Human Resources


As we head into a new year, there will be some noticeable changes in employee benefits that you and your clients should be made aware of. The following list encompasses a few of the items you may expect to change:

Required Reporting
Effective January 1, 2020, Medicare Secondary Payer reporting will now include prescription drug coverage. Right now, this is an optional procedure. It is handled by insurance carriers and third-party administrators. Employers should be aware that they may get requests for information from those carriers and third-party administrators. A more detailed explanation can be found here.

PCORI Fee Elimination
The PCORI fee will be eliminated for plan years ending before October 1, 2019. If an employer’s plan year ends between October 1, 2018 and December 31, 2018, then the last PCORI fee for that plan should have been paid by July of 2019. This would generally include plans that have plan years beginning November 1, December 1, or January 1. All other plans will make their last PCORI fee payment by the end of July 2020.

Out-of-Pocket Maximum Increase
In 2020, out-of-pocket maximums will increase to $8,150 for self-only coverage and $16,300 for family coverage. This represents an increase of about 3.20% from last year. HHS requires that the individual out-of-pocket maximum be embedded for each individual within the family OOPM. You can refer to the 2020 Benefit and Payment Parameters found here.

Health Insurance Tax
The Health Insurance Tax (HIT) which has been on a moratorium for 2019, will make a return in 2020 unless Congress acts on pending legislation to delay or repeal. This would result in increased premiums ranging from 2.7% to 4% according to actuarial experts.

Employer Mandate Affordability
The affordability percentage used in the safe harbors will be reduced to 9.78% in 2020. Employers should review their contribution levels to make sure they are within the new percentage requirement.

Individual Mandates in the States
Effective January 1, 2020, California and Vermont will have an individual mandate that will require employer reporting to be completed in 2021. New Jersey, which already has an individual mandate in place, will have to complete the employer reporting in 2020.

Self-Funded Plans
Employers that self-fund may have different benefits that cannot be subject to annual and lifetime limits. Self-insured employers should reevaluate which state plan they use as their benchmark for purposes of determining which benefits cannot be subject to annual and lifetime limits.

2020 Employer Mandate Penalties
As they do each year, the Department of Health and Human Services (HHS) calculates the health insurance premium growth rate. That rate is then used to adjust the amount of the ACA employer mandate penalties. Although not finalized, the 2020 employer mandate penalties could be $2,570 for the (a) penalty and $3,860 for the (b) penalty.

There is a lot of pending legislation that Congress could still take up before the recess. Issues pertaining to a Cadillac Tax repeal, transparency in prescription drug prices (H.R.3), redefining a full-time employee, surprise billing, and employer reporting can all be potentially addressed in the coming weeks.


Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.


Silver-loading refers to health insurers loading premium increases on the popular silver-level exchange plans to make up for the loss of Cost Sharing Reduction (CSR) payments. Loading premium surcharges onto silver plans boosted the size of the premium tax credits available to people with incomes below 400% of the federal poverty level. – The Trump Administration in an effort to end silver-loading has proposed changes to the current regulations.

Employee Benefit Advisor’s blog tends to focus on Human Resource and Benefit group related issues, like our monthly HR & Benefit Advisory publication. However, we believe silver-loading is an issue of interest to all in our field.


Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Telemedicine – Impact your health care costs

Group health insurance premium are expected to rise 15-18% in 2019 and Telemedicine can be an important cost containment tool, for both employer and employee.

In a study of 17,000 telemedicine participants, hospital admissions dropped by 30% and doctor visits were reduced by 60%, for a savings of 45% in unnecessary doctor and emergency room visits. The American Medical Association states that 70% of doctor visits can be handled over the phone, and 50% of the emergency room visits are non-emergencies. Telemedicine’s savings in claim costs range from $300 for a single employee to more than $1,000 per year for a family of 4.

Telemedicine provides 24/7 medical access to employees as part of their benefit package. Advances in communication technologies make accessing professional medical opinions easier. This is particularly important if the network is strictly local, employees live in rural areas, or employees are worried about access to doctors while traveling.

In addition to the obvious convenience – patients/employees do not have to take time away from work for a medical appointment, sitting in the doctor’s waiting room, eliminating travel time – patients/employees have increased access to medical experts in many fields. Telemedicine puts the employee in touch with US Board Certified physicians in their state to treat common ailments; cold/flu, sinus infections, allergies, pink eye, etc.

