Health Care Reform Updates & Human Resource News Alerts

Health Care Reform News

HR360::Health Care Reform
  • HHS Releases Sample Marketplace Employer Notice and Employer Appeal Request Form

    Posted on May 17, 2016
    Print

    Resources Provided As Part of Marketplace Employer Notice Program

    The U.S. Department of Health and Human Services (HHS) has released a sample employer notice that the federally-facilitated and certain state-based Health Insurance Marketplaces (Exchanges) will use as part of the employer notice program, which generally requires the Marketplaces to notify employers that one of their employees has been determined eligible for advance payments of the premium tax credit and cost-sharing reductions and has enrolled in a Marketplace plan. Because these events may trigger employer penalties under the Affordable Care Act's "pay or play" provisions, an employer appeal request form has also been provided by HHS.

    Receipt of Notices
    Under the HHS Notice of Benefit and Payment Parameters, Marketplaces must notify employers within a reasonable timeframe following any month of the employee's eligibility determination and enrollment. Previously released FAQs indicated that the Marketplaces would begin sending out employer notices in spring 2016, with additional notices to follow throughout the year.

    While the Marketplaces are permitted to send employer notices either on an employee-by-employee basis or in groups of employees, for 2016 the Marketplaces intend to send notices in groups of employees.

    Employer Appeals Process
    Appeal of an employer notice generally must be made within 90 days. In the appeal, the employer may assert that it provides its employee access to affordable, minimum value employer-sponsored coverage or that its employee is enrolled in employer coverage, and therefore that the employee is ineligible for advance payments of the premium tax credit. For more on the appeals process, click here.

    © 2012 - 2013 HR 360, Inc.
  • HHS Releases Final Rule on Civil Rights Provisions of the ACA

    Posted on May 16, 2016
    Print

    Rule Addresses Nondiscrimination in Health Care

    The U.S. Department of Health and Human Services (HHS) has released a final rule to amend section 1557 of the Affordable Care Act (ACA), which prohibits discrimination in certain health programs and activities on the basis of race, color, national origin, age, disability, or sex. The final rule applies to Health Insurance Marketplaces and any health program or activity that receives federal financial assistance from HHS.

    Among other things, the final rule establishes that the prohibition on sex discrimination includes discrimination based on pregnancy, gender identity, and sex stereotyping. While the final rule does not resolve whether discrimination on the basis of an individual’s sexual orientation status alone is a form of sex discrimination under section 1557, the rule makes clear that HHS's Office of Civil Rights will evaluate complaints that allege sex discrimination related to an individual’s sexual orientation to determine if they involve the sorts of stereotyping that can be addressed under section 1557.

    The rule also includes requirements for effective communication for individuals with disabilities and enhanced language assistance for people with limited English proficiency.

    You may read a summary of the final rule or the final rule in its entirety for more information.

    © 2012 - 2013 HR 360, Inc.
  • Reminder: Deadlines to File ACA Information Returns With IRS Approaching

    Posted on May 12, 2016
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    Due Date to File Paper Returns is May 31, 2016

    Employers subject to the new Affordable Care Act (ACA) information reporting requirements are reminded that the deadlines for filing the first ACA information returns with the IRS are quickly approaching. The first reporting deadlines in 2016 are for the 2015 calendar year and were previously extended as follows:

    • Applicable large employers (ALEs)—generally those with 50 or more full-time employees, including full-time equivalents (FTEs)—must file Forms 1094-C and 1095-C with the IRS no later than May 31, 2016 (or June 30, 2016 if filing electronically).
    • Self-insuring employers that are not considered ALEs, and other parties that provide minimum essential health coverage, must file Forms 1094-B and 1095-B with the IRS no later than May 31, 2016 (or June 30, 2016 if filing electronically).

    Employers and other coverage providers that do not comply with these extended due dates may be subject to penalties. As a reminder, reporting entities were also required to furnish employee/individual statements on or before March 31, 2016.

    Electronic Filing Requirements
    Reporting entities filing 250 or more Forms 1095-B or Forms 1095-C must electronically file them with the IRS. Additional information on electronic filing can be found on the IRS ACA Information Returns (AIR) Program webpage.

    © 2012 - 2013 HR 360, Inc.
  • HHS Interim Final Rule Amends Certain Special Enrollment Period Eligibility Requirements for Marketplace Coverage

    Posted on May 10, 2016
    Print

    Separate Guidance Outlines Six Special Enrollment Periods

    The U.S. Department of Health and Human Services (HHS) has announced an interim final rule which tightens the requirements for certain special enrollment periods (SEPs). Separate guidance also makes clear that SEPs in the Health Insurance Marketplace are only available in six defined and limited types of circumstances.

