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Health plan admin - misc


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Section 1557 Rule on the Horizon; Focus on Employer Mandate
"HHS continues to make progress, however slowly, in revisiting the Section 1557 rule.... Because Section 1557 includes a private right of action, covered entities -- such as hospitals, clinics, or state Medicaid programs -- that fail to comply with the regulations could be sued by someone that has faced discrimination and makes a claim under Section 1557.... [S]ome members of Congress are considering an additional push to repeal or delay the employer mandate ... In the meantime, the IRS continues to implement the employer mandate and recently submitted an information collection request to [OMB] regarding reporting requirements under the employer mandate." (Health Affairs)
Making Dependent Verification More Than a One-and-Done Project
"Dependents can represent up to 70% of your company health care costs ... 72% of [employers] never reverify dependents after an initial audit.... Reverifying your enrolled dependents every three years will ensure your organization is compliant with eligibility guidelines and can free up funds for new or enhanced benefit programs." (Alight Solutions)
Seventh Circuit to Plan Participants: File Suit Immediately or Lose De Novo Review
"[T]he Seventh Circuit held that [the employee] waived the argument that Reliance Standard's failure to render a timely decision on her claim compelled de novo review simply because she pursued administrative review through an appeal rather than pursued available remedies when the issue arose (i.e. immediately file a lawsuit).... The unintended consequence ... is that in the Seventh Circuit claimants are now incentivized, rather than discouraged, to immediately file a lawsuit in order to obtain a favorable standard of review[.]" [Dragus v. Reliance Standard Life Inc. Co., No. 17-1752 (7th Cir. Feb. 14, 2018)] (Roberts Bartolic)
Does a Change to a Group Health Plan's Employee Contribution Create a Change in Status Opportunity?
"[An] employee's ability to adjust his or her election depends: [1] on whether the applicable plan documents include language permitting cost-related election changes; and [2] whether the group health plan's cost change would be considered 'significant' or 'insignificant.' " (HUB International)
[Guidance Overview] New 2018 Federal Poverty Guidelines Affect ACA Safe Harbor
"[If] the cost of self-only coverage under an employer's lowest-cost minimum value plan is no more than 9.56% (for 2018) of the single Federal Poverty Guideline applicable to that individual for that year, then it will be treated as affordable. For 2018, the mainland Federal Poverty Guideline is $12,140 ... [To] satisfy the safe harbor ... the monthly premium amount cannot exceed $96.71[.]" (HUB International)
[Official Guidance] Text of 2018 IRS Form 8963: Report of Health Insurance Provider Information (PDF)
"On the first line, list information for the single-person covered entity or designated entity, whichever applies. Next, for a controlled group, separately list information for every person who is a controlled group member at the end of the day on December 31, 2017, and who would qualify as a covered entity in 2018 if it were a single-person covered entity (see instructions)." (Internal Revenue Service [IRS])
IRS Updates Publication 974 (Premium Tax Credit) to Address QSEHRAs
"Although Publication 974 is intended for individuals, employers (particularly those that provide QSEHRAs or are subject to employer shared responsibility) may also find it helpful. The new information regarding QSEHRAs is based on [IRS Notice 2017-67]." (Thomson Reuters / EBIA)
[Guidance Overview] Going Up But Never Down: 2018 ERISA Penalties
"The [DOL] announced increased penalties for employee benefit plans under ERISA. The increases generally apply to penalties that involve employee benefit reporting and disclosure failings if the penalty is assessed after January 2, 2018, and if the violation occurred after November 2, 2015. [A chart outlines] the ERISA penalty amounts assessed for violations on or before January 2, 2018, and those amounts assessed after January 2." (McDermott Will & Emery)
