On January 3, 2018, the Department of Labor issued proposed regulations that will make it easier for small employers to band together to form “association health plans” (“AHPs”), thereby providing access to more liberal...more
1/11/2018
/ Affordable Care Act ,
Association Health Plans ,
Corporate Counsel ,
Department of Labor (DOL) ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Employer Liability Issues ,
Executive Orders ,
Health Insurance ,
MEWAs ,
Proposed Regulation ,
Trump Administration
On October 13th, President Trump signed an Executive Order directing various federal agencies to consider how to achieve three administration health reform objectives: (1) expand access to Association Health Plans (AHPs); (2)...more
10/25/2017
/ Affordable Care Act ,
Association Health Plans ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Labor (DOL) ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Executive Orders ,
Healthcare Reform ,
Medical Reimbursement ,
MEWAs ,
New Guidance ,
Secretary of Labor ,
Trump Administration
In recent weeks, the Trump Administration has been considering allowing health insurance to be purchased across state lines and expanding access to “Association Health Plans” (AHPs) that could take economic advantage of...more
Mull v. Motion Picture Ind. Health Plan educates employers on the basics of the requirements of the Employee Retirement Income Security Act (ERISA) governing plan documents and summary plan descriptions. The lessons are...more
8/22/2017
/ Appeals ,
Benefit Plan Sponsors ,
Department of Labor (DOL) ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Employer Liability Issues ,
Motion Picture Industry ,
Plan Administrators ,
Plan Documents ,
Subrogation ,
Summary Plan Description
On August 1, Massachusetts Governor Charlie Baker signed into law H. 3822, “An Act Further Regulating Employer Contributions to Health Care” (the “Act”). The purpose of the Act is to shore up the finances of the...more
With its “employer mandate”—i.e., the requirement that applicable large employers make an offer of group health coverage to substantially all full-time employees or face the prospect of a penalty—the Affordable Care Act (ACA)...more
6/15/2017
/ Affordable Care Act ,
Captive Insurance Company ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Employer Mandates ,
Health Insurance ,
IRS ,
Large Employer ,
Medical Stop-Loss Rules ,
MEWAs ,
Self-Funded Health Plans
In an effort to make up for a funding shortfall in the Commonwealth of Massachusetts’ Medicaid program, state policymakers have proposed solutions that include a “play-or-pay” option under which employers who fail to offer...more
5/30/2017
/ Children's Health Insurance Program (CHIP) ,
Deficit Reduction ,
Employee Retirement Income Security Act (ERISA) ,
Employer Contributions ,
Employer Group Health Plans ,
Health Insurance ,
Healthcare Reform ,
Medicaid ,
Pay or Play ,
Preemption ,
State Legislatures
The stunning failure of the U.S. House of Representatives to pass the American Health Care Act (AHCA) (which we previously reported on here) has political and policy implications that we cannot forecast. Nor it is it clear to...more
3/28/2017
/ Affordable Care Act ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Health Insurance ,
Large Employer ,
Legislative Agendas ,
Medicaid ,
Medicaid Expansion ,
Preemption ,
Proposed Legislation ,
Repeal ,
State Health Plans ,
Trump Administration
We reported in a recent post on proposed regulations dealing with, among other things, the treatment of hospital indemnity or other fixed indemnity insurance products in the group market. This post takes a closer look at the...more
8/27/2016
/ Affordable Care Act ,
Department of Health and Human Services (HHS) ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Health and Welfare Plans ,
Health Insurance ,
Hospitals ,
Indemnity ,
Minimum Essential Coverage ,
NAIC ,
Supplemental Insurance
On June 10, the Departments of Treasury, Labor, and Health and Human Services (The “Departments”) issued a set of proposed regulations dealing with expatriate health plans, excepted benefits, lifetime and annual limits, and...more
The benefits world was set abuzz late last year with Equal Employment Opportunity Commission v. Flambeau, Inc., in which the Federal District Court for the Western District of Wisconsin upheld the validity of Wisconsin-based...more
Recently, we reported on Gobeille v. Liberty Mutual, in which the Supreme Court invalidated the Vermont all-payer claims data base law. Applying what appeared to us as a straight-forward application of existing ERISA...more
The Employee Retirement Income Security Act of 1974 (ERISA) made the regulation of employee benefit plans principally a matter of Federal concern. ERISA broadly and generally preempts—or renders inoperative—state laws that...more
