Search Results

From insurance crisis to strategic success: Discover how a multi-location warehousing operation transformed their risk management approach. The Situation A large multi-location warehousing company faced a critical challenge when their property insurance carrier announced non-renewal due to a shift in risk appetite. The client, who had previously worked with a small local broker, recognized they had outgrown their existing insurance relationship and needed more sophisticated solutions for their complex risk profile. Key Wins Why They Needed Change Misconceptions about risk profile impacting coverage options Previous broker relationship based on personal rather than technical capability Property insurance program facing non-renewal Complex risk profile including mixed-use facilities The Cottingham & Butler Approach Conducted a comprehensive risk analysis of mixed-use facilities Identified and addressed market misconceptions Leveraged technical expertise to secure optimal terms Ready to maximize your coverage? Learn how Cottingham & Butler can help your company!

Discover how strategic insurance restructuring and industry expertise transformed a food processor's inadequate coverage into a comprehensive risk management program. The Situation A St. Louis-area meat processor was operating with dangerous coverage gaps despite paying substantial premiums. Their existing broker provided no claims support, lacked industry expertise, and had no strategy to control rising insurance costs. Key Wins Why They Needed Change The client faced critical vulnerabilities that threatened their business stability: Equipment Risk : $25,000 Spoilage & Ammonia coverage wouldn't cover even a single significant incident Product Safety : $500,000 Recall coverage left them exposed to catastrophic recall events Cost Control : Premiums were rising with no strategy to stabilize them Expert Support : Lack of broker expertise in food industry meant missed opportunities and improper coverage design Claims Management : No claims advocacy or safety program support increased their risk exposure The Cottingham & Butler Approach Strategic Planning & Analysis Implemented a strategic roadmap targeting captive readiness through SMSC engagement, specifically focusing on reducing workers' compensation claim frequency with a clear 2025 captive option goals. Industry Expertise & Program Development Leverage specialized knowledge in food processing and large single location property placements to provide comparative benchmarking data, revealing adequate pricing but critical coverage gaps. Designed a comprehensive program solution through detailed operational assessment and targeted marketing efforts, carefully calibrated to the client's risk tolerance profile. Relationship Building & Lasting Vision Cultivated strong partnerships with both Owner and CFO throughout the sales process, successfully securing the CFO as an internal champion for their initiatives. Established a differentiated approach by focusing on generating long-term competition rather than conventional annual insurance cycles, demonstrating strategic foresight. Ready to maximize your coverage? Contact us today to begin your journey!

Each year, group health plan sponsors are required to complete an online disclosure form with the Centers for Medicare & Medicaid Services (CMS), indicating whether the plan’s prescription drug coverage is creditable or non-creditable. This disclosure requirement applies when an employer-sponsored group health plan provides prescription drug coverage to individuals who are eligible for coverage under Medicare Part D. CMS Disclosure Deadline The plan sponsor must complete the online disclosure within 60 days after the beginning of the plan year . For calendar year health plans, the deadline for the annual online disclosure is March 1, 2025 . In addition to the annual disclosure requirement, the disclosure to CMS must be made whenever any change occurs that affects whether the coverage is creditable. More specifically, within 30 days after any change in the plan’s creditable coverage status or after the termination of a plan’s prescription drug coverage. Online Disclosure Method Plan sponsors are required to use the online disclosure form on the CMS creditable coverage website. This is the sole method for compliance with the disclosure requirement unless the entity does not have internet access. The disclosure form lists the required data fields that must be completed in order to generate the disclosure notice to CMS, such as types of coverage, number of options offered, creditable coverage status, period covered by the disclosure notice, number of Part D-eligible individuals covered, date the creditable coverage disclosure notice is provided to Part D-eligible individuals, and change in creditable coverage status. Important Dates March 1, 2025 The deadline for sponsors of calendar year plans to complete an online disclosure form with CMS. Oct. 15, 2025 Group health plan sponsors must provide creditable coverage disclosures to Medicare-eligible individuals before this date. Action Steps To determine whether the CMS reporting requirement applies, employers should verify whether their group health plans cover any Medicare-eligible individuals (including active employees, disabled employees, COBRA participants, retirees, and their covered spouses and dependents) at the start of each plan year. Please reach out to your Cottingham & Butler team member for guidance on how to complete the disclosure for your plan. CMS has also provided instructions on how to complete the form.  For additional information, please visit CMS’ creditable coverage website , which includes links to the online disclosure form and related instructions.

