Current and Past Articles

Prefer to listen instead of read? No problem! Listen to the blog post at any time by clicking here.   At the end of 2024, President Biden signed the Paperwork Burden Reduction Act into law, which amended the Affordable Care Act to provide that employers are no longer required by default to deliver Forms 1095-C/1095-B to recipients if a series of criteria are satisfied. Instead, employers will be in compliance with the ACA’s furnishing requirement as long as they provide a “clear, conspicuous, and accessible notice” that recipients may request a copy of their Form 1095 and, upon receipt of request for a Form 1095, provide the statement to the recipient.  Guidance for how employers must provide such notice to their employees about their Forms 1095-B was already available, but at the time the Paperwork Reduction Act was signed into law, instructions for Forms 1095-C had not been released.  At the end of last week, the IRS confirmed that previous guidance set forth for the distribution of Forms 1095-B can now also be relied upon for distribution of Forms 1095-C.  The notice requirements for both types of forms are as follows:  A clear and conspicuous notice must be posted on a website that is reasonably accessible to all possible Form 1095 recipients. The employer’s public-facing website is likely the most appropriate location for this notice.  The employer may post a statement reading “Tax Information” on the website’s main page, which can link to a secondary page with the header IMPORTANT HEALTH COVERAGE TAX DOCUMENTS that includes the actual notice.  The notice must include an email address, physical address, and telephone number that can be used to request a copy of Form 1095.  For the 2024 reporting year, the notice should have been posted by March 3, 2025. The notice must remain in the same location on the website through October 15, 2025.  If, after posting notice of availability, the employer receives a request for a Form 1095, the Form 1095 must be provided within 30 days. Of note, the employer would need to hand-deliver or mail the form unless they obtain specific consent from the individual to provide the Form 1095 electronically.  Applicable Large Employers (ALEs) that wish to continue furnishing their Forms 1095-C to all recipients as part of their standard ACA reporting process (e.g., by mail) can continue to do so. The Act and the newly released instructions simply provide an alternative furnishing option for ALEs to consider. Given the March 3, 2025 posting deadline for employers to take advantage of this relief for 2024 Forms 1095-C, interested ALEs may want to begin first utilizing this alternative for the 2025 filings due in 2026.  Notably, this relief does not imply that employers responsible for furnishing and filing Forms 1095 should hold off on creating such forms unless/until employees request them. All ALEs and those non-ALEs with self-insured or level-funded health plans are still required to file their 2024 Forms 1094/1095 with the IRS by March 31, 2025. Similarly, state-level ACA form furnishing requirements remain unaffected by this alternative to the federal distribution requirement. As a reminder, MZQ furnishes Forms 1095 to recipients at no additional cost to our ACA reporting clients. 

Prefer to listen instead of read? No problem! Listen to the blog post at any time by clicking here.    Several notable developments have already occurred within the employee benefits compliance domain. Below are two updates that we want to ensure don’t slip past employers.   Expiration of telehealth relief for High Deductible Health Plans  When the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) was signed into law in 2020, one of its provisions was to allow qualified high deductible health plans (HDHPs) to provide telehealth services with little or no cost-sharing without requiring participants to satisfy their deductible, and without jeopardizing participant eligibility to contribute to a health savings account (HSA). The Consolidated Appropriations Act, 2023 extended this relief through December 31, 2024.  Many anticipated that The American Relief Act, 2025 would further extend this relief for employer-sponsored group health plans, but it was ultimately absent from the final version of the law. This means that once a group’s plan renews in 2025, providing cost-sharing for telehealth services at less than fair market value before a participant’s deductible is satisfied will disqualify the participant from HSA eligibility unless the telehealth service is for preventive care. Employers with non-calendar year plan years can continue to take advantage of the telehealth relief for a bit longer until their plan’s 2025 renewal, while employers with calendar-year no longer qualify for the relief.  For employers that want to maintain HSA eligibility for participants of their 2025 HDHP offering, we encourage those impacted by the expiration of this relief to (1) charge fair market value for telehealth (at least until the minimum HDHP deductible is met), (2) amend their plan documents to reflect any changes in cost-sharing, and (3) determine how they want to communicate those changes to employees (e.g., by distributing summaries of material modification).   Hospital indemnity notices no longer required  In the spring of 2024, the Departments of Health and Human Services, Labor, and the Treasury issued final rules governing employer-sponsored indemnity insurance. One requirement within these rules was a mandate that, for plan years beginning on or after January 1, 2025, any employer offering indemnity insurance include a prescribed notice spelling out the differences between fixed indemnity coverage and comprehensive coverage within any marketing, application, and enrollment materials that they provide to participants.  Several insurance companies challenged this requirement as not being authorized by law, and a district court judge agreed with those companies and struck down the new notice requirement at the end of 2024. Though an appeals process is possible, for now, employers that offer indemnity insurance do not need to provide these notices. 

