charges) for all items and services. This rule will go into effect in 2021. The information must include common billing and/or accounting codes and descriptions of the items or services so consumers can compare standard charges between hospitals. 

The rule will also require hospitals to make similar information available for 300 common shoppable services, which include services that consumers can schedule in advance such as x-rays, outpatient visits, and bundled services such as a cesarean delivery including pre- and post-delivery care. 

Civil monetary penalties of $300 a day will be imposed on hospitals that do not comply. 

The second rule which could impact employers and carriers is the Transparency in Coverage Proposed Rule. This rule is aimed to ensure consumers would be able to get estimates of their cost-sharing liability for health care for different providers, allowing them to both understand how costs for covered health care items and services are determined by their plan, and shop and compare costs for health care before receiving care. The rule is also intended to increase consumerism and provide opportunities for innovation in health care. 

The proposed rule would require all non-grandfathered group health plans or health insurance issuer:

• Make available to participants, beneficiaries and enrollees (or their authorized representative) personalized out-of-pocket cost information for all covered health care items and services through an internet-based self-service tool and in paper form upon request.
• Make available to the public, including stakeholders such as consumers, researchers, employers, and third-party developers the in-network negotiated rates with their network providers and historical payments of allowed amounts to out-of-network providers through standardized, regularly updated machine-readable files.

In addition to comments on the above items, the rule seeks comments on whether group health plans and insurance issuers should be required to make available through a standards-based application programming interface the cost-sharing information referenced above that is proposed to be disclosed through the internet-based self –service tool and the machine-readable files.

The information provided by the health plan would have to include: 

•    The participant’s estimated cost-sharing liability
•    Accumulated amounts (financial responsibility already incurred w/ respect to the deductible or out of pocket limits)
•    The negotiated rate, reflected as a dollar amount
•    Out-of-network allowed amount (if requested item or service is out of network)
•    Items and services content list
•    Notice of pre-requisites of coverage
•    Disclosure notice

This information would have to be provided in the following manners: 

•    Internet-based self-service tool
•    Paper form at no fee provided via mail no later than 2 business days after it is requested by the participant, beneficiary, or enrollee, with an option to allow participants to select delivery over the phone, via email, by fax, or face to face.

The proposed rule would allow employers and health insurance carriers to contractually agree that the information will be provided by the carrier. 

Danielle Capilla, JD
Director of Compliance, Employee Benefits
In her role as Director of Compliance, Employee Benefits, Capilla focuses on enhancing  Alera Group’s existing compliance capabilities and building new world-class solutions for Alera Group’s employee benefits clients. Her legal background helps Alera Group clients navigate the complex landscape of healthcare legislation, regulation and reform. Capilla currently serves as an adjunct professor at DePaul University College of Law and is the Federal and State Legislative Chair for the Downtown Chicago Chapter of the National Association of Health Underwriters (NAHU).

The information provided in this alert is not, is not intended to be, and shall not be construed to be, either the provision of legal advice or an offer to provide legal services, nor does it necessarily reflect the opinions of the agency, our employee or our clients. This is not legal advice and no client-lawyer relationship between you and Alera Group or any of its employees is or may be created by your use of this information. Rather, the content is intended as a general overview of the subject matter covered. This agency and the Alera Group are not obligated to provide updates on the information presented herein. Those reading this alert are encouraged to seek direct counsel on legal questions.

Two Medicare Enrollment Periods for 2020 Benefits

Posted on November 19th, 2019

Happy with your Medicare benefits? Not interested in making changes for 2020? Great! You don’t have to do a thing.

However, if you’re ready to make a change, there are two Medicare enrollment periods — one of which is now in full swing. The fall enrollment period runs from Oct. 15, 2019, to Dec. 7, 2019, with policies effective Jan. 1, 2020. The winter enrollment period runs from Jan. 1, 2020, to March 31, 2020, with policies effective the first day of the month following an application.

The difference between the two enrollment periods is that the fall enrollment is for any Medicare beneficiary enrolled in Parts A and B. The winter enrollment is for beneficiaries new to Medicare Part B and at least 65 years old.

