What Employers Need To Know About RxDC Reporting

| May 19, 2025
Close-up of a healthcare professional in blue scrubs with a stethoscope and clipboard.

As a group health plan sponsor, you must report information on prescription drugs, health care spending, and premiums you and your plan participants pay (RxDC reporting). Learn about your annual reporting obligations and how your service provider can help.

Section 204 of the Consolidated Appropriations Act of 2021 requires insurance companies and employer-sponsored health plans to submit information about prescription drugs, health care spending, and premiums paid by plan participants and sponsors. This is known as RxDC reporting. (Rx stands for prescription drugs; DC stands for data collection.)

The stated intent of RxDC reporting is to ensure the Department of Labor, Department of Health and Human Services, and Department of the Treasury have enough information regarding prescription drugs to understand where plan assets are being spent.

The statute requires these agencies to report on:

  • Prescription drug reimbursements under group health plans
  • Prescription drug pricing trends
  • The role of prescription drugs in premium increases or decreases under such plans

The agencies must post this information twice a year on a public website.

Read on for an overview of RxDC reporting as it relates to group health plans.

Information you must report

Every year, insurance companies and employer-sponsored health plans must report the following data points for the previous calendar year. This is known as the “reference year.” You must submit the following information through the Centers for Medicare and Medicaid Services (CMS) Health Insurance Oversight System by June 1. (CMS collects the data on behalf of the three agencies listed above.)

P2: Plan list — plan and reconciliation information  • The beginning and end dates of the plan year
• The number of participants, aka “members”Each state in which the plan or coverage is offered
D1: Premium and life years• The average monthly premium you pay on behalf of participants
• The average monthly premium your participants pay
• The total premium or premium equivalentThe total administration fees and stop-loss premiums
D2: Spending by categoryThe total spending on health care services, categorized by the type of costs, including:  
• Hospital costs
• Health care provider and clinical service costs, for primary care and specialty care separately
• Costs for prescription drugs covered by the medical benefit
Other medical costs
D3: Top 50 most frequent brand drugs• The 50 brand prescription drugs most frequently dispensed by pharmacies for claims paid by the plan or coverage
• The total number of paid claims for each of these
D4: Top 50 most costly drugs• The 50 most costly prescription drugs with respect to the plan or coverage by total annual spending
• The annual amount spent by the plan or coverage for each such drug
D5: Top 50 drugs by spending increase• The 50 prescription drugs with the greatest increase in plan expenditures
• The change in amounts expended by the plan or coverage for the plan year
D6: Drug rebates, fees and remuneration totals Any impact on premiums due to rebates, fees or other remuneration drug manufacturers paid to the plan or coverage, or its administrators or service providers, with respect to drugs prescribed to enrollees in the plan or coverage.
D7: Drug rebates by therapeutic classThe amounts paid for each therapeutic class of drugs and any reduction in premiums and out-of-pocket costs associated with rebates, fees or other remuneration.
D8: Drug rebates for the top 25 drugsThe amounts paid for each of the 25 drugs with the highest amount of rebates and other remuneration under the plan or coverage from drug manufacturers during the plan year.
Narrative response• A description of the market segment determination (size)
• A description of how net payments from federal or state reinsurance and cost-sharing reduction programs are accounted for
• The drugs missing from the CMS Plan Crosswalk, including the name and class
• The methods used to determine the estimated portion of bundled arrangements attributed to drugs covered under the medical benefit
• The types of rebates, fees and remuneration included or excluded for the top 25 drugs
• The methods used to allocate rebates, fees and remuneration
• The impact of rebates on premiums and cost-sharing
Your service provider can help you meet your reporting obligations

With some exceptions, RxDC reporting applies to public and private group health plans and issuers, regardless of grandfathered or funding status. 

Unfortunately, group health plan sponsors generally do not have the requisite information to complete RxDC reporting without coordinated efforts. You may have to rely on your service provider to facilitate your compliance obligations.

Fully insured plans

Issuers are technically responsible for compliance with RxDC reporting. The issuer is the keeper of the plan, and plan sponsors rent selected benefits from the issuers. However, issuers have shifted compliance reporting duties to plan sponsors, particularly with respect to premium and life years. (See D1 above.)

The issuer usually has every data point except the average monthly premium paid by members and employers on behalf of members. In response to this missing data, many insurance carriers sent surveys during early spring requesting contribution information.

For plan sponsors that received and responded to the surveys in a timely manner, carrier compliance was relatively easy to satisfy. However, for plan sponsors that didn’t reply or never received the survey, carriers responded by informing plan sponsors that they must find another solution for filing their D1.

Self-insured plans

Plan sponsors of self-insured plans (including level-funded plans and partially self-insured plans) are responsible for RxDC reporting. However, varying plan designs make compliance more complex.

This is especially true for plans that are not based on the calendar year and plans that do not have the same service provider managing their medical claims, pharmacy benefits and stop-loss reinsurance. Plan sponsors must coordinate with the third-party administrators (TPAs) and pharmacy benefit managers (PBMs) they engaged during the reference year.

Service providers have responded to the demand in different ways. For example, carriers of traditional level-funded plans generally take a similar approach as they do with their respective fully insured books.

Some TPAs coordinate with their preferred PBMs and may or may not charge a fee. Most service providers do not provide plan sponsors with the data necessary to complete the filing themselves. In short, there is little to no transparency.

RxDC reporting can help defend you against litigation

As a plan sponsor, you have a fiduciary responsibility to ensure the plan is operating according to the terms of the plan document, your service providers are meeting their contractual obligations, and you are paying your service providers a reasonable fee for their services. Data files D2-D8 provide germane information and can help you defend yourself against heightened scrutiny and litigation.

Preparing for your reporting obligations

Here are a few steps worth considering at renewal:

  • When reviewing service agreements, take note of how RxDC reporting is addressed.
  • Negotiate that data files be provided to you upon completion and filed at the plan level.
  • Ensure you have access to claims data and pharmaceutical claims information.
  • Understand how rebates are apportioned and negotiate that they flow back to the plan.
Need help?

