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Past ACA Articles

Archive for the ‘Past ACA Articles’ Category

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ACA 1094-C/1095-C Reporting Through EaseCentral

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It’s no secret, ACA compliance can be difficult and IRS reporting requirements are very complex. To successfully meet these obligations, it’s critical employers have the proper guidance and reporting infrastructure to manage and submit the data required.

After a thorough evaluation of the products in the market, we recommend EaseCentral for online ACA tracking and reporting. For a limited time, Claremont is offering complimentary* ACA 1094-C/1095-C reporting with a new broker subscription.

How To Get Started

Simply sign up now for a new EaseCentral standard plan, indicate Claremont as your referral source, and we’ll pay the EaseCentral fee for generating IRS Forms 1094-C and 1095-C for one year, up to three groups per broker. A $6 per employee value!
Sign Up Now and Save*!

 

To learn more about EaseCentral’s ACA reporting solution and get an overview of the ACA Large Employer Mandate compliance requirements, view our slides and recorded presentation.

Webinar: ACA Large Employer Mandate Compliance-YouTube Image

 

Need help understanding the ACA requirements?

Download our easy-to-use ‘Play or Pay’ guides to learn the ACA compliance requirements and how employers will be impacted by the Large Employer Mandate. You’ll get actionable tips and helpful examples to advise your clients and strengthen your relationships.

With Claremont, turn ACA compliance challenges and risks into opportunities to win and retain more business.

 

Questions?
Contact the small group experts at 800.696.4543 or info@claremontcompanies.com.

 

*This offer only applies to new EaseCentral subscriptions. This offer is not available if you already have an EaseCentral subscription.

The 21st Century Cures Act

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In a previous article, I wrote about federal guidance issued in 2013, Notice 2013-54, in which the Treasury Department and IRS, Department of Labor (DOL), and Health and Human Services (HHS) (collectively, the Departments) stated that reimbursement arrangements and employer payment plans that facilitate the pre-tax payment or reimbursement of premiums for individual medical coverage for active employees are impermissible. The Departments asserted that these arrangements generally are considered to be group health plans and are thus subject to rules applicable to group health plans. As such, they are impermissible, because they fail to comply with the market reforms that apply to group health plans under the Affordable Care Act (ACA), including the annual dollar limit prohibition and the preventive services requirement.

Congress, however, has reversed the Departments’ guidance. Congress has passed, and President Obama has signed the 21st Century Cures Act. The long and complex 900-page bill’s primary purpose is to provide funding for various medical and pharmaceutical research and development, reforms to the Food and Drug Administration, prescription opioid and heroin response, the Precision Medicine Initiative, and the cancer “moonshot” initiative spearheaded by Vice President Biden. However, the bill also has a provision that allows employers that are not “applicable large employers” (as defined in Code §4908H(c)(2)) to provide a “qualified small employer health reimbursement arrangement” if they do not offer a group health plan to any of their employees.

A “qualified small employer health reimbursement arrangement” is an arrangement that:

  1. is provided on the same terms to all eligible employees,
  2. is funded solely by an eligible employer,
  3. pays or reimburses an eligible employee for medical care expenses (as defined in IRS code section 213(d)), and
  4. pays or reimburses a maximum of $4,950 ($10,000 for family) (adjusted for inflation after 2016).

If the employee is not covered under Minimum Essential Coverage for the month in which medical care is provided, payments or reimbursements under the arrangement may be includible in gross income.

The bill specifically provides that, “the term ‘group health plan’ shall not include any qualified small employer health reimbursement arrangement.” Therefore, any “qualified small employer health reimbursement arrangement” is not subject to rules applicable to group health plans, including the annual dollar limit prohibition and the preventive services requirement. As such, small employer health reimbursement arrangements that facilitate the pre-tax payment or reimbursement of premiums for individual medical coverage for active employees are now permissible.

Future changes to health care as a result of the elections could, however, affect the implementation of this provision. Stay tuned for updates on how this legislation will be implemented.

For more information on the 21st Century Cures Act, read:

Questions?
Contact the small group experts at 800.696.4543 or info@claremontcompanies.com.

 

Extension for Furnishing 2016 Forms 1095-B & 1095-C to Individuals, But Not for Filing with IRS

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The IRS extended the due date for furnishing to individuals the 2016 Form 1095-B and the 2016 Form 1095-C from January 31, 2017 to March 2, 2017. Due to this automatic extension, no further extension may be obtained by application to the IRS, and the IRS will not formally respond to any previously submitted deadline extension requests relating to 2016 statements.

Health insurance carriers, self-insuring small employers, and other providers of minimum essential coverage are required to furnish Form 1095-B to individuals regarding coverage. Applicable Large Employers (those with 50 or more full-time employees, including full-time equivalent employees, in the previous year) are required to furnish Form 1095-C regarding the health insurance, if any, that the employer offered to its full-time employees.

The IRS did not extend the due date for filing Forms 1094-B, 1095-B, 1094-C, and 1095-C with the IRS. Accordingly, the deadline remains February 28, 2017 for paper filings, and March 31, 2017 for electronic filings. (Electronic filing is mandatory for entities required to file 250 or more Forms 1095.) However, filers may obtain an automatic 30-day extension by filing Form 8809 on or before the regular due date.

