Health Care Reform Updates & Human Resource News Alerts

Health Care Reform News

HR360::Health Care Reform
  • IRS Releases 2017 Version of Publication 5223 Regarding Substitute ACA Information Reporting Forms

    Posted on November 21, 2017
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    Publication Outlines Requirements for Substitute Forms 1094-B, 1095-B, 1094-C and 1095-C

    The tax year 2017 version of IRS Publication 5223 is now available, which sets forth the general rules and specifications for preparing substitute Forms 1094-B, 1095-B, 1094-C, and 1095-C. Paper forms that conform to the specifications listed in the publication may be privately printed and filed as returns with the IRS.

    In particular, Publication 5223 addresses the 2017 requirements for:

    • Using official IRS forms to file Affordable Care Act (ACA) information returns with the IRS;
    • Preparing acceptable substitutes of the official IRS forms to file ACA information returns with the IRS; and
    • Using official or acceptable substitute forms to furnish information to recipients.

    You may review IRS Publication 5223 in its entirety for additional details on the rules and specifications for preparing substitute Forms 1094-B, 1095-B, 1094-C, and 1095-C.

    © 2017 HR 360, Inc.
  • Reminder: Second Transitional Reinsurance Program Payment Due Nov. 15

    Posted on November 13, 2017
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    Final Payment Due for Contributing Entities That Opted for Two-Part Contribution

    The second transitional reinsurance contribution payment for the 2016 benefit year is due November 15, 2017 for issuers and certain self-insured group health plans (referred to as "contributing entities") that did not previously pay the entire 2016 benefit year contribution in one payment. The contributions are part of the three-year Transitional Reinsurance Program established by the Affordable Care Act, which began in 2014 and ended with the 2016 benefit year.

    Contribution Process
    The Transitional Reinsurance Program required contributing entities to make contributions to support payments to individual market issuers that cover high-cost individuals. For the 2016 benefit year, contributing entities were given the option to either:

    1. Pay the entire 2016 benefit year contribution in one payment (no later than January 17, 2017 reflecting $27.00 per covered life); or
    2. Make two separate payments, with the first remittance due by January 17, 2017 reflecting $21.60 per covered life, and the second remittance due by November 15, 2017 reflecting $5.40 per covered life.

    Click here for more on the Transitional Reinsurance Program.

    © 2017 HR 360, Inc.
  • HHS Proposes Allowing Brokers to Further Aid 2018 SHOP Enrollment

    Posted on November 09, 2017
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    SHOPs Can Begin Relying on the Proposed Rule

    The U.S. Department of Health and Human Services (HHS) has issued a proposed rule to provide states with greater flexibility in the operation and establishment of the Small Business Health Options Program (SHOP) Exchange. Among other items, the rule proposes allowing employers to directly enroll in SHOP coverage through a SHOP-registered agent or broker. If finalized, this enrollment approach would generally be 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 could also adopt the new approach.

    While HHS considers comments on its proposed rule, the agency is permitting FF-SHOPs (including state-based SHOPs using the federal platform), SHOP-registered brokers, and employers to begin operating in accordance with the proposed rule, starting on the first date on which employers can complete a group enrollment for a plan year that would take effect in 2018 (e.g., for plans with effective dates on or after January 1, 2018). State-based Exchanges operating their own SHOPs have this same flexibility.

    Click here for more information on the HHS proposal.

    © 2017 HR 360, Inc.
  • IRS to Begin Mailing 'Pay or Play' Penalty Letters

    Posted on November 07, 2017
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    Employers Will Have Opportunity to Respond Before Penalty Assessment

    The Internal Revenue Service (IRS) has announced that it will begin mailing employers letters informing them of their potential liability for a "pay or play" penalty for the 2015 calendar year in late 2017. However, before any penalty is assessed and notice and demand for payment is made, employers will have an opportunity to respond to the agency.

    What Will the Letter Contain?
    The IRS plans to issue Letter 226J to applicable large employers (ALE)—generally those with at least 50 full-time employees, including full-time equivalent employees, on average during the prior year—if it determines that, for at least one month in the year, one or more of the ALE's full-time employees was enrolled in a qualified health plan for which a premium tax credit was allowed (and the ALE did not qualify for an affordability safe harbor or other relief for the employee). Letter 226J will include, among other things:

    • A penalty payment summary table, itemizing the proposed payment by month;
    • An "employee premium tax credit list" which lists, by month, the ALE's employees who for at least one month in the year were full-time employees allowed a premium tax credit and for whom the ALE did not qualify for an affordability safe harbor or other relief;
    • A description of the actions the ALE should take if it agrees or disagrees with the proposed penalty payment; and
    • Form 14764, a response form.

