Employers Sponsoring Health Plans Should Audit Compliance Now To Avoid Excise Tax, Other Liability


Employers with more than 49 employees sponsoring health coverage should audit their 2020 health plan administration to confirm compliance with 40 federal requirements that if violated trigger an employer duty to pay excise taxes under Internal Revenue Code (“IRC”) Section 6939D if not caught and corrected before the original due date of the employer’s tax return along with other liabilities arising from those violations under the Employee Retirement Income Security Act (“ERISA”).

IRC Section 6039D requires an employer with 50 employees that sponsors a health plan to self report, self assess and pay excise tax penalties for those violations not caught and corrected before the original due date of businesses’ 2020 business tax return in addition to any benefit, fiduciary and other liabilities triggered for the plan and its fiduciaries under ERISA. The excise tax triggering violations include most Patient Protection and Affordable Care (“Obama Care”) adverse benefit determination and coverage requirements, the eligibility and nondiscrimination requirements of the Health Insurance Portability & Accountability Act (“HIPAA”), mental health parity, Consolidated Omnibus Reconciliation Act (“COBRA”) medical coverage continuation and others.

Employers should take well documented actions to audit compliance rather than presume the proper administration of their programs now to allow sufficient time to take corrective action before their original 2020 business tax filing deadline. While employers often are temped to presume or rely upon unaudited assurance from their insurer or third party administrator, sanctions imposed against major insurers by various regulatory agencies, complaints filed with the Department of Labor and state insurance departments and other audits reveal errors in administration frequently happen. Special COVID-19 rules and relief issued in response to the COVID-19 health care emergency enhance the likelihood of administrative errors during 2020. Given sensitive time deadlines and the information, employers ideally will want to complete this audit within the scope of attorney-client privilege sufficiently in advance of the earlier of the original due date of their business tax return or for self-insured health plans, the end of the stop loss run out period to allow sufficient time for necessary correction or other response. Paragraph

For more information about these or other employee benefit, heath and managed care, insurance or workforce issues, register and participate in the January Solutions Law Press, Inc. briefing on the 40 federal health plan rules covered by IRC Section 6039D  e-mail the author of this update, attorney Cynthia Marcotte Stamer.

More Information

We hope this update is helpful. For more information about the these or other health or other legal, management or public policy developments, please contact the author Cynthia Marcotte Stamer via e-mail or via telephone at (214) 452 -8297.

Solutions Law Press, Inc. invites you receive future updates by registering on our Solutions Law Press, Inc. Website and participating and contributing to the discussions in our Solutions Law Press, Inc. LinkedIn SLP Health Care Risk Management & Operations Group, HR & Benefits Update Compliance Group, and/or Coalition for Responsible Health Care Policy.

About the Author

Recognized by her peers as a Martindale-Hubble “AV-Preeminent” (Top 1%) and “Top Rated Lawyer” with special recognition LexisNexis® Martindale-Hubbell® as “LEGAL LEADER™ Texas Top Rated Lawyer” in Health Care Law and Labor and Employment Law; as among the “Best Lawyers In Dallas” for her work in the fields of “Labor & Employment,” “Tax: ERISA & Employee Benefits,” “Health Care” and “Business and Commercial Law” by D Magazine, Cynthia Marcotte Stamer is nationally recognized for her work and thought leadership on health and other health and employee benefit issues. 

An attorney board certified in labor and employment law by the Texas Board of Legal Specialization and Fellow in the American College of Employee Benefit Counsel, Ms. Stamer has worked as an on demand, special project, consulting, general counsel or other basis with health and other employee benefit plans, their sponsors, insurers, administrators, providers and others and others has published and spoken extensively on these concerns. 

A former lead advisor to the Government of Bolivia on its pension  project, Ms. Stamer also has worked internationally and domestically as an advisor and advocate for employer and other plan sponsors, fiduciaries, administrators, insurers, technology and other service providers, managed care organizations, direct primary care and other health care providers and others  on these and other legislative, regulatory and other legislative and regulatory design, drafting, interpretation and enforcement, as well as regularly advises and represents organizations on the design, administration and defense of workforce, employee benefit and compensation, safety, discipline, reengineering, regulatory and operational compliance and other management practices and actions.

Ms. Stamer also serves in leadership of a broad range of professional and civic organizations and provides insights and thought leadership through her extensive publications, public speaking and volunteer service with a diverse range of organizations including as Chair of the American Bar Association (“ABA”) Intellectual Property Section Law Practice Management Committee, Vice Chair of the International Section Life Sciences and Health Committee, Past ABA RPTE Employee Benefits & Other Compensation Group Chair and Council Representative and current Welfare Benefit Committee Co-Chair, Past Chair of the ABA Managed Care & Insurance Interest Group, past Region IV Chair and national Society of Human Resources Management Consultant Forum Board Member,  past Texas Association of Business BACPAC Chair, Regional Chair and Dallas Chapter Chair, former Vice President and Executive Director of the North Texas Health Care Compliance Professionals Association, past Board President of Richardson Development Center (now Warren Center) for Children Early Childhood Intervention Agency, past North Texas United Way Long Range Planning Committee Member, past Board Member and Compliance Chair of the National Kidney Foundation of North Texas, a Fellow in the American College of Employee Benefit Counsel, the American Bar Foundation and the Texas Bar Foundation and many others.

For more information about these concerns or Ms. Stamer’s work, experience, involvements, other publications, or programs, see www.cynthiastamer.com or contact Ms. Stamer via e-mail here.

About Solutions Law Press, Inc.™

Solutions Law Press, Inc.™ provides human resources and employee benefit and other business risk management, legal compliance, management effectiveness and other coaching, tools and other resources, training and education on leadership, governance, human resources, employee benefits, data security and privacy, insurance, health care and other key compliance, risk management, internal controls and operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press, Inc.™ resources available here such as:

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