Skills, tools and expertise on demand.

Proprietary tools help you calculate the broad business impacts of healthcare reform and assess the opportunities and liabilities of compliance as well as noncompliance, so you can make informed decisions. Education programs help your team understand the implications of inaction, errors or neglect, and clearly communicate what you need to know—and the steps you need to take to protect your organization.

Your Gallagher consultant has access to a compliance help desk staffed by regional compliance professionals who understand the financial, operational and strategic ramifications of today’s regulations. Through your advisor, you have access to that expertise and to a team of specialists who understand the details and can deliver the support your overworked HR staff needs. Qualified advisors are on call to address pressing issues related to the Patient Protection and Affordable Care Act (PPACA), ERISA, COBRA and more. You get the robust set of skills, tools and experience you need to handle your compliance issues—so you can focus on your core business.

Healthcare Reform Toolkits

To help employers better understand and comply with the most significant mandates imposed by healthcare reform, Gallagher has developed the following toolkits available for you to download below:

Two pillars of the Patient Protection and Affordable Care Act (“PPACA”) are the individual mandate and the employer mandate. Central to the ability of the government to administer both mandates is the gathering of information.

With regards to the individual mandate, IRS Code Section 6055 enacted by PPACA requires employers providing minimum essential coverage to report certain information to the IRS about the coverage provided and who it is provided to. With regards to the employer mandate, IRS Code Section 6056 enacted by PPACA requires applicable large employers to report information regarding the coverage offered to their employees. Both Sections 6055 and 6056 also require statements to be furnished to the individuals that are mentioned in the reports to the IRS. Although the penalty for the individual mandate was reduced to $0 as of January 1, 2019, employers are still required to report to the IRS and provide statements to employees.

Compliance experts at Gallagher have created this valuable toolkit filled with practical and useful information as you prepare to comply with these important requirements.

Sections 6055 and 6056 Reporting Requirements Toolkit

Determining who is a full-time employee for purposes of the Employer Mandate is not as simple and straightforward as it seems.  An employer must be mindful of temporary, seasonal, and variable hour employees, among others.  The final regulations for the Employer Mandate attempt to provide a framework by which employers can count the hours and determine the full-time status of their employees.  This complex set of regulations nestled within the larger set of regulations that govern the Employer Mandate dictate how employers must count hours.

To assist our clients through the complicated maze of regulation that they face, we have developed the Counting Hours Toolkit, which includes articles deconstructing the convoluted counting hours regulations, employer FAQs, provides a series of considerations for employers as they approach this issue, as well as providing pieces directed towards questions from and communications with employees.

Beginning on January 1, 2015 the employer shared responsibility mandate requires applicable large employers to offer, to substantially all of their full-time employees and their dependents, eligible employer-sponsored coverage or face potential penalties. In an effort to provide clarity to the many aspects of the mandate, regulators have issued an immense amount of guidance over an extended period of time. This has overwhelmed employers as they work to understand and calculate their potential penalties and chart a course to full compliance.

To assist employers in their efforts to fully understand this important provision of healthcare reform, the compliance experts at Arthur J. Gallagher (“AJG”) have constructed this toolkit that covers all aspects of the mandate through the use of a flyer that relates potential penalties, a whitepaper that provides substantive background on the employer mandate, a set of FAQs for employers, flowcharts that visualize the transitional relief rules, and webinars covering the entirety of the employer shared responsibility rules

The Patient Protection and Affordable Care Act requires applicable large employers (“ALEs”) to offer affordable, minimum value coverage to substantially all full-time employees, or to pay penalties. The IRS has begun assessing penalties, referred to as Employer Shared Responsibility Payments (“ESRPs”), on ALEs that failed to offer coverage in accordance with the ESR mandate in 2015. To assist employers in understanding the process associated with receiving a ESRP letter (via Letter 226J) and the possible courses of action that they may take, we have developed an Employer Shared Responsibility Payment Toolkit. The toolkit consists of an article, employer FAQs, a flowchart that provides fundamental information needed to understand and respond to an ESRP letter, as well as, matrices to assist employers in understanding the codes and the transitional relief that was available in 2015 Form 1095-C filings – all of which is essential for employers to evaluate and properly respond to a penalty assessment letter from the IRS.

