Archives: Affordable Care Act

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LGBTQ+ Protections Under the ACA are in Effect …Again!

The Department of Health and Human Services (HHS) announced Monday it now interprets—and will enforce—Section 1557 of the Affordable Care Act (ACA) to prohibit discrimination based on sexual orientation and gender identity, effective immediately. Section 1557 generally prohibits discrimination based on race, color, national origin, sex, age, and disability in any health program or activity … Continue Reading

Mental Health Parity Compliance Returns to Forefront for Group Health Plan Sponsors

The Consolidated Appropriations Act, 2021 (CAA) amended the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) to include substantial new compliance requirements. The Department of Labor (DOL), Health and Human Services, and the Treasury (collectively, the Departments) have released much-anticipated guidance for group health plans necessitating action from plan sponsors.  More…… Continue Reading

Lawmakers Seek Clarity on EEOC Regulations Concerning Incentives for COVID-19 Vaccinations

Providing incentives for employees to get the COVID-19 vaccine continues to be on the minds of organizations as vaccinations pick up speed. However, concerns about privacy and the shifting positions on wellness program regulation has left many employers wary about implementing more robust incentives. According to Bloomberg, two GOP members of Congress are urging the … Continue Reading

Wellness Programs and Water Bottles, the EEOC Proposes New Rules under the ADA and GINA

Since 1996, when Congress passed the Health Insurance Portability and Accountability Act (HIPAA), employers have been struggling with whether and to what extent they could offer incentives to employees to participate in certain “wellness programs.” The Equal Employment Opportunity Commission’s (EEOC) position on these programs has been a significant driver of those struggles, primarily due … Continue Reading

U.S. Supreme Court: State Law Regulating Pharmacy Benefit Managers is Not Preempted by ERISA

An Arkansas law regulating pharmacy benefit managers’ (PBMs) generic drug reimbursement rates, and affecting the cost of prescription drugs provided under ERISA-governed benefit plans and the administration of those plans, is not preempted by ERISA, the U.S. Supreme Court has held unanimously. Rutledge v. Pharmaceutical Care Management Association, No. 18-540, 2020 U.S. LEXIS 5988 (Dec. 10, … Continue Reading

U.S. Supreme Court to Take on Affordable Care Act … Again

This term, the U.S. Supreme Court returns to a challenge to the Affordable Care Act (ACA). In the consolidated cases of California v. Texas (No. 19-840) and Texas v. California (No. 19-1019), the Court will consider whether a group of states and private individuals have standing to challenge the ACA. If that procedural hurdle is cleared, the Court … Continue Reading

U.S. Supreme Court to Hear the First of Several ERISA Disputes This Term

The Supreme Court, whose new term begins today, the first Monday in October, will consider a number of cases impacting employee benefits and benefits litigation.  This is the first in a series analyzing these cases as they are heard by the Court.  The first issue up concerns prescription drug benefit regulation, and later in the … Continue Reading

Employee Benefits Issues to Consider Before Deciding to Furlough or Terminate Employees During the COVID-19 Pandemic

With the combination of our nation’s response to COVID-19 and the resultant economic downturn, employers of all sizes face the moral and financial dilemma of evaluating employee headcounts while businesses are grappling with the reality of the current situation.  Many employers are considering furloughs, or other types of approved leaves of absences, to reduce immediate … Continue Reading

Employers in Union-Related Group Health Plans Must Still Comply with ACA Reporting Requirements

Employers who provide health benefits to their union workforce through a multiemployer group health plan must satisfy all the Affordable Care Act (ACA) reporting requirements regarding their union employees… More… Continue Reading

Does Your Company Have to File Forms 1094/1095 in New Jersey?

Last week, the IRS issued it updated Form 1094-C and 1095-C instructions for 2019. Employers that employ New Jersey residents, however, may have more reading to do. New Jersey responded to the federal repeal of the Affordable Care Act’s (ACA) individual mandate, by enacting a mandate of its own. The New Jersey Health Insurance Market … Continue Reading

Is Your Employer Worksite Medical Clinic a Group Health Plan?

Worksite medical clinics, some offering round-the-clock access to medical providers via telemedicine, seem to be growing in popularity.  Promoters tout cost savings resulting from what would otherwise be lost productivity (employees whiling away afternoons waiting to see their private doctors or having to drive long distances to have blood drawn for routine laboratory work) and … Continue Reading

As The ACA Landscape Shifts Again, What’s an Employer to Do?

