Agencies Issue Proposed Guidance on Excepted Benefits

In their proposed rule on "Amendments to Excepted Benefits", the Departments of Labor, Treasury, and Health and Human Services indicated:

"This document contains proposed rules that would amend the regulations regarding excepted benefits under the Employee Retirement Income Security Act of 1974, the Internal Revenue Code (the Code), and the Public Health Service Act related to limited wraparound coverage. Excepted benefits are generally exempt from the requirements that were added to those laws by the Health Insurance Portability and Accountability Act and the Patient Protection and Affordable Care Act."

To read more, click here.

Mintz Levin Examines Look Back Period Communications

In "Explaining the Look-Back Measurement Method to Employees", Mintz Levin explains that:

"Many applicable large employers—i.e., employers that are subject to the Affordable Care Act’s (ACA) employer shared responsibility rules—have a pretty good sense of what these rules are, how they work, and what they plan to do to comply. A subset of these employers has gained a sophisticated understanding of the employer shared responsibility rules, while another (hopefully much smaller) subset has only a vague sense that they need to do something by or in 2015 in connection with extending coverage to full-time employees."

To read more, click here.

Buck Consultants Analyzes 2016 Reinsurance Contribution Rate and OOP Maximims

In "HHS Proposes 2016 Reinsurance Contribution Rate and OOP Maximums", Buck Consultants, a Xerox company explains that:

"The Department of Health & Human Services has proposed a 2016 transitional reinsurance rate of $27 and provided additional guidance in several key areas of the reinsurance program. HHS has also proposed 2016 out-of-pocket maximums of $6,850 for self-only coverage and $13,700 for other than self-only coverage, and provided guidance on the marketplace open enrollment periods for 2016 and later years."

To read more, click here.

ERIC members and trial members can read more here.

Buck Consultants Highlights 2015 Compliance Issues for Health Plans

In "2015 Planning for Health and Welfare Benefit Plan Operations", Buck Consultants, a Xerox company indicates:

"As 2014 comes to a close, it’s time for employers and plan sponsors to look forward to compliance issues for 2015. To that end, the calendar below presents a schedule of activities that address important deadlines for 2015. Additionally, the recently updated Reporting and Disclosure Guide identifies and addresses other activities that are event-based and participant specific. In terms of planning, many of the projects put in place in 2014 will need to be maintained for 2015, but employers and sponsors will also need to address some new issues."

To read more, click here.

Mintz Levin Analyzes Changes to the Minimum Value Rules

In "Health and Human Services (HHS) Wastes No Time Issuing Proposed Rules Modifying Minimum Value Rules", Mintz Levin indicates that:

"Over the last couple of months, we have followed and reported on a particular ACA compliance strategy under which an employer subject to the Affordable Care Act’s employer shared responsibility (or “pay-or-play”) rules satisfies the requirement to make an offer of coverage under a group health plan that has the look-and-feel of major medical coverage with one significant modification: the plan offers no inpatient hospital coverage or physician services... Following the convention established by promoters of these arrangements, we refer to these arrangements as “minimum value plans” or “MVP arrangements.” Because the monthly premium cost of MVP plans is far less expensive than the cost of traditional major medical coverage that includes inpatient hospital services or physician services, the cost to the employer to make such coverage affordable—and thereby avoiding exposure for assessable payments—is also lowered significantly."

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Buck Consultants Analyzes New FAQs on Premium Reimbursement Arrangements

In "New FAQs Address Premium Reimbursement Arrangements", Buck Consultants, a Xerox company explains that:

"Building on previous guidance, the departments have issued three new FAQs that address ACA market reform and other compliance issues for premium reimbursement arrangements. The departments warn that employers could be subject to significant excise taxes if they reimburse employees’ individual health insurance premiums either on a pre- or post-tax basis or if they offer employees with high claims risk a choice between the employer’s health plan and cash."

To read more, click here.

Buck Consultants Analyzes FAQ on Reference-Based Pricing and Out-of-Pocket Maximums

In "FAQ Offers Additional Guidance on Reference-Based Pricing and Out-of-Pocket Maximums", Buck Consultants, a Xerox Company explains that:

"The Departments of Labor, Health & Human Services, and Treasury recently issued an FAQ that provides clarification on how sponsors of non-grandfathered plans that use reference-based pricing may comply with ACA’s limits on out-of-pocket maximums. Group health plans that use reference-based pricing, or similar network designs, should review those plans for compliance with this guidance."

To read more, click here.

