Exclusive Updates

Expert Analysis

Exclusive materials are guides prepared by UBA legal and compliance staff that address frequently asked questions and that clearly explain key legislative rules and regulations that impact employers.

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ACA Market Stabilization Final Rule

This ACA Advisor provides information on the changes, updates and clarifications related to guaranteed availability of coverage, annual open enrollment periods, special enrollment periods, continuous coverage, network adequacy, and essential community providers.

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SBC Template and Required Addendums for Covered Entities under ACA Section 1557

This ACA Advisor reviews the requirements for a SBC, the changes made to the template by the regulatory agencies, the impact of Section 1557 of the ACA, as well as the addendum required for covered entities.

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IRS Memo on Fixed Indemnity Health Plan Benefits Tax Treatment

This Compliance Advisor reviews what fixed indemnity health plans are, the tax questions they raise, the IRS’ guidance, as well as analysis on when they should be excluded from gross income.

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Medicare Part D: Creditable Coverage Disclosures

Entities such as employers with group health plans that provide prescription drug coverage to individuals that are eligible for Medicare Part D have two major disclosure requirements that they must meet at least annually. This Compliance Advisor reviews those disclosures, how to determine if coverage is creditable, the required disclosures to plan participants about whether coverage is creditable, and how notices must be delivered.

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IRS Q&A About Employer Information Reporting on Form 1094-C and Form 1095-C

Recently, the IRS updated its longstanding Q&A guidance on codes that employers should use when completing Forms 1094-C and 1095-C. This ACA Advisor describes the IRS' updated guidance, including COBRA reporting information that had been left pending in earlier versions of the IRS guidance for the past year.

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21st Century Cures Act

This Compliance Advisor reviews the impact of the 21st Century Cures Act on the Mental Health Parity and Addiction Equity Act, health reimbursement arrangements (HRAs), and permitted uses and disclosures of protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA).

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IRS Delay in 6055 and 6056 Reporting for 2017

The IRS recently issued Notice 2016-70, delaying the reporting deadlines in 2017 for the 1095-B and 1095-C forms to individuals. Since the delay only pertains to select forms, this ACA Advisor reviews the forms affected, the delayed deadlines, the extension process, as well as the impact on individual taxpayers.

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FAQs on Tobacco Cessation Coverage and Mental Health / Substance Use Disorder Parity

This ACA Advisor reviews the recently issued "FAQs About Affordable Care Act Implementation Part 34 and Mental Health and Substance Use Disorder Parity Implementation” released by the Department of the Treasury, Department of Labor (DOL), and Department of Health and Human Services (HHS).

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Advance Informational Copies of 2016 Form 5500 Annual Return/Report

This Compliance Advisor reviews the modifications to the recently released advance informational copies of the 2016 Form 5500 annual return/report, and provides information on when to file Form 5500 and 5500-SF.

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Regulations Regarding Short-Term Limited-Duration Insurance, Excepted Benefits, and Lifetime/Annual Limits

This ACA Advisor reviews final regulations regarding short-term limited-duration insurance as well as final regulations for excepted benefits, specifically similar supplemental coverage and travel insurance. The publication also provides information on the definition of Essential Health Benefits for purposes of the prohibition on lifetime and annual limits.

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Instructions for Completing the Transitional Reinsurance Fee Filing

This ACA Advisor offers step-by-step guidance on TRF filing, including registration, completion of the Contribution Form (Form), uploading supporting documentation, entering payment information and available web training.

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Reporting Minimum Essential Coverage

This ACA Advisor reviews the most recent proposed regulations on how to report minimum essential coverage (MEC).

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State Guide to COBRA Supplemental Requirements

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal requirement of group health plans to provide COBRA continuation coverage to participants who lose coverage due to a qualifying event, when the employer had 20 or more full time employees. Over the years, many states enacted additional requirements similar to COBRA, either for small employers, or in addition to the federal COBRA requirements. This Compliance Advisor offers a comprehensive chart to outline each state’s specific continuation laws.