What can employers do? – Employee Benefit Advisors recommends companies build a communication program to educate employees. In addition to informing employees the services that can be accessed via telemedicine be sure to include instructions on downloading your health insurance carrier’s app and login.

Interestingly, a bill submitted in New York proposes creating a task force to study how telehealth and telemedicine might help employees in workers comp. The task force would examine how connected health technology could improve outcomes for workers on worker’s comp, increase access to care providers and enable those providers to improve compliance with worker’s comp guidelines. The committee would also explore how telehealth and telemedicine could help employers and reduce fraud.


Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

IRS Guidelines – Indexed for 2019

Social Security Tax is 6.2% on income up to $132,900 up from $ 128,400
Medicare Tax unlimited 1.45% to Unlimited

High Deductible Health Plans
Minimum Annual Deductible (Individual/Family) $1,350 / $2,700
Maximum Out-of-Pocket Limit (Individual/Family) $6,750 / $13,500

Health Savings Accounts
Individual / Family $3,500 /  $7,000
Catch-up Contribution $1,000

ACA Plan Limits

Out-of-Pocket Limits Individua; / Family $7,900 / $15,800

Flexible Spending Accounts
Health Care Flexible Spending Account Maximums $2,700
Dependent Care Spending Account Maximum $5,000

Mileage & Transportation
Standard Mileage Rates
58 cents per mile for business miles driven
20 cents per mile for medical or moving purposes
14 cents per mile driven in service of charitable organizations

Parking (monthly) $265
Mass Transit Passes (monthly) $265

Compensation Limit $280,000
Highly Compensated Employee Salary Amount $125,000
Annual Compensation for Key Employee $180,000
Defined Benefit Plan Limit $225,000
Defined Contribution Plan Limit $56,000

Retirement Plans
401(k) $19,000
401(k) Catch-up $6,000
403(b) $19,000
457(b)(2) and 124(c)(1) $19,000
457(b) Catch-up $6,000

IRA Limit $6,000/$7,000 for age 50+
Simple IRA Limit $13,000/$3,000 Catch-Up


Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Become a Mountain Man – A worthwhile New Years Resolution!

We can learn a lot from Mountain Men. Like taking the time to sharpen our saw.

The saw is like business operations. If you don’t take time to sharpen your methods and skills it could dramatically affect your business. Don’t be so focused on current day activities they don’t take time to evaluate operations to enhance results. Creating operational efficiencies is crucial to success.

As a Health Care Consultant / Broker and SCORE Volunteer I see it all too often. Here are two recommendations that I can help with that will pay long term dividends.

Health Care Consumption Audit – Health insurance is usually a company’s second highest operational expense. Creating a savings strategy for health insurance can create a significant contribution to the bottom line. Why not perform a Health Care Consumption Audit?

SCORE – Mentoring, workshops, turnaround consulting and advisory boards are all available through SCORE to help start and/or grow your business. SCORE mentors are experienced executives from diverse business backgrounds.


Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Why do hackers want your health care data?

Health care information has a much longer shelf-life than other targets like credit cards, which become useless once a consumer gets a new card. Medical and insurance information has value for years.

Employers, if an employee is hacked that employee will be totally engaged restoring their accounts. Employee Benefit Advisors strongly recommends offering Credit/Identity Monitoring and Restoration as a voluntary employee benefit.

How can you protect yourself? We asked Bryan Barnhart, President of Infiltration Labs, Cyber Crimes Investigator,  and Digital Forensic Specialist, and primary instructor for the U.S. Secret Service Network Intrusion Response course. As a retired Police Detective and U.S. Secret Service Electronic Crimes Task Force Investigator (in short, he knows his stuff) he has a few basic tips.

Cyber Security for the Masses
Use strong passwords and don’t reuse passwords
Change passwords frequently
Use a password manager
Check if your email/password has been compromised:
Use Two-Factor Authentication (2FA) for all accounts:
Don’t use open Wi-Fi or networks you can’t vouch for
If you must open Wi-Fi, use a VPN – Think before you click: Don’t click links or open attachments in suspicious emails

Uncertain about the various cyber security monitoring services available? Contact Bryan or Myself, we don’t have a horse in the race, however we use the same service.

Zocdoc: Find & Book Doctors

New to the area and don’t know anyone? Download the app and within 2 minutes find the perfect PCP, Specialist or Pediatrician. Zocdoc is the beginning of a new healthcare experience. Find doctors you love, read real reviews, book appointments instantly, and more with this award-winning app.

