Peel & Holland University

Reference Material

Reference Guides & Resources

We have compiled the following documents to keep you up to speed on all things health care reform. You can scroll through the entire page of documents or click on one of the headings below to access them. All documents are provided in PDF format.

General Health Care Reform Information

Compliance Information Updates


General Health Care Reform Information

Safe Harbor for Determining Full-Time Employee Status

New guidance has been issued on two requirements under the Affordable Care Act that become effective in 2014. This document specifically covers the safe harbor approach employers may use to determine whether an employee is full-time for the ACA's "pay-or-play" mandate.

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On the Radar...Benefits Planning & Health Reform in 2014

This document is intended to offer general guidance and strategy in preparation for 2014.


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Implications on Workplace Wellness Programs

The Affordable Care Act included several reforms directed at promoting and improving the effectiveness of workplace wellness programs. Updates include increased incentives to employees and a grant program for eligible small businesses that implement workplace wellness programs.

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Compliance Information

ACA Compliance Reporting Guideline 2016


This guide reviews the 2016 forms and instructions and notes relevant changes from 2015. It also addresses IRS guidance on the solicitation of social security numbers (“SSNs”) or taxpayer identification numbers (“TINs”) and the treatment of cash “opt-out” payments for reporting purposes.
The reporting requirements are complex, due in part to how the health care reform law was drafted. Our goal with this guide is to provide some clarity and best practices for employers.




Final Instructions for IRS Reporting on Individual and Employer Mandates

On February 9, 2015, the Internal Revenue Service (IRS) released final forms and instructions for reporting on individual and employer mandates. The instructions and forms will be used by applicable large employers, insurers and employers with self-insured plans.


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Responding to the Anthem Cyber Attack

Anthem Inc. (Anthem), the nation's second largest health insurer, revealed late on Wednesday, February 4 that it was the victim of a signifcant cyber-attack. According to Anthem, the attack exposed personal information of approximately 80 million individuals, including those insured by related Anthem companies. Anthem has reported that the exposed information includes member names, member health ID and Social Security numbers, dates of birth, addresses, telephone numbers, email addresses and employment information. The investigation of the massive data breach is ongoing, and media outlets have reported that class action suits have already been filed against Anthem in California and Alabama, claiming that lax Anthem security measures contributed to this incident.


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Small Employer Premium Only Plan Limited Relief

The IRS today released Notice 2015-17. In the Notice the IRS provides limited penalty relief to small employers (under 50 full-time employees) who are using certain premium reimbursement plans that the IRS had previously indicated violate the Affordable Care Act. The Notice does not change the IRS' position with respect to Premium Only Plans. However, it does grant a grace period for 2014 and part of 2015 for small employers that use cerain types of premium reimbursement arrangements to pay for individual coverage on the exchange, among other things. The relief from filing a form to report themselves and from paying the penalty ends June 30, 2015.  


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IRS Releases Final ACA Reporting Forms for Employers and Health Insurance Issuers

On Monday, February 9, 2015, the Internal Revenue Service (IRS) released final forms that applicable large employers and health insurance issuers will use to report information regarding employees' full-time status and health coverage, as required under the Affordable Care Act (ACA) starting in 2015. The first reporting will be due in the first quarter of 2016, reflecting the 2015 calendar year.  


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IRS Releases First Guidance on Cadillac Tax

The Internal Revenue Service released the first piece of guidance today on the Affordable Care Act's excise tax on high-cost health plans (a/k/a the "Cadillac Tax"), which is set to take effect in 2018.  


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IRS Releases Prior Guidance on Premium Reimbursement Arrangements; Provides Limited Relief

Continuing its focus on so-called "premium reimbursement" or "employer payment plans", the Internal Revenue Service (IRS) released IRS Notice 2015-17 on February 18, 2015. In this Notice, which was previewed and approved by both the Department of Labor (DOL) and Department of Health and Human Services (collectively with the IRS, the "Agencies") clarifies the Agencies' perspective on the limits of certain employer payment plans and offers som limited relief for small employers.


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Round Three: Oral Arguments in King vs. Burwell

On March 4 the Supreme Court was once again the venue for the third (but probably not the last) round in the ongoing boxing match that is the Affordable Care Act ("ACA").


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New HHS Regulations "Clarify" That Health Plans Covering Families Must Have "Embedded" Individual Cost-Sharing Limits

On February 27, 2015, the Department of Health and Human Services (HHS) released its final HHS Notice of Benefit and Payment Parameters for 2016. The lengthy regulation covers a wide range of topics affecting group health plans, including minimum value, determination of the transitional reinsurance fee, and qualified health plan rates and other market reforms applicable to the group and individual insurance markets.


