[Official Guidance]
IRS Form 4423 and Instructions: Application for Filing ACA Information Returns, August 2015 (PDF)
"Purpose of Form. If you are a foreign organization without an Employer Identification Number (EIN) and you need to request authorization to act as a Transmitter or Software Developer for electronically filing of Form 1094-B... and Form 1095-B ... and/or Form 1094-C ... and Form 1095-C... This form may also be used to update an existing application for an organization without an EIN. Do not submit this form if you are eligible for, or if you have an EIN assigned by the IRS. Applicants with an EIN must submit their Affordable Care Act Information Return Application electronically on www.irs.gov using e-services-online for tax professionals."
(Internal Revenue Service [IRS])
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[Guidance Overview]
The Scoop on MOOP
"[FAQ XXVII] stated, 'the self-only maximum annual limitation on cost sharing applies to an individual who is enrolled in family coverage or other coverage that is not self-only coverage under a group health plan.' The FAQ also stated that the departments would apply the clarification only for plan or policy years beginning in or after 2016.... The chairmen [of the House Ways and Means, Education and the Workforce and Energy and Commerce committees] have asked [HHS to provide] ... [1] the source of the statutory authority to enable the Administration to make this change in the [maximum out-of-pocket (MOOP)] limits; [2] any analyses that the Administration has conducted on the impact of the change on employers and employees; and [3] an
explanation of the basis for HHS's justification for making the policy change in a preamble and not in regulations."
(McGuireWoods LLP)
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[Guidance Overview]
Retirees Receiving Health Coverage: Must We Report Them?
"Section 6056 requires each applicable large employer to file an information return with the [IRS] and furnish a statement to all its full-time employees reporting the health care the employer offered (or did not offer). This includes any employees who were considered full-time for at least one month of the year. It does not include non-employees, such as someone who was retired the entire year."
(International Foundation of Employee Benefit Plans [IFEBP])
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Text of Second Circuit Opinion Allowing Mental Health Parity Claims Against Claims Administrator
23 pages. "[UnitedHealth Group (United)] argues that it cannot be held liable under [ERISA] section 502(a)(3) for violations of the Parity Act because it is the claims administrator of a self funded plan.... United argues that the Parity Act does not apply directly to it, because it is not a 'group health plan' and did not offer health insurance coverage to [plaintiff Jonathan Denbo, an individual who was a participant in the plan].... Denbo responds that United's Parity Act obligation is imposed on it not by the Parity Act itself, but rather by section 502(a)(3).... [The court finds that] section 502(a)(3) may impose a fiduciary duty arising indirectly from the Parity Act even if the Parity Act does not directly impose such a duty. For that reason, and because 'section 502(a)(3) admits of no limit . . . on the universe of possible defendants' ..., we hold that United is a proper
defendant for Denbo's Parity Act claim under Section 502(a)(3)." [N.Y. State Psychiatric Ass'n v. UnitedHealth Grp., No. 14-20-cv (2d Cir. Aug. 20, 2015)]
(U.S. Court of Appeals for the Second Circuit)
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CMS Webinar: FF-SHOP Updates
37 presentation slides; August 18, 2015. Topics: [1] Enrollment/Reconciliation Lessons Learned to Date; [2] FF-SHOP Switch Files for Non-renewals; and [3] Questions and Answers: Under-billing issue, Rate calculations;, Mid-year plan selections, Renewals, Enrollment/Reconciliation, Agents/Brokers; and Effectuation 834s.
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
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CMS Webinar: Federally-Facilitated Marketplace Agent and Broker Registration and Training Requirements for Plan Year 2016 (PDF)
39 presentation slides; August 19, 2015. Topics: [1] Role of Agents and Brokers in the Health Insurance Marketplaces; [2] Registration Overview; [3] Training Overview; [4] Training and Exams Requirements and Recommendations; [5] Agreement Requirements; [6] CMS-Approved Vendor Training Option; [7] Considerations for Business Entities; [8] Compensation/Credit for Agents and Brokers Operating in the FFM; and [9] Additional Resources.
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
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D.C. Health Link Launches New Physician Directory to Make Finding a Doctor Easier
"Called the Universal Doctor Directory 1.0, the new tool available on D.C. Health Link allows consumers to search individual and family plans to figure out which doctors participate in particular plans. The directory also allows consumers to find a new doctor by ZIP code, last name or specialty and then see which marketplace insurance plans the doctor accepts."
(The Business Journals)
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Social Security Disability Program: Shortfall Solutions and Consequences (PDF)
"The Disability Insurance Trust Fund is projected to be depleted in 2016. Past solutions utilized to forestall fund depletion have been the transfer of funds between the Old Age & Survivors Insurance Trust Fund and the Disability Insurance Trust Fund.... Solutions required now to avoid the pending Disability Trust Fund depletion are more significant than those that could have been implemented in the past."
(American Academy of Actuaries)
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Big Data: A New Paradigm for Health Plan Oversight and Consumer Protection?
"In this issue brief, [the authors] discuss how insurance regulators (primarily state DOIs and the federal Center for Consumer Information and Insurance Oversight, or CCIIO) and third parties are currently using data collection and how it could change under the ACA to improve health plan oversight and compliance. In particular, [they] discuss how the new ACA requirements could prompt a sea change in regulatory oversight -- and counterintuitively -- reduce the regulatory burden on health plans."
(Robert Wood Johnson Foundation)
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Benefits in General; Executive Compensation
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[Guidance Overview]
SEC Expands Executive Pay Disclosures (PDF)
"It is not clear how institutional investors or their advisers will use the pay ratio, if at all; though it is conceivable that labor pension funds may factor it into decisions whether to invest in a company.... Companies may face new challenges explaining large pay gaps to rank-and-file employees, and boards may think twice about giving their CEO a raise. And it may have an unexpected result, with chief executives who feel underpaid moving to privately held companies that don't face similar disclosure rules."
(Buck Consultants at Xerox)
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[Guidance Overview]
Understanding the SEC's CEO Pay Ratio Disclosure Rule and Its Implications (PDF)
9 pages. "Companies with a significant number of independent contractors will need to determine whether each individual is an employee for purposes of the new rules.... [W]hile the company must identify a specific employee as its median employee, it must be careful when preparing its narrative disclosure not to violate any privacy laws and provide information that will identify the individual whose compensation data is being presented.... Companies should also consider the practical impact of pay ratio disclosure on its employee population."
(Mayer Brown)
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Press Releases
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