PPI Benefit Solutions

COVID-19 Update

Benefits Compliance and COVID-19: Return to Work Frequently Asked Questions

COVID-19 Vaccine FAQ, Updated 1/28/21

COVID-19 State Quick Reference Chart, Updated 1/22/21

HHS Renews COVID-19 Public Health Emergency Proclamation

February 02, 2021

On January 7, 2021, HHS announced that the public health emergency proclamation for COVID-19 is renewed for another 90 days, beginning on January 21, 2021 (the date the previous HHS proclamation expired) and extends through April 20, 2021.

The CARES Act and the FFCRA require plans (including self-insured plans) to cover COVID-19 testing without cost-sharing and without pre-authorization. Importantly, that includes diagnostic tests approved, cleared, or authorized by the FDA, subject to a developer’s request for FDA emergency use authorization, or developed in and authorized by a state, as well as serological tests (antibody) tests. Those CARES Act/FFCRA requirements are effective from March 18, 2020, and last through the duration of the HHS-declared public health emergency.

Generally, the emergency declaration lasts for 90 days or until HHS declares that the public health emergency no longer exists, whichever occurs first. HHS may extend the public health emergency declaration for subsequent 90-day periods for as long as the public health emergency continues to exist. HHS previously renewed their declaration in April, July and October (which expired on January 21, 2021).

Employers should be aware of the HHS proclamation renewal. While carriers (for fully insured plans) and TPAs (for self-insured plans) will likely handle the administrative aspects of COVID-19 testing and billing, employers will want to understand the coverage requirements in connection with the proclamation extension.

HHS Proclamation

Healthcare Reform

Biden Administration Issues Executive Order to Strengthen the ACA and Create a Special Enrollment Period

On January 28, 2021, the president signed an executive order instructing federal agencies to examine their regulations in order to find ways to strengthen the ACA. In addition, this order will create a special enrollment period (SEP) in the federal health insurance marketplace, from February 15, 2021, to May 15, 2021.

The order directs agencies to review:

Policies that undermine protections for people with pre-existing conditions, including complications related to COVID-19.
Demonstrations and waivers under Medicaid and the ACA that may reduce coverage or undermine the programs, including work requirements.
Policies that undermine the Health Insurance Marketplace or other markets for health insurance.
Policies that make it more difficult to enroll in Medicaid and the ACA.
Policies that reduce affordability of coverage or financial assistance, including for dependents.

The order also revokes Executive Order 13765, which announced the Trump Administration’s intent to repeal the ACA. The order also revoked Executive Order 13813, which encouraged agencies to expand access to AHPs and allow coverage sales across state lines. Finally, the order requires agencies to review any policies and regulations issued as a result of those two orders and consider repealing, revising or rescinding them.

While the creation of the SEP will affect individuals that will enroll on the marketplace, employers should be mindful of this extension in case there are employees who seek to drop coverage under their plans to take advantage of the SEP. Specifically, the permissible qualifying event for a revocation due to enrollment in a qualified plan will allow an employee to drop their employer’s plan mid-year if they intend to enroll in the marketplace.

Since this order includes directives to agencies to act, details regarding implementation have not yet been worked out. We will keep an eye on developments and report them as they occur.

Announcement »
Executive Order »

Federal Updates

Biden Administration Freezes Certain Regulations

On January 20, 2021, the Biden Administration’s Chief of Staff Ronald Klain issued a memo to the heads of all executive departments and agencies announcing that there will be a freeze on regulations that fit certain criteria, pending review. All proposed rules in the pipeline but not yet in the Federal Register are put on hold, and all rules published in the Register but not yet effective are candidates for an extended 60-day extension, which could include a new 30-day comment period. Rules subject to this memo are to be reviewed by the heads of executive departments and agencies appointed or designated by the president after noon on January 20, 2021. There are several caveats and conditions that may affect whether these rules will be extended or even pulled off the Register, including whether they are subject to statutory or judicial deadlines and whether they meet some critical health, safety, environmental, financial or national security concern.

The independent contractor is one such rule that may be affected by the 60-day extension because its effective date is March 8, 2021. The proposed wellness incentive rules have already been pulled from the Register pending approval of the new EEOC chair, and it is possible that those rules will be put on hold indefinitely or substantially changed. Both of these matters were covered in the January 21, 2021, edition of Compliance Corner .