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IRS Releases Final Forms and Instructions for Affordable Care Act Reporting

In February 2015, the IRS released final forms and instructions related to information reporting under the Afforable Car Act (the "ACA"). These forms include Form 1095-B, Health Coverage, Form 1094-B, Transmittal of Health Coverage Information Returns, Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, and Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage.


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DOL Issues Final Rule Redefining "Spouse" Under FMLA

The Department of Labor (DOL) has issued its Final Rule revising the definition of "spouse" under the Family and Medical Leave Act.


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EEOC Releases Proposed Rule on Employee Wellness Plans
On April 16, 2015, the Equal Employment Opportunity Commission (EEOC) released a long awaited proposed rule on employee wellness programs. The rule is designed to help companies structure such programs to meet their obligations under the Americans with Disabilities Act (ADA).



Departments Clarify Out-of-Pocket Limit Rules for 2016
On May 26, 2015, the Departments of Health and Human Services, Labor, and Treasury, jointly released the twenty-seventh set of FAQs on Affordable Care Act implementation issues. The FAQs clarify the application of the ACA's out-of-pocket limit rules for plan years beginning in 2016.



ERISA Electronic Delivery- A Friendly Reminder


Many employers are devoting most (if not all) of their compliance time focused on the requirements of the Affordable Care Act (ACA). Employers and other plan sponsors should, of course, work diligently to ensure that they are meeting (or getting ready to meet) the complex ACA requirements, but they should be ever diligent and mindful of all of the rules generally applicable under the Employee Retirement Income Security Act of 1974 (ERISA).


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Agencies Issue Final SBC Rules


On June 16 the Internal Revenue Service, the U.S. Department of Labor, and Health and Human Services (the "Agencies") will release final regulations ("Regulations") for the Affordable Care Act's ("ACA's") Summary of Benefits and Coverage ("SBC") requirements. HHS also released a "Fact Sheet" to accompany the release of the Regulations. The Regulations largely follow and consolidate prior SBC guidance and break very little new ground.



PCORI Fees Due July 31, 2015


Employers that sponsor self-insured group health plans, including health reimbursement arrangements (HRAs) should keep in mind the upcoming July 31, 2015 deadline for paying fees that fund the Patient-Centered Outcomes Research Institute ("PCORI"). As background, PCORI was established as part of health care reform to conduct research to evaluate the effectiveness of medical treatments, procedures, and strategies that treat, manage, diagnose, and prevent illness or injury. 




U.S. Supreme Court Finds a Constitutional Right to Same-Sex Marriage


In a 5-4 holding released Friday, June 26, the United States Supreme Court found in Obergefell vs. Hodges that state prohibitions on same-sex marriage violate the Equal Protection and Due Process clauses of the Fourteenth Amendment to the U.S. Constitution. In short, this means that every state must allow same-sex couples to marry and must recognize same-sex marriages performed in other states. The decision invalidates any existing state band on same-sex marriage. 


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New Trade Act Quietly INcreases ACA Reporting Penalties


The Monday before the fourth of July, President Obama signed into law the Trade Preferences Extension Act of 2015, which contained several tax provisions in addition to the trade measuers that were the focus of the bill. Among the tax provisions were changes that increase the penalties associated with failure to file or furnish correct "information returns and payee statements," which include standard information returns, such as Forms W-2 and 1099, as well as new reporting forms required by the Affordable Care Act (ACA). 


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Reporting Requirements: Increased Penalties & New Electronic Filing Steps


The Trade Preferences Extension Act of 2015 ("Act"), signed into law by President Obama on June 29, 2015 significantly increases potential penalties for insurers and employers that fail to comply with the new Affordable Care Act (ACA) Minimum Essential Coverage (MEC) and Large Employer reporting requirements first due in 2016. 


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IRS Releases Draft 2015 Instructions for ACA Reporting Forms


The IRS has released draft 2015 instructions for the B-Series and C-Series reporting forms (1094-B, 1095-B, 1094-C and 1095-C) that will be used by employers and coverage providers to report certain information to full-time employees and the Internal Revenue Service(IRS).


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Tax Bill Proposes Cadillac Tax Delay
On Tuesday, December 15, 2015, the U.S. House of Representatives released a tax bill called the Protecting Americans From Tax Hikes Act of 2015, which, if passed into law, will place a two-year moratorium on the Affordable Care Act’s (ACA) medical device tax and the excise tax on high cost employer-sponsored health coverage (the “Cadillac tax”), and a one-year moratorium on the ACA’s annual fee on health insurers.

