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IRS Reverses Policy on Certifying Individual Mandate Compliance

On Oct. 13, 2017, the Internal Revenue Service (IRS) reversed a recent policy change in how it monitors compliance with the Affordable Care Act’s (ACA) individual mandate. For the upcoming 2018 filing season (filing 2017 tax returns):

  • The IRS‎ will not accept electronically filed tax returns where the taxpayer does not certify whether the individual had health insurance for the year; and
  • Paper returns that do not certify compliance with the individual mandate may be suspended pending receipt of additional information, and any refunds due may be delayed.

Action Steps

To avoid refund and processing delays when filing 2017 tax returns in 2018, taxpayers should indicate whether they (and everyone on their return) had health coverage, qualified for an exemption or are paying an individual mandate penalty. This process reflects the ACA’s requirements and the IRS’s obligation to administer the law.

The Individual Mandate

The ACA’s individual mandate, which took effect in 2014, requires most individuals to obtain acceptable health insurance coverage for themselves and their family members or pay a penalty.

The individual mandate is enforced each year on individual federal tax returns. Starting in 2015, individuals filing a tax return for the previous tax year will indicate, by checking a box on their individual tax returns, which members of their family (including themselves) had health insurance coverage for the year (or qualified for an exemption from the individual mandate). Based on this information, the IRS will then assess a penalty for each nonexempt family member without coverage.

Previous Policy on “Silent Returns”

Effective Feb. 6, 2017, the IRS announced that it would not automatically reject individual tax returns that did not provide this health insurance coverage information for 2016 (known as “silent returns”). Instead, […]

By |October 17th, 2017|Compliance, Employee Benefits, Employee Communications, Health Care Reform, Human Resources, Legislation, Medical|Comments Off on IRS Reverses Policy on Certifying Individual Mandate Compliance

White House Announces ACA Subsidies to Insurers Will End

OVERVIEW

The White House announced on October 12, 2017 that it will no longer reimburse insurers for cost-sharing reductions made available to low-income individuals through the Exchanges under the Affordable Care Act (ACA), effective immediately. Because Congress did not pass an appropriation for this expense, the Trump administration has taken the position that it cannot lawfully make the cost-sharing reduction payments.

This decision follows the U.S. House of Representatives’ position in a lawsuit it filed against the Obama administration in 2014 challenging the federal government’s authority to fund these cost-sharing reductions.

ACTION STEPS

While the immediate impact of this announcement is unclear, it could have a significant impact on individuals who enroll through the Exchange during the upcoming Nov. 1 open enrollment period. Some states have indicated their intention to sue the federal government to force these subsidies to be paid. However, until a federal court intervenes or Congress enacts an appropriation for these payments, it is possible that these cost-sharing reductions will no longer be paid.

ACA Subsidies

The ACA created two federal health insurance subsidies—premium tax credits and cost-sharing reductions—to help eligible individuals and families purchase health insurance through an Exchange. Cost-sharing reductions are available for individuals who have incomes of up to 250 percent of the federal poverty level and are also eligible for the premium tax credit.

Individuals who receive cost-sharing reductions will have lower out-of-pocket costs at the point of service (for example, lower deductibles and copayments).

The ACA requires insurers that offer Exchange health plans to reduce cost-sharing for eligible individuals and requires the federal government to reimburse insurers for the cost of that reduction on a monthly basis.

House of Representatives v. Burwell (now House v. Price)

On May 12, 2016, a federal district court judge for […]

By |October 13th, 2017|Health Care Reform, Legislation|Comments Off on White House Announces ACA Subsidies to Insurers Will End

Draft ACA Replacement Bill Released by Senate

On June 22, 2017, Republicans in the U.S. Senate released their proposal to repeal and replace the Affordable Care Act (ACA), called the Better Care Reconciliation Act (BCRA). The Senate bill closely mirrors the proposal passed in the House of Representatives—the American Health Care Act (AHCA)—with some differences. For example, unlike the AHCA, the BCRA:

  • Would enhance the ACA’s Section 1332 State Innovation Waiver program; and
  • Would not allow issuers to impose a surcharge for individuals who do not maintain continuous coverage.

Impact On Employers

The Senate has not taken a vote on any ACA repeal or replacement proposal at this time. The proposal would need a simple majority vote in the Senate to pass. However, amendments may be made before a Senate vote is taken.

Senate Republicans indicated that they would like to take a vote prior to the Senate’s July 4 recess. If the BCRA passes the Senate, it would need to go back to the House for approval before being signed into law by President Donald Trump. […]

By |June 25th, 2017|Health Care Reform, Legislation|Comments Off on Draft ACA Replacement Bill Released by Senate

Coordination of Benefits- Which plan pays the Bill?