If you decide to do some research on your own, keep in mind that there are a variety of names used for the two enrollment periods — sometimes the same name for both.

Enrollment Period: Oct. 15 to Dec. 7, 2019. Medicare’s Name: Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage. Other Names: Medicare Open Enrollment; Annual Election Period; Annual Enrollment Period

Medicare Supplement plans do have rate increases annually, which will happen on your policy anniversary date. If you already have Parts A or B, your insurance provider should have already sent you the “Annual Notice of Change” letter. It informs you of any changes to your plan such as premiums, copays, pharmacy networks and drug formularies.

During Enrollment You Can:

• Change from Original Medicare to a Medicare Advantage Plan or vice versa.
• Choose a different Medicare Advantage plan.
• Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage (Part D) or vice versa.
• Join a Medicare Prescription Drug Plan.
• Switch from one Medicare drug plan to another Medicare drug plan.
• Drop your Medicare prescription drug coverage completely.

Why You Might Want to Make a Change:

• Premiums for your plan will be significantly higher. Since Medicare supplement policy benefits are standardized, the only thing different between carriers and plans is the amount they charge you in monthly premiums.
• With Medicare Advantage policies, premiums may be higher but you may also wish to choose different benefits since benefits are not standardized.
• Your doctor is no longer in your Medicare Advantage plan network.
• Your medications are no longer covered.
   

What You Can’t Do:

• Enroll in Part B without a qualifying medical event. A qualifying event is marriage, adoption, divorce or someone on the plan dies.
• Apply for Medicare Advantage Plans that are not in your geographic region.
• Make changes between your Medicare plans without answering medical questions.
   

Enrollment Period: Jan. 1–March 31, 2020. Medicare’s Name: Medicare Advantage Open Enrollment Period. Other Names: Medicare Supplement Open Enrollment Period; Medicare Annual Enrollment Period; General Enrollment Period
 

During Enrollment You Can:

• If you’re in a Medicare Advantage Plan (with or without drug coverage), you can switch to another Medicare Advantage Plan (with or without drug coverage).
• You can leave your Medicare Advantage Plan and return to Original Medicare. If you do this, you’ll be able to join a Medicare Prescription Drug Plan.
• If you enrolled in a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without drug coverage) within the first three months that you have Medicare.
• Medicare beneficiaries can sign up for Part A and/or Part B if the following are applicable: you did not sign up when you were first eligible and you aren’t eligible for a Special Enrollment Period. After premiums are paid, your coverage will start July 1.

What You Can’t Do:

• Change from Original Medicare to a Medicare Advantage Plan.
• Join a Medicare Prescription Drug Plan if you’re in Original Medicare.
• Switch from one Medicare Prescription Drug Plan to another if you’re in Original Medicare.

For help with your Medicare plan, please contact us info@aleragroup.com. 

IRS Releases Draft 2019 ACA Reporting Forms and Instructions

Posted on November 14th, 2019

The IRS has released draft forms and instructions for the 2019 B-Series and C-Series reporting forms (Forms 1094-B, 1095-B, 1094-C and 1095-C) used by employers and coverage providers to report certain information to full-time employees and the Internal Revenue Service (IRS). 

As background, the Affordable Care Act (ACA) added Sections 6055 and 6056 to the Internal Revenue Code. These sections require employers, plans, and health insurance issuers to report health coverage information to the IRS and to participants annually. Section 6055 reporting requirements apply to insurers, employers that sponsor self-insured group health plans, and other entities that provide minimum essential coverage (such as multiemployer plans). Section 6056 reporting requirements apply to “applicable large employers” or “ALEs” (generally, employers with 50 or more full-time employees) and require reporting of health care coverage provided to the employer’s full-time employees.

Reporting under Sections 6055 and 6056 involves two sets of forms:  the “B-Series” (Forms 1094-B and 1095-B); and the “C-Series” (Forms 1094-C and 1095-C).  Each includes a transmittal form (Form 1094-B or 1094-C), which serves as a cover page and provides aggregate information, and an individualized form (Form 1095-B or 1095-C) for each employee for whom the employer is required to report.  