In addition to the rules that affect health plan benefits, several rules regarding retirement plans are subject to the freeze. Among them include the prohibited transaction exemption for investment advice, discussed in the December 24, 2020 edition of Compliance Corner, which was supposed to take effect on February 16, 2021, and the interim rule on lifetime income illustrations which was discussed in the October 1, 2020, edition of Compliance Corner, and scheduled for an effective date of September 18, 2021.

In addition to this executive action, Congress may also review federal agency rules issued during the last 60 legislative session days and nullify the ones it doesn’t like by a simple majority vote in both chambers. As of the publication of this article, Congress has not done so.

We will keep you updated on the status of these and other rules as they make their way through the federal administrative process.

Whitehouse Memo »

IRS Releases 2021 Fringe Benefits Guide

On January 27, 2021, the IRS released the 2021 draft Publication 15-B, the Employer’s Tax Guide to Fringe Benefits. This publication provides an overview of the taxation and exclusion rules applicable to employee benefits such as accident and health benefits, dependent care assistance, health savings accounts, and group term life insurance coverage. The guide also includes the related valuation, withholding and reporting rules.

The IRS updates Publication 15-B each year to incorporate any recent administrative, reporting or regulatory changes. The revisions also include applicable dollar maximums for certain tax-favored benefits for the current year.

The 2020 updates include the introduction of a new Form 1099-NEC for reporting non-employee compensation paid in 2020. Employers reporting non-employee compensation paid in 2020 should use Form 1099-MISC, which is due February 1, 2021.

The business mileage rate for 2021 is 56 cents per mile, which can be used to reimburse an employee for business use of a personal vehicle, and under certain conditions, to value the personal use of a vehicle provided to an employee. The 2021 monthly exclusion for qualified parking is $270 and the monthly exclusion for commuter highway vehicle transportation and transit passes is $270. For plan years beginning in 2021, the maximum salary reduction permitted for a health FSA under a cafeteria plan is $2,750.

Employers should be aware of the availability of the updated publication and most recent modifications.

IRS Publication 15-B »

CMS Extends Nonenforcement of ACA-Compliance for Certain Policies

On January 19, 2021, CMS announced an additional one-year extension for specific ACA compliance requirements for certain non-grandfathered individual and small group coverage known as “grandmothered” policies. Under the latest extension, states may permit insurers that have continually renewed eligible grandmothered policies since January 1, 2014, to again renew that coverage for a policy year beginning on or before October 1, 2022, provided that the policies end by January 1, 2023.

On November 14, 2013, CMS issued a letter outlining a transitional policy concerning health care reform mandates for coverage in the individual and small group markets. Under the policy, state authorities could allow health insurance issuers to continue certain coverage that would otherwise have been cancelled for failure to comply with the ACA requirements.

This initiative allowed individuals and small businesses to elect to re-enroll in such coverage. Specifically, the nonenforcement policy provided relief from the following market reforms:

Community rating
Guaranteed issue and renewability of coverage
Prohibition of coverage exclusions based on pre-existing conditions
Nondiscrimination based on health status
Nondiscrimination regarding health care providers
Comprehensive coverage (i.e., coverage of essential health benefits and the application of maximum out-of-pocket limits)
Coverage for participation in clinical trials

The nonenforcement policy has been continually extended since the initial announcement, thus permitting grandmothered policies to maintain an exemption from the above-mentioned requirements.

Although the CMS bulletin allows for the temporary continuation of these noncompliant plans at the federal level, it is important to note that the practice must still be approved by state regulators for policies to be available in a particular state. Insurers will then have a choice as to whether to keep offering the policies. The bulletin includes a notice that insurers can use in the event they issued coverage cancellation notices and will now provide the policyholder with the option to continue the coverage.

Accordingly, small employers who are currently covered by such grandmothered policies should be aware of the most recent nonenforcement extension. These employers should work with their advisors and insurers regarding possible renewal of the coverage.

CMS Bulletin »

DOL Announces 2020 Adjustments to ERISA Penalties

On January 14, 2021, the DOL published a final rule adjusting civil monetary penalties under ERISA. The annual adjustments relate to a wide range of compliance issues and are based on the percentage increase in the consumer price index for all urban consumers (CPI-U) from October of the preceding year. The DOL last adjusted certain penalties under ERISA in January of 2020.

