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Alera Group Selects National Property and Casualty Practice Leader

Posted on June 18th, 2019

DEERFIELD, IL – Alera Group, a national employee benefits, property & casualty, risk management and wealth management firm, appointed Mark Englert as national Property & Casualty Practice Leader.

Englert will be responsible for continuing Alera Group’s path toward building world-class property & casualty solutions. He will work closely with firms across the nation to enhance client experiences, build out new capabilities and coordinate services and resources between firms. Englert will look for additional capabilities already in existence within Alera Group, as well as identifying areas to enhance moving forward.

“We are very excited about the new depth and breadth that Mark’s expertise will bring to Alera Group’s Property & Casualty team,” said Jim Blue, President of Alera Group. “Mark will work closely with the entire leadership team on a collaborative basis to assist with many exciting initiatives.”

Englert comes to Alera Group from a national insurance broker, where he was a Managing Director. He brings more than 25 years of experience to his role with Alera Group.

“I look forward to continuing to develop Alera Group’s property & casualty resources within each individual firm, as well as a collaborative whole,” said Mark Englert. “Our ongoing leverage of property & casualty expertise allows us to design unrivaled national solutions for each of our firms, creating even more exceptional experiences for our clients.”

As Property & Casualty Practice Leader, Englert joins Alera Group as the latest member of an industry-leading team of professionals who are dedicated to Alera Group’s collaborative growth across the United States. For more information about Alera Group, visit www.aleragroup.com.

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About Alera Group
Based in Deerfield, IL, Alera Group’s over 1,500 employees serve thousands of clients nationally in employee benefits, property and casualty, risk management and wealth management. Alera Group is the 15th largest independent insurance agency in the country. For more information, visit www.aleragroup.com or follow Alera Group on Twitter: @AleraGroupUS.

HHS Proposes Revisions to ACA Section 1557 Regulations

Posted on June 11th, 2019

HHS Proposes Revisions to ACA Section 1557 Regulations

At the end of May, the Department of Health and Human Services (HHS) released a proposed rule to revise regulations previously released under Section 1557 of the Affordable Care Act (ACA). The HHS goal with the proposed rule is to remove what the department views as redundancies and inconsistencies with other laws, as well as reduce confusion.

Changes in Compliance with Section 1557 Proposed Rule

ACA Section 1557 applies to “covered entities” – i.e., health programs or activities that receive “federal funding” from HHS (except Medicare Part B payments), including state and federal Marketplaces.  Examples include hospitals, health clinics, community health centers, group health plans, health insurance issuers, physician’s practices, nursing facilities, etc.

Under current rules, “covered entities” include employers with respect to their own employee health benefit programs if the employer is principally engaged in providing or administering health programs or activities (i.e., hospitals, physician practices, etc.), or the employer receives federal funds to fund the employer’s health benefit program.  Group health plans themselves are subject to the rule if they receive federal funds from HHS (e.g., Medicare Part D Subsidies, Medicare Advantage). In other words, employers who aren’t principally engaged in providing health care or health coverage generally aren’t subject to these rules directly unless they sponsor an employee health benefit program that receives federal funding through HHS, such as a retiree medical plan that participates in the Medicare Part D retiree drug subsidy program.

The most prominent proposed change is to the provision in Section 1557 which provides protections against discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs or activities. HHS’ proposed regulation would revise the definition of discrimination “on the basis of sex” that currently includes termination of pregnancy, sex stereotyping, and gender identity. The proposed rule, if finalized, would remove gender identity, stereotyping, and pregnancy termination as protected categories under Section 1557—though they will remain protected under other civil rights laws and regulations.

Certain compliance requirements on covered entities will also change, including the narrowing the scope of who Section 1557 regulates. Entities not principally engaged in healthcare will be subject to Section 1557 only to the extent they are funded by HHS. Entities whose primary business is providing healthcare will also be regulated if they receive federal financial assistance. A “health program or activity” specifically would not include employee benefit programs, including short-term plans and self-funded ERISA plans as long as they do not receive funding from HHS. The proposed rule also regulates insurance carriers only with respect to products for which the carrier receives federal financial assistance; the current rule regulates all products if the carrier received federal funding for at least one product.

