Tag Archives: IRS

Regulatory roundup

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

IRS releases final and temporary rule on health providers’ fee
The Internal Revenue Service (IRS) released final regulations that provide rules for the definition of a covered entity for purposes of the fee imposed by section 9010 of the Patient Protection and Affordable Care Act (ACA), as amended. The final regulations supersede and adopt the text of temporary regulations that provide rules for the definition of a covered entity. These regulations affect persons engaged in the business of providing health insurance for U.S. health risks.

To read the entire rule, click here.

Federal agencies propose rule on short-term, limited-duration insurance
The U.S. Departments of Treasury, Labor (DOL), and Health and Human Services (HHS) have released a proposed rule that would amend the definition of short-term, limited duration insurance for purposes of its exclusion from the definition of individual health insurance coverage.

The proposed rule would make it easier to obtain coverage through short-term health insurance plans by allowing insurers to sell policies that last under a year. The new rules stem from an executive order the president signed in October aimed at boosting competition, giving consumers more choices, and lowering premiums.

To learn more, click here.

How CBO and JCT analyze major proposals that would affect health insurance coverage
The Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) released a report that estimates the budgetary effects of most types of major legislative proposals that would affect both spending and revenues using a process that involves many steps and many analysts. The report focuses on the process that the agencies use to analyze proposals affecting health insurance coverage for people under age 65, such as legislation that would make major changes to the ACA.

For more information, click here.

Regulatory roundup

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

IRS publishes best practices for tax filings related to individual shared responsibility provision
The Internal Revenue Service (IRS) released a document offering best practices for practitioners to gather necessary information to use in preparing 2017 tax returns for their clients, including information that may be helpful to demonstrate compliance with health coverage requirements of the Patient Protection and Affordable Care Act (ACA). General requirements on filing a complete and accurate tax return continue to apply. Preparers are expected to resolve conflicting or contradictory statements from their clients during the return preparation process.

Under the individual shared responsibility provision of the ACA, all individuals are required to have qualifying healthcare coverage (called minimum essential coverage), qualify for an exemption, or make an individual shared responsibility payment (ISRP) with their federal income tax returns. An individual is responsible for himself or herself, his or her spouse (if filing a joint return), and any individuals who could be claimed as dependents (collectively, the tax household). Under the recently enacted Tax Cuts and Jobs Act, taxpayers must continue to report coverage, qualify for an exemption, or pay the individual shared responsibility payment for tax years 2017 and 2018.

For more information, click here.

Guidance on corrected, incorrect, or voided forms 1095-A
Individuals enrolled in health coverage through a healthcare marketplace must complete a Form 1095-A, Health Insurance Marketplace Statement, early in the year following the year of coverage. They should use the information on the form to claim the premium tax credit, to reconcile advance payments of the premium tax credit, or both, when filing their tax returns. Some taxpayers may receive a second Form 1095-A because the information on the initial form was incorrect or incomplete. The IRS has published information related to corrected or voided Forms 1095-A for tax years 2014 through 2017.

For more information, click here.

Regulatory roundup

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

Guide for electronically filing ACA Information Returns for software developers and transmitters
The Internal Revenue Service (IRS) has published its Guide for Electronically Filing Affordable Care Act (ACA) Information Returns (AIR) for Software Developers and Transmitters (Processing Year [PY] 2018). The guide 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.

Health insurance provider fee moratoriums released
The IRS has published questions and answers regarding the health insurance provider fees on its website. The posting offers perspective on several issues, including the following:

• Under the 2019 moratorium, is there a health insurance provider fee in 2019?
• Must Form 8963 be filed in the 2019 fee year?
• Do the 2017 or 2019 moratoriums affect the 2018 fee year?
• Does the 2019 moratorium apply to fee year 2019 or data year 2019?

For more information, click here.

IRS Letter 226J requesting “shared responsibility” payments under the ACA

If your human resources (HR) or finance team has received Internal Revenue Service (IRS) Letter 226J—which provides an initial estimate of the tax penalty for noncompliance in 2015 of the Patient Protection and Affordable Care Act (ACA) employer mandate—you should make every effort to respond within 30 days, indicating your agreement or demonstrating other facts that could reduce or eliminate the proposed tax penalty.