Coordination of Benefits

Your employee is covered under your companies benefits and also under their spouses.  So which plan pays first? That’s the question that arises when a plan participant or beneficiary is entitled to coverage under more than one plan or insurance policy. Coordination of Benefit (COB) rules, as specified in plan documents or insurance policies, will answer these questions and that’s why it is important to make certain those plan documents address coordination of benefits. However, if those rules are unclear and therefore a dispute arises that isn’t resolved then the issue will be decided in court.

Often the way the courts resolve these disputes differs based on the kind of plan or insurance policies involved. To provide more information, some of the COB issues that self-funded Employee Retirement Income Security Act (ERISA) plans face are highlighted below. […]

By |June 20th, 2017|Compliance, Employee Benefits|Comments Off on Coordination of Benefits- Which plan pays the Bill?

Church-affiliated Plans Are Exempt from ERISA- Supreme Court Ruling

The U.S. Supreme Court issued a decision on June 5. 2017 holding that an employee benefit plan may be exempt from the Employee Retirement Income Security Act (ERISA) as a “church plan” even if a church did not establish it. The court held that the ERISA exemption for church plans applies to certain organizations that are affiliated with churches, regardless of how their benefit plans were established.

Because this is consistent with how federal agencies currently interpret and enforce ERISA, the ruling does not change any obligations for most employers. The decision does, however, settle and resolve a recent wave of litigation involving employers with religious affiliations, such as hospitals.

Action Steps

Employers with church affiliations should be aware of the specific criteria an employee benefit plan must meet to qualify for ERISA’s church-plan exemption. All employers that sponsor employee benefit plans should ensure that their plans either meet the criteria for an ERISA exemption or comply with all applicable ERISA requirements.  […]

By |June 15th, 2017|Uncategorized|Comments Off on Church-affiliated Plans Are Exempt from ERISA- Supreme Court Ruling

House Votes 217-213 to pass the American Health Care Act (AHCA)

Members of the U.S. House of Representatives voted 217-213 to pass the American Health Care Act (AHCA).  The AHCA is the proposed legislation to repeal and replace the Affordable Care Act (ACA).

The AHCA needed 216 votes to pass in the House. Ultimately, it passed on a party-line vote, with 217 Republicans and no Democrats voting in favor of the legislation. The AHCA will only need a simple majority vote in the Senate to pass.

If it passes both the House and the Senate, the AHCA would then go to President Donald Trump to be signed into law.

Impact on Employers

The AHCA will now move on to be considered by the Senate. It is likely that the Senate will make changes to the proposed legislation before taking a vote. The AHCA would only need a simple majority vote in the Senate to pass.

However, unless the AHCA is passed by the Senate and signed by President Trump, the ACA will remain intact.

Legislative Process

The AHCA is budget reconciliation legislation, so it cannot fully repeal the ACA. Instead it is limited to addressing ACA provisions that directly relate to budgetary issues—specifically, federal spending and taxation. A full repeal of the ACA must be introduced as a separate bill that would require 60 votes in the Senate to pass.

Since the AHCA was introduced, it has been amended several times. To address concerns raised by both Democrats and fellow Republicans, the House Republican leadership released amendments to the legislation on March 20, 2017, followed by a second set of amendments on March 23, 2017. On March 23, 2017, House leadership withdrew the AHCA before taking a vote. After the withdrawal, Republicans made additional amendments (the MacArthur amendments) to […]

By |May 5th, 2017|Compliance, Health Care Reform, Legislation|Comments Off on House Votes 217-213 to pass the American Health Care Act (AHCA)

Cafeteria Plans: Allowing Midyear Election Changes

If you work in human resources the following scenario should sound familiar: An employee wanders in and starts to complain bitterly that they can no longer afford the medical or dental coverage they signed up for and demand you let them drop the coverage immediately (midyear).  Good luck explaining that it’s not you who won’t let them drop their coverage.  It’s those pesky rules in place within the IRS Section 125 plan you have in place.

Internal Revenue Code Section 125 cafeteria plans state that participant elections must be made before the first day of the plan year or the date taxable benefits would currently be available, whichever comes first. These elections are generally irrevocable until the beginning of the next plan year. This means that participants cannot make changes to their cafeteria plan elections during a plan year just because they no longer want the coverage.

IRS regulations do permit employers to design their cafeteria plans to allow employees to change their elections during the plan year if certain conditions are met. The IRS clearly lists permitted or qualifying events that allow participants to change his or her election midyear as long as the change is consistent with the event.  Some examples are an employee has a spouse who loses or gains employment, birth of a child, marriage and divorce.  Also, the IRS did expand the midyear election change rules in response to certain Affordable Care Act (ACA) provisions.

