The proposed rules on use of financial incentives within workplace wellness programs were published by the Equal Employment Opportunity Commission (EEOC) on April 16, 2015. These rules align the wellness provisions of the Affordable Care Act (ACA) and the Health Insurance Portability and Accountability Act (HIPAA) with the nondiscrimination rules in the Americans with Disabilities Act (ADA).
As employer groups with 51-100 employees renew or purchase health insurance coverage in 2016, they must abide by the rules and regulations governing the small group market, including those related to benefit coverage and essential health benefits; actuarial value, and premium rating restrictions, such as adjusted community rating and no medical underwriting.
The small group rules apply to fully insured plans, including those purchased in the Small Business Health Options Program (SHOP) marketplace.
In some markets, the state and insurance carriers may give employers the option to keep their plan for a while longer by:
- Changing their plan year to maximize the time the employer can keep their plan in 2016.
- Taking advantage of transitional relief, which allows employers in some states to keep their current plans through Sept. 30, 2017.
Employers that self-insure (self-funded) are not subject to these requirements.
Options and requirements vary by state, issuer and segment. For more information, please contact us for a consultation at 832-482-2494 or via email through the “contact us” page on our website.
Recently, your health insurance company may have requested your Social Security number, as well as the Social Security numbers of your spouse and your qualifying dependents. Due to a new reporting requirement, you will need to report qualifying health coverage (referred to as “minimum essential coverage”) on your yearly income tax return. This new reporting requirement will begin for the 2015 tax year, and your social security number is required by the Internal Revenue Service (IRS) for Form 1095-B. Here are some common questions you may have regarding this process.
Almost two-thirds of tax filers who received insurance via the state or federal insurance Marketplaces had to pay back an average of $729 of the Advance Premium Tax Credit (APTC), cutting their potential refund by almost one-third, according to analysis of filing data by H&R Block (NYSE: HRB), the world’s largest consumer tax preparation company. The Advanced Premium Tax Credit was designed to pay a portion of a person’s health insurance premium each month, the amount was based upon projected income amounts. The intent is to help make health insurance “affordable”. So, for example, if your health insurance premium on the individual exchange was $500 per month, and you got a premium tax credit, you might pay $250 and the government would pay the other $250.
However, if you projected your income incorrectly when you signed up, or it changed during the year, you might not qualify for the original subsidy amount. So you’d have to pay back part or all of the subsidy at tax time.
H&R Blocks research found that the average refund for those with an APTC who filed was $2,195. The average premium tax credit reconciliation repayment amount was $729, which equated to a 33-percent reduction from their average refund.
Here is a link to the H&R Block article: http://newsroom.hrblock.com/hr-blocks-final-aca-stats-refunds-impacted-received-advance-tax-credit/
The IRS recently released the final forms and instructions for Section 6055 and 6056 reporting. Additionally, the IRS released Publication 5196, Understanding Employer Reporting Requirements of the Health Care Law, in order to help employers prepare for reporting in 2016.
Forms 6055 and 6056 are not required to be filed for 2014, but employers may choose to voluntarily file in 2015 for 2014 coverage using the released forms and instructions.
In late February, the Internal Revenue Service (IRS) released Notice 2015-17, which offers guidance on the prohibition of employer payment plans. These plans are arrangements that pay for or reimburse premiums for individual health plans.
The notice reiterates that employer payment plans are not compliant with the Affordable Care Act (ACA) provisions that took effect in 2014. However, the notice also states that an increase in employee compensation, not conditional on the employee’s purchase of individual health insurance, is not considered an employer payment plan.
The notice clarifies confusion caused by some employers’ interpretations of Revenue Ruling 61-146 as support for employer payment plans. To counter the misinterpretation, the notice stated that this ruling does not address the application of the ACA’s market reforms and therefore should not be read as though it does.
Violating these ACA provisions can result in an excise tax of $100 per employee for each day that an employer is out of compliance.
The notice also provides information regarding transitional relief from the fines. Employers that are not applicable large employers (ALEs) under the ACA’s employer shared responsibility rules, as well as S corporation health care arrangements for 2-percent shareholder-employees, may be eligible for transition relief. The transition relief is available to eligible employers on a temporary basis until June 30, 2015. After that date, employers that are not in compliance may be liable for the excise tax.
The relief is not included for stand-alone HRAs or arrangements that cover employees’ medical expenses other than insurance premiums.