Employee Benefits & Executive Compensation Blog

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Category Archives: Affordable Care Act

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Notice Requirement for Small Employer HRAs Delayed Pending Regulations

On February 27, 2017, the Internal Revenue Service issued Notice 2017-20 delaying the notice requirement for qualified small employer health reimbursement arrangements (“QSEHRAs”).  By way of background, prior to enactment of the 21st Century Cures Act (“Cures Act”) in December 2016, the Affordable Care Act prohibited HRAs unless they were integrated with group health plans.  … Continue Reading

Repealing and Replacing the ACA: Five Developments Likely to Occur in the Years Ahead

On the back of the 2016 United States presidential election results, the health care industry ponders how a Republican president and Congress will transform the business environment. The health care industry has a number of important questions which need to be examined. Proskauer’s Health Care Group looks at key issues, including: the meaning of “repeal … Continue Reading

IRS Extends Distribution (Not Filing) Deadline for ACA Reporting and Continues Good Faith Standard

Today, the IRS announced (see Notice 2016-70) an extension to the distribution (but not filing) deadline for the Affordable Care Act (ACA) reporting requirements set forth in Sections 6055 and 6056 of the Internal Revenue Code (the “Code”).  Under Code Section 6055, health coverage providers are required to file with the IRS, and distribute to … Continue Reading

Marketplace Subsidy Notices – What Employers Should Know

As promised by the Centers for Medicare & Medicaid Services (CMS) in late-2015, the Federally-Facilitated Marketplaces (FFMs) have started sending notices informing employers that employees have enrolled in a FFM and were determined eligible for premium subsidies. Because the employer shared responsibility penalties set forth in Section 4980H of the Internal Revenue Code (the “Code”) … Continue Reading

Health and Human Services, Labor and Treasury Departments Release New Summary of Benefits and Coverage Templates and Accompanying Documents

The Departments of Health and Human Services (“HHS”), Labor (“DOL”), and Treasury (the “Departments”) have jointly released final changes to the Summary of Benefits and Coverage (“SBC”) template, the Uniform Glossary, and accompanying documents. Background The ACA requires group health plans and health insurance issuers to compile and provide to consumers an SBC that describes … Continue Reading

ACA Reporting Update – The Final Stretch

After months of preparation and multiple iterations of (sometimes conflicting) IRS guidance, health coverage providers and applicable large employers are nearing the end of the 2015 reporting season under the Affordable Care Act (ACA). By way of background, the ACA added new Sections 6055 and 6056 to the Internal Revenue Code (the “Code”).  Code Section … Continue Reading

Big Employer Win in Wellness Program Case EEOC v. Flambeau

For the past couple of years, the U.S. Equal Employment Opportunity Commission (EEOC) has been challenging employer wellness programs for their alleged violations of the Americans with Disabilities Act (ADA).  The most recent EEOC challenge was in EEOC v. Flambeau, Inc., (No. 14-cv-638-bbc (December 31, 2015)).  In this case, the U.S. District Court for the … Continue Reading

IRS Extends Deadlines for Affordable Care Act Reporting

Today, the IRS released Notice 2016-4, which extended the distribution and filing deadlines for the Affordable Care Act (ACA) reporting requirements set forth in Sections 6055 and 6056 of the Internal Revenue Code (the “Code”).  Under Code Section 6055, health coverage providers are required to file with the IRS, and distribute to covered individuals, forms … Continue Reading

IRS Notice 2015-87 (Part 1) – IRS Issues New HRA Integration Rules

On December 16, 2015, the Internal Revenue Service issued Notice 2015-87 containing guidance on a wide-range of topics under the Affordable Care Act (ACA). In addition to providing guidance on affordability and COBRA matters (which will be described in subsequent blogs), Notice 2015-87 builds upon prior guidance to regulate further the use of health reimbursement … Continue Reading

So-Called Cadillac Tax Delayed until 2020

On December 16, 2015, the House of Representatives struck a tentative deal on an appropriations bill that would fund the federal government through the 2016 fiscal year.  Among other things, the 2016 Consolidated Appropriations Bill would delay the effective date of the controversial 40% excise tax on high-cost health plans (commonly referred to as the … Continue Reading