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IRS Provides Guidance on HRAs, FSAs, Pay-or-Play and Other Issues
On December 16, 2015, the IRS released Notice 2015-87, which contains guidance on a broad range of topics under the Affordable Care Act (“ACA”), including:
  • Health Reimbursement Arrangements (“HRAs”)
  • The application of COBRA to health FSAs with a carryover feature
  • Section 6056 Reporting (Applicable Large Employers)
    • Treatment of employer provided flex-credits, opt-out payments and HRAs
    • Cash-in-lieu payments under the Service Contract Act (“SCA”) or Davis Bacon Act (“DBA”)
    • Penalty relief for “good faith” reporting
  • Section 4980H Employer Mandate (Pay-or-Play)
    • Increases to “affordability” safe harbors
    • Increased pay-or-play penalties starting in 2015
    • Hours of service for employees on short- or long-term disability


New Agency Guidance and Relief on Offering Student Health Insurance
On Feb. 5, 2016, the Departments of the Treasury, Labor, and Health and Human Services (the Departments) issued a technical release (2016-01) addressing the application of market reforms and other provisions of the Affordable Care Act (ACA) to student health coverage, and providing temporary transition relief from enforcement by the Departments for non-compliant colleges and universities.


Administration Extends Temporary “Fix” For Individual and Small Group Plans
In 2013, the Obama Administration responded to nationwide complaints about health insurance plans being cancelled or not renewed because of the requirements of the Affordable Care Act (ACA) by offering a one-year moratorium on key aspects of the market reform provisions under the Act. That relief was subsequently extended for two years to policy years beginning on or before October 1, 2016 in the small group and individual markets.


Agencies Release New Summary of Benefits and Coverage Templates
Health care reform expands ERISA’s disclosure requirements by requiring that a summary of benefits and coverage (SBC) be provided to applicants and enrollees before enrollment or re-enrollment. Specifically, an SBC must be provided at open enrollment, initial enrollment and special enrollment or upon request. The SBCs allow health insurance shoppers to more easily make comparisons among available health plans and assist enrollees to better understand and use their own coverage.


Class Action Lawsuit Alleges Dave & Buster's Reduced Hours to Avoid ACA
The Affordable Care Act (‘‘ACA’’) exposes applicable large employers to penalties if they do not offer full-time employees health insurance that meets the ACA’s minimum value and affordability requirements. One strategy for minimizing exposure to penalties under the employer shared responsibility provisions of the ACA is to minimize the number of “full-time employees,” meaning the number of employees working 30 or more hours per week on average. Employers can accomplish this by reducing the number of hours employees work so that they will not be considered to be “full-time” as defined by the ACA, which will require coverage to be offered to fewer employees.


Congress Extends Parity to Mass Transit Benefits – Permanently
On December 18, 2015, the President signed the Consolidated Appropriations Act, 2016 (CAA), which, among other changes to the Internal Revenue Code, permanently and retroactively restores parity by equalizing the limits for pre-tax parking and commuter benefits. In light of the CAA’s retroactive effect, the IRS released Notice 2016-06, which provides guidance for employers that provided transit benefits in excess of $130 per month on an after tax basis in 2015. The table below contains the adjusted limits for 2015 and 2016. Note that at least one state, Massachusetts, does not follow federal tax law in this regard and limits pre-tax mass transit benefits to $130 per month in 2016 for state tax purposes.


HHS Finalizes 2017 Out-of-Pocket Maximums and Marketplace Guidance
On March 8, 2016, HHS published the final version of its 2017 Notice of Benefit and Payment Parameters. The Notice is issued each year as part of the Affordable Care Act (ACA). For the most part, the guidance is focused on the ACA Marketplaces and insurers offering qualified health plans. It does, however, include several items relevant to employers and group health plans, specifically:
  • Annual limits for cost sharing (out-of-pocket limits)
  • Marketplace eligibility notifications to employers
  • Marketplace annual open enrollment period
  • Small Business Health Options (SHOP) Exchange

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HHS Announces Start to Phase 2 of HIPAA Audit Program
On March 21, 2016 the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) announced the start of phase 2 (Phase 2) of the Health Insurance Portability and Accountability Act (HIPAA) Audit Program. Phase 2 will consist of more than 200 desk and onsite audits of both covered entities and business associates to determine their compliance with HIPAA’s Privacy, Security, and Breach Notification rules. By contrast, the Phase 1 pilot audit program conducted in 2011 and 2012 targeted only covered entities and involved just 115 audits.