Download our Compliance Overview Brief, Cafeteria Plans: Midyear Election Changes, for all the details on permitted election changes:

Cafeteria Plans Midyear Election Changes 06 28 16

By |March 28th, 2017|Uncategorized|Comments Off on Cafeteria Plans: Allowing Midyear Election Changes

What Employers Need to Know About Telemedicine and HSA Eligibility

Telemedicine is becoming a popular method of providing a variety of medical services. Telemedicine benefits allow employees to interact with their doctor via phone, video chat, email or text for diagnosis, consultation, and treatment.

Employers that offer high-deductible health plans (HDHPs) that are compatible with health savings accounts (HSAs) need to understand how a telemedicine benefit may impact participants’ HSA eligibility.

The Internal Revenue Service (IRS) has not specifically addressed the impact of telemedicine on HSA eligibility. However, the general rules for HSA contributions strictly limit the types of health plan coverage that eligible individuals may have. Whether telemedicine is disqualifying coverage for HSA purposes depends on how the telemedicine benefit is structured. Employers that want to offer a telemedicine benefit while preserving HSA eligibility will need to make sure that the telemedicine benefit is designed in a way that is HSA–compatible.

Telemedicine Benefits

Telemedicine is a way for health care professionals to provide patient care through technology (such as a web-based communication or phone/video chat) rather than in-person consultations. For example, through telemedicine, a patient may be able to communicate in real-time with his or her doctor from home via phone, video chat, email or text for the purpose of medical evaluation, diagnosis, and treatment.

While telemedicine is not a new type of employee benefit, it is growing in popularity with employers and employees. Telemedicine can provide easier access to health care services for employees who live in rural areas and employees who travel frequently for work. By accessing health care professionals through telemedicine, employees can avoid having to take time off from work for in-person office visits. Also, because telemedicine consultations are generally less expensive than in-person visits, incorporating a telemedicine benefit may help control health coverage costs. In some states, health insurance policies are required to cover at least some telemedicine services.

Before implementing a telemedicine benefit, employers should consider the compliance issues associated with this type of benefit. Employers that sponsor HDHPs will also want to consider whether the telemedicine coverage could disqualify employees from making HSA contributions.

[…]

By |March 22nd, 2017|Uncategorized|Comments Off on What Employers Need to Know About Telemedicine and HSA Eligibility

ACA Replacement Bill Released by House Committees

Overview

The Republican leadership in the U.S. House of Representatives issued two bills on March 6, 2017 to repeal and replace the Affordable Care Act (ACA) through the budget reconciliation process. These bills, which were issued by the Ways and Means Committee and the Energy and Commerce Committee, are collectively known as the American Health Care Act.

To become law, these bills must go through the legislative process, although a budget reconciliation bill can be passed with a simple majority vote. Debate on the legislation is scheduled to begin on March 8, 2017.

Impact on Employers

If enacted, the new law would not repeal the ACA entirely, although it would make significant changes to key provisions.

The ACA’s employer and individual mandates would be repealed retroactively beginning in 2016. Key consumer protections, like the ACA’s prohibition on pre-existing condition exclusions and dependent coverage to age 26, would remain intact.

See below for a summary of the bills’ important provisions:

Legislative Process

The two separate bills that make up the American Health Care Act were released in response to a budget resolution passed by Congress on Jan. 13, 2017. The budget resolution is a nonbinding spending blueprint that directs House and Senate Committees to create federal budget “reconciliation” legislation.

Once drafted, any budget reconciliation bill can be passed by both houses with a simple majority vote. If these bills are passed in both the Senate and the House, the law would then go to President Donald Trump for approval. However, a full repeal of the ACA cannot be accomplished through this process.

ACA Provisions Not Impacted

The majority of the ACA is not affected by the new legislation. For example, the following key ACA provisions would remain in place:

  • Cost-sharing limits on […]
By |March 8th, 2017|Compliance, Health Care Reform|Comments Off on ACA Replacement Bill Released by House Committees

The Individual Healthcare Mandate May Be Impacted By IRS Change

Overview

The Internal Revenue Service (IRS) has signaled a change in how it monitors compliance with the Affordable Care Act’s (ACA) individual mandate. Under this change, tax returns will no longer be automatically rejected if they do not certify whether the individual had health insurance for […]

By |February 24th, 2017|Health Care Reform|Comments Off on The Individual Healthcare Mandate May Be Impacted By IRS Change