Additionally, more flexible standards concerning individuals with limited English proficiency are proposed, including revising the “tagline” requirement. The tagline requirement requires distributing certain notices in 15 different languages in every “significant” publication associated with a health plan (anything larger than a brochure or postcard). HHS views this requirement as being too costly without data to back up that the taglines are beneficial. If the proposed rule is finalized, the tagline requirement will be eliminated.

Although there are provisions and definitions that will be changed or eliminated, parts of Section 1557 will remain intact. Likewise, HHS expects other agencies and departments to oversee and enforce nondiscrimination laws that will no longer be under HHS purview.

What to Expect Next

HHS is required to allow public comments of the proposed rule until approximately July 23, 2019. Once public commenting is closed and considered, HHS will likely release a final rule with answers to certain comments unless there are major changes to the proposed rule.

Until the proposed rule is finalized, employers who are covered entities (or whose plans are covered entities) should continue to treat termination of pregnancy, sex stereotyping, and gender identity as protected categories in relation to health programs and activities. Likewise, all other areas of Section 1557 should continue to be followed, including who is regulated and the tagline requirement. States and localities may give greater protections so it is important to keep in mind that there may be further requirements under those local laws and regulations.

 

About the Author.  This alert was prepared for Alera Group by Marathas Barrow Weatherhead Lent LLP, a national law firm with recognized experts on the Affordable Care Act.  Contact Peter Marathas or Stacy Barrow at pmarathas@marbarlaw.com or sbarrow@marbarlaw.com.

The information provided in this alert is not, is not intended to be, and shall not be construed to be, either the provision of legal advice or an offer to provide legal services, nor does it necessarily reflect the opinions of the agency, our lawyers or our clients.  This is not legal advice.  No client-lawyer relationship between you and our lawyers is or may be created by your use of this information.  Rather, the content is intended as a general overview of the subject matter covered.  This agency and Marathas Barrow Weatherhead Lent LLP are not obligated to provide updates on the information presented herein.  Those reading this alert are encouraged to seek direct counsel on legal questions.

© 2019 Marathas Barrow Weatherhead Lent LLP.  All Rights Reserved.

How to Fight the Opioid Epidemic

Posted on June 5th, 2019

Death from an accidental opioid overdose has become one of the top five causes of death in recent years.

The United States is experiencing an epidemic of opioid addiction. The National Safety Council released a report that a person born in 2017 has a greater chance of dying from an accidental opioid overdose than from a car crash. Accidental opioid overdose is now one of the top five causes of death behind heart disease, cancer, respiratory disease and suicide.

The Centers for Disease Control and Prevention estimates that the total “economic burden” of prescription opioid misuse in this country is $78.5 billion a year, which includes the costs of health care, lost productivity, treatment, and use of the criminal justice system.

This article addresses the problem of opioids in all aspects of the organization, not just workers compensation. It’s important to limit the use of opioids as much as possible in workers compensation cases (we’ve written about this in previous newsletters). But it’s not always possible to rule out opioids in treating injuries. That’s why it’s necessary to develop a coherent anti-opioid policy that addresses the problem in all aspects of the firm, not just in the workers comp setting. For one thing, by creating awareness of the problem among all employees, an injured employee can hopefully make more informed decisions relating to opioid use.

What Employers Can Do

Train managers to identify early signs and symptoms of substance use disorders and help employees get treatment. If an employee has been using opioids, there are cost-effective workplace programs that can help employees avoid or manage a drug crisis. Effective programs consist of:

  • Written policies
  • Employee education
  • Management training
  • Employee assistance program
  • Drug testing

Written Policy

A written policy tells your employees exactly what is expected at work and what options are available should they have a drug problem.

Work with your legal counsel, workers comp risk managers, and human resources department to ensure the policy follows federal and state guidelines.

A few topics your policy could cover:

  • Prohibited behavior, including possessing or selling drugs or intoxicants
  • Employee responsibilities
  • Disciplinary actions
  • Who to call for treatment

Employee Education

Start with management teams; and share information with employees through workshops, flyers, emails, videos and social media. When hosting social events, require they be alcohol and drug-free.

Wellness talks can be an opportunity to discuss how easy it is to become addicted to opioids. Tell employees that substance use disorder is a preventable and treatable illness, and your workplace is recovery-friendly.

Review policies about substance abuse affecting hiring, discipline, retention and termination of employees. Encourage employees to use sick days not only when they are ill, but for medical, dental, mental and/or chemical health.

