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Final Rules: 90-Day Waiting Period and Orientation Period
Final regulations were released by the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (IRS) (The Departments) regarding the Affordable Care Act (ACA) 90-day waiting period rules, including the new one month “orientation period”, which may be imposed prior to the start of the waiting period.
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How Employers Should Handle MLR Rebates 2014
For the third year, employers who sponsor an insured group health plan may be receiving a Medical Loss Ratio (MLR) rebate from their insurers. Self-funded medical benefit plans are not subject to these requirements. The rebates raise several fundamental questions for employers including:
- How much (if any) of the rebate must be distributed to plan participants?
- How quickly must I distribute the participants’ share?
- What options do I have in distributing the employees’ share?
- What are the tax consequences of the various distribution options that are available?
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Final Rules Amending Definition of Excepted Benefits
The Departments of the Treasury, Labor, and HHS (the Departments) have released final rules that amend regulations regarding the definition of excepted benefits. The guidance specifically addresses limited-scope dental and vision plans as well as employee assistance programs (EAPs) and what requirements must be met for such plans to be considered excepted benefits exempt from the requirements of the Health Insurance Portability and Accountability Act (HIPAA) and the Affordable Care Act (ACA). For the most part, the final rules adopt the proposed rules from December 2013.View Insight -
Section 125 Rules to Recognize Two New Permitted Election Changes
For those employers who choose to adopt such changes, the new rules provide more flexibility for individuals in either of two scenarios: (i) those changing from employer-sponsored group health coverage to other minimum essential coverage (MEC) options due to a reduction in hours; or (ii) those changing from employer-sponsored group health coverage to a qualified health plan (QHP) during a special enrollment period or annual open enrollment period through a public Marketplace (Exchange).View Insight -
IRS Releases ACA Employer Reporting Instructions
The IRS has released draft instructions for the employer health plan reporting requirements contained in the Affordable Care Act (ACA). Applicable large employers, and small employers who offer self-funded plans, now have the information they need to start planning for the required reporting beginning in 2016 for 2015 health plan data.
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Transitional Reinsurance Contribution Form to be Available Oct. 24th
The first submission of membership numbers to the Department of Health and Human Services (HHS) for purposes of the transitional reinsurance contributions is due by November 15th of this year. Employers who sponsor self-funded health plans must report membership and schedule the first payment via a form on www.pay.gov. CMS has just announced that the form will be available on October 24th. In addition, CMS has provided a form manual with detailed instructions as to the submission process.
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Health Plan ID (HPID) Requirement Delayed
On October 31st The Centers for Medicare and Medicaid Services (CMS) announced an indefinite delay in the Health Plans ID (HPID) requirements applicable to self-funded employer sponsored health plans. Officially described as an enforcement delay, the announcement means that large self-funded employers will not be required to obtain an HPID by November 5th, 2014 as originally required. No further information regarding a new deadline, or other changes to the HPID requirements, was contained in the announcement.
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Employer Can Not Pay for Employees Individual Health Insurance
In the most direct guidance released to date, the DOL has issued new FAQs that make it clear employers are not permitted to pay for the cost of individual health insurance for employees, even if the payments are made on an after tax basis. The guidance also prohibits employers from providing cash to employees to encourage them to waive the employer’s plan and purchase individual health insurance instead.
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ACA: What Employers Need to Know about the Individual Mandate
As we all know, the Affordable Care Act (ACA) Individual Mandate requirements make their first appearance in annual income tax filing for an individual’s tax year 2014. Most taxpayers had minimum essential coverage in 2014. For those, the process is simple: Check the box at Line 61 in the “Other Taxes” Section. Taxpayers who purchased coverage on the ACA Marketplace (Exchange) have received Form 1095-A. That’s easy. What if the taxpayer received a premium tax credit from the Exchange? That’s not so easy.
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EEOC Issues Regulations Addressing ADA Requirements for Employer Wellness Programs
The EEOC has issued long-awaited proposed regulations addressing ADA requirements for employer wellness programs. The guidance also addresses the interaction between the new EEOC rules and the existing ACA and HIPAA wellness rules.
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Employer Reporting Requirements
Beginning in early 2016, employer reporting will be required for the first time based on data from the 2015 calendar year. Depending on the size of the employer and the funding arrangement of the benefits offered, employer reporting requirements vary in regard to what type of information needs to be reported (if any) and whether the employer is required to use Forms 1094-B and 1095-B (the “B” forms) or Forms 1094-C and 1095-C (the “C” forms). This issue brief covers who is responsible for reporting and which forms should be used in different situations.
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California Family Rights Act (CFRA)
The California Fair Employment and Housing Council issued updates to the California Family Rights Act (CFRA), which will take effect July 1, 2015. The changes clarify some CFRA positions, and modify the law to more closely align with the federal Family and Medical Leave Act (FMLA).