The forms for calendar year 2019 are due to employees by January 31, 2020. Forms are due to the IRS by February 28, 2020 if filing by paper and by March 31, 2020 if filing electronically.  The forms that must be filed and distributed depend on whether the employer is an ALE and the type of coverage provided. Employers filing 250 or more of a particular form are required to file with the IRS electronically. The following table summarizes the responsible parties and forms applicable to the ACA’s reporting requirements. 

2019 Draft Instructions

The draft forms and instructions can be found here:

• Form 1094-B
• Form 1095-B
• B-Series Instructions
• Form 1094-C
• Form 1095-C
• C-Series Instructions

The draft instructions reflect the newly increased penalty structure (generally leaving the penalty at $270 per return, but increasing the penalty cap from $3.275 million to $3.339 million). 

Note Regarding 2019 Form 1095-C, Line 15.  The section 4980H “affordability” safe harbor percentage threshold is adjusted to 9.86% for plan years beginning in 2019, up from 9.56%.

Employers should continue to work closely with their insurance broker and other trusted advisors when determining how their organization will address the reporting requirements. Unless extended, 1095-C and 1095-B forms for the 2019 calendar year are due to participants by January 31, 2020. Forms 1094/1095-C and 1094/1095-B are due to the IRS by February 28, 2020 if filing by paper and by March 31, 2020 if filing electronically.  Employers should endeavor to file timely, as the IRS has begun enforcing penalties against employers who have failed to file timely or file electronically when required. 

About the Author.  This alert was prepared for Alera Group by Marathas Barrow Weatherhead Lent LLP, a national law firm with recognized experts on the Affordable Care Act.  Contact Peter Marathas or Stacy Barrow at pmarathas@marbarlaw.com or sbarrow@marbarlaw.com.

The information provided in this alert is not, is not intended to be, and shall not be construed to be, either the provision of legal advice or an offer to provide legal services, nor does it necessarily reflect the opinions of the agency, our lawyers or our clients.  This is not legal advice.  No client-lawyer relationship between you and our lawyers is or may be created by your use of this information.  Rather, the content is intended as a general overview of the subject matter covered.  This agency and Marathas Barrow Weatherhead Lent LLP are not obligated to provide updates on the information presented herein.  Those reading this alert are encouraged to seek direct counsel on legal questions.

© 2019 Marathas Barrow Weatherhead Lent LLP.  All Rights Reserved.

Will College Savings Plans be Necessary if College is Free?

Posted on November 12th, 2019

Free college tuition is an appealing idea as higher education costs continue to rise. Can the proposals of presidential candidates be counted on?

The 2020 presidential election is a year away, yet one issue already is grabbing the public’s attention. Many candidates are promising student loan forgiveness and free college. If you offer an employer-sponsored college savings plan, you’re probably wondering if it will still be necessary.

College costs are a top concern for many families. The College Board says a moderate budget for a public college is about $25,290 per academic year and $50,900 for a private college. Unfortunately, most households aren’t equipped to handle these costs. A Sallie Mae representative estimates that only about 10 percent of families pay the cost of college out of pocket, while the rest borrow or use a combination of resources.

Democrats announced several solutions, all government-supported programs. For instance, Candidate Sen. Bernie Sanders would make two- and four-year public colleges and universities tuition- and debt-free. Sen. Kamala Harris proposes making community college free and four-year public college debt-free. Sen. Elizabeth Warren proposed eliminating tuition and fees at public two-year and four-year colleges. Former Vice President Joe Biden suggests streamlining the Public Service Loan Forgiveness program, focusing on teachers.

Republican President Donald Trump made major changes to student loan forgiveness programs, including eliminating taxing student loan discharge for people who qualify for the Death or Total and Permanent Disability clause (this only applies to loans discharged after Jan. 1, 2018, and the provision is set to expire in 2025). Also, the Tax Cut and Jobs Act of 2017 expanded 529 college savings plans to cover K-12 private school expenses.

