Health Care Reform Updates & Human Resource News Alerts

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HR360::Health Care Reform
  • How Summer Hires May Impact ALE Status

    Posted on May 17, 2018
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    Employers May Apply a Reasonable, Good Faith Interpretation of the Term 'Seasonal Worker'

    Employers looking to hire seasonal workers this summer are reminded that there is an exception when measuring workforce size to determine whether they are an applicable large employer (ALE) subject to the Affordable Care Act's employer shared responsibility ("pay or play") provisions.

    What Is 'Pay or Play'?
    The pay or play provisions require ALEs—generally those with at least 50 full-time employees, including full-time equivalent employees (FTEs)—to offer affordable health insurance that provides a minimum level of coverage to full-time employees (and their dependents) or pay a penalty tax if any full-time employee is certified to receive a premium tax credit for purchasing individual coverage on the Health Insurance Marketplace (Exchange).

    Seasonal Worker Exception
    If an employer's workforce exceeds 50 full-time employees (including FTEs) for 120 days or less (or 4 calendar months) during the preceding calendar year, and the employees in excess of 50 who were employed during that period were seasonal workers, the employer is not considered an ALE for the current calendar year. A seasonal worker for this purpose is an employee who performs labor or services on a seasonal basis (e.g., retail workers employed exclusively during holiday seasons are seasonal workers).

    Seasonal Worker Versus Seasonal Employee
    While the terms "seasonal worker" and "seasonal employee" are both used in the pay or play provisions, only the term "seasonal worker" is relevant for determining whether an employer is considered an ALE. For this purpose, employers may apply a reasonable, good faith interpretation of the term "seasonal worker." For more information on the difference between a seasonal worker and a seasonal employee under pay or play, please refer to IRS Pay or Play Q&A #26.

    © 2018 HR 360, Inc.
  • Employers: Don't Forget to Pay PCORI Fees

    Posted on May 11, 2018
    Print

    Affected Employers Must File IRS Form 720

    Employers that sponsor certain self-insured health plans—including some health reimbursement arrangements (HRAs) and health flexible spending arrangements (health FSAs)—are reminded that they are responsible for Patient-Centered Outcomes Research Institute (PCORI) fees. Fees for self-insured plans with plan years that ended in 2017 are due July 31, 2018, and are required to be paid via IRS Form 720, Quarterly Federal Excise Tax Return.

    Employer-sponsored self-insured plans with plan years that ended between January 1, 2017 and September 30, 2017 must pay a fee of $2.26 multiplied by the average number of lives covered under the plan. Employer-sponsored self-insured plans with plan years that ended between October 1, 2017 and December 31, 2017 must pay a fee of $2.39 multiplied by the average number of lives covered under the plan. Details on how to determine the average number of lives covered under a plan are included in these regulations.

    © 2018 HR 360, Inc.
  • How to Correct Form 1094-C and 1095-C Errors

    Posted on April 26, 2018
    Print

    Employers Should Correct Errors As Soon As Possible

    Although the deadlines for employers to file and furnish their 2017 Forms 1094-C & 1095-C have passed, employers should confirm the accuracy of these forms and correct any errors on them soon to avoid noncompliance penalties.

    To correct the paper version of the original Form 1094-C filed with the IRS, employers generally should:

    • Prepare a Form 1094-C including the correct information
    • Enter an "X" in the CORRECTED checkbox at the top of the form
    • File the corrected Form 1094-C with the IRS

    To correct the paper version of a Form 1095-C, employers generally should:

    • Prepare a new Form 1095-C
    • Enter an "X" in the CORRECTED checkbox at the top of the new Form 1095-C
    • File the corrected Form 1095-C, along with a non-authoritative Form 1094-C (DO NOT mark the CORRECTED checkbox on the Form 1094-C), with the IRS
    • Furnish the employee a copy of the corrected Form 1095-C

    For more information on correcting errors, see the 2017 Instructions for Forms 1094-C and 1095-C.