    The response to Letter 226J will be due by the response date shown on the letter, which generally will be 30 days from the date of Letter 226J. Letter 226J will also contain the name and contact information of a specific IRS employee that the ALE should contact if the ALE has questions about the letter.

    How Does an ALE Make a Pay or Play Penalty Payment?
    If, after correspondence between the ALE and the IRS, the IRS determines that an ALE is liable for a penalty payment, the IRS will assess the payment and issue a notice and demand for payment, Notice CP 220J. That notice will instruct the ALE on how to make a payment, if any. Notably, ALEs will not be required to include the payment on any tax return that they file or to make a payment before notice and demand for payment.

    Click here for more information from the IRS.

    © 2017 HR 360, Inc.
  • Eight States Extend 2018 Open Enrollment Deadlines

    Posted on November 03, 2017
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    Federal Open Enrollment Deadline Remains December 15

    Open enrollment for 2018 coverage in both the federal and state Health Insurance Marketplaces began on November 1 for individuals and families. However, the following state-based Marketplaces have open enrollment periods that extend past the federal Marketplace's December 15 deadline for enrollment:

    • California: Covered California's open enrollment period ends December 15, 2017 for coverage starting January 1, 2018. Individuals have until January 15, 2018 to enroll in coverage starting February 1, 2018, and January 31, 2018 for coverage starting March 1, 2018.
    • Colorado: Connect for Health Colorado's open enrollment period ends December 15, 2017 for coverage starting January 1, 2018. Individuals have until January 12, 2018 to enroll in coverage starting February 1, 2018.
    • Connecticut: Access Health CT's open enrollment period ends December 22, 2017 for coverage starting January 1, 2018.
    • District of Columbia: DC Health Link's open enrollment period ends December 15, 2017 for coverage starting January 1, 2018. Individuals have until January 15, 2018 to enroll in coverage starting February 1, 2018, and January 31, 2018 for coverage starting March 1, 2018.
    • Massachusetts: Massachusetts Health Connector's open enrollment period ends December 23, 2017 for coverage starting January 1, 2018. Individuals have until January 23, 2018 to enroll in coverage starting February 1, 2018.
    • Minnesota: MNsure's open enrollment period ends December 20, 2017 for coverage starting January 1, 2018. Individuals have until January 14, 2018 to enroll in coverage starting February 1, 2018.
    • Rhode Island: HealthSource RI's open enrollment period ends December 23, 2017 for coverage starting January 1, 2018.
    • Washington: Washington Health Plan Finder's open enrollment period ends December 15, 2017 for coverage starting January 1, 2018. Individuals have until January 15, 2018 to enroll in coverage starting February 1, 2018.

    Note: Some states may still be able to extend their 2018 open enrollment deadlines. Individuals are advised to consult their state's Marketplace for the latest updates.

    © 2017 HR 360, Inc.
  • IRS Releases New Guidance on QSEHRAs

    Posted on November 02, 2017
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    Notice & Other Requirements Clarified

    The Internal Revenue Service (IRS) has released guidance further clarifying the rules regulating qualified small employer health reimbursement arrangements (QSEHRAs). QSEHRAs—which are health reimbursement arrangements exempt from the Affordable Care Act's market reforms—may be offered by employers with fewer than 50 full-time equivalent employees that do not offer a group health plan to any of its employees to reimburse employees for medical expenses, including individual health insurance policy premiums. Highlights of the guidance are described below. 

    Guidance Highlights

    • Written Notice Deadline: An employer that provides a QSEHRA during 2017 or 2018 must generally furnish its initial written notice to its eligible employees by the later of (a) February 19, 2018, or (b) 90 days before the first day of the plan year of the QSEHRA. Q&A #38 of the guidance explains what information must be included in the notice.
    • "Same Terms" Requirement: Employers are required to provide the QSEHRA on the same terms to all eligible employees. However, the guidance states that QSEHRA payments or reimbursements may vary based on the age of covered individuals or the number of individuals covered in accordance with the variation in the price of an insurance policy in a relevant individual health insurance market.
    • Form W-2 & PCORI Requirements: An employee's permitted benefit under a QSEHRA must be reported in box 12 of his or her Form W-2 using code FF. In addition, QSEHRA sponsors are subject to the Patient-Centered Outcome Research Institute (PCORI) fee, which generally requires them to file Form 720, Quarterly Federal Excise Tax Return, annually by July 31 of the year following the last day of the plan year.

    The IRS guidance contains many helpful FAQs. Click here to read the guidance in its entirety.

    © 2017 HR 360, Inc.

