On January 22, 2016, the court in Joseph and Gail F. v. Sinclair Services Company, D. Utah No. 2:14-cv-00505, held that a self-funded plan violated the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction...more
Since our earliest postings, we have warned of a notion, prevalent among employee counsel, that an employer plan sponsor unlawfully retaliates against an employee by reducing her work hours in order to deprive her of ACA...more
Lawyers, politicians, economists, climate scientists, fad diet peddlers . . . we all know that it’s child’s play to persuade people of what they want to believe. Perhaps that explains the persistence of so many...more
On December 28, 2105, the IRS released its Notice 2016-4, granting much needed time for employers and their filing services to catch up to Affordable Care Act Information Return (AIR) Program developments. ...more
It’s the “silly season” on the Hill and a busy season for ACA regulators. This article gives you brief notes about Notice 2015-87, information reporting relief and the § 4980I delay buried in the omnibus spending bill....more
12/22/2015
/ Affordable Care Act ,
Cadillac Tax ,
Code Sections 4980H ,
Davis-Bacon Act ,
Employer Group Health Plans ,
Federal Contractors ,
HRA ,
Information Reports ,
Large Employer ,
Penalties ,
Section 6056 ,
Service Contract Act ,
Shared Responsibility Rule
Was the title of a 1970 soul hit for the Chairmen of the Board. Though your love for ACA information reporting is unlikely to grow as a result, you may need a little more time to get it done. This article responds to multiple...more
This is the annual hodge-podge of changes to the risk adjustment, reinsurance, and risk corridors programs, cost sharing parameters, cost-sharing reductions, and Healthcare.gov user fees, usually filling hundreds of Federal...more
“Isn’t this an ACA blog?” Yes, it is. “So, why are you writing about disability plan administration?” Because they said so. The preamble to the proposed rules explains – Inasmuch as disability and lost earnings can be sources...more
Today, the ACA enforcement agencies (DOL, HHS, IRS) jointly published final rules, effective January 1, 2017, on grandfathered plan status, pre-existing condition exclusions, lifetime and annual limits, rescissions, dependent...more
Sixty-seven months ago, Congress ordered employers of 200 or more full-time employees to switch from opt-in to opt-out enrollment. See 29 U.S.C. § 218a. But the enforcement agencies could not write a rule that did more good...more
We work closely with employers (mostly ALEs) and an array of service providers – payroll processors, benefit plan consultants and administrators, software developers and transmitters, employee leasing firms, insurance brokers...more
In June 2013, DOL, HHS and IRS explained that they view employer-sponsored wellness programs as narrow exceptions to the ACA’s health status discrimination prohibition. Early this year, the EEOC slathered-on its own rules,...more
11/4/2015
/ Affordable Care Act ,
Americans with Disabilities Act (ADA) ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Discrimination ,
Employer Group Health Plans ,
Equal Employment Opportunity Commission (EEOC) ,
GINA ,
Inducement ,
IRS ,
Spouses ,
Wellness Programs
“None,” is our best guess, practically speaking. Congress passed much of what became the consolidated Affordable Case Act under “budget reconciliation” rules, which preclude a filibuster and enable a bill to pass the Senate...more
In Notice 2015-60 (October 9, 2015), the IRS announced that the PCORI fee will rise to $2.17 per covered life for plan years ending on or after October 1, 2015 and before October 1, 2016. For plan years ending on or after...more
We were asked that recently, proving that there is such a thing as a wrong question. Let’s break it down. The same person may be both a “seasonal worker” and a “seasonal employee,” but those terms are used to discuss separate...more
With little apparent Democrat opposition, the U.S. House of Representatives on September 28 routinely passed a bill to allow employers of 50 to 100 employees to avoid the ACA’s especially heavy regulation of small group...more
On September 18, 2015, the Centers for Medicare and Medicaid Services (CMS) published a set of “Frequently Asked Questions Regarding the Federally-Facilitated Marketplace’s (FFM) 2016 Employer Notice Program.”...more
9/22/2015
/ Affordable Care Act ,
Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Certifications ,
Department of Health and Human Services (HHS) ,
Employer Mandates ,
Federal Health Insurance Exchanges ,
Guidance Update ,
Health Insurance ,
Health Insurance Exchanges ,
Healthcare.gov ,
IRS ,
Public Health Insurance Marketplace ,
Reporting Requirements ,
Subsidies ,
Tax Credits ,
Tax Liability
On September 16, 2015, the IRS finalized these ACA coverage reporting Forms and Instructions... We report here, with minimal analysis, changes that we recognized on first comparison to the 2015 Draft Forms and Instructions....more
9/21/2015
/ Affordable Care Act ,
COBRA ,
Employer Mandates ,
Health Insurance ,
HRA ,
Insurance Industry ,
IRS ,
Medicare ,
Minimum Essential Coverage ,
Multiemployer Plan ,
Reporting Requirements ,
Required Forms ,
Self-Insured Health Plans ,
TRICARE
The FDA’s 105-page final rule on chain restaurant nutrition labeling of menu items now has an associated, 53-page, draft guidance document, supplementing the FDA’s 132-page Food Labeling Guide, we learned from the September...more
...So, why did HHS need over five years to propose the set of rules published September 8? Here are a few highlights. For brevity’s sake, we omit foreign language service requirements, disability accommodation, compliance...more
9/11/2015
/ Affordable Care Act ,
Age Discrimination ,
Anti-Discrimination Policies ,
Association Discrimination ,
Comment Period ,
Covered Entities ,
Department of Health and Human Services (HHS) ,
Employer Group Health Plans ,
Essential Health Benefits ,
Gender Discrimination ,
Health Insurance ,
Pregnancy ,
Proposed Regulation ,
Public Health Insurance Marketplace ,
Race Discrimination ,
Sex Discrimination ,
Sexual Orientation Discrimination ,
State Health Insurance Exchanges ,
Title IX ,
Title VI ,
Transgender
Here’s the coming dilemma: let IRS assess employer mandate taxes based on errant Healthcare.gov subsidy certifications or appeal those errors to prevent those assessments. “Where’s the dilemma?” you say. Here: once you...more
Why should you care? Subsidy certification of even one applicant claiming to be a full-time employee not offered affordable, qualifying 2015 coverage can cause the IRS to assess a non-deductible tax against the applicant’s...more
On August 18, 2014, we posted our, “First Look at ACA Employer Compliance Software.” It’s time for an update. We invited less than a dozen vendors to answer these twenty-two questions....more
8/26/2015
/ Affordable Care Act ,
Employee Benefits ,
Form 1094 ,
Form 1095 ,
IRS ,
Large Employer ,
Payroll Taxes ,
Software ,
Surveys ,
Technology ,
Vendors
At about the same time as last year, the IRS has released draft ACA coverage information reporting Forms and Instructions to be used early next year. There are many small differences and one HUGE difference. The IRS decided...more
8/13/2015
/ Affordable Care Act ,
COBRA ,
Employer Group Health Plans ,
Form 1094 ,
Form 1095 ,
Form 8809 ,
Full-Time Employees ,
IRS ,
Multiemployer Plan ,
Required Forms ,
W-2
This seems to be a trend. ACA amendments with some bipartisan support can get done if they are buried in unrelated legislation. When the President signed H.R. 3236, the ACA employer mandate was amended to promote small...more