STATE AND FEDERAL REGULATIONS

BeneCo provides Legislative Alerts on a monthly or more frequent basis as needed. These are derived from what our leadership is reading and designed to keep employers informed of the top most relevant issues in the state and federal regulatory environment.

 

October 2017

Reminder: Don’t Miss the October 14th Deadline for Medicare Part D Coverage Notices
Plan sponsors that offer prescription drug coverage must provide notices of “creditable” or “non-creditable” coverage to Medicare-eligible individuals before each year’s Medicare Part D annual enrollment period—this year, by Oct. 14, 2017. …read more

August 2017

New York Employers: Get Ready for Mandatory Paid Family Leave
Effective January 1, 2018, employers that provide Disability Benefits Law coverage to New York-based employees will also be required to provide Paid Family Leave coverage. The PFL will be phased in over the next four years, with the duration and amount of the paid leave benefit increasing each year. …read more

July 2017

How to Set Up Your Cafeteria Plan for Pretax Employee Benefits
Many employers permit employees to pay for their premium share of contributions on a pretax basis through cafeteria plans, which provide a special exception to general federal income tax rules applicable to an employee’s income. …read more

May 2017

IRS Announces HSA and HDHP Limitations for 2018
ACA out-of-pocket maximums are higher than the maximums for HDHPs. The ACA requires that the family out-of-pocket maximum include ’embedded’ self-only maximums on essential health benefits. The HDHP rules do not have a similar rule, and therefore one family member could incur expenses above the HDHP self-only out-of-pocket maximum ($6,650 in 2018). …read more

April 2017

Congress Considers Bills to Reform More than the Affordable Care Act
Not all health care legislation being debated in Congress is about repealing the Affordable Care Act (ACA). Efforts to protect work-site wellness initiatives, address the regulation of self-insured health plans and help small businesses band together in shared health plans are also underway. …read more

March 2017

ACA Nondiscrimination Nationwide Count Injunction Issue
The U.S. District Court of North Texas issued a preliminary injunction that bans the U.S. Department of Health and Human Services (HHS) from enforcing requirements in its Affordable Care Act (ACA) Nondiscrimination Section 1557 regulations prohibiting discrimination on the basis of gender identity. This injunction applies nationwide. …read more

January 2017

Deadline Around the Corner for Form 1095-C Employee Statements — Unlikely to Change If ACA Is Repealed
The deadline for employers to furnish the Form 1095-C employee statements is March 2, 2017…. [T]here is not much time left to accurately complete lines 14, 15, and 16, print and address the Forms, and place the Forms in the mail. Predictably, some employers are waiting to see what happens in the opening weeks of President Trump’s administration. …read more

View more Legislative Alerts in the sections below:

  • 2016

    Special Edition: November 2016

    Extension for Good-Faith Reporting and 2016 Forms 1095-C and 1094-C
    On November 18, 2016, the Internal Revenue Service issued Notice 2016-70, extending both the due date for furnishing individuals with Forms 1095-C and 1095-B, in addition to certain good-faith transition relief to the 2016 information reporting requirements under Code sections 6055 and 6056. …read more

    November 2016

    Post Election ACA Update:The Future of Healthcare and Compliance
    The future of health care benefits, post election, is top of mind for everyone. There are changes coming to the Affordable Care Act which will in turn impact the insurance plan that all Americans purchase. Certainly no one has a lock on exactly what will happen, but there is enough published information to provide some very educated theories. …read more

    October 2016

    HHS Proposes 2018 OOP Maximums and Marketplace Guidance
    “In 2017, the OOP limits will be $7,150 for self-only coverage and $14,300 for other than self-only coverage. HHS has proposed 2018 OOP maximums of $7,350 for self-only coverage and $14,700 for other than self-only coverage…. [A table] summarizes the ACA indexed dollars limits for 2018 and prior years.” …read more

    September 2016

    Medicare Part D – Creditable Coverage Notification Requirements
    The Medicare Modernization Act (MMA) requires entities (whose policies include prescription drug coverage) to notify Medicare eligible policyholders whether their prescription drug coverage is creditable coverage, which means that the coverage is expected to pay on average as much as the standard Medicare prescription drug coverage. For these entities, there are two disclosure requirements that must be done every year……read more

