Posts Categorized: Affordable Care Act

Newly Released FAQs Address Health Plan Compliance Issues

in Affordable Care Act, Health Benefits

New FAQs (Part 31) have been issued highlighting various compliance issues and can be found at  The questions address a wide range of issues, including preventive care, coverage for clinical trials, required disclosures, the Women’s Health and Cancer Rights Act, rescissions, reference pricing and mental health parity requirements.  Here are a few highlights from these new FAQs: — Preventive care coverage, with no cost-sharing, includes coverage of bowel preparation medication prescribed for colonoscopies performed as screening procedures because the preparation is an integral part of the procedure. — When a plan uses reasonable medical management techniques in determining preventive… Continue Reading

Expected Timeline for New SBC Template

in Affordable Care Act, Health Benefits

The Department of Labor has issued a new FAQ (Part 30) stating that after March 28, 2016 (the end of the comment period for the proposed changes to the Summary of Benefits and Coverage template and related documents), the Departments will finalize the SBC template and associated documents “expeditiously.”   The intent is for the new template to be used beginning on:  the first day of the first open enrollment period that begins on or after April 1, 2017, for plan years beginning on or after that date.  For calendar year plans, this means the new template would be used with… Continue Reading

Comments Requested for Revisions to the SBC Template

in Affordable Care Act

The Department of Labor has submitted a request for comments on revised templates for the Summary of Benefits and Coverage (SBC), Uniform Glossary and related material.  The new proposed forms and instructions can be found here. One significant proposed change to the SBC includes the addition of another example of costs.  The new SBC, in addition to providing typical costs for pregnancy and type 2 diabetes, would also require costs for a foot fracture, including services for ambulance services, emergency room care, x-rays, crutches and physical therapy. We will provide more detailed information about these proposed changes in the near… Continue Reading

Liability under ERISA for Reducing Work Schedules?

in Affordable Care Act, Court Cases

Earlier this week, the Southern District of New York denied a motion to dismiss a case against Dave & Buster’s, Inc. – a development that is sure to concern many employers around the country.  This case, Marin v. Dave & Busters,  raises the question of whether an employer, by reducing its employees’ full-time hours to avoid providing health insurance or paying a penalty under the Affordable Care Act, is discriminating in violation of ERISA Section 510.  In a nutshell, ERISA Section 510 makes it unlawful for an employer to discriminate against a participant for exercising a right to which he… Continue Reading

Happy New Year from the IRS

in Affordable Care Act, Tax Issues

Yet another end-of-year brings another late-breaking IRS notice. The IRS has extended the deadlines that apply to employers and coverage providers for reporting health coverage through the 2015 Forms 1094/1095.  Specifically, IRS Notice 2016-4: Extends the date for providing Forms 1095-B and 1095-C to individuals from February 1, 2016 to March 31, 2016; and Extends the filing date with the IRS for Forms 1094-B, 1095-B, 1094-C, and 1095-C  from March 31, 2016 to June 30, 2016, if filing electronically, and from February 29, 2016 to May 31, 2016 if not filing electronically. These extensions are automatic, and supersede the 30… Continue Reading