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Salary Considerations under the New DOL Standards

On December 1, 2016, the Department of Labor (DOL) will implement changes raising the minimum compensation for exempt employees to $47,476 annually. While salary is just half of a two-part equation that includes a duties test of essential job functions, scrutiny is under way to analyze compensation and find solutions to avoid conflict with the new rule. This Compliance Advisor reviews the perils of having all employees work 40 hours and get approval for overtime, workable solutions using salary increases, bonuses or incentives--as well as considerations when paying nonexempt staff on a salary basis.

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The ACA and the Individual Shared Responsibility Requirement, Including an Update on Proposed Regulations Issued on July 8, 2016

Under the ACA individual mandate, most people residing in the U.S. are required to have minimum essential coverage or they must pay a penalty. Employers are not required to educate employees about their individual responsibilities under the ACA, but this Advisor simply provides information on minimum essential coverage, exemptions, subsidy eligibility, proposed regulations that affect individuals, and other information that employers will find helpful to know.

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OSHA's Final Rule on Electronic Tracking of Workplace Injuries and Illnesses

Beginning in 2017, certain employers with as few as 20 employees at a single site will be required to electronically file information about employee injuries and accidents that occurred in the prior year. This Compliance Advisor reviews the public disclosure concerns associated with this rule, seven current practices that that are affected, as well as key dates related to this rule.

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Frequently Asked Questions about the Patient-Centered Outcomes/Comparative Effectiveness (PCORI) Fee

All plans that provide medical coverage to employees owe a Patient-Centered Outcomes/Comparative Effectiveness (PCORI) Fee. There are no exceptions for small employers, government, church or not-for-profit, grandfathered or union plans, so employers should be aware of who must make the payment, due dates, calculation methods and more. UBA’s “Frequently Asked Questions about the Patient-Centered Outcomes/Comparative Effectiveness (PCORI) Fee” addresses 12 key aspects of this fee.

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Overtime Exemption Rules Arrive

This UBA Compliance Advisor reviews the final revisions to the white collar overtime exemption rules in the Fair Labor Standards Act, including who the new rule applies to, how a white collar employee qualifies for an overtime exemption, the threshold for highly compensated employees, and how to calculate salary.

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Nondiscrimination Regulations Relating to Sex, Gender, Age, and More Finalized

This UBA ACA Advisor outlines the HHS final rule related to nondiscrimination regulations including who is affected, how the rule addresses sex, gender, and sexual orientation discrimination, how marketplace plans and third party administrators are affected, discrimination against persons with Limited English Proficiency (LEP) and disabilities, enforcement mechanisms, and the key differences between the proposed and final rule.

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Same-Sex Marriages and Group Health Benefits

This ACA Advisor reviews how Supreme Court cases, other state litigation, and the DOL definition of “spouse” now impact employers, including tax treatment of same-sex spouses and FMLA administration.

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Benefit and Payment Parameters Rule and HIP FAQ

This UBA publication reviews the 2017 Benefit and Payment Parameters (BPP) rule, including the annual open enrollment periods for the individual market, rating areas for small group health plans, guaranteed availability and renewability, broker and agent registration to assist consumers with applying for Exchange coverage, the employer notice system when its employees are determined to be eligible for a tax credit, and exemptions to the individual mandate.

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Proposed Summary of Benefits and Coverage Template and Updates

The Department of Labor (DOL) recently issued proposed revisions to the Summary of Benefits and Coverage SBC) template and related materials to apply to plan or policy years beginning on or after January 1, 2017. This ACA Advisor provides background information, a summary of the proposed changes and information on how to provide public comments.

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Reference Chart on ACA Fees and Penalties

ACA has introduced a multitude of new fees that employers must pay, in addition to penalties for non-compliance with employer shared responsibility rules. These dollar amounts change annually, as does the percentage amount used to calculate affordability in relation to the ACA. UBA has created a reference chart on the applicable 2015 and 2016 percentages and dollar amounts to help employers understand the indexed penalty and updated fee amounts.

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IRS Final Rule on Minimum Value

The IRS issued a final rule that clarifies various topics relating to the Patient Protection and Affordable Care Act (ACA) and premium tax credit eligibility provisions. This ACA Advisor covers rules related to child income, wellness incentives, HRA contributions and flex credits, continuation coverage, and mid-month enrollment.

