United Benefit Advisors Insight and Analysis Blog

Handling of Retaliation Complaints under Section 1558 of the Affordable Care Act

Posted by: Nancy Bourque    Jan 10, 2017 9:30:00 AM

The Occupational Safety and Health Administration (OSHA) recently released a final rule on the procedures for the handling of whistleblower complaints under Section 1558 of the Patient Protection and Affordable Care Act (ACA). The regulations protect employees (which includes former employees and applicants for employment) who may have been subject to retaliation for seeking assistance under certain affordability assistance provisions, or for reporting potential violations of the ACA’s consumer protections.

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Topics: whistleblower complaints, ACA, Affordable Care Act, retaliation, OSHA, Nancy Bourque, consumer protection

Emphasis on Consumerism in Health Care Expected Post 2016 Elections

Posted by: Michael Weiskirch    Jan 4, 2017 11:51:49 AM

I really need to stop spending so much time reading the news. I subscribe to several news aggregators, plus a number of content sources: blogs, industry experts and other publications. I pore through news about politics, world affairs, and information related to HR, benefits, and technology – the field I work in. I sometimes do this (I must admit) while stuck at a stoplight or in line at the store. In all fairness, I do this to keep up on current events and trends impacting my field and my clients’ interests. But I need to stop doing it so much because it can be a huge time waster.

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Topics: health care consumerism, UBA Health Plan Survey, ACA, Obamacare, compliance with health care reform, CDHPs, health care cost

Interim Final Regulation on Maximum Civil Monetary Penalties

Posted by: Danielle Capilla    Dec 29, 2016 10:30:00 AM

The Department of Health and Human Services (HHS) recently issued interim final regulations that adjust for inflation the maximum civil monetary penalties (CMP) that fall under HHS's jurisdiction. The regulations reflect changes required by the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 (the Act).

Adjustments under the Act were effective on August 1, 2016, and HHS's CMP adjustment regulations were effective on September 6, 2016. HHS issued its regulations for immediate implementation, without the notice and comment procedures that normally accompany new regulations.

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Topics: HIPAA, ACA, Affordable Care Act, monetary penalties, group health insurance, compliance, Danielle Capilla

Employer Exchange Subsidy Notices: Should You Appeal?

Posted by: Vicki Randall    Dec 15, 2016 10:30:00 AM

Under the Patient Protection and Affordable Care Act (ACA), all public Exchanges are required to notify employers when an employee is receiving a subsidy (tax credits and cost-sharing reductions) for individual health insurance purchased through an Exchange. According to the final rules published in August 2013, employers have the right, but are not required, to engage in an appeal process through the IRS if they feel an employee should not be receiving a subsidy because the employer offers minimum value, affordable coverage.

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Topics: ACA, Affordable Care Act, health insurance exchanges, health insurance subsidy, employer shared responsibility, Compliancedashboard, Vicki Randall, Dan Bond, IRS Reporting Rules

IRS Delay in 6055 and 6056 Reporting for 2017

Posted by: Danielle Capilla    Dec 8, 2016 10:30:00 AM

Under the Patient Protection and Affordable Care Act (ACA), individuals are required to have health insurance while applicable large employers (ALEs) are required to offer health benefits to their full-time employees. In order for the Internal Revenue Service (IRS) to verify that (1) individuals have the required minimum essential coverage, (2) individuals who request premium tax credits are entitled to them, and (3) ALEs are meeting their shared responsibility (play or pay) obligations, employers with 50 or more full-time or full-time equivalent employees and insurers will be required to report on the health coverage they offer. Final instructions for the 1094-B and 1095-B and the 1094-C and 1095-C forms were released in September 2016, as were the final forms for 1094-B, 1095-B, 1094-C, and 1095-C. The reporting requirements are in Sections 6055 and 6056 of the ACA.