    © 2018 HR 360, Inc.
  • Small Businesses May Be Able to Keep Existing Health Coverage Through 2019

    Posted on April 19, 2018
    Print

    Policies Renewed Under Extended Transitional Policy Must End by December 31, 2019

    A previously extended transitional policy which allows health insurance issuers, at their option, to continue group coverage that would otherwise be terminated or cancelled has been further extended to policy years beginning on or before October 1, 2019, provided that all policies end by December 31, 2019. Health insurance issuers that renew coverage under the extended policy are required to provide standard notices to affected small businesses for each policy year.

    Policies subject to the transitional relief will not be considered to be out of compliance with key Affordable Care Act provisions, including:

    • The requirement to cover a core package of items and services known as essential health benefits;
    • The requirement that any variations in premiums be limited with regard to a particular plan or coverage to age, tobacco use, family size, and geography;
    • The requirements regarding guaranteed availability and renewability of coverage; and
    • The requirements relating to coverage for individuals participating in approved clinical trials.

    Click here to review the extended transitional policy.

    © 2018 HR 360, Inc.
  • 2019 Cost-Sharing Limits for Most Group Health Plans Released

    Posted on April 10, 2018
    Print

    HHS Issues Key Rule for 2019

    A new rule from the U.S. Department of Health and Human Services (HHS) addresses, among other things, the requirement under the Affordable Care Act that non-grandfathered group health plans limit annual out-of-pocket cost-sharing for coverage of essential health benefits under the plan. Under the rule, these out-of-pocket expenses may not exceed $7,900 for self-only coverage or $15,800 for family coverage in 2019.

    © 2018 HR 360, Inc.
  • New Rule Allows Brokers to Further Aid SHOP Enrollment

    Posted on April 10, 2018
    Print

    Rule Effective for Plan Year 2018

    The U.S. Department of Health and Human Services (HHS) has issued a new rule that allows employers to directly enroll in SHOP (Small Business Health Options Program) coverage through a SHOP-registered agent or broker. This enrollment approach is now generally available in federally-facilitated SHOPs (FF-SHOPs), including state-based Exchanges using the federal platform for SHOP, for plan years beginning on or after January 1, 2018. State-based Exchanges operating their own SHOPs can also adopt this new approach.

    For more information, please contact the SHOP that applies in your state.

    © 2018 HR 360, Inc.

    HR News and Alerts

    HR360::Health Care Reform
    • How Summer Hires May Impact ALE Status

      Posted on May 17, 2018
      Print

      Employers May Apply a Reasonable, Good Faith Interpretation of the Term 'Seasonal Worker'

      Employers looking to hire seasonal workers this summer are reminded that there is an exception when measuring workforce size to determine whether they are an applicable large employer (ALE) subject to the Affordable Care Act's employer shared responsibility ("pay or play") provisions.

      What Is 'Pay or Play'?
      The pay or play provisions require ALEs—generally those with at least 50 full-time employees, including full-time equivalent employees (FTEs)—to offer affordable health insurance that provides a minimum level of coverage to full-time employees (and their dependents) or pay a penalty tax if any full-time employee is certified to receive a premium tax credit for purchasing individual coverage on the Health Insurance Marketplace (Exchange).

      Seasonal Worker Exception
      If an employer's workforce exceeds 50 full-time employees (including FTEs) for 120 days or less (or 4 calendar months) during the preceding calendar year, and the employees in excess of 50 who were employed during that period were seasonal workers, the employer is not considered an ALE for the current calendar year. A seasonal worker for this purpose is an employee who performs labor or services on a seasonal basis (e.g., retail workers employed exclusively during holiday seasons are seasonal workers).

      Seasonal Worker Versus Seasonal Employee
      While the terms "seasonal worker" and "seasonal employee" are both used in the pay or play provisions, only the term "seasonal worker" is relevant for determining whether an employer is considered an ALE. For this purpose, employers may apply a reasonable, good faith interpretation of the term "seasonal worker." For more information on the difference between a seasonal worker and a seasonal employee under pay or play, please refer to IRS Pay or Play Q&A #26.

      © 2018 HR 360, Inc.
    • Employers: Don't Forget to Pay PCORI Fees

      Posted on May 11, 2018
      Print

      Affected Employers Must File IRS Form 720

      Employers that sponsor certain self-insured health plans—including some health reimbursement arrangements (HRAs) and health flexible spending arrangements (health FSAs)—are reminded that they are responsible for Patient-Centered Outcomes Research Institute (PCORI) fees. Fees for self-insured plans with plan years that ended in 2017 are due July 31, 2018, and are required to be paid via IRS Form 720, Quarterly Federal Excise Tax Return.