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IRS Notice 2015-87: HRAs, Affordability, and More

This ACA Advisor reviews a long list of provisions covered in IRS Notice 2015-87 relating to: health reimbursement arrangements (HRAs) and other employer payment plans, the impact of HRAs, flex credits, opt-out incentives or fringe benefit payments on affordability calculations relating to applicable large employers (ALEs), IRS reporting that is required for ALEs, rules for health savings accounts (HSAs) for individuals eligible for benefits administered from the Department of Veterans Affairs (VA), COBRA rules in relation to unused health flexible spending arrangement (HFSA) funds and a reiteration of safe harbors relating to good faith reporting for ALEs.

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Agencies Issue Final Rule on Grandfathered Health Plans and Other Initiatives

Federal agencies recently issued a final rule that essentially combined a variety of interim final rules and non-regulatory guidance on a variety of Patient Protection and Affordable Care Act (ACA) initiatives such as grandfathered health plans, preexisting condition exclusions, internal and external appeals, rescissions of coverage, lifetime and annual limits, emergency care access and dependent coverage. This ACA Advisor explains these consolidated provisions that will all go into effect on January 1, 2017.

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Proposed 2018 Benefit Payment and Parameters Rule Released

Federal agencies have released the proposed rule for the 2017 Benefit Payment and Parameters. This ACA Advisor reviews all the updates and provisions being proposed to help employers plan and comment.

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Temporary Safe Harbor for Online Posting of SBCs

This ACA Advisor explains what a Summary of Benefits and Coverage (SBC) is, when and how they must be provided, and what these documents must contain. It also covers a new temporary safe harbor for some issuers that was recently announced by the Department of Health and Human Services (HHS).

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IRS Proposes Minimum Value Rule Change to Mesh IRS and HHS Rules

Employers that are subject to play or pay requirements of providing minimum essential and affordable, minimum value coverage should ensure that the plans they are offering provide substantial coverage of inpatient hospitalization and physician services. If they do not, their employees will be eligible for a premium tax credit to subsidize the cost of health insurance.

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HHS Proposes First of Anticipated Nondiscrimination Regulations

Section 1557 of the Patient Protection and Affordable Care Act (ACA) provides that individuals shall not be excluded from participation, denied the benefits of, or subjected to discrimination under any health program or activity which receives federal financial assistance, on the basis of race, color, national origin, sex, age, or disability. The Department of Health and Human Services (HHS) has issued the first of the anticipated nondiscrimination rules, which sets forth proposed regulations to implement Section 1557.

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ACA Information Returns

Under the Patient Protection and Affordable Care Act (ACA), applicable large employers (ALEs) are required to report to the Internal Revenue Service (IRS) on the health coverage they offer in order to verify they are meeting their obligations under the law. Employers with 250 or more 1095 Forms must file their reports electronically with the "Affordable Care Act Information Returns" or AIR. This UBA ACA Advisor publication details the steps that have been identified for employers to use AIR.

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DOL Issues Guidance on Classification of Independent Contractors

The DOL has determined that many employers are incorrectly classifying employees as independent contractors, which can harm the worker and open the employer up to various liabilities. Though there is no clear-cut checklist or rule in determining a worker’s status, UBA’s publication, “DOL Issues Guidance on Classification of Independent Contractors”, reviews the factors employer should consider when determining if an individual is an independent contractor or an employee.

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IRS Issues Second Notice to Assist in Developing Cadillac Tax Regulations

Beginning in 2018, plans that provide coverage that exceeds a threshold will owe an excise tax on high cost employer-sponsored health coverage, also known as the “Cadillac tax”. UBA’s ACA Advisor, “IRS Issues Second Notice to Assist in Developing Cadillac Tax Regulations” covers who is liable, treatment of controlled groups, exclusions of amounts attributable to the excise tax, HSAs/Archer MSAs/FSAs/ HRAs, age and gender adjustments, payment and more.

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Veterans with TRICARE; VA Coverage Won't Count Toward Applicable Large Employer Status

The Surface Transportation and Veterans Health Care Choice Improvement Act (STVHCC), also known as H.R. 3236, is focused on surface transportation programs but affects rules regarding how to count employees under the Patient Protection and Affordable Care Act (ACA) as well as health savings account (HSA) eligibility for individuals receiving care through the Veterans Administration.