Parents and students should not rely on promises of free tuition. They should instead continue saving in plans such as the 529 plan. Even if one of these proposals becomes law and pays for tuition and fees, students still should save money for textbooks or living expenses. If a child decides to not attend college, 529 funds can be transferred to different family members or used to pay for graduate school.

How a 529 College Savings Plan Works

Nearly every state has at least one 529 plan that offers a full or partial tax deduction for residents. Individuals investing in a 529 account in their home state can use the funds to pay for tuition at a qualified school in another state.

There are two types of 529 plans: prepaid tuition plans and college savings plans. Prepaid plans allow investors to purchase tuition at today’s cost — enabling them to lock in the cost of tuition. The more popular option, a college savings plan, invests contributions in stocks, mutual funds, and bonds. Because earnings are tied to market performance, investment growth is not guaranteed.

Contributions to a 529 plan are after-tax dollars and grow tax-free. This means that distributions are not taxed when the student withdraws the funds for qualified expenses. Qualified expenses include tuition at eligible public or private two-year or four-year institutions; books, supplies and equipment (such as computers and Internet access); as well as reasonable costs for room and board.

In 2019, the most an individual can annually contribute to a plan is $15,000 without incurring a gift tax liability. 529 plans also can be bundled — allowing for a $75,000 contribution in one year rather than over a five-year period for gift tax purposes. Individuals also may fund multiple 529 plans for different children without incurring gift tax consequences, as long as the annual contribution for any one beneficiary doesn’t exceed the limit.

Employer-sponsored 529 Savings Plans

To encourage employers to offer 529 plans, seven states drive participation by offering employers a state income tax credit or deduction for matching employee 529 plan contributions. States currently participating include Arkansas, Colorado, Illinois, Nebraska, Nevada, Wisconsin and Utah.

For an employee to qualify for tax savings, most states require residents to contribute to their home state’s 529 plan. If the employer offers a 529 plan from a different state, the employee could miss out on potential tax savings.

Employees also should know that employer 529 matches are taxed as income and they will owe both federal and state taxes on the contributions. That may change, because federal legislation is pending to exclude employer 529 plan contributions from the employee’s gross income. 

Contact info@aleragroup.com for more information!

Alera Group Acquires Capital Region Benefits

Posted on November 12th, 2019

Alera Group, a national employee benefits, property and casualty, retirement services and wealth management firm, today announced that it has acquired Capital Region Benefits, effective November 1, 2019.

Capital Region Benefits, an independent insurance agency located in Camp Hill, Pennsylvania, has provided group benefit insurance services to Central Pennsylvania employers since 2004.  Capital Region Benefits also provides health reimbursement arrangement (HRA) and COBRA administrative services to both employers and other broker partners and is the national third-party administrator for VBA, a Pittsburgh-based non-profit vision preferred provider organization that delivers cost contained group vision benefits.

 “We are excited to welcome the Capital Region Benefits team, led by Diane Barber, to Alera Group,” said Alan Levitz, CEO of Alera Group. “The collaboration between Capital Regions and AIA is already well established.  We look forward to these two firms continuing to grow together.”

“As an Alera Group company, we look forward to providing more tailored resources and tools to our clients as part of their benefit plans,” said Diane Barber, President of Capital Region Benefits. “The combination of Alera Group’s national scope and our powerful local relationships positions us for continued growth and success.”

Capital Region Benefits joins Alera Group through AIA, Alera Group. The Capital Region Benefits employees will continue serving clients in their current roles. Terms of the transaction were not disclosed.

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About Alera Group
Based in Deerfield, IL, Alera Group’s over 1,800 employees serve thousands of clients nationally in employee benefits, property and casualty, retirement services and wealth management. Alera Group is one of the 20 largest independent insurance agencies in the country. For more information, visit www.aleragroup.com or follow Alera Group on Twitter: @AleraGroupUS

Health FSA Contribution Limit Increases to $2,750 for 2020 Plan Years

Posted on November 7th, 2019

IRS Increases Health FSA Contribution Limit for 2020, Adjusts Other Benefit Limits

On November 6, 2019, the Internal Revenue Service (IRS) released Revenue Procedure 2019-44, which raises the health Flexible Spending Account (FSA) salary reduction contribution limit by $50 to $2,750 for plan years beginning in 2020. The Revenue Procedure also contains the cost-of-living adjustments that apply to dollar limitations in certain sections of the Internal Revenue Code. 