[Guidance Overview] New DOL Regs Require Changes to Plan Claims Procedures
"One could avoid dealing with the new regulations by referencing a third-party determination of disability, such as a determination by the Social Security Administration. The practical problems with that approach are that the Social Security Administration can take a long time to determine that a disability exists, and the SSA definition may be a more restrictive definition of disability, which could raise employee relations concerns. Also, in the qualified retirement plan area, a more restrictive definition may result in an impermissible cut-back of an accrued benefit, such as where a retirement subsidy attaches to a finding of a disability." (Davis Wright Tremaine LLP)
[Guidance Overview] Four Items to Consider in Light of IRS Letter 226J
"Each Letter 226J [the author] reviewed in private practice has had egregious errors.... [T]he codes an employer entered on lines 14 and 16 of the Form 1095-C was a determining factor (or at least a theoretically determining factor) whether an employer received a Letter 226J.... While little can be done in 2016 and 2017 it is critical that all employers know when an employee is a full-time employee and needs to be offered coverage in order to avoid the section 4980H penalties.... [A]ll employers should be recording their offers of coverage and retaining signed waivers of coverage." (Accord)
2017 in Review: ERISA Guidance and Enforcement (PDF)
11 pages. "In 2017, the principal focus in the administration of [ERISA] by the [DOL] appropriately remained one of the extraordinary developments under DOL's new fiduciary definition and related exemptions (Fiduciary Rule). DOL's regular program of issuing advance guidance and enforcing the statute continued in a more conventional manner as well ... The regulatory guidance plans under ERISA and the Internal Revenue Code, as they relate to employee benefits and executive compensation, were also recently updated." (Eversheds Sutherland)
Fifth Circuit Reverses District Court Health Plan Fraud Decision
"Cigna [had] filed suit against Humble in hopes of protecting itself -- and health plans for which it serves as claims administrator -- from healthcare fraud and abuse. In exchange, Cigna faced a judgment against it in excess of $16 million. The Fifth Circuit's decision vindicating Cigna's position constitutes a significant victory for ERISA plans, insurers, and other payors[.]" [Connecticut General Life Ins. Co. v. Humble Surgical Hospital, LLC, No. 16-20398 (5th Cir. Dec. 19, 2017)] (Seyfarth Shaw LLP)
California Regulators to Investigate Aetna's Medical Coverage Decisions
"The Department of Managed Health Care, which regulates the vast majority of health plans in California, said Monday it will investigate Hartford, Ct.-based Aetna after CNN first reported Sunday that one of the company's medical directors had testified in a deposition related to the lawsuit that he did not examine patients' records before deciding whether to deny or approve care. Rather, he relied on information provided by nurses who reviewed the records -- and that was how he was trained by the company, he said." (Kaiser Health News)
Plan Limitations Period That Was Not Disclosed in Benefit Denial Letter Is Unenforceable
"The court observed that although the Fourth Circuit has not decided this question, the First, Third, and Sixth Circuits have concluded that a benefit denial must state a plan-imposed time limit for filing suit in order for the limit to be enforced against a participant[.]" [Starnes v. Universal Fidelity Administrators Co., No. 17-3073 (D.S.C. Feb. 5, 2018)] (Thomson Reuters Practical Law)
The Educated Fiduciary: How to Up Your Game
"Read at least one newsletter regularly.... Schedule an on-site fiduciary training session.... Subscribe to blogs.... Sign up for webinars.... Attend a formal education program.... Familiarize yourself with materials on the DOL's website.... Develop written policies with your advisers.... Prepare a checklist of things to do each year.... Read up on your own." (Cohen & Buckmann, P.C.)