In today's economic climate, businesses of all sizes are grappling with rising healthcare costs. However, innovative solutions are emerging that benefit both employers and employees. What many organizations don't realize is that a small portion of their workforce—just 5% of members—typically accounts for 75% of their total healthcare spending. This insight opens the door to strategic approaches that can significantly reduce costs while ensuring employees receive the care they need. Hidden Opportunities in Healthcare Coverage The key to managing healthcare costs isn't about reducing benefits—it's about finding smarter coverage options that better match each employee's specific situation. Here are some real-world examples of how companies are achieving remarkable savings: The Medicare Advantage When a company discovered their 67-year-old employee was struggling with high healthcare costs, they explored Medicare as an alternative. Thanks to recent Medicare improvements, including a $2,000 out-of-pocket maximum on prescription drugs and a $35 cap on insulin, the employee saved over $6,500 in annual out-of-pocket expenses. This change not only benefited the employee but also prevented a 10% increase in the employer's renewal rates. Finding Better Options for COBRA Recipients COBRA coverage, while valuable, isn't always the most cost-effective solution. In one case, a COBRA participant was paying $800 monthly for coverage, significantly impacting the company's renewal rates. Through a careful review of available options, they found an individual marketplace plan that covered the same doctors, hospitals, and prescriptions—saving the participant $4,000 annually while simultaneously reducing costs for the employer. Creative Solutions for Family Coverage A mid-sized organization with 200 employees faced a common challenge: high costs due to extensive dependent coverage. Their innovative solution? They introduced an incentive program that reimbursed 100% of healthcare deductibles, copays, and out-of-pocket costs for employees and spouses who opted to join their spouse's employer plan instead. The results were impressive: 20% of families switched plans, leading to annual savings of nearly $250,000. This approach created a win-win situation—employees received comprehensive coverage with no out-of-pocket costs, while the company significantly reduced its healthcare spending. The Path Forward These success stories highlight a crucial point: managing healthcare costs doesn't require sacrificing quality of care. Instead, it's about: 1. Understanding that one size doesn't fit all when it comes to healthcare coverage 2. Educating employees about alternative options that might better suit their needs 3. Creating innovative incentive programs that benefit both the organization and its employees 4. Taking a proactive approach to benefits management Smart healthcare solutions aren't just about cutting costs—they're about finding the right fit for each situation. By thinking creatively and exploring all available options, organizations can create substantial savings while ensuring their employees have access to the healthcare coverage they need. Remember: The most effective healthcare solutions often come from looking beyond traditional approaches and being willing to explore innovative alternatives that benefit everyone involved.

As we close the books on 2024, our captive insurance program continues to demonstrate exceptional value for our members. The numbers tell a compelling story of financial returns, operational efficiency, and strategic risk management that sets our program apart from others in the trucking industry. The past year has delivered outstanding results for our trucking captive members. We’ve maintained an impressive 99.7% voluntary retention rate across all trucking captive members – a testament to the program's enduring value and member satisfaction. Our commitment to proactive renewal management has paid off. We released renewal terms on average 50 days prior to their renewal date across all seven trucking captives. This early notification gives members an abundance of time for strategic planning and decision-making. The financial benefits have been particularly impressive. We're pleased to report that 40% of trucking captive members received an Auto Liability rate decrease this renewal, while an even more substantial 76% of members saw a decrease in their Workers' Compensation rates. Additionally, our program returned $19M in dividends to trucking captive members in 2024, demonstrating the significant financial advantages of participation. Our strong 2024 performance demonstrates the success o f our captive insurance program. For companies seeking greater control and financial returns from their insurance programs, Cottingham & Butler's captives continue to deliver proven results and member satisfaction. Contact your Cottingham & Butler captive expert t o see how these captive results could positively impact your business!