IRS Issues FAQs on Transitional Reinsurance Program

In "ACA Section 1341 Transitional Reinsurance Program FAQs", the Internal Revenue Service (IRS) indicates that:

"Section 1341 of the Affordable Care Act establishes a transitional Reinsurance Program to help stabilize premiums for coverage in the individual market during the years 2014 through 2016. The statute requires all health insurance issuers and third-party administrators on behalf of self-insured group health plans to make contributions under this program to support payments to individual market issuers that cover high-cost individuals (payment-eligible issuers)...The following questions and answers provide information on the treatment of contributions made under the Reinsurance Program."

To read more, click here.

DOL Issues Guidance on Stop-Loss Insurance

In Technical Release No. 2014-01: Guidance on State Regulation of Stop-Loss Insurance, the U.S. Department of Labor indicates that:

"Under current law, employers and other sponsors of group health plans may either provide coverage through an insurance contract or instead, pay benefits directly, as claims occur. In general, private sector employment-based group health plans that self-insure are not subject to State health insurance laws, including coverage laws, rating policies, and certain other State consumer protections applicable to health insurance...Employers and other sponsors of self-insured group health plans, especially small employers, may face large fluctuations in claims, and they frequently seek to reduce this risk by purchasing stop-loss insurance."

To read more, click here.

IRS Issues Guidance on Plans Without In-Patient Hospitalization Services

In Notice 2014-69: Group Health Plans that Fail to Cover In-Patient Hospitalization Services, the Internal Revenue Service indicates that:

"The Department of Health and Human Services (HHS) and the Department of the Treasury (including the Internal Revenue Service) (collectively, the Departments) have become aware that certain group health plan benefit designs that do not provide coverage for in-patient hospitalization services are being promoted to employers. A plan that fails to provide substantial coverage for these services would fail to offer fundamental benefits that are nearly universally covered, and historically have been considered integral to coverage, under typical employer-sponsored group health plans. Promoters of these plans contend that the plans satisfy minimum value within the meaning of the Affordable Care Act (including section 36B(c)(2)(C)(ii)of the Internal Revenue Code (Code) and final HHS regulations under section1302(d)(2)(C) of the Affordable Care Act (referred to in this notice as minimum value or MV)), as determined through use of the on-line MV Calculator referred to in final HHS regulations and proposed Treasury regulations."

The Notice is available here.
ERIC members and trial members can read more here.

Agencies Issue More ACA FAQs

In "FAQs about Affordable Care Act Implementation (Part XXII)", the the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury indicate that:

"[T]hese FAQs answer questions from stakeholders to help people understand the new law and benefit from it, as intended...On September 13, 2013, DOL and the Treasury published guidance on the application of the market reforms and other provisions of the Affordable Care Act to health reimbursement arrangements (HRAs), certain health flexible spending arrangements (health FSAs) and certain other employer health care arrangements.(1)HHS issued contemporaneous guidance to reflect that HHS concurs in the application of the laws under its jurisdiction as set forth in the DOL and Treasury Department guidance.(2) Subsequently, on May 13, 2014, two FAQs were made available on the IRS website addressing employer health care arrangements.(3)"

To read more, click here.

Supreme Court to Hear ACA Subsidies Case

Scotusblog reports in "Court to rule on health care subsidies" that:

"The Supreme Court, moving back into the abiding controversy over the new health care law, agreed early Friday afternoon to decide how far the federal government can extend its program of subsidies to buyers of health insurance. At issue is whether the program of tax credits applies only in the consumer marketplaces set up by 16 states, and not at federally-run sites in 34 states."

To read more, click here.

ERIC members and trial members can read more here and here.

HHS Delays HPID Requirement for Health Plans

The Department of Health and Human Services recently announced on its website that:

"Effective October 31, 2014, the...Department of Health & Human Services (HHS)...announces a delay, until further notice, in enforcement of 45 CFR 162, Subpart E, the regulations pertaining to health plan enumeration and use of the Health Plan Identifier (HPID) in HIPAA transactions adopted in the HPID final rule (CMS-0040-F).

This enforcement delay applies to all HIPAA covered entities, including healthcare providers, health plans, and healthcare clearinghouses."

To read more, click here.