[Guidance Overview] No Further Delays for Enhanced Disability Claims Procedures
"For plans where the administrator will retain the discretion to make disability determinations, the plan sponsor should, prior to April 1, [1] ensure that plan administrators and benefits staff are aware of, and will follow, the new rules in practice; [2] update plan documents and SPDs to reflect the new procedures; and [3] update ABD letters, disability claims forms, communications, notices, company intranet, and employee handbooks[.]" (McCarter & English)
[Official Guidance] Text of IRS Q&As on Information Reporting by Health Coverage Providers (Section 6055)
Updated Feb. 9, 2018 with the addition of questions 30-35, which address Extended Due Dates and Transition Relief. (Internal Revenue Service [IRS])
[Official Guidance] Text of 2017 DOL Form M-1: Report for Multiple Employer Welfare Arrangements (MEWAs) (PDF)
87 pages. "The Form M-1 is used to report information concerning a multiple employer welfare arrangement (MEWA) and any entity claiming exception (ECE). Reporting is required pursuant to ERISA section 101(g), 104(a), 505 and 734 of [ERISA], and 29 CFR 2520.101-2 and 103-1. You must file the Form M-1 electronically." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
[Guidance Overview] 2017 IRS Publication 974: Premium Tax Credit (PDF)
79 pages; Feb. 1, 2018. "If you were provided a QSEHRA, your employer should have reported the annual permitted benefit in box 12 of your Form W-2 with code FF. If the QSEHRA is considered affordable coverage for a month, no premium tax credit (PTC) is allowed for the month. If the QSEHRA is not considered affordable coverage for a month, you may still be eligible for the PTC but you must reduce the monthly PTC (but not below -0-) by the monthly permitted benefit amount." (Internal Revenue Service [IRS])
Tax Bill Affects ERISA Settlements
"Any settlement of employment litigation should take account of taxes... The Tax Cuts and Jobs Act ... makes a number of changes ... The after-tax cost to defendants of a settlement has gone up. The 2018 corporate tax rate drops to 21 percent from generally 35 percent in 2017 ... If a corporate defendant settles for $100,000 in 2017, that will cost a net $65,000 after taxes. But if that settlement is made in 2018, it will cost the defendant $79,000 after taxes because the deduction saves fewer taxes." (Bob Blum Mediation)
National ACA Marketplace Signups Dipped a Modest 3.7 Percent This Year
"As a group, the 15 states plus the District of Columbia with state-based marketplaces, including those using the Healthcare.gov enrollment platform, exceeded last year's totals this year by 0.2 percent, while the 34 states that relied on the federal healthcare.gov marketplace saw total signups drop by about 5.3 percent.... Rhode Island (12.1%), Kentucky (10.4%), and Washington State (7.6%) saw the largest share increases in signups, while Louisiana (-23.5%), West Virginia (-19.5%), and Arizona (-15.6%) had the largest drop in shares of signups." (Henry J. Kaiser Family Foundation)
[Guidance Overview] Potential 'Gotchas' with the Tax Cuts and Jobs Act
"[The Act] narrows the ability to obtain a hardship distribution for a casualty loss.... [Employers] should check with their record keepers to ensure that they are aware of and prepared to administer the new rule.... [T]ax-exempt employers will be subject to unrelated business taxable income ('UBTI') for mass transit and parking benefits provided to their employees.... Tax-exempt employers who continue to provide on-site athletic facilities will be subject to UBTI." (Wilkins Finston Friedman Law Group LLP)
[Official Guidance] IRS Q&As: Information Reporting by Employers on Form 1094-C and Form 1095-C
Updated Feb. 5, 2018. "These Q&As provide additional information about completing Form 1094-C and Form 1095-C for calendar year 2017 that are to be filed in 2018. The Q&As may be used in conjunction with the Instructions for Forms 1094-C and 1095-C, which provide detailed information about completing the forms." (Internal Revenue Service [IRS])
[Official Guidance] IRS Q&A: Corrected, Incorrect or Voided Forms 1095-A
"The information provided on this page relates to corrected or voided Forms 1095-A for tax years 2014 through 2017. There are differences amongst the years[.]" (Internal Revenue Service [IRS])
Annual Reminder to Submit Creditable Coverage Disclosures to CMS by March 1
"Each year, group health plan sponsors that provide prescription drug coverage to individuals eligible for Medicare Part D must disclose to the CMS whether that coverage is 'creditable' or 'non-creditable.' The disclosure obligation applies to all plan sponsors that provide prescription drug coverage, even those that only offer prescription drug coverage to active employees, and not to retirees. Calendar year plans must submit this year's disclosure to CMS by March 1, 2018." (Conduent)
