Search
RSS
Our Attorneys

DISCLAIMER: This blog is published for general information only - it is not intended to constitute legal advice and cannot be relied upon by any person as legal advice.  U.S. Treasury Regulations require us to notify you that any tax-related material in this blog (including links and attachments) is not intended or written to be used, and cannot be used, for the purpose of avoiding tax penalties, and may not be referred to in any marketing or promotional materials.  While we welcome you to contact our authors, the submission of a comment or question does not create an attorney-client relationship between the Firm and you. 

Entries in Health Plans (53)

Friday
Jan222016

IRS Issues Guidance on Employer Health Plan Opt-Out Payment Arrangements

Late last month the IRS released, in the form of 26 Q/As in Notice 2015-87, guidance on the application of various provisions of the Affordable Care Act to employer-sponsored health coverage.  The Notice covers a number of important issues, including the effect of health reimbursement account contributions, cafeteria plan flex credits, and employer opt-out payments on an employee’s cost of coverage for purposes of determining affordability under Code § 4980H(b).  The Notice also addresses the application to government entities of the employer shared responsibility rules, information reporting for applicable large employers, health savings account matters for persons eligible for benefits through the Department of Veterans Affairs, COBRA continuation coverage for carried over health flexible spending account balances, and penalty relief for employers that make a good faith effort to comply with the ACA reporting rules. 

Regarding employer opt-out arrangements, for months the IRS has stated, informally in various settings, that an employer should include the value of an opt-out payment in determining and reporting an employee’s cost of coverage.  (An opt-out payment is taxable income provided to an employee for waiving coverage under the employer’s health plan.)  Under this rule an opt-out payment might cause an employee’s cost of coverage to become unaffordable, thereby potentially subjecting the employer to an assessable payment.  Though the statutory and regulatory basis for this position is somewhat thin, a senior official at the IRS confirmed this view to us last summer. 

Oddly enough, Notice 2015-87 both confirms and retreats from this position.  Specifically, it provides that until the issuance of further guidance a payment under any opt-out payment arrangement in place prior to December 17, 2015 need not be reported on Form 1095-C and will not, on its own, cause an employer to be subject to a shared responsibility penalty.  Further (as confirmed by communication with the principal author of the Notice) and again until IRS guidance states otherwise, a payment under a conditional opt-out arrangement (for example, one requiring an employee to show proof of coverage under the spouse’s plan in order to receive the payment) adopted at any time need not be reported on Form 1095-C and will not, on its own, cause an employer to be subject to a shared responsibility penalty. 

Though the Notice provides that, for the time being, opt-out payments under certain arrangements need not be added to an employee’s cost of coverage for purposes of reporting and determining affordability, such payments will be added to an employee’s cost of coverage for purposes of determining (i) the employee’s eligibility for a subsidy on the Exchange, and (ii) whether the employee might be exemption from a penalty under the individual mandate. 

Monday
Apr272015

EEOC Finally Releases Notice of Proposed Rulemaking for Wellness Programs

For nearly a year the U.S. Equal Employment Opportunity Commission (EEOC) has endured harsh criticism from employers, members of the United States Senate, and the benefits community at large for commencing legal actions challenging employer-sponsored wellness programs before issuing guidance regarding the compliance status of those programs under the Americans with Disabilities Act (ADA).  At long last the EEOC has released a Notice of Proposed Rulemaking (the “Notice”) addressing how Title I of the ADA applies to employer wellness programs.  The good news is that the proposed regulations contained in the Notice hew fairly close to existing regulations published by other federal agencies and are generally limited to programs that involve disability-related inquiries and medical examinations. There are significant differences, however, regarding maximum rewards for programs that target tobacco use, the application of reward limits to certain participatory wellness programs, and the notice requirements that apply to wellness programs.  Perhaps most importantly, the Notice attempts to address what makes participation in a wellness program “voluntary” and, thus, compliant with one of the safe harbor exceptions to the prohibition on employer-sponsored medical examinations under the ADA.  Nevertheless, several questions affecting the legal compliance status of wellness programs remain.  

Click to read more ...

Wednesday
Nov262014

2014 Year-End Employee Benefit Plans Compliance Advisory

The 2014 end-of-year rush seems somewhat less frantic than in years past.  Nevertheless, with a month left in the year many employers may find themselves scrambling to meet plan amendment and notice deadlines, and planning for 2015 may still be in process for some.  This summary discusses a few key developments regarding employee benefit plans – especially group health plans – for employers to consider as they finish 2014 and move into 2015, including developments in:

  • Retirement Plans,
  • Health Plans and Health Care Reform, and
  • EEOC Challenges to Wellness Programs.

Click to read more ...

Monday
Nov032014

CMS Delays HPID Application Deadline 

On October 31, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a statement delaying enforcement of the health plan identifier (HPID) requirement.  Specifically, Controlling Health Plans (CHPs) are no longer required to obtain HPIDs by the originally announced deadline of November 5, 2014, which has been delayed “until further notice.”  Because the duration of this enforcement delay is unknown, we recommend that CHP sponsors move forward with the application process to obtain HPIDs.  Details about the HPID requirement and the application process are available here.  We will continue to provide further updates on delayed enforcement of the HPID requirement on our blog, Employee Benefits Update.

Thursday
Oct162014

Are you Experienced? A Look at the HPID Application Experience 

Under final rules issued September 5, 2012 by the Department of Health and Human Services under HIPAA, nearly all employer group health plans are required to obtain a unique health plan identification number (HPID) by November 5, 2014.  (We summarize the final rules briefly here.)  Health plans with less than $5 million in annual receipts have until November 5, 2015 to comply.  With less than three weeks to go until the deadline, employers still have questions about the requirements and the application process.  From what we have heard from some clients, the application process can take at least a couple of days so don’t wait until November 5 to get started.   

Click to read more ...