Prefer to listen instead of read? No problem! Listen to the blog post by clicking here.      When it comes to taking care of your team, providing a strong health insurance plan is one of the best ways to show you value their well-being. A well-designed plan can help you attract top talent, boost retention, and foster a healthier, more productive workforce. But with all the options, how do you know where to start?  Here’s a step-by-step guide to building an employee health insurance plan. 

Prefer to listen instead of read? No problem! Listen to the blog post at any time by clicking here.    The Departments of Labor, Health and Human Services, and the Treasury, along with the Office of Personnel Management (collectively, the Departments), recently released a set of FAQs that provide additional insight for employers on compliance with the Consolidated Appropriation Act of 2021’s (CAA, 21) gag clause prohibition and attestation requirements. The CAA, 21 (1) prohibits gag clauses within health plan provider agreements that restrict access to price and quality information, and (2) requires employers to file an annual attestation with CMS confirming that such gag clauses are not in place. Employers that sponsor fully insured plans may rely on their carrier to satisfy this reporting requirement on their behalf. Those with self-funded or level-funded plans are permitted to contract with their TPA to complete the attestation on their behalf; however, the legal obligation to file the attestation ultimately remains with the plan sponsor.    The FAQs provide welcome guidance to employers as plan sponsors, suggesting that more information about their plan should be available upon request. Specifically, the new FAQs clarify that:  Downstream agreements qualify as a prohibited gag clause under the CAA, 21. A “downstream agreement” exists where a plan sponsor has contracted with a TPA or other service provider and that TPA/service provide has a contract in place with a third party (e.g., an owner of a network) that prohibits the TPA/service provider from sharing price and quality information with the plan sponsor and/or plan participants, beneficiaries, referring providers, etc. To prevent these indirect restrictions on the plan, the Departments expect plan sponsors to include provisions in their contracts with TPAs/service providers that prohibit them from entering into downstream agreements that permit such restrictions.  Prohibited gag clauses under the CAA, 21 include provisions in agreements between plans and service providers that prevent the plan sponsor from sharing de-identified claims data with a business associate or limit their ability to do so. The circumstances that qualify as impermissible restrictions on de-identified claims and encounter information include any limitation on the scope, scale, or frequency of electronic access to such data.  When a plan sponsor is unable to remove a prohibited gag clause from a contract they have with a TPA/service provider, including one reflected in a downstream agreement that vendor has with another party, the plan sponsor should nonetheless ensure that their annual gag clause compliance attestation is submitted to CMS. In this instance, the plan sponsor is supposed to provide in their attestation at least:  The non-compliant provision(s) their TPA/service provider won’t remove from the agreement;  The name of the TPA/service provider;  Information about the TPA/service provider’s conduct that confirms the service provider interprets the agreement to contain a prohibited gag clause;  Information about the plan sponsor’s requests that the prohibited gag clause(s) be removed from such agreement; and  Any other steps the plan or issuer has taken to come into compliance with the provision.  The Departments will take this information into account when establishing the plan sponsor’s compliance with the CAA, 21’s gag clause prohibition requirements, and may ultimately investigate the TPA/service provider, particularly if this vendor restricts the plan sponsor’s access to de-identified claims and encounter data.  These FAQs the Departments have provided are particularly notable because they affirm that plan sponsors should have access to important claims data that will help them fulfill their fiduciary duties towards the plan. Furthermore, they provide valuable clarity regarding how plan sponsors should attest when they are unable to fully comply with the gag clause prohibition requirements, despite their best efforts. We encourage plan sponsors, particularly those with self-insured or level-funded plans, to carefully consider the TPA/service provider contracts they have in place, add any provisions necessary to prohibit gag clauses in downstream agreements, and thoroughly document any and all efforts made to remove any prohibited gag clauses before the next gag clause compliance attestation is due at the end of 2025. MZQ is happy to provide assistance through MZQuick Attest, our Gag Clause Compliance Attestation service; more information about this is available here. 