For help with your RxDC reporting, contact your plan administrator or OneGroup’s Employee Benefits Team. You can also find resources on the CMS’ RxDC landing page. 

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem.

Copyright © 2024 Applied Systems, Inc. All rights reserved.

Self-Funding Health Benefits: What Employers Need to Know

| May 12, 2025
Healthcare costs and fees concept.Hand of smart doctor used a calculator and smartphone, tablet for medical costs at hospital in morning light

Insights from our Recent Self-Funding Health Benefits 101 Webinar

As healthcare costs continue to rise, more employers are exploring self-funding as a strategic alternative to traditional fully insured health plans. In our recent Self-Funding Health Benefits 101 Webinar, team members from BPAS Health Benefits Consulting and OneGroup’s SVP of Employee Benefits discussed the risks and benefits of Self-Funding Health Benefits. They offered valuable insights from their organizations considering the self-funding approach.

Why Self-Funding?

Self-funding allowers employers to pay for healthcare claims directly, rather than paying a fixed premium to an insurance carrier. This model has several advantages:

  • Cost savings: Employers can retain savings when actual claims are lower than expected. Over time, this can result in 8-10% savings compared to fully insured plans.
  • Flexibility: Self-funded plans are not subject to state mandates, allowing employers to tailor benefits to their workforce. For example, fertility coverage can be customized rather than following state-imposed requirements.
  • Transparency and Control: Employers gain access to detailed claims data, allowing for more informed decision-making, improved utilization management, and the development of targeted wellness initiatives.
Understand the Risks

While the benefits are compelling, self-funding also comes with risks that should be considered before making decisions to follow this model:

  • Claims Volatility: Monthly costs can fluctuate significantly due to high-cost claims or seasonal trends.
  • Administrative Complexity: Employers must manage multiple vendors, including third-party administrators (TPAs), pharmacy benefit managers (PBMs), and stop-loss carriers.
  • Compliance Responsibilities: Self-funded employers must navigate additional responsibilities under HIPAA, and many are also subject to ERISA compliance rules.
Mitigating Risk with Stop-Loss Insurance

To manage financial exposure, most self-funded employers purchase stop-loss insurance. This coverage reimburses the employer for claims that exceed a certain threshold, providing a safety net against catastrophic costs.

Transitioning to Self-Funding

A successful transition requires careful planning. Key steps include:

  • Engaging Leadership Early: Secure buy-in from finance and HR teams at least a year in advance.
  • Vendor Coordination: Notify current carriers of the intent to move to self-funding and begin evaluating TPAs and stop-loss providers.
  • Employee Education: Communicate changes clearly to employees, emphasizing what will and won’t change in their experience.
  • Compliance Preparation: Draft a Summary Plan Description (SPD) and ensure readiness for federal reporting requirements.
Is Self-Funding Right for You?

The ideal candidate for self-funding typically has 250-500+ full-time benefits eligible employees, but each organization is unique and any employer with more than 100 full-time employees may consider self-funding. BPAS offers a proprietary analytics tool to help employers model potential savings and risks based on their specific demographics and claims history.

Emerging Trends to Watch

Self-funded employers should stay informed about evolving healthcare trends, including:

  • Gene Therapies: High-cost treatments with transformative potential.
  • GLP-1 Medications: Popular for weight loss but costly and controversial.
  • Regulatory Changes: Ongoing updates to federal compliance requirements.
Conclusion

Self Funding isn’t a one-size-fits-all solution, but for many employers, it offers a path to greater control, customization, and cost efficiency. With the right partners and preparation, the transition can be smooth and rewarding. Our OneGroup Employee Benefits and BPAS Health Benefits Consulting teams can help you decide if self-funding health benefits is the best model for your business and guide you in the right direction.

CLICK HERE TO VIEW PRESENTATION MATERIALS

BPAS and OneGroup are subsidiaries of Community Financial System, Inc. (CFSI). As sister companies, BPAS and OneGroup are able to operate as one company working as one team. Leveraging their combined expertise in employee benefits consulting, actuarial services, brokerage, analytics, and HR consulting, BPAS and OneGroup work together to refine and enhance your benefit strategies.

To learn more about OneGroup’s Employee Benefits services, visit our website. To learn more about BPAS’s Health Benefits Consulting services, visit their website.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.

Your Nonprofit might have hidden gaps in protection

| May 10, 2025
happy volunteers packing food in donation boxes

Use this checklist to uncover the hidden risks in your nonprofit operations.

Nonprofits often make small operational changes and don’t realize those changes can create insurance gaps. You might have made changes that inadvertently reduced or increased your risk.

Use this checklist to remind yourself of the past year’s changes.

