Final Forms and Instructions for ACA Information Reporting Released

The IRS recently released the final forms and instructions for information reporting under the Affordable Care Act (“ACA”).  The final forms and instructions will be used for reporting in 2016 concerning 2015 coverage.  The final forms and instructions can be accessed below.

Form 1094-B

Form 1095-B

Instructions for Forms 1094-B and 1095-B

Form 1094-C

Form 1095-C

Instructions for Forms 1094-C and 1095-C

The final forms do not contain any significant changes from the prior draft versions.  Both sets of final instructions also remain largely unchanged, but they contain a few important modifications with respect to reporting specific types of coverage.  For example, the final instructions modified the rules for reporting multiemployer plan coverage, COBRA coverage, and HRA coverage. Read More ›

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New Draft Instructions Released for ACA Information Reporting

As explained in my previous blog, Code Sections 6055 and 6056, added by the Affordable Care Act (“ACA”), require all employers (even small employers) sponsoring self-funded health plans and large employers to file information returns with the IRS and furnish statements to employees concerning the health coverage offered or provided to these employees and their dependents.  Mandatory reporting begins in 2016 with respect to 2015 coverage. Reporting 2014 coverage in 2015 was voluntary.

On August 6, 2015, the IRS released the 2015 draft instructions for mandatory reporting. The 2015 draft instructions contain several changes from the 2014 instructions for voluntary reporting. Read More ›

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ACA Information Reporting Penalties Have Been Increased

Code Sections 6055 and 6056 require large employers and all employers (even small employers) sponsoring self-funded health plans to file information returns with the IRS and furnish statements to applicable employees concerning the health coverage offered or provided to these employees and their dependents.  This information reporting begins in 2016 with respect to 2015 coverage.  It will be similar to Form W-2 reporting.

The Trade Preferences Extension Act of 2015 (the “TPEA”), enacted on June 29, 2015, increased the penalties for failing to comply with these new reporting requirements.  Before the TPEA, penalties were $100 per failure with an annual maximum of $1.5 million.  Read More ›

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May Companies Reduce Employee Hours to Avoid ACA Requirements?

The Affordable Care Act (the “ACA”) generally requires that large employers offer health coverage that meets certain requirements to their full-time employees (i.e., employees working 30 hours or more per week) and their children to avoid paying potential tax penalties.  Some employers have decided to reduce certain employees’ hours to less than 30 hours per week, rendering these employees ineligible for health coverage under the terms of an applicable group health plan while insulating the employer from any ACA tax liability with respect to these employees.

A class action suit filed in May against Dave & Buster’s Inc. (“D&B”) contends that this conduct violates ERISA Section 510 and requires D&B to reinstate coverage for those employees who were reduced to part-time status.  Read More ›

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EEOC Proposed Regulations May Require Revisions to Your Tobacco Prevention Wellness Program

In our April 21 blog, Wellness Programs: Agencies Issue Helpful Guidance but Look Before You Leap, Nancy Campbell wrote about the release of the much-anticipated EEOC proposed regulations concerning wellness programs.  In her blog, Nancy briefly touched upon some of the differences between the EEOC proposed regulations and the final HIPAA wellness regulations issued by the Departments of Treasury, Labor, and Health and Human Services on June 3, 2013.

One of the most noteworthy differences between the two regulations is the treatment of the maximum permissible reward that employers can offer to employees under wellness programs designed to prevent or reduce tobacco use.  Read More ›

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IRS Forms and Instructions Finalized for Reporting Health Coverage

On February 8, 2015, the IRS released final forms and instructions for reporting health coverage pursuant to Code Sections 6055 and 6056, which were added by the Health Care Reform Act.  Please see our SW Benefits Update, “Final IRS Forms and Instructions for Reporting Health Coverage Clarify Large Employer Requirements for 2015 and Beyond” for more information on this reporting and the noteworthy revisions to the instructions.  The forms and instructions can be found here, and in the SW Benefits Update. Read More ›

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EAPs That Meet Four Requirements May Avoid Application of Health Care Reform

Benefits provided through an employee assistance program (“EAP”) may be considered group health plan coverage, which would subject the EAP to the health care reform requirements mandated by HIPAA and the Health Care Reform Act, unless the EAP meets the criteria for being “excepted benefits.”

In September 2013, the IRS, HHS, and DOL collectively issued Notice 2013-54, which stated that, through 2014, benefits provided through an EAP were considered excepted benefits if the EAP did not provide “significant benefits in the nature of medical care.”  The notice did not elaborate on the terms “significant” or “medical care,” but the notice permitted employers to use a reasonable, good faith interpretation of these terms.  Read More ›

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HHS Extends November 17 Deadline to Submit Covered Lives Data under Reinsurance Program

The Health Care Reform Act created the transitional reinsurance program, which requires most self-insured health plans to make contributions to HHS for the 2014, 2015, and 2016 calendar years, in an attempt to stabilize premiums in the individual market.  The contribution amount is determined by the number of covered lives under each plan.  For 2014, the contribution amount is $63 per covered life.  The number of covered lives must be calculated and submitted to HHS by November 15 of each year.  The first filing was due November 17, 2014 for the 2014 calendar year (November 15, 2014 was a Saturday).

HHS has extended this November 17, 2014 deadline until December 5, 2014Read More ›

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November 5 Deadline to Obtain HPID Delayed by HHS

On October 31, 2014, HHS announced a delay, “until further notice,” in the enforcement of the regulations pertaining to Health Plan Identifiers (HPIDs) and their use in HIPAA standard electronic transactions.  For more information on the HPID requirements, please see our October 1, 2014 SW Benefits Update, “HIPAA Requires Many Health Plans to Obtain a Health Plan Identifier by November 5, 2014.”  This enforcement delay applies to all HIPAA-covered entities, including healthcare providers, health plans, and healthcare clearinghouses.

The decision to delay enforcement was based, in part, on a recommendation by the National Committee on Vital and Health Statistics (NCVHS), which is an advisory body to HHS.  Read More ›

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Gear Up for Reporting of Health Coverage

Starting in 2016, Section 6055 of the Internal Revenue Code (the “Code”), which was added by the Health Care Reform Act, requires all entities providing “minimum essential coverage” (“MEC”) to submit information to the IRS concerning each covered individual for the 2015 calendar year.  Section 6055 also requires these entities to provide statements containing similar information to certain covered individuals.  MEC is broadly defined to include any group health plan or group health insurance that is not an excepted benefit (e.g., stand-alone dental or vision plans). As noted, all entities providing MEC must comply with Section 6055. This includes, for example, all employers sponsoring self-insured group health plans, regardless of employer size.  Read More ›

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