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Want to shake it up when it comes to your benefits package? These 10 companies prove all that's holding you back is your imagination!

BASF
Offerings include flexible work arrangements, comprehensive wellness, eldercare and childcare. BASF’s headquarters in Germany includes an onsite nursery, a fitness and health studio, an onsite medical consulting service and a practice for physical therapy.

JPMorgan/Chase
Began offering autism benefits to its 160,000 U.S. employees, following a well-received autism awareness event that took place inside the firm. They provide coverage for the initial autism diagnosis and the various types of therapies that are often prescribed for the neurobiological disorder, which could include Applied Behavioral Analytics (ABA), Cognitive Behavioral Therapy (CBT), nutritional counseling, periodic developmental screening, individual or group family therapy, speech and occupational and physical therapy, as needed, in addition to medication management.

Netflix
Only 12% of U.S. private-sector employees have access to any paid family leave through their jobs, according to the U.S. Department of Labor. In addition to the company’s now famous unlimited time off policy for vacation and sick days, they offer as much as one year of paid time off to new mothers and fathers.

Boxed
Began paying for college tuition for the children of employees, as well as the wedding expenses of all unmarried employees.

PwC
With an average employee age of 28, this company began helping nearly half of its 46,000 employees pay down their student loans. The company contributes $100 per month ($1,200 per year) for up to six years (a maximum of $7,200) directly to its employees’ student loan servicer, for non-management employees.

Michelin
Provides biometrics, personal health reviews and family health centers offering concierge medicine to its 22,000 North American employees, offering up to $2,000 a year as a health reimbursement arrangement for a biometrics scan. The company spends about $250 million a year on total healthcare, which includes four $5 million per year family health centers. Through the centers, along with gym reimbursements, free medication for condition management and on-site gyms, the company reduced metabolic syndrome by 12% in three years.

Comcast
Provides discounted services that save employees up to $3,000 per year. Employees also receive discounted tickets to the Universal Orlando and Hollywood theme parks, and 20% off Fandango gift cards, on top of a diverse benefits package that includes child and eldercare resources and adoption assistance in addition to the usual benefit offerings.

Aflac
The average tenure at this company is 18 years, thanks to their approach to professional development coaching, employee surveys, social media, and group-focused networking.

Microsoft
Doubled paid time off for new parents, added companywide holidays, and increased company’s 401(k) match in an effort to equalize healthcare and retirement benefits.

La Macchia Enterprises
More than 95% of the workforce participates in the company’s wellness program thanks to efforts to make wellness part of their work culture every day, stocking fridges with fruits, vegetables and healthy snacks, having walking meetings, and an annual “Wellness Action Day” with wellness vendors, healthy snacks and fitness games for employees and their families.

See anything that might stir up your benefits offerings?

Let us know how we can help.

Source: Kathryn Mayer, 10/23/16 “How 10 Companies Are Breaking the Benefits Mold” Employee Benefit News Retrieved 10/30/16 from: http://www.benefitnews.com/news/how-10-companies-are-breaking-the-benefits-mold

I only see one major medical insurance carrier doing this any more in Southern California, but they all used to require any agent getting appointed to sell their insurance to vow, in writing, not to add supplemental onto their plans. Why? They were trying to sell their more expensive platinum plans to employers that covered everything. Some of us vaguely remember 1st dollar coverage, right? If supplemental gap insurance was offered to an employer, they would figure out that they could save a lot of money by going with the least expensive high-deductible plan, covering the employee’s deductible with inexpensive gap insurance.

Oh how times have changed. With the underlying health care costs out of control, premiums became out of reach for most employers, who then insisted on the least expensive, consumer-driven, high-deductible plans, adding on an HSA. And here we are.

There is just one fatal flaw with this picture that is keeping employees from getting the health care they need. Americans aren’t saving. I’m not here to point fingers or assess blame, it’s just our current reality. The personal savings rate in America is around 4.4 percent, which is a huge fall from 2012’s 10.5 percent. Almost half of Americans would not be able to cover an unanticipated expense of $500, and almost a quarter wouldn’t be able to cover even $100. Yet today's deductibles can reach as high as $10,000 before insurance kicks in.

Given this reality, gap insurance is now a necessity. Most major carriers realize this and have stopped requiring agents to sign a promise not to partner CDHDs and gap insurance. In fact, most of them are now offering supplemental insurance as well. I’m just curious why it still seems to be hush-hush. Why isn’t the administration, in pushing CDHDs on the ACA exchanges, and preaching consumer-driven health care for all, speaking about the necessity of gap insurance, while Americans adjust to saving for high-deductibles? It needs to be shouted from the mountaintops. Right now, I’m in the Rocky Mountains of Colorado for the Labor Day weekend - so that’s what I’m doing. Have a safe, healthy and enjoyable holiday. When you get back to work, make sure your employees, whose labor you value, have access to gap insurance as part of your benefit offerings so they can access the health care they need to keep being productive for your business.

