Making a List, Checking it Twice – 2017

It’s that time of year when boys and girls start making their lists for the holidays, but we in the employee benefits world make a very different kind of list.  In the rapidly changing world of employee benefits and executive compensation law, checklists can be particularly helpful to make sure important issues do not fall through the cracks.  Each year we publish health and welfare, cost-of-living, executive compensation, and qualified retirement plan checklists to help individuals stay apprised of changes in the law, changes that they might need to make to their employee benefits plans, and various notice requirements.  We just published the last of our annual checklists.  Read More ›

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IRS to Begin Enforcing 4980H Penalties on Large Employers Before End of 2017

On November 2, 2017, the IRS issued guidance regarding the enforcement of Employer Shared Responsibility payments, otherwise known as the Section 4980H penalty. Questions 55-58 of the IRS Questions and Answers on Employer Shared Responsibility Provisions Under the Affordable Care Act indicate that the IRS is moving forward with assessing penalties on Applicable Large Employers (“ALEs”) who failed to offer appropriate health care coverage under Section 4980H for the 2015 calendar year.

An ALE is generally an employer who employs at least 50 full-time employees during the calendar year. An ALE will be assessed a penalty for the 2015 year if any full-time employee received a premium tax credit or cost-sharing reduction and either: (a) the employer failed to provide minimum essential health coverage to 95% of its full-time employees; or (b) the employer offered minimum essential health coverage to 95% of its full-time employees, but the coverage was not affordable or did not provide minimum value. Read More ›

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Wellness Incentives Under Scrutiny After District Court Decision

In the most recent updates to the AARP v. EEOC wellness case (AARP v. EEOC, D.D.C., No. 1:16-cv-02113), the District Court for the District of Columbia has ordered the Equal Employment Opportunity Commission (“EEOC”) to review the wellness regulations related to the Genetic Information Nondiscrimination Act (“GINA”) and the Americans with Disabilities Act (“ADA”) with respect to the amount of incentives that an employer may provide under a wellness program.

The ADA and GINA both permit the collection of certain health information by an employer so long as the disclosure is “voluntary.” However, neither the ADA nor GINA provides a definition of what is considered “voluntary.”  In May of 2016, the ADA and GINA wellness regulations were finalized and provide, in relevant part, that a wellness program can offer incentives or penalties of up to 30% of the cost of self-only coverage. Read More ›

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Transgender Benefits Revisited?

In a series of tweets published on July 26, 2017, President Trump announced a ban on transgender service in the armed forces.  In the wake of this reversal of government policy, employers may question the current state of transgender benefits and whether additional changes are forthcoming.

On May 18, 2016, the Department of Health and Human Services (“HHS”) issued final regulations implementing the nondiscrimination provisions of the Affordable Care Act (“Section 1557”), which prohibit, in part, the categorical refusal of coverage to transgender participants and require that individuals be treated consistent with their self-selected gender identity.  As a result of these changes, many employer group health plans started covering an array of transgender benefits ranging from mental health counseling to gender reassignment surgery. Read More ›

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Open Enrollment Looms and ACA Changes are Uncertain – What are Employers to Do?

On the morning of July 28, 2017, another effort to repeal or replace the Affordable Care Act (“ACA”) failed in a 49-51 Senate vote when three Republican senators voted against the bill. Attempts to pass even a trimmed down “skinny” version of the bill were unsuccessful.  Following this dramatic vote, the path forward for health care reform is as uncertain as ever.

With fall open enrollment fast approaching, employers may be wondering what actions to take with respect to their health plans. Given the uncertainty of whether changes will be made to the ACA before open enrollment, employers may wish to proceed as though the ACA will remain in effect for 2018. Read More ›

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Recent Mental Health Parity Guidance — A Good Reminder to Review Your Health Plan for Compliance

The Mental Health Parity and Addiction Equity Act of 2008 (“MHPAEA”) generally requires that the financial requirements and treatment limitations that apply to mental health and substance use disorder (“MH/SUD”) benefits cannot be more restrictive than the financial requirements and treatment limitations that apply to medical and surgical (“M/S”) benefits.  Financial requirements include, for example, deductibles and coinsurance.  Treatment limitations can be quantitative (e.g., limits on the number of days or visits covered under the plan) or non-quantitative (“NQTL”) (e.g., requiring participants to obtain prior authorization before treatment).

The MHPAEA and its implementing regulations also require plan administrators to provide various disclosures upon request regarding MH/SUD benefits.  Read More ›

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Why Isn’t My “Free” Preventive Health Care Free?

In my opinion, one of the best changes made by the Affordable Care Act is the mandate that requires health plans to provide certain specified preventive services without imposing any cost sharing.  This is sometimes referred to as “free” preventive care.  As a result of this mandate, deductibles, copays, coinsurance, and other cost sharing may not be imposed on the specified preventive services if they are provided by an in-network provider. 

The thing that is so great about free preventive care is that it results in better health outcomes for employees and their families, while, at the same time, saving employers from paying larger health claims when illnesses are not diagnosed early.  Read More ›

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Full Steam Ahead: IRS Moves Forward to Collect Affordable Care Act Penalties

As efforts to reform the Affordable Care Act (the “ACA”) stall in Congress, a recent government report suggests that the Internal Revenue Service is preparing to identify and collect employer shared responsibility penalties.

The Treasury Inspector General for Tax Administration issued the report, Affordable Care Act: Assessment of Efforts to Implement the Employer Shared Responsibility Provision, two weeks after House leadership retracted a bid to repeal and replace the ACA.

The report indicates that the IRS processed over 400,000 Forms 1094-C (Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns) and nearly 110 million Forms 1095-C (Employer-Provided Health Insurance Offer and Coverage) as of last October.  Read More ›

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Curing What Ails You – Relief for Small Employer HRAs

The impact of the Affordable Care Act (“ACA”) on health reimbursement arrangements (“HRAs”) has not been favorable.  Many employers got rid of their HRAs or integrated them with a major medical plan in order to avoid significant penalties under ACA.  These rules imposed a significant burden on small employers, because many small employers used HRAs to reimburse employees for the cost of individual health insurance policies they purchased rather than sponsor a group health plan.

In IRS Notice 2015-17, Q&A1, the IRS granted limited relief for small employer HRAs through June 30, 2015.  However, at the end of last year, small employers received greater relief in the form of the 21st Century Cures Act (the “Cures Act”). Read More ›

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Trumping the Affordable Care Act? Not So Fast – Impact of Executive Order on Employers Unclear

On January 20, 2017, President Trump signed an Executive Order (“Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal,” hereinafter referred to as the “Order”) relating to the future of the Affordable Care Act (“ACA”).  The stated goal is to direct the agencies (IRS, HHS, and DOL) to waive or defer provisions of the ACA that would “impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products or medications.”  Notoriously absent from this list is any mention of employers or plans.  Read More ›

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