Health & Welfare Plans Newsletter

December 21, 2016

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[Official Guidance]

2016 IRS Publication 974: Premium Tax Credit (PDF)
74 pages, dated Dec. 20, 2016. "If you, your spouse with whom you are filing a joint return, or a dependent was enrolled in coverage through the Marketplace for 2016 and advance payments of the premium tax credit (APTC) were made for this coverage, you must file a 2016 return and attach Form 8962, Premium Tax Credit (PTC).... You must attach Form 8962 even if someone else enrolled you, your spouse, or your dependent."
Internal Revenue Service [IRS]

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[Guidance Overview]

HHS Finalizes the 2018 Out-of-Pocket Maximums
"While it is anticipated that Congress will pass, and President-elect Trump will sign, legislation to repeal certain provisions of the ACA starting as soon as 2017, it is unlikely that the ACA OOP limits will be one of those provisions.... [A table in this article] summarizes the ACA indexed dollars limits for 2018 and prior years."
Xerox HR Services

[Guidance Overview]

CMS Announces 2018 Annual ACA Cost-Sharing Limits
"[N]on-grandfathered group health plans are required to limit the amount plan participants and beneficiaries pay towards in-network 'essential health benefits.' ... For plan years beginning in 2018, the ACA cost sharing limit will increase to $7,350 for individual coverage (an increase of $200 from 2017) and $14,700 for family coverage (an increase of $400 from 2017)."
Lockton

[Guidance Overview]

IRS Extends Deadline to Furnish Forms 1095-C and 1095-B, and Extends Good Faith Transition Relief from Reporting Penalties
"[Notice 2016-70] delays the deadline from January 31, 2017 to March 2, 2017 for employers to furnish the Form 1095-C to full-time employees and for providers of health coverage (such as insurers and multiemployer trusts that provide self-funded health plan benefits) to furnish the Form 1095-B to covered individuals. While employers and providers of 'minimum essential coverage' ... will still have to file the forms with the IRS by the original February 28, 2017 deadline if filing by paper, or March 31, 2017 if filing electronically, the 30-day delay for furnishing statements to employees and covered individuals gives employers and plans more time to help ensure forms are prepared properly and completely."
Trucker Huss

[Guidance Overview]

2017 Compliance Deadlines Approach for Illinois, Cook County, and Chicago Sick Leave Laws
"Illinois employers must revise sick leave policies to comply with new Chicago, Cook County and Illinois laws that go into effect as early as January 1, 2017. This article briefly summarizes and reconciles the three laws, so that you can begin to take action, to the extent you have not done so already."
Quarles & Brady LLP

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EBSA/OIG Shows Path Out of Forest for Patients, Plans and Service Providers
"EBSA offers guidance for denied health care benefit claims after OIG reports EBSA did not have the ability to protect the estimated 79 million plan participants in self-insured health plans from improper denials of health claims.... EBSA is advocating for new 5500 Schedule J reporting requirements to include a range of claims payment data ... [It] appears the EBSA is providing guidelines or possible 'Red Flags' for possible investigations into violations.... EBSA has made it clear that it is committed to conducting focused yet robust health investigations that seek global corrections of violations in order to restore losses to participants who were harmed."
AVYM Healthcare Revenue Consultants

Employers Act to Control Pharmacy Cost Trend
Infographic. "A surge in specialty pharmacy requires companies to employ a host of approaches, emphasizing specialty pharmacy utilization in order to be a best performer."
Willis Towers Watson

What Will Happen to the ACA Under the Trump Administration?
"Mr. Trump has chosen Tom Price to head [HHS] and he will be charged with repealing or replacing the ACA. Mr. Price, a six-term Congressman ..., has introduced legislation every year since 2009 to replace the ACA. Mr. Price's proposal, called the 'Empowering Patients First Act,' provides some clues regarding the future of the ACA under the incoming administration. [1] Repeal of the individual mandate ... [2] Reduced pre-existing condition protections ... [3] Promotion of Health-Savings Accounts."
Frost Brown Todd LLC

Two Recipients of ACA Cost-Sharing Subsidies Seek Voice in Litigation
"On December 20, two of the 5.9 million individuals who actually benefit from CSRs asked the court to allow them to intervene in the House v. Burwell appeal to protect their interests in continuing to receive the CSRs, which are opposed by the House and, in their view, may well not be adequately protected by the Trump administration."
Health Affairs

How Does CBO Define and Estimate Health Insurance Coverage for People Under Age 65?
"[This article] [1] describe[s] how CBO defines health insurance coverage (private and public) for people under 65 who are not institutionalized and who are not members of the active-duty military.... [2] explain[s] how the agency estimates the number of insured and uninsured people in that population for the most recent year for which data on actual coverage exist.... [3] describe[s] where CBO obtains the data to estimate coverage, the limitations of those sources, and how CBO adjusts its estimates because of those limitations."
Congressional Budget Office [CBO]

Challenges in Estimating the Number of People with Nongroup Health Insurance Coverage Under Proposals for Refundable Tax Credits
"Some policymakers have expressed interest in developing proposals to replace the current tax-based subsidies for the purchase of private health insurance in the nongroup (or individual) market under the [ACA] with refundable tax credits that would be structured differently from those under current law.... [This article describes] the challenges CBO and JCT would face in estimating the number of people who would purchase coverage in the nongroup market, and the scope of that coverage, under such proposals. (Similar challenges could arise in the group market if tax credits were extended to people with employment-based coverage.)"
Congressional Budget Office [CBO]

Benefits in General

[Official Guidance]

Text of IRS Disaster Relief Announcement ATL-2016-11, for Victims of Wildfires in Tennessee
"Victims of the wildfires, that took place beginning on November 28, 2016 in parts of Tennessee, may qualify for tax relief from the [IRS].... [A]ffected taxpayers in Sevier County will receive tax relief. Individuals who reside or have a business in Sevier County may qualify for tax relief.... [C]ertain deadlines falling on or after November 28, 2016, and before March 31, 2017 are granted additional time to file through March 31, 2017."
Internal Revenue Service [IRS]

The Legacy of Phyllis Borzi, DOL's Champion for Employee Benefits
"Phyllis Borzi has one month to go in office as assistant secretary for [EBSA], but stacks of files are still heaped on her desk and on the floor.... Borzi [said] that she came into office in 2009 with three goals, or 'pillars': transparency, accountability and minimizing conflicts of interest.... Count among the wins the plan fee disclosure regulations under Section 408(b)(2) of [ERISA], the hard-fought fiduciary rule and an abundance of guidance under the [ACA]. Among rules that didn't get to the finish line was one that would have helped plan sponsors, especially small plan sponsors, provide lifetime plan participation illustrations."
Bloomberg BNA

Executive Compensation and Nonqualified Plans

Ho, Ho ... How? A Guide to Making Year-End Donations of Company Stock to Charities
"For a charitable donation of company stock acquired from equity compensation, the tax treatment is the same as it is for donations of any stock to a qualified charity.... With a charitable gift of appreciated shares held long-term, the donation you make and the deduction you get are greater than they would be if you were to instead sell the shares and donate the cash proceeds. This is because when you donate shares, you avoid paying the capital gains tax."
myStockOptions.com

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David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016 BenefitsLink.com, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of BenefitsLink.com, Inc., or in the case of third party materials, the owner of that content. You may not alter or remove any trademark, copyright or other notice from copies of the content.

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