      Employer-sponsored self-insured plans with plan years that ended between January 1, 2017 and September 30, 2017 must pay a fee of $2.26 multiplied by the average number of lives covered under the plan. Employer-sponsored self-insured plans with plan years that ended between October 1, 2017 and December 31, 2017 must pay a fee of $2.39 multiplied by the average number of lives covered under the plan. Details on how to determine the average number of lives covered under a plan are included in these regulations.

      © 2018 HR 360, Inc.
    • How to Correct Form 1094-C and 1095-C Errors

      Posted on April 26, 2018
      Print

      Employers Should Correct Errors As Soon As Possible

      Although the deadlines for employers to file and furnish their 2017 Forms 1094-C & 1095-C have passed, employers should confirm the accuracy of these forms and correct any errors on them soon to avoid noncompliance penalties.

      To correct the paper version of the original Form 1094-C filed with the IRS, employers generally should:

      • Prepare a Form 1094-C including the correct information
      • Enter an "X" in the CORRECTED checkbox at the top of the form
      • File the corrected Form 1094-C with the IRS

      To correct the paper version of a Form 1095-C, employers generally should:

      • Prepare a new Form 1095-C
      • Enter an "X" in the CORRECTED checkbox at the top of the new Form 1095-C
      • File the corrected Form 1095-C, along with a non-authoritative Form 1094-C (DO NOT mark the CORRECTED checkbox on the Form 1094-C), with the IRS
      • Furnish the employee a copy of the corrected Form 1095-C

      For more information on correcting errors, see the 2017 Instructions for Forms 1094-C and 1095-C.

      © 2018 HR 360, Inc.
    • Small Businesses May Be Able to Keep Existing Health Coverage Through 2019

      Posted on April 19, 2018
      Print

      Policies Renewed Under Extended Transitional Policy Must End by December 31, 2019

      A previously extended transitional policy which allows health insurance issuers, at their option, to continue group coverage that would otherwise be terminated or cancelled has been further extended to policy years beginning on or before October 1, 2019, provided that all policies end by December 31, 2019. Health insurance issuers that renew coverage under the extended policy are required to provide standard notices to affected small businesses for each policy year.

      Policies subject to the transitional relief will not be considered to be out of compliance with key Affordable Care Act provisions, including:

      • The requirement to cover a core package of items and services known as essential health benefits;
      • The requirement that any variations in premiums be limited with regard to a particular plan or coverage to age, tobacco use, family size, and geography;
      • The requirements regarding guaranteed availability and renewability of coverage; and
      • The requirements relating to coverage for individuals participating in approved clinical trials.

      Click here to review the extended transitional policy.

      © 2018 HR 360, Inc.
    • 2019 Cost-Sharing Limits for Most Group Health Plans Released

      Posted on April 10, 2018
      Print

      HHS Issues Key Rule for 2019

      A new rule from the U.S. Department of Health and Human Services (HHS) addresses, among other things, the requirement under the Affordable Care Act that non-grandfathered group health plans limit annual out-of-pocket cost-sharing for coverage of essential health benefits under the plan. Under the rule, these out-of-pocket expenses may not exceed $7,900 for self-only coverage or $15,800 for family coverage in 2019.

      © 2018 HR 360, Inc.
    • New Rule Allows Brokers to Further Aid SHOP Enrollment

      Posted on April 10, 2018
      Print

      Rule Effective for Plan Year 2018

      The U.S. Department of Health and Human Services (HHS) has issued a new rule that allows employers to directly enroll in SHOP (Small Business Health Options Program) coverage through a SHOP-registered agent or broker. This enrollment approach is now generally available in federally-facilitated SHOPs (FF-SHOPs), including state-based Exchanges using the federal platform for SHOP, for plan years beginning on or after January 1, 2018. State-based Exchanges operating their own SHOPs can also adopt this new approach.

      For more information, please contact the SHOP that applies in your state.

      © 2018 HR 360, Inc.