Because of the extension, some individual taxpayers may not receive a Form 1095-B or Form 1095-C by the time they are ready to file their 2016 tax return. Taxpayers may rely on other information received from their employer or other coverage provider for purposes of filing their returns. Taxpayers do not need to wait to receive Forms 1095-B and 1095-C before filing their returns. Individuals need not send the proof of coverage to the IRS when filing their returns but should keep it with their tax records.

Extension of Good Faith Transition Relief

The IRS will again grant transition relief from penalties to reporting entities that can show that they have made good-faith efforts to comply with the information-reporting requirements for 2016 (both for furnishing to individuals and for filing with the IRS). This relief applies to entities that report incorrect or incomplete information – either on statements furnished to individuals or returns filed with the IRS – such as missing and inaccurate taxpayer identification numbers and dates of birth, as well as other information required on the return or statement. No relief is provided in the case of reporting entities that do not make a good-faith effort to comply or that fail to file an information return or furnish a statement by the due dates (as extended described above).

For further information, download this IRS notice.

Interested in complimentary ACA 1094-C/1095-C reporting through EaseCentral? Check out our limited time offer.


Need help understanding the ACA requirements?

Download our easy-to-use ‘Play or Pay’ guides to learn the ACA compliance requirements and how employers will be impacted by the Large Employer Mandate. You’ll get actionable tips and helpful examples to advise your clients and strengthen your relationships.

With Claremont, turn ACA compliance challenges and risks into opportunities to win and retain more business.

 

Questions?
Contact the small group experts at 800.696.4543 or info@claremontcompanies.com.

 

US Court of Appeals: OK to Buy Standalone Fixed Indemnity Plans

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On July 1, 2016, the U.S. Court of Appeals for the D.C. Circuit, agreed with the district court’s decision to stop the enforcement of Health and Human Service’s regulation regarding fixed indemnity insurance.

The Affordable Care Act (ACA) established certain requirements and limitations on health insurance plans. However, excepted benefits are exempt from these requirements and limitations. Fixed indemnity insurance is an excepted benefit if (a) the benefits are provided under a separate policy, certificate, or contract of insurance, and (b) they are offered as independent, non-coordinated benefits.

Fixed indemnity insurance policies pay out a fixed amount of cash upon the occurrence of a particular medical event. Some fixed indemnity insurance policies provide coverage only for specified diseases, such as cancer. These policies provide limited coverage and are not Minimum Essential Coverage, which is what individuals are required to have to comply with the Individual Mandate and Applicable Large Employers are required to offer to avoid one of the Large Employer Mandate penalties. Nevertheless, the Court noted that, “many individuals found it cost-effective to forego Minimum Essential Coverage (even despite the penalty) in favor of these fixed indemnity policies.”

In 2014, a Health and Human Services regulation added to the criteria that allowed fixed indemnity insurance to be considered excepted benefits. Particularly, fixed indemnity insurance plans are excepted benefits if they are provided only to individuals who have Minimum Essential Coverage. According to the Court, “this new rule effectively eliminated standalone fixed indemnity plans altogether.” In response, several providers challenged the regulation as going beyond the scope of Health and Human Services’ authority. The district court stopped Health and Human Service’s enforcement of the regulation and the U.S. Court of Appeals for the D.C. Circuit affirmed this decision. This means that consumers may continue to buy standalone fixed indemnity plans.

To learn more about the Large Employer Mandate and Minimum Essential Coverage, download Claremont’s essential ‘Play or Pay’ guides.

Questions?
Contact the small group experts at 800.696.4543 or info@claremontcompanies.com.

 

Webinar: ACA Large Employer Mandate Compliance

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This timely webinar with EaseCentral discusses the Large Employer Mandate requirements and how to ease the compliance burden for employers.

You’ll learn about:

View the slides and recorded presentation.

Webinar: ACA Large Employer Mandate Compliance-YouTube Image

Watch The Video

 

Are you prepared to provide ACA compliance guidance?

97% of employers expect their benefits broker to answer compliance questions and provide guidance, according to a recent Zywave survey. To address these expectations, brokers are required know the Large Employer Mandate (also known as Play or Pay) and how employers will be impacted — which can be complicated. But don’t worry, Claremont provides the resources you need to effectively and efficiently guide your employer groups.

If you’re not yet comfortable with the Large Employer Mandate, download our easy-to-use ‘Play or Pay’ guides filled with actionable tips and helpful examples to advise your clients and grow your business.

To get started with EaseCentral’s ACA solution, simply sign up online.

Questions?
Contact the small group experts at 800.696.4543 or info@claremontcompanies.com.

 

ALEs and Employee-Only Coverage

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An Applicable Large Employer (ALE) may be meeting its Large Employer Mandate obligation to offer Minimum Essential Coverage and a Minimum Value plan, but are they certain they are offering coverage to all eligible employees and dependents? If your client has selected an employee-only coverage plan, the employer may be exposing their business to a penalty. While the employer does not need to contribute towards the cost of dependent coverage, they are required to offer coverage to dependent children.

