Category Archives: Benefit news

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

New draft Form 1094-1095 information returns published
The Internal Revenue Service (IRS) has released draft 2017 versions of Form 1094/1095 information returns. The draft instructions for the forms have not been released.

Draft Form 1094-B – Transmittal of Health Coverage Information Returns
Draft Form 1095-B – Health Coverage
Draft Form 1094-C – Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns
Draft Form 1095-C – Employer-Provided Health Insurance Offer and Coverage

Forms 1094-B and 1095-B are used by coverage providers to report health plan enrollment as required by Code § 6055. Forms 1094-C and 1095-C are used by applicable large employers (ALEs) to report information relevant to Code § 4980H employer shared responsibility penalties as required by Code § 6056.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

CMS chief actuary releases memo on the financial effects related to the American Health Care Act
A new memorandum from the Centers for Medicare and Medicaid Services (CMS) summarizes the Office of the Actuary’s estimates of the financial and coverage effects through 2026 of selected provisions of the American Health Care Act (AHCA) of 2017 (H.R. 1628).

To read the entire memo, click here.

DOL releases information regarding mental health parity
The U.S. Department of Labor (DOL) released the following documents related to mental health parity:

Frequently Asked Questions
Draft of Mental Health Parity Disclosure Statement
Request for Information (RIF)

Paid family leave proposal leaves states with funding issues to consider

President Donald Trump’s 2018 budget proposal includes a paid family leave insurance program for workers in the United States. Under the president’s proposal, states would be allowed to design the paid leave program for their own jurisdictions as long as the benefits meet minimum standards. This means that some states may have a lot to consider when preparing for a new insurance program, such as funding methods, administration, and specific benefit design features. The article “Paid family leave in the United States” by Paul Correia offers some perspective.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

Technical guidance for self-insured health plans on federal external review process
The U.S. Department of Health and Human Services issued “Technical Guidance – Standards for Self-Insured Non-Federal Governmental Health Plans and Health Insurance Issuers Offering Group and Individual Coverage.” This release replaces the technical guidance issued June 22, 2011, with standards adopted in the final regulation at 76 FR 37208 that further define requirements under Public Health Service Act (PHS Act) section 2719(b)(1).

For more information, click here.

Agencies issue ACA FAQs, Part 37
The U.S. Departments of Treasury, Labor (DoL), and Health and Human Services released frequently asked questions (FAQs) Part 37 regarding Patient Protection and Affordable Care Act (ACA) implementation. The FAQs highlight: health reimbursement arrangements (HRAs); integration of HRAs with group health plans sponsored by the employer of a spouse of an employee; Code Section 162(m)(6); and more.

To read the FAQs, click here.

DoL issues FY 2016 MHPAEA enforcement fact sheet
The Employee Benefits Security Administration (EBSA) enforces the law governing 2.2 million private employment-based group health plans, which cover 130.8 million participants and beneficiaries. EBSA relies on its 460 investigators to review plans for compliance with ERISA, including the Mental Health Parity and Addiction Equity Act (MHPAEA). EBSA released its first annual MHPAEA enforcement fact sheet, summarizing its enforcement activity in fiscal year (FY) 2015.

To read the fact sheet, click here.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

IRS updates Q&As about ACA information reporting
The Internal Revenue Service (IRS) has updated the following three question and answer (Q&A) documents regarding Patient Protection and Accountable Care Act (ACA) information reporting by employers.

Q&A about Information Reporting by Employers on Form 1094-C and Form 1095-C

Q&A on Reporting of Offers of Health Insurance Coverage by Employers (Section 6056)

Q&A on Employer Shared Responsibility Provisions Under the Affordable Care Act

Employers and coverage providers: 11 facts about healthcare information forms
Under the ACA, businesses that provide health insurance to their employees must submit information returns to the IRS and individuals reporting on health coverage. Taxpayers can use the information on these forms when they file their tax returns to verify the months that they had minimum essential coverage and determine if they satisfied the individual shared responsibility provision of the healthcare law. The IRS will use the information on the statements to verify the months of the individual’s coverage. The IRS’s “Health Care Tax Tip 2016-82” provides some information about these information return forms, the purpose of each, and noteworthy dates.

For more information, click here.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

Final rule on health insurance premium tax credit
The Internal Revenue Service (IRS) released a final rule relating to the health insurance premium tax credit (premium tax credit). These final regulations affect individuals who enroll in qualified health plans through health insurance exchanges and claim the premium tax credit, and exchanges that make qualified health plans available to individuals and employers.

These final regulations also affect individuals who are eligible for employer-sponsored health coverage.

To read the entire rule, click here.

New HHS report details impact of the Affordable Care Act
The U.S. Department of Health and Human Services (HHS) released an extensive compilation of national and state-level data illustrating the substantial improvements in healthcare for all Americans in the last six years. According to the HHS data, the uninsured rate has fallen to the lowest level on record, and 20 million Americans have gained coverage thanks to the Patient Protection and Affordable Care Act (ACA). But beyond those people who would otherwise be uninsured, millions of Americans with employer, Medicaid, Medicare, or individual market coverage have benefited from new protections as a result of the law.

To access the report, click here.

Guide for electronically filing ACA Information Returns (AIR) for software developers and transmitters
A new IRS publication outlines the communication procedures, transmission formats, business rules, and validation procedures for information returns transmitted electronically through the AIR system.

For more information, click here.

DoL issues final rule on claims procedures for disability benefits
The U.S. Department of Labor (DoL) released a final regulation revising the claims procedure regulations under ERISA for employee benefit plans providing disability benefits. The final rule revises and strengthens the current rules primarily by adopting certain procedural protections and safeguards for disability benefit claims that are currently applicable to claims for group health benefits pursuant to the ACA. This rule affects plan administrators, participants, and beneficiaries of plans providing disability benefits, and others who assist in the provision of these benefits, such as third-party benefits administrators and other service providers.

To read the final rule, click here.