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Proposed Rule Would Extend ACA Reporting Furnishing Deadlines
On Nov. 22, 2021, the IRS released a proposed rule that would extend the annual furnishing deadlines for Sections 6055 and 6056 reporting under the Affordable Care Act (ACA).
FAQs Clarify COVID-19 Vaccine Coverage and Premium Discounts
Premium Discounts for COVID 19 Vaccination Generally Must be Offered as Part of a Wellness Program  On Oct. 4, 2021, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) issued FAQs addressing rules regarding premium
Proposed Rule Would Expand Electronic Filing Requirement
Proposal Would Effectively Eliminate Paper Filings for Most Employers On July 23, 2021, the IRS published a proposed rule that would expand the requirement to file certain information returns electronically, including those under the Affordable Care Acts (ACA) reporting requirements
Changes Anticipated to Contraceptive Coverage Rules
The Departments Intend to Amend Existing Religious and Moral Exemptions On Aug. 16, 2021, the Departments of Health and Human Services (HHS), Labor (DOL) and the Treasury (Departments) issued a frequently asked question (FAQ) regarding enforcement of the contraceptive coverage
PCORI Fees Due Aug. 2, 2021
The Fee is $2.54 per Covered Life for Plan Years Ending in 2020 The Affordable Care Act (ACA) requires health insurance issuers and self insured plan sponsors to pay Patient Centered Outcomes Research Institute fees (PCORI fees). Issuers and plan
U.S. Supreme Court Rejected Challenge to ACA
Supreme Court Determined there was No Legal Right to Sue On June 17, 2021, the U.S. Supreme Court rejected a lawsuit challenging the constitutionality of the Affordable Care Acts (ACA) individual mandate in a 7 2 ruling. This
Draft Forms for 2021 ACA Reporting Released
2021 ACA Reporting is Due in Early 2022 The IRS has released draft 2021 versions of Forms 1094 C, 1095 C, 1094 B and 1095 B that employers will use in early 2022 to report under Internal Revenue Code Sections
HHS Finalizes Remainder of the 2022 Notice of Benefit and Payment Parameters
The Notice Includes Additional Benefit and Payment Standards for 2022 On May 5, 2021, the Department of Health and Human Services (HHS) published a second Notice of Benefit and Payment Parameters (NBPP) for 2022 that finalized the remainder of the
CMS Extends Exchange Special Enrollment Due to COVID-19
The Special Enrollment Period will Now be Available through Aug. 15, 2021, via HealthCare.gov On March 23, 2021, the Centers for Medicare & Medicaid Services (CMS) announced that it is extending access to a special enrollment period (SEP) through Exchanges
IRS Releases Additional Section 6056 Codes for ICHRAs
These Codes were Previously Reserved on the 2020 Instructions for Forms 1094 C and 1095 C On Feb. 2, 2021, the Internal Revenue Service (IRS) provided two additional codes from Code Series 1, that can be used on Form 1095
Biden Issues Executive Order to Strengthen the ACA
The Order Directs Federal Agencies to Review Existing Policies to Determine whether they Undermine the ACA On Jan. 28, 2021, President Joe Biden issued an executive order that is intended to strengthen the Affordable Care Act (ACA) and Medicaid. The
CMS Provides Exchange Special Enrollment Due to COVID-19
The Special Enrollment Period will be Available Feb. 15 May 15, 2021, through HealthCare.gov On Jan. 28, 2021, the Centers for Medicare & Medicaid Services (CMS) announced a new special enrollment period (SEP) due to the coronavirus (COVID 19)
Small Businesses May Be Able to Keep Existing Non-ACA Compliant Health Plans Through 2022
On Jan. 19, 2021, the Department of Health and Human Services (HHS) extended an existing transition policy for certain health plans that do not comply with the Affordable Care Act for an additional year, to policy years beginning on or before Oct. 1, 2022. Any plans that are renewed under this extended transition policy must comply with the specified requirements by Jan. 1, 2023.