Mintz Levin Examines the ACA Employer Shared Responsibility Rules

In "Misunderstanding 'Offer[s] of Coverage on Behalf of Another Entity;”, Mintz Levin explains that:

"Applicable large employers faced with the prospect of complying with the Affordable Care Act’s employer shared responsibility rules must grapple with and understand what it means to make an offer of minimum essential coverage under an eligible employer-sponsored [group health] plan to their full-time employees. Final regulations implementing these rules determine an individual’s status as an “employee” by applying the “common law” standard, the contours of which were examined in a previous post. Identifying an employer’s common law employees in a two-party arrangement is a simple matter. But this is not always the case in three-party arrangements (i.e., those in which workers are hired from or through commercial staffing firms or professional employer organizations). Three-party arrangements invite the question—whose employee is it? Where the Act’s employer shared responsibility rules are concerned, the answer to that question tells us which entity must make the requisite offer of coverage when assessing exposure for assessable payments."

To read more, click here.

HHS Issues Additional Guidance on HPID Requirements for ERISA Plans

In "Additional Guidance on HPID Requirements for Self-Insured Plans", Buck Consultants, a Xerox Company indicates that:

"Sponsors of self-insured large health plans must apply for an HPID for each controlling health plan by November 5, 2014. Guidance issued yesterday confirms that employers can obtain just one HPID for each ERISA plan."

To read more, click here.

ERIC Outraged over Latest Wellness Suit Brought by EEOC

On Monday, the Equal Employment Opportunity Commission (EEOC) filed a memorandum in Federal District Court in Minnesota asking for a Temporary Restraining Order (TRO), alleging that wellness programs sponsored by Honeywell violated both the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA).

“This is an outrageous development, and one that could potentially jeopardize not only the health of America’s workers, but also that of their spouses,” said Gretchen Young, ERIC Senior Vice President for Health Policy.

To read more, click here.

Mintz Levin Discusses Employer Responding to Marketplace Notices

In "What’s an Employer to Do (with Marketplace Notices)?", Mintz Levin explains that:

"Under the Affordable Care Act’s employer shared responsibility rules, applicable large employers (those with 50 or more full-time and full-time equivalent employees on business days during the preceding calendar year) incur exposure for assessable payments under Internal Revenue Code § 4980H when an applicable premium tax credit or cost-sharing reduction is allowed or paid for one or more low- or moderate-income full-time employees who have been certified to the employer as qualifying for an advance premium tax credit under Code § 36B. The final Code § 4980H regulations refer to this certification as a “Section 1411 Certification,” which is a reference to Act § 1411(a). This provision gives the Department of Health and Human Services (“HHS”) the authority to determine whether individuals are eligible to enroll in qualified health plans through a public exchange and whether they are eligible for a premium tax credit."

To read more, click here.

New Timeline for Employer Health Compliance

In "Updated Timeline of Highlights for Employer Group Health Plan Compliance with the Affordable Care Act", Epstein Becker Green explains that:

"Since enactment of the Affordable Care Act (“ACA”), the regulators have promulgated a myriad of regulations implementing the ACA’s requirements for group health plans. Over the past several years, the Obama administration has delayed many different elements of the ACA’s requirements, in large part, to give the regulators sufficient time to promulgate guidance. As the employer shared responsibility penalties become a reality for employers with plan years beginning on and after January 1, 2015, we have updated our timeline for employer group health plans to assist employers in staying current with the ACA’s requirements and deadlines."

To read more, click here.

ERIC Files Comment Letter on Draft Forms and Instructions for ACA Reporting

The ERISA Industry Committee (ERIC) recently filed comments with the Treasury Department and Internal Revenue Service on the draft forms and instructions for the Affordable Care Act (ACA) reporting requirements applicable to health plan coverage offered under employer-sponsored plans.

In its letter, ERIC urges the government to provide additional time to comply with the reporting requirements, to simplify the requirements, and to provide a number of clarifications regarding the forms and instructions. Among others, ERIC asked the government to specify the circumstances under which an employer may apply some of the alternative reporting methods as well as for additional guidance on when employers may use substitute forms.

ERIC's comment letter is available here.

Mintz Levin Examines Reference Pricing Models

In "Rethinking ACA Compliance Strategies Involving Reference Pricing Models and “MVP” Arrangements," Alden Bianchi of Mintz Levin indicates:

"Under the Affordable Care Act’s rules governing employer shared responsibility...where an applicable large employer makes an offer of group health plan coverage that is both “affordable” and provides “minimum value” to substantially all of its full-time employees, the employer is not liable for assessable payments under Code § 4980H. In an effort to drive down the cost of complying with these rules, certain applicable large employers...have sought less expensive ways to offer coverage that is both “affordable” and provides “minimum value”...which included the reference pricing models and “MVP arrangements” that some employers were considering. Two recent developments, one in the form of a set of FAQs issued by the Departments of Health and Human Services, Labor and Treasury/IRS, and the other a mere (though troubling) rumor, may cause employers to reconsider both these approaches."

To read more, click here.