Supreme Court Agrees to Hear Contraceptive Mandate Cases

As part of its requirement that non-grandfathered group health plans provide benefits for certain preventive care without cost sharing, the Affordable Care Act (“ACA”) requires these plans to cover at least one form of women’s contraception in each of the 18 methods identified by the Food and Drug Administration.  The U.S. Supreme Court previously ruled … Continue Reading

New Affordable Care Act FAQs Provide Guidance on Preventive Services, Wellness Programs and Mental Health Parity

On October 23, 2015, the Departments of Labor, Health and Human Services and Treasury (the “Agencies”) jointly released their twenty-ninth (XXIX) set of Frequently Asked Questions (FAQs) about Affordable Care Act (ACA) implementation.  This latest set of FAQs generally (1) clarify that certain services performed ancillary to various preventive services must also be covered without … Continue Reading

ACA Automatic Enrollment Mandate Repealed by Bipartisan Budget Act

On Monday, November 2nd, the President signed the Bipartisan Budget Act of 2015 (BBA).  Some legislators had hoped that a budget deal would at least include a repeal of the controversial 40% excise tax on high-cost health care (the so-called “Cadillac Tax”).  However, the BBA left the Affordable Care Act (ACA) largely intact, with the … Continue Reading

EEOC Grapples with Proposed Rule Comments on Wellness Program; Additional Guidance Expected Soon

As we previously reported here, the Equal Employment Opportunity Commission (EEOC) released Proposed Rules on April 16, 2015 to provide guidance under the Americans with Disabilities Act (ADA) on permissible employer incentives for employee participation in wellness programs.  Comments on the proposed rules were due on or before June 19, 2015.  The EEOC received approximately … Continue Reading

New Final Regulations and FAQs Provide Guidance on Preventive Services Coverage

Through new FAQs and final regulations, the U.S. Departments of Labor (“DOL”), Health and Human Services (“HHS”) and the Treasury (the “Departments”) have further clarified various issues related to the preventive care coverage requirement for non-grandfathered group health plans under the Affordable Care Act (“ACA”) as related to preventive care coverage. Background The ACA requires … Continue Reading

New IRS Guidance on 40% Excise Tax Previews Future Regulatory Complexity

Although public opposition to the 40% excise tax on high-cost health care (the so-called “Cadillac Tax”) is rapidly growing, the IRS continued to develop a regulatory framework for administration of the excise tax through its issuance of Notice 2015-52 on July 30, 2015. Similar to the first notice on this topic, Notice 2015-52 merely identifies … Continue Reading

ACA Reporting Update: New Forms, Higher Penalties & Other Guidance

With the impending deadline early next year, most applicable large employers are (or should be) in the process of gearing up for what is perhaps the biggest Affordable Care Act (“ACA”) compliance challenge this year — the information reporting requirements found in Sections 6055 and 6056 of the Internal Revenue Code (the “Code”). Many employers … Continue Reading

Agencies Issue Final Regulations on the Summary of Benefits and Coverage (SBC) Requirements

As promised in the FAQ issued on March 30, 2015, the U.S. Departments of the Treasury, Labor and Health and Human Services  (the Departments) have issued final regulations regarding the summary of benefits and coverage (SBC) and uniform glossary for group health plans and health insurance coverage in group and individual markets under the Patient … Continue Reading

Reminder: Non-Grandfathered Plans Must Implement Embedded Out-of-Pocket Maximums

As employers and plans prepare for 2016 open enrollment, they must be sure to address in their benefit design and with their third party vendors the new embedded out-of-pocket maximum limitations on individuals that were announced at the end of May by the U.S. Departments of Labor (“DOL”), Health and Human Services (“HHS”) and the … Continue Reading

King v. Burwell – Supreme Court Upholds Premium Subsidies under Federally-Run Marketplaces; ACA Remains (Mostly) Unfazed

On June 25, 2015, the United States Supreme Court released its much anticipated King v. Burwell decision regarding the validity of premium assistance issued by Federally-run Marketplaces.  Chief Justice Roberts, writing for the 6-3 majority, agreed with the Internal Revenue Service’s (IRS) interpretation that premium assistance under the Patient Protection and Affordable Care Act of … Continue Reading
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