Inform employees that there are alternatives to opioids for pain management, and that opioids are not more effective for most pain. Dr. Don Teater, a medical advisor for the National Safety Council, said that for pain related to common workplace-related injuries, opioids are not any more effective than non-steroidal anti-inflammatory drugs (NSAIDS) alternatives such as Tylenol, Advil or generic ibuprofen. They also usually are more affordable and safer than opioids.

Management and supervisor training

Train supervisors to convey the company policy to enforce drug and prescription drug policies, and that there are programs available to help battle addiction. Supervisors also must know what to do if someone seeks assistance or they see signs that someone is under the influence.

The medication Naloxone temporarily blocks opioid effects during an overdose. Make sure you have Naloxone on hand and supervisors are trained to administer it if an employee overdoses.

Employee Assistance Program

Consider a plan with an Employee Assistance Program (EAP). An EAP assists employees in resolving personal problems, including alcohol or substance abuse; child or elder care issues; relationship challenges; financial or legal problems; wellness matters; and assistance in handling traumatic events. Vendors who are part of comprehensive health insurance plans can provide care over the phone, computer or in person at no cost to employees.

Drug testing

While drug testing can be intrusive, it also is a valuable tool to prevent drug-related incidents. Drug-testing programs often curb drug abuse because employees fear getting caught. Seek legal guidance before starting any drug testing program to ensure it complies with state law and federal guidelines. Also, remember that testing done before an employee starts work will not detect drug use after they begin employment.

Please contact us if you need assistance in developing substance abuse guidelines for your firm.

Preparing for a Workers’ Compensation Premium Audit

Posted on May 29th, 2019

Your workers’ compensation policy might include a provision that allows your insurer to conduct a workers’ compensation premium audit. The results of the audit will affect your premiums, so it benefits you to be prepared!

Your workers’ compensation premiums depend on two factors: your payroll and your classifications. Insurers assign a classification code to the employer based on industry. Your employees will also have occupational codes. These codes reflect the relative risks of the industry and the job. For example, in a relatively high-hazard industry like heavy construction, most employees will have high-hazard jobs; their occupational code would reflect that risk. But the bookkeeper and other office staff would have a lower risk of injury, so they would have different job codes.

Unless you’re a smaller employer with a “minimum premium” policy, your workers’ compensation policy likely includes a provision that allows your insurer to conduct a workers’ compensation audit. That’s because your premiums are based on an estimate of your payroll and employees’ job classifications. At the end of the policy period, an audit will determine the insurer’s actual risk exposure based on exact payroll and classifications. This “audited exposure” determines whether you owe additional premium or whether the insurer owes you a refund.

Insurers may conduct an audit shortly after a policy starts to ensure the accuracy of their premium estimate. More commonly, they will conduct an audit at the end of the policy term. You might get audited annually or less frequently. If your policy has a three-year “look back,” for example, the insurer reserves the right to audit premiums for the past three years. When it does, it can collect premiums owed for that time, but it will also refund you any overpayments you might have made.

Audits have another important function. The information on your organization’s payroll, classifications and loss experience will be pooled with data from other employers. These statistics help insurers more accurately predict their risk and rate their policies.

What Does an Insurer Look for in an Audit?

The insurer will look for three types of information:

  • Payroll information: You’ll want a list of all employees and the hours they work, along with their payroll information. Payroll for workers’ compensation purposes may differ from payroll you report for tax purposes. This can include: wages or salaries; commissions; bonuses; overtime; and sick, holiday and vacation pay. Some states allow employers to count overtime pay as straight time, and you can generally exclude tips.
  • Job descriptions: These should include a list of daily duties and where employees perform those duties. Be as accurate as possible. Job descriptions will determine the employee’s occupational class, which determines the rate you’ll pay for coverage.
  • Independent contractors and subcontractors: Be prepared by having pay information on any of your independent contractors. Your insurer might request it to ensure you are not avoiding paying workers’ compensation by misclassifying workers who should be classified as employees.

You might also need information on subcontractors’ employees, including occupational class and payroll. In some industries, particularly construction, a sub’s employees might not have adequate coverage, leaving the employer liable for claims. To avoid this, obtain certificates of insurance from your subcontractors, showing that they had workers’ compensation coverage on their employees during the time they worked for you.

