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CA Bereavement Leave as of January 2023

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Starting Jan 1, 2023, employers with five or more employees must abide by new bereavement leave provisions. This is due to an amendment that was made to California Family Rights Act (CFRA) on September 29, 2022. This modification included the implementation of Assembly Bill No. 1949 (AB-1949). Under this bill, eligible employees may take up to five days of bereavement leave as a result of the death of a family member.

 

Overview

The following information outlines the implications of a bereavement leave:

  • A leave must be completed within three months of the dated death
  • Leave may be unpaid however, employees are entitled to use other leave balances, such as available sick leave
  • Days taken for leave are not required to be taken consecutively
  • The leave must be taken in accordance with any current leave policy, with the assurance that the employee is granted no less than five days of bereavement leave.
  • An employee must provide documentation of the death of a family member within 30 days of the first leave if requested by an employer.
  • A covered employer is required to maintain confidentiality regarding the employee’s request and documentation for bereavement leave.

 

This Bereavement Leave Update is provided for informational purposes only and should not be construed as legal or a recommendation of any kind. While we have attempted to provide current, accurate, and clearly expressed information, this information is provided “as is,” and MNJ Insurance Solutions makes no representations or warranties regarding its accuracy and completeness.

The Basics Employers Need to Know About CAA Prescription Drug Reporting

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Rx reporting is a federal mandate that requires insurance companies and group health plans to provide a report of prescription drug data to the government. Logistics regarding the act can be found under Section 204 (of Title II, Division BB) of the Consolidated Appropriations Act, 2021 (CAA).

 

CAA Submission Requirements

The following list includes the information that the CAA requires insurance companies and employer-based health plans to submit:

  • Prescription drugs that are the most frequently prescribed
  • Prescription drugs that account for the most spending
  • Spending reports on prescription drugs and healthcare services
  • Prescription drug rebates from drug manufacturers
  • Premiums and cost-sharing that patients pay

 

            What does the government do with this information?

The federal government wants to use the information and data to examine the prescription drug industry with the potential to make legislative or regulatory changes. Centers for Medicare & Medicaid Services (CMS.gov) expresses that this information will be helpful to:

  • Identify the central causes of increases in prescription drug and healthcare spending
  • Understand how prescription drug rebates impact premiums and out-of-pocket costs
  • Promote transparency in prescription drug pricing

 

Important information and deadlines

This is an annual reporting requirement; plans an issuers will generally submit these reports in June each year, reporting information for the prior calendar year. Please note that it is required to comply with this mandate regardless if your company is fully insured or self-funded. The following deadlines should be noted:

 

Calendar Year to Report Deadline
2022 June 1, 2023
Subsequent calendar years June 1st of each year

 

For more information on this topic, please contact MNJ Insurance Solutions.

 

This Rx reporting summary is provided for informational purposes only and should not be construed as legal or a recommendation of any kind. While we have attempted to provide current, accurate, and clearly expressed information, this information is provided “as is,” and MNJ Insurance Solutions makes no representations or warranties regarding its accuracy and completeness.

 

Resources

CMS.gov provides the following resource:

  • On Nov. 23, 2021, the Departments published an interim final ruleregarding the requirement to report pharmacy and drug costs.
  • Transparency in coverage FAQswere released on Aug. 20, 2021.
  • An FAQabout the submission grace period and reporting flexibilities for 2020 and 2021 data was released on Dec. 23, 2022.
  • More information, including RxDC reporting instructions, is available through the HHS’ RxDC website.
  • Prescription Drug Data Collection (RxDC) Reporting Instructions: https://regtap.cms.gov/reg_librarye.php?i=3860

 

 

No Surprises Act Summary and What Employers and Employees Need to Know

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As of January 2022, the “No Surprise Act” provides protection for consumers from unexpected bills for out-of-network care in an emergency and certain non-emergency settings. By enforcing better consumer protection and price transparency, the new regulations will help create better patient experiences and provide better financial protection for individuals.