Highlights of the penalties that may be levied against sponsors of ERISA-covered plans include:

Failure to file Form 5500 maximum penalty increases from $2,233 to $2,259 per day that the filing is late
Failure to furnish information requested by the DOL penalty increases from $159 to $161 maximum per day
Penalties for a failure to comply with GINA and a failure to provide CHIP notices increases from $119 to $120 maximum per day
Failure to furnish SBCs penalty increases from $1,176 to $1,190 maximum per failure
Failure to file Form M-1 (for MEWAs) penalty increases from $1,625 to $1,644 per day

These adjusted amounts are effective for penalties assessed after January 15, 2021, for violations that occurred after November 2, 2015. The DOL will continue to adjust the penalties no later than January 15 of each year and will post any changes to penalties on their website.

To avoid the imposition of penalties, employers should ensure ERISA compliance for all benefit plans and stay updated on ERISA’s requirements. For more information on the new penalties, including the complete listing of changed penalties, please consult the final rule below.

Final Rule »

IRS Updates FAQ on FFCRA Tax Credits

On January 29, 2021, the IRS released updated FAQs on FFCRA paid sick leave and family leave tax credits. The COVID-related Tax Relief Act of 2020 (included in the Consolidated Appropriations Act of 2021) extends employers' ability to apply for such credits through March 31, 2021, and the FAQ updates incorporate that change.

The FFCRA included provisions mandating employers with less than 500 employees to provide paid leave to employees who are unable to work or telework due to certain COVID-19-related reasons. To offset the financial burden to covered employers, the FFCRA provides for federal tax credits to fund the leave payments. Originally, the credits applied to qualified leave payments made between April 1, 2020, and December 31, 2020. However, the COVID-related Tax Relief Act of 2020 extends employers' ability to continue to provide paid leave under the FFCRA through March 31, 2021.

This is optional for employers; however, if they do provide such leave, then they can apply for the tax credits available under the FFCRA for leave granted under the extension. Eligible employers can receive a tax credit for the full amount of the paid sick leave and family leave (which includes related health plan expenses and the employer's share of Medicare tax) on the leave provided through March 31, 2021.

Eligible employers can claim these tax credits via Form 941, Employer’s Quarterly Federal Tax Return. Alternatively, employers can benefit by reducing their federal employment tax deposits; however, they should consult with their tax advisors before doing so.

Employers should be aware of these developments and review the updated guidance when applying for available tax credits mentioned above.

IRS News Release »
IRS COVID-19 Related Tax Credits for Required Paid Leave Provided by Small and Midsize Businesses FAQs »

Retirement Update

IRS Releases Covered Compensation Tables for 2021 Plan Years

On January 15, 2021, the IRS released Revenue Ruling 2021-3, which provides tables of covered compensation for 2021 plan years. The tables can be used in determining benefits for qualified plans that use a permitted disparity formula for employer-provided contributions or benefits.

A permitted disparity contribution formula allows an employer to provide additional benefits to employees whose compensation exceeds certain levels, such as the social security wage base, without violating applicable non-discrimination requirements. All employees receive employer-provided social security benefits based on their compensation up to the taxable wage base, but not on compensation beyond that level. Under the permitted disparity rules, an employer’s contribution formula can be integrated with social security to take this difference into account, within certain limits.

The regulations define covered compensation as the average of the taxable wage bases in effect for each calendar year during the 35-year period ending with the last day of the calendar year in which the employee reaches the social security retirement age. For the 2021 year, the taxable wage base is $142,800. To determine an employee’s covered compensation, a plan can use the IRS tables, which are developed by rounding the actual amounts of covered compensation for different years of birth.

Employers who sponsor retirement plans that use a permitted disparity formula for employer contributions should be aware of the ruling and availability of the updated tables.

Revenue Ruling 2021-3 »

Announcements

Reminder: Medicare Part D Disclosure to CMS

As a reminder, employers who sponsor a group health plan that provides prescription drug coverage to Medicare Part D eligible individuals must disclose to CMS, on an annual basis, whether the coverage qualifies as creditable or non-creditable. The disclosure is due no later than 60 days after the beginning of each plan year. Thus, for calendar year plans, the disclosure is due March 1, 2021.