Imagine you paid premiums for years toward insurance you assumed you had.  The employer collected your premiums via payroll deduction and remitted the amount to the insurance company, who accepted the payments. Now imagine that you’ve experienced an event that means you need to utilize the insurance you have paid for all these years, only to learn that you were ineligible to receive any payments after submitting a claim. Finally, imagine how angry you may feel. If you’re reading this, you aren’t likely the disgruntled employee in this scenario.  You probably have some authority or working knowledge of your company’s employee benefit plans and you may be asking yourself this question: who’s at fault?  What happened in the Sun Life Settlement? Unfortunately, the scenario described above really happened and happens more frequently than most of us care to think about. For life insurance company, Sun Life, a class action lawsuit was filed against them on behalf of many participants who paid premiums but were denied a right to their claim because they were declared ineligible. Here is what prompted the lawsuit. A participant in a group-sponsored life insurance plan filed a life insurance claim for her adult son who had sadly passed away. Unfortunately, because of his age, he was no longer eligible for the coverage as a dependent child despite the employer having continued to deduct premiums for the coverage. The employee then filed this lawsuit on behalf of a class of similarly situated employees. Sun Life agreed to settle these claims because they thought it better for all parties not to undergo time-consuming and costly litigation. While lawsuits are not common, the situation involves an industry-wide issue related to ERISA group plans where employers commonly serve as the plan administrators, enroll their employees for coverage, maintain their employees’ eligibility information and deduct premiums from their employees’ payroll. Insurers are not generally provided the ongoing, detailed enrollment information until a claim is made; upon which time the insurer will check to make sure the recipient is eligible before paying the claim. If an employer collects payment and an insurer denies the claim due to ineligibility, who is responsible – the employer or the insurance company? Well, given the choice between suing a small or medium-sized company or a behemoth insurance company, most plaintiffs’ attorneys will steer their clients toward the deeper pockets. However, that doesn’t mean the employer bears no responsibility nor that employer could not be joined as a party later in the suit if finger-pointing proves to be the best defense. What should employer plan sponsors do? At the end of the day, an employer is responsible for managing the eligibility rules of its benefits plans. It may be relatively easy and straightforward to know that a terminated employee is no longer eligible to participate in your medical plan (except through COBRA continuation coverage) but non-medical benefits are sometimes forgotten.  It is reasonable to imagine a scenario where an employee doesn’t know the dependent eligibility rules of these plans or forget about them and continues to pay the premiums on a dependent who has long exceeded the age limit.  As an employer sponsoring an ERISA plan, you have a fiduciary obligation to make sure your employee’s money is spent for their benefit. This includes making sure money is not collected for coverage which the employee or dependent is ineligible.  We suggest employers review their eligibility rules on an annual basis, following enrollment, to ensure employees and dependents continue to be eligible for elected benefits. Employers who are list billed by the insurance carrier should still review eligibility to make sure premiums collected from employees are accurate. This review should look at a range of eligibility rules for all benefits before payroll deductions begin, including (but not limited to): Dependent child life insurance for age limits, student status and/or disability provisions; Spouse dependents with all coverages to ensure marital status; Sending proper notices regarding conversion rights when dependents are no longer eligible for coverage; Life insurance for amounts above guaranteed issue limits to ensure that evidence of insurability (EOI) has been received and approved by your insurance provider; and And any other coverages that require evidence of insurability. Additionally, it is important to confirm the rules of when employees lose eligibility for all benefit plans if they cease being actively at work for leaves (other than FMLA) including workers compensation and layoff. What should you do if you receive a Settlement Notice from Sun Life? Read the contents of the packet and don’t throw it away!  The notice provided by the court-appointed settlement administrator will include specific instructions to employees who are deemed part of the class. The notice will also include specific instructions for you, the employer. If you have employees who are deemed part of the class, you may need to send a court-approved notice to your affected employees (past and present). If an employer sends the notice to their employees, the proposed settlement includes a release for such employers from any claims an employee may have relating to this matter.  If you use a TPA to help you administer this plan, you should notify your TPA to coordinate a communication plan with any employees deemed part of the settlement class.  Please reach out to your C&B Team to help you determine your specific obligations if you receive a Sun Life Settlement Notice. If you would like to learn more about how to check the eligibility rules of your benefits plans or conduct an eligibility audit, please contact your C&B Team.

Navigating the world of transportation compliance can feel like driving through a maze of regulations and requirements. In this Motor Carrier Safety webinar, we explored the critical aspects of FMCSA compliance and audit preparation for transportation companies. Key points of discussion included understanding the comprehensive audit process, company credential requirements under Parts 387 and 390, commercial license standards under Part 383, and driver qualification requirements under Part 391. We also covered the distinction between regulatory requirements and best practices, providing clarity on common misconceptions that many companies face during compliance reviews. Key Takeaways Understanding the Audit Process Allow us to introduce the investigation (audit) process, various audit factors, and help you understand the scoring system and how you are rated. It is much easier to be prepared for an investigation if you always stay prepared.  Knowledge is power. This webinar helped participants understand Parts 387 and 390 Company Credentials and Requirements, Part 383 Commercial License Standards, and Part 391 Qualification of Drivers of the Compliance Review process.   Mitigation Strategies and Continuous Improvement The Compliance Review process can be complex; however, it can be navigated if you have proper guidance and understanding of the regulations that apply to you and your organization. Often, best practices are confused with regulatory requirements.  This webinar assisted participants with knowing the difference between the two. Regularly reviewing your records and documentation will ensure that you are providing the best data to represent your Company’s safety standards and protocols.   Additional Resources Again, being prepared is invaluable and having accurate resources to help you navigate the FMCSA regulatory world can allow you to better understand the process. Click here to download the presentation.