Qualified Commuter Parking and Mass Transit Pass Monthly Limit Increase

For 2020, the monthly limits for qualified parking and mass transit are $270 each (up $5 from 2019).

Adoption Assistance Tax Credit Increase

For 2020, the credit allowed for adoption of a child is $14,300 (up $220 from 2019). The credit begins to phase out for taxpayers with modified adjusted gross income in excess of $214,520 (up $3,360 from 2019) and is completely phased out for taxpayers with modified adjusted gross income of $254,520 or more (up $3,360 from 2019).

Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) Increase

For 2020, reimbursements under a QSEHRA cannot exceed $5,250 (single) / $10,600 (family), an increase of $100 (single) / $150 (family) from 2019.

Reminder: 2020 HSA Contribution Limits and HDHP Deductible and Out-of-Pocket Limits

Earlier this year, the IRS announced the inflation adjusted amounts for HSAs and high deductible health plans (HDHPs).

The ACA’s out-of-pocket limits for in-network essential health benefits have also increased for 2020.  Note that all non-grandfathered group health plans must contain an embedded individual out-of-pocket limit within family coverage if the family out-of-pocket limit is above $8,150 (2020 plan years).  Exceptions to the ACA’s out-of-pocket limit rule are also available for certain small group plans eligible for transition relief (referred to as “Grandmothered” plans).  Unless extended, relief for Grandmothered plans ends December 31, 2020.

ACA Reporting Penalties (Forms 1094-B, 1095-B, 1094-C, 1095-C)

The table below describes penalties related to returns filed in the applicable year (e.g., the 2020 penalty is for returns filed in 2020 for calendar year 2019).  Note that failure to issue a Form 1095-C when required may result in two penalties, as the IRS and the employee are each entitled to receive a copy (increased for willful failures, with no cap on the penalty).

About the Authors.  This alert was prepared for Alera Group by Marathas Barrow Weatherhead Lent LLP, a national law firm with recognized experts on the Affordable Care Act.  Contact Peter Marathas or Stacy Barrow at pmarathas@marbarlaw.com or sbarrow@marbarlaw.com

The information provided in this alert is not, is not intended to be, and shall not be construed to be, either the provision of legal advice or an offer to provide legal services, nor does it necessarily reflect the opinions of the agency, our lawyers or our clients.  This is not legal advice.  No client-lawyer relationship between you and our lawyers is or may be created by your use of this information.  Rather, the content is intended as a general overview of the subject matter covered.  This agency and Marathas Barrow Weatherhead Lent LLP are not obligated to provide updates on the information presented herein.  Those reading this alert are encouraged to seek direct counsel on legal questions.

© 2019 Marathas Barrow Weatherhead Lent LLP.  All Rights Reserved.

A Beneficiary’s Guide to Filing a Life Insurance Claim

Posted on November 6th, 2019

A life insurance policy can be a thoughtful way to provide for loved ones after you die. But what happens if you are the beneficiary of someone’s life insurance policy?

Losing someone close to you is a difficult situation. Fortunately, however, filing a claim is usually straightforward. Here is what you should do if you want to receive the benefits from a policy.

Determine if You’re the Beneficiary

Hopefully, you know where a copy of the policy is located. The life insurance company might alert you, but if not, there are several ways to find a copy of the policy if it is not readily available:

•    If you have access to login information, check the insurance company’s claims portal.

•    Look for a PDF that may have been downloaded onto a hard drive.

•    Call life insurance companies that do business in your state, particularly if the policyholder had any other type of policy with that company.

•    Ask the benefits administrator of the policy holder’s employer if they offer a group life insurance policy.

