The report must include:

• Beginning and end dates of the plan year;
• Number of plan participants;
• Enrollment and premium information, including average monthly premiums paid by employees vs. employers;
• Total health care spending broken down by type of cost (primary care; hospital care; specialty care; prescription drugs; and other medical costs, including wellness services), including prescription drug spending by enrollees vs. employers and issuer;
• The 50 most frequently dispensed brand prescription drugs;
• The 50 costliest prescription drugs, based on total annual spend;
• The 50 prescription drugs that had the biggest increase in plan or coverage expenditures over the previous year;
• The prescription drug rebates, fees and other remuneration paid by drug manufacturers to the plan or insurer in each therapeutic class of drugs, as well as for each of the 25 drugs that yielded the highest amount of rebates;
• The impact of drug rebates, fees and other remuneration on premiums and out-of-pocket costs.

Uncertainty over some of the reporting requirements remains, particularly for small employers that don't readily have access to this level of information. Further guidance is anticipated once the final rule is released, to include the forms to be used for reporting this information.

PCORI fees

The IRS has released the 2022 Patient-Centered Outcomes Research Institute (PCORI) fee for self-funded plans with plan years that end on or after October, 1, 2021, and before October 1, 2022. The new fee is $2.79 per covered life, and payments are due on or before July 31, 2022.

ACA safe harbor update

Under the Affordable Care Act (ACA), employers are required to offer affordable health care options to eligible employees. The IRS decreased the affordability percentage index from 9.81% in 2021 to 9.61% in 2022. Coverage is deemed affordable if the employee's contribution for self-only coverage does not exceed 9.61% of the employee's income. The IRS has indicated the percentage will increase to 9.7% for 2023.

For employers who use the Federal Poverty Level (FPL) Safe Harbor method, coverage is deemed affordable if the employee's required monthly contribution for the lowest-cost, self-only, ACA-compliant coverage does not exceed the FPL for a single individual. Eligible employees must not be required to pay more than $103.15 per month for plans beginning July 11, 2021, to December 31, 2022.

End of good faith for ACA reporting errors

The IRS has announced it will no longer offer good-faith relief from ACA reporting errors. It's important for employers to review Forms 1094-B or C and 1095-C before they are filed with the IRS to ensure they are accurate and correct any inaccurate information as quickly as possible following discovery of the error. The change affects filings for 2021 and all future filings. Penalties may be assessed for reporting errors. The IRS may impose penalties of up to $280 per form for failing to furnish an accurate Form 1095-C or 1095-B to an employee, plus an additional $280-per-form penalty for failing to file an accurate form with the IRS. The potential penalty per employee, therefore, is $560. That can result in a significant fine for large employers.

The IRS also announced it's making permanent the extension for providing Forms 1095-C to employees, which verifies employer-provided health coverage and determines eligibility for premium tax credits for coverage purchased on the exchange. The new deadline for providing the forms is March 2, pushed back from January 31 each year.

Important state updates

There are two important state and local regulatory requirements of note because they affect any employer in the U.S. who has an employee living within the state or region.

The Consumer Coverage Disclosure Act (CCDA) applies to any employer in the U.S. with a group health plan who has an employee who lives in Illinois, works in Illinois, or whose operating base is in Illinois. Under the law, covered employers must provide all Illinois-based employees who are eligible (or presumably will be eligible) for health insurance under that group health plan an easy-to-understand comparison between the group health plan's essential health benefits (EHBs) offerings and the EHBs that are required in the state-regulated individual market. It's important to not this is not a coverage requirement, but a reporting requirement.

This information must be provided to employees upon hire, annually and upon request. The intent of the CCDA is to make employees aware of what's covered under state-regulated plans that may not be covered under their employer's plan so they can explore a market-based plan during the open enrollment period if they see fit. Penalties can range from $500 to $5,000, depending on employer size and number of offenses for failure to provide the disclosure.

San Francisco – the city and the county – is reinstating reporting requirements for all U.S.-based employers who have employees residing in the county. Since 2008, the city and county of San Francisco have required any U.S. employer with employees residing in the city or county to either provide health coverage, pay an employee's actual healthcare expenses or make payments to the Healthy San Francisco program. Related reporting requirements were suspended during COVID-19 but are now required and due May 2, 2022.

Keeping up with regulatory changes and new reporting requirements adds to the already stressed workloads of HR professionals. Mistakes can be costly and take significant time to correct, so it's important to understand what's required and seek assistance as needed. HR professionals should work with their plan administrators, tax professionals and others to ensure compliance. This will enable them to focus on other important tasks and best position their organizations for the future.

Danielle Capilla is Vice President of Compliance, Employee Benefits, with Alera Group.

Read more: 

• No more surprises! Navigating compliance with medical billing legislation
• How recent regulatory changes affect FSAs and dependent care accounts
• 4 FAQs for employers about ACA compliance