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  1. How does the Cadillac tax apply to an EGWP plan? Under the ACA, there is a 40% tax on the excess cost of health insurance. A Part D Employer Group Waiver Plan ("EGWP") provides insurance that supplements Medicare. How do the Medicare reimbursements get treated for Cadillac tax purposes? Example: Assume monthly cost of EGWP plan is $1,000 and that Medicare pays for $750 and employer/insurer pays for $250. Is the total $1,000 considered the cost of health insurance or just the $250 paid by the employer/insurer?
  2. Does anyone have any ideas as to what the proper correction would be under 4980D(f)(3) for credits made to a non-integrated HRA? It is clear from the IRS, DOL, and HHS guidance that a non-integrated HRA will fail to comply with the annual dollar limit prohibition and preventive services requirements. If a plan sponsor (in the multiemployer plan context) makes credits to an HRA account and then later finds out the individual was not enrolled in a group health plan (rendering the HRA account "non-integrated"), what could be done to correct and avoid being slapped with the $100 per day/per individual excise tax penalty? 4980D(f)(3) states that: (3) Correction A failure of a group health plan shall be treated as corrected if— (A)such failure is retroactively undone to the extent possible, and (B)the person to whom the failure relates is placed in a financial position which is as good as such person would have been in had such failure not occurred. My thoughts: 1. The sponsor could "un-credit" the amount credited to the HRA. This addresses subsection (A) regarding the retroactive "undoing" of the failure. But what about (B)? If the plan also has an FSA feature, presumably the employer could "re-credit" the amount to the FSA, which should place the individual in as good a position they would have been under the HRA (no tax recognition, can reimburse eligible medical expenses, potentially a rollover feature). And if the plan doesn't have an FSA option?... 2. The sponsor could un-credit the HRA, turn around and give that amount to the employee after-tax and gross up his or her wages. 3. The noncompliance period under 4980D(b)(2) would run from the date the individual had both credits to his or her HRA account and was not enrolled in a group health plan, and would end on the date the HRA was un-credited and the employee was made whole. 4. The sponsor could potentially take advantage of the reasonable diligence exception under 4980D©(1) if it required employees to fill out an attestation form certifying that they are enrolled in group health plan coverage. If the employee is not enrolled in the sponsor's coverage, what more should the sponsor be expected to do to exercise reasonable diligence in knowing the failure (i.e., not being enrolled in GHP coverage) exists?
  3. Has anyone successfully obtained an HPID as required in 45 C.F.R. § 162.512 for a self-insured multiemployer welfare plan? The process seems to involve registering a "company" with HHS. I'm not clear on how a multiemployer plan would do this. Potentially register the board of trustees as the "company"? I'd appreciate any thoughts. -Greg
  4. Question about permissible plan design under the ACA. As I understand it, annual dollar limits for essential health benefits are prohibited under the ACA. However, it has been suggested to me that it would be permissible to lower the coverage level after a certain limit is met. For instance, prescription drugs would be covered 100% after a $5 copay for the first $20,000 in annual expenses, but only at 30% after $20,000. Any thoughts on this? I'd imagine that a plan couldn't cover at only 1% after $20,000 because that would be a de facto annual limit.
  5. I'm working to determine whether a company that reimburses its employees up to $5,000 each for the cost of their acquiring health insurance can keep this plan in 2014. Some suggested that this type of arrangement would violate the rules on annual limits (particularly in light of FAQ 11). However, I'm becoming convinced that this type of plan will remain permissible in 2014, given that it is only reimbursing premiums - which do not constitute an essential health benefit. This is based on 29 C.F.R. 2590.715-2711(b)(1), which states: "The rules of this section do not prevent a group health plan, or a health insurance issuer offering group health insurance coverage, from placing annual or lifetime dollar limits with respect to any individual on specific covered benefits that are not essential health benefits to the extent that such limits are otherwise permitted under applicable Federal or State law." I would be interested in getting thoughts from other practitioners. For anyone interested, I noticed this debate was also happening in the comments section of the below article. http://healthaffairs.org/blog/2013/01/25/implementing-health-reform-health-reimbursement-arrangements-and-more/
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