CMS Disclosure Form »
CMS Disclosure Guidance »

Reminder: Upcoming IRC 6055 and 6056 Reporting Deadlines

Employers that were ALEs in 2020 must comply with IRC Section 6056 reporting in early 2021. Specifically, ALEs must complete and distribute a Form 1095-C to full-time employees by March 2, 2021 (the IRS changed this from January 31, 2021). The form should detail whether the employee was offered minimum value, affordable coverage during 2020. The forms may be mailed, electronically delivered, or delivered by hand (although proof of delivery in some manner is recommended).

If an employer sponsored a self-insured plan during 2020, it must comply with Section 6055 reporting in 2021. Self-insured employers with 50 or more FTEs must complete Section III of Form 1095-C detailing which months the employee (and any applicable spouse and dependents) had coverage under the employer’s plan. If the self-insured employer has fewer than 50 FTEs, it must complete and distribute a Form 1095-B with such information. Again, the forms must be delivered to employees by March 2, 2021.

Employers must also file the forms with the IRS by March 1, 2021 (as February 28, 2021 falls on a Sunday), if filing by paper, and March 31, 2021, if filing electronically. Those that are filing 250 or more forms are required to file electronically. Lastly, the employer is required to file the transmittal Form 1094-C (if filing Forms 1095-C) or Form 1094-B (if filing Forms 1095-B).

As a reminder, the IRS recently provided penalty relief for employers which will allow them to forego distributing the Form 1095-B to individuals. This comes after the IRS accepted comments on the necessity of the Forms 1095-B now that the individual mandate penalty has been zeroed out. If employers post a notice on their website that the document is available upon request, and fulfil any such request within 30 days, then they will not have to distribute the Forms 1095-B to covered individuals. But keep in mind that there is no such penalty relief for Form 1095-C.

Form 1094-B »
Form 1095-B »
Form 1094-C »
Form 1095-C »
Instructions for Forms 1094-B and 1095-B »
Instructions for Forms 1094-C and 1095-C »

FAQ

FAQ: If the individual mandate penalty is zero, do I still need to provide the Form 1095-C to employees? If so, can these forms be provided electronically?

Yes; the Form 1095-C must still be distributed to employees.

ALEs with an average of 50 or more full-time employees (including full-time equivalent employees) during the preceding calendar year must report to the IRS how they complied with the employer mandate. Specifically, under Code Section 6056, ALEs must complete a Form 1095-C for each full-time employee and report whether that full-time employee was offered coverage meeting the minimum value and affordability requirements. This reporting obligation applies regardless of whether the plan is insured or self-funded.

Additionally, as required by Code Section 6055, an ALE must report to the IRS those who were covered by the plan and for which months. A self-insured ALE would include this information in Part III of the Form 1095-C. The carrier would report this information for an insured plan.

The 2020 1095-C forms must be filed with the IRS by March 1 (if filing by paper) or March 31 (if filing electronically). These fillings should be submitted to the IRS with the transmittal Form 1094-C. As in past years, the deadline for distributing the forms to individuals is extended from January 31 to March 2, 2021.

Congress reduced the federal mandate penalty to zero, so individuals will not pay a federal tax penalty for failing to have coverage. However, the Form 1095-C is used to determine if an ALE is complying with the employer mandate and to determine if an individual is eligible for a premium tax credit for coverage purchased on the exchange. So the form still needs to be filed AND distributed to employees.

Furthermore, if the employer has employees residing in DC, CA, NJ, RI or MA, these regions have individual mandates that would rely upon the information reported in the Form 1095-C. Although the federal individual mandate penalty was reduced to zero, employees residing in these states could face state penalties for failing to maintain coverage. An employer with employees residing in these states may also be subject to additional state filing requirements.

The Form 1095-Cs must be mailed or hand-delivered, unless the recipient affirmatively consents to receive the statement in an electronic format. If mailed, the statement must be sent to the employee’s last known permanent address, or if no permanent address is known, to the employee’s temporary address.

For electronic delivery, the recipient’s affirmative consent must relate specifically to receiving the Form 1095-C electronically. An individual may consent on paper or electronically, such as by email. If consent is on paper, the individual must confirm the consent electronically. This affirmative consent requirement is designed to ensure that statements are furnished electronically only to individuals who can access them. Once an individual provides such affirmative consent to receive the Form 1095-C electronically, the form may be furnished either by email or by informing the individual how to access the statement on the employer’s website.