    Special Enrollment Periods
    The new guidance clarifies that SEPs are only available in the following circumstances:

    1. Loss of other qualifying coverage (e.g., employer-based coverage);
    2. Change in household size (e.g., due to marriage or birth);
    3. Change in residency;
      • Effective July 11, 2016 and subject to certain exceptions outlined in the interim final rule, individuals requesting a SEP as a result of a change in his or her residence must have minimum essential coverage for one or more days in the 60 days preceding the change in residence.
    4. Change in eligibility for Marketplace coverage or for financial help to purchase such coverage;
    5. Enrollment errors made by the Marketplace or a health plan; or
    6. Other special circumstances which apply to, among others, victims of domestic abuse or natural disasters.

    Availability of SEPs
    The interim final rule also removes a January 1, 2017 implementation deadline by which Marketplaces would otherwise have had to provide advance availability (which provides qualified individuals with 60 days before or after a triggering event to select a qualified health plan) of the residency SEP. The rule also removes the requirement that SEPs for the loss of a dependent or for no longer being considered a dependent due to divorce, legal separation, or death be offered by January 1, 2017. Marketplaces can still provide either SEP, but implementation and the timing of that implementation are now at the option of the Marketplace.  

    For more information about the new guidance, please review the HHS Fact Sheet.

    © 2012 - 2013 HR 360, Inc.
  • Newly Updated IRS ACA Webinars Now Available for Employers

    Posted on May 06, 2016
    Print

    Videos Cover "Pay or Play" and Information Reporting Requirements

    The Internal Revenue Service (IRS) has released newly updated webinars for employers interested in learning more about the employer provisions, information reporting, and related tax requirements that are part of the Affordable Care Act (ACA).

    The webinars cover the following topics:

    • Employer Shared Responsibility Provisions ("Pay or Play"): Explains how to determine applicable large employer (ALE) status, the definition of a full-time employee, and transition relief for 2015.
    • ALE Information Reporting Requirements for Tax Year 2015: Details the reporting and filing responsibilities for ALEs, rules for multi-employer plans, filing extensions, and transition relief for 2015. 
    • Information Reporting Requirements for Providers of Minimum Essential Coverage: Discusses the reporting requirements for small self-insured employers (that are not considered ALEs), the definition of minimum essential coverage, the information reporting forms, and other available resources.

    In addition, the IRS is expected to release a webinar on how to correct information reporting errors in the near future.

    These and other ACA webinars can be accessed at any time through the IRS Video Portal.

    © 2012 - 2013 HR 360, Inc.
  • IRS Guidance for Individuals Receiving a Corrected or Voided Form 1095-A

    Posted on May 03, 2016
    Print

    Helpful Information on When to File an Amended Return & More

    Individuals that were enrolled in Health Insurance Marketplace coverage in 2015 should have received a Form 1095-A, Health Insurance Marketplace Statement, from the Marketplace. Some individuals may have received corrected or voided Forms 1095-A because the information on their initial forms were incorrect or incomplete. Alternatively, they may have received a letter from the Marketplace indicating that they should disregard a received Form 1095-A, which means that the form has been voided.

    The Internal Revenue Service (IRS) is providing the following guidance for such individuals:

    Corrected Forms 1095-A
    Individuals who have already filed a tax return will need to determine the effect the changes to the corrected forms might have on their returns. Some changes may require an individual to file an amended tax return. For information on how to assess the changes made, please visit the IRS' webpage on corrected or voided Forms 1095-A. Individuals uncertain about whether to amend a tax return may also want to consult with a tax preparer.

    Individuals that believe the information on a corrected Form 1095-A is incorrect or that have additional questions about the form should contact the Marketplace.

    Voided Forms 1095-A
    Individuals who receive voided Forms 1095-A (or letters stating that their forms have been voided) after having already filed a tax return and claiming the premium tax credit using the original Form 1095-A that the Marketplace sent in error should file an amended tax return. Individuals with coverage through the Marketplace who believe they should not have received a voided form should contact the Marketplace immediately to receive an accurate Form 1095-A.

    IRS Q&As are available for more information regarding Form 1095-A and other health care information forms for individuals.

    © 2012 - 2013 HR 360, Inc.

