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[Official Guidance]

Text of IRS Q&As About Information Reporting by Employers on Form 1094-C and Form 1095-C
Updated Dec. 22, 2016. "Form 1094-C is used to report to the IRS summary information for each employer and to transmit Forms 1095-C to the IRS. Form 1095-C is used to report information about each employee.... These FAQs provide additional information about completing Form 1094-C and Form 1095-C for calendar year 2016 that are to be filed in 2017. The FAQs 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]


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[Official Guidance]

Text of IRS Q&As on Reporting of Offers of Health Insurance Coverage by Employers (Section 6056)
Updated Dec. 22, 2016. "Certain employers are required to report to the IRS information about whether they offered health coverage to their employees and if so, information about the coverage offered. This information also must be provided to employees. These FAQs address these reporting requirements."
Internal Revenue Service [IRS]

[Official Guidance]

Text of IRS Q&As on Employer Shared Responsibility Provisions Under the ACA
Updated Dec. 22, 2016. "The [ACA] added the employer shared responsibility provisions under section 4980H of the Internal Revenue Code. [These FAQs] provide answers to frequently asked questions about the employer shared responsibility provisions."
Internal Revenue Service [IRS]

[Guidance Overview]

Qualified Small Employer Health Reimbursement Arrangements Available for Small Employers (PDF)
"A small employer may sponsor a QSEHRA.... The determination ... is made on a controlled group basis... [An] eligible employer is generally one that employs fewer than 50 full-time employees (including full-time equivalent employees) in the previous year.... The small employer may not offer a group health plan to any of its employees (e.g., medical, dental, vision plans, etc.).... [T]he controlled group rules apply in determining whether a group health plan is offered to any employee."
Trucker Huss

[Guidance Overview]

Is Your Employer Group Health Plan Design Compliant with the Section 1557 Nondiscrimination Rules?
"If you or your health plan are deemed a covered entity under Section 1557, you have some additional compliance measures to undertake, which include: [1] Ensuring your group health plan offers compliant coverage (changes must be made by January 1, 2017) [2] Posting appropriate notices within significant publications, on the premises, and on your website [3] Ensuring proper grievance procedures are adopted and followed ... Here are the questions you should be asking[.]"
Fraser Trebilcock


Online Learning Course: COBRA

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

Even though the ACA has made health care coverage easier for individuals to obtain, group insurance plans must continue to offer COBRA coverage. This course will explain the technicalities of COBRA, including who is entitled and how it must be administered.

[Guidance Overview]

IRS Releases Final Regs on Premium Tax Credit, But Delays Rules on Affordability Implications of Opt-Out Payments
"The regulations do not finalize the proposed rules on the affordability implications of arrangements under which employers make available additional compensation to employees who decline the employer's health plan coverage (referred to as 'opt-out payments'). If employer coverage is not affordable because the amount of the available opt-out payment increases the employee's required contribution, more employees can become eligible for premium tax credits, thus exposing more ALEs to potential Code Section 4980H(b) penalties. The IRS is still examining the issues raised by opt-out arrangements and expects to finalize those proposed regulations separately."
Thomson Reuters / EBIA

[Guidance Overview]

District of Columbia Passes Expansive Paid Leave Law
"The Mayor's opposition is rooted in the financial burden that will be placed on the DC government to create a new agency to administer paid leave and the anomaly that nearly two-thirds of eligible DC employees reside outside the jurisdiction in either Maryland or Virginia.... The paid leave program will be funded through a 0.62% employer payroll tax of the annual wages of each covered employee. The collection of this tax is scheduled to begin on March 1, 2019.... It is estimated that over $246 million will be collected each year and over 500,000 employees will be covered."

The Painful Truth: Opioids and Your Health Plan
"Opioid abusers cost employers nearly twice as much ($19,450) in healthcare expenses on average annually as non-abusers ($10,853), or $8 billion annually in medical expenses alone. Opioid abuse costs employers an additional $10 billion from absenteeism and presenteeism.... One out of every three opioid prescriptions is being abused. 259 million opioid prescriptions were written in 2012, enough for every American adult to have their own bottle of pills."
Chelko Center for Benefits Management

What's Confusing Us About Mental Health Parity
"[C]overage criteria for medical/surgical benefits are often considered proprietary so comparison is impossible; benefit denials often do not offer enough information to allow consumers to appeal; independent reviewers sometimes have perverse incentives when looking at appeals; and the list goes on. All of these issues are exacerbated by growing pains as regulators, health plans, providers, and patients work out their rights and responsibilities under the law."
Health Affairs

Addendum to Joint Congressional Investigative Report Into the Source of Funding for the ACA Cost Sharing Reduction Program (PDF)
32 pages, dated Dec. 2016. "As the Administration scrambled to make the CSR payments on time, senior IRS officials learned about the source of funding for the CSR program and immediately raised concerns about the legality of the funding source.... [T]hey were provided an unusual Action Memorandum signed by Secretary Lew explicitly authorizing the permanent appropriation as the source of funding and shown OMB's memorandum justifying the Administration's actions. This memorandum, however, does not provide a cognizable legal basis for using the permanent appropriation to fund the CSR program."
Committee on Ways and Means, U.S. House of Representatives

Congress Likely to Amend Affordable Care Act in 2017
"Segal expects that the 115th Congress, which convenes in January 2017, will act quickly to repeal the parts of the [ACA] that can be repealed without triggering a filibuster in the Senate. This will likely involve ... [the same process] that Congress followed in late 2015 and early 2016 when it passed HR 3762, legislation to repeal the significant parts of the [ACA]. That legislation was vetoed by President Obama on January 8, 2016, and the House failed to override the veto on February 2, 2016. Congress will likely pass much of this legislation again, and this time a bill will be signed, not vetoed. This Update provides background on the budget process, including what can -- and cannot -- be achieved through it. The Update also briefly addresses the regulatory and enforcement process and what may occur using those administrative tools."
Segal Consulting

Benefits in General

[Guidance Overview]

Text of IRS Publication 15-B: Employer's Tax Guide to Fringe Benefits, for Use in 2017 (PDF)
32 pages; dated Dec. 16, 2016. "What's New: Cents-per-mile rule.... Qualified parking exclusion and commuter transportation benefit.... Contribution limit on a health flexible spending arrangement (FSA)."
Internal Revenue Service [IRS]

[Guidance Overview]

Final DOL Regs Extend Enhanced Claims Procedure Rules to Disability Benefits
"The final regulations, which apply to claims for disability benefits filed on or after January 1, 2018, follow the proposed rules fairly closely. In general, they require more detail in denial notices (for both initial claims and appeals), impose additional criteria to ensure independence and impartiality in decisionmaking, treat most rescissions as adverse benefit determinations, allow claimants to go directly to court if a plan's procedures do not strictly comply with the requirements, and make disability claims subject to the same 'culturally and linguistically appropriate' rules as group health plan claims."
Thomson Reuters / EBIA

[Guidance Overview]

DOL Releases Final Regulations for Disability Benefit Claims Procedures
"[P]articipants may now appeal rescissions of coverage. However, a rescission based on the participant's non-payment of premiums is not an adverse benefit determination.... Plan administrators must explain the protocols that were used to determine the participant's benefit claim.... Plan administrators must inform participants, in benefit denial notices, that they are entitled to access, free of charge, all documents relevant to the adverse claim determinations."
The Wagner Law Group

Press Releases

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