[Guidance Overview] Text of IRS Fact Sheet: Individual Shared Responsibility Provision (Section 5000A) Return Preparer Best Practices (PDF)
Updated Feb. 2, 2017. "This document represents best practices for practitioners to gather necessary information to use in preparing 2017 tax returns for their clients, including information that may be helpful to demonstrate compliance with the ACA's health coverage requirements." (Internal Revenue Service [IRS])
Steps for Making Employee Benefits a Year-Round Conversation
"Find the resources to help you create and deploy your communications. As you develop your communications, keep the these things in mind: Stick with one or two topics for each communication (unless you're doing a newsletter); keep your content short (use bullet points where you can) and engaging -- let employees know what's in it for them up front and early on; avoid attaching files to emails; and if you can use short videos to communicate information, do it." (Willis Towers Watson)
ACA Cadillac Tax Delayed by Two More Years
"The Cadillac Tax was originally intended to go into effect in 2018, but President Obama delayed the effective date until 2020. The Act now delays the Cadillac Tax until 2022. The Act also affects implementation of two other ACA taxes: the medical device tax has been delayed until 2020; and while the Health Insurance Tax will be collected this year, it will be suspended during 2019 and then come back in 2020." (Morgan Lewis)
The CHIP Extension: Potential Impacts for Employers
"Increased costs and reduced eligibility in CHIP will force families utilizing this coverage to re-evaluate their options as the program adjusts to these changes.... Employers could see an increase in the number of children covered on their plans as impacted families look for alternative coverage options." (Hill, Chesson & Woody)
[Opinion] Text of Comment Letters to DOL on Proposed Regs Defining 'Employer' Under Section 3(5) of ERISA: Association Health Plans
The 79 letters posted to the DOL website as of Jan. 31, 2018 were submitted to DOL in response to its request for comments on proposed regs for association health plans. Deadline for comments is March 6, 2018. (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
Massachusetts Issues Employer Assessment Regs
"These employer assessments are intended to curb the growing cost of the state's public health programs and are offset by lower state unemployment insurance rates. Both the higher assessments and lower unemployment rates are scheduled to sunset in two years. Massachusetts employers with six or more employees in the state must also submit employer health care coverage forms annually." (Willis Towers Watson)
[Guidance Overview] IRS Q&As on 2017 Moratorium for Health Insurance Provider Fee
"[1] Under the 2019 moratorium, is there a health insurance provider fee in 2019? ... No.... [2] Must Form 8963 be filed in the 2019 fee year? ... No.... [3] Do the 2017 or 2019 moratoriums affect the 2018 fee year? ... No.... [4] Does the 2019 moratorium apply to fee year 2019 or data year 2019? ... The 2019 moratorium applies to fee year 2019.... [5] How do the 2017 and 2019 moratoriums affect the filing obligation or fee amount for the 2018 fee year? ... The 2017 and the 2019 moratoriums have no effect on the filing obligation or fee amount for the 2018 fee year." (Internal Revenue Service [IRS])
Federal Courts in Tennessee: Claimants and Administrators Must See the Administrative Process All the Way Through
"[Two recent] decisions reflect the courts' view of the importance of the ERISA 'administrative process' playing out to the very end, even if it results in a decision coming out beyond the statutory deadline. There's certainly appeal to the notion that the administrative process should be a flexible, open, information-sharing process not hampered by the rigidity of statutory deadlines or the fail-safe of substantial compliance.... Sometimes it makes sense to file suit immediately, other times it makes sense to allow the administrator to continue with the decision-making process. But I have different advice for Tennesseans: On Day 46, do not pass Go, do not collect $200, go straight to court." (Roberts Bartolic)
Employee Benefits Changes in 2018
"The end of the individual mandate for healthcare coverage may lead to an increase in the number of employees and their family members who will not buy health insurance.... Employees with employer-provided health coverage may not have enrolled their spouse or children in prior years because their family could have obtained coverage at a lower rate through some other program." (Butterfield Schechter LLP)