An ALE’s failure to file the Form 1095-C with the IRS, or to distribute it to employees, could result in significant penalties. The penalty is $280 per failure. For example, if an employer failed to file the form with the IRS and to distribute it to one employee, the penalty could be $560. Accordingly, if the employer fails to file or distribute the Form 1095-C for numerous employees, the potential liability could be substantial.

State Updates

Colorado

February 2, 2021

Marketplace Special Enrollment Period

On January 28, 2021, the Division of Insurance announced that the state will open its marketplace for enrollment. The announcement was made in conjunction with the federal government announcement that it would open the federal marketplace, as reported elsewhere in this edition of Compliance Corner.

The standard open enrollment period for the state marketplace ended on January 15, 2021. The marketplace will be reopened from February 8 through May 15, 2021, to enroll more state residents who do not have health insurance through their employers.

While this change will affect individuals that will enroll on the marketplace, employers should be mindful of this extension in case there are employees who seek to drop coverage under their plans to take advantage of the marketplace’s special open enrollment period. Specifically, the permissible qualifying event for a revocation due to enrollment in a qualified plan will allow an employee to drop their employer’s plan mid-year if they intend to enroll in the marketplace.

State announcement »

Massachusetts

February 2, 2021

Additional Guidance Addressing COVID-19 Vaccines

On January 21, 2021, Commissioner Anderson issued Bulletin 2021-01, providing updated guidance reminding carriers that they should facilitate members’ access to COVID-19. This bulletin adds additional carrier expectations to those that were expressed in Bulletin 2020-32 (which was discussed in the January 7, 2021, edition of Compliance Corner).

This bulletin clarifies that the Division of Insurance expects carriers to:

Forgo any cost sharing for vaccinations at providers’ offices (including from out-of-network providers
Reimburse providers (whether in-network or out-of-network) for the cost of administering COVID-19 vaccines at a level that is higher than the MassHealth rate of reimbursement
Reimburse providers for the vaccine separately if it is administered and billed separately from the full office or emergency visit
Pay all subrogation claims for any vaccines administered at pop-up locations, mass vaccination sites, or public clinics hosted by state or municipal health departments

The division also encourages carriers that are acting as administrators to self-insured plans to follow this guidance as well.

Although this bulletin is directed towards insurance carriers, employers based in Massachusetts should familiarize themselves with this guidance as they continue to contend with participants being affected by COVID-19.

Bulletin 2021-01 »

New Jersey

February 2, 2021

Coverage for COVID-19 Immunizations

On January 7, 2021, Commissioner Caride issued Bulletin No. 21-01, which provides guidance to health insurers on preventive health services, including COVID-19 immunizations. The bulletin prohibits carriers – including those administering self-funded plans – from charging any cost sharing for qualifying coronavirus preventive services delivered in-network or out-of-network. Additionally, the Department of Banking and Insurance expects carriers to assess their readiness and take all steps to ensure that insureds have access to COVID-19 immunizations and their administration. When vaccines require multiple doses, carriers should communicate to insureds that they need to get both doses of the same vaccine. Carriers should also provide information to providers on how to submit claims for reimbursement of the immunizations.

Although this bulletin is directed towards insurance carriers, employers based in New Jersey should familiarize themselves with this guidance as individuals begin to access COVID-19 immunizations.

Bulletin No. 21-01 »

COVID-19 Exchange Special Enrollment Period

On January 29, 2021, Commissioner Caride released Bulletin No. 21-03, providing a special enrollment period (SEP) on the state exchange as a part of New Jersey’s ongoing response to the COVID-19 pandemic. The SEP will be in effect from February 1, 2021, through May 15, 2021. Individuals may only elect coverage through the state exchange (Get Covered New Jersey) during open enrollment or special enrollment periods.

During this SEP, individuals who are not already enrolled in an individual health benefits plan can apply for coverage through the exchange or directly through carriers. The SEP will also allow individuals who are already enrolled in a health benefits plan to replace their coverage with coverage on the exchange. The coverage will be effective no later than the first of the next month after an individual’s enrollment.

