Category: Health and Welfare Plans
Are You Ready for a HIPAA and ACA Audit?
It's no secret that the Office of Civil Rights of the Department of Health and Human Services has been expanding its enforcement activity under the privacy and security standards of HIPAA. And it's not surprising that enforcement activity is in the offing under the Affordable Care Act as well...
Final Omnibus Rules Under HIPAA Will Affect Business Associate Arrangements
In a previous post about the new Final Omnibus Rule under HIPAA, we highlighted important changes regarding the process by which potential privacy breaches must be evaluated and classified for notification purposes. As we observed in that post, changes that have been characterized by the Office of Civil Rights...
HHS Makes Significant Changes to HIPAA Breach Notification Rules
Three years ago, almost to the day, we posted the first of a two part analysis of the Interim Final Rules published by the U.S. Department of Health and Human Services ("HHS") governing the HIPAA privacy breach notification requirements. We now return to that subject in light of the...
Working with the New Annual Limit on FSA Contributions
The Patient Protection and Affordable Care Act modified the rules relating to cafeteria plans to impose a new $2,500 annual limit on the amount that an employee may elect to contribute to a health flexible spending account ("health FSA"), effective January 1, 2013. The modification came in the form...
2012 Year End Benefit Plan Compliance Checklist and Reminders for Employers
By comparison to past years, the end of 2012 and beginning of 2013 seem not to bring all that much in the way of new legal compliance burdens regarding retirement plans, health plans, and deferred compensation plans. For the most part employers face the continued implementation of changes in...
HSAs in Operation: Ten Common Questions
It's open enrollment season and many employers are implementing high-deductible health plans (HDHPs) with a Health Savings Account (HSA) feature. Our prior posts about HDHPs and HSAs have explored the general eligibility requirements for HDHP/HSA arrangements and HSA contributions . Today we address common questions about the operation of...
Summary of Benefits and Coverage Must be Provided Soon
As employers prepare for their fall 2012 open enrollment efforts, we wanted to offer a reminder that a Summary of Benefits and Coverage (or "SBC") will now have to be provided to group health plan participants and beneficiaries. For group health plans having open enrollment periods, this new requirement...
How Should Employers Handle Medical Loss Ratio Rebates?
Many employers have now received rebates from insurance companies whose use of premium dollars to pay non-health benefit expenses exceed the limits imposed under the medical loss ratio ("MLR") standards of the Patient Protection and Affordable Care Act. Under the Affordable Care Act, insurance carriers in the large group...
The Verdict on Health Care Reform: Impact on Employer Health Plans
The United States Supreme Court ruled yesterday that the Patient Protection and Affordable Care Act of 2010 ("ACA") is constitutional in almost all respects, striking down only those provisions that would withhold all Medicaid funds from States that do not implement the expanded Medicaid coverage prescribed by the ACA.The...
The First Circuit’s DOMA Decision: What It Means for Employers
On May 31, 2012 the U.S. Court of Appeals for the First Circuit, in Massachusetts v. United States Department of Health and Human Services , declared Section 3 of the Defense of Marriage Act (DOMA) unconstitutional. Section 3 defines marriage for purposes of applying all federal statutes as "a...
HSA Contributions: Making Sense of the Moving Parts
As we have noted, high-deductible health plans (HDHPs) with a Health Savings Account (HSA) feature are growing in popularity. Our last post on HDHP/HSA arrangements explored some of the general eligibility questions we are asked most frequently. Today we address common questions about HSA contributions. 1. Are contributions limited...
Implementing an HSA with HDHP: How Hard Could it Be?
High-deductible health plans (HDHPs) with a Health Savings Account (HSA) feature are growing in popularity. While implementing an HDHP/HSA arrangement can be complicated, having a sense of the landscape can prevent uncomfortable bumps and bruises. This post explores some of the general eligibility questions we are asked most frequently...
Unclaimed Benefits and State Escheat Laws
From time to time we are asked whether a plan administrator must report and remit unclaimed plan benefit payments as abandoned or unclaimed property to various states under their escheat and unclaimed property statutes. Clients are usually asking about how to handle uncashed retirement plan benefit checks, and this...
An Over-the-Counter Remedy for the Health Risk Assessment Headache
A number of clients have recently asked a relatively simple question: Can they require an employee to take a health risk assessment ("HRA") as a condition of participation in a wellness program or group health plan? This question seems simple enough. Nevertheless, the answer involves unraveling a complex web...
Agencies Broadly Expand Required Preventive Services for Women Under Health Care Reform
On Monday Treasury, Labor, and HHS released an amendment to the interim final regulations on preventive care. This amendment adopts new standards that broadly expand required preventive services for women under health care reform. As discussed in prior posts , health care reform requires that non-grandfathered health plans cover...