Source: Lake, R. 05/18/2016. 23 Dizzying average American savings statistics. Retrieved 8/30/16 from: https://www.creditdonkey.com/average-american-savings-statistics.html

I know. We're hearing "culture of wellness" everywhere we turn. But it is more than just a new HR flavor of the month.

Hopefully you've read my take on what's happening with the switch to high-deductible plans. Not only can making sure you provide employees with a way to fill the gap, between their current savings and their deductible requirements, help them with this transition -- making sure you genuinely have a culture of wellness at your company will go a long way in making your employees feel like you haven't left them hanging in all this health care reform riga-ma-roll.

The reality is, 40% of corporate wellness programs are not effective. You have to realize that if your wellness program amounts to some biometrics, some bouncy balls and some lip service, your wellness program won't be successful either.

To succeed, your wellness program must be an genuine expression of your company's culture.

When you succeed, you're not just improving employee well-being - you are also boosting your talent acquisition, as well as your employee performance and retention.

According to the Society for Human Resource Management (SHRM), the returns on investment of an effective wellness program are significant and those healthy ROIs grow over time. A Harvard University study of 100 peer-reviewed journal articles found that a
properly designed wellness program can expect to yield an ROI on health care cost reductions of 3.27:1 and an ROI on absence and related costs of another 2.73:1 after about three years. These ROIs are nothing to sneeze at, and are something your C-Level executives can get behind. (To calculate ROI, the amount saved as a result of a program (e.g., lower health care spending) is divided by the dollars spent on the program. The result is expressed as a ratio, with an ROI of 2.50:1 indicating a return of $2.50 for every $1 invested.)

So where is the yellow brick road to an effective wellness program? It really does start with your culture. Here are some tips to ease on down that road.

Define Goals
I assume you have a business plan. And I assume that business plan contains not only your goals, but your mission, vision and values, which drive your goals. When all of those pieces are connected, you can grow the kind of culture you need to shape a work environment your employees find supportive.

Your wellness plan must have goals. You couldn't run a business without goals -- you can't run an effective wellness program without goals. What do you want employees to strive for? And how do these goals connect to the overall goals and your company culture? Once you've figured this out, it is important to share and explain these goals with your employees -- and get their buy-in.

But this means you have to take a step back, and make sure your employees understand your company goals and cultural values as well, or they can't connect the dots. They need to understand where your wellness goals for them fit into the big picture.

A 2015 Achievers survey of North American employees found that 61% don’t even know their company’s mission, and an additional 61% don’t know the cultural values of their workplace.

If your employees can't connect these dots, how can you expect them to buy-in?  How can you expect them to genuinely engage? They need to be able to clearly see how the success of your business, and achieving your company's goals, depends upon improving their well-being.

Ask employees what they want
You would think this tip would be a no-brainer. If you want to create a wellness program that employees are willing to engage in -- simply ask them what they want and need. Surprisingly, many employers don't do this.

A 2015 survey of employees published by Quantum Workplace and Limeade, found that employees aren't interested in just biometrics and bouncy balls. They want benefits that address a broader definition of well-being, not just physical health. For example, 76.7% want time off to recharge and 60% want work-life balance benefits. Probably more basic requests than what you were afraid of, but the fact is, few employers actually offer these simple elements as part of their wellness program.

If you'll ask, your employees might come up with some very simple, very inexpensive, very creative requests. And maybe you just want to phrase the question in terms of what would make it easier for them to do their jobs rather than tying it to wellness, especially if you already have a flailing wellness program that employees are not engaged in. Some well-being requests are bound to be among the answers.

By asking, you are not only finding out the best pieces to include in your wellness program to make it effective and engaging for employees -- but you are communicating to them that you value their opinions and care about their well-being, which boosts overall engagement, period.
In fact, the Quantum Workplace and Limeade survey found that respondents were 38% more engaged and 18% more likely to go the extra mile when they felt their employers cared about their well-being.

Make It Easy
Honestly, most of the wellness programs I've seen that are failing are making it too hard. Not only do employees end up feeling like it's just another monkey on their back -- so do the HR staff. It just ends up being another disconnect between employees and management.

It just makes sense. When programs are simple, employees are more likely to engage. A 2014 Aon Hewitt survey found that 40% of millennials said they’re more likely to participate in health and wellness programs if they’re easy and convenient. Don't ask employees to spend more time at work then they already are. Don't ask employees to give up their lunch or break times either. Then it's punishment -- and that doesn't improve anyone's well-being. If you're going to plan any events during lunch or breaks, employees need to see something in it for them that is enticing enough to engage them. They may very well be using their lunch and breaks to take care of household issues as it is, rather than relaxing and actually taking mental/physical/emotional rest. Create game-like programs that don't take away from work responsibilities. Set time aside -- yes -- out of the workday for exercise, and stress-relief breaks. Remember those ROIs?