Nonprofit operations
  • Did you change your entity structure (e.g., from a sole proprietor to a limited liability corporation)?
  • Did you expand your services, client base or distribution to multiple states?
  • Did you expand your supply, services or distribution to an international service area?
  • Do you accept online or electronic payments?
  • Do you accept cryptocurrency?
  • Do you host or maintain a payment or client self-service portal on your website or social media page?
  • Do you provide transportation for youth or host groups or activities involving minors?
  • Do you have a board of directors?
  • Do you have volunteers or unpaid helpers you rely on for your operations?
  • Do you advertise digitally or in print?
  • Do you give advice or provide professional services?
Nonprofit property (leased or owned)
  • Is your property within the range of a fire station, or have you installed a private firefighting system (if you’re in a rural area)?
  • Did you install a rooftop solar panel system or solar roof tiles?
  • Did you renovate, upgrade or add space to your property?
  • Did you upgrade your HVAC, plumbing, electrical system, siding, roof or windows?
  • Did you add a security system to your property or parking lot?
  • Do you rent out a portion of your property or share your space?
  • Do you have any detached structures (garages, sheds or other outbuildings not connected to your nonprofit)?
  • Do you rent out a portion of your garage or other outbuildings for parking or storage?
  • Do you have collectibles or high-value artwork on display?
  • Do you store inventory on-site or at a warehouse?
  • Did you install signs or awnings?
  • Do you allow pets on the premises?
  • Do you rent out a portion of your garage or another outbuilding?
  • Is your building an older or vintage property?
  • Do you have a pool or hot tub on your premises?
  • Do you have a sidewalk or another public walkway you’re responsible for clearing?
  • Have you made substantial permanent improvements to the building you rent?
Data collection, computers and networks
  • Did you change your computers or data network?
  • Do your staff members work from home all or part of the time?
  • Do you store client, donor or volunteer personal information on a networked server or website?
  • Do you accept credit cards or other types of monetary transactions?
  • Do you use biometrics (fingerprint scanners or facial recognition) for your operations?
Autos or vehicles your nonprofit owns
  • Do you own vehicles?
  • Do you use electric scooters, mopeds, motorcycles, ATVs or golf carts to get around at your nonprofit?
  • Do your employees or volunteers drive their personal vehicles for donation pickups, client visits, errands, client services or outings?
  • Do you have custom wraps, logos or paint designs on your nonprofit vehicles?
Employee and volunteer liability
  • Did you increase or decrease your number of employees or volunteers?
  • Do you use contractors, or temporary or gig workers?
  • Do you use volunteer staff for any part of your operations?
  • Do you offer a pension or retirement plan?
  • Do you use artificial intelligence (chatbots, recruit bots, scanners, etc.) for hiring or career advancement?
  • Do your employees access petty cash, client records or other sensitive information in the course of their duties or on behalf of clients?
Liability that you might have answered “yes” to

You might have a risk liability that creates a significant coverage gap for your nonprofit.

Nonprofit liability:Insurance solution:
Your property is in an area that has flash rains, snowmelts, thunderstorms, floods or mudslides, or relies on a sewer system.Property and business owners policies do not cover flooding. A flash rain or snowmelt can cause a flood in a nonflood plain. An inch of water can cause over $25,000 in damage. (Think of the equipment and storage in your basement or first floor.)
Your property has plumbing or relies on a sewer system.Sewage backup could force you to close for a while. Sewer backup insurance differs from flood insurance. We can explain the details.
Your property is near a fault line or could experience an earthquake or earth movement.Earthquakes are not covered under commercial property insurance. If your nonprofit gets damaged, it may need substantial repairs, especially if it’s not an earthquake-resistant design. You can buy a separate earthquake policy or add it to your property coverage.
You don’t know if your property is insured for market or replacement value.The market value of a building is not the same as its replacement value. Market value is what someone will pay for your property. Replacement value is what it will cost to rebuild your property. Replacement value can exceed market value by tens of thousands of dollars. Reevaluate your property limits every few years to stay current with market costs (inflation, weather, supply chain shortages and labor costs).
You’re interested in rebuilding your property with energy-efficient materials after a property loss.A green materials and equipment upgrade endorsement reimburses a portion of the cost of rebuilding using energy-efficient materials.
You lease your space, but you have made substantial improvements to the property.If you rent your space and you’ve installed permanent improvements (like high-end flooring or built-ins), improvements and betterments insurance will reimburse you for the cost.
Your operations involve clients, vendors or a brick-and-mortar location.Commercial liability insurance covers your damages if you are sued for defamation, a dog bite, bodily injury or property damage you’ve caused to others.
You own an older property.Ordinance or law coverage helps when local or other laws require you to rebuild your entire property to code, even the undamaged parts.
You display art or a valuable collection on site.Collectors and their collections require distinct insurance. An agreed value is an agreed-upon price for replacement. The appraised value depends on an appraiser’s valuation of the collection item.
You host programs or services for youth, people with disabilities or the elderly.You could be at risk for harassment and molestation allegations as a service provider. Many liability policies specifically exclude abuse and molestation. You’ll need additional coverage for these risks.
You hire or work with employees, volunteers or contractors.Your employees, contractors, volunteers and potential employees can sue you for unfair work or hiring practices. Workers’ compensation covers you for injuries on the job, but it doesn’t cover you for allegations of discrimination, wrongful termination, harassment, wrongful failure to employ, failure to promote or other human rights complaints. Employment practices liability insurance helps with legal defense costs and settlements.
You have a board of directors.Your board members might be held personally liable for harassment, abuse, discrimination or financial misappropriation. Directors and officers insurance can help with this risk.
You have an indispensable or irreplaceable person.A key person can be an owner or even a namesake synonymous with your nonprofit. Key person insurance is a type of life insurance that provides a temporary revenue stream after a critical staff member dies. This can give you time to hire a replacement.
Your property is accessible or visible to the public or employees.Workplace violence insurance helps with victim coverages, liability, income and extra expenses due to acts of violence and attacks with deadly weapons (guns, knives and others) at your organization.
You are active on social media.Check your general liability limits if you’re active on social media or other media platforms. You might need to increase your limits or get a commercial umbrella or media liability policy. The lawsuit and defamation risks are much higher if you interact with a global audience.
Your staff members travel domestically.If your staff members travel for nonprofit business, add travel insurance to your coverage. It comes in handy for travel cancellation and medical payments if an illness or accident occurs.
Your staff members travel internationally.If your staff members travel internationally, especially for high-profile events, consider kidnapping and ransom insurance. It can help with negotiations, payments, media management and other sensitive issues.
You have employees or volunteers who can access cash, data or other resources.Employee theft or crime insurance helps you recoup costs associated with theft and loss due to an employee’s actions. If your employees or volunteers are part of a theft ring, your general liability policy won’t help.
You store client and donor data or use the internet to process payments.You could be liable for a breach of personal information on your servers or in the cloud. Fines and required mitigation efforts like providing credit monitoring services can cost thousands. Cyber liability can be as costly as a property loss, so cyber insurance is essential.
Let’s talk soon

Even if it doesn’t appear on this list, please ask our team about any coverage that interests you. We’ll be in touch to discuss protection for your nonprofit.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.