    HR News and Alerts

    HR360::Health Care Reform
    • HHS Releases Sample Marketplace Employer Notice and Employer Appeal Request Form

      Posted on May 17, 2016
      Print

      Resources Provided As Part of Marketplace Employer Notice Program

      The U.S. Department of Health and Human Services (HHS) has released a sample employer notice that the federally-facilitated and certain state-based Health Insurance Marketplaces (Exchanges) will use as part of the employer notice program, which generally requires the Marketplaces to notify employers that one of their employees has been determined eligible for advance payments of the premium tax credit and cost-sharing reductions and has enrolled in a Marketplace plan. Because these events may trigger employer penalties under the Affordable Care Act's "pay or play" provisions, an employer appeal request form has also been provided by HHS.

      Receipt of Notices
      Under the HHS Notice of Benefit and Payment Parameters, Marketplaces must notify employers within a reasonable timeframe following any month of the employee's eligibility determination and enrollment. Previously released FAQs indicated that the Marketplaces would begin sending out employer notices in spring 2016, with additional notices to follow throughout the year.

      While the Marketplaces are permitted to send employer notices either on an employee-by-employee basis or in groups of employees, for 2016 the Marketplaces intend to send notices in groups of employees.

      Employer Appeals Process
      Appeal of an employer notice generally must be made within 90 days. In the appeal, the employer may assert that it provides its employee access to affordable, minimum value employer-sponsored coverage or that its employee is enrolled in employer coverage, and therefore that the employee is ineligible for advance payments of the premium tax credit. For more on the appeals process, click here.

      © 2012 - 2013 HR 360, Inc.
    • HHS Releases Final Rule on Civil Rights Provisions of the ACA

      Posted on May 16, 2016
      Print

      Rule Addresses Nondiscrimination in Health Care

      The U.S. Department of Health and Human Services (HHS) has released a final rule to amend section 1557 of the Affordable Care Act (ACA), which prohibits discrimination in certain health programs and activities on the basis of race, color, national origin, age, disability, or sex. The final rule applies to Health Insurance Marketplaces and any health program or activity that receives federal financial assistance from HHS.

      Among other things, the final rule establishes that the prohibition on sex discrimination includes discrimination based on pregnancy, gender identity, and sex stereotyping. While the final rule does not resolve whether discrimination on the basis of an individual’s sexual orientation status alone is a form of sex discrimination under section 1557, the rule makes clear that HHS's Office of Civil Rights will evaluate complaints that allege sex discrimination related to an individual’s sexual orientation to determine if they involve the sorts of stereotyping that can be addressed under section 1557.

      The rule also includes requirements for effective communication for individuals with disabilities and enhanced language assistance for people with limited English proficiency.

      You may read a summary of the final rule or the final rule in its entirety for more information.

      © 2012 - 2013 HR 360, Inc.
    • Reminder: Deadlines to File ACA Information Returns With IRS Approaching

      Posted on May 12, 2016
      Print

      Due Date to File Paper Returns is May 31, 2016

      Employers subject to the new Affordable Care Act (ACA) information reporting requirements are reminded that the deadlines for filing the first ACA information returns with the IRS are quickly approaching. The first reporting deadlines in 2016 are for the 2015 calendar year and were previously extended as follows:

      • Applicable large employers (ALEs)—generally those with 50 or more full-time employees, including full-time equivalents (FTEs)—must file Forms 1094-C and 1095-C with the IRS no later than May 31, 2016 (or June 30, 2016 if filing electronically).
      • Self-insuring employers that are not considered ALEs, and other parties that provide minimum essential health coverage, must file Forms 1094-B and 1095-B with the IRS no later than May 31, 2016 (or June 30, 2016 if filing electronically).

      Employers and other coverage providers that do not comply with these extended due dates may be subject to penalties. As a reminder, reporting entities were also required to furnish employee/individual statements on or before March 31, 2016.

      Electronic Filing Requirements
      Reporting entities filing 250 or more Forms 1095-B or Forms 1095-C must electronically file them with the IRS. Additional information on electronic filing can be found on the IRS ACA Information Returns (AIR) Program webpage.

      © 2012 - 2013 HR 360, Inc.
    • HHS Interim Final Rule Amends Certain Special Enrollment Period Eligibility Requirements for Marketplace Coverage

      Posted on May 10, 2016
      Print

      Separate Guidance Outlines Six Special Enrollment Periods

      The U.S. Department of Health and Human Services (HHS) has announced an interim final rule which tightens the requirements for certain special enrollment periods (SEPs). Separate guidance also makes clear that SEPs in the Health Insurance Marketplace are only available in six defined and limited types of circumstances.