Although this change affects the individual market, employers should keep this in mind as it would likely create a qualifying event that would allow for an employee to potentially drop employer coverage (for themselves or their dependents) to go on the New Jersey exchange.

Bulletin No. 21-03 »

New York

February 2, 2021

Guidance Provided on Use of COVID-19 Sick Leave

On January 20, 2021, the Department of Health released supplemental guidance regarding the application of COVID-19 sick leave for eligible employees. These provisions address an employee’s return to work following a period of COVID-19 sick leave and such employee’s entitlement to additional leave.

The state enacted a law in March 2020 that provided sick leave and job-related protections to employees subject to a mandatory or precautionary order of quarantine or isolation due to COVID-19. Generally, the size and annual income of the employer determine the duration of an employee’s leave and whether such leave is paid. The law did not indicate whether an employee was entitled to leave for more than one order of quarantine or isolation.

The new guidance explains that an employee does not need to be tested for COVID-19 before returning to work following a period of mandatory quarantine or isolation (except for nursing home staff). However, an employee who continues to receive, or subsequently receives, a positive COVID-19 diagnostic test result must not report to work. Such an employee shall be deemed subject to a mandatory order of isolation and shall be entitled to the state’s COVID-19 sick leave, regardless of whether the employee already received such sick leave for the prior period of quarantine or isolation. In such event, the employee must provide documentation from a licensed medical provider or testing facility of the positive test result, unless the employer conducted the test.

The guidance limits an employee’s qualification for COVID-19 sick leave to a maximum of three orders of quarantine or isolation. Each of the second and third orders requires a positive COVID-19 diagnostic test result.

Additionally, if an employer mandates that an employee who is not otherwise subject to a mandatory or precautionary order of quarantine or isolation must remain out of work due to exposure or potential exposure to COVID-19, the employer is required to continue to pay the employee at the employee’s regular rate of pay. Payment at such regular rate of pay would continue until the employer allows the employee to return to work or the employee becomes subject to a mandatory or precautionary order of quarantine or isolation. Once the employee is subject to one of those orders, they would receive sick leave as required by the state’s COVID-19 sick leave law.

Employers should be aware of the additional guidance and should review their leave policies for compliance. Employers may want to consult with employment law counsel for assistance.

Guidance on Use of COVID-19 Sick Leave »

Oregon

February 2, 2021

COVID-19 Temporary Paid Leave Program

The Oregon legislature recently established the COVID-19 Temporary Paid Leave Program to provide coverage to individuals that are not eligible for FFCRA leave. The leave is provided if the employee is unable to work due to the need to quarantine or self-isolate because of COVID-19. Up to 10 days of leave will be provided through the program, and it is only available if the employee’s employer does not provide COVID-19-related paid time off.

In order to be eligible under the program, employees must meet all the following requirements:

They work in Oregon and are required to file an Oregon personal income tax return.
They are directed to quarantine by a local or tribal public health authority or healthcare provider because of exposure to someone infected or have COVID-19-related symptoms and are seeking a medical diagnosis.
They are not able to work (including telework) because they need to quarantine or isolate.
They do not expect to earn more than $60,000 individually or $120,000 jointly in 2020.
Their employer does not provide COVID-19-related paid sick leave or they have exhausted their available COVID-19-related paid sick leave.
They are not applying for unemployment insurance benefits for the time off due to quarantine or isolation.
They are not applying for workers’ compensation benefits for the time off due to quarantine or isolation or experiencing COVID-19 symptoms.
They are not seeking or using benefits from similar COVID-19 quarantine relief programs in Oregon or another state.
They are not applying for or receiving other forms of paid leave from their employer during their quarantine or isolation, such as banked sick leave or vacation leave.
They are not laid off or furloughed by their employer.
They must have notified their employer that you need to quarantine or isolate.
They can claim only one quarantine period.
They are not self-employed.
They are not part of the gig economy (Lyft, Uber, DoorDash, GrubHub, Instacart, etc.)
They are not being paid off the record (this means their employer is not reporting their income to the state and often employers who pay off the record pay in cash).

Employees will apply with the state to receive the benefit. Approved applicants will receive a check in the mail, and the money is taxable.

Employers with Oregon employees that are not offering any paid time off for employees who have the need for COVID-related leave should be mindful of this program.