HHS Partially Finalizes Notice of Benefit and Payment Parameters for 2022
On Jan. 19, 2021, the Department of Health and Human Services (HHS) published a Notice of Benefit and Payment Parameters for 2022 that finalized some of the standards included in the proposed notice issued at the end of 2020. This notice describes certain benefit and payment parameters under the Affordable Care Act that apply for the 2022 benefit year.
Stimulus Bill With Ban on Surprise Medical Bills Signed Into Law
On Dec. 27, 2020, President Donald Trump signed the Consolidated Appropriations Act of 2021 into law, a $900 billion stimulus bill that includes emergency economic relief, government funding and tax cuts. The bill also includes the No Surprises Act, a ban on surprise medical bills, which will take effect beginning in 2022.
PCORI Fee Amount Adjusted for 2021
The Fee is $2.66 per Covered Life for Plan Years Ending in 2021 The IRS issued Notice 2020 84, which increases the Patient Centered Outcomes Research Institute (PCORI) fee amount for plan years ending on or after Oct. 1, 2020,
Departments Issue Transparency in Coverage Final Rule
On Oct. 29, 2020, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) issued a final rule regarding transparency in coverage that imposes new transparency requirements on group health plans and health insurers in the individual and group markets.
2021 Health FSA Contribution Limit Announced
Contribution Limit to Remain the Same in 2021 The IRS has announced that the contribution limit for health flexible spending arrangements (health FSAs) will remain at $2,750 in 2021. For 2020, the contribution limit was also set at $2,750.
Final Forms and Instructions for 2020 ACA Reporting Released
2020 ACA Reporting is Due in Early 2021 The IRS has released final 2020 forms and instructions for use in early 2021 to report under IRS Code Sections 6055 and 6056 for the 2020 calendar year. 2020
Draft Instructions for 2020 ACA Reporting Released
2020 ACA Reporting is Due in Early 2021 The IRS has released draft 2020 instructions for Forms 1094 B and 1095 B, and draft 2020 instructions for Forms 1094 C and 1095 C that employers will use in early 2021 to report under IRS
IRS Provides ACA Reporting Relief for 2020
2020 Furnishing Deadline Delayed and Additional Transition Relief Granted The IRS has delayed the deadlines by which employers must furnish 2020 Forms 1095 C and 1095 B in early 2021. For 2020, the furnishing deadline was Feb. 1, 2021, Since
President Trump Issues Health Care Plan Executive Order
The America First Health Care Plan aims to Protect People with Preexisting Conditions and Combat Surprise Medical Billing On Sept. 24, 2020, President Donald Trump introduced his plan for affordable, high quality health care, called the America First Health Care
Supreme Court Vacancy May Impact ACA Litigation
Whether Justice Ginsburgs Seat should be Filled Prior to the November Election is the Subject of Much Controversy On Sept. 18, 2020, U.S. Supreme Court Justice Ruth Bader Ginsburg passed away at the age of 87. Under federal law, the
ACA Pay or Play Penalties Increase in 2021
The Adjusted Penalty Amounts for 2021 are $2,700 and $4,060 Under the Affordable Care Acts employer shared responsibility (pay or play) rules, applicable large employersgenerally those who have 50 or more full time employees (including full time equivalent employees)may be
Trump Signs Executive Orders to Lower Drug Prices
On July 24, 2020, President Donald Trump issued a series of executive orders in an effort to lower drug prices.
ACA Affordability Contribution Rate Set at 9.83% for 2021
For plan years beginning in 2021, the Internal Revenue Service has announced that health insurance coverage from applicable large employers will generally be considered affordable if the employee's required contribution for the lowest-cost self-only health plan offered is 9.83% or less of his or her household income for the taxable year.
Court Upholds Expansion of Short-term, Limited-duration Insurance
On July 17, 2020, a federal appeals court upheld a 2018 final rule expanding short-term, limited-duration insurance for purposes of the Affordable Care Act.