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Topics: ACA, ACA reporting, PPACA reporting, applicable large employers, IRS Form 6055 and 6056, Danielle Capilla, health insurance

Frequently Asked Questions about the Transitional Reinsurance Fee (TRF)

Posted by: Danielle Capilla    Nov 16, 2016 10:30:00 AM

The transitional reinsurance fee (TRF) applies to fully insured and self-funded major medical plans for 2014, 2015, and 2016. The purpose of the fee is to provide funds to help stabilize premiums in the individual insurance market in view of uncertainty about how the Patient Protection and Affordable Care Act (ACA) would affect claims experience. While insurers are responsible for reporting and paying the fee on the policies they issue, the fee will generally be passed on to the employer. Plan sponsors of self-funded plans (or their representatives) must report and pay the fee to the federal government at www.pay.gov. Below are the answers to the top five most common questions about the TRF.

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Topics: Transitional Reinsurance Fee, TRF, ACA, PPACA, ACA fees, group medical benefits, Danielle Capilla

2016 Election Results: The Potential Impact on Health and Welfare Benefits

Posted by: Danielle Capilla    Nov 14, 2016 10:30:00 AM

Following the November 2016 election, Donald Trump (R) will be sworn in as the next President of the United States on January 20, 2017. The Republicans will also have the majority in the Senate (51 Republican, 47 Democrat) and in the House of Representatives (238 Republicans, 191 Democrat). As a result, the political atmosphere is favorable for the Trump Administration to begin implementing its healthcare policy objectives. Representative Paul Ryan (R-Wis.) will likely remain the Speaker of the House. Known as an individual who is experienced in policy, it is expected that the Republican House will work to pass legislation that follows the health care policies in Speaker Ryan's "A Better Way" proposals. The success of any of these proposals remains to be seen.

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Topics: 2016 election, Affordable Care Act, ACA, PPACA, healthcare policy

UBA Survey: Grandmothering Protects Many Small Employers from Rate Increases

Posted by: Mary Drueke-Collins, FSA    Nov 10, 2016 10:30:00 AM

One goal of the Affordable Care Act (ACA) was to develop uniformity in coverage to ensure that all medical coverage included certain services. However, two interim regulations were passed, essentially allowing individuals and employers to keep their plans that were not completely ACA-compliant. Those regulations were termed “grandfathering” and “grandmothering.” Grandfathering was available to all employers that wanted to keep the plans they had in place prior to the passage of the ACA. For a plan to maintain grandfathered status, there were significant restrictions to plan design modifications and changes to employee contributions. The reality was that very few employers were able to maintain grandfathered status. In the 2016 UBA Health Plan Survey, only 5.9 percent of plans were still grandfathered.

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Topics: grandmothering, Affordable Care Act, health insurance cost, ACA, PPACA, transition relief, UBA Health Plan Survey, Mary Drueke-Collins

Employer FYI: Individual Mandate Requirements and Proposed Regulations

Posted by: Danielle Capilla    Nov 9, 2016 10:30:00 AM

Though employers are not required to educate employees about their individual responsibilities under the Patient Protection and Affordable Care Act (ACA), it is helpful to know about the individual mandate.

The individual responsibility requirement (also known as the individual mandate) became effective for most people as of January 1, 2014. Under the individual mandate, most people residing in the U.S. are required to have minimum essential coverage or they must pay a penalty. Many individuals will be eligible for financial assistance through premium tax credits (also known as premium subsidies) to help them purchase coverage if they buy coverage through the health insurance Marketplace (also known as the Exchange).

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Topics: Individual mandate, ACA, Affordable Care Act, PPACA, minimum essential coverage, Danielle Capilla

Employer Considerations When Offering Health Coverage under the SCA or DBA

Posted by: Danielle Capilla    Nov 3, 2016 10:30:00 AM

Employers that are subject to the McNamara-O’Hara Service Contract Act (SCA), Davis-Bacon Act (DBA), and Davis-Bacon Related Acts (Related Acts), and who are considered an applicable large employer (ALE) under the Patient Protection and Affordable Care Act (ACA) must ensure that they meet the requirements of all three acts, despite the fact that the interplay between them can be confusing and misunderstood. The Department of Labor has provided guidance for these employers based on two U.S. Department of Labor (DOL) documents: its December 28, 2015, Notice 2015-87 (DOL Notice) and its March 30, 2016, All Agency Memorandum Number 220 (DOL Memo).

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Topics: ACA, PPACA, Danielle Capilla, McNamara-O'Hara Service Contract Act, Davis-Bacon Act, SCA, DBA, wage and fringe benefit requirements, employer shared responsibility, applicable large employers