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Trade Bill Increases ACA Reporting Penalties; Reinstates Tax Credit

The Trade Preferences Extension Act of 2015 includes significant increases for failure to complete IRS reporting forms under sections 6055 and 6056 of the Patient Protection and Affordable Care Act (ACA). UBA’s “Trade Bill Increases ACA Reporting Penalties; Reinstates Tax Credit” provides the details.

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Potential Employer Penalties under the Affordable Care Act

Employers that do not meet the requirements of the Affordable Care Act (ACA) need to be concerned about several potential penalties.

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Essential Health Benefits, Minimum Essential Coverage, Minimum Value Coverage: Whats the Difference?

The Affordable Care Act (ACA) uses terms that sound alike for three very different things.

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What You Need To Know About Medicare Secondary Payer Rules

Under federal regulations, Medicare is a secondary payer for many individuals who have an employer group health plan available to them, either as an employee or the dependent spouse or child of the employee. Read the answers to thirteen key questions about Medicare Secondary Payer rules including who is affected, what coverage must be offered to Medicare-eligible employees, whether Medicare premiums can be reimbursed, and more.

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Excepted Benefits - "Limited Scope" Dental and Vision Plans and EAPs

Excepted benefits are health benefits that are limited enough in scope to be exempt from many of the requirements of the Affordable Care Act (ACA), such as annual dollar limits, reporting on W-2s and various fees. To understand the final regulations defining when dental and vision plans and employee assistance plans (EAPs) will be considered “excepted benefits,” download UBA's ACA Advisor, "Excepted Benefits - "Limited Scope" Dental and Vision Plans and EAPs".

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Medical Loss Ratio (MLR) Rebate Considerations for Private and Church/Government Plans

Insurers whose medical loss ratios did not meet federal standards for 2013 (85% for large group and 80% for small group and individual policies) must pay rebates to policyholders in 2014. UBA offers publications that outline the rules for handling MLR rebates. Due to the differences in how private and government/church plans are to determine and distribute MLR rebates, download the publication below that is appropriate for your situation.



Option for Some to Renew Policies That Do Not Fully Meet ACA Standards

On March 5, 2014, the Department of Health and Human Services (HHS) released a Bulletin that allows state insurance departments to permit the renewal through October 1, 2016, of individual and small group policies that do not meet the “market reform” requirements of the Affordable Care Act (ACA). UBA has developed an analysis of this Bulletin for employers.

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FAQ about Eligibility Waiting Periods

The 90-day maximum for eligibility waiting periods is effective as of the start of the 2014 plan year. As employers are beginning to implement this new requirement, many have questions. United Benefit Advisors (UBA) has created a ACA Advisor that addresses a number of recurring questions about this new provision.

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Frequently Asked Questions about the W-2 Reporting Requirement

Employers that issued 250 or more W-2s in the prior calendar year must include the value of “employer sponsored group health coverage” on their employees’ W-2s. This means that an employer that issued 250 or more W-2s during 2012 must include the value of employer-sponsored coverage on the employee’s 2013 W-2 (to be issued in January 2014). The same rules apply as were applied in last year’s reporting. UBA has developed FAQs to assist employers with this reporting requirement.

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Frequently Asked Questions about the Exchange (Marketplace) Notice

On Sept. 11, 2013, the Department of Labor (DOL) issued an FAQ that stated that no penalties will apply to employers that fail to provide the exchange/marketplace notice. Despite this FAQ, employers may still want to provide the notice, to provide information to employees and to reduce the risk of unanticipated liability.

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ACA and the Individual Shared Responsibility Requirement

Although the employer shared responsibility requirements have been delayed to 2015, the individual responsibility requirement (also known as the individual mandate) is still scheduled to take effect in 2014. Under the individual mandate, most people residing in the U.S. will be required to have minimum essential coverage, or they will have to pay a penalty. Many individuals will be eligible for financial assistance, through premium tax credits (also known as premium subsidies), to help them purchase coverage if they buy coverage through the health insurance marketplace (also known as the exchange).

Summary of Benefits and Coverage FAQs

Employers must provide a Summary of Benefits and Coverage (SBC) for group health plans, with several underlying requirements that the SBC must meet.

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Please note that UBA continually updates its compliance library as new notices, rules, proposed rules and other ACA information becomes available, so some of our publications may be superseded by later guidance.

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