To perform the audit, the insurer might simply send you a form to complete. If you get a paper-based (or web-based) audit request, respond as quickly and completely as possible.

Sometimes an insurer will want to do a physical audit, in which the auditor visits the employer’s location. If there are questions on your audit, or if you think the insurer has misclassified some of your employees, you might request a physical audit.

We can help you prepare for a workers’ compensation audit. For more information, please contact us.

IRS Releases 2020 HSA Contribution Limits and HDHP Deductible and Out-of-Pocket Limits

Posted on May 29th, 2019

This alert is of interest to all employers that sponsor group health plans.  Note that employers with “grandfathered” or “grandmothered” plans are not subject to the ACA out-of-pocket limits, although the HSA/HDHP rules still apply if the plan is an HSA-qualified HDHP.

In Rev. Proc. 2019-25, the IRS released the inflation adjusted amounts for 2020 relevant to HSAs and high deductible health plans (HDHPs).  The table below summarizes those adjustments and other applicable limits.

 

2020 2019 Change
Annual HSA Contribution Limit
(employer and employee)
Self-only: $3,550
Family: $7,100
Self-only: $3,500
Family: $7,000
Self-only: +$50
Family: +$100
HSA catch-up contributions
(age 55 or older)
$1,000 $1,000 No change
Minimum Annual HDHP Deductible Self-only: $1,400
Family: $2,800
Self-only: $1,350
Family: $2,700
Self-only: +$50
Family: +$100
Maximum Out-of-Pocket for HDHP
(deductibles, co-payment & other amounts except premiums)
Self-only: $6,900
Family: $13,800
Self-only: $6,750
Family: $13,500
Self-only: +$150
Family: +$300

Out-of-Pocket Limits Applicable to Non-Grandfathered Plans

The ACA’s out-of-pocket limits for in-network essential health benefits have also been announced and have increased for 2020.

 

2020 2019 Change
ACA Maximum Out-of-Pocket Self-only: $8,150
Family: $16,300
Self-only: $7,900
Family: $15,800
Self-only: +$250
Family: +$500

Note that all non-grandfathered group health plans must contain an embedded individual out-of-pocket limit within family coverage, if the family out-of-pocket limit is above $8,150 (2020 plan years) or $7,900 (2019 plan years).  Exceptions to the ACA’s out-of-pocket limit rule are available for certain small group plans eligible for transition relief (referred to as “Grandmothered” plans).  A one-year extension of transition relief was recently announced extending the transition relief to policy years beginning on or before October 1, 2020, provided that all policies end by December 31, 2020.

Next Steps for Employers

As employers prepare for the 2020 plan year, they should keep in mind the following rules and ensure that any plan materials and participant communications reflect the new limits:

  • HDHPs cannot have an embedded family deductible that is lower than the minimum HDHP family deductible of $2,800.
  • The out-of-pocket maximum for family coverage for an HDHP cannot be higher than $13,800.

All non-grandfathered plans (whether HDHP or non-HDHP) must cap out-of-pocket spending at $8,150 for any covered person.  A family plan with an out-of-pocket maximum in excess of $8,150 can satisfy this rule by embedding an individual out-of-pocket maximum in the plan that is no higher than $8,150. This means that for the 2020 plan year, an HDHP subject to the ACA out-of-pocket limit rules may have a $6,900 (self-only)/$13,800 (family) out-of-pocket limit (and be HSA-compliant) so long as there is an embedded individual out-of-pocket limit in the family tier no greater than $8,150 (so that it is also ACA-compliant).

The information provided in this alert is not, is not intended to be, and shall not be construed to be, either the provision of legal advice or an offer to provide legal services, nor does it necessarily reflect the opinions of the agency, our lawyers or our clients. This is not legal advice. No client-lawyer relationship between you and our lawyers is or may be created by your use of this information. Rather, the content is intended as a general overview of the subject matter covered. This agency and Marathas Barrow Weatherhead Lent LLP are not obligated to provide updates on the information presented herein. Those reading this alert are encouraged to seek direct counsel on legal questions. © 2018 Marathas Barrow Weatherhead Lent LLP. All Rights Reserved.

Ways to Make Childcare Costs a Little More Affordable

Posted on May 22nd, 2019

Childcare can be an employee’s most expensive work-related expense. Fortunately, there is a benefit program you can offer that will at least provide tax relief to employees who use daycare providers.