Inspire employees. Tie it all in to your overall company vision, sewing it into a package with simple integrations and connections to the benefits, programs, HR platforms and apps you already use. That way, employees can easily access and share information about everything related to their health, well-being and performance in a transparent format.

Get everyone involved
Can your employees rub elbows with your CEO in your wellness activities? There is no better way to make your wellness program a genuine expression of your corporate values and culture. Your leaders need to be highly visible in your wellness program. "People don't do what you say, they do what you do" is completely true here. That's how you make it real.

The Aon Hewitt survey found that 53% of millennial employees said they were open to their direct manager playing an active role in encouraging them to get and stay healthy.

When your employees can experience a connection from top to bottom and bottom to top between your wellness program and your company culture, then, and only then, will your employees internalize the message that their personal well-being truly matters.


Sources:
SHRM
"Wellness Program ROI Depends on Design and
Implementation"
Steven F. Cyboran and Sadhna Paralkar, M.D.
7/26/2013
Retrieved 3/2/16 from https://www.shrm.org/hrdisciplines/benefits/articles/pages/wellness-roi-design.aspx

Employee Benefit Advisor
"Why a client’s corporate culture is critical to wellness success"
Henry Albrecht
March 29 2016
Retrieved March 29, 2016 from http://www.employeebenefitadviser.com/opinion/why-a-clients-corporate-culture-is-critical-to-wellness-success

Hospitals and Pharmaceuticals may have some legitimate issues somewhere, but we’ve recently seen two that definitely aren’t.

Hospitals complaining about the loss in revenue since Americans no longer go to the ER for a sniffle?

Pharmaceuticals complaining about high deductible health plans, because now consumers, instead of insurance, are expected to pay their exorbitant prices?

Novo Nordisk, the Danish company known best for its diabetes care products, is funding a backlash against insurance companies "cost--shifting...to patients," trying to keep the spotlight off of their high prices?

Really?

The good news here is that getting more Americans insured and giving them the wheel with consumer-driven, high-deductible health plans is getting results!

Poof!  CDHPs are pulling back the curtain on the provider/pharmaceutical wizards, and exposing pricing that consumers will not tolerate.  Health care providers and pharmaceuticals now must deal directly with consumers, instead of hiding behind insurance carriers — who have been voices in the wilderness about unsustainable health care costs — until now.  

We’re not saying insurance carriers are lily white in the scheme of things.  Insurance carriers have had their own bag of tricks.  Hopefully, the gig is up for them, too!

We believe it will be, if we can continue down the consumer-driven path.

Look how quickly consumers started hollering at their representatives in Congress to DO something, and wa! la! investigations and hearings abound!

Of course, we believe more in consumers’ and business’ ability to swiftly turn this ship around then in Congress.  Less government involvement, more free enterprise is the most elegantly simple solution!

Do the hospitals and pharmaceuticals have any idea how they sound?

Hospitals identified inappropriate ER visits by uninsured Americans as a big factor in defending their high cost of health care — as they raked it in!  Now, that it’s being fixed, they’re complaining about the loss of those ill-gotten gains.  Actually, KevinMD predicts it’s lose the fat time, and that one-third of hospitals will close by 2020.  Hopefully, lean, quality health care providers will be all that is left.

Pharmaceuticals haven’t even really ever had to address the skyrocketing costs of their drugs in any significant way, when only the insurance carriers (and employers) were complaining.  What did employees care — insurance and their employer paid for it.

Now, facing the consumer having to reach into their pocket, pharmaceuticals have no where to hide — and no plausible explanation!

Makes me think of an interview with a pharmaceutical rep I heard on the radio (believe it was NPR).  I’m afraid I didn’t catch the name of the program or the people.  The host was relentless in coming back around every time and asking the question again when the rep. tried to weasel out of a direct answer to why the drug prices were so high, and how they could justify $$$$% increases.  The rep. kept responding “discounts,” that no one actually pays those prices because of the discounts they offer the insurance companies.  Huh?  The gig is up!  Consumers are not going to play that silly game with pharmaceuticals and insurance carriers ought be heaving a sigh of relief, though we’re sure there is still a ways to go.

FILL THE GAPS
With transparency starting to happen, someone needs to shout from the rooftops to let consumers know they need to focus on unsustainable prices, not going back to letting high prices hide behind first dollar insurance.  That's one big reason we got to $3 trillion dollars in the first place.  If it has to be me, so be it!