Choices, Competition and Clout: New Proposed Regulations on Health Insurance Exchanges
Last week the U.S. Department of Health and Human Services ("HHS") released proposed regulations designed to implement the provisions of the Affordable Care Act calling for the establishment of State-based affordable insurance exchanges ("Exchanges"). As explained by HHS in the preamble to the proposed regulations, "Exchanges will offer Americans...
Traps for the Unwary: COBRA and Retiree Medical
Employers often ask about their obligations to offer COBRA benefits to terminating employees who are eligible for retiree medical coverage, and with good reason. The interplay between COBRA and alternative retiree coverage is complicated, and an employer faces steep penalties in the event of a mistake. Whether COBRA coverage...
Double Dose of Relief for Non-Profit Hospitals and Certain Insurance Companies Under Health Care Reform
Over the past week the IRS has doled out a double dose of relief for non-profit hospitals and health insurance organizations that were facing reporting and compliance deadlines created by the Affordable Care Act: (1) delayed reporting of community care/community benefit activities by tax-exempt hospitals; and (2) temporary reprieve...
Maine Revamps Its Health Insurance Laws
Last week Maine Governor Paul LePage signed into law new legislation (L.D. 1333) intended to make sweeping changes to the Maine individual and small employer group health insurance markets. Reasonable minds disagree on the efficacy (and desirability) of the law. While many of the changes primarily affect those who...
IRS Describes Potential Approaches to Employer Shared Responsibility Under Health Care Reform
Treasury and the IRS have given us a peek at how they may implement the employer shared responsibility provisions of health care reform, set to take effect in 2014. These provisions, commonly known as the "play or pay" mandate, will impose a penalty on applicable large employers that do...
Reporting Health Care Costs on Form W-2
The Affordable Care Act requires employers to report on Form W-2, for informational purposes only, the cost of the group health benefits provided to each employee. IRS Notice 2011-28 (issued March 29, 2011) provides interim guidance on how this new information reporting obligation is to be implemented. Employers are...
Expanded Form 1099 Reporting Repealed, Free Choice Vouchers Likely Next
Late yesterday President Obama signed into law legislation to repeal the expanded Form 1099 reporting requirements passed under health care reform. This new legislation, supported by the President, marks Congress' first successful rollback of health care reform. As discussed in an earlier post , the new legislation repeals a...
HHS Early Retiree Reinsurance Program to Stop Accepting Applications
If your company has a retiree medical plan and has not applied to participate in the Early Retiree Reinsurance Program (ERRP), now is the time to do so. HHS has announced that it will stop accepting applications for the ERRP as of 30 calendar days after April 5, 2011...
Health Care Reform: One Year Later (Part 2)
This is the second in our two-part series of posts regarding the status of health care reform one year after the Patient Protection and Affordable Care Act was signed into law. Part 1 summarized the state of compliance by employers, offered a quick survey of regulatory guidance and highlighted...
Health Care Reform: One Year Later (Part 1)
One year ago today President Obama signed the Patient Protection and Affordable Care Act – the landmark health care reform legislation – into law. A week later he signed the Health Care and Education Reconciliation Act of 2010 (containing the "Senate fixes") to complete the legislative process that made...
Maine Receives Waiver from Medical Loss Ratio Requirements Under Health Care Reform
The federal Department of Health and Human Services has granted Maine's request for a waiver from health care reform's medical loss ratio rule . This new rule requires health insurance companies to devote at least 80 cents (85 cents in the large group market) of every premium dollar to...
HHS Releases Information Regarding Early Retiree Reinsurance Program Expenditures
Earlier this week HHS revealed that it expects to distribute about $3.6 billion in reimbursements under the Early Retiree Reinsurance Program (ERRP) to employers and other sponsors of retiree medical plans during fiscal 2011. (The federal fiscal year runs from October 1 through September 30.) The remaining funds, approximately...
IRS Issues Important New Guidance on Health FSA and HRA Debit Cards
Today the IRS issued new guidance allowing the continued use of health FSA and HRA debit cards for the purchase of prescribed over-the-counter (OTC) medicines and drugs. This new guidance modifies prior guidance, discussed here , which generally prohibited the use of health FSA and HRA debit cards to...
Agencies Delay Enforcement of Nondiscrimination Rules for Insured Health Plans
Recognizing that further guidance is needed to help health plan sponsors comply with certain health care reform rules, today the IRS released Notice 2011-1 , which delays new health care reform nondiscrimination rules until such time as regulatory guidance may be issued. Absent this Notice, the new nondiscrimination rules...
Agencies Finally Amend Grandfather Regulations Under Health Care Reform
Treasury, Labor, and HHS have finally released an amendment to the grandfathered health interim final regulations . The amended regulation revises earlier guidance, discussed here , here , and here , by allowing group health plans to switch insurance contracts and issuers and still retain grandfather status. Specifically, group...
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