With open enrollment season upon us, here are some tips to help employers prepare for enrollment, remind you of important rules and requirements, and maximize participation.
Important Rules and Requirements
Electronic Enrollments - ERISA Requirements for Electronic Disclosure
- Must notify employees when documents are posted
- Must follow ERISA's style and content requirements
- Participants have a right to paper copies
- Employees who do not have work-related computer access must consent to electronic delivery
Annual Open Enrollment Timing Rules
- Takes place prior to beginning of plan year for which elections are made
- Elections for pre-tax benefits must be effective on a prospective basis
- Ends well in advance of upcoming plan year to allow time to:
- Confirm elections
- Administer enrollment
- Conduct preliminary nondiscrimination testing
- Issue ID cards
Plan Design Changes
- Review plan documents
- Make any necessary updates
- Communicate changes to participants with an updated Summary Plan Description (SPD) or a Summary of Material Modifications (SMM)
ACA Affordability Standard
Under the ACA's employer shared responsibility rules, applicable large employers (ALEs) are required to offer affordable, minimum value health coverage to their full-time employees (and dependent children) or risk paying a penalty. These employer shared responsibility requirements are also known as the "employer mandate" or "pay to play" rules.
- For plan years that begin on or after January 1, 2019, the affordability percentage is 9.86%. That means that employer-sponsored coverage for the 2019 plan year will be considered affordable under the employer shared responsibility rules if the employee's required contribution for self-only coverage does not exceed 9.86% of the employee's household income for the tax year.
Out-of-Pocket Maximum (OOPM)
Non-grandfathered plans must comply with an annual limit on cost-sharing for coverage of essential health benefits (EHB).
- $7,350 for self-only
- $14,700 for family
- $7,900 for self-only coverage
- $15,800 for family (or anything other than self-only coverage)
HDHP and HSA Contribution Limits
Enrollment in a High Deductible Health Plan allows employees to establish a Health Savings Account (HSA). The IRS adjusts limits annually for changes in cost-of-living.
|Type of Limit||2018||2019||Change|
|HSA Contribution Limit||Self-only||$3,450||$3,500||Up $50|
|HSA Catch-up Contributions
(not subject to adjustment for inflation)
|Age 55 or older||$1,000||$1,000||None|
|HDHP Minimum Deductible||Self-only||$1,350||$1,350||None|
|HDHP Maximum Out-of-Pocket Expense Limit (deductibles, copayments, and other amounts, but not premiums)||Self-only||$6,650||$6,750||Up $100|
Health FSA LimitThe ACA imposes dollar limits on employees' pre-tax contributions to a health FSA.
- $2,650 in 2018
- 2019 limits not yet released
- Employers can impose their own limits that are lower than the ACA's limits
- Consider making a Limited Purpose FSA available to employees who establish Health Savings Accounts (HSA)
Carrier Plan Design Changes
Carriers will occasionally change benefits to their existing plans. Some of the more common changes may include:
- Incorporate ACA's higher allowed maximum out of pocket limits
- Change in Rx Formulary for specific segment
- Implement new Rx programs
If any of these changes occur to your plan be sure to communicate this to your employees. The same goes for plan design changes you opted to make - be sure to highlight those changes to your employees.
Open Enrollment Notices
There are many required notices employers must provide their employees. Talk to your employee benefits consultant if you are unsure which apply to your group.
- Affordable Care Act (ACA)
- Uniform Summary of Benefits and Coverage (SBC)
- Disclosure of Grandfathered Status
- Patient Protection and Selection of Providers
- Americans with Disabilities Act (ADA)
- Notice for wellness programs that collect health information
- GINA - Genetic Information Nondiscrimination Act
- Health Insurance Portability and Accountability Act (HIPAA)
- HIPAA/ACA/Wellness - notice of alternative standard
- Privacy and security
- Other notices:
- Children's Health Insurance Program (CHIPRA)
- Mental Health Parity and Addiction Equity Act (MHPAEA)
- Michelle's Law
- Newborns' and Mothers' Health Protection Act (NMHPA)
- Women's Health and Cancer Rights Act (WHCRA)
Tips for Maximizing Participation
- Be ready to answer employee questions regarding healthcare reform legislation. Understand how the legislation affects your benefits offerings and be prepared to share this knowledge with employees
- Make a list of anything new and exciting that will enhance your open enrollment processes
- Consider online enrollment programs and software if you haven't already
- Maintain records of employee questions, comments, concerns, preferred communication methods, and other information to create a FAQ
- Consider offering new benefits, even if they are 100% voluntary
- Hold employee meetings to review coverage options and changes
- Communicate helpful phone numbers and websites to employees looking for additional resources
- Be sure employees have received all of the following: open enrollment schedule, statement of current coverage, plan specific changes and rates, plan specific summaries, open enrollment booklet and forms, deadline for open enrollment, and pertinent contact information.
- Send frequent reminders
- Make yourself available through various mediums for employees to contact you with questions
Post Enrollment Tips
- Check enrollment forms for any missing information
- Check enrollment forms for any information that was incorrectly filled out
- Submit all enrollment forms to the carrier
- Ensure compliance with any health care reform provisions that affect your plan and employees
- Follow up to ensure employees received ID cards
Looking for assistance with any of these items? Contact us at info@GoCGO.com.
Please note, this blog post is not intended to be exhaustive nor should any discussions or opinions be construed as legal advice - it is intended for educational and/or informational purposes only.