But it is true that consumers have something to holler about. There is one potential train wreck on the very near horizon in all of this.  High deductibles may be putting consumers in the driver’s seat, but consumers don’t have the money to pay the high deductibles.  The result?  They are not seeking medical care.

In fact, many say their high deductible makes their health insurance all but useless.

The fix?  As Americans transition to that kind of savings, (if they can), gap insurance is a necessity.  An HSA is fine, and the tax break is great — but that is not going to magically create more savings.  If consumers don’t have it, they just don’t have it!  

It is vital to pair CDHPs with either voluntary insurance that consumers pay for, which is a lot cheaper than a $6,000 deductible, or supplementary insurance that employers decide to pay for, or a blend of the two.

We’re on the right track! Make sure your employees are able to fill in the gap, then, as Dory said in Finding Nemo, we need to “just keep swimming!”

Let us know how we can help.


Sources:
Alicia Caramenico, Fierce Healthcare, February 9, 2012
“Hospitals lose reimbursement for 'unnecessary' ER visits”
http://www.fiercehealthcare.com/story/hospitals-lose-reimbursement-unnecessary-er-visits/2012-02-09

David Houle and Jonathan Fleece, KevinMD, March 14, 2012
“Why One-Third of Hospitals Will Close by 2020”
http://www.kevinmd.com/blog/2012/03/onethird-hospitals-close-2020.html

Harris Meyer, Modern Healthcare, December 3, 2015
“Drugmakers make valid point about insurers' role in high drug costs”
http://www.modernhealthcare.com/article/20151203/BLOG/151209957?utm_campaign=socialflow&utm_source=twitter&utm_medium=social

Lenny Bernstein, Washington Post, December 4, 2015
"New patient coalition aims to take on cost of health care, access to quality treatment"
https://www.washingtonpost.com/news/powerpost/wp/2015/12/04/new-patient-coalition-aims-to-take-on-cost-of-health-care-access-to-quality-treatment/

Rene Letourneau, for HealthLeaders Media , November 25, 2015
“Red Flags for Hospitals in Medicaid Expansion States”
http://healthleadersmedia.com/content.cfm?topic=HEP&content_id=323216

Robert Pear, New York Times, Nov. 14, 2015
“Many Say High Deductibles Make Their Health Law Insurance All but Useless”
http://www.nytimes.com/2015/11/15/us/politics/many-say-high-deductibles-make-their-health-law-insurance-all-but-useless.html?_r=0
 
Susan McBride, Randy Notes, Managed Healthcare, April 01, 2014
“Hospitals Must Mitigate ACA Revenue Loss”
http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/content/tags/billing/hospitals-must-mitigate-aca-revenue-loss

We're hoping ACA Reporting is old news for you, that you've been collecting the necessary information all year, and you're ready to go!

But since we've received some frantic calls from companies who have this nagging feeling their advisors aren't really "on top of it," and they don't feel confident in what to do -- here is ACA Reporting 101.  It's like when you first learned to ride a bike.  We'll hold on until you get your balance, and then let go as you fly. 

We've also given you a year-end checklist (especially for California employers in light of recent changes).

The purpose behind the new Affordable Care Act reporting requirement is to make certain Applicable Large Employers (ALE) report whether each individual employee is covered by minimum essential coverage, and that an offer of minimum essential coverage that provides minimum value was made to each full-time employee.  But -- it's not quite that simple, as you're about to see.

Since we're approaching the end of the year, we are going to preface a discussion of ACA Reporting with some loose ends that you also need to make sure you "tie up."

Year-End HR Considerations
(Especially for California Employers)

1. Review your Independent Contractors:
Who are you paying via 1099?  Recent court decisions and administrative rulings have narrowed the definition significantly.  January 1 is the best time to make sure everyone is properly classified.  When in doubt, classify "employee" then consult with your attorney.

2. Review your employee's salary classification:
If the DOL's proposed amendments to increase the salary threshold for employee overtime exemptions pass, don't be caught off guard.

Take a look at all of your employees that are currently below the proposed threshold:

• Effective January 1, 2016, this amount in California will increase to approximately $800 per week ($41,600 per year), when California's minimum wage increases to $10.00 per hour.
  
• The new federal proposal raises that amount to $970 per week ($50,440 annually).
• There is also a proposed increase in the "highly compensated" exemption from $100,000 to $125,148 annually.

Should any of your employees within this salary band be earning overtime?  Now is the best time to minimize overtime liability and reclassify those employees.
 
3. Organize your personnel files:
Take the time to organize your employee files and I-9 Forms:

• separate the terminated employees from the active
• keep I-9 files separate from employee personnel files and maintain them for one-year post-termination
• keep terminated employee personnel files for three years after the date of separation

4. Review your paystubs:
Make sure your accounting, human resources, and payroll administrators are all collaborating to ensure compliance with the new reporting requirements on paid sick leave.
You want to avoid being one of the California employers being hit with the recent plague of PAGA suits .  You can't afford to assume your third-party payroll provider has it covered.

