United Benefit Advisors Insight and Analysis Blog

New ACA Implications for Cafeteria Plans: Change in Status and Changing Employee Elections

Posted by: Danielle Capilla    Jul 21, 2015 12:00:00 PM

Cafeteria plans, or plans governed by IRS Code Section 125, allow employers to help employees pay for expenses such as health insurance with pre-tax dollars. Employees are given a choice between a taxable benefit (cash) and two or more specified pre-tax qualified benefits, for example, health insurance. Employees are given the opportunity to select the benefits they want, just like an individual standing in the cafeteria line at lunch.

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Topics: employee benefits, section 125 plans, PPACA Affordable Care Act, Danielle Capilla, cafeteria plan, IRS Code Section 125

IRS Releases Draft 2015 Forms for 6055/6056 Reporting

Posted by: Danielle Capilla    Jul 16, 2015 12:00:00 PM

Health insurance taxesBackground

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.

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Topics: PPACA Affordable Care Act, 6055 Reporting, 6056 Reporting, Play or Pay, Individual mandate, employer shared responsibility, Danielle Capilla

U.S. Supreme Court Upholds ACA Subsidy Eligibility on Federal Exchanges

Posted by: Danielle Capilla    Jul 7, 2015 12:00:00 PM

The Supreme Court issued its opinion in King v. Burwell, holding that the Internal Revenue Service (IRS) may issue regulations to extend tax-credit subsidies to coverage purchased through Exchanges established by the federal government under the Patient Protection and Affordable Care Act (ACA). The six-to-three opinion was authored by Chief Justice John Roberts, who was joined by Justices Kennedy, Ginsburg, Breyer, Sotomayor, and Kagan. Justice Scalia dissented, and was joined by Justices Thomas and Alito.

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Topics: health insurance exchanges, health care reform, PPACA Affordable Care Act, The Patient Protection and Affordable Care Act, insurance Marketplace, health care subsidies, U.S. Supreme Court, Danielle Capilla

Mid-Size Employers and Transition Relief: How to Delay Offering Health Benefits until January 2016

Posted by: Danielle Capilla    Jul 2, 2015 12:00:00 PM

The employer shared responsibility (i.e., "play or pay") requirements went into effect in 2015 for large employers only (those with 100 or more full-time or full-time-equivalent employees). Even though they generally will not be liable for penalties until 2016, mid-size employers (employers with 50 to 99 full-time or full-time-equivalent employees) will need to report on the coverage they offered for 2015, so long as they meet the maintenance requirements for transition relief. To avoid penalties – beginning in 2015 for large employers, and in 2016 for eligible mid-size employers – employers must offer health benefits to employees who work an average of 30 or more hours per week, or 130 hours per month.

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Topics: PPACA Affordable Care Act, health benefits, Play or Pay, United Benefit Adivsors, Danielle Capilla, employer-shared responsibility reporting, transition relief

Are Electronic Plan Documents ACA-Compliant?

Posted by: Peter Freska    Jul 1, 2015 12:35:21 PM

There is always something to be concerned about. Please read on.

Many have talked about the options for posting compliance documents online. It is interesting to note that posting documents on a company’s intranet is not enough. Especially in light of the new court decision (Thomas v. CIGNA Group Insurance, E.D.N.Y. (2013)), the topic is even more important. Historically, companies have mailed out hard copies of their compliance packets, Summary Plan Descriptions (SPDs), Summary of Benefits and Coverage (SBC), and Summary of Material Modifications (SMM). If this packet contains the Patient Protection and Affordable Care Act (PPACA) State Exchange notification, it also needs to go to new hires within 14 days.

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Topics: PPACA Affordable Care Act, summary of benefits and coverage, Peter Freska, The LBL Group, Summary of Material Modifications, compliance documents, Summary Plan Description

Cost-Sharing Limits; Provider Discrimination FAQ Released

Posted by: Danielle Capilla    Jun 25, 2015 12:00:00 PM

Recently, federal agencies, including the Department of Labor (DOL), issued a short five-question FAQ on two ACA-related issues: limitations on cost-sharing and provider discrimination.

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Topics: PPACA Affordable Care Act, Group health plans, cost-sharing limit, provider discrimination

Employers Procrastinating?

Posted by: Peter Freska    Jun 18, 2015 12:00:00 PM

Employee Benefit News published an article titled, “Employers procrastinating on ACA recordkeeping compliance.” It is an interesting read, as it refers to a recent survey by PricewaterhouseCoopers in which “Only 10% of some 480 employers in 36 industries responding to a recent poll have implemented an in-house or outsourced solution to comply with Affordable Care Act reporting requirements.” This is an alarming number, as employers may be subject to significant penalties for non-compliance.

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Topics: PPACA, UBA Partner Firms, PPACA Affordable Care Act, PPACA reporting, employer-shared responsibility reporting, The LBL Group

PCORI Fees Due July 31 for Many Health Plans. How Much Do You Owe?

Posted by: Danielle Capilla    Jun 16, 2015 12:00:00 PM

PPACA created a private non-profit corporation called the Patient-Centered Outcomes Research Institute (PCORI). The Institute's job is to research the comparative effectiveness of different types of treatment for certain diseases, and to share its findings with the public and the medical community. The goal is to improve quality of treatment and reduce unnecessary spending. The Patient-Centered Outcomes Research Institute (PCORI) fee is to support this research and applies from 2012 to 2019.

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Topics: compliance, PPACA Affordable Care Act, PCORI, group health insurance, Danielle Capilla, PPACA fees

Preventive Service Requirement FAQ

Posted by: Danielle Capilla    Jun 4, 2015 12:00:00 PM

Preventive CareOn May 11, 2015, the Department of Labor (DOL) along with other federal agencies issued an FAQ regarding the implementation of the Patient Protection and Affordable Care Act (PPACA) that focused on coverage of preventive services. Non-grandfathered group health plans and health insurance offered in the individual or group markets must provide certain listed benefits with no cost-sharing to the beneficiary. The FAQ provided information on some commonly confusing or ambiguous requirements.

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Topics: PPACA Affordable Care Act, contraception, Department of Labor, anesthesia, preventive services, well-woman care, colonoscopy, Danielle Capilla, BRCA testing, preventive screening

Question of the Month: How is PPACA's "IRS Form W-2 safe harbor" regarding affordability calculated?

Posted by: Danielle Capilla    May 21, 2015 12:00:00 PM

Answer: Under PPACA, coverage is considered affordable if it costs less than 9.5 percent of an employee's household income. Because employers are often unaware of an employee's household income, there are three safe harbors that an employer can use to determine affordability. One is the "IRS Form W-2 safe harbor," and under it coverage is affordable if the employee's contribution for self-only coverage is less than 9.5 percent of his W-2 (Box 1) income for the current year. Box 1 reports taxable income and might be artificially low for an individual with high 401(k), 403(b) or Section 125 deferrals, or who takes unpaid leave. There are no adjustments to account for this.

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Topics: health care, PPACA Affordable Care Act, Affordability, W-2 safe harbor, affordable health care