Archives: Health Care Reform

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Employers Must Provide Notices Regarding Availability of Exchange Coverage

A provision of the 2010 health care reform law requires employers to provide notices, by March 1, 2013, to all employees regarding the availability of health coverage options through the state-based exchanges created pursuant to that law. In January, the Department of Labor had announced delayed enforcement of the exchange coverage notice provision (which added Section … Continue Reading

More Guidance on the Summary of Benefits and Coverage (But No Surprises)

The Department of Labor, Health and Human Services and the Treasury collectively published new FAQs regarding the requirement to provide a summary of benefits and coverage (SBC) under the Affordable Care Act (ACA) (http://www.dol.gov/ebsa/faqs/faq-aca14.html#footnotes). The FAQs include an updated SBC template and an updated sample completed SBC (available at cciio.cms.gov and www.dol.gov/ebsa/healthreform).  It is noteworthy … Continue Reading

Proposed Regulations on Certificates of Creditable Coverage

Proposed regulations published on March 21, 2013 addressed not only the 90-day waiting period rule discussed below but also the eventual elimination of notices of creditable coverage under HIPAA’s preexisting condition exclusions rules. The 2010 health care reform law prohibits group health plans from imposing preexisting condition exclusions, effective for plan years beginning on or … Continue Reading

Government Proposes Expanded Relief From Contraceptive Mandate

As explained in an earlier post, the 2010 health care reform law requires health plans to provide women’s preventive care and services without cost sharing. Regulations issued August 1, 2011 included all FDA-approved contraception for women in the definition of women’s preventive care and services. That includes abortion and abortifacient drugs (like the so-called “morning-after” pill). The regulations … Continue Reading

Employer Relief – Extension for Issuing Health Care Reform Exchange Coverage Notice

As expected, the government issued guidance (in the form of frequently asked questions posted on the Department of Labor’s website) postponing the due date for employers to issue notices regarding the availability of health coverage under state exchanges. Under the 2010 health care reform law, a provision added to the Fair Labor Standards Act requires … Continue Reading

Health Care Reform Resource Center

We are pleased to announce the launch of Jackson Lewis’ Health Care Reform Resource Center. Our Resource Center provides one convenient place for you to obtain key health care reform-related law, agency guidance, Jackson Lewis articles and related information. We hope you find this resource helpful.… Continue Reading

IRS Releases Proposed Regulations on Employer Penalty under Health Care Reform Law

The IRS released proposed regulations last week that amplify and modify earlier guidance issued on the 2010 health care reform law’s employer penalty provision.  Highlights of the proposed regulations include: For purposes of determining whether an employer has the threshold 50 full-time employees, an employer can use any consecutive 6-month period in 2013, instead of … Continue Reading

More Health Care Reform Fees – Redistribution of Risk

Employers wrestling with how to budget for the additional costs associated with the 2010 health care reform law have one more cost to consider: the “transitional reinsurance program” fee. Barely discussed in the public forum up to now (probably because the amount per plan was not determinable), the government has clarified how this fee could impact … Continue Reading

How Employers Can Approach Health Care Reform’s Shared Responsibility Penalty

Many employers put off making plans to deal with the employer shared responsibility penalty provision of the 2010 health care reform law until after the November elections.  With President Obama’s re-election and no real possibility of legislative repeal, procrastinating further would be ill-advised.  Employers need to understand now the way the penalty can be triggered … Continue Reading

IRS Provides Guidance Regarding New Limit on Health FSA Contributions

The Internal Revenue Service (IRS) has provided guidance regarding the new salary reduction contribution limits to health flexible spending arrangements (health FSAs) under Internal Revenue Code section 125 cafeteria plans in Notice 2012-40, issued May 30, 2012. Currently, there are no statutory limits on employee salary reduction contributions to health FSAs, but plan sponsors typically … Continue Reading

Health Care Reform Update: DOL Provides Guidance on Summary of Benefits and Coverage Requirement

The US Department of Labor (“DOL”) has released frequently asked questions (“FAQs”) regarding implementation of the federal health care reform law’s summary of benefits and coverage requirement. (This set of FAQs is Part VIII in the general series about implementation of the law.) See our earlier blog post regarding the summary of benefits and coverage regulations that were … Continue Reading

Group Health Plan Summary of Benefits and Coverage Due By Next Open Enrollment

  The agencies primarily responsible for enforcing the Patient Protection and Affordable Care Act of 2010 issued 150 pages of final regulations implementing the mandate that group health plans and insurers provide a four-page summary of benefits and coverage to individuals who enroll in health plans. Under the regulations issued February 9, 2012, plan administrators and … Continue Reading

Additional IRS Guidance on W-2 Reporting of Health Care Costs

The Internal Revenue Service (“IRS”) has  amended its guidance to employers on how to report the cost of group health coverage. Notice 2012-9 addresses, among other things, cost determinations for employee assistance programs, wellness programs, and health reimbursement arrangements.  Internal Revenue Code section 6051(a)(14), enacted as part of the Patient Protection and Affordable Care Act of … Continue Reading

Eleventh Circuit Decides Health Care Reform Individual Mandate Is Unconstitutional

The individual mandate provision of the 2010 health care reform law is unconstitutional, the U.S. Court of Appeals for the Eleventh Circuit decided in Florida v. HHS on August 12th. The Sixth Circuit previously held in Thomas More Law Center v. Obama that the individual mandate is constitutional. Therefore, the Eleventh Circuit decision creates a circuit split, … Continue Reading

New Rules Require Health Plans to Cover Women’s Contraception

Group health plans that are not grandfathered under the 2010 health care reform law (the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010) must provide women’s contraception without cost-sharing beginning with the first plan year that starts on or after August 1, 2012. The three agencies … Continue Reading

IRS Delays Enforcement of Health Care Reform Nondiscrimination Provisions for Insured Group Plans

The Internal Revenue Service has given a last-minute holiday gift to sponsors of insured group health plans.  It announced delayed enforcement for the new nondiscrimination provisions applicable to insured group health plans under the Patient Protection and Affordable Care Act of 2010 (as amended by the Health Care and Education Reconciliation Act of 2010; together … Continue Reading

HHS Updates Guidance on Obtaining Waivers from PPACA Annual Limits

The Patient Protection and Affordable Care Act (Affordable Care Act), requires the Secretary of Health and Human Services (HHS) to impose restrictions on the imposition of annual limits on the dollar value of essential health benefits in a new or existing group health plan for plan years beginning on or after September 23, 2010 and prior to January 1, 2014. Interim final regulations published on June 28, 2010, established these restricted annual limits, along with the possibility for a waiver from these restricted annual limits as granted by HHS if complying with the interim final regulations would result in a significant decrease in access to benefits or a significant increase in premiums.… Continue Reading
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