    HR News and Alerts

    HR360::Health Care Reform
    • IRS Releases 2017 Version of Publication 5223 Regarding Substitute ACA Information Reporting Forms

      Posted on November 21, 2017
      Print

      Publication Outlines Requirements for Substitute Forms 1094-B, 1095-B, 1094-C and 1095-C

      The tax year 2017 version of IRS Publication 5223 is now available, which sets forth the general rules and specifications for preparing substitute Forms 1094-B, 1095-B, 1094-C, and 1095-C. Paper forms that conform to the specifications listed in the publication may be privately printed and filed as returns with the IRS.

      In particular, Publication 5223 addresses the 2017 requirements for:

      • Using official IRS forms to file Affordable Care Act (ACA) information returns with the IRS;
      • Preparing acceptable substitutes of the official IRS forms to file ACA information returns with the IRS; and
      • Using official or acceptable substitute forms to furnish information to recipients.

      You may review IRS Publication 5223 in its entirety for additional details on the rules and specifications for preparing substitute Forms 1094-B, 1095-B, 1094-C, and 1095-C.

      © 2017 HR 360, Inc.
    • Reminder: Second Transitional Reinsurance Program Payment Due Nov. 15

      Posted on November 13, 2017
      Print

      Final Payment Due for Contributing Entities That Opted for Two-Part Contribution

      The second transitional reinsurance contribution payment for the 2016 benefit year is due November 15, 2017 for issuers and certain self-insured group health plans (referred to as "contributing entities") that did not previously pay the entire 2016 benefit year contribution in one payment. The contributions are part of the three-year Transitional Reinsurance Program established by the Affordable Care Act, which began in 2014 and ended with the 2016 benefit year.

      Contribution Process
      The Transitional Reinsurance Program required contributing entities to make contributions to support payments to individual market issuers that cover high-cost individuals. For the 2016 benefit year, contributing entities were given the option to either:

      1. Pay the entire 2016 benefit year contribution in one payment (no later than January 17, 2017 reflecting $27.00 per covered life); or
      2. Make two separate payments, with the first remittance due by January 17, 2017 reflecting $21.60 per covered life, and the second remittance due by November 15, 2017 reflecting $5.40 per covered life.

      Click here for more on the Transitional Reinsurance Program.

      © 2017 HR 360, Inc.
    • HHS Proposes Allowing Brokers to Further Aid 2018 SHOP Enrollment

      Posted on November 09, 2017
      Print

      SHOPs Can Begin Relying on the Proposed Rule

      The U.S. Department of Health and Human Services (HHS) has issued a proposed rule to provide states with greater flexibility in the operation and establishment of the Small Business Health Options Program (SHOP) Exchange. Among other items, the rule proposes allowing employers to directly enroll in SHOP coverage through a SHOP-registered agent or broker. If finalized, this enrollment approach would generally be 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 could also adopt the new approach.

      While HHS considers comments on its proposed rule, the agency is permitting FF-SHOPs (including state-based SHOPs using the federal platform), SHOP-registered brokers, and employers to begin operating in accordance with the proposed rule, starting on the first date on which employers can complete a group enrollment for a plan year that would take effect in 2018 (e.g., for plans with effective dates on or after January 1, 2018). State-based Exchanges operating their own SHOPs have this same flexibility.

      Click here for more information on the HHS proposal.

      © 2017 HR 360, Inc.
    • IRS to Begin Mailing 'Pay or Play' Penalty Letters

      Posted on November 07, 2017
      Print

      Employers Will Have Opportunity to Respond Before Penalty Assessment

      The Internal Revenue Service (IRS) has announced that it will begin mailing employers letters informing them of their potential liability for a "pay or play" penalty for the 2015 calendar year in late 2017. However, before any penalty is assessed and notice and demand for payment is made, employers will have an opportunity to respond to the agency.

      What Will the Letter Contain?
      The IRS plans to issue Letter 226J to applicable large employers (ALE)—generally those with at least 50 full-time employees, including full-time equivalent employees, on average during the prior year—if it determines that, for at least one month in the year, one or more of the ALE's full-time employees was enrolled in a qualified health plan for which a premium tax credit was allowed (and the ALE did not qualify for an affordability safe harbor or other relief for the employee). Letter 226J will include, among other things:

      • A penalty payment summary table, itemizing the proposed payment by month;
      • An "employee premium tax credit list" which lists, by month, the ALE's employees who for at least one month in the year were full-time employees allowed a premium tax credit and for whom the ALE did not qualify for an affordability safe harbor or other relief;
      • A description of the actions the ALE should take if it agrees or disagrees with the proposed penalty payment; and
      • Form 14764, a response form.