The Society for Human Resource Management (SHRM) states that dependent status under the PPACA is based on the relationship between a child and a participant and that a large employer that fails to offer coverage to employees’ dependents is not meeting the ACA requirements for coverage and therefore subject to an assessable penalty.

Did you know groups with substantially fewer than 50 employees may be an ALE?
If you have ALEs in your book that are on employee-only coverage, we can assist those groups written with Covered California.

To learn more about the Large Employer Mandate and how to identify Applicable Large Employers, download our essential ‘Play or Pay’ guides.

Questions?
Contact the small group experts at 800.696.4543 or info@claremontcompanies.com.

Congress Passes Cadillac Tax Delay

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The federal spending and tax-break package that passed Congress on December 18, 2015, delaying the implementation of the ACA “Cadillac tax” for two years, is welcome news to businesses of all sizes that offer generous health care plans to attract and retain top talent.

The Cadillac tax will impose a 40% excise tax on health insurance premiums that exceed a specified dollar limit that would be adjusted annually based on the Consumer Price Index (CPI). With the rapid pace of medical inflation, the tax will outgrow itself quickly and impact many employers not only with the cost of the tax, but the tremendous compliance burden involved in calculating the tax, and the security issues it creates. Mercer has estimated that a third of employers would be subjected to the tax by 2018 when it was originally set to kick in, and that 60% of employers could be hit by 2022.

Under the delay for 2018 and 2019, the tax will now take effect beginning in January 2020. Language in the package also permanently makes the tax a deduction for employers and calls for a study by the comptroller on appropriate age and gender adjustments in consultation with the National Association of Insurance Commissioners (NAIC). Nationally, the California Association of Health Underwriters (CAHU) supports the delay of the Cadillac/excise tax as a short-term measure, but they remain fully committed to a complete repeal of the tax, based on the projected impact on employer-sponsored insurance coverage. Inclusion of these delays can be an important first step to achieve complete repeal, but in the short term, like NAHU, CAHU hopes the delay will bring some relief to the broker community and their clients.

 

Questions?
Contact the small group experts at 800.696.4543 or info@claremontcompanies.com.

 

IRS Extends ACA Reporting Deadline for Employers

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The Affordable Care Act (ACA) requires information reporting under Internal Revenue Code Sections 6055 and 6056. The purpose of Section 6055 reporting is to report, to the IRS and individuals, those covered by Minimum Essential Coverage (MEC) and therefore not liable for the Individual Mandate penalty. The purpose of Section 6056 reporting is to provide the IRS with information to administer the Large Employer Mandate, determine whether an employer owes a penalty, and verify the premium tax credit eligibility of employees.

On December 28, 2015, the IRS issued Notice 2016-4, which extends the due dates for the 2015 information reporting requirements, both furnishing to individuals and filing with the IRS. The due date for furnishing the 2015 Form 1095-B (generally provided by carriers to inform individuals that they had MEC) and the 2015 Form 1095-C (provided by Applicable Large Employers) was extended from January 31, 2016, until March 31, 2016. The due date for filing with the IRS was extended from February 29, 2016, to May 31, 2016, if not filing electronically, and from March 31, 2016, to June 30, 2016, if filing electronically.

To learn more, download Claremont’s essential ‘Play or Pay’ guides.

Questions?
Contact the small group experts at 800.696.4543 or info@claremontcompanies.com.

 

Controlled and Affiliated Service Groups – ALE Determination

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The Large Employer Mandate requires Applicable Large Employers (ALEs) to offer Minimum Essential Coverage (MEC), that is Minimum Value (MV) and affordable, to substantially all of its full time (FT) employees and their dependents (does not include spouses) or otherwise be assessed a penalty. Employers must first determine if it’s an ALE. An ALE is an employer that employed an average of at least 50 FT and full-time equivalent (FTE) employees in the prior calendar year. What many employers may not know is that under the Large Employer Mandate, all employees of all businesses that are part of a controlled group and/or affiliated service group must be treated as employed by a single employer and thus must be calculated together when determining ALE status. This can result in businesses with only a few employees being an ALE if the business is part of a controlled group and/or affiliated service group and the number of FT and FTE employees combined for all businesses that are part of the controlled group and/or affiliated service group equal 50 or more.

A controlled group is a combination of two or more businesses that are under common control or ownership. There are three types of controlled groups – parent-subsidiary, brother-sister, and combined. An affiliated service group is another type of group of related employers. It is comprised of two or more organizations that have a service relationship and, in some cases, an ownership relationship. There are three types of affiliated service groups – two include a First Service Organization (FSO) and either an A-organization or B-organization, and the third is a Management Group.

More information and examples on controlled groups and affiliated service groups can be found in the following IRS publication.

There are many complex rules that go into what makes up a controlled group and affiliated service group. It’s best to seek the advice of legal and/or tax counsel to determine controlled group and/or affiliated service group status. Claremont can assist you with a referral to a legal or tax professional if needed.

To learn more about the Large Employer Mandate, download Claremont’s essential ‘Play or Pay’ guides.

Questions?
Contact the small group experts at 800.696.4543 or ACA@claremontcompanies.com.