In the challenging landscape of transportation insurance, delivering value isn't just about finding coverage—it's about building relationships and leveraging expertise to create tailored solutions. When a devastating truck fire threatens to derail insurance costs, most companies brace for skyrocketing premiums. But for one Missouri-based transportation company, this potential crisis became a testament to the power of strategic insurance partnerships. Transportation Consultant, Carly Hermann and Account Administrator, Deanna Gudenkauf partnered together with their client and turned what could have been a financial setback into an unexpected win.   Understanding the Client's Needs At the beginning of our partnership, the company consisted of 6 trucks and 16 trailers, specializing in long-haul refrigerated transport. Like most motor carriers at this time, pricing is a major concern with freight rates being down and insurance pricing rapidly on the rise. Our team prioritized finding exceptional reefer coverage without limitations on mechanical breakdown or driver error, while avoiding exclusions that could affect hard liquor transport. The client also emphasized the importance of efficient communication, rapid certificate processing, instant cargo limit updates online, and comprehensive documentation for shipper contract requirements.   Navigating Renewal Challenges After working together for nearly four months, an unexpected claim occurred that created challenges for both the motor carrier and our agency. A truck fire resulted in a total loss, reducing the company's operational fleet and raising concerns about future renewal rates in an already challenging marketplace. Despite this significant loss during a policy year—a $65,000 claim resulting in a 74% loss ratio—the carrier's renewal offer came in at $93,27 3. While this increase fell below the industry average, when considering the complete pricing picture, motor carriers face the frustration of finding an extra $6,000 . Creating a Strategic Solution Our approach combined several key elements to address these challenges: Comprehensive market exploration to identify optimal coverage options Strategic separation of cargo coverage to maximize cost efficiency Leveraging strong carrier relationships to negotiate better terms Collaborative teamwork between producer and account administration Three months before renewal, we developed a comprehensive plan. This included identifying promising markets, preparing the carrier's narrative, and building a compelling case for why they deserved better terms than their data might suggest. Through careful negotiation and close collaboration with the client on expectations, we achieved a breakthrough solution. The final package delivered premium savings of $16,488, reducing the total premium to $76,784.43.   "Everyone has their own perception of price savings," Carly notes, "but to be able to come in below the current pricing and put money back in a client's pocket, it's the best feeling as an agent."   Looking Forward This success story exemplifies our commitment to delivering value beyond basic insurance coverage. By working closely with motor carriers to effectively tell their story, leveraging market expertise, maintaining strong carrier relationships, and providing dedicated customer service, we continue to demonstrate our value as a trusted partner in transportation insurance.   The most rewarding aspect of this renewal wasn't just the significant premium savings—it was proving that even in challenging circumstances, with the right approach and team, we can exceed client expectations and strengthen long-term partnerships.   Are you interested in learning more about how we can help optimize your transportation insurance program? Contact our team today to discuss your specific needs.

FOR IMMEDIATE RELEASE January 10, 2025 DUBUQUE, IA - Cottingham & Butler, the 4th largest privately and independently held insurance broker in the United States, announced the acquisition of Perspective Consulting Partners, an employee benefits firm specializing in public sector and educational institutions.   This strategic acquisition strengthens Cottingham & Butler's presence in the public and education sectors while expanding its geographic footprint in Iowa. Perspective Consulting Partners' team brings deep expertise in public sector and educational institution benefits, complementing Cottingham & Butler's comprehensive employee benefits solutions.   "This acquisition aligns perfectly with our growth strategy and enhances our ability to serve public sectors and educational institutions," said Nicole Pfeiffer, Senior Vice President of Employee Benefits, Cottingham & Butler. "Perspective's specialized expertise combined with our resources and innovative solutions will create great value for clients."   The Perspective team, led by Stacy Wanderscheid, will join Cottingham & Butler's Employee Benefits Practice. "Joining Cottingham & Butler allows us to provide our clients with enhanced resources while maintaining our commitment to exceptional service," Wanderscheid said. “Our clients will benefit from expanded resources that will help control costs, streamline administration, and create exceptional employee experiences.” About Cottingham & Butler | Founded in 1887, Cottingham & Butler is a fourth-generation, family-owned business providing innovative insurance and risk management solutions to clients nationwide. As the 4th largest privately held insurance broker in the U.S., the company brings industry-leading resources and expertise to help organizations control costs and protect assets.   Contact:  Kassy Herrig AVP, Marketing – Cottingham & Butler 563-587-5605 kherrig@cottinghambutler.com

