Healthcare

Monday, 02 May 2016

Self-insurance remains a popular post-ACA option

Written by Thomson Reuters

The practice of self-insuring for health benefits claims has been on a steady upward climb over the past two decades. The Affordable Care Act (ACA) was predicted to trigger a spike in self-insurance — particularly among smaller employers. But, at least so far, the reality is different. The basis of the prediction was an anticipated upward cost pressure on fully insured plans attributable to, among other factors, new ACA-imposed taxes on insurance companies...

Published in Healthcare
Tuesday, 29 March 2016

Studies show achieving ACA goals demands trial, error and patience

Written by Thomson Reuters

No one really expected the Affordable Care Act (ACA) to be the silver bullet that would stop health care cost inflation dead in its tracks. Yet, perhaps understandably, many employers remain frustrated by the substantial challenge of managing these expenses. A pair of new studies, however, yield some practical insights into the fine-tuning and persistence needed to control costs and keep employees as healthy as possible. AMA analysis The first study is entitled “Cost-Sharing Obligations, High-Deductible Health Plan Growth, and Shopping for Health Care: Enrollees With Skin in the Game...

Published in Healthcare
Tuesday, 29 March 2016

Mind your Form M-1, whether you’re a MEWA or not

Written by Thomson Reuters

Form M-1 is used to report compliance with group health plan mandates under Part 7 of the Employee Retirement Income Security Act, as well as under provisions of the Affordable Care Act (ACA). The form must be filed by multiple employer welfare arrangements (MEWAs) providing medical benefits other than exclusively excepted benefits — regardless of whether the MEWA is a group health plan. In addition, many entities claiming not to be MEWAs because of the exception for collectively bargained plans are still required to file Form M-1 for the first three years after the entity last “originated” or in certain other special circumstances. Annual Form M-1 filings are due March 1 of the year following the calendar year being reported...

Published in Healthcare
Tuesday, 29 March 2016

How are seasonal workers treated under the “play or pay” provision?

Written by Thomson Reuters

Question: Our company has a regular full-time workforce of approximately 40 employees. This year, we’re planning to hire about 80 more full-time retail employees in November and December for the holiday shopping season. How do we determine whether doing so will subject us to the Affordable Care Act’s (ACA’s) employer shared responsibility rules? Answer: To determine whether your company is subject to the ACA’s employer shared responsibility rules — commonly referred to as the “play or pay” provision — you must count all of your employees...

Published in Healthcare
Tuesday, 01 March 2016

Can we match our employees’ pretax HSA contributions?

Written by Thomson Reuters

Question: Under our company’s cafeteria plan, qualifying participants can make pretax salary reduction contributions to their Health Savings Accounts (HSAs). Can our company make matching contributions based on a percentage of participants’ pretax HSA contributions? Answer: Probably. Some employers’ HSA contributions are subject to strict comparability requirements that effectively prohibit matching contributions because the contributions would trigger a 35% excise tax on the employer...

Published in Healthcare
Tuesday, 01 March 2016

IRS extends due dates for 2015 Forms 1094 and 1095

Written by Thomson Reuters

At the end of last year, the IRS extended the deadlines for the Affordable Care Act’s information reporting on Forms 1094 and 1095 for 2015. Specifically, Forms 1094-B and 1095-B are to be filed by providers of health coverage (mostly insurers, but also some self-insuring employers and others). Meanwhile, Forms 1094-C and 1095-C are to be filed by applicable large employers. The forms provide information to the IRS and individuals for administration of the individual mandate, employer shared responsibility and premium tax credits...

Published in Healthcare
Tuesday, 01 March 2016

Diplomatic relations: Reconsidering spousal coverage

Written by Thomson Reuters

The Affordable Care Act (ACA) doesn’t require spousal coverage — only coverage for dependent children. For this reason, as employers continue to grapple with high plan costs, many are reconsidering whether and how to offer health care insurance to their employees’ spouses. The dollar savings are there for the taking. But many employees would likely frown on seeing spousal coverage suddenly become expensive or vanish entirely...

Published in Healthcare
Monday, 01 February 2016

Can we incentivize employees with high claims costs to opt out?

Written by Thomson Reuters

Question: Our company offers coverage under a self-insured major medical plan to full-time employees. Can we offer cash incentives to those with a history of high claims costs to opt out of our plan and buy individual policies instead? Answer: In a word, no. This idea was addressed in guidance jointly issued just last year by the IRS, the Department of Labor and the Department of Health and Human Services...

Published in Healthcare
Monday, 01 February 2016

IRS Notice 2015-87 addresses many aspects of the ACA

Written by Thomson Reuters

The IRS issued Notice 2015-87 late last year to provide guidance on how various provisions of the Affordable Care Act (ACA) apply to employer-sponsored health plans. The guidance, which includes 26 questions and answers, is generally applicable to plan years beginning on or after December 16, 2015, though it can be relied on for earlier periods. Let’s look at some highlights. Employer contributions When required employee contributions to buy employer-sponsored coverage aren’t “affordable,” as defined under the ACA, employees are potentially eligible for premium tax credits and applicable large employers (ALEs) may face liability under the “play or pay” provision...

Published in Healthcare
Monday, 01 February 2016

Tap the brakes: Cadillac tax delayed, but challenges remain

Written by Thomson Reuters

As 2015 was winding down, Congress pushed back the effective date of the “Cadillac tax” two years. The much-debated provision of the Affordable Care Act (ACA) will now take effect on January 1, 2020, instead of January 1, 2018. As originally conceived, the Cadillac tax was supposed to affect only particularly generous, or “luxury,” health care plans. But many analysts believe it will, either immediately or eventually, impact quite a few “nonluxury” plans as well...

Published in Healthcare
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