DOL’s Final Fiduciary Rules for Investment Advisors Apply to HSAs
On April 8, 2016, the DOL finalized its fiduciary regulations which, among other things, expand the definition of who is an ERISA fiduciary to those providing “investment advice” with respect to Health Savings Accounts (HSAs). As a result, the new guidance regarding what constitutes investment advice and the rules for best interest standards apply to HSAs in the same way in which they apply to IRAs, 401(k) and other retirement plans.


Final FLSA Overtime Regulations to Take Effect December 1, 2016
The reporting service Bloomberg BNA has reported that the U.S. Department of Labor’s (DOL’s) final overtime regulations will take effect December 1, 2016. The Obama administration is planning to provide additional details this evening and release the full rule tomorrow (May 18). The final regulations more than double the existing minimum salary threshold for overtime exemption from $23,660 to $47,476.


U. S. Department of Labor - Final Overtime Rules
The U. S. Department of Labor (DOL) today released the new rules raising the nation’s exempt salary threshold from $455 per week/$23,660 to $913 per week/$47,476 annually. This is the first time since 2004 that the white collar overtime regulations have been updated.


EEOC Releases Final Rules for Wellness Programs under ADA and GINA
On Monday, May 16, the Equal Employment Opportunity Commission (EEOC) released final regulations (Final Regulations) under Title I of the Americans with Disabilities Act (ADA) and Title II of the Genetic Information Nondiscrimination Act (GINA) governing wellness programs. The ADA rules cover an employer’s requests for health information from employees and the GINA rules cover requests for health information from family members.


Beware of FICA-Reduction Arrangements Using Wellness Programs
It has come to our attention that certain arrangements are being marketed to employers that are intended to reduce an employer’s FICA obligation by significantly increasing employees’ pre-tax salary reductions. We want to caution employers against entering into these types of arrangements before having a conversation with an employee benefits attorney who understands them. This alert provides some background on these schemes and our concerns with them.


Employers that sponsor self-insured group health plans, including health reimbursement arrangements (HRAs) should keep in mind the upcoming August 1, 2016 deadline for paying fees that fund the Patient-Centered Outcomes Research Institute (PCORI). As background, PCORI was established as part of health care reform to conduct research to evaluate the effectiveness of medical treatments, procedures and strategies that treat, manage, diagnose or prevent illness or injury. PCORI fees were first due in July 2013 for plan years that ended on or after October 1, 2012. Under health care reform, most employer sponsors and insurers will be required to pay PCORI fees until 2019.


ACA Reporting Update:
AIR System Will Remain Up and Running after June 30th Deadline
This version clarifies the timeframes within which corrections must be made.
While the deadline to electronically file Affordable Care Act (ACA) information returns with the IRS passed on June 30, 2016, the ACA Information Returns (AIR) system used to electronically file those returns will remain up and running.


Marketplace Subsidy Notices: What Employers Need to Know


In late June, the U.S. Department of Health and Human Services (HHS) reportedly mailed out several hundred thousand notices to employers, dated June 21, 2016, informing them that one or more of their employees have been certified as eligible for a premium subsidy through a federal Health Insurance Marketplace. Employers in states with state-run Marketplaces may have received similar notices since 2015; however, HHS has just begun sending notices from the federal Marketplaces this June.


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HHS Issues Final Rule on ACA Nondiscrimination Provisions (Section 1557)
In May, the Department of Health and Human Services (HHS) published a final rule implementing Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination on the basis of, among other grounds, sex (including gender identity) in certain health programs and activities. Specifically, entities covered under the rule cannot deny, cancel, limit or refuse to issue health coverage; deny or limit a claim; or impose additional cost sharing on a protected individual.


DOL Proposes Changes to Annual Reporting for ERISA Plans
The U.S. Department of Labor (DOL) recently proposed revisions to Form 5500 (Annual Return/Report for Employee Benefit Plan), the related schedules, and the rules that govern the forms. In general, these changes would first apply for the 2019 plan year, although certain changes may be implemented earlier. These proposed revisions were published on July 21, 2016, and comments are being accepted for 75 days, through October 4.


Enrollment Counts for Transitional Reinsurance Fee Due November 15, 2016
Employers with self-insured major medical plans are reminded to report their membership count to the U.S. Department of Health and Human Services (“HHS”) via the website by November 15, 2016, as part of the Affordable Care Act’s (“ACA”) transitional reinsurance fee (the “Fee”).