Written content in blog post: Copyright © 2023 Applied Systems, Inc. All rights reserved.

Legal Alert: IRS Releases 2026 HSA Contribution Limits and HDHP Deductible and Out-of-Pocket Limits

| May 9, 2025
US Capitol Building - IRS Adjustments

In Rev. Proc. 2025-19, the IRS released the inflation adjusted amounts for 2026 relevant to Health Savings Accounts (HSAs) and high deductible health plans (HDHPs).

The table below summarizes those adjustments and other applicable limits.

20262025Change
Annual HSA Contribution Limit (employer and employee)Self-only: $4,400
Family: $8,750		Self-only: $4,300
Family: $8,550		Self-only: +$100
Family: +$200
HSA catch-up contributions (age 55 or older)$1,000$1,000No change
Minimum Annual HDHP DeductibleSelf-only: $1,700
Family: $3,400		Self-only: $1,650
Family: $3,300		Self-only: +$50
Family: +$100
Maximum Out-of-Pocket for HDHP (deductibles, co-payment & other amounts except premiums)Self-only: $8,500
Family: $17,000		Self-only: $8,300
Family: $16,600		Self-only: +$200
Family: +$400
Out of Pocket Limits Applicable to Non-Grandfathered Plans

The ACA’s out-of-pocket limits for in-network essential health benefits have also been announced and have increased for 2026.

20262025Change
ACA Maximum Out-of-PocketSelf-only: $10,150
Family: $20,300		Self-only: $9,200
Family: $18,400		Self-only: +$950
Family: +$1,900

Note that all non-grandfathered group health plans must contain an embedded individual out-of-pocket limit within family coverage if the family out-of-pocket limit is above $10,150 (2026 plan years) or $9,200 (2025 plan years). Exceptions to the ACA’s out-of-pocket limit rule have been available for certain non-grandfathered small group plans eligible for transition relief (referred to as “Grandmothered” plans) since policy years renewed on or after January 1, 2014. Each year, CMS has extended this transition relief for any Grandmothered plans that have been continually renewed since on or after January 1, 2014. However, in its March 23, 2022 Insurance Standards Bulletin, CMS announced that the limited nonenforcement policy will remain in effect until CMS announces that such coverage must come into compliance with relevant requirements. Thus, we will no longer see annual transition relief announced.

Next Steps for Employers

As employers prepare for the 2026 plan year, they should keep in mind the following rules and ensure that any plan materials and participant communications reflect the new limits:

  • HSA-qualified family HDHPs cannot have an embedded individual deductible that is lower than the minimum family deductible of $3,400.
  • The out-of-pocket maximum for family coverage for an HSA-qualified HDHP cannot be higher than $17,000.

All non-grandfathered plans (whether HDHP or non-HDHP) must cap out-of-pocket spending at $10,150 for any covered person. A family plan with an out-of-pocket maximum in excess of $10,150 can satisfy this rule by embedding an individual out-of-pocket maximum in the plan that is no higher than $10,150. This means that for the 2026 plan year, an HDHP subject to the ACA out-of-pocket limit rules may have a $8,500 (self-only) / $17,000 (family) out-of-pocket limit (and be HSA-compliant) so long as there is an embedded individual out-of-pocket limit in the family tier no greater than $10,150 (so that it is also ACA-compliant).

More Information

For additional information, contact our Employee Benefits team.

This alert was prepared for OneGroup by Barrow Weatherhead Lent LLP, a national law firm with recognized experts on the Affordable Care Act. Contact Stacy Barrow or Nicole Quinn-Gato at [email protected] or [email protected].

The information provided in this alert is not, is not intended to be, and shall not be construed to be, either the provision of legal advice or an offer to provide legal services, nor does it necessarily reflect the opinions of the agency, our lawyers, or our clients. This is not legal advice. No client-lawyer relationship between you and our lawyers is or may be created by your use of this information. Rather, the content is intended as a general overview of the subject matter covered. This agency and Barrow Weatherhead Lent LLP are not obligated to provide updates on the information presented herein. Those reading this alert are encouraged to seek direct counsel on legal questions.

© 2025 Barrow Lent LLP. All Rights Reserved.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.

You’re a Board Member – Manage Your Personal Liability and Risk Exposure

| May 9, 2025
Diverse group of executives working together around a boardroom table

Have you been invited to join the board as a member of the directors and officers team? You’ll want to learn about their D&O coverage to protect yourself from personal liability risk.

You’ve been invited to serve as a director or officer on the board of a corporation or nonprofit. This is an exciting opportunity that also comes with potential liability exposures across several areas, including employment and fiduciary liability.

Nonprofits and corporations have unique risks. In general, larger companies mean greater risks, but the cost to defend and settle a lawsuit isn’t relative. If a smaller nonprofit is accused of mishandling donations, it might bankrupt the entire organization. And while larger corporations have deeper pockets, the cost to defend a multilayered lawsuit out of pocket could mean the difference between sinking or swimming.

Are you personally liable for a company loss?

The short answer is yes. As a board member, you could be held personally liable for the decisions and actions of the board, even in the case of impropriety on the part of other members. A lawsuit might name everyone at an organization, including board members, before a determination is made. This leaves you open to risk and exposes you to potential liability, especially if your board doesn’t have appropriate insurance.

Limits and expectations of board members

As a board member, you’re expected to take your duties seriously and make reasonably informed decisions. But you’re not expected to guarantee results or prevent setbacks. The business judgment rule can protect directors and officers from the effects of honest mistakes, provided they were made in good faith.

You’ll still need to provide evidence of good faith (such as meeting minutes, training and other reasonable care actions) when responding to accusations. You’ll also need to mount a legal defense, even if you’re ultimately found innocent, which can be costly if you’re not covered by your organization.

Who’s at risk? It’s on a case-by-case basis

No organization is too small to create some form of D&O liability if its directors and officers have discretion over money and other governance issues. This can include condo boards, nonprofits, schools, churches, associations and for-profit corporations. There’s a lot of liability spread across an ever-growing canvas of industries.