The program is the Dependent Care Assistance Program (DCAP). If you can’t offer a DCAP, employees also can use the Dependent Care Tax Credit (DCTC) – some employees may qualify for both.

A DCAP, also known as a Dependent Care Flexible Spending Account (FSA), usually is funded by employees through payroll deductions from pre-tax dollars. Employees submit documentation about their expenses to obtain reimbursement from their DCAP account for eligible dependent care expenses, such as babysitting.

Employees will not be taxed for expenses including:

•    Care for children under the age of 13

•    Funds that enable employees and spouses of employees to be employed or search for work.

•    Care for dependents age 13 and older who cannot care for themselves. This includes elderly parents or dependents with disabilities while at work or attending school.

Though many people consider their pets as children, funds may not be used to pay for boarding or pet walking services.

The maximum amount employees can save in a DCAP or dependent care FSA in 2019 is $5,000 per year if the employee is married and filing a joint return, or if the employee is a single parent. Married employees who are filing separately may contribute up to $2,500 per year per parent. The funds are “use it or lose it” and must be spent by the end of the year.

One thing to understand about DCAPs or dependent care FSAs, is that unlike health care FSAs, they do not have to provide a set amount of funds throughout the year. The amount available for reimbursement is limited to the number of employee contributions made to that point, reduced by prior reimbursements.

In comparison, a DCTC is a tax credit an employee can claim on their federal income tax return. They will receive a 20- to 35-percent tax credit for up to $3,000 in expenses for one qualifying employee and $6,000 in expenses for married couples. Funds used to claim the credit are subject to federal income tax, Social Security and Medicare tax; however, the credit can reduce or eliminate those taxes.

Differences Between DCAP and DCTC

A DCAP works best for those who have high adjusted gross incomes. It also works best for individuals, since they will be able to qualify for the DCAP higher maximum of $5,000 instead of the DCTC $3,000 maximum.

DCAPs also work well in states with state income taxes, because the DCAP normally reduces the state income tax liability while DCTC generally does not.

Best Uses for the DCAP Funds

The most obvious way employees can use their DCAP funds is paying for recurring childcare expenses during the work week. However, similar uses qualify for reimbursement as well:

•    Before and after school care

•    Day camps during the summer or over spring break (overnight camps don’t qualify)

•    Sick child care

What an Employer Should Know

DCAPs generally must comply with requirements in the Internal Revenue Code Section 129 to provide tax-free dependent care assistance benefits. Also, DCAPs allowing employees to make pre-tax contributions are subject to the Code Section 125 rules for cafeteria plans, plus rules applying to health FSAs (not including the uniform coverage rule). DCAPs are not group health plans, therefore employees can may contribute to health savings accounts (HSAs) provided they have a Qualified High Deductible Health Plan and meet the other HSA rules.

A DCAP often is part of a Section 125 cafeteria benefit plan, which allows employees the choice between dependent care and other non-taxable benefits. Employers are responsible for reimbursing employees for dependent care expenses, making payments to third parties and/or providing a dependent care facility for employees’ dependents.

Qualified programs must be documented with a separate written plan that is part of a larger plan providing a choice of taxable or nontaxable benefits (a Sec. 125 cafeteria benefit plan). While the program need not be funded, it must meet the following requirements of Sec. 129(d): DCAPs can be (and often are) included as part of a Sec. 125 cafeteria benefit plan, which allows employees to choose between dependent care and other nontaxable benefits, or cash.

Not every company can take advantage of a DCAP. For instance, companies with many highly compensated employees may not qualify. To find out if a DCAP is right for your company, please call us.

OSHA to Publish Specific Rules for Preventing Workplace Violence

Posted on May 22nd, 2019

There are four types of workplace violence. You should know the four ways to mitigate it.

The Occupational Safety and Health (OSH Act) has traditionally invoked the General Duty Clause, rather than any specific rules, to address workplace violence. It requires employers to provide a safe and healthful workplace for all workers covered by the OSH Act. Employers who do not take reasonable steps to prevent or abate a recognized violence hazard in the workplace can be cited.

However, legislators on the House Education and Labor Committee are working to promulgate specific rules for preventing workplace violence in the healthcare sector, since it is particularly prone to workplace violence. On May 1, Secretary of Labor R. Alexander Acosta appeared before the Committee and faced questions from lawmakers.

