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FAQ on SBC Published

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In a jointly released Affordable Care Act FAQ, the Department of Labor (DOL) clarifies that the regulators intend to finalize changes in the near future to the summary of benefits and coverage (SBC) templates and glossary of terms applicable for use during open enrollments for health plans renewing on or after January 1, 2016 and for newly eligible employees under those plans.
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Categories: Health Care Reform, Compliance | Tags: SBC

Play or Pay and COBRA

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How does Play or Pay affect the offer of COBRA for an applicable large employer’s (ALE’s) medical plan when a qualifying event occurs? The only COBRA qualifying event that has any interaction with Play or Pay for these ALEs is reduction in hours. If a full time employee has their hours reduced mid-year, the ALE has three (3) options for when to offer COBRA depending on how tolerant the ALE is for the risk of paying a penalty: 1) offer COBRA immediately; 2) wait until the start of the next ...
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Categories: Health Care Reform, Compliance | Tags: COBRA , 1095-C , Measurement , Play , Pay
The IRS has published a Q&A clarifying why insurers are requesting the Social Security numbers of covered participants and their spouses and dependents. The Q&A states that if an individual fails to provide the SSNs that are requested by the insurer that the participant could receive a notice from the IRS that they are liable for the individual shared responsibility payment for not having health coverage.
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Categories: Health Care Reform, Compliance | Tags: Reporting , CMS , 1095-B
Section 1411 of the Affordable Care Act (ACA) establishes the procedures for determining an individual’s eligibility for subsidies from the Health Insurance Marketplace (aka Exchange). Under Treasury Department regulation, a Section 1411 Certification is the certification to an employer that an employee has enrolled in a qualified health plan through the Exchange and been provided a subsidy.
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Categories: Health Care Reform, Compliance | Tags: 1094-C , 1095-C , Report , penalty

CMS Clarifies Cost Sharing Limits for HDHPs

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CMS has clarified, in a Q&A, that high deductible health plans (HDHPs) cannot impose cost sharing for any individual covered by the HDHP that exceeds the individual cost sharing limits established under health care reform. For 2015, the individual cost sharing limit is $6,600.
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Categories: Health Care Reform, Compliance | Tags: HDHP , Limit , Cost Sharing

Court Finds Premium Increase is COBRA Event

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A federal court for the district of Maryland has ruled in favor of two former employees that they should have been offered COBRA when their employer charged them the entire premium to continue coverage while suspended.
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Categories: Benefits in General, Compliance | Tags: COBRA

DOL Clarifies Same-Sex Spousal FMLA Rights

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Last week, the DOL issued a Final Rule regarding the definition of "spouse" under the Family and Medical Leave Act (FMLA) effective March 27, 2015. Employers and human resources consultants will want to be aware of the changes the Final Rule makes to prior guidance on the application of FMLA for same-sex spouses.
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Categories: Benefits in General, Compliance | Tags: same sex , fmla

Proof of Health Coverage

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How should employers respond to employees that request proof of health coverage from the employer for calendar year 2014 and why are they asking?
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Categories: Health Care Reform, Compliance | Tags:

Cadillac Tax Guidance Issued

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Although not set to go into effect until 2018, the 40% excise tax on the excess cost of total health coverage, better known as the Cadillac Tax, has been on the minds of brokers and employers alike for which plans count toward the total cost of health coverage, how the total cost is calculated and who pays the excise tax if there is excess cost. The IRS recently issued preliminary guidance in Notice 2015-16 to answer those questions and is seeking comments before issuing final regulations.
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Categories: Health Care Reform, Compliance | Tags: Cadillac , Excise
The IRS, in Notice 2015-17, has provided transition relief allowing small employers that continued to reimburse or pay for their employees’ individual medical plans in 2014 and/or are continuing to do so in 2015 to escape the excise tax penalties for doing so. This guidance is contrary to IRS Notice 2013-54 and subsequent guidance that prohibits an employer from paying for or reimbursing employees for their individual medical insurance premiums under what the regulation referred to as an “emp...
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Categories: Health Care Reform, Compliance | Tags: individual , premium , reimburse , payment
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