Small organizations — even without a lot of money, lawsuits can happen

As a practical matter, local groups such as churches, parent-teacher associations and recreational sports leagues may not have enough in assets to justify the cost of a lawsuit. But individual members of a board of directors might. It all depends on the issue being litigated and the legal team involved.

Reach out to your insurance professional and lawyer to review your organization’s various insurance policies, along with your own policies and exposures.

  • Be clear on the insurance policies in play, and their exclusions and limits.
  • Review the organization’s activities, service base and risk factors (such as youth groups, elder care, developmentally disadvantaged). Depending on the organization, you could be held to a higher standard, regardless of organizational assets.
Public organizations and for-profit corporations — the risk grows

The risks can be high if you serve on a school board, municipal council, public health board or some other tax-supported public body. The risks also increase within for-profit corporations that answer to shareholders.

For example, shareholders could launch a lawsuit against the corporation if assets are sold off or a product line is terminated, and shareholders feel that decision unnecessarily devalued the stock value. Recent IPOs are also at risk for lawsuits and the trend is on the rise.

Nonprofits are at risk — the larger the service net, the greater the risk

The larger the organization you serve, the greater the financial risk — and the more protection you need. That maximum applies to all organizations, however benevolent their mission may be. If you join the board of a nonprofit cultural institution with a priceless art collection, you can expect scrutiny.

Additionally, if you sit on a board that oversees homeless issues in a large urban area, then your risk may increase due to multiple locations or inexperienced volunteer staff.

Even contracted help for a temporary job can be a liability. For example, if a drywall contractor hired to repair walls assaults a volunteer at the shelter, the organization can be held liable. The organization is expected to have a process for background checks and vetting vendors.

Public perception is a risk

Liability isn’t always connected to financial loss. The loss of public reputation due to negative media exposure can be a loss — and an even harder one to recover from.

D&O liability — who insures the board?

Apart from their general liability, directors and officers also have potential liability from the organization they serve, as well as its shareholders, beneficiaries and other stakeholders. That’s where D&O liability insurance comes in.

Here are a few things to ask your organization about D&O insurance for its board members:

  • Am I covered directly for any legal costs or damages I incur? This is called side A coverage. It presumes that you would manage your own defense and could potentially offer more control over settlements.
  • Will the organization defend me and pay damages for me? This is called side B coverage. Your defense is managed by the company or organization, but you have little to no control over the settlement of claims. It generally reimburses the company for expenses incurred defending its executives, directors and officers.
  • Does the organization have its own coverage? This is called side C coverage. It responds to lawsuits against the company or organization, which can include its employees, board members and other staff. But this shared coverage could leave you personally exposed if the limits are too low. The coverage amount might be depleted by other board members or the organization’s own defense before your defense is complete.

Your insurance professional and lawyer can advise you on purchasing your own D&O coverage.

Coordinated risk management — personal liability gaps

What protection do you need? The biggest hurdle is covering the gaps between your personal liability and the organization’s liability. You can start by finding out what coverage your organization currently has in place.

Commercial general liability

Confirm whether executives and board members are insured under the organization’s commercial general liability (CGL) insurance policy. A CGL policy covers your organization’s liability for bodily injury or property damage to an unrelated third party, and directors and officers are typically covered. But the coverage is usually limited and may not be enough to support a lawsuit or catastrophic loss.

Talk to your insurance professional about how much coverage your organization’s CGL would offer you. Get a copy of the policy so you can understand the coverage.

Hired and nonowned auto liability — coverage for personal vehicles

How many times have you run an errand for your organization or company? Hired and nonowned auto liability insurance covers these situations. CGL policies do not cover auto accidents.

Fleet coverage and traditional owned auto policies cover the vehicles owned by the company or organization. But many organizations don’t own the vehicles used by their employees, volunteers and board members. There is a chance your organization would not be covered if it is held liable for injuries caused by someone driving their own car to run errands on its behalf.

The driver’s personal auto insurance will respond first, but you and the organization may be exposed if there are catastrophic injuries and the coverage limits run out.

Directors & Officers liability (D&O)

Sides A, B and C are stackable lines of coverage, meaning one coverage side should respond when the other does not. If your organization has side C coverage, you can seek out additional sides to stack on your own.

Think in terms of long-haul and worst-case scenarios when insuring yourself. If you depend solely on an organization-provided policy and that policy has slim limits, there may not be enough money left to mount a legal defense for every board member once those limits are exhausted. You could be left with a big legal fee.

Either way, you might want to talk to your insurance agent about getting your own personal D&O policy as a secondary line. Your personal D&O coverage should respond once all limits are exhausted on the primary (the organization’s) D&O policy.

Cyber liability

Cyber attacks are a growing risk, with no signs of slowing down. It’s no longer sufficient to assume only big companies or banks are at risk.

The care of personally identifiable information (PII) is a liability that goes beyond storage of credit card or banking information. All data is of interest hackers, who can make big money off buying, selling and trading all types of PII on the dark web, including client, volunteer, benefactor, employee and business contact information.

It’s all worth something to someone and you’d be surprised how little is needed to recreate entire identities. Your agency needs a plan and may even be legally required to have one, depending on the state you’re in.

Many management liabilities — review your policy exclusions

Not long ago, it was enough for directors and officers to be covered under a CGL or a D&O policy. But laws and the insurance industry are changing. There are many other types of management liability insurance coverages you should consider.

  • Cyber liability for data breaches due to the loss, exposure, theft and/or corruption of electronic info
  • Employment practices liability (EPL), which includes volunteers and employees, claims of discrimination, harassment, violence and abuse in the workplace
  • Environmental liability for contamination of air, water or land caused by your organization
  • Product liability for manufacturing defects that cause catastrophic injury
  • Sexual abuse or molestation for incidents that occur at your organization or company
  • Crime or fidelity for incidents involving theft by employees
  • Media liability for publishing, marketing or trusted information sources for libel or slander

In the past, a D&O policy would typically cover claims alleging cyber, employment practices, abuse, environmental liability or (less often) product liability. But recently the trend is to exclude or restrict coverage with the expectation that the organization will purchase separate policies addressing those exposures.