The IRS’s guidance on the Letter and penalties comes in the form of Questions & Answers (#55-58), “Making an Employer Shared Responsibility Payment.” In general, the guidance discusses the ACA’s requirements and provides information on how employers should respond to the Letter, with instructions on disagreeing with the IRS’s penalty determination and additional steps that group health plan sponsors may take, including appeals.

Here are a few key facts about the employer mandate:

• Employers are “applicable large employers” (ALEs) if they have at least 100 full-time employees. The ACA required ALEs to offer “affordable coverage” to at least 70% of these employees in 2015. The coverage percentage increased to 95% in 2016.
• Affordable coverage means that employee contributions for self-only coverage are less than 9.5% of the employee’s household income. The self-only cost is the marker in the ACA rules, even if the employee elected an option to cover more than just themselves under the health benefit plan. The rules permit use of an employee’s W-2 wages as a safe harbor substitute for the employee’s household income. In addition, your healthcare coverage must be the equivalent of at least a bronze-level plan on the health insurance exchange, covering 60% of the costs. This is known as minimum essential coverage (MEC).
• An ALE had to send IRS Forms 1095-C for 2015 to employees early in 2016 to use in their personal income tax filings. The Form 1095-C summarized the months in which you offered an employee (and qualified dependents) healthcare coverage. Concurrently, ALEs filed Forms 1094-C with the IRS. This form indicated the number of full-time employees who were offered coverage in 2015, either in each month or for the entire year.
• Based on the information in Forms 1095-C and 1094-C, the IRS determines the initial tax penalty for a failure to offer affordable coverage to 70% of full-time employees for at least one month during the year.

There are several other details ALEs must assess and examine, including new IRS Form 14764 (employer response form) and Form 14765 (a list of employees who allegedly caused the failure).

For information about and responding to the IRS’s Letter 226J, please contact your Milliman consultant.

Regulatory roundup

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

Health plan choice and premiums in the 2018 federal health insurance exchange
The U.S. Department of Health and Human Services (HHS) has issued a brief that presents information on qualified health plans (QHPs) available on the federal health insurance exchange for states that use the HealthCare.gov platform. National estimates and summary tables are presented in each section of the text. State-specific estimates are in the appendix.

For more information, click here.

ACA AIR submission composition and reference guide published
The Internal Revenue Service (IRS) has published “Affordable Care Act (ACA) Information Returns (AIR) Submission Composition and Reference Guide.” The document provides details on composing and submitting Forms 1094/1095-B and Forms 1094/1095-C by transmitters to the IRS. The scope of the document addresses the application-to-application (A2A) messages exchanged on a Simple Object Access Protocol (SOAP) basis between client and exposed web service endpoints and the user interface (UI)-browser-based web, requiring human initiation.

For more information, click here.

Guidance on the requirements for providing a qualified small employer health reimbursement arrangement released
The IRS published Notice 2017-67 offering guidance on the requirements for providing a qualified small employer health reimbursement arrangement (QSEHRA) under section 9831(d)—which was added to the Internal Revenue Code by the 21st Century Cures Act (Cures Act)—the tax consequences of the arrangement, and the requirements for providing written notice of the arrangement to eligible employees.

For more information, click here.

IRS updates FAQs on employer-shared responsibility payments
The IRS updated its website listing frequently asked questions (FAQs) on employer-shared responsibility provisions under the Patient Protection and Affordable Care Act (ACA), including questions and answers regarding employer-shared responsibility payments.

For more information, click here.

COLAs for retirement, Social Security, and health benefits for 2018

With the release of the September 2017 Consumer Price Index (CPI) by the U.S. Bureau of Labor Statistics, the U.S. Social Security Administration (SSA) and the Internal Revenue Service (IRS) have announced cost-of-living adjustment (COLA) figures for Social Security and retirement plan benefits, respectively, for 2018. The 2018 adjusted figures for high-deductible health plans (HDHPs) and health savings accounts (HSAs) included in this Client Action Bulletin were released by the IRS earlier this year and are provided here for convenience.