Employee Benefits & Executive Compensation Blog

The View from Proskauer on Developments in the World of Employee Benefits, Executive Compensation & ERISA Litigation

Category Archives: Health Care Reform

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CBO Releases Updated Cost Estimate of American Health Care Act of 2017

On May 24, 2017, the Congressional Budget Office (“CBO”) and the staff of the Joint Committee on Taxation (“JCT”) released a cost estimate for H.R. 1628, known as the American Health Care Act of 2017 (the “AHCA”).  The CBO and the JCT issued cost estimates for prior versions of the AHCA on March 23, 2017 … 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

More Multiemployer Plan Relief – Final Rule Exempts Self-Insured/Self-Administered Plans from Transitional Reinsurance Fee in 2015 and 2016

On March 5, 2014, the Department of Health and Human Services released a Final Rule addressing, among other things, transitional reinsurance fees payable in the 2014 through 2016 benefit years. By way of background, under the Affordable Care Act (“ACA”), a transitional reinsurance fee applies to most group health plans. The transitional reinsurance fee is … Continue Reading

Coverage of Dependents: Final “Pay-or-Play” Regulations Exclude Stepchildren and Others; Extend Prior Transitional Relief

As previously reported, the IRS recently released final regulations on the Affordable Care Act’s (ACA) employer “shared responsibility” provisions, also known as the “pay-or-play” mandate. Under the mandate, in order to avoid potential penalties, an applicable large employer (generally, 50 or more full-time equivalent employees (100 or more in 2015)) must offer affordable, minimum value … Continue Reading

Relief for Multiemployer Plans (and the Employers That Love Them)

As previously reported, on Monday, February 10, 2014, the IRS released final regulations on the Affordable Care Act’s (ACA) employer “shared responsibility” provisions, also known as the “pay-or-play” mandate. While the final regulations have (predictably) received mixed reviews, some employers – most notably those with 50 to 99 employees or those that covered almost but … Continue Reading

“Pay-or-Play” & Contingent Workers: Final Regulations Provide Clarity But Not Complete Relief

As previously reported, on February 10, 2014, the IRS issued final regulations on the Affordable Care Act’s (ACA) employer shared responsibility requirements—the so-called “pay-or-play” mandate. In the regulations, the IRS provides new and additional guidance on a wide range of issues relating to the implementation of the pay-or-play rules. Among them, the IRS has restated … Continue Reading

ACA Shared Responsibility Penalties – Am I subject to (b) or not to (b)? That is the $3,000 question!

As previously reported, on Monday, February 10, 2014, the IRS released final regulations on the Affordable Care Act’s (ACA) employer “shared responsibility” provisions, also known as the “pay-or-play” mandate. The final regulations include a number of important transition rules that are intended to phase in the pay-or-play penalties during 2015 and 2016. A number of … Continue Reading

They’re Back! Final Regulations On Employer “Pay-or-Play” Mandate Released – IRS Provides Transition Relief To Employers with 50-100 Employees

On Monday, February 10, 2014, the IRS released final regulations on the Affordable Care Act’s (ACA) employer “shared responsibility” provisions, also known as the “pay-or-play” mandate. The final regulations weigh in at 227 pages. We will review them over the coming days and will release additional communication pieces once we fully digest these new regulations. … Continue Reading

Supreme Court to Resolve Circuit Split in Health Care Reform Cases

The Supreme Court will review two of the numerous lawsuits challenging the Affordable Care Act’s (ACA) requirement that group health plans and insurers cover, without cost-sharing, contraceptives and/or abortifacients (the “Contraceptive Mandate”). The plaintiffs in these suits are secular, for-profit corporations and their owners, and they assert that being forced to comply with the Contraceptive … Continue Reading

Claims Administrator Not Liable Under ERISA For Alleged Failure to Follow ACA’s Enhanced Benefit Claim Procedures

A federal court in New York appears to have issued the first published decision addressing alleged violations of the enhanced benefit claim procedures arising out of the Affordable Care Act (ACA). The new procedures contain various participant-friendly provisions, such as the right to external review, that alter ERISA’s existing benefit claim procedures for non-grandfathered welfare … Continue Reading

Oklahoma’s Challenge to Health Care Reform’s “Employer Mandate” May Proceed

A federal district court recently ruled that, at the pleadings stage, Oklahoma established standing to pursue its suit to bar enforcement of the Affordable Care Act’s (“ACA”) shared responsibility penalty provisions. Oklahoma ex rel. Pruitt v. Sebelius, No. CIV-11-30, 2013 WL 4052610 (E.D. Okla. Aug. 12, 2013). ACA contains a shared responsibility provision (also known … Continue Reading

Benefit Issues in Puerto Rico: Impact of the ACA, ERISA and the PBGC

This article highlights some recent developments that employers with Puerto Rico employee benefits arrangements should consider concerning compliance with U.S. federal laws on health care reform and the Patient Protection and Affordable Care Act (“ACA”), fiduciary duties under the Employee Retirement Income Security Act of 1974 (“ERISA”), and Pension Benefit Guaranty Corporation (“PBGC”) coverage issues.  … Continue Reading

PPACA Penalties Delayed One Year

The Obama Administration announced today that it intends to delay for one year the effective date of the employer “play or pay” penalties under health care reform, which were set to become effective in 2014. According to a press release this evening, the Administration intends to issue formal guidance next week implementing transition rules to … Continue Reading

IRS Releases Guidance on Wellness Programs and “Affordability” under the Employer Mandate

On May 3, 2013, the IRS released proposed regulations on certain provisions relating to the federal premium tax credits that eligible individuals will use to purchase subsidized health insurance coverage from public exchanges starting in 2014.… Continue Reading

Agencies Issue Updated Summary of Benefits and Coverage

On April 23rd, the DOL, HHS and IRS (the “Agencies”) released an updated template for the Summary of Benefits and Coverage (“SBC”) that group health plans and issuers are required to send to plan participants.  This updated SBC is the template to be used by plan sponsors and issuers to comply with the SBC requirements … Continue Reading

Agencies Issue New FAQs Regarding Implementation of ACA

The US Departments of Labor, Health and Human Services (HHS), and the Treasury (the “Agencies”) jointly issued yesterday a document entitled “FAQs about the Affordable Care Act Implementation Part XV” (“FAQs”) addressing four issues of concern with respect to implementation of the Affordable Care Act (“ACA”) by group health plans and health insurers offering group … Continue Reading
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