It’s unknown whether OSHA will promulgate similar specific rules for other sectors of the economy that are also highly prone to workplace violence. But any rules from OSHA will likely be based on the four types of workplace violence and set forth some basic steps for mitigating workplace violence.

Four types of workplace violence

1.   Criminal intent. “The perpetrator has no legitimate relationship to the business or its employees and is usually committing a crime in conjunction with the violence. These crimes can include robbery, shoplifting, trespassing and terrorism. The vast majority of workplace homicides (85 percent of them) fall into this category,” according to Dr. Di Ann Sanchez, in her introduction to The SHRM Workplace Violence Survey.

2.   Customer or client. “The perpetrator has a legitimate relationship with the business and becomes violent while being served by the business.” Sanchez explained. This category includes customers, clients, patients, students, inmates and any other group for which the business provides services. It is believed that a large portion of customer/client incidents occur in the health care industry in settings such as nursing homes or psychiatric facilities; the victims are often patient caregivers. Police officers, flight attendants and teachers are other examples of workers who may be exposed to this kind of workplace violence, which accounts for approximately 3 percent of all workplace homicides.

3.   Worker-on-worker. The perpetrator is an employee or past employee who attacks or threatens another employee(s) or past employee(s) in the workplace. Worker-on-worker fatalities account for approximately 7 percent of all workplace homicides.

4.   Personal relationship. The perpetrator usually does not have a relationship with the business but has a personal relationship with the intended victim. This category includes victims of domestic violence assaulted or threatened while at work and accounts for about 5 percent of all workplace homicides.

 

Steps to mitigate workplace violence

1.   Create policies that protect workers.

Outline what is and what is not acceptable behavior. The most common factors to address should include bullying, discrimination, drug and alcohol use and following safety procedures. Be sure everyone in the organization understands and agrees to follow the policies.

2.   Improve Systems and Physical Premises

Implement security measures, such as cameras and data security, as well as improved lighting. Enable workers with technology that connects them to signal alerts to authorities and your community.

3.   Limit Access to Non-Employees.

Typical tools include:

• ID cards for employees and visitors

• Sign-in desk

• Access-card entry systems

• Video surveillance (inside and outside)

• Security guards who patrol the buildings and grounds

• Metal detectors at building entry points

• Uber/Lyft reimbursement for employees who normally walk or bike to work but have to work late

4.   Train and Communicate.

Train employees to be aware of factors that could jeopardize security. To reduce tension in the workplace, encourage employees to communicate with each other regularly and be open-minded about fellow workers. Implement an employee notification system to make employees aware of any potentially dangerous situations.

For risk management advice and help planning your anti-violence workplace policy, please contact us.

REMINDER: PCORI Fees Due By July 31, 2019

Posted on May 20th, 2019

This alert is of interest to all employers that sponsor self-insured group health plans, including Health Reimbursement Arrangements (HRAs).  Note that the PCORI fee does not apply to most health FSAs.

Employers that sponsor self-insured group health plans, including health reimbursement arrangements (HRAs) should keep in mind the upcoming July 31, 2019 deadline for paying fees that fund the Patient-Centered Outcomes Research Institute (PCORI).  As background, the PCORI was established as part of the Affordable Care Act (ACA) to conduct research to evaluate the effectiveness of medical treatments, procedures and strategies that treat, manage, diagnose or prevent illness or injury.  Under the ACA, most employer sponsors and insurers will be required to pay PCORI fees until 2019 (the fee does not apply to plan years ending on or after October 1, 2019).  For employers with calendar year plans, this July’s payment will be their final PCORI filing.

The amount of PCORI fees due by employer sponsors and insurers is based upon the number of covered lives under each “applicable self-insured health plan” and “specified health insurance policy” (as defined by regulations) and the plan or policy year end date.  This year, employers will pay the fee for plan years ending in 2018.

  • For plan years that ended between January 1, 2018 and September 30, 2018, the fee is $2.39 per covered life and is due by July 31, 2019.
  • For plan years that ended between October 1, 2018 and December 31, 2018, the fee is $2.45 per covered life and is due by July 31, 2019.

For example, a plan year that ran from July 1, 2017 through June 30, 2018 will pay a fee of $2.39 per covered life.  Calendar year 2018 plans will pay a fee of $2.45 per covered life.