Virtually every organization today has some level of exposure. It’s likely board members do, too.

Due diligence and a risk management protection plan

With this potential for risk, what should you do when you get an invitation to serve as a director or officer?

  • Schedule an appointment with your insurance professional and tell them about your plans to join the board.
  • Gather as much information as you can from the organization’s financial statements and claims history. Their willingness (or unwillingness) to provide them says a lot.
  • Ask questions about their current insurance coverage such as commercial general liability, D&O liability, hired and nonowned auto, environmental liability, cyber liability, crime and fidelity, abuse and molestation liability and EPL.
  • Ask to review their policies with your insurance professional so you can make an informed insurance strategy for your own personal liability.
  • Ask if the organization has assessed its cyber, employment and environmental exposures.
  • Review any written risk management plans for addressing exposure areas.
  • Review your insurance options with your insurance professional annually as laws and exclusions change.
Coordinate with your insurance professional

It’s an honor to be considered for a board membership. Transparency with information is part of that process and it’s essential to your personal risk management exposure planning. If you’re satisfied with the responses you get, you can feel confident about assuming a leadership position within a responsibly run organization. Talk to our team to help guide you on this exciting path of opportunity.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.

Written content in blog post: Copyright © 2024 Applied Systems, Inc. All rights reserved.

Retaining Young Talent with Well-Being Benefits

| May 6, 2025
Couple of business people discussing tasks walking in the office hall

Millennials and Gen Z employees prioritize wellness when choosing an employer. Explore benefits that can help you keep your current and future workforce.

Employee well-being is more than a talking point. It’s a critical element of retaining millennial and Generation Z (Gen Z) employees.

Over 70% of employees in these generations say they would leave their current employer for an organization that emphasizes their well-being. Nearly 70% say their productivity would improve with an employer supporting their wellness. And more than 30% would take less pay to be in a happier, healthier workplace.

These figures come from a survey of 10,000 millennial and Gen Z employees by the wellness platform Lifesum.

Understanding younger employees’ wellness priorities

According to the Lifesum survey, millennials and Gen Z employees prioritize physical and mental health to prolong their health longevity.

“Health longevity” is a longer period in which people can maintain physical activity and cognitive acuity as they age.

Younger employees want a better understanding of nutrition and sleep to support these goals. The human resources magazine HRO Today reports that millennials and Gen Z employees seek information on how food, energy, stress and sleep affect their physical and mental health.

The focus on mental health is particularly critical. A white paper from the management consultancy Deloitte shows younger generations are struggling with mental health. Forty percent of Gen Z and 35% of millennial employees say they are stressed or anxious most or all of the time.

Benefits supporting workplace well-being

According to a survey by Georgetown University and Bank of America, paid time off and flexible work schedules are the top workplace well-being benefits young adults are seeking.

Additional benefits that take a whole-person approach to employee wellness can further support your younger employees. Offerings include:

  • Affordable and accessible mental health benefits
  • Employee assistance program resources
  • Gift cards for healthy meal deliveries
  • Mindfulness and mental health apps
  • Online fitness classes and gym memberships
  • On-site and online cooking classes
  • Personalized nutrition programs
  • Sleep apps and education
  • Stress management tools
Well-being is good for employees and employers

The statistics highlight the importance of employee well-being benefits for retaining younger generations. But employee wellness is good for all employees and organizations. According to a global survey by the management consultancy WTW, employers focused on well-being are twice as likely to report better employee engagement, productivity and financial outcomes.

To explore how wellness benefits can improve your retention strategy now and into the future, talk to OneGroup’s Human Resources Consulting Team. They can help you discover well-being offerings that support your younger employees’ health and your organization’s business goals.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.

Copyright © 2024 Applied Systems, Inc. All rights reserved.

Filing Form 5500

| May 5, 2025
Business performance checklist concept, businessman using laptop doing online checklist survey, filling out digital form checklist.

Form 5500 filings verify employee benefits plans’ annual reporting requirements. Documenting thorough and accurate data is critical to ensure compliance and avoid penalties. These details can help.

Is your employee benefits plan subject to the Employee Retirement Income Security Act (ERISA)? If so, it’s crucial to understand the Department of Labor (DOL)’s annual filing requirements for IRS Form 5500.

Form 5500 ensures that benefits plans meet annual reporting requirements and regulations under the Internal Revenue Code and ERISA. Providing accurate information validates plans’ financial stability, protects employees’ benefits and legal rights, and enhances trust in employee benefits plans.

Applicable benefits plans include health and welfare, retirement and self-funded plans.

You must file Form 5500 if your benefits plan holds its assets in a trust or has 100 participants or more at the beginning of the plan year. To support your filing efforts, let’s examine deadlines and documentation requirements for Form 5500.

Deadlines

You must file Form 5500 electronically by the last day of the seventh month following the end of the plan year. For calendar year plans, the Form 5500 deadline is July 31.

File your form using the ERISA Filing Acceptance System (EFAST2).

Once you register electronically through EFAST2, you’ll be asked to provide plan information and upload the required documentation.

If you need an extension, you must file Form 5558 before your plan’s deadline. The one-time extension provides an additional 2½ months to complete Form 5500. Your new deadline will be Oct. 15, notes the legal news site LexBlog.

Meeting Form 5500 deadlines is critical to avoid penalties. The advisory and public accounting firm Withum reports that late filings can result in fines from the IRS and DOL. The IRS penalty is $250 each day that Form 5500 is late, up to $150,000 for the plan year. The DOL penalty is $2,670 a day, and there is no maximum to this penalty.

Summary annual report

The payroll solutions company Justworks notes that you must also provide plan participants with a summary annual report outlining the information in Form 5500. This report includes information on your plan’s financial condition and highlights participants’ right to receive a copy of the full annual report. You must distribute the summary annual report to plan participants within two months of your Form 5500 deadline.