    Join Marissa Rufo, JD, MBA, MZQ Consulting, for the latest Compliance Corner!  When: Tuesday, February 18, 2025, 11:00 AM Pacific / 2:00 PM Eastern Where: Zoom | Register here   A Deep Dive into the New Mental Health Parity (MHP) Rules and What They Mean for Plans in 2025 and 2026 The new MHP rules are here, and they bring significant changes for health plan sponsors and administrators. This webinar will take you step-by-step through the key updates, breaking down what these changes mean for plan compliance, funding structures, and employee benefits strategy. You’ll learn how these updates will impact your operations, what steps you need to take now to prepare, and how to ensure smooth transitions as these regulations take effect. Gain a clear understanding of the rules and actionable insights to future-proof your plans for 2025 and 2026. Who is MZQ Consulting?  MZQ Consulting is a boutique ACA and benefits compliance consultancy helping people navigate the complex world of employee benefits compliance through deep expertise and superb client service. Want to attend? Save your seat by clicking here.  {% module_block module “widget_1cab5fe7-992d-479b-b8d1-f854882928af” %}{% module_attribute “btn” is_json=”true” %}{% raw %}{“link”:{“no_follow”:false,”open_in_new_tab”:true,”rel”:”noopener”,”sponsored”:false,”url”:{“content_id”:null,”href”:”https://us02web.zoom.us/meeting/register/tZAlfu2tqTotEt1u6mruOOyUF0X8PKz5CHJu#/registration”,”href_with_scheme”:”https://us02web.zoom.us/meeting/register/tZAlfu2tqTotEt1u6mruOOyUF0X8PKz5CHJu#/registration”,”type”:”EXTERNAL”},”user_generated_content”:false},”title”:”I want to attend”}{% endraw %}{% end_module_attribute %}{% module_attribute “btn_type” is_json=”true” %}{% raw %}”cta”{% endraw %}{% end_module_attribute %}{% module_attribute “child_css” is_json=”true” %}{% raw %}{}{% endraw %}{% end_module_attribute %}{% module_attribute “css” is_json=”true” %}{% raw %}{}{% endraw %}{% end_module_attribute %}{% module_attribute “cta” is_json=”true” %}{% raw %}”160409781517″{% endraw %}{% end_module_attribute %}{% module_attribute “definition_id” is_json=”true” %}{% raw %}null{% endraw %}{% end_module_attribute %}{% module_attribute “field_types” is_json=”true” %}{% raw %}{“animation”:”group”,”layout”:”group”,”custom_class”:”text”,”is_in_viewport”:”boolean”,”cta”:”cta”,”style”:”group”,”anchor_link_id”:”text”,”btn”:”group”,”btn_type”:”choice”}{% endraw %}{% end_module_attribute %}{% module_attribute “label” is_json=”true” %}{% raw %}null{% endraw %}{% end_module_attribute %}{% module_attribute “layout” is_json=”true” %}{% raw %}{“alignment”:”center”,”margin_top”:0}{% endraw %}{% end_module_attribute %}{% module_attribute “module_id” is_json=”true” %}{% raw %}100522671426{% endraw %}{% end_module_attribute %}{% module_attribute “path” is_json=”true” %}{% raw %}”2023 Power Theme child/modules/mini-cta”{% endraw %}{% end_module_attribute %}{% module_attribute “schema_version” is_json=”true” %}{% raw %}2{% endraw %}{% end_module_attribute %}{% module_attribute “smart_objects” is_json=”true” %}{% raw %}[]{% endraw %}{% end_module_attribute %}{% module_attribute “smart_type” is_json=”true” %}{% raw %}”NOT_SMART”{% endraw %}{% end_module_attribute %}{% module_attribute “style” is_json=”true” %}{% raw %}{“cta_size”:”pwr-cta–full-width”,”cta_style”:”pwr-cta–primary-solid”}{% endraw %}{% end_module_attribute %}{% module_attribute “tag” is_json=”true” %}{% raw %}”module”{% endraw %}{% end_module_attribute %}{% module_attribute “type” is_json=”true” %}{% raw %}”module”{% endraw %}{% end_module_attribute %}{% module_attribute “wrap_field_tag” is_json=”true” %}{% raw %}”div”{% endraw %}{% end_module_attribute %}{% end_module_block %}

Prefer to listen instead of read? No problem! Listen to the blog post by clicking here.   Our lives are increasingly digital. Shopping, entertainment, and conversations all happen online. But the more virtual life comes, the more we crave genuine connections. We’re looking for more than a product or a service. We want an authentic experience where we are true to who we are and what we do and interact with people who are doing the same. The human element makes your business relatable, trustworthy, and memorable. When people feel that from you, they want to work with you, work for you, and recommend you. You’ll attract your people—the ones who will stick around and help you grow. It also lets you see the bigger picture, helping you focus on what makes your business unique and who you serve. You can uncover and clarify your purpose, which, in turn, helps you attract customers who will connect with your brand. That’s a fantastic feeling!