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Looking Ahead: 2020 Compliance News

Top compliance updates employers and consultants need to know.

ACA OOP Limitations

On April 25, 2019, the Department of Health and Human Services released the 2020 Affordable Care Act (“ACA”) out-of-pocket (“OOP”) maximums for 2020. ACA OOP limitations increased 3.16%.

2019

2020

Self-Only

$7,900

$8,150

Family

$15,800

$16,300

HSA and HDHP Limitations

On May 28, 2019 the IRS released the health savings account (“HSA”) and high deductible health plan (“HDHP”) limits for 2020. For 2020, maximum HSA contributions increased 1.01% and HDHP OOP maximums increased 1.02%.

2019

2020

HSA Contribution Limit

Self-Only:        $3,500

Family:             $7,000

Self-Only:        $3,550

Family:             $7,100

Catch-Up Contribution Limit (for HSA-eligible participants who turn 55 by year-end)

$1,000

$1,000

Minimum HDHP Deductible

Self-Only:        $1,350

Family:             $2,700

Self-Only:        $1,400

Family:             $2,800

HDHP OOP Maximum

Self-Only:        $6,750

Family:            $13,500

Self-Only:        $6,900

Family:            $13,800

Poverty Guidelines

The IRS released the 2020 Affordability Percentage (9.78%) for employers using the federal poverty line safe harbor to avoid § 4980H(b) Employer Shared Responsibility penalties. As specified in FAQ No. 29, the following formula shows the maximum self-only monthly contribution for Plans using this safe harbor: (9.78% x 2019 Poverty Guideline) / 12.

Jurisdiction

2019 Poverty Guidance

Maximum Self-Only Monthly Contribution (2020)

Alaska

$15,600

$127.14

Hawaii

$14,380

$117.20

Any other US State

$12,490

$101.79

District of Columbia

$12,490

$101.79

2020 Medicare Part D Benefit Parameters

On April 1, 2019, CMS issued the 2020 Medicare Part D Benefit Parameters used in determining whether coverage is creditable for required disclosures. View guidance here. Pages 64-65 show the “Standard Benefit” parameters for 2020, which will be used to determine whether coverage is creditable:

Standard Benefit

2020 Parameter

Change from 2019

Deductible

$435

+ $20

Initial Coverage Limit

$4,020

 + $200

Out-of-Pocket Threshold (see FN1)

$6,350

+ $1,250

Total Covered Part D Spending at the Out-of-Pocket Threshold for Non-Applicable Beneficiaries (defined in FN3)

$9,038.75

+ $1,385

Estimated Total Covered Part D Spending for Applicable Beneficiaries (defined in FN4)

$9,719.38

+$1,579.84

Minimum Cost-Sharing in Catastrophic Coverage Portion of the Benefit

Generic / Preferred Multi-Source Drugs

$3.60

+ $.20

Other

$8.95

+ $.45

For more information about Creditable Coverage, please visit the Creditable Coverage section of CMS.gov.

 

Preventive Service Guidelines

§ 2713 of the Affordable Care Act provides sources for preventive services that must be covered under the health reform law without cost sharing requirements, which are generally summarized at https://www.healthcare.gov/coverage/preventive-care-benefits/. The specific resources for employers and plan advisors to review include:

  1. [E]vidence-based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventive Services Task Force;”
    1. Find more specific guidance here.
    2. The following items were released in 2019:

TopicDescriptionGradeRelease Date of Current Recommendation
Bacteriuria screening: pregnant womenThe USPSTF recommends screening for asymptomatic bacteriuria using urine culture in pregnant persons.BSeptember 2019*
BRCA risk assessment
and genetic counseling/testing
The USPSTF recommends that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations with an appropriate brief familial risk assessment tool. Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing.BAugust 2019*
Breast cancer preventive medicationsThe USPSTF recommends that clinicians offer to prescribe risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women who are at increased risk for breast cancer and at low risk for adverse medication effects.BSeptember 2019*
Gonorrhea prophylactic medication: newbornsGonorrhea prophylactic medication: newborns The USPSTF recommends prophylactic ocular topical medication for all newborns to prevent gonococcal ophthalmia neonatorum.AJanuary 2019*
Hepatitis B screening: pregnant womenThe USPSTF recommends screening for hepatitis B virus (HBV) infection in pregnant women at their first prenatal visitAJuly 2019*
HIV preexposure prophylaxis for the prevention of HIV infectionThe USPSTF recommends that clinicians offer preexposure prophylaxis (PrEP) with effective antiretroviral therapy to persons who are at high risk of HIV acquisition.AJune 2019
HIV screening: adolescents and adults ages 15 to 65 yearsThe USPSTF recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk of infection should also be screened.AJune 2019*
HIV screening: pregnant womenThe USPSTF recommends that clinicians screen for HIV infection in all pregnant persons, including those who present in labor or at delivery whose HIV status is unknown.AJune 2019*
Perinatal depression: counseling and interventionsThe USPSTF recommends that clinicians provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions.BFebruary 2019

*Previous recommendation was an “A” or “B.”

  1. “[I]mmunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved;”
  1. “[W]ith respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration.”
  1. “[W]ith respect to women, such additional preventive care and screenings not described in paragraph (1) as provided for in comprehensive guidelines supported by the Health Resources and Services Administration for purposes of this paragraph.”

 

PCORI Fees

Per IRS guidance, the PCORI fee for plan years ending after September 30, 2018 and before October 1, 2019 is equal to $2.45 per covered life. No PCORI fee is owed by plan year which end after Sept. 30, 2019.

 

2020 FSA Contributions

Beginning in 2020, employees may contribute an additional $50 to their flexible spending accounts, per IRS guidelines given in Title 26  U.S. Code § 125(i) . Contribution limits are typically made in October, ahead of many Open Enrollment periods. If an employer decides to adopt the new limits, this delayed IRS announcement may require swift communication by human resources teams.

2019

2020

FSA Contribution Limit     

$2,700

$2,750

 


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