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Health Insurance Penalties

BCLP

Compliance Check-Up: Illinois Consumer Coverage Disclosure Act

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On August 21, 2021, Illinois enacted the Consumer Coverage Disclosure Act (the “CCDA”) requiring that Illinois employers provide a disclosure to employees which comparing the employer’s group health plan compares with the...more

Bricker Graydon LLP

Can you Charge Smokers More for Your Health Plan?  

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Several new lawsuits have been filed recently alleging that employers violated HIPAA’s non-discrimination rule by charging higher health insurance premiums to employees who use tobacco products. ...more

Bricker Graydon LLP

Is My Health Plan Affordable Enough?

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As employers increasingly struggle with rising health plan costs, the IRS has provided some good news. Recently, the IRS announced that the Affordable Care Act (ACA) affordability threshold will increase to 9.96% of household...more

Foley & Lardner LLP

Virginia Bureau of Insurance Issues Guidance Clarifying Material Change and Required Notifications for Managed Care Health...

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On July 22, the Virginia Bureau of Insurance (BOI) issued Administrative Letter 2025-02 (the Letter) to all licensed insurers writing Managed Care Health Insurance Plans (MCHIPs) in Virginia. The Letter clarifies what...more

Haynes Boone

False Claims Act - 2025 Mid-Year Review

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The False Claims Act continues to be one of the most commonly used weapons in the government’s enforcement arsenal to address various forms of fraud. In addition to our “Year in Review” publication providing an overview of...more

Woodruff Sawyer

IRS Issues Affordability Percentage Adjustment for 2026

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The Internal Revenue Service (IRS) has released Rev. Proc. 2025-25, which contains the inflation adjusted amounts for 2026 used to determine whether employer-sponsored coverage is “affordable” for purposes of the Affordable...more

Troutman Amin LLP

SCAMMERS OR DUMMIES?: Selling Limited Benefits Plans to Consumers Seeking Health Insurance Lands Four Dudes In Hot Water–BUT Are...

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The lead generation industry is fascinating. If there is one over arching mantra it is this– monetize all data available. And sometimes that can get folks into BIG trouble, especially when lead buyers end up pitching...more

Carlton Fields

Faulty COBRA Notices Can Cost Big Bucks

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When COBRA cases survive motions to dismiss, big dollars are at stake. Marrow v. E.R. Carpenter Co., No. 8:23-cv-02959, is a class action lawsuit filed in the U.S. District Court for the Middle District of Florida on behalf...more

Mitratech Holdings, Inc

ACA Reporting Deadlines for 2025: What You Need to Know

Understanding reporting rules for the Affordable Care Act (ACA) is more than a best practice. It’s a legal imperative. If your reports aren’t timely and accurate, you face penalties....more

Fisher Phillips

5 New ACA Reporting and Penalty Rules Employers Will Be Happy About

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Two new federal laws bring good news to employers subject to reporting and other requirements under the Patient Protection and Affordable Care Act (ACA). President Biden approved laws in December that not only ease the...more

Bass, Berry & Sims PLC

2025 Changes to ACA Employer Information Reporting Obligations and the Employer Shared Responsibility Penalties

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In December 2024, Congress and President Biden passed two laws—the Paperwork Burden Reduction Act (PBRA) and the Employer Reporting Improvement Act (ERIA)—that made important changes to employers’ responsibilities regarding...more

Faegre Drinker Biddle & Reath LLP

Affordable Care Act Penalty and Reporting Relief

The Employer Reporting Improvement Act and the Paperwork Burden Reduction Act (PBA), each signed into law in December 2024, provide the following penalty and reporting relief for plan sponsors required to provide minimum...more

Venable LLP

Changes to the ACA: Reporting and Employer Penalties

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President Biden recently signed into law the Paperwork Burden Reduction Act and the Employer Reporting Improvement Act. These new laws make important changes to the Affordable Care Act (ACA)....more

Stotler Hayes Group, LLC

Avoiding Transfer Penalties: How to Identify Successful Strategies to Remove Penalties on Medicaid Eligibility for the Skilled...

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Medicaid is the primary payer for 63% of nursing facility residents, propping up a large part of the industry’s funding. ...more

The Volkov Law Group

American Life Insurance Company Settles with OFAC for $178,421 Related to Apparent Violations of Iranian Transactions and...

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The U.S. Department of the Treasury’s Office of Foreign Assets Control (“OFAC”) recently settled with American Life Insurance Company (“ALICO”), a Delaware-based subsidiary of MetLife, Inc., for $178,421, addressing apparent...more

Fenwick & West LLP

California’s SB 1120 Regulates AI in Health Plan Utilization Review and Management Activities Starting in January

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On September 28, California Gov. Gavin Newsom signed Senate Bill 1120 Health Care Coverage: Utilization Review into law, amending § 1367.01 of the Health and Safety Code and § 10123.135 of the state’s Insurance Code....more

Mandelbaum Barrett PC

Medicaid Final Agency Decision Reaffirms Criteria Necessary to Qualify for Caregiver Child Exception

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Certain Medicaid programs impose a transfer penalty on applicants who have transferred resources (assets) for less than fair market value within five (5) years preceding the Medicaid application. Simply stated, the transfer...more

Verrill

A Primer on COBRA Continuation Coverage for Health Care Flexible Spending Accounts

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It is a common practice for employers to offer employees a health care flexible spending account (“Health FSA”) option under a cafeteria plan. However, employers (and their COBRA administrators) may not be aware that Health...more

Foley & Lardner LLP

Don’t You Forget About Me: Terminating Employees and Benefits to Think About

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No matter the size of your organization, at some point in time employees leave. As we noted previously, it behooves human resources and other departments to provide departing employees with an exit letter that includes...more

Lippes Mathias LLP

New York State Medicaid Updates for 2024

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Medicaid is a joint federal and state program that provides health coverage to millions of Americans. Federal law requires states to comply with certain minimum requirements, but New York is considered a maximum state in that...more

Foley & Lardner LLP

Postponement in the Massachusetts Patients First Act Penalties

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On July 5, 2022, the Commonwealth of Massachusetts re-extended the implementation and enforcement date for the “Patients First Act”, sometimes referred to as the Massachusetts No Surprises Act, to January 1, 2025. As...more

Foley & Lardner LLP

Massachusetts DPH Delays Enforcement Penalties for State Surprise Billing Law

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The Massachusetts Department of Public Health (DPH) has delayed the enforcement penalties for the new notice requirements under the “Patients First Law” until July 1, 2022. This news comes as a relief to the provider...more

Saul Ewing LLP

2021 Limits Announced

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Federal agencies recently announced cost-of-living adjustments on Social Security taxable earnings and maximum benefits, limits on compensation and deferrals for retirement plans, and limits on health and welfare plans....more

McAfee & Taft

IRS announces relief for certain Form 1094/1095 reporting requirements

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In a similar move as in previous years, the IRS has issued relief from certain Form 1094-C and 1095-C reporting requirements under the Affordable Care Act relating to employee health plans, as well as relief from certain...more

Proskauer - Employee Benefits & Executive...

What Employers Should Know about ACA Shared Responsibility Payments

A recently released redacted report from the Treasury Inspector General for Tax Administration (TIGTA) offers some helpful insights for employers who may be assessed shared responsibility payments because the IRS thinks they...more

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