President Joe Biden signed two bills into law on Dec. 23, 2024, that will streamline the Affordable Care Act's (ACA) reporting requirements under Internal Revenue Code Sections 6055 or 6056. These changes affect how employers and health coverage providers (reporting entities) must provide information to the IRS about health plan coverage and related statements to individuals. Individual Statements Only Required Upon Request Under existing rules, reporting entities must provide annual statements to each individual who is provided minimum essential coverage (under Section 6055) and each full-time employee of an applicable large employer (under Section 6056). These statements are provided using Forms 1095-B and 1095-C; however, the IRS currently allows Forms 1095-B to be provided to individuals upon request if certain requirements are satisfied. The Paperwork Burden Reduction Act essentially codifies this alternative manner of furnishing Forms 1095-B and extends this flexibility to furnishing Forms 1095-C. Accordingly, reporting entities are no longer required to send Forms 1095-B and 1095-C to covered individuals unless a form is requested. Reporting entities must give individuals timely notice of this option in accordance with any requirements set by the IRS. Requests must be fulfilled by Jan. 31 of the year following the calendar year to which the return relates or 30 days after the date of the request, whichever is later. Electronic Consent for Individual Statements The IRS currently allows reporting entities to offer Forms 1095-B and 1095-C to individuals electronically. The Employer Reporting Improvement Act co difies this flexibility and provides that statements can be provided electronically to individuals if they have affirmatively consented “at any prior time” (unless they have revoked such consent in writing). Substituting Birth Dates for TINs The new legislation codifies the ability under Section 6055 to substitute a covered individual’s birth date in lieu of their taxpayer identification number (TIN), without the requirement to first make reasonable efforts to obtain the TIN. Other ACA Pay-or-Play Provisions Applicable large employers, or ALEs (generally those with 50 or more full-time employees), are subject to IRS penalties if they do not offer affordable minimum essential coverage under the ACA’s employer shared responsibility (“pay-or- play”) rules. The new legislation increases the time ALEs have to respond to IRS penalty assessment warning letters from 30 days to 90 days. The legislation also imposes a six-year time limit on when the IRS can try to collect assessments.

The Affordable Care Act (ACA) made widespread reforms to health plan coverage when it was enacted in 2010. Since then, changes have been made to various ACA requirements for employer-sponsored health coverage. These changes include annual cost-of-living increases to certain ACA dollar limits, adjustments to ACA reporting requirements and updates to preventive care coverage guidelines. Changes to some ACA requirements will take effect in 2025 for employers sponsoring group health plans. For example, the affordability percentage under the ACA’s employer mandate rules for applicable large employers (ALEs) will increase slightly for plan years beginning in 2025, which may provide ALEs with more flexibility when setting their employee contribution rates. To prepare for 2025, employers can use this checklist to review these ACA requirements and develop a compliance strategy. Employers should ensure that their health plan documents, including the summary of benefits and coverage (SBC), are updated to reflect any new plan limits. Employers should also ensure that up-to-date information is communicated to employees at open enrollment time. Plan Design Changes The following plan design requirements have changed for 2025: Limits on cost sharing for essential health benefits; Coverage affordability percentage under the employer mandate rules; and Dollar amounts for calculating penalties under the employer mandate rules. Reporting Deadlines The following deadlines apply for reporting under Sections 6055 and 6056: March 3, 2025 : Individual statements for 2024 must be furnished by this date. An alternative method of furnishing Form1095-B is available; and March 31, 2025 : Electronic IRS returns for 2024 must be filed by this date. Links and Resources IRS Rev. Proc. 2024-35 indexed the ACA’s affordability percentage for plan years beginning in 2025. IRS Rev. Proc. 2024-14 modified the penalty amounts under the ACA’s employer mandate for 2025. CMS guidance established the cost-sharing limits for 2025 plan years. Plan Design Changes Overall Cost-sharing Limits Confirm that your plan’s out-of-pocket limit for essential health benefits (EHB) does not exceed the ACA’s limit for the plan year beginning in 2025.  Effective for plan years beginning on or after Jan. 1, 2025, a health plan’s out-of-pocket limit for EHB may not exceed $9,200 for self-only coverage and $18,400 for family coverage. This limit applies to all non-grandfathered group health plans, including fully insured and self-funded plans. Any out-of-pocket expenses required by or on behalf of an enrollee with respect to EHB must count toward the cost-sharing limit. This includes deductibles, copayments, coinsurance and similar charges but excludes premiums and spending on noncovered services. Also, plans that use provider networks are not required to count an enrollee’s expenses for out-of-network benefits toward the ACA’s cost-sharing limit. If you have a health savings account (HSA)-compatible high deductible health plan (HDHP), keep in mind that the plan’s out-of-pocket maximum must be lower than the ACA’s limit. For 2025, the out-of-pocketmaximum for HDHPs is $8,300 for self-only coverage and $16,600 for family coverage . Health Flexible Spending Account (FSA) Limits If you have a health FSA, confirm that its dollar limit on employees’ salary reduction contributions will not exceed the adjusted limit for the plan year beginning