5. Analyze compensation practices.
Make sure your compensation policies and practices are ready for when the California Fair Pay Act goes into effect January 1st. You now must evaluate employees by job duties, not titles, to ensure equal compensation for women and men. If you find a disparity in pay, either fix it or be ready to explain.

ACA Reporting 101

We must place a disclaimer here.  This content is provided as a general guide.  Us this guide to consult with your 1) benefit advisor 2) tax advisor 3) payroll advisor 4) legal advisor for specific advise regarding your particular circumstances.

Are you ready?  Here we go!

Form 1094-C and 1095-C Reporting
Applicable Large Employers are required to file annual Affordable Care Act reports with the IRS verifying that they made offers of coverage to all full-time employees on IRS Forms 1094-C and 1095-C.

Form 1094-C is a summary report provided to the IRS that includes:

• information about your related employers
• identification of your full-time employees to whom qualifying offers of group health coverage are made
• and the duration of the offers

The IRS will be using the information you provide to determine the pay-or-play penalty, and to assess eligibility for individual premium tax credit for coverage purchased in the Health Insurance Marketplaces.

You provide Form 1095-C to both the IRS and to each of your full-time employees. It includes information regarding the specific employee's group health coverage and whether spouses and dependents are covered.

Similar to a Form W-2 and Form W-3, a separate Form 1095-C should be provided to each of your full-time employees and then filed with the IRS using the transmittal Form 1094-C.

Determine Your ALE Status
According to the ACA definition, an Applicable Large Employer (ALE) averages at least 50 full-time or full-time equivalent employees.  Note that the reporting requirement applies to you for 2015 even if you were under 100 full-time employees and not subject to the pay-or-play penalty in 2015.  (If you have less than 50, go to this link to see your ACA reporting requirements: https://www.irs.gov/Affordable-Care-Act/Employers/Tax-Considerations-for-Employers-with-Fewer-than-50-Employees)

• For employers with 50-99 full-time or full-time equivalent employees, transition relief is provided through the Employer Mandate for 2015, but you must still complete Forms 1094-C and 1095-C to be in compliance.
• Employers who sponsor self-insured health plans who are not ALEs still have reporting obligations as health coverage issuers under Section 6055, as explained below.
• In the case of related employers within a controlled group, all of the employers must be aggregated to determine the number of "full-time" or "full-time equivalent employees" employed by an ALE for the purpose of determining ALE status.  These "corporate families" are referred to as an "Aggregated ALE Group" in the IRS' final instructions, and each ALE within the Aggregated ALE Group is an ALE member.
• The IRS requires a report for each separate employer identification number (EIN), whether an autonomous ALE or an ALE member, even if ALE members have separate EINs but participate in the same self-funded group health plan.
• The IRS also states that each ALE must report the names and EINs of the other entities in the ALE's controlled group (the Aggregated ALE Group) on Form 1094-C.
  
• The final IRS 2015 instructions clarify that you need to disregard an employee for any month in which the employee is covered under TRICARE or Veterans Administration coverage, consistent with The Surface Transportation and Veterans Health Care Choice Improvement Act of 2015.
  

Decide Whether to Outsource ACA Reporting
You have to make the call (urgently at this point) as to whether you are up to handling ACA reporting or if you need to outsource. 

1. Do you have the ability to collect the significant amount of 2015 data required from your payroll, benefit departments, benefit enrollment systems and third party vendors?
2. Do you have the ability to compile all of this data onto Form 1094-C and Form 1095-C?
3. Do you have the ability to complete a test-run of the IRS ACA reporting software with your data?

if your answer is "no" to the questions above, you must immediately select & contract a third party vendor to allow enough time for them to assist you in compiling, inputing and testing to ensure that your reports are working properly.

Consult Advisors Regarding Reporting Questions
True to form, the IRS rules for ACA reporting are quite detailed, and you may be subject to different special rules. You would be wise to ramp up your reporting preparation efforts at this point, if you have not already
done so, and to review the following guidance with your advisors, staff, and vendors:

• 2015 Form 1094-C (https://www.irs.gov/pub/irs-pdf/f1094c.pdf)
• 2015 Form 1095-C (https://www.irs.gov/pub/irs-pdf/f1095c.pdf)
• 2015 Instructions for Forms 1094-C and 1095-C (https://www.irs.gov/instructions/i109495c/ar01.html)
• Section 6056 Regulations (http://www.gpo.gov/fdsys/pkg/FR-2014-03-10/pdf/2014-05050.pdf)
• IRS Publications 5164 and 5165, and the AIR Submission Composition and Reference Guide [all related to electronic filing] (https://www.irs.gov/for-Tax-Pros/Software-Developers/Information-Returns/Affordable-Care-Act-Information-Return-AIR-Program)
• IRS Publication 5223 [related to the use of substitute forms and statements] (https://www.irs.gov/pub/irs-pdf/p5223.pdf)

IRS Report Filing and Employee Statement Plan
The Form 1094-C and Form 1095-C must be provided to the IRS at the same time as your Forms W-2 and W-3.

