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We Received an Exchange Subsidy Notice…Now What?

August 9, 2016

Authors

Serena Yee and Chris Rylands

We Received an Exchange Subsidy Notice…Now What?

August 9, 2016

by: Serena Yee and Chris Rylands

ACA Blue HighlightThe Affordable Care Act exchanges/marketplaces are required to notify employers of any employees who have been determined eligible for advance payments of the premium tax credit or cost-sharing reductions (i.e., subsidy) and enrolled in a qualified health plan through the exchange.

A few weeks ago the U.S. Department of Health and Human Services (HHS) began issuing these notices to employers for 2016. If you received such a notice, this means that at the time of applying for health care coverage through the exchange, the employee indicated that:

  • you made no offer of health coverage;
  • you offered health coverage, but it either wasn’t affordable or didn’t offer minimum value; or
  • he or she was unable to enroll in the health coverage due to a waiting period.

Now, receipt

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“King” of the Road

July 6, 2015

Authors

Chris Rylands and Lisa Van Fleet

“King” of the Road

July 6, 2015

by: Chris Rylands and Lisa Van Fleet

ACAIn Roger Miller’s 1964 hit by the above name, he tells the tale of “a man of means by no means,” a man just scraping to get by. While he may not have a phone, a pool, pets, or cigarettes (and really, what does he need that last item for anyway?), after the Supreme Court’s 6-3 decision on June 25, however, such a man might be able to secure a premium tax credit to help pay for health insurance (yes, we realize he’d probably be Medicaid eligible, but just work with us here).

But what does the ruling mean for employers? At first, it might appear that it doesn’t mean very much; life under the Affordable Care Act will continue to move along much as it has for the last few

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IRS Expands Permissible Mid-Year Election Changes for Health Coverage Under Cafeteria Plans

September 23, 2014

Authors

benefitsbclp

IRS Expands Permissible Mid-Year Election Changes for Health Coverage Under Cafeteria Plans

September 23, 2014

by: benefitsbclp

Last Thursday, the IRS issued Notice 2014-55 (“Notice”), which expands the scope of permissible mid-year election changes under the cafeteria plan rules to allow an employee to revoke an election of employer-sponsored health coverage in the event of the employee’s reduction in hours of service (even if there is no loss of eligibility for coverage) or to avoid duplicative coverage (or a gap in coverage) under a non-calendar year group health plan due to the purchase of coverage through a Marketplace.

The guidance under the Notice is effective as of September 18, 2014 and may be relied on immediately even though the IRS has yet to amend the cafeteria plan regulations to reflect the new guidance.

Background

153773052Elections under a cafeteria plan have generally been irrevocable during a period

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Kind of Halbig Deal

July 22, 2014

Authors

Chris Rylands

Kind of Halbig Deal

July 22, 2014

by: Chris Rylands

You may have heard about the potentially crippling blow to ACAMoney Puzzle (as some have described) dealt by a three-judge panel of the D.C. Circuit Court of Appeals today in Halbig v. Burwell.  Basically, a group of individuals and employers challenged the IRS rule that allowed tax credits to help pay for individual coverage through federally-run ACA marketplaces.  Their argument was that the literal reading of the statute only allowed these subsidies for individual policies purchased through state-run marketplaces.

At first blush, this might not sound all that important to employers, but it very well could be.  If this ruling holds, then it would undercut the ability of the IRS to impose the employer shared responsibility/“play or pay” penalties.

Recall

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Modifying the Affordable Care Act to Make It Better

June 25, 2014

Authors

benefitsbclp

Modifying the Affordable Care Act to Make It Better

June 25, 2014

by: benefitsbclp

One of my law school professors and now good friends, Professor Burt Brody, has been contemplating beneficial changes to the Affordable Care Act.  I think he is on to something beneficial.

Professor Brody has written an op-ed piece published in the Desert Sun on May 21, 2014.  In the column, he supports the notion of having the health insurance industry participate fully in the correction, and he eschews the notion of “national health care” in its pejorative sense.  Professor Brody, without saying so, realizes that the Act is a health insurance reform act, not truly a health care reform act.