NOTE: The insurance carrier is responsible for paying the PCORI fee on behalf of a fully insured plan.  The employer is responsible for paying the fee on behalf of a self-insured plan, including an HRA.  In general, health FSAs are not subject to the PCORI fee.

Employers that sponsor self-insured group health plans must report and pay PCORI fees using IRS Form 720, Quarterly Federal Excise Tax Return.   If this is the employer’s last PCORI payment and they do not expect to owe excise taxes that are reportable on Form 720 in future quarters, they may check the “final return” box above Part I of Form 720.

Note that because the PCORI fee is assessed on the plan sponsor of a self-insured plan, it generally should not be included in the premium equivalent rate that is developed for self-insured plans if the plan includes employee contributions.  However, an employer’s payment of PCORI fees is tax deductible as an ordinary and necessary business expense.

 

Historical Information for Prior Years

  • For plan years that ended between October 1, 2017 and December 31, 2017, the fee is $2.39 per covered life and is due by July 31, 2018.
  • For plan years that ended between January 1, 2017 and September 30, 2017, the fee is $2.26 per covered life and is due by July 31, 2018.
  • For plan years that ended between October 1, 2016 and December 31, 2016, the fee is $2.26 per covered life and was due by July 31, 2017.
  • For plan years that ended between January 1, 2016 and September 30, 2016, the fee is $2.17 per covered life and was due by July 31, 2017.
  • For plan years that ended between October 1, 2015 and December 31, 2015, the fee was $2.17 per covered life and was due by August 1, 2016.
  • For plan years that ended between January 1, 2015 and September 30, 2015, the fee was $2.08 per covered life and was due by August 1, 2016.
  • For plan years that ended between October 1, 2014 and December 31, 2014, the fee was $2.08 per covered life and was due by July 31, 2015.
  • For plan years that ended between January 1, 2014 and September 30, 2014, the fee was $2 per covered life and was due by July 31, 2015.
  • For plan years that ended between October 1, 2013 and December 31, 2013, the fee was $2 per covered life and was due by July 31, 2014.
  • For plan years that ended between January 1, 2013 and September 30, 2013, the fee was $1 per covered life and was due by July 31, 2014.
  • For plan years that ended between October 1, 2012 and December 31, 2012, the fee was $1 per covered life and was due by July 31, 2013.

 

Counting Methods for Self-Insured Plans

Plan sponsors may choose from three methods when determining the average number of lives covered by their plans.

Actual Count method.  Plan sponsors may calculate the sum of the lives covered for each day in the plan year and then divide that sum by the number of days in the year.

Snapshot method.  Plan sponsors may calculate the sum of the lives covered on one date in each quarter of the year (or an equal number of dates in each quarter) and then divide that number by the number of days on which a count was made. The number of lives covered on any one day may be determined by counting the actual number of lives covered on that day or by treating those with self-only coverage as one life and those with coverage other than self-only as 2.35 lives (the “Snapshot Factor method”).

Form 5500 method.  Sponsors of plans offering self-only coverage may add the number of employees covered at the beginning of the plan year to the number of employees covered at the end of the plan year, in each case as reported on Form 5500, and divide by 2.  For plans that offer more than self-only coverage, sponsors may simply add the number of employees covered at the beginning of the plan year to the number of employees covered at the end of the plan year, as reported on Form 5500.

Special rules for HRAs. The plan sponsor of an HRA may treat each participant’s HRA as covering a single covered life for counting purposes, and therefore, the plan sponsor is not required to count any spouse, dependent or other beneficiary of the participant. If the plan sponsor maintains another self-insured health plan with the same plan year, participants in the HRA who also participate in the other self-insured health plan only need to be counted once for purposes of determining the fees applicable to the self-insured plans.

 

The information provided in this alert is not, is not intended to be, and shall not be construed to be, either the provision of legal advice or an offer to provide legal services, nor does it necessarily reflect the opinions of the agency, our lawyers or our clients. This is not legal advice. No client-lawyer relationship between you and our lawyers is or may be created by your use of this information. Rather, the content is intended as a general overview of the subject matter covered. This agency and Marathas Barrow Weatherhead Lent LLP are not obligated to provide updates on the information presented herein. Those reading this alert are encouraged to seek direct counsel on legal questions. © 2018 Marathas Barrow Weatherhead Lent LLP. All Rights Reserved.