• February 29, 2016 is your paper-filing deadline and March 31, 2016 is your electronic-filing deadline for forms 1094-C and 1095-C for the 2015 calendar year.
• February 1, 2016 is your deadline to provide form 1095-C to each full-time employee.
• Extensions/Waivers - the IRS' final 2015 instructions provide extension procedure details for: 

          -filing your forms and/or providing employee         
           statements
          -waivers of electronic filing requirement
          -filing/providing substitute returns or employee 
           statements
          -filing corrected forms

• Electronic filing is required if you file at least 250 returns.
  
• If you must file electronically, your software programmers and reporting staff should consult and review IRS Publication 5165 (Guide for Electronically Filing Affordable Care Act Information Returns for Software Developers and Transmitters) (Early Look for Processing Year 2016); IRS Publication 5164 (Test Package for Electronic Filers of Affordable Care Act Information Returns); and various guidance on electronic filing and important software requirements, available online at: https://www.irs.gov/for-Tax-Pros/Software-Developers/Information-Returns/Affordable-Care-Act-Information-Return-AIR-Program.
• You also need to review the instructions for registering for the AIR electronic filing system and applying for a "Transmitter Control Code," which must be received in the mail before you can file Forms 1094-C or 1095-C electronically; the same applies if you are a health coverage issuer who is required to file Forms 1094-B and 1095-B electronically.
• Lastly, if you are thinking about using substitute forms and statements, you should review IRS Publication 5223 with your vendors and advisors.

Decide Who was a Full-time Employee for at Least One Month of the Year
Each ALE member must file a Form 1095-C for:

1. each employee who was a full-time employee for any month of the calendar year (https://www.irs.gov/Affordable-Care-Act/Employers/Understanding-2015-Transition-Relief-under-Employer-Shared-Responsibility-Provisions)
2. for any employee who enrolls in self-funded coverage, whether or not full-time for any month.

Generally, you should work to identify full-time employees, using your method of choice under the ACA, prior to the ACA reporting deadline. Then you can confirm which employees must receive Form 1095-C and complete Form 1094-C.

You must report your total employee and total full-time employee counts for each month on Form 1094-C based on a consistent "snapshot" methodology (e.g., on the first day of the month, last day of the month, etc.).

The IRS' final instructions revised the methodology to allow you to base your employee count on the number of employees as of the 12th day of each month.

This step does not apply if you are eligible for the 98 percent offer rule described in the instructions for Forms 1094-C and 1095-C above.

Determine the Types of Coverage Offered and How Each Type Should be Reported
ALE with Employees Covered under a Self-Insured Plan.
If you offer coverage through a self-insured health plan sponsored by your company, you must complete Form 1095-C, Parts I, II, and III, for any employee who enrolls in the health coverage, whether or not they are a full-time employee for any month of the calendar year. You also will need to complete the Form 1095-C for each full-time employee.

ALE with Employee Covered under an Insured Medical Plan.
If you offer coverage through an insured group health plan sponsored by your company, you will need to complete Form 1095-C, Parts I and II. You should not complete Part III.

ALE with Employees Covered under a Multi-Employer Plan. Relying on the multi-employer plan interim rule relief for a given month means you'll need to complete Form 1095-C, Parts I and II and, in Part II, you will enter 1H on line 14, skip line 15, and report 2E on line 16, regardless of whether the employee was eligible to enroll or enrolled in coverage under the multi-employer plan.

The instructions for line 16 create an exception to the 2C enrollment code for the 2E multi-employer interim rule relief code.

While the IRS may change the requirements for reporting multi-employer plan coverage for 2016 and future years, the instructions for 2015 resolve much of the ambiguity that has been plaguing multi-employer plans about the need to exchange data with employers.

You might still need to obtain offer and enrollment information from the multi-employer plan if there are full-time employees who receive offers of coverage but:

     (a) the employer has no obligation to contribute on 
          their behalf,
     (b) they are offered coverage that is not affordable,
     (c) they are offered coverage that does not provide
          minimum value, or
     (d) they are offered coverage that does not cover
           eligible individuals' dependent children.

HIPAA issues regarding if such a data exchange between multi-employer plans and contributing employers were required still have not been addressed by the IRS and HHS.

