United Benefit Advisors Insight and Analysis Blog

FAQs on Tobacco Cessation Coverage and Mental Health / Substance Use Disorder Parity

Posted by: Danielle Capilla    Dec 20, 2016 10:30:00 AM

Recently, the Department of the Treasury, Department of Labor (DOL), and Department of Health and Human Services (HHS) (collectively, the Departments) issued FAQs About Affordable Care Act Implementation Part 34 and Mental Health and Substance Use Disorder Parity Implementation.

The Departments' FAQs cover two primary topics: tobacco cessation coverage and mental health / substance use disorder parity.

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Topics: group health insurance, Danielle Capilla, tobacco cessation, mental health, medical insurance, substance abuse

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

State Guide to COBRA Supplemental Requirements

Posted by: Danielle Capilla    Nov 22, 2016 10:30:00 AM

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal requirement of group health plans to provide COBRA continuation coverage to participants who lose coverage due to a qualifying event, when the employer had 20 or more full time employees. Over the years, many states enacted additional requirements similar to COBRA, either for small employers, or in addition to the federal COBRA requirements. UBA has created a chart to outline each state’s specific continuation laws. For a sampling of the types of laws employers need to be aware of, consider these seven states (and view our full Compliance Advisor with the detail on all 50 states)

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Topics: compliance, COBRA, Danielle Capilla, COBRA continuation coverage, group benefit plans

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

Final Marital Status Definitions and Spouse/Partner Coverage Trends

Posted by: Danielle Capilla    Nov 15, 2016 10:30:00 AM

Recently, the Internal Revenue Service (IRS) issued final regulations that define terms used in the Internal Revenue Code (IRC) describing the marital status of taxpayers for federal tax purposes. In general, for federal tax purposes, the terms "spouse," "husband," and "wife" mean an individual lawfully married to another individual. The term "husband and wife" means two individuals lawfully married to each other. A marriage of two individuals is recognized for federal tax purposes if the marriage is recognized by the state, possession, or territory of the United States in which the marriage is entered into, regardless of domicile.

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Topics: group health insurance, UBA Health Plan Survey, Danielle Capilla, nondiscrimination rules, spousal coverage, partner coverage, marital status

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

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

Are Opt-Outs on the Way Out?

Posted by: Danielle Capilla    Oct 27, 2016 10:30:00 AM

Opt-out payments or cash in lieu of benefits have been a staple in the employee benefits industry for many years. Employers offer individuals who are eligible to enroll in their group health plan a sum of money, typically paid monthly, to those who waive enrollment in the group health plan. Employers who offer group health plans often use opt-out payments to share the savings they receive when an employee chooses not to enroll in the benefits offered.

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Topics: employee benefits, UBA Health Plan Survey, Danielle Capilla, opt-out arrangement, waive medical coverage

Controlled Groups and Affiliated Service Groups: How They Apply to the ACA

Posted by: Danielle Capilla    Oct 18, 2016 10:30:00 AM

The Patient Protection and Affordable Care Act (ACA) imposes a penalty on “large” employers that either do not offer “minimum essential” (basic medical) coverage, or who offer coverage that is not affordable (the employee’s cost for single coverage is greater than 9.5 percent of income) or it does not provide minimum value (the plan is not designed to pay at least 60 percent of claims costs). A large employer is one that employed at least 50 full-time or full-time equivalent employees during the prior calendar year. To discourage employers from breaking into small entities to avoid the penalty, the ACA provides that, for purposes of the employee threshold, the controlled group and affiliated service group aggregation rules will apply to health plans. Essentially, this means that the employees of a business with common owners or that perform services for each other may need to be combined when determining if the employer is “large.”

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Topics: ACA, PPACA, minimum essential coverage, Danielle Capilla, Large Employers, controlled group, affiliated service group

Nondiscrimination Rules for Cafeteria Plans

Posted by: Danielle Capilla    Oct 13, 2016 10:30:00 AM

A cafeteria plan is an employer-provided written plan that offers employees the opportunity to choose between at least one permitted taxable benefit and at least one qualified employee benefit. There is no federal law that requires employers to establish cafeteria plans; however, some states require employers to have cafeteria plans for employees to pay for health insurance on a pre-tax basis.

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Topics: Danielle Capilla, cafeteria plan, nondiscrimination rules, benefits compliance, Section 125 plan