[Guidance Overview] Massachusetts Issues Employer Assessment Regs
"The Massachusetts Department of Unemployment Assistance (DUA) recently issued regulations and FAQs explaining how the EMAC supplement will work. Payments will be due quarterly ... The higher EMAC rate and EMAC supplement will appear in employers' first-quarter unemployment insurance statements for 2018, and payment is due April 30. Other recent legislation ... requires that employers with six or more employees notify the DUA of their offer to pay or arrange for employees' health coverage and describe the coverage, although forms and instructions for doing so are not yet available." (Willis Towers Watson)
[Guidance Overview] New Disability Claims Procedure Rules Take Effect April 1 (PDF)
"The Final Rule is very likely to increase the administrative costs and burdens of administering disability benefits under ERISA plans and is likely to make it easier for claimants to pursue their claims in court. Key changes to the procedures that ERISA plans must use to process disability claims include: ... [1] Disclosure of the basis for disagreeing with a third party.... [2] Right to review and respond to new information before final decision.... [3] Strict compliance and possible de novo review." (Groom Law Group)
[Guidance Overview] 2017 Year in Review, Plus What Lies Ahead in 2018 (PDF)
49 presentation slides, with link to audio. Topics include: [1] ACA: Repeal and Replace? [2] ACA Marches On: ALE Status, Employer Mandate Pay or Play; 2018 Increased Pay or Play Penalties; 2015 Pay or Play Penalty Letters Arrive; 2020 Cadillac Tax Still Looms (Delayed!). [3] Tax Cuts and Jobs Act. [4] California Leave Law Updates. [5] San Francisco Ordinance Updates. (ABD Insurance & Financial Services)
[Official Guidance] Text of Instructions for IRS Form 2848: Power of Attorney and Declaration of Representative (PDF)
Jan. 23, 2018. "A checkbox has been added to line 5a to allow the taxpayer to authorize the designated representative(s) to access the taxpayer's IRS records via an Intermediate Service Provider.... The designation of Student Attorney or CPA has been changed to Qualifying Student.... When a representative with a Power of Attorney calls the IRS on your behalf, they must pass authentication procedures prior to the IRS speaking to them about your tax information." (Internal Revenue Service [IRS])
Apple Adds Medical Records Feature for iPhone
"The feature is to become part of Apple's popular Health app. It will enable users to transfer clinical data -- like cholesterol levels and lists of medications prescribed by their doctors -- directly from their medical providers to their iPhones, potentially streamlining how Americans gain access to some health information." (The New York Times; subscription may be required)
For Benefit Platforms, Employers Pick User Experience Over Cost
"The most valuable outcomes employers have found in their experience with benefits administration platforms are best-in-class employee user experience (49 percent) and the ability to integrate benefits technology with HR functions (37 percent).... Only 23.9 percent of employers cited [cost] as most important in 2017, down from 64.4 percent in 2016." (Society for Human Resource Management [SHRM])
2018 Healthcare Trends
"The constant demand for the latest and greatest in technology could have the greatest impact on healthcare in 2018. Innovations in digital technology are spurring a rise in data management and improving the delivery of medical care." (DataPath)
DOL Announces April 1, 2018 Applicability Date for Disability Benefit Claims Procedures
"[It] is imperative for employers to work with their insurance carriers, third party administrators, and attorneys to ensure that all underlying disability plans/benefits and associated documentation (including any ERISA wrap plans, Code section 125 cafeteria plans, and claims denial forms) are reviewed and updated to ensure legal compliance with the requirements for claims filings beginning after April 1, 2018." (Fraser Trebilcock)
Implications of the New Tax Law for Employee Benefit Plan Sponsors
"[1] The new tax law effectively eliminates the [ACA] individual shared responsibility penalty, but not until 2019. [2] Some changes were made to retirement plan rules, but many changes that were initially proposed did not make it into the final law. [3] The new tax law suspends from 2018 through 2025 the ability of an employer to deduct, and in some cases the employee to exclude from income, a number of fringe benefits. [4] A new employer tax credit was created for certain employers who provide paid leave under the [FMLA]." (Sibson Consulting)