Draft Forms 1094-C and 1095-C for 2020 ACA Reporting Released
2019 ACA Reporting is Due in Early 2020 The IRS has released draft 2020 versions of Forms 1094 C and 1095 C that employers will use in early 2021 to report on the group health insurance coverage they offered during
Proposed Rule Would Allow Changes to Certain Grandfathered Health Plans
On July 10, 2020, the Departments of Labor, Health and Human Services and the Treasury issued a proposed rule that would allow grandfathered group health plans to make certain changes to cost-sharing requirements without losing grandfather status.
U.S. Supreme Court Upholds Exemptions to ACA Contraceptive Mandate
Additional Employers May Opt Out of Providing Contraceptive Coverage On July 8, 2020, the U.S. Supreme Court upheld two regulations expanding exemptions from the contraceptive coverage mandate under the Affordable Care Act (ACA). Under the regulations, plan sponsors that object
CMS Extends MLR Reporting Deadline Due to COVID-19
Issuers Now Have Until Aug. 17 to Submit 2019 Annual Reporting Form The Centers for Medicare & Medicaid Services (CMS) announced a relaxed enforcement policy related to the medical loss ratio (MLR) reporting deadline, due to the public health emergency
HHS Finalizes ACA Section 1557 Rule
On June 12, 2020, the U.S. Department of Health and Human Services (HHS) issued a final rule that revises the implementation of the Affordable Care Acts Section 1557 nondiscrimination provisions on gender identity and language access.
PCORI Fee Amount Adjusted for 2020
On June 8, 2020, the IRS issued Notice 2020-44, which increases the Patient-Centered Outcomes Research Institute (PCORI) fee amount for plan years ending on or after Oct. 1, 2019, and before Oct. 1, 2020.
Reminder: PCORI Fees Due July 31, 2020
As a reminder, employers that sponsor certain self-insured health plans are responsible for Patient-Centered Outcomes Research Institute (PCORI) fees. Fees for plan years that ended in 2019 are due July 31, 2020.
HHS Issues Final Notice of Benefit and Payment Parameters for 2021
On May 14, 2020, the Department of Health and Human Services (HHS) published its final Notice of Benefit and Payment Parameters for 2021. This final rule describes benefit and payment parameters under the Affordable Care Act (ACA) that apply for the 2021 benefit year.
U.S. Supreme Court Rules Federal Government Must Pay $12 Billion to Insurers
On April 27, 2020, the U.S. Supreme Court ruled that the federal government must reimburse health insurance issuers for losses that they suffered under the Affordable Care Acts (ACA) risk corridor program.
DOL Continues to Enforce Mental Health Parity Law
The DOLs Employee Benefits Security Administration (EBSA) released its annual enforcement report on the Mental Health Parity and Addiction Equity Act (MHPAEA) for 2019. According to EBSA, vigorous enforcement of MHPAEA is one of its top enforcement priorities.