•    Look for premium payment stubs.

•    Contact your state’s insurance department as well as its unclaimed property office. This usually can be accessed online.

•    In rare cases, the insurance company may have gone out of business since the insured person purchased the policy or the company may have changed its name or merged with another company. In these situations, you’ll have to do some research.

Once you have a copy of the policy, determine whether you’re a primary beneficiary or a secondary beneficiary. If there is more than one primary beneficiary, you will have to split the death benefit. If you or someone else is named a secondary beneficiary, then no benefits will be paid unless all the primary beneficiaries are dead or refused to receive the benefit. If the primary beneficiary can’t or won’t accept the life insurance proceeds, the contingent beneficiary must file a claim with the life insurance company.

Four Easy Steps

Once you have a copy of the policy and can prove you are the beneficiary, there are four steps to making a claim:

•    1st step: Call the policyholder’s insurance agent to notify them of the death of the policy holder. The agent will be able to help you fill out the necessary forms.

•    2nd step: Get several certified copies of the death certificate from the funeral director.

•    3rd step: Submit the death certificate to the life insurance company so the claim process can begin.

•    4th step: Choose a payment method. Select how you want the life policy paid out. The most common choices are:

•    Lump-sum payout – the entire payout in one amount.

•    Specific income provision – a scheduled payout over time of a determined amount.

•    Life income option – a monthly payout based on the death benefit and your life expectancy.

•    Life income with a specified period – a payout of a specific amount for a guaranteed period of time.

•    Joint and last survivor income – a fixed amount each month until you die. There is also an option where you can give a portion to a third-party.

•    Interest income option – The company holds the proceeds and pays you interest.

Denied Claims

Life insurance can be denied for one of two reasons:

•    If the policyholder gave false information, such as saying they didn’t smoke during the underwriting phase and then they died of lung cancer within two years of starting the life insurance policy.

•    If the policyholder took their life within the first two years of the life insurance policy. As the beneficiary, you will not receive a payout, but you will get a return of the premiums paid.

As always, talk to your insurance agent for assistance when filing a claim. 

Alera Group Acquires HR inTune

Posted on November 6th, 2019

Alera Group, a national employee benefits, property and casualty, risk management and wealth management firm, today announced that it has acquired the business assets of HR inTune, effective October 1, 2019.

HR inTune, located in Berwyn, Pennsylvania, is a human resource consulting firm that helps to address complex workforce management needs through different configurations of HR outsourcing. The firm offers an array of HR services, including compensation program implementation, HR compliance, leadership training, technology analysis and support, and more.

“HR inTune brings exciting enhancements to Alera Group’s existing HR service offerings,” said Alan Levitz, CEO of Alera Group. “We are thrilled to welcome the HR inTune team, led by Jamie Honigman, and we look forward to the many ways future collaboration will positively impact our clients.”

“Becoming part of Alera Group is a powerful next step for our firm,” said Jamie Honigman, President of HR inTune. “With the national resources of Alera Group, we are positioned for growth through collaboration, elevating our clients’ experience as we offer more resources and tools than ever before.”

HR inTune joins Alera Group through their Philadelphia location. The HR inTune service team will continue serving clients in their current roles. Terms of the transaction were not disclosed.

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About Alera Group
Based in Deerfield, IL, Alera Group’s over 1,800 employees serve thousands of clients nationally in employee benefits, property and casualty, risk management and wealth management. Alera Group is one of the 20 largest independent insurance agencies in the country. For more information, visit www.aleragroup.com or follow Alera Group on Twitter: @AleraGroupUS

Massachusetts Employers Must File HIRD Form by December 15

Posted on November 5th, 2019

As part of Massachusetts’ expanded Employer Medical Assistance Contribution (EMAC) program, employers with 6 or more employees in Massachusetts must submit a health insurance responsibility disclosure (HIRD) form annually, which collects information about employer-sponsored health insurance offerings.  Employers throughout the Commonwealth should have received email communication from the Department of Revenue (DOR) indicating that the HIRD form must be completed by December 15, 2019. 