      The response to Letter 226J will be due by the response date shown on the letter, which generally will be 30 days from the date of Letter 226J. Letter 226J will also contain the name and contact information of a specific IRS employee that the ALE should contact if the ALE has questions about the letter.

      How Does an ALE Make a Pay or Play Penalty Payment?
      If, after correspondence between the ALE and the IRS, the IRS determines that an ALE is liable for a penalty payment, the IRS will assess the payment and issue a notice and demand for payment, Notice CP 220J. That notice will instruct the ALE on how to make a payment, if any. Notably, ALEs will not be required to include the payment on any tax return that they file or to make a payment before notice and demand for payment.

      Click here for more information from the IRS.

      © 2017 HR 360, Inc.
    • Eight States Extend 2018 Open Enrollment Deadlines

      Posted on November 03, 2017
      Print

      Federal Open Enrollment Deadline Remains December 15

      Open enrollment for 2018 coverage in both the federal and state Health Insurance Marketplaces began on November 1 for individuals and families. However, the following state-based Marketplaces have open enrollment periods that extend past the federal Marketplace's December 15 deadline for enrollment:

      • California: Covered California's open enrollment period ends December 15, 2017 for coverage starting January 1, 2018. Individuals have until January 15, 2018 to enroll in coverage starting February 1, 2018, and January 31, 2018 for coverage starting March 1, 2018.
      • Colorado: Connect for Health Colorado's open enrollment period ends December 15, 2017 for coverage starting January 1, 2018. Individuals have until January 12, 2018 to enroll in coverage starting February 1, 2018.
      • Connecticut: Access Health CT's open enrollment period ends December 22, 2017 for coverage starting January 1, 2018.
      • District of Columbia: DC Health Link's open enrollment period ends December 15, 2017 for coverage starting January 1, 2018. Individuals have until January 15, 2018 to enroll in coverage starting February 1, 2018, and January 31, 2018 for coverage starting March 1, 2018.
      • Massachusetts: Massachusetts Health Connector's open enrollment period ends December 23, 2017 for coverage starting January 1, 2018. Individuals have until January 23, 2018 to enroll in coverage starting February 1, 2018.
      • Minnesota: MNsure's open enrollment period ends December 20, 2017 for coverage starting January 1, 2018. Individuals have until January 14, 2018 to enroll in coverage starting February 1, 2018.
      • Rhode Island: HealthSource RI's open enrollment period ends December 23, 2017 for coverage starting January 1, 2018.
      • Washington: Washington Health Plan Finder's open enrollment period ends December 15, 2017 for coverage starting January 1, 2018. Individuals have until January 15, 2018 to enroll in coverage starting February 1, 2018.

      Note: Some states may still be able to extend their 2018 open enrollment deadlines. Individuals are advised to consult their state's Marketplace for the latest updates.

      © 2017 HR 360, Inc.
    • IRS Releases New Guidance on QSEHRAs

      Posted on November 02, 2017
      Print

      Notice & Other Requirements Clarified

      The Internal Revenue Service (IRS) has released guidance further clarifying the rules regulating qualified small employer health reimbursement arrangements (QSEHRAs). QSEHRAs—which are health reimbursement arrangements exempt from the Affordable Care Act's market reforms—may be offered by employers with fewer than 50 full-time equivalent employees that do not offer a group health plan to any of its employees to reimburse employees for medical expenses, including individual health insurance policy premiums. Highlights of the guidance are described below. 

      Guidance Highlights

      • Written Notice Deadline: An employer that provides a QSEHRA during 2017 or 2018 must generally furnish its initial written notice to its eligible employees by the later of (a) February 19, 2018, or (b) 90 days before the first day of the plan year of the QSEHRA. Q&A #38 of the guidance explains what information must be included in the notice.
      • "Same Terms" Requirement: Employers are required to provide the QSEHRA on the same terms to all eligible employees. However, the guidance states that QSEHRA payments or reimbursements may vary based on the age of covered individuals or the number of individuals covered in accordance with the variation in the price of an insurance policy in a relevant individual health insurance market.
      • Form W-2 & PCORI Requirements: An employee's permitted benefit under a QSEHRA must be reported in box 12 of his or her Form W-2 using code FF. In addition, QSEHRA sponsors are subject to the Patient-Centered Outcome Research Institute (PCORI) fee, which generally requires them to file Form 720, Quarterly Federal Excise Tax Return, annually by July 31 of the year following the last day of the plan year.

      The IRS guidance contains many helpful FAQs. Click here to read the guidance in its entirety.

      © 2017 HR 360, Inc.