Archives: Health Plans

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Health Plans Must Certify Ability to Conduct Electronic Transactions

By December 31, 2015, group health plans must complete a testing process and certify that they are able to conduct electronic transactions in accordance with uniform standards and operating rules.  Plans must also ensure that third-party administrators and other outside vendors are in compliance with the electronic transaction rules if the vendors conduct transactions on … Continue Reading

Can You Reduce Your VEBA’s Taxable Income?

Recent guidance from the IRS suggests that it will be helpful to segregate funding for retiree health benefits from funding for all other welfare benefits (such as retiree life insurance, disability benefits, and health benefits for active employees) in order to minimize tax liabilities.  A proposed regulation issued earlier this year indicates that segregating the … Continue Reading

Health Plan I.D. Application Deadline Is Approaching

Group health plan sponsors and administrators focused on compliance with ACA’s shared responsibility rules might not be aware that another compliance deadline is looming.   By November 5, 2014, most group health plans must apply to the Centers for Medicare & Medicaid Services (CMS) for a unique health plan identifying number.  (Please visit the “Deadlines” page … Continue Reading

Final Health Coverage Reporting Rules Offer Employers Little Relief

Many employers will face two significant new reporting requirements for employee health coverage starting next year: Section 6055 Return:  Employers and insurers that provide minimum essential coverage must report information to the IRS about each covered individual for each month, and provide a copy of the report to covered employees and retirees. Section 6056 Return:  … Continue Reading

Top Ten Things to Know about the Final Shared Responsibility Regulations

The final shared responsibility regulations under the Affordable Care Act, issued earlier this month, in large part maintain the rules set forth in the proposed regulations.  However, there are several ways in which the final regulations modify or clarify these rules.  Below is a top ten list (which we’re sure David Letterman would use if … Continue Reading

Compliance Strategies for Employee Assistance Programs

If an employee assistance program (“EAP”) provides counseling for substance abuse, stress, depression, and similar health problems, the Labor Department and IRS regard it as a group health plan.  Unless the EAP qualifies for an exception, it will have difficulty complying with the group health plan coverage requirements and other mandates. Recent guidance from the … Continue Reading

New Guidance Clarifies Minimum Essential Coverage Rules

Starting in 2014, most individuals must maintain minimum essential health coverage or pay a penalty.  (Please see our post here for a description of the health coverage mandates that apply to individuals and their families.)  The Internal Revenue Service recently issued a proposed regulation clarifying the minimum essential coverage rules and other aspects of the … Continue Reading

Dust Off HIPAA Policies and Procedures Before HHS Comes Knocking

Employers should be aware that the Department of Human Services (“HHS”) is stepping up its enforcement of requirements for covered entities, such as group health plans, to adopt and implement policies and procedures for protecting and securing protected health information in accordance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).  As our … Continue Reading

Could Smoking Cessation Programs Violate Mental Health Parity Rules? Traps for the Unwary in Recent Regulations

The Obama administration recently issued final regulations implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addition Equity Act of 2008 (the “MHPAEA”).  The regulations implement the MHPAEA’s prohibition against imposing limits on mental health and substance use disorder benefits that are more restrictive than the limits on medical and surgical benefits.  The … Continue Reading

Fiduciaries May Be Responsible for Call Center Statements to Fill in Gaps in SPD

A recent Seventh Circuit case, Killian v. Concert Health Plan (Nov. 7, 2013), highlights two important principles for any plan sponsor or fiduciary: If a plan document or summary plan description leaves out information and says to call a phone number for details, plan fiduciaries can be responsible for call center representatives’ oral statements and … Continue Reading

Potential Savings Opportunity for Sponsors of Self-Insured Medical Plans

By now, employers who sponsor self-insured medical plans are familiar with the fees they must pay to fund Patient-Centered Outcomes Research (“PCORI”) and the Transitional Reinsurance Program. This post describes a detail that can have a significant effect on the amount that each sponsor must pay. Both fees are calculated as a dollar amount per covered … Continue Reading

IRS Issues Special Administrative Procedures for DOMA Tax Refund Claims by Employers

