Archives: Medical Plans

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Look Beyond the ACA Wellness Regulations When Designing Your Program, EEOC Sues Employer Over Its Program

The EEOC could sue my company over the wellness program that is part of our medical plan? Yes, that agency recently sued an employer in Wisconsin claiming the penalty the employer imposed for nonparticpation in its program was too significant, causing the medical inquiries under the program to be involuntary for purposes of the Americans … Continue Reading

Affordable Care Act Employer Penalties – Another Reason to Make Sure Workers are Properly Classified as Employees or Independent Contractors

Beginning next year, an applicable large employer that does not offer affordable minimum value group health coverage to its fulltime employees (and their children up to age 26) will be vulnerable to employer shared responsibility penalties under Internal Revenue Code §4980H.  Whether an employer is an “applicable large employer” depends on its number of fulltime … Continue Reading

IRS GUIDANCE: EMPLOYEE INCOME TAX CORRECTION FOR SAME-SEX SPOUSAL HEALTH COVERAGE AFTER UNITED STATES V. WINDSOR

  On June 27, 2014, the IRS released Information Letter 2014-0012, which contains guidance for employees who have had the value of same-sex spousal coverage under employer health plans — which until recently was required to be included in gross income — reported on their Forms W-2. BACKGROUND Historically, the employer cost of opposite-sex spousal … Continue Reading

Dueling Decisions in the 4th and D.C. Circuit Courts of Appeals Spell More ACA Uncertainty for Employers

Just as employers are gearing up to prepare for compliance with the Shared Responsibility rules under the ACA, a pair of decisions from two federal appeals courts has thrown a curve ball into what was already a complicated assessment of risk for employers and raised new questions. The U.S. Court of Appeals for the District … Continue Reading

Getting Ready for 2015: How Government Contractors, Health Care Reform, and the Family Medical Leave Act Intersect

It’s summer now, mid-year 2014. Open enrollment for the 2015 health plan year is just around the corner. . . We want to make sure that all employers are ready. We want to ensure, as well, that government contractors specifically understand the intersection of the Service Contract Act (SCA) with other federal laws. To be … Continue Reading

Wellness Program Update: EEOC is Planning to Issue Proposed Regulations to Address ADA, GINA Issues

In May, the Equal Employment Opportunity Commission (EEOC) announced that it intends to issue proposed regulations addressing health plan-based wellness programs. According to the EEOC’s announcement, the guidance is expected to address the following items: Does title I of the Americans with Disabilities Act (ADA) allow employers to offer financial inducements and/or impose financial penalties as part of … Continue Reading

Remember ERISA Basics: SPD and Eligibility

During the past 14+ years practicing employee benefits law, I’ve seen many changes, not the least of which has been the Affordable Care Act (ACA). However, with all of the recent changes flowing from the ACA, it is important not to forget some very basic and long-standing aspects of plan compliance, design, drafting and administration, … Continue Reading

DOL Proposes Changes to Model Notices and Procedures

The Department of Labor (DOL) has published proposed regulations containing amendments to the COBRA notice provisions.  The amendments are intended to align the model general and election notices with the Affordable Care Act provisions already in effect and to ensure that the DOL will have flexibility to modify the model notices going forward. The proposed … Continue Reading

U.S. Surgeon General’s Report May Spur More Wellness Program Activity

A U.S. Surgeon General’s Report issued this month marks fifty years since the Surgeon General’s landmark report in 1964 that set in motion a nationwide campaign to reduce and hopefully eliminate tobacco smoking in the United States. Also during this month, rules under the Affordable Care Act (ACA) go into effect, enhancing employers’ ability to … Continue Reading

Employers Don’t Have to Give More Than One Shot Per Year at Avoiding a Tobacco Surcharge, According to DOL FAQs

The Departments of Labor, Treasury and Health and Human Services issued final regulations on June 3, 2013, that implement PHS Act section 2705, added by the Affordable Care Act (ACA), and existing provisions under ERISA and the Code. The preamble to those regulations stated that the Departments anticipated issuing future subregulatory guidance as necessary. Frequently … 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

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

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

FAQs on Coverage for Adult Children Under Health Reform

As group health plans brace for open enrollment periods under the new Patient Protection and Affordable Care Act of 2010, one of the key issues they face is the Act’s new coverage requirements for adult children. Previously, a child became ineligible for family coverage under a group health plan for federal tax purposes once the … Continue Reading
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