7 pages; Dec. 12, 2021. "Form 1095-B is used to report certain information to the IRS and to taxpayers about individuals who are covered by minimum essential coverage.... Every person that provides minimum essential coverage to an individual during a calendar year must file an information return reporting the coverage. Filers will use Form 1094-B (transmittal) to submit Forms 1095-B (returns)" [Also available: 2022 IRS Form 1094-B and 2022 IRS Form 1095-B.]  MORE >>

"Does a bonus or other incentive for an agent or broker that is introduced after the beginning of an Open Enrollment Period [OEP] violate the guaranteed availability provisions of the [ACA]? ... Does a post-OEP bonus or other incentive need to be applied retroactively to all enrollments occurring for the same plan year?"  MORE >>

18 pages; Dec. 13, 2022. "ALE Members that offer employer-sponsored, self-insured coverage also use Form 1095-C to report information to the IRS and to employees about individuals who have minimum essential coverage under the employer plan." [Also available: 2022 IRS Form 1094-C and 2022 IRS Form 1095-C]  MORE >>

"The regulations permanently extend the deadline for furnishing a given year's Forms 1095-B and 1095-C to individuals until 30 days after January 31 of the immediately following year (or the next business day, if the 30th day falls on a Saturday, Sunday, or legal holiday). The extension replaces the 30-day extension that could be requested for good cause ... [T]he regulations provide an alternative to automatically furnishing statements in certain situations."  MORE >>

"The new final regulations ensure that the automatic 30-day extension will again be available for this year's ACA reporting at the start of 2023 -- as well as all future years of ACA reporting.... The IRS has also proposed regulations that would reduce the required electronic filing threshold to employers filing just 10 or more returns. That reduced 10-return electronic filing threshold has not been finalized and therefore is not currently being enforced."  MORE >>

"[E]mployers should update employee payroll deductions with the 2023 rates for state-mandated short-term disability (STD) and paid family and medical leave (PFML). Employers should also ensure they are using the most up-to-date STD/PFML model workplace posters and notices, which some states update annually.... [S]ome states require employers to notify employees annually of their rights or of PFML rate changes before they are implemented. [This article outlines] updates to the state-mandated STD and PFML rates and model posters/notices[.]"  MORE >>

"This year's payment notice largely proposes to continue existing risk adjustment policies, a contrast with the 2022 and 2023 payment notices, each of which proposed substantial changes to risk adjustment (some of which were ultimately finalized). The proposed rule would, however, make some policy changes."  MORE >>

"[I]nformation on the certification shared with the employer and words used by employees to explain an absence both matter to the proper administration of FMLA leave.... [An] employee cannot be faulted for failing to comply with company policy if the policy is unclear or the employee lacked notice of the policy.... If leave is unforeseeable, and it is the first time the employee is seeking leave for an FMLA-qualifying reason, they are not required to assert FMLA rights or even mention the act." [Render v. FCA US LLC, No. 21-2851 (6th Cir. Nov. 16, 2022)]  MORE >>

"U.S. health care spending grew 2.7% to reach $4.3 trillion in 2021, slower than the increase of 10.3% in 2020.... Private health insurance spending increased by 5.8% in 2021 to $1.2 trillion.... Total out-of-pocket spending increased by 10.4% in 2021 following a decline of 2.6% in 2020.... Retail prescription drug spending increased 7.8% to $378.0 billion in 2021, a faster rate than in 2020 when spending increased by 3.7%."  MORE >>

"Manufacturers likely will take a variety of steps in and out of Medicare to mitigate the impact of the law on their net revenues.... [O]ne important area is likely to be altered pricing and rebating practices in the Medicare and commercial drug markets, especially where the new IRA pricing benchmarks do not account for payer and pharmacy benefit manager (PBM) rebates (... [This article describes] likely impacts of the IRA on rebates as well as other potential impacts of the new law."  MORE >>

"In most states, the small group market is still cheaper than the individual market ... the main response to ICHRAs so far has been silence.... [L]evel funding is a far more popular workaround, with nearly 40 percent of small firms that offer coverage reporting use of a level funded plan."  MORE >>

"Since the October 15 deadline has passed, the [DOL] has identified more than 3,200 Form 5500s that were filed without the required audit report.... The DOL has sent emails to those plan administrators ... and if they do not receive an amended filing with the audit report, they will send a formal Notice of Rejection that states the plan administrator has 45 days to comply ... According to the DOL, the primary reason plan administrators open themselves to compliance risk is that they do not pay attention to the correspondence."  MORE >>