Employee Benefits & Executive Compensation Blog

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Category Archives: Affordable Care Act

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District Court Holds Third-Party Administrator Violated ACA’s Anti-Discrimination Rules by Administering Self-Insured Plan’s Exclusion for Gender-Affirming Care

On the heels of several recent court decisions concerning gender-affirming care, a federal district court in Washington concluded that the denial of benefits for gender-affirming care by a third-party administrator (“TPA”) administering a self-insured plan violated Section 1557 of the Patient Protection and Affordable Care Act (the “ACA”).  By way of background, Section 1557 sets … Continue Reading

IRS Permanently Extends Deadlines for ACA Reports to Individuals

On December 15, 2022, the Internal Revenue Service (“IRS”) published final regulations that make permanent certain relief and changes relating to the Affordable Care Act (“ACA”) reporting requirements. Specifically, the final regulations (1) include an automatic 30-day extension for providing Forms 1095-B and 1095-C to covered individuals and employees, which would otherwise be due on … Continue Reading

Notice 2022-41: IRS Expands Mid-Year Cafeteria Plan Change Opportunities to Address “Family Glitch”

Updated November 15, 2022 On October 11, 2022, the IRS and the Treasury Department released final regulations relating to premium tax credit eligibility for families, along with companion cafeteria plan guidance in Notice 2022-41.[1]  The final regulations are expected to extend eligibility for premium tax credits to some dependents who were previously ineligible for the … Continue Reading

IRS Proposal Extending Deadlines for ACA Reports to Individuals

The Internal Revenue Service (“IRS”) recently issued proposed regulations affecting certain reporting deadlines under the Patient Protection and Affordable Care Act (“ACA”).  Specifically, proposed regulations would make permanent an automatic 30-day extension for issuing Forms 1095-B and 1095-C to covered individuals and employees, which would otherwise be due by January 31. The proposed regulations also … Continue Reading

What Employers Should Know about ACA Shared Responsibility Payments

A recently released redacted report from the Treasury Inspector General for Tax Administration (TIGTA) offers some helpful insights for employers who may be assessed shared responsibility payments because the IRS thinks they failed to offer adequate health coverage, as required by the Affordable Care Act (ACA). The TIGTA report shows a wide gap between the … Continue Reading

The Saga Continues – Fifth Circuit Affirms ACA Individual Mandate’s Unconstitutionality; Remands for Further Consideration

Roughly a year ago, we reported on a district court judge’s determination that the Affordable Care Act’s (“ACA”) individual mandate was unconstitutional and that, therefore, the entire ACA was invalid. A detailed summary of the district court’s decision can be found in our December 17, 2018 post. Not surprisingly, this ruling was appealed to the … Continue Reading

“Cadillac Tax” on High-Cost Group Health Plans Repealed

On December 20, 2019, the President signed into law the “Further Consolidated Appropriations Act, 2020” (the “Act”). Among many other things, the Act repeals the Affordable Care Act’s controversial 40% excise tax on high-cost health care (commonly referred to as the “Cadillac Tax”). From an economic perspective, the Cadillac Tax was intended to generate tax … Continue Reading

New Jersey Individual Mandate Requires State Filings in March 2020

The Affordable Care Act’s individual mandate (i.e., the requirement that most individuals obtain adequate health insurance or pay a penalty) is dead.  A side effect of the ACA mandate’s demise is that states are beginning to step-in and pass their own versions of the individual mandate.  Massachusetts, of course, has long had an individual mandate … Continue Reading

HHS Proposes to Narrow Scope of Nondiscrimination Regulations under Affordable Care Act

The U.S. Department of Health and Human Services (HHS) recently proposed regulations that scale back nondiscrimination protections under Section 1557 of the Affordable Care Act (ACA). The new regulations, proposed on May 24, 2019, represent a marked shift in HHS’s policy by loosening the nondiscrimination requirements imposed on health plans and other entities and substantially … Continue Reading

Nationwide Injunction Halts Exemptions and Accommodations to the ACA Contraceptive Coverage Mandate

On January 14, 2019, a district court in the Eastern District of Pennsylvania granted a nationwide preliminary injunction halting the application of final regulations governing religious and moral-based exemptions from the Affordable Care Act (“ACA”) mandate to cover contraceptives without cost sharing. The final regulations would have dramatically expanded the scope of existing exemptions and … Continue Reading