    Special Addition: August 2016

    DOL Penalties Adjusted for Inflation
    In 2015, the Federal Civil Monetary Penalties Inflation Adjustment Act Improvements Act amended the Inflation Adjustment Act of 1990, requiring federal agencies to issue an interim rule by July 1, 2016 to adjust their civil monetary penalties for inflation through October 2015. The Department of Labor (DOL) published an interim final rule on June 30, 2016, to adjust the civil monetary penalties enforced by the DOL for inflation. The catch up adjustments apply to penalties assessed after August 1, 2016, for associated violations that occurred after November 2, 2015…read more

    August 2016

    Nondiscrimination Rule Expands Administrative Practices, Notice/Language Requirements and Coverage for Certain Plans
    Employers and plan sponsors should determine whether they are subject to the regulation. If so, many requirements are already effective. However, they have until October 16, 2016…to comply with the notice requirements and until the first plan year beginning on or after January 1, 2017 to make coverage changes to health insurance or group health plan benefit design…read more

    July 2016

    Final Rule on Nondiscrimination in Health Programs and Activities
    The Department of Health and Human Services (HHS), and specifically the Office of Civil Rights (OCR), issued a final rule on nondiscrimination in health programs and activities under Section 1557 of the Affordable Care Act (ACA). This section of the ACA serves protected classes of individuals whose health coverage may not be denied, cancelled, limited or refused on the basis of race, color, national origin, sex, age, or disability. The final rule clarifies existing nondiscrimination requirements, and sets new implementation standards for Section 1557.

    The broad application of this final rule will affect the federal and state Marketplaces, all health care providers and health insurance issuers and employers that receive federal financial assistance. Financial assistance from HHS includes Medicare Part A, student health plans, advanced premium tax credits and many other programs…read more

    June 2016

    DOL’s Overtime Rules Update
    On May 18, 2016, ten months after the publication of its proposed rule, the U.S. Department of Labor (“DOL”) issued its final rule (the “Final Rule”) updating the Fair Labor Standards Act’s (“FLSA”) overtime regulations relating to the executive, administrative, professional and highly compensated employee exemptions.

    As a recap, the FLSA generally requires covered employers to pay their employees at least the federal minimum wage (currently $7.25 per hour) for all hours worked and overtime pay at 1.5 times the employee’s regular rate of pay for all hours worked over 40 in a workweek. The FLSA exempts from these rules, however, employees employed in bona fide executive, administrative or professional capacities, or “highly compensated employees.” The DOL has traditionally defined these exempt classifications by requiring the satisfaction of two tests: (1) the salary test; and (2) the standard duties test…read more

    Special Edition: June 2016

    EEOC Issues New Guidance on Leave of Absence and ADA Accommodations
    On May 9, 2016, the U.S. Equal Employment Opportunity Commission (EEOC) issued a new guidance document addressing the intersection of employer-provided leave of absence and the Americans with Disabilities Act (ADA). This document does not create any new EEOC agency policy or propose any new law; rather, it consolidates current guidance on the ADA, employer leave policies, reasonable accommodations, the interactive process, undue hardship, and other relevant sub-topics.

    While the EEOC guidance document is not binding law, employers should take it into consideration when making decisions related to leaves of absence…read more

    May 2016

    HHS Announced New Health Plan Out-of-Pocket Limits for 2017
    The Department of Health and Human Services (HHS) has proposed 2017 health plan out-of-pocket (OOP) maximums of $7,150 for self-only coverage and $14,300 for family (other than self-only) coverage.

    The Affordable Care Act (ACA) imposes annual OOP maximums on the amount that an enrollee in a nongrandfathered health plan—including self-insured and large-group health plans—must pay for covered essential health benefits through cost-sharing…read more

    February 2016

    Each year, group health plan sponsors that provide prescription drug coverage to individuals eligible for Medicare Part D must disclose to [CMS] whether that coverage is ‘creditable’ or ‘non-creditable.’ The disclosure obligation applies to all plan sponsors that provide prescription drug coverage, even those that do not offer prescription drug coverage to retirees. Calendar year plans must submit this year’s disclosure to CMS by February 29, 2016…read more

  • 2015

    December 2015

    Prior to December 28th, 2015 the IRS required Applicable Large Employers to furnish their full-time employees with form 1095-C by February 1st, 2016. Likewise, health insurance issuers and Applicable Large Employers who self-insure were required to furnish their health insurance policy holders with form 1095-B, or 1095-C Part III, no later than February 1st, 2016. As of December 28th, 2015 the due date for furnishing these forms has been extended to March 31st, 2016. Additionally, the due date for filing with the IRS (forms 1094-C and 1094-B along with the companion forms 1095-C and 1095-B) has been delayed from February 29th, 2016 to May 31st, 2016 if not filing electronically and from March 31st, 2016 to June 30th, 2016 if filing electronically. This notice pertains to 2015 forms filed in 2016 only, and will not apply for any other years…read more