in 2025. The ACA imposes a dollar limit on employees’ pre-tax contributions to a health FSA. This limit is indexed each year for cost-of-living adjustments. An employer may set their own dollar limit on employees’ contributions to a health FSA as long as the employer’s limit does not exceed the ACA’s maximum limit in effect for the plan year. For plan years beginning in 2025, the health FSA limit is $3,300. If you have a health FSA that allows carryovers of unused amounts, confirm that the maximum unused amount from a plan year starting in 2025 that is allowed to be carried over to the immediately following plan year beginning in 2026 does not exceed the adjusted limit. For plan years beginning in 2025, the health FSA carryover limit is $660. First-dollar Preventive Care Coverage Confirm that your health plan covers the latest recommended preventive care services without imposing any cost sharing.  Non-grandfathered health plans must cover certain preventive health services without imposing cost-sharing requirements (i.e., deductibles, copayments or coinsurance) when the services are provided by in-network health care providers. These preventive health services include, for example, many cancer screenings, blood pressure, diabetes and cholesterol tests, vaccinations against diseases, and counseling on topics such as quitting smoking and losing weight. This coverage mandate also includes preventive health services for women, such as well-woman visits, breastfeeding support, domestic violence screening and contraceptives. The ACA’s preventive care guidelines are periodically updated based on new medical research and recommendations. Updated guidelines generally take effect for plan years beginning on or after one year from the date the updated guideline is issued. Health plans are required to adjust their first-dollar coverage of preventive care services based on the latest preventive care recommendations. More information on the recommended preventive care services is available from  HealthCare.gov . Excepted Benefit Health Reimbursement Arrangement (HRA) If you offer an excepted benefit HRA, confirm that its maximum benefit amount for the plan year beginning in 2025 does not exceed $2,150. Employers with traditional group health plans may offer a limited benefit HRA that is exempt from the ACA’s market reforms. This HRA, called an excepted benefit HRA, can be used to reimburse employees’ eligible medical care expenses, up to $1,800 each year, as adjusted by the IRS for inflation. For 2025 plan years, the maximum benefit for excepted benefit HRAs is $2,150. Grandfathered Plan Status If you have a grandfathered plan, determine whether it will maintain its grandfathered status for the 2025 plan year.  Grandfathered plans are exempt from some of the ACA’s mandates. A grandfathered plan’s status will affect its compliance obligations from year to year. Here are some additional points to keep in mind: If a plan will lose its grandfathered status for 2025, confirm that the plan has all of the additional patient rights and benefits required by the ACA for non-grandfathered plans. This includes, for example, coverage of preventive care without cost-sharing requirements. If a plan will keep its grandfathered status, continue to provide the Notice of Grandfathered Status in any plan materials provided to participants and beneficiaries that describe the benefits provided under the plan (such as the plan’s summary plan description and open enrollment materials). A model notice  is available from the Department of Labor (DOL). Employer Mandate Rules ALE Status for 2025 Will you be an ALE for 2025?  The ACA’s employer mandate rules apply only to ALEs. ALEs are employers with 50 or more full-time employees (including full-time equivalent employees) on business days during the preceding calendar year. Employers determine each year, based on their current number of employees, whether they will be considered an ALE for the following year. Under the ACA’s employer mandate rules, ALEs are required to offer affordable, minimum value (MV) health coverage to their full-time employees (and dependent children) or pay a penalty. An ALE will be subject to penalties if one or more full-time employees receive a subsidy for purchasing health coverage through an Exchange. An individual may be eligible for an Exchange subsidy either because the ALE does not offer coverage to that individual, or offers coverage that is unaffordable or does not provide MV. If you answered “no,” you can stop completing this section of the checklist. Because your company is not an ALE for 2025, the ACA’s employer mandate rules do not apply. Offer of Health Plan Coverage Do you offer health coverage to your full-time employees? To correctly offer coverage to full-time employees, ALEs must determine which employees are full-time employees under the ACA’s definition. A full-time employee is an employee who is employed, on average, at least 30 hours of service per week (or 130 hours of service in a calendar month). The IRS provides two methods for determining full-time employee status for purposes of offering coverage: the monthly measurement method and the look-back measurement method. If you answered “no,” your company will be subject to penalties if one or more of your full-time employees receives a subsidy to purchase health coverage through an Exchange. Is your health plan coverage affordable? Health plan coverage is considered affordable if the employee’s required contribution to the plan does not exceed 9.5% of the employee’s household income for the taxable year (as adjusted each year). The affordability test applies only to the portion of the annual premiums for self-only coverage and does not include any additional cost for family coverage. Also, if an employer offers multiple health coverage options, the affordability test applies to the lowest-cost option that provides MV. Because an employer generally will not know an employee’s household income, the IRS has provided three optional safe harbors that ALEs may use to determine affordability based on information that is available to them: the Form W-2 safe harbor, the rate of pay safe harbor and the federal poverty level (FPL) safe harbor. For plan years beginning in 2025, the adjusted affordability percentage is 9.02%. This is an increase to the affordability threshold from the 2024 plan year when the affordability percentage was 8.39%. As a result, employers may have more flexibility when setting employee contribution levels for the 2025 plan year. For example, the maximum monthly contribution for ALEs with calendar-year plans that use the FPL safe harbor is $113.20 for 2025 (up from $101.94 for 2024).   