Cadillac Tax Delayed to 2022 in Budget Deal
"There continues to be wide bipartisan support for repealing the Cadillac Tax. However, there is no consensus approach to replacing the lost revenue from full repeal. While it remains unlikely that the tax will ever fully take effect, the long planning process required to prepare for its effect will continue to make employers nervous each time the effective date closes in." (ABD Insurance & Financial Services)
[Official Guidance] Text of OPM FEHB Program Carrier Letter 2018-01: Federal Employees Health Benefits Program Call Letter (PDF)
"This is our annual call for benefit and rate proposals from Federal Employees Health Benefits (FEHB) Program carriers. This letter sets forth the policy goals and initiatives for the FEHB Program for 2019. You must submit your benefit and rate proposals for the contract term beginning January 1, 2019 by May 31, 2018." (U.S. Office of Personnel Management [OPM])
[Guidance Overview] Good News for Employers: Continuing Resolution Provisions That Will Affect Employer-Sponsored Group Health Plans
"[1] A two-year delay of the 'Cadillac tax' (the 40% excise tax on high-cost employer-sponsored group health plans). The tax ... now will be effective in 2022.... With another delay, it's unlikely the IRS will issue regulations soon.... [2] A one-year suspension of the tax on health insurers. The tax is in effect for 2018, but suspended for 2019. The tax had previously been suspended for 2017." (Conduent)
How the ACA Individual Mandate Repeal Can Impact Reporting and Plan Design Requirements
"[1] Employers must continue to meet ACA information reporting requirements.... [2] Consider auditing past reporting.... Risk for potential penalties still looms and should be addressed.... [3] Employers must monitor impact to ... program costs which are predicted to rise, [and] re-evaluate COBRA coordination issues as communicated in Marketplace notices, [along with] any impact to opt-out programs." (Employee Benefit Adviser)
Squash Health Plan 'Buyer's Remorse' Before It Starts
"If you offer a High Deductible Health Plan (HDHP) with a Health Savings Account (HSA), your employees are starting to use the plan now. But an HDHP can be tough to navigate -- especially for newcomers -- and your employees can become instantly confused and frustrated by their new plan.... Human Resources needs to get out in front of employees with thoughtful, comprehensive and explicit communications materials." (Frenkel Benefits)
[Guidance Overview] New York Paid Family Leave Is Now in Effect
"[If] you haven't done so already, [you must] obtain PFL coverage from your insurer, similar to the way in which you've secured disability coverage under New York's Disability Benefits Law (DBL).... While you were permitted to start making deductions last summer, as of January 1, 2018, you are required to make these deductions.... You should educate your employees about the new law in several ways ... This law differs from FMLA and requires employers and employees to complete forms and provide information that is distinct from what is required by the FMLA." (Mintz Levin)
CMS Posts New Info on Role of Agents and Brokers in 2018 Open Enrollment
"On January 18, 2018, HHS posted a summary of some additional plan year 2018 open enrollment metrics ... The slides also included key areas for ongoing agent/broker assistance (such as paying premiums to effectuate coverage, data matching issues, and special enrollment period changes), as well as other marketplace updates." (Health Affairs)
[Guidance Overview] Disaster Area Tax Relief Does Not Extend to ACA Reporting
"The IRS has announced tax deadline extensions to individuals and businesses affected by the Thomas fire and subsequent flooding, mud and debris flow in Santa Barbara and Ventura counties.... The relief does not extend to ... [d]eadlines applicable to ACA Forms 1094-C (Transmittal Form) and 1095-C (Employee Statements) for 2017, required to be filed and furnished by Applicable Large Employers. Those deadlines remain as follows: File Form 1095-Cs w/IRS by February 28, 2018 (paper); April 2, 2018 (e-file); Furnish Form 1095-Cs to Employees by March 2, 2018." (E is for ERISA)
Questions Employees Are Still Asking About ACA 1095s
"[1] What is this form I'm receiving? ... [2] Who is sending it to me, when, and how? ... [3] Why are you sending it to me? ... [4] I thought the [ACA] requirement to have health insurance was repealed. Do I still need this form? ... [5] What am I supposed to do with this form? ... [6] What if I get more than one 1095 form? ... [7] What if I did not get a Form 1095-B or a 1095-C? ... [8] I have more questions -- Who do I contact?" (International Foundation of Employee Benefit Plans [IFEBP])