Alera Group Acquires ARMS Insurance Group

Posted on May 9th, 2019

DEERFIELD, IL — Alera Group, a leading national insurance firm, today announced its acquisition of ARMS Insurance Group (ARMS), effective May 1, 2019.

ARMS, a General Agency headquartered in Bethel Park, Pennsylvania, has served insurance brokers throughout western Pennsylvania and the surrounding states for over 25 years. ARMS provides insurance brokers with sales support, distribution and streamlined service to a wide array of insurance markets.  Primary areas of expertise include employee benefits, senior medical, individual medical and workers compensation products.

“ARMS Insurance Group, under the leadership of Tino Rionda, is an exciting expansion of our presence in Pennsylvania.  We will work together to leverage ARMS’ brokerage reach and to create exceptional client experiences for ARMS brokers,” said Alan Levitz, CEO of Alera Group. “We are thrilled to welcome their remarkable team to our company.”

“As an Alera Group company, we look forward to offering expanded resources, tools and knowledge from a best in class service provider to our broker partners.” said Tino Rionda, Managing Partner of ARMS. “We are beyond excited about this opportunity for growth, learning and innovation, while remaining committed to the personal service our brokers have come to expect.”

All ARMS employees will continue operating out of the firm’s existing location under the name ARMS Insurance Group, an Alera Group Agency, LLC.

Alera Group was formed in early 2017 and is one of the nation’s foremost independent insurance agencies. For more information on partnering with Alera Group, visit Partner With Us at www.aleragroup.com.

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About Alera Group
Based in Deerfield, IL, Alera Group’s over 1,600 employees serve thousands of clients nationally in employee benefits, property and casualty, risk management and wealth management. Alera Group is the 15th largest privately held firm in the country. For more information, visit www.aleragroup.com or follow Alera Group on Twitter: @AleraGroupUS.

M&A Contact
Rob Lieblein, Chief Development Officer
Email: rob.lieblein@aleragroup.com
Phone: 717-329-2451

Media Contact
Jessica Tiller, Weiss PR
Email: jtiller@weisspr.com
Phone: 443-621-7690

Alera Group Acquires Shepler & Fear General Agency, Inc.

Posted on May 8th, 2019

DEERFIELD, IL — Alera Group, a leading national insurance firm, today announced its acquisition of Shepler & Fear General Agency (SFGA), effective May 1, 2019.

Founded in 2009, SFGA is a premier general agency located in Roseville, California. The firm specializes in large group, small group, and self-funding plans, serving brokers throughout California since 2009. Characterized by innovation, SFGA works with each broker partner in a consultative approach to increase sales success.

“Shepler & Fear is an outstanding firm. We welcome them to Alera Group and Dickerson Insurance Services with excited anticipation of the growth to come as both General Agencies extend their presence and their product portfolio throughout California,” said Alan Levitz, CEO of Alera Group. “Their commitment to providing the best tools, resources, and expertise to their brokers collaborating to create an exceptional client experience is tightly aligned with Alera Group’s mission.”

“It is thrilling to join Alera Group, one of the leading national firms in our industry, as we continuously seek to create elevated client experiences for our brokers,” said David L. Fear Sr., Managing Partner of SFGA. “Partnering with Dickerson Insurance Services locally and Alera Group nationally will be a powerful part of our ongoing goal to serve our clients with exceptional resources and expertise.”

SFGA joins Alera Group through California General Agency, Dickerson Insurance Services. All SFGA employees will continue operating out of the firm’s existing location under the name Dickerson Insurance Services, an Alera Group Company.

Alera Group was formed in early 2017 and is one of the nation’s foremost independent insurance agencies. For more information on partnering with Alera Group, visit Partner With Us at www.aleragroup.com.

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About Alera Group
Based in Deerfield, IL, Alera Group’s over 1,600 employees serve thousands of clients nationally in employee benefits, property and casualty, risk management and wealth management. Alera Group is the 15th largest privately held firm in the country. For more information, visit www.aleragroup.com or follow Alera Group on Twitter: @AleraGroupUS.

M&A Contact
Rob Lieblein, Chief Development Officer
Email: rob.lieblein@aleragroup.com
Phone: 717-329-2451

Media Contact
Jessica Tiller, Weiss PR
Email: jtiller@weisspr.com
Phone: 443-621-7690

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