      Special Enrollment Periods
      The new guidance clarifies that SEPs are only available in the following circumstances:

      1. Loss of other qualifying coverage (e.g., employer-based coverage);
      2. Change in household size (e.g., due to marriage or birth);
      3. Change in residency;
        • Effective July 11, 2016 and subject to certain exceptions outlined in the interim final rule, individuals requesting a SEP as a result of a change in his or her residence must have minimum essential coverage for one or more days in the 60 days preceding the change in residence.
      4. Change in eligibility for Marketplace coverage or for financial help to purchase such coverage;
      5. Enrollment errors made by the Marketplace or a health plan; or
      6. Other special circumstances which apply to, among others, victims of domestic abuse or natural disasters.

      Availability of SEPs
      The interim final rule also removes a January 1, 2017 implementation deadline by which Marketplaces would otherwise have had to provide advance availability (which provides qualified individuals with 60 days before or after a triggering event to select a qualified health plan) of the residency SEP. The rule also removes the requirement that SEPs for the loss of a dependent or for no longer being considered a dependent due to divorce, legal separation, or death be offered by January 1, 2017. Marketplaces can still provide either SEP, but implementation and the timing of that implementation are now at the option of the Marketplace.  

      For more information about the new guidance, please review the HHS Fact Sheet.

      © 2012 - 2013 HR 360, Inc.
    • Newly Updated IRS ACA Webinars Now Available for Employers

      Posted on May 06, 2016
      Print

      Videos Cover "Pay or Play" and Information Reporting Requirements

      The Internal Revenue Service (IRS) has released newly updated webinars for employers interested in learning more about the employer provisions, information reporting, and related tax requirements that are part of the Affordable Care Act (ACA).

      The webinars cover the following topics:

      • Employer Shared Responsibility Provisions ("Pay or Play"): Explains how to determine applicable large employer (ALE) status, the definition of a full-time employee, and transition relief for 2015.
      • ALE Information Reporting Requirements for Tax Year 2015: Details the reporting and filing responsibilities for ALEs, rules for multi-employer plans, filing extensions, and transition relief for 2015. 
      • Information Reporting Requirements for Providers of Minimum Essential Coverage: Discusses the reporting requirements for small self-insured employers (that are not considered ALEs), the definition of minimum essential coverage, the information reporting forms, and other available resources.

      In addition, the IRS is expected to release a webinar on how to correct information reporting errors in the near future.

      These and other ACA webinars can be accessed at any time through the IRS Video Portal.

      © 2012 - 2013 HR 360, Inc.
    • IRS Guidance for Individuals Receiving a Corrected or Voided Form 1095-A

      Posted on May 03, 2016
      Print

      Helpful Information on When to File an Amended Return & More

      Individuals that were enrolled in Health Insurance Marketplace coverage in 2015 should have received a Form 1095-A, Health Insurance Marketplace Statement, from the Marketplace. Some individuals may have received corrected or voided Forms 1095-A because the information on their initial forms were incorrect or incomplete. Alternatively, they may have received a letter from the Marketplace indicating that they should disregard a received Form 1095-A, which means that the form has been voided.

      The Internal Revenue Service (IRS) is providing the following guidance for such individuals:

      Corrected Forms 1095-A
      Individuals who have already filed a tax return will need to determine the effect the changes to the corrected forms might have on their returns. Some changes may require an individual to file an amended tax return. For information on how to assess the changes made, please visit the IRS' webpage on corrected or voided Forms 1095-A. Individuals uncertain about whether to amend a tax return may also want to consult with a tax preparer.

      Individuals that believe the information on a corrected Form 1095-A is incorrect or that have additional questions about the form should contact the Marketplace.

      Voided Forms 1095-A
      Individuals who receive voided Forms 1095-A (or letters stating that their forms have been voided) after having already filed a tax return and claiming the premium tax credit using the original Form 1095-A that the Marketplace sent in error should file an amended tax return. Individuals with coverage through the Marketplace who believe they should not have received a voided form should contact the Marketplace immediately to receive an accurate Form 1095-A.

      IRS Q&As are available for more information regarding Form 1095-A and other health care information forms for individuals.

      © 2012 - 2013 HR 360, Inc.