[Guidance Overview] DOL Changes Disability Claims and Appeals Regs
"If your self-insured STD benefit is, in fact, subject to ERISA, you'll need to amend your plan documents.... If your self-insured STD benefit is, in fact, subject to ERISA and you are making disability determinations in-house, consider looking for an advise-to-pay vendor.... Review the definition of 'disability' or 'disabled' in your other ERISA-covered benefit plans (e.g., profit-sharing, 401(k), defined benefit, non-qualified deferred comp, top-hat, etc.) and consider whether and to what extent you should change that definition." (ERISAfire)
Supreme Court Again Denies Review of ERISA Forum Selection Clauses
"This is the third time in as many years that the high court has denied review of this issue.... The Solicitor General sided with the [DOL], which has filed amicus briefs in support of the participants in each of the appellate cases. However, the Solicitor General recommended that the issue percolate more in the appellate courts. Since then, the Eighth and Seventh Circuits have issued orders that align with the Sixth Circuit. And the Supreme Court has denied review of each of the decisions." (Greensfelder)
[Guidance Overview] IRS Provides Guidance on Qualified Small Employer Health Reimbursement Arrangements
"According to [IRS Notice 2017-67], a separate benefit up to the maximum permitted benefit must be provided to each eligible employee, regardless of whether employees are covered under an individual health policy or a family policy. Therefore, spouses who work for the same employer and who are covered under a family policy must both receive the full family benefit coverage.... However, eligible employees may not be reimbursed for duplicate costs, so the total premium reimbursement for Employees A and B may not exceed the $10,000 annual premium for their family health insurance policy." (von Briesen & Roper, s.c.)
[Official Guidance] Text of 2017 IRS Instructions for Form 8889: Health Savings Accounts (HSAs) (PDF)
"Use Form 8889 to: [1] Report health savings account (HSA) contributions (including those made on your behalf and employer contributions), [2] Figure your HSA deduction, [3] Report distributions from HSAs, and [4] Figure amounts you must include in income and additional tax you may owe if you fail to be an eligible individual." (Internal Revenue Service [IRS])
A Game Plan for Employers Facing Possible ACA Penalties
"Letter 226-J only provides 30 days to defend against a penalty assessment. The first step is to review the IRS notice carefully, focusing on whether the facts recited in the letter are accurate.... If the facts in the Letter 226-J are correct, ... you should assess whether you have additional defenses.... Your final reaction should be to generate a response to the Letter 226-J, as you will be presumed to owe the amount assessed if you do not respond, and the IRS may levy assets to collect." (Carlton Fields)
[Guidance Overview] No More Delays! DOL Says New Disability Claims Rules Take Effect April´┐Ż2
"[1] Identify all ERISA-covered plans sponsored by the employer that provide disability benefits.... [S]hort-term disability (STD) plans may or may not be subject to ERISA.... In addition, some retirement plans have disability-based provisions and could be caught up in the new rules. [2] Confirm that all ERISA-covered plans that provide disability benefits have updated claims procedures in effect on April 2.... [T]he procedures should be in writing and ready to be implemented by this date.... [3] Update summary plan descriptions (SPDs) to include the new procedures, and distribute the revised SPDs." (Mintz Levin)
[Official Guidance] Text of IRS Disaster Relief CA-2018-01, for Victims of Wildfires, Flooding, Mudflows and Debris Flows in California
"Individuals who reside or have a business in Los Angeles, San Diego, Santa Barbara and Ventura Counties may qualify for tax relief.... [C]ertain deadlines falling on or after Dec. 4, 2017 and before April 30, 2018, are granted additional time to file through April 30, 2018." (Internal Revenue Service [IRS])
[Guidance Overview] Massachusetts to (Again) Require Health Care Reporting by Employers
"The form must be completed and submitted under oath annually by any employer with 6 or more employees in Massachusetts; and it must disclose whether the employer has offered to pay or arrange for the purchase of health care insurance. If so, the form must include information about premium costs, benefits offered, cost sharing details, eligibility criteria and other information that is 'deemed necessary by the division.' " (Mintz Levin)

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