The IRS issued a notice today setting forth special procedures by which employers may claim a refund of FICA taxes that were paid on employee benefits solely because of the application of the Defense of Marriage Act (“DOMA”).  Section 3 of DOMA prohibited the IRS from recognizing same-sex marriages for federal tax purposes and was … Continue Reading

Not To Miss the Party, Department of Labor Joins the Place Of Celebration Approach Following Windsor

The Department of Labor issued a technical release today addressing the effect of the Supreme Court’s decision in U.S. v. Windsor on employee benefit plans.  The Windsor decision struck down section 3 of the Defense of Marriage Act, thereby requiring the federal government to recognize same-sex marriages that are recognized under state law.  The IRS … Continue Reading

Department of Labor Confirms No Penalty For Failing to Provide Exchange Notice

The Affordable Care Act requires employers to provide to employees a written notice about public health exchanges (now called Health Insurance Marketplaces).  The Department of Labor issued a frequently asked question today confirming that employers subject to the Fair Labor Standards Act (FLSA) should provide the notice by October 1, 2013, but there is no … Continue Reading

Health Coverage Reporting Rules Create New Burdens for Employers

The IRS has released proposed regulations that implement two significant new reporting requirements for employer group health plans.  Employers and insurers that provide minimum essential health coverage must report information to the IRS about the coverage provided to each individual for each month, with a copy of the statement to the individual.  Employers with at … Continue Reading

Celebrating the Arrival of Windsor Guidance: Same-Sex Marriages Will Be Recognized For Federal Tax Purposes Based on Place of Celebration

The IRS issued guidance today defining same-sex marriage for purposes of federal tax rules.  Following the Supreme Court’s decision in United States v. Windsor last June invalidating section 3 of the Defense of Marriage Act (DOMA), federal law no longer limits the definition of marriage to opposite sex spouses.  However, the Windsor decision did not … Continue Reading

ACA Employer Mandate Survives Constitutional Challenge

A federal court of appeals has ruled unanimously that the employer mandate under the Affordable Care Act is a valid exercise of Congress’s constitutional power to regulate commerce.  The employer mandate requires employers with more than 50 full-time employees to provide affordable health coverage or pay a penalty.  The plaintiffs argued that the Commerce Clause … Continue Reading

Final Rules Confirm Contraceptive Coverage Exemption and Accommodation for Religious Institutions

Final regulations issued recently clarify and confirm the contraceptive coverage exemption and accommodation for religious institutions.  The Affordable Care Act generally requires non-grandfathered group health plans and insurance policies to cover the cost of contraceptives.  A religious employer, however, is entirely exempt from this requirement under the final regulations and under related guidelines issued by … Continue Reading

Treasury Delays ACA’s Employer Mandate until 2015

The Department of Treasury announced today that it is delaying the effective date of the tax imposed on employers (with at least 50 full-time employees) who fail to provide health coverage to full-time employees and their child dependents.  Under the Affordable Care Act, an employer that does not provide adequate coverage could be subject to … Continue Reading

Supreme Court’s DOMA Decision Has Significant Implications for Employers and Employee Benefit Plans

Earlier today in United States v. Windsor, the Supreme Court struck down section 3 of the federal Defense of Marriage Act (“DOMA”).  Section 3 of DOMA limits the definition of marriage for purposes of federal law to marriage between individuals of the opposite sex.   The Court held that DOMA deprives same sex couples of due … Continue Reading

Two Recent Reports Indicate Some Optimism Regarding Health Care Costs

Two recently released reports indicate that the cost of healthcare will not increase as much as previously expected.  Milliman recently issued the 2013 Milliman Medical Index, showing that the total annual cost of healthcare for a typical family of four covered by an employer-provided plan increased in 2013 by 6.3%.  According to the report, this is … Continue Reading

Misclassified Workers Create Penalty Risks Under Health Reform

Earlier this year we described the IRS’s Voluntary Classification Settlement Program (VCSP), which substantially reduces an employer’s liability for back taxes when the employer voluntarily reclassifies employees who have been treated as independent contractors.  Through June 30, the relief program is available even if the employer did not file Forms 1099 reporting the compensation paid … Continue Reading
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