The past few years have been busy when it comes to compliance. Benefit pros have had to deal with all the COVID-19 related relief regs. Examples include the extended deadlines for COBRA premiums and changes to FSAs and independent care account contributions. That’s a lot of “back of the house” administrative work. And then there were non-COVID-19 related substantive changes.
Unfortunately, 2022 isn’t going to be any easier, as far as compliance goes.
“This is a big year,” said Danielle Capilla, JD, VP of Compliance, Employee Benefits at Alera Group, in an interview with HR Morning. “It’s the first year that we don’t have good-faith reporting relief for the Affordable Care Act (ACA) reporting. And there are many employers who haven’t done the best job with their ACA filing because they’ve had this relief. But now it’s time to be double-checking all your facts and figures to get those filings as accurate as possible.”
Industry experts, like Capilla, have concerns that some employers are going to get caught up and see stiffer penalties in the future because they were lax in their reporting process and not filing the way they should have been. Previously, in the rush of things, firms may have just slapped a code on their forms just to get them accepted into the IRS’s system and then fix them later when they had time. But now firms need to worry about doing it correctly from the get-go or face stiff penalties.
Consolidated Appropriations Act
The other big issue that happened in the last year was the passing of the Consolidated Appropriations Act (CAA), 2021. This massive bill has multiple sections that touched back to benefits compliance. One of them is broker transparency. It’s extremely important to make sure all brokers are meeting these new requirements.
But there are new employer requirements as well. One is making sure that medical ID cards now have the additional required information on it, like:
- out-of-pocket maximum limitations, and
- a telephone number and website address where enrollees can obtain additional information about their coverage.
Pharmacy transparency reporting
Another major issue on the horizon: This December employers are going to have their first deadline for pharmacy transparency reporting.
“The way it reads right now is there are no exceptions for small employers,” said Capilla. “It applies to everyone. Self-funded, fully insured, large, small and everyone in between must do this pharmacy reporting.
“The concern that we have is most employers, particularly those with a fully insured plan, don’t have access to the information that’s needed to complete the reporting. That’s something their carrier or TPA (third-party administrator) would have. And there are a lot of employers saying, if I have to report all these pieces of information and I don’t have them, what am I going to do in December?”
Currently, carriers are working on it, agencies are working on creating additional guidance and consumer organizations have gone to the agencies letting them know small employers don’t have the information urging them to produce an exception.
Right now, it’s a wait and see game.
“But any employer with a group health plan needs to be concerned about this because the first round of reporting is due on Dec. 28, 2022, and then every July thereafter,” said Capilla. “It’s going to be a big reporting process, just like ACA reporting, 5500 reporting and all those other things that already take some of our time and financial budget. We’re shoehorning another one in there now.”
How can benefit pros stay in compliance?
To stay compliant and not get overwhelmed, Capilla advises Benefits pros to get organized and pay close attention to what the regulatory agencies are saying. Don’t get all caught up in the day-to-day operations and forget about what’s coming down the road.
It’s important to keep checking back in with the regulatory agencies to get updates. One way to do that, according to Capilla, is through continuing education and watching their emails for regulatory updates.
“So, more than ever this year is going to be about keeping your eye on the horizon and getting things on your calendar with enough time to get them done properly,” said Capilla.
There are other components of the CAA that fall on carriers to do this year. But Benefits pros should be paying close attention to them too, because they’ll have a trickle-down effect to plan participants.
“Benefit pros need to be aware of these things so when participants ask questions they can give an educated answer,” explained Capilla. “There are requirements about hospitals and carriers releasing pricing information. So, you’d better believe plan participants are going to have questions about this, like: Where do I find it? How can I look it up? Why isn’t something I care about on there? So, it’s just something benefit pros need to stay in the know on.”
For those firms who don’t have an HR department, but rather one or two people who do it all, Capilla says it’s vital to make sure sure you have really good broker and vendor partners.
“Make sure you’re picking best in class vendor partners who will truly be your partner and be that safety net for you,” she advises. “They’re going to be there reminding you what needs to get done, by when and how they can help you.
“If you have a broker that you’re only seeing once a year at renewal, you’ll probably want to reconsider that relationship because that means you’re definitely missing things.”
So, this is the timeframe to make sure all your partners are people you can truly trust and rely on to alert you to the things that might not come up in your day-to-day dealings.
Things in 2022 will remain fast paced.
What’s to come? Capilla noted we continue to await further guidance on CAA components, as well as new wellness regs. So, they could be coming at any time now.
Her final advice: “It’s not a year to be sleepy and not paying attention.”