Compliance Considerations for 2017 Health Benefits Planning

In finalizing 2017 health benefit designs, contribution strategies, vendor terms, and employee communications, employers need to keep pace with the latest Affordable Care Act (ACA) requirements and other developments impacting health plans. Mercer has issued a list of top 10 compliance issues to consider.

Wellness: If your wellness program includes a health risk assessment or biometric screening or seeks spousal information, evaluate whether the program meets the new Equal Employment Opportunity Commission (EEOC) rules. Work with vendors on wellness issues to ensure compliance with EEOC’s final Americans with Disabilities Act and Genetic Information Nondiscrimination Act rules.

Essential health benefits and ACA nondiscrimination rules: Federal agencies, especially the U.S. Department of Health and Human Services (HHS), continue to issue regulations that will have direct and indirect effects on how large employers design benefits. For 2017, employers should determine whether updated state benchmark plans for essential health benefits and final ACA nondiscrimination rules affect plan designs contemplated for the next plan year.

Mental health parity: Confirm your plan meets recent parity guidance about coverage of mental health and substance use disorders (MH/SUDs), and prepare for possible U.S. Department of Labor (DOL) audits of health plans’ compliance. Also consider the Mental Health Parity and Addiction Equity Act (MHPAEA) when selecting vendors. Assign responsibility for parity compliance in service agreements with vendors that handle both medical and MH/SUD benefits, and monitor vendor performance on parity issues.

Employer shared-responsibility (ESR) strategy and reporting: Assess 2017 health plan design and eligibility terms against ESR strategy, checking whether medical options meet minimum value, minimum essential coverage (MEC), and affordability standards. Review current measurement methods for identifying full-time employees, and evaluate individual and Internal Revenue Service (IRS) coverage-reporting processes, including correction steps. Adjust these procedures as required or desired for ACA compliance in 2017.

Preventive care: Confirm non-grandfathered group health plans comply with final ACA rules on cost-free preventive coverage. Modify benefit terms for 2017 plan year to reflect latest recommendations and guidance on preventive care, including FAQs on colonoscopy-preparation prescriptions and requests for contraceptives not on a plan’s approved list.

NEXT: More compliance issues to consider

SBC model documents: Ensure delivery practices and procedures for your health plan’s summary of benefits and coverage (SBC) align with final rules now in effect. Prepare to use updated SBC model materials on or after April 1, 2017.

FLSA final overtime rules’ impact on employee benefit plans: Account for any benefit impact stemming from the final Fair Labor Standards Act (FLSA) regulations redefining employees entitled to overtime compensation. If desired, consider amending benefit plans to keep overall staffing costs as neutral as possible.                  

Expatriate group health plans: Position group health plans covering globally mobile employees to take advantage of ACA relief under the Expatriate Health Coverage Clarification Act or other ACA and Employee Retirement Income Security Act (ERISA) exemptions.

HIPAA privacy, security, and electronic transactions: Revisit health plans’ privacy and security obligations under the Health Insurance Portability and Accountability Act (HIPAA). Consider whether evolving security threats merit strengthening risk-assessment or risk-management activities. Watch for revived federal requirements for self-insured group and other health plans to obtain national health plan identifiers and certify HIPAA compliance in specific electronic transactions.

DOL fiduciary rule: Assess the potential impact starting in April 2017 that DOL’s final conflict-of-interest rule for investment advice fiduciaries could have on health savings accounts (HSAs) and ERISA health or welfare plans with an "investment component," such as universal or whole life insurance policies.