Here are a few of the protections you should be aware of:

  1. The No Surprise Act protects patients from receiving surprise medical bills or balance billing resulting from emergency services from out-of-network providers or out-of-network air ambulance services without prior authorization. In other words, you should not be charged more than in-network cost-sharing for specific out-of-network services.
  2. The Act bans out-of-network charges for certain services if the individual is at an in-network facility, including services such as anesthesiology or radiology provided by out-of-network providers. The reason for this is because individuals would not know that the provider is out-of-network if they are at an in-network facility.
  3. The Act requires health care providers and facilities to provide individuals with an easy-to-understand notice explaining the applicable billing provisions and who to contact if the provider or facility has violated the individual’s new protections.
  4. The Act also includes requirements that facilities provide “Good Faith Estimates” to individuals and Advance Explanation of Benefits. More guidance on this provision are still being formalized as of 2022.

We believe that The No Surprise Act creates better financial protection for consumers.

For more information on how MNJ Insurance Solutions can help your company and employees, please contact us today.

2023 ACA Pay or Play Increasing Penalties

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On August 16, 2022, the IRS revised the penalty amounts for the employer shared responsibility (pay or play) rules under the Affordable Care Act (ACA) for 2023. For the calendar year 2023, the adjusted $2,000 penalty amount is $2,880, and the revised $3,000 penalty amount is $4,320.

 

Pay Or Play Penalty

An applicable large employer (ALE) that complies with the pay or play regulations is only subject to penalties if at least one full-time employee receives a subsidy for Exchange coverage. In general, employees provided affordable minimum value (MV) coverage are not qualified for these Exchange subsidies. Based on the circumstances, the pay-or-play rules allow for applying either the 4980H(a) penalty or the 4980H(b) penalty.

 

  • Under Section 4980H(a): If an ALE does not provide coverage to around 95% of its full-time workers (and dependents), and any full-time worker obtains a subsidy toward their Exchange plan, the ALE will be subject to a penalty. For any applicable month, the monthly fine imposed on ALEs that do not provide coverage to almost all full-time employees and their families equals the number of full-time employees at the ALE (minus 30), multiplied by 1/12 of $2,000 (as adjusted).

 

  • Under Section 4980H(b): If at least one full-time employee receives a subsidy through an Exchange due to the ALE not providing coverage to all full-time employees, the ALE’s coverage being prohibitively expensive, or the ALE’s coverage not providing MV, the ALE may still be subject to a penalty even if it offers coverage to nearly all full-time employees (and dependents). For each full-time employee who receives a subsidy, an ALE is subject to a monthly fine equal to 1/12 of $3,000 (as adjusted) for any applicable month. Nevertheless, the 4980H(a) penalty amount is the maximum punishment for an ALE.

 

 

Important Dates Description
August 16, 2022 For 2023, the IRS published revised pay-or-play penalty amounts.
March 1, 2022 Prior to this, the IRS updated the 2023 affordability percentage to 9.12%
2024 Calendar year Updates are based on coverage offered during the 2023 calendar year

 

This ACA Pay Penalty Outline is provided for informational purposes only and should not be construed as legal or a recommendation of any kind. While we have attempted to provide current, accurate, and clearly expressed information, this information is provided “as is,” and MNJ Insurance Solutions makes no representations or warranties regarding its accuracy and completeness.

 

*source:https://content.zywave.com/file/b1f47fcf-ae5c-4d8a-a1b2-1d74f01159e9/ACA%20Pay%20or%20Play%20Penalties%20Will%20Increase%20for%202024.pdf *

 

2022 MetLife: 20th Annual Employee Benefit Trends Study

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As workplace dynamics continue to change and evolve, it is important to understand the shifting environments. The pandemic brought accelerating trends to the market, including but not limited to greater interest in flexible working arrangements, more work-life balance, financial well-being, mental health awareness, and much more. The MetLife’s 20th Annual U.S. Employee Benefit Trends Study 2022 delivers actionable insights for forward-thinking employers, as they develop strategic plans and benefits to adopt a more holistic view of employee needs to serve their dynamic workforce.

 

We hope this study is helpful for employers and HR professionals looking to take intentional and meaningful action to innovate their benefit strategies within an ever-evolving workforce.

#EmployeeBenefitTrends2022 #mnjinsurance #Metlife

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