Employees Eligible for COBRA
According to the final IRS 2015 instructions, an offer of COBRA coverage at termination of employment should not be reported as an offer of coverage in your ACA reporting -- regardless of enrollment. However, COBRA coverage offers due to a reduction in hours are reported in the same manner as an offer of that type of coverage to any other active employee.

Penalties
Tax reporting penalties effective for 2015 filings which, if assessed, apply in addition to the Employer Mandate penalties that would be assessed under the ACA, are listed in the IRS' final instructions.

• You may be able to reduce or waive ACA reporting penalties for failures that are due to reasonable cause or that are timely corrected.
• Additionally, penalties will not be assessed for 2015 ACA reports as long as you can show you made good faith efforts to comply with the new ACA reporting requirement. (Whew!)
• But -- you have to meet report filing deadlines and furnish appropriate statements.  This short-term penalty relief is available only for incorrect or incomplete information provided on 2015 reports and statements. Employers who fail to furnish the reports may be assessed penalties of $250 per return --up to $3,000,000.

Form 1094-B and 1095-B Reporting
If your company sponsors a self-insured health plan, providing minimum essential coverage (MEC), or otherwise provides a MEC to your employees, you must prepare annual ACA reports reflecting enrolled employees' months of coverage.

Most will fulfill their reporting obligations by using Forms 1094-B and 1095-B (though ALEs sponsoring self-insured coverage can instead use Forms 1094-C and 1095-C).  2015 Forms:

• 1094-B (https://www.irs.gov/pub/irspdf/f1094b.pdf)
• 1095-B (https://www.irs.gov/pub/irs-pdf/f1095b.pdf)
• 2015 instructions (https://www.irs.gov/instructions/i109495b/index.html )

Multiple Types of MEC
For employees covered by multiple types of MEC, the instructions to Forms 1094-B and 1095-B clarify certain special reporting rules that apply. In two situations, only one type of MEC would need to be reported:

• an employee is covered by more than one type of MEC provided by the same provider (an example would be a self-insured employer-sponsored health reimbursement arrangement, or "HRA," and a self-insured group health plan sponsored by the same employer)
• an employee is eligible for one type of MEC only if he or she is covered by other MEC for which reporting is required (as an example, an employee  is only eligible for an HRA if enrolled in the major medical plan offered; you don't need to report the HRA coverage for an employee covered by both).

Taxpayer Identification Numbers and Social Security Numbers
According to the IRS' final instructions for Forms 1094-B and 1095-B, Form 1095-B furnished to recipients may truncate social security numbers (SSNs), taxpayer identification numbers (TINs), or your company's employer identification number (EIN), but not the
filer's EIN. For now, you will not be subject to penalties for failure to report a TIN if you comply with the regulatory procedures for soliciting TINs, with certain modifications described in detail in IRS Notice 2015-68.

"Responsible Individual" Defined
The "responsible individual" is the person who, based on a relationship to the covered employee, the primary name on the coverage, or some other circumstances, should receive the statement.

Generally, the statement recipient should be the
taxpayer (tax filer) who would be liable for the individual shared responsibility payment for the covered employee.

Further, the preamble to the regulations under Section 6055 makes clear that "[a] responsible individual is a primary insured, employee, former employee, uniformed services sponsor, parent, or other related person named on an application who enrolls one or more individuals, including him or herself, in minimum essential coverage."
79 Fed. Reg. 13220 (March 10, 2014).

Get In Gear
The deadlines to furnish statements and file reports are right around the corner. Now is the time for you to organize your data and develop your plan for compliance.

We know you can do it, so we're letting go to let you fly!  Wheeeeeeeee!

Sources:

IRS - "Affordable Care Act"
https://www.irs.gov/Affordable-Care-Act

Fox Rothschild LLP.
Sahara Pynes, November 11, 2015.
"Year-End HR Considerations | California Employment Law" http://californiaemploymentlaw.foxrothschild.com/2015/11/articles/wageandhour/year-end-hr-considerations/

Seyfarth Shaw.
Nicole D. Bogard M'Alyssa Mecenas. 11/10/15
"Health Care Reform Reporting Is Coming: Is Your Company Prepared?"
http://www.seyfarth.com/uploads/siteFiles/publications/HealthCareReformManangementAlert_Issue95_11.10.2015.pdf

Fisher & Phillips LLP.
Lorie Maring. "ACA Reporting 101" 11/2/15
http://www.laborlawyers.com/aca-reporting-101

Don't ya love do-overs?

Well, if you're nervous about doing the new ACA reporting right, at least you get to do a test run, and do it over if you make some mistakes.

The IRS has recently opened up its Affordable Care Act Assurance Testing system which allows employers to see
if their reporting software is correctly filling out the 2014 Forms 1094 and 1095. In November, the testing system will be cued up with the 2015 reporting forms.