One thing has been clear since the Patient Protection and Affordable Care Act was signed into law: there are lots of moving parts and keeping track of them can be difficult for an employer. One of the more difficult aspects of compliance with the healthcare law will be keeping tabs on the fees and taxes brought forth by the new law. GBS has developed this toolkit to help our clients gain a better understanding of and be better prepared for the fees that lay ahead. This toolkit emphasizes four major fees: the Patient-Centered Outcome Research Institute Fee (PCORI Fee), the Transitional Reinsurance Fee, the Health Insurer Fee, and the Excise Tax on High-Cost Health Coverage ("Cadillac Tax").

An audit of health and welfare plans by the Department of Labor (“DOL”) can be a trying experience for any business. This stress can be particularly amplified when considering that you have been trying to keep your health and welfare plans up-to-date with the voluminous requirements of the existing laws, as well as, with the frequent deluge of requirements from the Patient Protection and Affordable Care Act (“PPACA”). The breadth of requirements creates many opportunities for errors to occur. The first step to successfully surviving an audit is knowing what to expect and being prepared. In light of increased audit activity from the DOL, GBS has prepared this toolkit to provide you with an understanding of what a DOL audit looks like – from the initial DOL audit letter to self-compliance tools to sample response letters.

The toolkit begins with GBS’ article on the uptick of audits and how they now address PPACA. We also provide you with a piece on twelve DOL hot spots to beware of. Links are provided to two self-compliance tools provided by the DOL, which, in addition to being useful checklists, give an understanding of what the DOL is looking at. We also provide you valuable sample DOL audit letters and responses.

How has healthcare reform impacted your wellness programs? Employer-sponsored wellness programs that come in all shapes and sizes. In general, these programs attempt to address body, mind and pocketbook―helping employers reduce benefit costs and lost work time, while increasing employees' productivity and satisfaction. Prior to the passage of healthcare reform, HIPAA prohibited group health plans from discriminating against plan participants in terms of eligibility, benefits or premiums based on a health factor.

An exception was permitted for wellness programs that would allow a limited amount of rewards, or penalties, in return for adherence to a wellness program. In general, while healthcare reform adopted many aspects of the HIPAA Rule related to wellness programs, there were a number of significant changes introduced by the final HIPAA (as amended by PPACA) regulations issued in June 2013.  In addition, the EEOC issued final regulations under the ADA and GINA in May 2016. This toolkit helps employers understand how healthcare reform, ADA and GINA impact employer-sponsored wellness programs.

Annually employers are required to provide to participants and beneficiaries a Summary of Benefits and Coverage (“SBC”). Regulations specify the information that must be included in the SBC, and when the employer must provide the SBC to employees.

To help you navigate through the numerous nuances of the SBC requirements, Gallagher has developed this toolkit, composed of a variety of tools and resources to help you understand and comply. The SBC Disclosure Toolkit incorporates all guidance issued by the federal government through December 2018.

Healthcare reform amended the Internal Revenue Code to require that employers report the aggregate cost of "applicable employer-sponsored coverage" on employee W-2s. As a result of the requirement, many employers have been:

  • Wondering if their plans are subject to the healthcare reform W-2 reporting requirement.
  • Wondering how to correctly calculate the value of the benefits provided.
  • Confused about the types of benefits to be included on employees' W-2s.

In an effort to help you navigate the W-2 requirements, Gallagher has developed numerous tools to help you understand, comply, and communicate these changes to your employees.

The Patient Protection and Affordable Care Act requires that insurance companies spend at least 80% of premiums collected on medical care and quality improvement activities in the small group and individual markets (85% in the large group market). Rebates are provided to consumers by insurers that do not meet this standard – the 80/20 rule. Insurers that fail to meet the standard must send a notice of the failure to their customers explaining the purpose of the rule, the amount by which the insurance company missed the goal, and the percentage of the premium being returned.

To assist you with understanding the MLR requirements, below are Gallagher’s comprehensive MLR article and FAQs, as well as, FAQs and model notices developed by the government.