CMS Issues FAQs on Coronavirus and Essential Health Benefits Coverage
EHB Generally Includes Coverage for the Diagnosis and Treatment of Coronavirus On March 12, 2020, the Centers for Medicare & Medicaid Services (CMS) issued frequently asked questions (FAQs) on essential health benefits (EHB) coverage and the coronavirus (COVID 19). EHB
U.S. Supreme Court Will Hear Challenge to ACA
Supreme Court Will Review ACAs Constitutionality On March 2, 2020, the U.S. Supreme Court agreed to hear a legal challenge to the Affordable Care Act (ACA). The case involved is Texas v. Azar, a lawsuit challenging the constitutionality of the
Small Businesses May Be Able to Keep Existing Non-ACA Compliant Health Plans Through 2021
Policies Renewed Under Extended Non Enforcement Policy Must Comply by Jan. 1, 2022 On Jan. 31, 2020, the Department of Health and Human Services (HHS) extended an existing transition policy for certain health plans that do not comply with the
HHS Issues Proposed Notice of Benefit and Payment Parameters for 2021
If Finalized, These Standards Will Apply for the 2021 Benefit Year  On Jan. 31, 2020, the Department of Health and Human Services (HHS) published its proposed Notice of Benefit and Payment Parameters for 2021. This proposed rule describes benefit and
New Bill Fully Repeals Cadillac Tax, Medical Devices Tax, and Providers Fee
On Dec. 20, 2019, President Trump signed into law a spending bill that repeals the following three taxes and fees under the Affordable Care Act (ACA):
Appeals Court Affirms Ruling that ACA Individual Mandate is Unconstitutional
Lower Court Will Determine Whether the Remainder of the ACA Can Stand  On Dec. 18, 2019, a federal appeals court ruled in Texas v. Azar that the Affordable Care Acts (ACA) individual mandate is unconstitutional due to the elimination of
House Approves Spending Bill to Repeal Unpopular ACA Taxes
The U.S. House of Representatives has passed a spending bill that would repeal three largely unpopular taxes and fees under the Affordable Care Act.
IRS Releases Final Forms and Instructions for 2019 ACA Reporting
The 2019 ACA Reporting is Due in Early 2020 The IRS has released final 2019 versions of Forms 1094 C, 1095 C, 1094 B, and 1095 B that employers will use in early 2020 to report on the group health
DOL Issues Proposed Transparency in Coverage Model Disclosures
Documents Would Satisfy Proposed Coverage Disclosure Requirements On Nov. 15, 2019, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) issued a proposed rule regarding transparency in coverage for group health plans and health insurers
IRS Provides ACA Reporting Relief
2019 Furnishing Deadline Delayed and Additional Transition Relief Granted The IRS has delayed the deadlines by which employers must furnish 2019 Forms 1095 C and 1095 B in early 2020. As a result Employers with 50
IRS Releases Draft Forms and Instructions for 2019 ACA Reporting
The 2019 ACA Reporting is Due in Early 2020 The IRS has released draft 2019 versions of Forms 1094 C, 1095 C, 1094 B, and 1095 B that employers will use in early 2020 to report on the group health
Health Insurance Providers Fee Will Increase in 2020
Fee Amount to Increase to $15,522,820,037 in 2020 The IRS has announced that the health insurance providers fee amount will be $15,522,820,037 in 2020. Employers are generally not responsible for paying the health insurance providers fee. However, health insurance carriers
IRS Confirms ACA Pay or Play Penalties Still Apply
Recently, the Internal Revenue Service released an information letter regarding the Affordable Care Act's employer shared responsibility (pay or play) penalties.
Updated IRS Pay or Play Q&As Contain 2020 Penalty Amounts
The IRS has updated its Q&As on the Affordable Care Act's employer shared responsibility (pay or play) requirements, including the penalty amounts that will apply for 2020. Each year, penalty amounts are increased based on the premium adjustment percentage for the year.
ACA Affordability Contribution Rate Set at 9.78% for 2020
For 2020 plan years, employer health coverage will be considered affordable if the employee's required contribution is 9.78% or less of his or her household income for the taxable year.
Reminder: PCORI Fees Due July 31
As a reminder, employers that sponsor certain self-insured health plans are responsible for Patient Centered Outcomes Research Institute (PCORI) fees. Fees for plan years that ended in 2018 are due July 31, 2019.
HHS Proposes Rolling Back ACA Nondiscrimination Regulations
The Department of Health and Human Services has released a proposed rule that would eliminate portions of the existing regulations under Section 1557 of the Affordable Care Act (ACA), which addresses nondiscrimination in certain health care programs.
DOL Issues Additional Guidance on Scope of Enforcement Relief for AHPs
The U.S. Department of Labor has issued questions and answers on the scope of its enforcement relief for association health plans, described in an earlier policy statement.