As employers and their third-party administrators begin to wrap-up their Patient Protection and Affordable Care Act (“ACA”) reporting for the 2018 tax year, we’ve started to receive questions about what comes next.  As we discussed here, with the implementation of the Tax Cuts and Jobs Act of 2017 (the “Act”), the ACA’s “individual mandate” effectively … Continue Reading

Ho! Ho! Ho! Where Did It Go?

On December 14, 2018, a federal district judge sitting in Texas ruled that, without the so-called “individual mandate” which requires individual taxpayers to maintain minimum essential coverage, the rest of the Patient Protection and Affordable Care Act as amended (widely known as the “ACA”) is “INVALID”. What was the case about? Texas v United States … Continue Reading

IRS Announces Filing Extension for Furnishing 2018 Forms 1095-B and 1095-C and Continued Good Faith Transition Relief

In IRS Notice 2018-94, the IRS announced an extension for furnishing 2018 IRS Forms 1095-B (Health Coverage) and 1095-C (Employer-Provided Health Insurance Offer and Coverage), from January 31, 2019, to March 4, 2019.  The IRS issued this extension in response to requests by employers, insurers, and other providers of health insurance coverage that additional time … Continue Reading

2018 Tax Reform Series: Goodbye to the Individual Mandate

This is the seventh article in our series covering various tax and employee benefits-related changes contained in the Tax Cuts and Jobs Act signed by the President on December 22, 2017. Once significant change made by the Act, summarized below, is the elimination of the Affordable Care Act’s individual mandate, effective 2019. Background Long an … Continue Reading

Employers Rejoice – IRS Announces Filing Extension for Furnishing 2017 Forms 1095-B and 1095-C and Continued Good Faith Transition Relief

In IRS Notice 2018-06, the IRS announced a 30-day automatic extension for the furnishing of 2017 IRS Forms 1095-B (Health Coverage) and 1095-C (Employer-Provided Health Insurance Offer and Coverage), from January 31, 2018 to March 2, 2018.  This extension was made in response to requests by employers, insurers, and other providers of health insurance coverage … Continue Reading

Your Not So Kind (or Welcome) Early Holiday Gift from the IRS: Letter 226j

On more than one occasion since passing the Affordable Care Act (“ACA”), the IRS has given some type of early holiday “gift” to alleviate pending compliance concerns for employers. One of the most significant of these occurred in late December 2015, when the IRS extended the mandated filing periods for Forms 1094/1095, which gave employers … Continue Reading

On-Site Clinics: What Effect on HDHPs and HSAs?

As of October 2017, Health Care Still Uncertain. We already know the state of health care in the United States continues to whipsaw, as an October 25th ruling demonstrates: a federal district court confirmed that the Trump Administration need not fund the Affordable Care Act (“ACA”) subsidies that offset insurance copays and deductibles for some … Continue Reading

Exemption to ACA Contraceptive Mandate Extended to For-Profit Entities and Individuals

Exemption to ACA Contraceptive Mandate Extended to For-Profit Entities and Individuals Under the ACA, employers must provide plans that cover birth control and other preventative health services with no out-of-pocket costs. Certain religious employers with religious objections to providing contraceptive services have been exempt from the requirement. (Accommodations have also been provided to non-profit religious … Continue Reading

Crossing the Threshold – Small Business to “ALE”

While many of us have been crossing our fingers behind our backs, hoping that the Affordable Care Act’s employer reporting and shared responsibility penalties would be repealed, many small businesses have crossed the threshold to applicable large employer (ALE) status as a result of hiring or business ownership changes. A business that averaged 50 or … Continue Reading

Loss of COBRA Subsidies – A Marketplace Conundrum

While helping employers craft severance packages, we have often cautioned that a well-meaning offer by an employer to subsidize a former employee’s COBRA coverage for a period of time can result in unintended consequences. Namely, when that subsidy ends, that former employee may find himself or herself with a very high COBRA premium and no … Continue Reading

Where Do We Stand with Health Care?

The American Heath Care Act was designed to provide health care reform and to replace former President Obama’s Affordable Care Act (the “ACA”). However, the House of Representatives, under President Trump’s direction, cancelled its vote in late March because of lack of overall support from Republicans to get passage of the bill in the House. … Continue Reading

Introducing the American Health Care Act! Wait! … Not so fast!

The House Ways and Means Committee and the Energy and Commerce Committee (the two congressional committees having primary responsibility for health care legislation) released draft legislation for repealing and replacing aspects of the Obama administration’s 2010 health care reform law on March 6, 2017 (the “ACA”). The bill, dubbed the American Health Care Act, is … Continue Reading
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