The IRS submission requirements for using the ACA Assurance Testing system advise to:
“read the instructions carefully prior to preparing the submission.”

“Code definitions for Offer of Coverage Codes and Safe Harbor Codes are defined in the instructions and are not
provided in the narrative but must be included within your submission where appropriate,” the IRS cautions.

Good Faith Effort

In addition to a test run, for 2015, employers who file will have protection even if your filing is incorrect or incomplete, as long as you show you made good faith efforts to comply with the ACA reporting requirements. Michael Weiskirch, a principal at EmployeeTech Inc. says a “good-faith effort” is defined as an employer simply attempting to complete the forms.

But the good-faith effort for 2015 tax year will disappear in 2016 and penalties will apply for incorrect information after that.

Test runs begin in November, but hopefully, you've been already collecting the necessary information.  Having the ability to track and manage the required data should be happening now, according to Weiskirch. He says the requirements “have put benefit advisers and their clients
at a crossroads and have created a small panic in selecting the ‘just right’ solution.”

Over the last two years, a flood of ACA reporting solutions have entered the market, some stand-alone some
that are to be integrated with your existing HR, payroll or benefit systems.

Reporting Requirements

Whatever method you choose, here's what  is required by the IRS:

• Beginning next year, applicable large employers (ALEs), (generally meaning employers with 50 or more full-time employees in the preceding year), must report whether: a) an individual is covered by minimum essential coverage; b) and that an offer of minimum essential coverage that provides minimum value was made to each full-time employee.
• ALEs use Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, and Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, to report the information required.
  
  

“The IRS will use these forms to enforce the employer penalties, individual mandate and tax credit eligibility rules under the Affordable Care Act,” the Wagner Law Group cautions.

“With mandatory reporting for ALEs beginning in 2016, understanding the reporting requirements is critical. Accordingly, employers should give careful attention to this and all future IRS guidance as the reporting deadline rapidly approaches,”  the group adds.

In addition to the test run, the IRS issued a Q&A notice to clarify for employers what's coming:

"Is an ALE member that sponsors a self-insured health plan required to file Form 1094-C and Form 1095-C if the ALE member has no full-time employees?"

"Generally, yes.  An ALE member that sponsors a self-insured health plan in which any employee or employee’s spouse or dependent has enrolled is required to file Form 1094-C and Form 1095-C, whether or not that employer has any full-time employees and whether or not that individual is a current employee or a full-time employee. For an individual who enrolled in coverage who was not an employee in any month of the year, the employer may file Forms 1094-B and 1095-B for that individual."

"Is an employer that is not an ALE member required to file under the Affordable Care Act if the employer sponsors a self-insured health plan that provides minimum essential coverage?"

"No; however, such an employer is subject to the reporting obligations under the Affordable Care Act. An employer that is not an ALE member that sponsors a self-insured health plan in which any individual has enrolled is not subject to the reporting requirements of ACA. Such an employer will generally satisfy its reporting obligations by filing Form 1094-B and Form 1095-B."

"Is an ALE member required to report under the Affordable Care Act with respect to a full-time employee who is not offered coverage during the year?"

"Yes.  An ALE member is required to report information about the health coverage, if any, offered to each of its full-time employees, including whether an offer of health coverage was – or was not – made. This requirement applies to all ALE members, regardless of whether they offered health coverage to all, none, or some of their full-time employees.  For each of its full-time employees, the ALE member is required to file Form 1095-C with the IRS and furnish a copy of Form 1095-C to the employee, regardless of whether or not health coverage was or was not offered to the employee. Therefore, even if an ALE member does not offer coverage to any of its full-time employees, it must file returns with the IRS and furnish statements to each of its full-time employees to report information specifying that coverage was not offered.

For the full IRS list of questions and answers about reporting requirements for employers, see their Reporting Offers of Health Insurance Coverage by Employers page on IRS.gov/aca.


Sources: Melissa A Winn, IRS allows employers to test run ACA reporting | Benefit News http://ebn.benefitnews.com/news/health-care-reform/irs-allows-employers-to-test-run-ACA-reporting, 9/9/15, 11:32 AM

Questions and Answers to Help Your Organization Understand ACA Reporting Requirements
IRS Health Care Tax Tip 2015-56, September 16, 2015
http://www.irs.gov/Affordable-Care-Act/Employers/Questions-and-Answers-to-Help-Your-Organization-Understand-ACA-Reporting-Requirements

IRS Clarifies ACA Reporting Requirements for Large
Employers, 6-9-15, http://www.benefitnews.com/news/health-care-reform/irs-clarifies-aca-reporting-requirements-for-large-employers-2746619-1.html