For the last half of 2015, we spent a good deal of time explaining the Affordable Care Act reporting requirements that applied to carriers and large employers. This post examines the how of ACA reporting. In particular, it...more
Issued at the end of last year, Notice 2015-87 provided detailed guidance on a host of topics. The notice has been referred to colloquially in some quarters as the “pot luck” notice. Among other things, the notice, in Q&A 4,...more
It took a while, but most employers and their advisors have finally gotten the hang of the Affordable Care Act’s employer shared responsibility rules. That is, they understand generally that:
1. “Applicable Large...more
Affordability—i.e., whether health coverage is “affordable”—occupies an important place in the Affordable Care Act’s (ACA) regulatory scheme. Under that law’s individual mandate, no penalties are imposed for failure to...more
The recently enacted Bipartisan Budget Act of 2015 repealed Section 1511 of the Affordable Care Act (ACA), which generally would have required employers with more than 200 full-time employees to automatically enroll new...more
In an earlier post, we reported on a troubling development in the draft 2015 instructions for Forms 1094-B and 1095-B which, if adopted, would have required sponsors of Health Reimbursement Arrangements (“HRA”) to issue...more
11/3/2015
/ Affordable Care Act ,
Employer Group Health Plans ,
Final Rules ,
Form 1094 ,
Form 1095 ,
HRA ,
IRS ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Medicare Part B ,
Minimum Essential Coverage ,
Reporting Requirements ,
State Medicaid Programs ,
Supplemental Insurance ,
TRICARE ,
U.S. Treasury
As we noted in a previous post, the recently issued final 2015 Instructions for Forms 1094-C and 1095-C changed certain of the rules relating to the reporting for offers of COBRA coverage where the COBRA qualifying event...more
10/29/2015
/ Affordable Care Act ,
American Bar Association (ABA) ,
COBRA ,
Employer Group Health Plans ,
Employer Liability Issues ,
Final Rules ,
Form 1094 ,
Form 1095 ,
Full-Time Employees ,
Health Insurance ,
IRS ,
Part-Time Employees ,
Reporting Requirements ,
Safe Harbors ,
Self-Funded Health Plans ,
Shared Responsibility Rule ,
Termination ,
U.S. Treasury
In Notice 2014-69, the Treasury Department and the IRS clarified that a group health plan that fails to provide substantial coverage for in-patient hospitalization and physician services will not be treated as providing...more
9/30/2015
/ Affordable Care Act ,
Amended Regulation ,
Department of Health and Human Services (HHS) ,
Employer Group Health Plans ,
Employer Liability Issues ,
Health Insurance ,
Hospitals ,
IRS ,
Minimum Essential Coverage ,
Minimum Value Plans ,
Physicians ,
Proposed Regulation ,
Tax Credits ,
U.S. Treasury
The IRS recently issued final instructions for Forms 1094-B and 1095-B and Forms 1094-C and 1095-C . The 2015 Instructions for Forms 1094-B and 1095-B implement a suggestion we made in a previous post relating to the...more
9/22/2015
/ Affordable Care Act ,
COBRA ,
Employer Group Health Plans ,
Employer Liability Issues ,
Expatriates ,
Final Guidance ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
HRA ,
IRS ,
Minimum Essential Coverage ,
Minimum Value Plans ,
Multiemployer Plan ,
Proposed Regulation ,
Reporting Requirements ,
Self-Funded Health Plans ,
U.S. Treasury
The Affordable Care Act’s reporting rules—which are set out in Internal Revenue Code §§ 6055 and 6056—solicit the information needed by the Internal Revenue Service to enforce the individual and employer shared responsibility...more
9/15/2015
/ Affordable Care Act ,
Employer Group Health Plans ,
Employer Mandates ,
Internal Revenue Code (IRC) ,
IRS ,
Large Employer ,
Look-Back Measurement Period ,
Minimum Essential Coverage ,
Reporting Requirements ,
Shared Responsibility Rule ,
Subsidies
The Affordable Care Act’s (ACA) employer shared responsibility rules provide applicable large employers (i.e., those with 50 or more full-time and full-time equivalent employees on business days during the preceding calendar...more
9/10/2015
/ Affordable Care Act ,
Employer Group Health Plans ,
Excise Tax ,
Health Insurance ,
IRS ,
MEWAs ,
Multiemployer Plan ,
Professional Employer Organization ,
Reporting Requirements ,
Shared Responsibility Rule ,
Staffing Agencies ,
Taft-Hartley Act ,
Tax Credits
When it comes to mergers and acquisitions involving at least one applicable large employer (ALE), the substantive rules governing employer shared responsibility (under Internal Revenue Code § 4980H) and the corresponding...more
9/1/2015
/ Affordable Care Act ,
Asset Purchaser ,
COBRA ,
Employer Group Health Plans ,
Final Rules ,
Health Insurance ,
IRS ,
Large Employer ,
Reporting Requirements ,
Shared Responsibility Rule ,
Social Security Taxes ,
Stock Deals ,
Successors ,
U.S. Treasury ,
Wages