The world of compliance can be complicated at times, especially considering its ever-changing nature.

All the same, it is important to keep up to date with the latest rules and regulations, especially for brokers and advisors, so they can ensure clients are better set up for success. Also important is that benefits managers offer protection from any consequences stemmed from violating newly established provisions. Keeping up with compliance will also help provide the best service for clients, resulting in the best outcomes for employees and enrollees overall.

Now, as we ease into 2023, there are several key updates to consider to ensure utmost compliance.

One of these is in regard to virtual healthcare, or tele-health. As we know, this has become more prominent in the past several years, especially during the pandemic, as it has often presented safer and more convenient options for patients. On this note, the Consolidated Appropriations Act (CAA) of 2022 allowed for first dollar coverage of virtual healthcare through the end of the year and established greater protections for consumers related to medical billing and transparency in healthcare.

While it seemed possible the legislation would not be extended into the new year, the CAA of 2023 was fortunately passed extending the program. As a result, high deductible health plans (HDHPs) can waive the deductible for virtual healthcare services and participants will still be eligible for a health savings account (HSA). [1]

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Employers should also pay close attention to what constitutes disease management versus wellness practices because this will likely continue to be a factor in determining which services are covered in specific plans. Whether the virtual service provides treatment for an actual ailment or the service is nonessential will make a difference for those who have a HDHP. In cases such as virtual care for mental health, this can very much qualify as medical care in many cases, especially when prescriptions are involved, but it is important that it works with cost sharing and that enrollees are able to use it to meet their minimum deductible. If compliance rules aren’t carefully followed, it could disqualify the HDHP to the point where the employee cannot contribute to an HSA any longer.

Additionally, companies that offer wellness plans must be very careful about requiring different kinds of health assessments, even if participation in the plan is voluntary.

Ongoing litigation with AARP is bringing a diverse set of defendants regarding privacy concerns, where the U.S. Equal Employment Opportunity Commission (EEOC) has remained deadlocked on this issue, providing little clarity over rules and regulations. [2] This typically presents one of two options for employers. If the tolerance for risk is low, some companies have opted to remove anything from a wellness plan that could constitute a privacy concern and redesign the program to stay within the lines.

In terms of coverage affordability, another key compliance topic to keep an eye on is the “family glitch fix.” This refers to a family’s ability to receive subsidies through a public exchange. Traditionally, if the coverage offered to an employee was affordable on an individual level, the family of the employee could be restricted from receiving subsidies through the exchange, causing various issues in obtaining this needed coverage for some time now; hence being labeled a major “glitch” in the system.

Furthermore, since this has not been able to be resolved through the legislative process, administrators are now working to fix it through the regulatory process. Now, instead of looking at the affordability of the individual coverage for the employee, brokers are able to establish plans based on the coverage offered to the family as a whole; a major win for many!

The family glitch fix will not have any impact on the employee mandate. Meaning, the affordability for the employee mandate will still be based on the individual coverage offered to the employee. As of right now, the fix does not change any of the employer’s reporting obligations either and no new paperwork should be required. The fix simply allows for employers to offer an affordable individual plan while not necessarily barring the family from gaining a subsidy.

While these are just a few of the latest trends and revisions in compliance, it is imperative to realize that these items are typically in constant motion. One of the best ways to keep up to date with the latest compliance topics is to establish a good working relationship with your broker and keep up to date with various reputable media regarding any new updates to rules.

As one example, Holmes Murphy often hosts in-person and online events where experts speak on various topics throughout the employee benefits space, including many compliance-related topics.

[1] Telehealth policy updates for Providers. Health Resources and Service Administration (HRSA) Online. Last accesses on February 8, 2023.
[2] AARP Foundation Files Charge Against Workplace Wellness Program in Illinois. AARP. Online. Last accessed on February 8, 2023
[3] Kelly. S. Family glitch fix for ACA premium subsidies finalized. HealthcareDive/Informa. Online. Published on October 12, 2022. Last accessed on February 2023.

Featured image: Employees in Office Environment. Photo courtesy: © 2016 – 2023 Mimi Thian on Unsplash

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