His suggestion is to take the amount that the federal government spends today on health care, and dole it out to everyone with a Social Security card – that’s every legal American – based on age brackets and veteran status that reflects perceived need for  health

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COBRA Participants: Act Quickly to Maximize Cost Savings with ACA Special Enrollment Opportunity

May 28, 2014

Authors

Lisa Van Fleet and Serena Yee

COBRA Participants: Act Quickly to Maximize Cost Savings with ACA Special Enrollment Opportunity

May 28, 2014

by: Lisa Van Fleet and Serena Yee

Health Insurance and MoneyIn a recent CMS Bulletin, the Department of Health & Human Services announced a one-time special enrollment period for individuals who are currently eligible for, or enrolled in, COBRA continuation coverage to enroll in qualified health plans in the Marketplace.  This special enrollment period applies to the Federally Facilitated Marketplace (FFM) and ends July 1, 2014.

A person eligible for, or enrolled in, COBRA coverage is generally permitted to enroll in the Marketplace only (i) when the person is initially eligible for COBRA or has exhausted his or her COBRA coverage rights, (ii) during annual open enrollment, or (iii) during some other special enrollment period.  This one-time special enrollment period allows eligible individuals in states that utilize the FFM to terminate their COBRA coverage and enroll in

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As Different as Night and…Later That Night

May 9, 2014

Authors

Chris Rylands

As Different as Night and…Later That Night

May 9, 2014

by: Chris Rylands

Night

In one episode of Friends, Rachel, after breaking up with Ross (the paleontologist, played by David Schwimmer) started dating Russ (a periodontist, also Schwimmer).  The two Schwimmer characters, who may as well be clones but for their different spheres of employment, are sizing each other up in an exchange in the coffee shop after which Monica, Ross’s sister, observes ”They’re as different as night and… later that night.”

Monica’s observation is also applicable in comparing employer-sponsored coverage with ACA exchange coverage.  Consider this analysis by Avalere Health examining the data of enrollees in the ACA exchanges.  Of note, they said the following:

Double digit premium increases are likely in many markets in 2014.  Despite initial concerns about the age mix of exchange enrollees, the current age distribution appears to

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Check it Out and Check it Off: 2014 Group Health Plan Checklist

October 14, 2013

Authors

benefitsbclp

Check it Out and Check it Off: 2014 Group Health Plan Checklist

October 14, 2013

by: benefitsbclp

This is cross-posted from our recent client alert.

With 2014 just around the corner, numerous mandates under the Patient Protection and Affordable Care Act, as amended (“PPACA”) are about to become effective.  Below is a checklist of upcoming PPACA mandates that employers must implement in 2014, as well as a list of existing enrollment and annual notice requirements that group health plan sponsors should consider during open enrollment.

Additionally, with the recent decision of the U.S. Supreme Court in U.S. v. Windsor overturning part of the Defense of Marriage Act (“DOMA”), group health plan sponsors should take into account the impact of this decision on their plans.  As such, a brief summary of relevant DOMA considerations are provided below.

For a refresher on the PPACA mandates which became effective this year, please see our 2013 group health plan checklist here.

I. Requirements That Apply to All Group Health

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UPDATE: Health Insurance Marketplace Notice: RELAX!…BUT DON’T PLAY DEAD

September 17, 2013

Authors

Serena Yee and Lisa Van Fleet

UPDATE: Health Insurance Marketplace Notice: RELAX!…BUT DON’T PLAY DEAD

September 17, 2013

by: Serena Yee and Lisa Van Fleet

Health care reform created a new Section 18B of the Fair Labor Standards Act (“FLSA”) to require employers to furnish notice of the coverage options available through Health Insurance Marketplace to employees. The Secretary of Labor delegated responsibility for regulations under the new law to the Department of Labor’s Employee Benefits Security Administration (“EBSA”).

The new notice requirement was to take effect on March 1, 2013.  However, in a set of FAQs published on January 24, 2013, the EBSA concluded that the notice requirement should be delayed for several reasons.  The EBSA anticipated that distribution of the notices would take place in the late summer or fall of 2013, which would coordinate with the open enrollment period for Exchanges (see our earlier post).

On May 8 2013, the EBSA published Technical Release 2013-02, which offered guidance on various aspects of the marketplace notice, including the required content,

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