If you answered “no,” your company will be subject to penalties if one or more of your full-time employees receives a subsidy to purchase health coverage through an Exchange. Does your health plan coverage provide MV? A health plan provides MV if the plan’s share of the total allowed costs of benefits provided under the plan is at least 60% of those costs. Three approaches may be used for determining MV: an MV calculator, design-based safe harbor checklists or actuarial certification. In addition, any plan in the small group market that meets any of the “metal levels” of coverage (i.e., bronze, silver, gold or platinum) provides MV. In addition, plans that do not provide inpatient hospitalization or physician services (referred to as non-hospital/non-physician services plans) do not provide MV.  If you answered “no,” your company will be subject to penalties if one or more of your full-time employees receives a subsidy to purchase health coverage through an Exchange. Possible Penalty Amounts If your company may be liable for an ACA penalty, calculate the possible penalty amount. Depending on the circumstances, one of two penalties may apply under the ACA’s employer mandate rules: the 4980H(a) penalty or the 4980H(b) penalty. Here’s an overview of these penalties: Under Section 4980H(a), an ALE will be subject to a penalty if it does not offer coverage to “substantially all” full-time employees (and dependents) and any one of its full-time employees receives an Exchange subsidy. For 2025, the 4980H(a) monthly penalty is equal to the ALE’s number of full-time employees (minus 30) multiplied by 1/12 of $2,900 for any applicable month; and Under Section 4980H(b), an ALE offering coverage to “substantially all” full-time employees (and dependents) may still be subject to penalties if at least one full-time employee obtains an Exchange subsidy because the employer’s coverage is unaffordable or does not provide MV or the ALE did not offer coverage to all full-time employees. For 2025, the 4980H(b) monthly penalty assessed on an ALE for each full-time employee who receives a subsidy is one-twelfth of $4,350 for any applicable month. However, the total penalty for an ALE is limited to the 4980H(a) penalty amount. Reporting of Coverage (Code Sections 6055 and 6056) Affected Employers Is your company subject to ACA reporting under Code Sections 6055 or 6056? The following employers are subject to ACA reporting under Internal Revenue Code (Code) Sections 6055 and 6056: Employers with self-funded health plans (Section 6055 reporting) ALEs with either fully insured or self-funded health plans (Section 6056 reporting) Employers who are not ALEs and have fully insured health plans are not subject to these ACA reporting requirements. Employers subject to this reporting must file certain forms with the IRS each year and provide annual statements to individuals who are covered under the health plan (under Section 6055) and each of the ALE’s full-time employees (Section 6056). Note that ALEs with self-funded plans are required to comply with both reporting obligations. However, to simplify the reporting process, the IRS allows ALEs with self-funded plans to use a single combined form to report the information required under both Sections 6055 and 6056. If you answered “no,” you can stop completing this section of the checklist, as your company is not subject to ACA reporting under Sections 6055 or 6056. File Electronic Returns by Deadline For the 2024 calendar year, file electronic returns with the IRS by March 31, 2025. Under Code Section 6055, reporting entities will generally file Forms 1094-B (a transmittal) and 1095-B (an information return). Under Code Section 6056, entities file Forms 1094-C (a transmittal) and 1095-C (an information return). Employers reporting under both Sections 6055 and 6056 (i.e., ALEs with self-funded plans) use a combined reporting method by filing Forms 1094-C and 1095-C. The normal deadline for electronic ACA reporting is March 31 each year. Reporting entities may receive an automatic 30-day extension to file with the IRS by completing and filing Form 8809 (Application for Extension of Time To File Information Returns) by the due date of the returns. Provide Individual Statements by Deadline For the 2024 calendar year, provide individual statements by March 3, 2025. Written statements must be provided to individuals within 30 days of Jan. 31, 2025. Because the deadline falls on a weekend, the individual statements must be furnished by the next business day, which is March 3, 2025.  