  • For calendar year plans, the summary annual report deadline is Sept. 30.
  • If you receive a Form 5500 filing extension to Oct. 15, your summary annual report deadline is Dec. 15.
Documentation requirements

With Form 5500, the IRS and DOL want to understand the financial stability of your employee benefits plans. They also want participants and beneficiaries to have access to information protecting their plan benefits and rights.

Each year, you’ll need to identify the following information on Form 5500:

  • The type of benefits plan you’re offering
  • Whether this form is a first filing or an amended return
  • Any benefits subject to collective bargaining
  • If you’re requesting a deadline extension
  • If your plan is retroactively adopted as allowed by Section 201 of the SECURE Act

You’ll need to upload the required documentation, including:

  • General information about the plan sponsor and plan administrator
  • Plan details such as benefits provided, insurance contracts and funding arrangements
  • Total plan participants, including active participants, vested participants and beneficiaries
  • An auditing statement from an independent qualified public accountant reporting on your plan’s financial statements and any schedules you need to include in your filing

According to Forbes magazine, relevant schedules typically include Schedules A, C, G and R, which require the following details:

  • Schedule A: Insurance information
  • Schedule C: Service provider information
  • Schedule G: Financial transaction schedules
  • Schedule R: Retirement plan information

You’ll also need to file your administrative expenses. Administrative expense reporting is intended to ensure your plan is paying reasonable fees and receiving appropriate services in return. According to LexBlog, you must report the following administrative expenses:

  • Salaries and allowances for plan employees
  • Actuarial fees
  • Auditing fees
  • Legal fees
  • Recordkeeping fees
  • Trustee/custodial fees
  • Valuation/appraisal fees
  • Other expenses, such as office equipment, supplies, rent and similar costs related to the operation of your plan

LexBlog notes that the DOL often uses Form 5500 to spot violations. Providing thorough and accurate data is essential to avoid fines, penalties and litigation. The DOL and IRS can penalize organizations for inaccurate or incomplete submissions, particularly if they suspect willful neglect or falsified data.

The DOL encourages employers to voluntarily self-correct ERISA violations. The Delinquent Filer Voluntary Compliance Program (DFVCP) can help you correct violations if you file Form 5500 late or fail to file. The DFVCP allows you to satisfy DOL requirements and reduce civil penalties.

For more information about the DFVCP, visit the Employee Benefits Security Administration (EBSA)’s Correction Programs webpage.

Filing your Form 5500

The DOL’s EFAST2 site can help you find, fill out and file your Form 5500 quickly and efficiently.

Many organizations turn to third parties for Form 5500 preparation and completion. However, plan fiduciaries still have ultimate responsibility. Understanding the details behind Form 5500 can protect your organization, plan and participants.

If you have multiple welfare benefits plans, you may want to consolidate them into a single plan with a wrap document. Doing so enables you to file one Form 5500 instead of multiple forms for each benefits plan.

A wrap document can reduce costs by simplifying your reporting, administrative and compliance requirements. OneGroup’s Employee Benefits Team can help you create a wrap document that is compliant with plan documentation, communication and deadline requirements.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem.

Copyright © 2024 Applied Systems, Inc. All rights reserved.

Things to Think About When Starting a Small Business

| May 1, 2025
Portrait Of A Successful Small Business Owner Holding Flowers And Standing At Bakery Entrance

One way to ensure that your business thrives is to stay ahead of the risks. Check out this list of key concerns to keep in mind as your business grows and evolves.

Many businesses are born from a single brilliant idea. As that idea is put into motion, the company grows. But along with that growth comes risk.

There are over 33 million small businesses in the United States, according to the Small Business Administration. The owners of these businesses face many risks. Would you be prepared if a disaster struck?

You may initially think you are, but there’s a good chance your business isn’t fully protected from loss. Regularly assessing your risks and modifying your plans can help you safeguard your business and stay nimble in the face of evolving threats.

Select a business entity carefully

Maybe you started your business with a specific business entity in mind, such as a sole proprietorship. But as your business expands, this structure may no longer fit your needs. Ask yourself periodically if your business entity setup is still relevant, and whether you need to evolve. Thinking through this question will help minimize your risk.

Many business structure options exist, such as limited liability corporations, limited liability partnerships, general partnerships, S-corporations and C-corporations. Every option has its pros and cons, and whether an option is relevant for your business will depend largely on your circumstances.

Selecting the right structure allows you to create a wall between your personal assets and your business. This is critical when considering your exposure. Speak with an attorney to discuss the details of your business and which business entity is the best fit.

Hold your personal assets carefully

Hold your personal assets strategically to keep them safe. Most business owners hope they’ll never face a lawsuit or another situation that could threaten their assets, but it’s important to consider this risk.

For example, you might decide to invest in a trust or keep some assets in the name of a spouse or child. For smaller businesses, it’s best to keep separate bank accounts for business and personal expenses.

Keep track of your credit

Your personal credit may intersect with your business credit, depending on your business structure. This is a good reason to carefully consider the various entity structures and which one is right for your situation.

For example, operating your business through a specific type of entity may help keep losses and liabilities away from your personal balance sheet and off your credit report. At times, business loans, including business credit cards, may require a personal guarantee. This means you’re personally liable for any debt incurred on the account.

Consider a business owners policy

A business owners policy combines three essential insurance coverages for your small business:

  • Business property insurance for the location you rent or own and any property like tools, equipment or inventory
  • General liability insurance for the cost of property damage, bodily injury or advertising claims
  • Business income (interruption) insurance for lost income if you can’t operate due to a covered event, such as a fire or theft
Think outside the box in terms of professional liability

Doctors, lawyers, accountants and other professionals aren’t the only ones who need professional liability insurance. Anyone who has a special skill or knowledge is considered a professional and could be at risk for a lawsuit alleging malpractice or negligence. For example, wedding planners and hairstylists have faced lawsuits even though most of these businesses don’t think they need professional liability insurance.