COVID-19 Temporary Paid Leave Program »
FAQs »
Employee Flier »

Pennsylvania

February 2, 2021

Pittsburgh COVID-19 Emergency Paid Sick Leave Act

The COVID-19 Emergency Paid Sick Leave Act is a temporary ordinance signed into law on December 9, 2020, and is effective immediately. It will remain in effect until the public health emergency ends. Employers with 50 or more total employees must provide eligible employees with 80 hours of paid COVID-19 sick leave. Eligible employees are those who perform at least 51% of their work in Pittsburgh, including telework. It also includes those that normally work in Pittsburgh, but are teleworking from another location during the pandemic.

Qualified reasons for leave are as follows:

If a healthcare provider or public health authority or employer determines that an employee would be a health risk to others due to exposure to COVID-19, or due to that employee exhibiting symptoms of COVID-19.
If an employee must care for a family member due to that family member being determined as a health risk to others due to exposure to COVID-19, or due to that family member showing symptoms of COVID-19.
If an employee needs to quarantine due to being diagnosed with COVID-19, showing symptoms of COVID-19, or needs to seek diagnosis or other care for COVID-19.
If an employee must care for a family member who needs to quarantine or otherwise seek treatment/diagnosis under item iii) above.

There is no specific notice requirement, but the best practice would be for employers to inform employees of the availability of this paid leave.

Pittsburgh COVID-19 Emergency Paid Sick Leave FAQs »

Rhode Island

February 2, 2021

Deadlines Extended for Individual Mandate Reporting

As part of Rhode Island’s individual mandate, employers providing minimum essential coverage to Rhode Island residents must file a return with the Division of Taxation and a return to each individual.

Generally, reporting to Rhode Island residents and the division is due by January 31. For tax year 2020 only, the deadline has been extended to March 2, 2021 (to distribute returns to employees) and to March 31, 2021 (to file with the division).

As background, as of January 1, 2020, Rhode Island residents are required to have qualifying healthcare coverage, or pay a penalty (a “shared responsibility payment”), unless a hardship, religious, or other exemption applies. As part of this requirement, certain employers have reporting obligations to the division and to individuals. The law provides that Forms 1095-B and 1095-C issued by the employer for federal reporting purposes is sufficient to meet the Rhode Island reporting requirement but also provides an option to report via a flat file containing the same information.

Generally, employers will need to distribute Form 1095-C to employees and the IRS – which are current requirements under the ACA’s employer mandate – and then to the division by January 31 of the year following the calendar year for which the return was required to be made. However, the deadline to distribute Form 1095-C to employees has been extended to March 2, 2021, and the deadline to file with the division to March 31, 2021. These extensions only apply to tax year 2020 reporting. Plan sponsors of fully insured plans should note that if the insurer completes the reporting requirements described above, then no further reporting is required.

Employers with employees located in Rhode Island should be aware of these developments.

Department of Revenue Health Insurance Mandate Reporting Requirements FAQ »

South Carolina

February 2, 2021

Grandmothered Plans Extended Through 2022

On January 19, 2021, the Department of Insurance issued Bulletin Number 2021-01 to announce a one-year extension of the renewal policy with respect to certain non-grandfathered individual and small group policies known as “grandmothered” policies. The bulletin follows an extension by CMS of the federal non-enforcement policy concerning specific ACA compliance requirements for these grandmothered plans, as reported elsewhere in this edition of Compliance Corner.

On November 14, 2013, CMS issued a letter outlining a transitional policy with respect to the healthcare reform mandates for coverage in the individual and small group markets. This non-enforcement policy provided relief from certain market reforms, such as the prohibition of coverage exclusions based on pre-existing conditions and non-discrimination based on health status. Under the policy, state authorities could allow health insurance issuers to continue eligible coverage that would otherwise have been cancelled for failure to comply with the ACA requirements.

The department originally announced the state’s intent to allow insurers to continue such coverage via Bulletin 2013-12 issued on November 19, 2013. The transitional policy has been extended by CMS and the department every year since the initial announcement.

Accordingly, small employers who are currently covered by grandmothered policies issued in South Carolina should be aware of the most recent non-enforcement extension. This type of coverage may now be renewed for plan or policy years beginning on or before October 1, 2022, so long as no such coverage extends beyond December 31, 2022. Affected employers should work with their advisors and insurers regarding possible renewal of the coverage.

