Employee Benefits Law Report

Archives: Health Care Reform

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Health Care Reform Reaches The Supreme Court – Two Days Down, One to Go

The Supreme Court on Tuesday, March 27 heard oral arguments on the most pivotal issue concerning the implementation of the health care reform legislation. The issue before the Court on Tuesday concerned the constitutionality of the individual mandate that is at the heart of the recent legislation (i.e., the obligation imposed on all covered individuals, effective in 2014, to either purchase health care coverage or pay a penalty for refusing to do so). … Continue Reading

Implementing $2,500 FSA Limits for Non-Calendar Year Plans – Start Now

Beginning January 1, 2013, the Patient Protection and Affordable Care Act ("PPACA") requires plan sponsors to limit pre-tax health flexible spending account ("FSA") contributions to no more than $2,500 per calendar year. There are currently no limits on health FSA contributions. This change is anticipated to be a revenue-raiser, because the new limit is lower than most existing plan-imposed pre-tax FSA contribution limits, and affected employees will pay taxes on more of their salary. … Continue Reading

The Early Retiree Reinsurance Program — Go Forth and Spend

The Patient Protection and Affordable Care Act (“PPACA”) contained a provision that established the Early Retiree Reinsurance Program (“ERRP”), the goal of which was to encourage plan sponsors to retain health care coverage for retirees through at least 2013. The ERRP was designed to provide reimbursement to eligible sponsors of employment-based plans for a portion … Continue Reading

Health Care Plan Summary of Benefits and Coverage Distribution Deadline Quickly Approaching for Employers

Employers who maintain health plans may recall from our prior blogs (see "Health Care Plan Annual Enrollment Triage: The Summary of Benefits and Coverage Standards Have Not Been Issued Yet and May Just Have to Wait" and "Health Care Plan Summary of Benefits and Coverage: Still No Final Model, But Substantial Excise Taxes are Looming Anyway") that they would soon need to address the new Summary of Benefits and Coverage ("SBC"), although urgent action would need to wait until the issuance of final guidance. Well, the wait is over.… Continue Reading

Independent Contractor Misclassification

On our sister blog – Employer Law Report – Sara Hutchins Jodka discusses the IRS Voluntary Compliance Settlement Program. This program was designed to provide eligible employers partial relief from the federal employment taxes and penalties that typically result from misclassifying workers as independent contractors. Given the amount of attention that federal and state agencies … Continue Reading

Supreme Court Gets Into The Act On Health Care Reform

The table now is set for the last chapter in our long (and, to many, excruciating) debate over the constitutionality of the health care reform legislation enacted in 2010. At a conference last Thursday, November 10, the members of the United States Supreme Court voted to consider an appeal of one of the lower court decisions dealing with the constitutionality of the landmark legislation.… Continue Reading

Health Care Shared Responsibility’s Missing Link – Reconciliation With The Employer

The Patient Protection and Affordable Care Act (PPACA) shared responsibility provisions require speculation about whether health care coverage will be affordable for an individual. Whether affordable coverage was available, whether an individual was eligible for a premium credit, and whether an employer was subject to penalties, cannot be determined until after the individual files a personal tax return. … Continue Reading

Health Care Plan Summary of Benefits and Coverage: Still No Final Model, But Substantial Excise Taxes Are Looming Anyway

In our prior blog, we explained that under principles of triage, employers may need to focus on the current annual enrollment and wait to take care of the Summary of Benefits and Coverage ("SBC"). Although the SBC does not need immediate attention, we caution employers not to wait too long or take the SBC responsibilities too lightly.… Continue Reading

CLASS Dismissed – No Actuarially Sound Federal Long-Term Care Program Developed

The Patient Protection and Affordable Care Act gave the Secretary of Health and Human Services, Kathleen Sebelius, a hefty to-do list. One of those tasks was to develop at least three actuarially sound long-term care benefit plans that met specified criteria and would remain solvent for 75 years. This was to pave the way for the Community Living Assistance Services and Support ("CLASS") program. … Continue Reading

Is The Judicial Ping Pong Game Over Health Care Reform Coming To A Merciful Close?

The Obama administration was faced with a deadline to ask for an en banc review by the 11th Circuit Court of Appeals of a decision that declared the health care reform legislation's individual mandate unconstitutional. Under applicable court rules, such a request had to be filed by Monday, September 26. A decision to seek such a review would have caused further delay, and very likely would have delayed the timing of a decision on the legislation by the Supreme Court until after the 2012 national elections.… Continue Reading

Health Care Plan Annual Enrollment Triage: The Summary of Benefits and Coverage Standards Have Not Been Issued Yet and May Just Have to Wait

M*A*S*H* taught us how to do triage, and MacGyver taught us to creatively think our way out of an impossible situation. Both are skills that may come in handy for the many employers who maintain calendar year health plans and who were in the process of preparing for annual enrollment when the Summary of Benefit … Continue Reading

Health Care Reform Update: Grandfathered Plans

The Department of Labor (“DOL”) has published Frequently Asked Questions describing the scope of the anti-abuse rule (available here). Generally, transferring employees from one grandfathered plan or benefit package (transferor plan) to another (transferee plan) will cause the transferee plan to relinquish grandfather status if amending the transferor plan to replicate the terms of the transferee … Continue Reading

11th Circuit Court of Appeals Rules Individual Mandate Unconstitutional, But Rest of Health Reform Law is Severable from Mandate

The U.S. Court of Appeals for the Eleventh Circuit in Atlanta on Friday ruled, in the 26-state challenge to the Patient Protection and Affordable Care Act (PPACA) in Florida v, U.S. Dept. of Health and Human Services, that the health care reform law’s requirement that nearly all Americans have health insurance is unconstitutional. This ruling comes two months after the U.S. Court of Appeals for the Sixth Circuit upheld the constitutionality of PPACA.… Continue Reading

PPACA Standards For Coverage Of Preventive Care Extended To Contraceptives

On Monday, August 1, 2011, the Obama administration announced new guidelines that require health care plans to cover certain women’s preventive services, including birth control and voluntary sterilization. The action taken by the United States Department of Health and Human Services (the “HHS”) adopts recommendations made by the Institute of Medicine, which recently issued a … Continue Reading

Washington Simmers…And It’s Not the Heat!

Most Americans (other than those focused solely on the resolution of the NFL lockout) have taken notice of the partisan scramble going on here in Washington these days over the debt ceiling limit and our seemingly out-of-control federal deficit. As I write this, partisan bickering and veto threats are the order of the day—even as … Continue Reading

After Earlier Grace, Departments Now Relax Certain Health Claims Procedure Requirements

Fresh off an extension this past spring of an enforcement grace period with respect to internal health claims and appeals requirements, sponsors of non-grandfathered group health plans received some more welcome news recently with the relaxation of certain group health claims procedure requirements first announced in interim final rules issued in July 2010. Although plan … Continue Reading
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