Additionally, if you expand your business to cover a new industry, check with your insurance professional. They can help make sure your existing policy extends to the new business.

Plan for business interruptions

A fire, a hurricane or another event can bring your business to a halt. For these and other unexpected events, business interruption insurance is essential. If you suffer a covered event, it will step in to assist with expenses. 

Without business interruption insurance, such an event could put your business in jeopardy. For small businesses, this could mean tapping into your personal savings to keep operations flowing and pay employee wages.

Since business interruption insurance only kicks in for a covered event, talk to your insurance professional about adding flood, earthquake and sewer backup coverage to your policy. Just a few inches of water can cause tens of thousands of dollars in damage. (And you won’t be covered if you don’t have flood or sewer backup insurance.)

When estimating your business income coverage limits, use the annual gross earnings listed on your business financial records.

The bottom line

You’re passionate about your company’s future. One way to ensure it continues to thrive is to stay ahead of the risks. If you need help understanding your business’s risks, arrange a meeting with our team for sound advice.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.

Written content in blog post: Copyright © 2024 Applied Systems, Inc. All rights reserved.

New Version of the I-9 Form for 2025

| April 24, 2025
Woman Applying For Visa At Table

U.S. Citizenship and Immigration Services (USCIS) has released a new version of Form I-9, which reintroduces the term “alien” as an option for categorizing an employee’s citizenship or immigration status.

This change aligns the form with statutory language. Previously, in 2023, the Biden administration had replaced “alien” with “noncitizen” in Form I-9 and other official documents, considering “alien” to be dehumanizing.

The updated Form I-9, dated January 20, 2025, and expiring on May 31, 2027, includes several changes:

  • Restored the term “alien”
  • Revised descriptions for two List B documents in the Lists of Acceptable Documents
  • Updated statutory language and a revised DHS Privacy Notice in the instructions

Employers can continue using the Form I-9 with the August 1, 2023, edition date until it expires on May 31, 2027. However, electronic versions must be updated by July 31, 2026 with the new form dated January 20, 2025. 

Starting April 3, 2025, E-Verify and E-Verify+ will update the Citizenship Status selection to reflect the new language. Depending on the form edition used, employees and employers might still see “noncitizen authorized to work” instead of “alien authorized to work” in some E-Verify cases.  

For more information

For more details, you can visit the USCIS website: USCIS Form I-9 Changes

Reach out to OneGroup’s Human Resources Consulting team for an I-9 toolkit to help you prepare in case Immigration and Customs Enforcement (ICE) visits your organization. This toolkit will ensure you have all the necessary documentation and procedures in place to remain compliant with immigration laws.

Source: Cardman, M. (2025, April 7). Minor changes to Form I-9 and E-Verify updates. Brightmine.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.

Enhancing Return to Work and Timely Claims Reporting in Public Sector Organizations

| April 21, 2025
Coworkers greets their colleague who return to work.

In the public sector, ensuring a smooth and efficient return to work (RTW) process and timely claims reporting is crucial for maintaining workforce productivity and minimizing costs.

At OneGroup, we understand the unique challenges faced by public sector organizations and are committed to providing insights and solutions to enhance these processes.

The Importance of a Robust Return to Work Program

A well-structured RTW program is essential for several reasons:

  1. Employee Well-being: Facilitating a quick and safe return to work helps employees recover faster and reduces the psychological impact of being away from work.
  2. Cost Reduction: Effective RTW programs can significantly reduce the costs associated with long-term disability and workers’ compensation claims.
  3. Productivity: Keeping employees engaged and productive, even in a limited capacity, helps maintain organizational efficiency.
Key Components of an Effective RTW Program
  1. Early Intervention: The sooner an injured employee receives support, the better their chances of a successful return. This includes immediate medical attention and a clear RTW plan.
  2. Communication: Maintain open lines of communication between the injured employee, their healthcare provider, and the organization. This ensures everyone is on the same page regarding the employee’s progress and capabilities.
  3. Modified Duties: Offer temporary or modified duties that accommodate the employee’s current abilities. This helps them stay connected to the workplace while they recover.
  4. Training and Support: Provide training for supervisors and managers on how to support returning employees effectively. This includes understanding the legal requirements and best practices for RTW.
The Role of Timely Claims Reporting

Timely claims reporting is another critical aspect of managing workplace injuries and illnesses. Here’s why it matters:

  1. Legal Compliance: Public sector organizations must adhere to strict reporting timelines to comply with state and federal regulations.
  2. Accurate Documentation: Prompt reporting ensures that all details of the incident are accurately documented, which is crucial for processing claims and preventing disputes.
  3. Cost Management: Delays in reporting can lead to increased claim costs due to prolonged treatment and potential legal complications.
  4. Employee Trust: Demonstrating a commitment to timely and efficient claims handling builds trust with employees, showing that their well-being is a priority.
Strategies for Improving Timely Claims Reporting
  1. Training and Education: Regularly train employees and supervisors on the importance of timely claims reporting and the steps involved.
  2. Streamlined Processes: Implement clear and straightforward reporting procedures to make it easy for employees to report incidents promptly.
  3. Use of Technology: Leverage technology to automate and track the reporting process, ensuring no steps are missed and deadlines are met.
  4. Regular Audits: Conduct regular audits of your claims reporting process to identify and address any bottlenecks or areas for improvement.

At OneGroup, we believe that a proactive approach to return to work and timely claims reporting can significantly benefit public sector organizations. By prioritizing these areas, you can enhance employee well-being, reduce costs, and maintain a productive workforce. For more information on how we can support your organization, please contact us today.

Contact Us

To learn more about unique public sector risks and how to address them, contact OneGroup’s team.

Matt Maguire, Regional President, North Country at [email protected].

Todd Goodman, Risk Management Consultant at [email protected].

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.

Please note coverage can not be bound or a claim reported without written acknowledgment from a OneGroup Representative.