Bulletin 2021-01 »

Washington

February 2, 2021

COVID-19 Testing and Telehealth Rules Extended

On January 8, 2021, Commissioner Kreidler extended Emergency Order No. 20-02 until February 7, 2021, requiring that COVID-19 testing be provided without cost-sharing or preauthorization and that insurers provide increased flexibility regarding the use of telemedicine.

Employers can notify their plan participants that may still need to receive testing that the testing will continue to be provided without cost-sharing and that telemedicine will still be available.

Further Partially Extending Emergency Order 20-02 »

Extension of Emergency Orders on COVID-19 Testing and Surprise Billing

On January 22, 2021, Gov. Kreidler issued orders extending emergency orders 20-01 and 20-06. Emergency Order 20-01, which has been extended through February 21, 2021, requires health insurers to waive copays and deductibles for COVID-19 testing. The order also requires insurers to allow a one-time early refill for prescription drugs.

Emergency Order 20-06, which has also been extended through February 21, 2021, protects consumers from receiving surprise bills for lab fees related to COVID-19 diagnostic testing. The order also encourages insurers to report out-of-network labs that are not publishing or honoring the cash price of COVID-19 diagnostic testing.

These orders apply to insurers but also provide employers with information about the continued coverage of COVID-19 testing.

Further Extending Emergency Order 20-01 »
Further Extending Emergency Order 20-06 »

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PPI in the News Compliance Corner - February 4, 2021 Archive
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COVID-19 Update

HHS Renews COVID-19 Public Health Emergency Proclamation

Healthcare Reform

Biden Administration Issues Executive Order to Strengthen the ACA and Create a Special Enrollment Period

Federal Updates

Biden Administration Freezes Certain Regulations

IRS Releases 2021 Fringe Benefits Guide

CMS Extends Nonenforcement of ACA-Compliance for Certain Policies

DOL Announces 2020 Adjustments to ERISA Penalties

IRS Updates FAQ on FFCRA Tax Credits

Retirement Update

IRS Releases Covered Compensation Tables for 2021 Plan Years

Announcements

Reminder: Medicare Part D Disclosure to CMS

Reminder: Upcoming IRC 6055 and 6056 Reporting Deadlines

FAQ

FAQ: If the individual mandate penalty is zero, do I still need to provide the Form 1095-C to employees? If so, can these forms be provided electronically?

State Updates

Colorado

February 2, 2021

Massachusetts

February 2, 2021

New Jersey

February 2, 2021

New York

February 2, 2021

Oregon

February 2, 2021

Pennsylvania

February 2, 2021

Rhode Island

February 2, 2021

South Carolina

February 2, 2021

Washington

February 2, 2021

FAQ

Compliance Corner Archive

PPI in the News Compliance Corner - February 4, 2021 Archive You are here: Home / PPI in the News / Compliance Corner - February 4, 2021 Archive

COVID-19 Update

HHS Renews COVID-19 Public Health Emergency Proclamation

Healthcare Reform

Biden Administration Issues Executive Order to Strengthen the ACA and Create a Special Enrollment Period

Federal Updates

Biden Administration Freezes Certain Regulations

IRS Releases 2021 Fringe Benefits Guide

CMS Extends Nonenforcement of ACA-Compliance for Certain Policies

DOL Announces 2020 Adjustments to ERISA Penalties

IRS Updates FAQ on FFCRA Tax Credits

Retirement Update

IRS Releases Covered Compensation Tables for 2021 Plan Years

Announcements

Reminder: Medicare Part D Disclosure to CMS

Reminder: Upcoming IRC 6055 and 6056 Reporting Deadlines

FAQ

FAQ: If the individual mandate penalty is zero, do I still need to provide the Form 1095-C to employees? If so, can these forms be provided electronically?

State Updates

Colorado

February 2, 2021

Massachusetts

February 2, 2021

New Jersey

February 2, 2021

New York

February 2, 2021

Oregon

February 2, 2021

Pennsylvania

February 2, 2021

Rhode Island

February 2, 2021

South Carolina

February 2, 2021

Washington

February 2, 2021

FAQ

Compliance Corner Archive

PPI in the News Compliance Corner - February 4, 2021 Archive
You are here: Home / PPI in the News / Compliance Corner - February 4, 2021 Archive