Employer Alert – IRS Email Scam
The newest scam involving a fraudulent email notice from the Internal Revenue (IRS) may have your
employees coming to you asking about their insurance coverage for 2014.
The Internal Revenue Service late last week issued an alert to tax payers and tax professionals for an IRS scam
related to the ACA.


IRS Increases Health FSA Contribution Limit for 2017
On October 25, 2016, the Internal Revenue Service (IRS) released Revenue Procedure 2016-55, which raised the health Flexible Spending Account (FSA) salary reduction contribution limit to $2,600 for plan years beginning in 2017. The Revenue Procedure also released the cost-of-living (COLA) adjustments that apply to dollar limitations in certain sections of the Internal Revenue Code (Code). The following summarizes other adjustments relevant to individuals and employer sponsors of welfare and fringe benefit plans.


Post-Election Returns: What Now for Obamacare?
The votes have been counted and Donald Trump is the president-elect and Republicans control Congress. Among the many questions around the proverbial water cooler is what now for “Obamacare”? While it is impossible for anyone to predict the future, we undertake to make a short, best guess about the future of the Affordable Care Act (“ACA”).


IRS Provides a 30-Day Extension for Furnishing Forms 1095
and Extends Good Faith Transition Relief The Internal Revenue Service (IRS) has released Notice 2016-70, which extends the deadline for furnishing Forms 1095-B and 1095-C to individuals from January 31, 2017 to March 2, 2017. The Notice did not delay the due date for filing the forms with the IRS, which remains February 28 if filing by paper, or March 31 if filing electronically.


Judge Blocks Overtime Rule Set to Take Effect December 1
On Tuesday, November 22 a federal judge issued a nationwide injunction blocking the U.S. Department of Labor (“DOL”) from implementing its new overtime rule scheduled to take effect December 1, 2016. The rule would have affected approximately 4 million executive, administrative and professional (“EAP”) employees, making them eligible for time-and-a-half pay for all hours worked in excess of 40 per week if their salary is below $913 per week ($47,476 per year). The new threshold would have doubled the current threshold of $455 per week ($23,660 per year).


White Collar Exemption Preliminary Injunction
Yesterday, U. S. District Judge Amos Mazzant out of Texas issued a nationwide preliminary injunction against the Department of Labor’s (DOL) white collar exemption increase. The final rule to the Fair Labor Standards Act was issued May 18, 2016 to take effect December 1, 2016. Raising the nation’s White Collar exemption salary threshold for the first time since 2004, from $455 per week/$23,660 to $913 per week.


Congress Passes Law Expanding use of HRAs by Small Employers
On December 7, 2016, the Senate passed the 21st Century Cures Act (“Cures Act”), an omnibus measure that includes the Small Business Healthcare Relief Act (“Relief Act”), which significantly expands small employers’ options for providing health coverage. The Cures Act passed both houses of Congress by a wide margin and the President has indicated that he will sign it into law. Once signed, the law will be effective for plan years beginning on or after January 1, 2017. The Relief Act is Title XVIII of the Cures Act and starts on page 824.


President Trump Issues Executive Order on the Affordable Care Act
President Trump moved swiftly after taking office on Friday, issuing an Executive Order intended to minimize the economic and regulatory burdens of the Affordable Care Act (“ACA”). The order is somewhat symbolic and has no immediate effect on employers, many of whom are in the process of complying with the ACA’s onerous reporting requirements (Forms 1094 and 1095), which are not rescinded by the order.


IRS to Continue Accepting Tax Returns without Indication of Health Insurance
The IRS has announced that it will continue to process tax filings of individuals whose returns do not indicate whether they have maintained health insurance as required under the Affordable Care Act (ACA). The announcement is in direct response to the President’s January executive order to ease the ACA’s economic and regulatory burdens.


White House Extends Transition Relief for Non-Compliant Plans through 2018
On February 23, 2017, the White House announced a one-year extension to the transition policy (originally announced November 14, 2013 and extended several times since) for individual and small group health plans that allows issuers to continue policies that do not meet ACA standards.


House Committees Release Proposed Legislation to Repeal and Replace the ACA
On Monday, March 6, the U.S. House of Representatives Ways and Means and Energy and Commerce Committees released the American Health Care Act (AHCA), their proposed legislation to repeal and replace the Affordable Care Act (ACA) through the budget reconciliation process, which requires a simple majority vote of Congress.