Health and Wellness Penalties


Reference

 

Health & Wellness Penalties

 

 

2023

2022

2021

CHIPRA

Failure to inform an employee of CHIP coverage opportunities

 Up to $137 per day per employee Up to $127 per day per employee Up to $120 per day per employee

COBRA

Failure to provide compliant COBRA notices

  $110 per day from the date of compliance failure $110 per day per violation; in addition, ERISA provide notice penalties of up to $110 per day from the date of compliance failure $100 per day per violation; in addition, ERISA provide notice penalties of up to $110 per day from the date of compliance failure

DOL

Failure to furnish to the DOL any requested information relating to the employee benefit plan

 Up to $184 per day not to exceed $1,846 per request Up to $171 per day not to exceed $1,613 per request Up to $161 per day not to exceed $1,594 per request

FMLA

Willful failure to post FMLA general notice

 Up to $204 for each separate violation Up to $189 for each separate violation Up to $178 for each separate violation

(ACA) 4980H(a)

ALEs that fail to offer coverage to at least 95 percent of full-time employees (and their dependents) TooltipAnd one or more full-time employees receive a premium tax credit

 $2,880 times ALE’s full-time employees (minus up to 30) TooltipAssessed and calculated monthly using monthly employee count (minus 30) times 1/12 of penalty above $2,750 times ALE’s full-time employees (minus up to 30) TooltipAssessed and calculated monthly using monthly employee count (minus 30) times 1/12 of penalty above $2,700 times ALE’s full-time employees (minus up to 30) TooltipAssessed and calculated monthly using monthly employee count (minus 30) times 1/12 of penalty above

(ACA) 4980H(b)

ALEs that offer coverage to at least 95 percent of full-time employees (and their dependents), but the coverage is either unaffordable or does not offer minimum value TooltipAnd one or more full-time employees receive a premium tax credit

 $4,320 times the number of ALEs full-time employees who receive a premium tax credit TooltipAssessed and calculated monthly using employees receiving a tax credit for a month times 1/12 of penalty above and capped at the 4980H(a) assessment (if it were applicable) $4,120 times the number of ALEs full-time employees who receive a premium tax credit TooltipAssessed and calculated monthly using employees receiving a tax credit for a month times 1/12 of penalty above and capped at the 4980H(a) assessment (if it were applicable) $4,060 times the number of ALEs full-time employees who receive a premium tax credit TooltipAssessed and calculated monthly using employees receiving a tax credit for a month times 1/12 of penalty above and capped at the 4980H(a) assessment (if it were applicable)

Form 1095-B

Failure to file a correct information return and failure to provide a correct payee statement TooltipPenalties are reduced if failure is corrected within specified timeframes

 $290 per return/statement with a max penalty of $3,532,000 per year $280 per return/statement with a max penalty of $3,426,000 per year $280 per return/statement with a max penalty of $3,392,000 per year

Form 1095-C

Failure to file a correct information return and failure to provide a correct payee statement TooltipPenalties are reduced if failure is corrected within specified timeframes

 $290 per return/statement with a max penalty of $3,532,500 per year $280 per return/statement with a max penalty of $3,426,000 per year $280 per return/statement with a max penalty of $3,392,000 per year

Form 5500

Fail to file a properly completed annual report

 Up to $2,586 per day that the filing is late Up to $2,400 per day that the filing is late Up to $2,259 per day that the filing is late

GINA

Failure of a plan sponsor of group health plan that fails to meet requirements with respect to genetic information

 $137 per day per employee $127 per day per employee $120 per day per employee

M-1

Failure of MEWA to file annual MEWA Report

 Up to $1,881 per day for each failure Up to $1,746 per day for each failure Up to $1,644 per day for each failure

Medicare

Failure of an insurer, TPA, or fiduciary for a group health plan to provide information identifying whether the plan is a primary plan to Medicare to HHS

 Not Yet Available Up to $1,325 per day for each failure Up to $1,247 per day for each failure

SBC

Failure to furnish required documents to a requesting participant, such as an SBC

 Up to $1,362 per failure Up to $1,264 per failure Up to $1,190 per failure

SPD and SAR

Failure to provide an SPD, SAR, or plan document within 30 days of receiving a request from a plan participant or beneficiary

 $110 per day per employee $110 per day per employee $110 per day per employee

HIPAA Penalty Chart for 2022

Culpability/State of Mind

Minimum Penalty/Violation

Maximum Penalty/Violation

Annual Limit

Tier 1

 Violations involving no knowledge $127 $63,973 $1,919,173

Tier 2

 Reasonable cause violations $1,280 $63,973  $1,919,173

Tier 3

 Willful neglect violations that are corrected $12,794 $63,973  $1,919,173

Tier 4

 Willful neglect violations that are not corrected $63,973 $1,919,173  $1,919,173