An alternative method of furnishing Form 1095-B is available. Under this alternative method, an employer must post a clear and conspicuous notice on its website stating that responsible individuals may receive a copy of their statement upon request. The notice must be posted by the due date for furnishing ACA statements and generally remain posted until Oct. 15. Patient-Centered Outcomes Research Institute (PCORI) Fee Pay PCORI Fees (Self-funded Plans only) Pay PCORI fees by July 31, 2025, for plan years ending in 2024. Under the ACA, employers with self-funded plans must pay PCORI fees each year. These fees are reported and paid using IRS Form 720 (Quarterly Federal Excise Tax Return). For fully insured plans, the health insurance issuer is responsible for reporting and paying these fees. PCORI fees are due each year by July 31 of the year following the last day of the plan year. For plan years ending in 2024, the PCORI fee payment is due July 31, 2025. Disclosure Requirements SBC Provide an updated SBC in connection with the plan’s open enrollment period for 2025. Health plans and issuers must provide an SBC to applicants and enrollees to help them understand their coverage and make coverage decisions. The SBC should be included with the plan’s enrollment materials. If coverage automatically renews for current participants, the SBC must generally be provided no later than 30 days before the beginning of the new plan year. The SBC must follow strict formatting requirements. Federal agencies have provided templates and related materials , including instructions and a uniform glossary of coverage terms, for health plans and health insurance issuers to use. It should be updated before the plan’s open enrollment period to reflect any changes in coverage for the upcoming plan year. For self-funded plans, the plan administrator is responsible for providing the SBC. For insured plans, both the plan and the issuer are obligated to provide the SBC; however, this obligation is satisfied for both parties if either one provides the SBC. Typically, the issuer will prepare the SBC for an insured health plan, although the employer may need to provide it to employees. Employee Notice of Exchange Provide all new hires with a written notice about the ACA’s health insurance Exchanges. The DOL has provided  model Exchange notices for employers to use, which require some customization. Notice of Patient Protections Provide a Notice of Patient Protections if your health plan requires participants to designate a participating primary care provider. Under the ACA, group health plans and issuers requiring the designation of a participating primary care provider must permit each participant, beneficiary and enrollee to designate any available participating primary care provider (including a pediatrician for children). Additionally, plans and issuers providing obstetrical/gynecological care and requiring the designation of a participating primary care provider may not require preauthorization or referrals for obstetrical/gynecological care. If a health plan requires participants to designate a participating primary care provider, the plan or issuer must provide a notice of these patient protections whenever the summary plan description (SPD) or similar description of benefits is provided to a participant. If a plan is subject to this notice requirement, it should be confirmed that it is included in the plan’s open enrollment materials.  Model language is available from the DOL. Grandfathered Plan Notice If you have a grandfathered plan, make sure to include information about the plan’s grandfathered status in plan materials describing the coverage under the plan, such as SPDs and open enrollment materials. Model language is available from the DOL. This Compliance Overview is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice. ©2024 Zywave, Inc. All rights reserved.

At Cottingham & Butler, we strive to be "Better Every Day", not only at work, but with our involvement within our community as well. This belief stemmed the idea for an internal organization, called the C&B Better Initiative , powered by our people. To be apart of this grou p, teammates donate $100 per quarter. During the quarterly meetings, attendees hear from three incredible organizations and learn about the work they are doing for residents within our community.  Th is gives our teammates an opportunity to listen, learn, and ask questions. Upon hearing from each organization, they vote on the which they believe is most deserving, and the full $12,500 from that quarter goes to the respective winner.   Recently, was the Q4 meeting and celebration, where team members heard impact stories from past winners, listened to the top three organizations for the quarter, and voted on this quarter's grant recipient. The three organizations our people heard from were Convivium, St. Mark Youth Enrichment, and Dubuque Food Pantry. The first place grant recipient was Convivium! Due to the generosity of our team, all three organizations were able to walk away with a donation! After this recent event, our people have given over $180,000 since 2021 for this initiative.   When talking to Vice President in Employee Benefits, Jackie Ronning. She reflects on what it has meant to give back to her community.   "I have always felt passionate about giving back," Jackie Ronning said. "When I was a child, my family benefited from some non-for-profits in my community. I have never forgotten the impact that even a small gesture can mean, so I try to give back when I can. I also know that there are many organizations that I just don’t know about here in the Dubuque community. The C&B Better Initiative has provided a really unique opportunity to learn about the needs in our community and also helps identify where our collective money can make the biggest impact." With a little team work, you can accomplish great things. Our team at Cottingham & Butler was able to come together and make an impact on our community. We are looking forward to giving back to more local organizations with this initiative, and helping our community become "Better Every Day". Ready to make a difference? Discover how you can join our team of changemakers! Seeking assistance for your organization? Visit Grants Homepage | Community Foundation of Greater Dubuque ( dbqfoundation.org )   to learn more and apply for our grant.