Posts Categorized: Health Benefits

Required Reading – New Instructions for ACA Reporting

in Affordable Care Act, Health Benefits, Tax Issues

Unlike the forms for the 2015 calendar year, the 2016 Forms 1095-C must be provided to employees by January 31 and must be submitted to the IRS electronically by March 31 (for those with under 250 forms submitting on paper, the deadline is February 28).  Newly revised forms and instructions for this purpose have just been released.  Although the forms have not changed much, the instructions have changed significantly.  The penalties for failing to file a correct form with the IRS or an individual is $260 for each; certain caps and exceptions apply. Even those who mastered the 2015 instructions… Continue Reading

The Latest Win for Wellness Programs May Be More of a Win for the EEOC

in Health Benefits, Wellness Programs

Although the U.S. District Court for the Eastern District of Wisconsin held that the employer wellness program at issue in EEOC v. Orion Energy Systems did not violate the ADA, the EEOC may find much it likes in this court’s rationale.  The Americans with Disabilities Act (ADA) prohibits employers from requiring employees to undergo medical examinations or answer disability-related questions, but provides certain exceptions that relate to benefit plans or wellness programs.  There have been several recent cases interpreting these exceptions, many of which had been clear wins for employer wellness programs. In this case, Orion (the employer) waived the… Continue Reading

ACA Reporting – Multiple Coverage and Requesting SSNs

in Affordable Care Act, Health Benefits

Newly proposed IRS regulations seek to clarify certain aspects of reporting of minimum essential coverage by employers and issuers under Code Section 6055.  Here, we focus on proposals that impact employer reporting (Part III of Form 1095-C).  These rules do not affect Parts I and II of Form 1095-C. No duplicative reporting required:  Because the prior rules regarding reporting of duplicative minimum essential coverage (MEC) were confusing, these proposed rules clarify that: If an individual is covered by more than one plan providing MEC provided by the same reporting entity (the plan sponsor, for a single-employer self-funded plan), reporting is… Continue Reading

Proposed Rules for Expatriate Health Plan and Certain Excepted Benefits under ACA

in Affordable Care Act, Health Benefits

Newly proposed regulations address the application of the Affordable Care Act to expatriate health plans (whether insured or self-insured), travel insurance and certain other excepted benefits, effective for plan years beginning on and after January 1, 2017.  These regulations include proposed conforming amendments relating to the Expatriate Health Coverage Clarification Act of 2014 (EHCCA) which generally exempts expatriate health plans from many of the ACA requirements.  The proposed rules mainly reflect prior guidance as well as the requirements of EHCCA. It is important to remember that expatriates may still be subject to the individual mandate (but these plans may qualify… Continue Reading

Certain Mental Health/Substance Abuse Plan Provisions Raise Red Flags

in Health Benefits, Wellness Programs

The Department of Labor has provided sample mental health/substance abuse (MH/SA) plan provisions that require scrutiny to determine compliance with the federal Mental Health Parity rules (MHPAEA).  Here are some common red flags: Pre-Authorization or Pre-Service Notification requirements – Blanket requirements for all MH/SA services – Review required following a certain number of days of in-patient treatment – Medical necessity and prescription drug reviews that differ from those imposed on medical services (such as deferring to attending physicians for medical reviews but not MH/SA or requiring authorization every 90 days for prescriptions relating to MH benefits but not medical) –… Continue Reading