• See neighborhood doctors in your insurance network
• Book appointments with over 50 different medical specialties, including dentists, primary care doctors, allergists, OBGYNs, dermatologists, family doctors, urologists, psychologists, ophthalmologists, podiatrists, optometrists, pediatrists and more
• Read verified reviews from other patients
• See open appointment times and book instantly and keep track of your medical calendar. No phone calls necessary, even for same day bookings!
• Algorithm lets you search by specialties and conditions, like diabetes, obesity/weight loss, cancer, yellow eyes, bleeding, cysts, sore throat and more.
• Check in on the app to complete your paperwork and save time at the office
• Receive text reminders before your appointments

More Features
• Find doctors near your location with a convenient map
• Read doctors’ professional statements, learn about their education, and see what languages they speak
• Keep track of your physicians and easily schedule follow-up appointments from your Medical Team homepage
• Stay on top of important checkups with Wellness Reminders


Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Rx Management – CoPay Accumulator Programs

With Accumulator Programs the manufacturer’s payments no longer count toward a patient’s deductible or out-of-pocket maximum. Employers and health plans could potentially save big money because accumulators shift a majority of drug costs to patients and manufacturers.

Normally, a manufacturer’s payments from a copay program count toward a patient’s deductible and annual out-of-pocket maximum. Once these annual limits are reached, the plan pays for all subsequent prescriptions.

Problem is the Accumulator Programs will lower a plan’s drug spending by discouraging the appropriate utilization of specialty therapies and reducing adherence.

You may recognize Copay Accumulator by other names; UnitedHealthcare uses the term “Coupon Adjustment: Benefit Plan Protection program,” Express Scripts uses the term “Out of Pocket Protection program.” Choose your poison, both are misleading, especially to the patient.

For a deep dive into the potential impact of CoPay Accumulator Programs I recommend reading the article (link below) from Adam J. Fein, Ph.D. (Drug Channels) that highlights many potential concerns to Copay Accumulator Programs. Copay Accumulators: Costly Consequences of a New Cost-Shifting Pharmacy Benefit

“Cadillac Tax” and Health Insurance Industry Fee Delayed in Spending Bill

A major victory in the continuing resolution that is keeping the federal government funded. The package included an additional two-year delay of the Cadillac Tax on employer-sponsored health insurance plans until 2022 and a moratorium in 2019 of the Health Insurance Tax on all plans.

Previously suspended for 2016 and 2017, the 2.3% excise tax on U.S. medical device revenues also restarted on Jan. 1, but will now remain suspended for two years through the end of 2019.


Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

IRS will NOT accept 1040 without ACA Health Coverage Reporting

Employee Benefit Advisors recommends companies inform employees of the following. – The original announcement came out in October 2017, however EBA thought it would be a good reminder to post at this time.

Reminder: The new tax law does not actually repeal the individual mandate. It eliminates the penalty (penalty is zero) starting in 2019, not 2017 or 2018. However, the penalty can be reinstated with an update to the tax law.   The requirement for companies with 50+ FTEs to offer health insurance remains.


The IRS has stated that it will not accept Forms 1040 for the 2017 tax year if the taxpayer does not report on the ACA’s health coverage reporting requirements. This is the first year that the IRS has put in place system changes to its Form 1040 review process that would reject tax returns during processing in instances where the taxpayer does not provide this information.

Background. The ACA’s individual mandate requires most individuals to obtain minimum essential health insurance coverage for themselves and any dependents or pay a penalty. Form 1040 instructs taxpayers to report whether they (and every dependent listed on their return) had health insurance coverage, were eligible for an exemption from the ACA’s coverage requirement, or will make an individual shared responsibility payment.

For prior tax seasons, the IRS had delayed processing of tax returns that did not answer the health care coverage questions, but it did not prevent the return from ultimately being processed.

Guidance. For 2017 tax returns, the IRS has stated it will not accept the electronic tax return until the taxpayer indicates whether they (and all of their dependents) met the ACA requirements or are paying the penalty. In addition, returns filed on paper that do not address the ACA reporting requirements may be suspended pending the receipt of additional information, and refunds may be delayed.

In response to the IRS’s revised review process for Forms 1040, to avoid refund and processing delays when filing 2017 tax returns, taxpayers should indicate whether they (and everyone listed as dependents on their tax return) had health insurance coverage, qualified for an exemption or made a shared responsibility payment.

The IRS guidance is available at:


Content is provided for information purposes by The Wagner Law Group and may not be relied upon as specific legal advice.

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