The HIRD reporting requirement is administered by MassHealth and the DOR through the employer’s MassTaxConnect (MTC) account.  Employers may complete the HIRD form by logging into their MTC Withholding Tax account and selecting the “File HIRD” hyperlink under the “I Want To” section. The form will be available starting November 15 and will be used to assist MassHealth in identifying its members with access to qualifying insurance who may be eligible for the MassHealth Premium Assistance Program.  The DOR has published FAQs available here: https://www.mass.gov/info-details/health-insurance-responsibility-disclosure-hird-faqs.

Under the law, employers who knowingly falsify or fail to file the form may be subject to a penalty of $1,000 – $5,000 for each violation. 

Next Steps

Employers should check with their payroll provider to determine if they will assist with the filing.  While the HIRD form may be filed by either the employer or its payroll company, it’s the employer’s responsibility to ensure that the form is timely filed.

The form is used to indicate whether the employer has offered to pay or arrange for the purchase of health insurance and information about that insurance, such as the premium cost, benefits offered, cost-sharing details, eligibility criteria and other relevant information.  The HIRD form will be used to assist MassHealth in identifying its members with access to qualifying insurance who may be eligible for the MassHealth Premium Assistance Program. The Premium Assistance Program helps eligible working individuals and families pay for qualifying employer-sponsored insurance.

About the Authors.  This alert was prepared for Alera Group by Marathas Barrow Weatherhead Lent LLP, a national law firm with recognized experts on the Affordable Care Act.  Contact Peter Marathas or Stacy Barrow at pmarathas@marbarlaw.com or sbarrow@marbarlaw.com.

The information provided in this alert is not, is not intended to be, and shall not be construed to be, either the provision of legal advice or an offer to provide legal services, nor does it necessarily reflect the opinions of the agency, our lawyers or our clients.  This is not legal advice.  No client-lawyer relationship between you and our lawyers is or may be created by your use of this information.  Rather, the content is intended as a general overview of the subject matter covered.  This agency and Marathas Barrow Weatherhead Lent LLP are not obligated to provide updates on the information presented herein.  Those reading this alert are encouraged to seek direct counsel on legal questions.

© 2019 Marathas Barrow Weatherhead Lent LLP.  All Rights Reserved.

On the Road Again – But With Insurance

Posted on November 1st, 2019

Traveling for work can be exciting, but only if you know that your coverage has your back! Whether you're traveling by plane, train or automobile, you can have peace of mind knowing that your travel insurance can protect you against every traveler's worst nightmares. 

One way to ensure their lives are easier is by providing business travel insurance. While travel insurance policies vary, they usually include:

•    Cost of emergency medical evacuations and repatriation coordination. Evacuation from another country can cost hundreds of thousands of dollars. Evacuation for security reasons also can be expensive.

•    Reimbursement for essentials while the airline searches for lost luggage.

•    Medical and dental costs, including locating local medical facilities. This is important if employees travel outside the United States since their health insurance might not be valid in other countries. Some health coverage might only operate on a reimbursement basis. This means the employee must pay for treatment out of their own pockets and wait for reimbursement by their insurance company.

•    Trip cancellation coverage for non-refundable expenses when a trip is canceled for a covered reason, such as death in the family or illness.

•    Travel delay coverage provides some money for unexpected hotel, dining and transportation when travel is delayed for a covered reason.

•    Baggage coverage provides some reimbursement when luggage is irretrievably lost, damaged or stolen.

Business travel insurance also can provide emergency travel assistance services, such as locating alternative flights, tracking lost luggage and finding local medical care. Sometimes it can provide business-specific services and obtaining business equipment, translators, drivers and special event tickets.

Your business can pay for the coverage outright or employees can purchase coverage on a per-trip basis and be reimbursed. If the employee purchases the coverage, they should buy it right after making the first trip payment. This timing is important because some benefits, including pre-existing medical condition waivers; canceling for any reason and canceling for work reasons; only apply if the policy is purchased 10 to 15 days from when the trip deposit was made.

Please contact us for more information at info@aleragroup.com.