    October 2015

    The Affordable Care Act (ACA) dictated that groups between 50 and 99 employees would fall under community rating effective January 1, 2016. Since the law was passed in March of 2010, we and the insurance carriers have been working to provide a solution to avoiding or delaying groups of your size falling into community rating. It is our belief that this will simply drive up costs for you and your employees.…read more

    September 2015

    The IRS’ testing system allows employers to see if their software is correctly filling out the 2014 Forms 1094 and 1095…. Filing for 2014 was voluntary, and the IRS didn’t even release the final versions of the forms until February of 2015. So now the feds are opening up the testing system as a way for firms to make sure everything is in order — before costly penalties are attached to the filing process in 2016. Then, beginning in November, the ACA Assurance Testing System will be ready for the 2015 reporting forms…read more

    August 2015

    Beginning in early 2016, information reporting provisions under the Patient Protection and Affordable Care Act (the “ACA,” commonly referred to as “Health Care Reform”) require many employers to file annual information returns with the Internal Revenue Service (the “IRS”) and provide annual statements to employees containing health plan coverage information. Compliance is mandatory. Failure to file the required informational returns (or filing incomplete or inaccurate forms) could result in both reporting penalties and penalties under the ACA’s shared responsibility provisions (the so-called pay or play mandate). Employers should prepare now to meet these reporting requirements…read more

    June 2015

    The PCOR fee is assessed based on the number of employees, spouses and dependents that are covered by the plan. The fee is $1 per covered life for plan years ending before Oct. 1, 2013, and $2 per covered life thereafter, subject to adjustment by the government. For plan years ending between Oct. 1, 2014, and Sept. 30, 2015, the fee is $2.08. The Form 720 instructions are expected to be updated soon to reflect this increased fee…read more

    May 2015

    The EEOC’s proposed rule attempts to clarify what does and does not constitute a permissible wellness program in light of the ADA’s protections…. The Commission stated that ‘it has a responsibility to interpret the ADA in a manner that reflects both the ADA’s goal of limiting employer access to medical information and HIPAA’s and the Affordable Care Act’s provisions promoting wellness programs…read more

    February 2015

    In September 2014, the IRS made several updates to the Internal Revenue Manual (IRM) that provide insight on the notices and enforcement methods the Service will use this tax season to ensure taxpayers comply with the Patient Protection and Affordable Care Act (PPACA).1 Most of these compliance efforts focus on the premium tax credit and the individual shared-responsibility payment (“individual mandate”). The IRS is anticipating three early PPACA-related issues: premium tax credit calculation errors, advance premium tax credit reconciliation discrepancies, and problems with individual mandate penalty assessments and collection. …read more

  • 2014

    October 2014

    Mondays’ SCOTUS ruling (Burwell v. Hobby Lobby) upholds the rights of “closely held” businesses to exercise some religious freedoms as it pertains to their health care coverage, namely certain women’s health services mandated by the ACA. …read more

    August 2014

    The Centers for Medicare and Medicaid Services (CMS) requires employers that offer prescription drug coverage to notify their Medicare eligible participants of the creditability status of the prescription drug plan. This notification must be provided prior to the start of the annual Part D enrollment period which, in the past, has been November 15th through December 31st of each year. Beginning with the 2012 plan year, the Affordable Care Act moved the Medicare Part D annual enrollment period to October 15th through December 7th, changing the date the notices are due to October 15th. …read more

    July 2014

    Just a reminder that the PCORI fee is due for your self-funded medical plans and HRA plans on July 31, 2014. The IRS recently issued a revised Form 720: “Quarterly Excise Tax Return,” along with a related payment voucher Form 720-V which should be used to report and remit the PCORI fee. …read more

    June 2014

    The Department of Labor (DOL) on May 2, 2014, released a new model general notice form and model election notice form for providing COBRA notices to employees, and a related notice of proposed rulemaking on the COBRA notice requirements, published in the May 7 edition of the Federal Register. …read more

    April 2014

    Each year, group health plan sponsors that provide prescription drug coverage to individuals eligible for Medicare Part D must disclose to the Centers for Medicare & Medicaid Services (CMS) whether that coverage is “creditable” or “non-creditable.” The disclosure obligation applies to all plan sponsors that provide prescription drug coverage, even those that do not offer prescription drug coverage to retirees. Calendar year plans must submit this year’s disclosure to CMS by March 1, 2014. …read more

 

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