Eighth Circuit Decision On“Cross-Plan Offsetting” Illustrates Importance Of Careful Plan Drafting

The U.S. Court of Appeals for the Eighth Circuit recently weighed in on a practice for recovering health plan overpayments known as “cross-plan offsetting.” In addition to shining a light on the controversial (but potentially useful) practice, the decision offers an important lesson in plan drafting that extends beyond the particular case. The case is … Continue Reading

[Podcast]: Texas Judge Declares Affordable Care Act Unconstitutional

In this episode of the Proskauer Benefits Brief, partner Robert Projansky and associate Katrina McCann discuss the recent district court case, Texas et al. v. The United States of America, which declared the Affordable Care Act (ACA) unconstitutional. On December 14, 2018, a district court judge in the Northern District of Texas deemed the entirety of the Affordable Care Act … Continue Reading

District Court Declares Entire Affordable Care Act Unconstitutional – What It Means for Employers and Plan Sponsors

In a surprising turn of events, on Friday, December 14th, a district court judge in the Northern District of Texas declared that the Affordable Care Act’s (“ACA”) individual mandate is unconstitutional and that, a result, the entire ACA is invalid. Although the ACA remains in effect for the time being and an immediate appeal to … Continue Reading

Massachusetts Health Insurance Responsibility Disclosure Form Must Be Filed by November 30 and Annually Thereafter

Massachusetts recently published guidance regarding its new Health Insurance Responsibility Disclosure (HIRD) annual filing, which is due for the first time on November 30, 2018 and then annually thereafter. This new HIRD form replaces one that was suspended in 2014 because it became unnecessary due to the ACA’s reporting requirements. The new HIRD requirement consists … Continue Reading

[Podcast]: ACA Employer Assessment Letters

In this episode of the Proskauer Benefits Brief, senior counsel Damian Myers and associate Liz Down examine the IRS’s enforcement of the Affordable Care Act’s (ACA) employer shared responsibility mandate. We discuss how the IRS is assessing penalties and offer tips on what employers can do when they receive assessment notices. Be sure to tune in for the … Continue Reading

Congress Delays the “Cadillac Tax” and Other ACA-Related Taxes and Fees

On January 22, 2018 Congress passed (and the President signed) the Federal Register Printing Savings Act (the “Act”), which temporarily (until February 8, 2018) continued funding federal government activity and appropriates funds to various health-related programs (e.g., the Children’s Health Insurance Program, Medicaid, and childhood obesity programs).  In addition to providing for appropriations, the Act … Continue Reading

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

Following the old “better late than never” axiom, the IRS recently announced (see Notice 2018-06) that once again it would be extending 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 … Continue Reading

ACA Employer Mandate Assessments Coming

Within the past few weeks, IRS officials have informally indicated that the IRS would begin assessing tax penalties under the Affordable Care Act’s (ACA) employer shared responsibility. The IRS has now updated its Questions and Answers on Employer Shared Responsibility Provisions under the Affordable Care Act (see Q&As 55-58) and has issued a form preliminary … Continue Reading

Health Care Reform Roundup – Issue 10

After months of failed attempts to pass any health care reform legislation, it appears efforts to pass a bipartisan bill to improve the Affordable Care Act (ACA) are picking up steam. Below is a summary of regent health care reform developments.… Continue Reading

Health Care Reform Roundup – Issue 9

After health care reform efforts failed in late-Spring/early-Summer, things have been quiet. However, Congress returned to DC this week. Although legislative focus now appears to be on general tax reform, we expect some health care reform legislation (whether stand-alone or as part of tax reform) during the new session. Recent developments are provided below. Senator Hatch Introduces … Continue Reading

Health Care Reform Weekly Roundup – Issue 8

Below is a summary of significant health care reform developments over the past two weeks. GOP Repeal and Replace Efforts Stalled. After releasing a revised version of the Better Care Reconciliation Act (BCRA) on July 13, 2017, Senate Republican leadership pushed strongly for its passage. After the BCRA failed to get sufficient support, the Senate … Continue Reading

Health Care Reform Weekly Roundup – Issue 7

All eyes are on the Senate at the moment as efforts to round-up support for the Better Care Reconciliation Act (BCRA) continue. Developments over the past week are summarized below. On July 13, 2017, the Senate released a revised version of the BCRA in an effort to placate Senators who have been reluctant to support … Continue Reading
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