Reminder: PCORI Fees Due July 31
As a reminder, employers that sponsor certain self-insured health plans are responsible for Patient-Centered Outcomes Research Institute (PCORI) fees. Fees for plan years that ended in 2018 are due July 31, 2019.
New Jersey Updates Information on Health Care Reporting Requirement
New Jersey recently updated its website information on employer health coverage reporting.
AHP Coverage Can Generally Be Maintained Through Plan Year or Term
The U.S. Department of Labor (DOL) has appealed a March federal court decision striking down parts of the DOL rule on association health plans (AHPs).
2020 Cost-Sharing Limits for Most Group Health Plans Released
Under a new rule, out-of-pocket expenses may not exceed $8,150 for self-only coverage or $16,300 for family coverage in 2020.
Small Businesses May Be Able to Keep Existing Non-ACA Compliant Health Coverage Through 2020
A previously extended non-enforcement policy which allows health insurance issuers, at their option, to continue group coverage that would otherwise be terminated or cancelled has been further extended to policy years beginning on or before October 1, 2020, provided that all policies come into compliance by January 1, 2021.
Court Strikes Down Association Health Plan Rule
A federal judge has ruled that two parts of the DOL rule expanding employers' ability to join in association AHPs violate ERISA.
Reminder: ACA Information Reporting Deadlines Approaching
The IRS deadlines for filing and furnishing Forms 1094 and 1095 are fast approaching.
ACA Remains in Effect After Court Rules Law Unconstitutional
A federal district court in Texas has ruled the entirety of the Affordable Care Act (ACA) unconstitutional. However, the ACA remains in effect.
IRS Moves Back Furnishing Deadlines for Forms 1095-C and 1095-B
The IRS has moved back the deadline by which employers must furnish Forms 1095-C and 1095-B in early 2019.
2019 Health FSA Contribution Limit Announced
The IRS has announced that the contribution limit for health flexible spending arrangements (health FSAs) will be $2,700 in 2019.
Administration Proposes Allowing All Employers to Offer HRAs to Reimburse Individual Health Insurance Policy Premiums
A new proposed rule would permit all employers to offer health reimbursement arrangements (HRAs) to reimburse employees' individual health insurance policy premiums if certain conditions are met. Currently, many employers are prohibited from offering such HRAs.
IRS Releases Forms 1094 and 1095 for Early 2019 Reporting
The IRS has released the Forms 1094-C, 1095-C, 1094-B, and 1095-B that employers will use in early 2019 to report on the group health insurance coverage they offered during the 2018 calendar year. Instructions on how to complete Forms 1094-C and 1095-C and Forms 1094-B and 1095-B have also been released.
Hardship Exemptions from Individual Mandate Can Now Be Claimed on Tax Returns
The Centers for Medicare and Medicaid Services (CMS) has announced that individuals will be able to claim hardship exemptions from the Affordable Care Acts individual mandate for tax year 2018 on their 2018 federal income tax return.
Short-Term Health Insurance Soon Available For Up To 36 Months
Effective October 3, 2018, a new rule will allow individuals to purchase short-term, limited-duration health insurance coverage for a period of less than 12 months, and renew such coverage for up to 36 months.
Understanding IRS 'Pay or Play' Penalty Letters
The Internal Revenue Service (IRS) is currently issuing Letter 226-J to certain applicable large employers (ALE)generally those with at least 50 full-time employees, including full-time equivalent employees, on average during the prior yearthat it believes owe a penalty for failure to comply with the Affordable Care Act's employer shared responsibility provisions ("pay or play" provisions). In conjunction with Letter 226-J, employers will receive Form 14764, which they can use to respond to Letter 226-J.
2019 'Pay or Play' Affordability Percentage Set at 9.86%
For plan years beginning in 2019, the Internal Revenue Service has announced that coverage will generally be considered affordable if the employee's required contribution for the lowest cost self-only health plan offered is 9.86% or less of his or her household income for the taxable year.
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