Premium Insights

Complex laws, simplified

Premium materials are UBA propriety knowledge that draws from the research and experience of UBA legal staff and other sources. Complex laws and regulations are reviewed, simplified, organized and uniquely packaged for ease of use.

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Health Insurance Marketplace Notice and OMB Expiration Date

Under the Patient Protection and Affordable Care Act (ACA), an applicable employer must provide a written notice about the Health Insurance Marketplace to each employee. This ACA Advisor explains the OMB expiration date and what to do if the OMB approval number on the model notice has expired.

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Qualified Small Employer Health Reimbursement Arrangements and ERISA

This Compliance Advisor discusses ERISA’s definitions of “group health plan”, as well as the law’s legislative history governing exclusions to help employers determine if ERISA applies to a reimbursement arrangement.

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IRS Reporting Tip: Form 1094-C, Line 22

Form 1094-C, often referred to as the "transmittal form" or "cover sheet”, is used in combination with Form 1095-C to determine employer shared responsibility penalties. Form 1094-C has a section labeled "Certifications of Eligibility" that instructs employers to "select all that apply" with four boxes that can be checked. This ACA Advisor helps clarify the "Line 22" question or boxes to help employers determine what, if any, boxes they should select.

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Cafeteria Plans: Qualifying Events and Changing Employee Elections

This ACA Advisor helps employers understand the various change in status events that allow employees to make changes to cafeteria plan elections. Includes numerous examples, including scenarios involving employees or their spouses or dependents entering into domestic partnerships, ending periods of incarceration, losing or gaining TRICARE coverage, and cost changes to an employer health plan.

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2017 Annual Benefit Plan Limits Card

Many employee benefit limits are automatically adjusted each year for inflation (this is often referred to as an "indexed" limit). An annual favorite among employers, UBA offers a quick reference chart showing the 2017 cost of living adjustments for health and Section 125 plans, qualified plans, and Social Security/Medicare withholding. This at-a-glance resource is a valuable desk tool for employers and HR practitioners.

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IRS Releases 2016 Forms and Instructions for 6055/6056 Reporting

This 16-page ACA Advisor reviews the final instructions and forms to be used for section 6055/6056 reporting, including 2016 updates, critical form highlights/explanations, sample situations, and more.

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Controlled Groups and Affiliated Service Groups

The ACA imposes a penalty on "large" employers that either do not offer "minimum essential" (basic medical) coverage, or that offer coverage that is not affordable or it does not provide minimum value. To discourage employers from breaking into small entities to avoid the penalty, the ACA provides that, for purposes of the employee threshold, the controlled group and affiliated service group aggregation rules will apply to health plans. This ACA Advisor reviews the four types of controlled groups, three types of Affiliated Service Groups and other related aggregation rules.

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Employer Considerations When Offering Health Coverage under the SCA or DBA

Employers that are subject to the McNamara-O’Hara Service Contract Act (SCA), Davis-Bacon Act (DBA), and Davis-Bacon Related Acts (Related Acts), and who are considered an applicable large employer (ALE) under the ACA must ensure that they meet the requirements of all three acts, despite the fact that the interplay between them can be confusing and misunderstood. This ACA Advisor reviews the DOL’s guidance on how to comply with each applicable law.

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Nondiscrimination Rules for Cafeteria Plans

This Compliance Advisor reviews rules governing Cafeteria Plans, key definitions related to nondiscrimination testing, the Eligibility test, the Contributions and Benefits Test, and safe harbors.

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Understanding Wellness Programs and their Legal Requirements

This ACA Advisor reviews five main questions that wellness program sponsors should ask and work through to determine the obligations of their wellness program under ACA, HIPAA, ADA, GINA, and/or ERISA, as well as considerations for wellness programs that involve tobacco use in any way. With over 20 pages of comprehensive guidance, examples and frequently-asked questions, this is a “must-have” resource.

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Are Opt-Outs on the Way Out?

For many years, so long as employers were offering opt-outs uniformly to all benefit-eligible employees, the government had little, if any, regulation over opt-outs. This ACA Advisor reviews how multiple government agencies are tightening the parameters around permissible opt-outs, and reviews best practices in light of recent regulatory guidance.

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Frequently Asked Questions (FAQ) About Wellness Programs’ Legal Requirements

This ACA Advisor has over 50 questions and answers about wellness programs, including the difference between participatory and health-contingent programs; when they must comply with HIPAA/PPACA, ADA, GINA and/or rules; activity-only vs. outcome-based programs; what terms like “reasonable design” “tobacco-free” and “reasonable alternative standard” mean; what employers can and cannot do with incentives; confidentiality requirements; penalties; and more.

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IRS/SSA/CMS Data Match Guide on Instructions from CMS

Employers are required to complete the IRS/SSA/CMS Data Match report within 30 days of receipt of the Data Match Personal Identification Number (PIN), unless an extension has been requested and approved. This Compliance Advisor provides detailed diagrams to help you complete each part of the questionnaire.

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OSHA Reporting Changes: Employer Checklist

The Occupational Safety and Health Administration (OSHA) has issued sweeping changes to record-keeping and reporting rules. This Compliance Advisor offers an at-a-glance checklist to help employers determine if they are a covered employer and if so, how to review employee communications, policies and handbooks for compliance.

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IRS Reporting: Now What?

Applicable large employers and self-funded employers of all sizes have now completed the first round of required IRS reporting under the Patient Protection and Affordable Care Act (ACA). Employers that did not fulfill all of their obligations under the employer shared responsibility provision (play or pay) might owe a penalty to the IRS. This ACA Advisor explains when the penalty is triggered, how the penalty will be assessed and documentation employers must have.

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What Employers Need to Know about the IRS-SSA-CMS Data Match Program

With the uptick in IRS-SSA-CMS Data Match letters, employers are seeking more information about the program and their reporting obligations. This UBA Compliance Advisor explains the program, the Medicare Secondary Payer rules, the excise tax, and penalties for not completing the questionnaire.

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State Guide to Small Group Definition

UBA conducted a 50-state survey to capture the varied state definitions of "small employer" in the wake of the PACE Act. This chart summarizes each state's final definition for quick reference.

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Play or Pay Penalty and Counting Employees

As you likely know, the “employer mandate” section of the Affordable Care Act requires companies with 50 or more employees to either provide adequate and affordable coverage to their workers or pay tax penalties. But just how are those 50 to be counted?

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COBRA and the Affordable Care Act

The Consolidated Omnibus Budget Reconciliation Act (COBRA) requires employers to offer covered employees who lose their health benefits due to a qualifying event to continue group health benefits for a limited time at the employee's own cost. This ACA Advisor offers and in-depth look at qualifying events that trigger COBRA, the ACA impact on COBRA, measurement and look-back issues, health FSA carryovers, and reporting on the coverage offered.

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Template Letter to Employees about IRS Forms 1095-B and 1095-C

UBA has created a template letter that employers may use to draft written communication to employees regarding what to expect in relation to IRS Forms 1095-B and 1095-C, and what employees should do with a form or forms they receive. The template is meant to be adjustable so employers can add pertinent additional information.

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2016 Annual Limits Card

Many employee benefit limits are automatically adjusted each year for inflation (this is often referred to as an "indexed" limit). UBA offers a quick reference chart showing the 2016 cost of living adjustments for health and Section 125 plans, qualified plans, and Social Security/Medicare withholding. This at-a-glance resource is a valuable desk tool for employers and HR practitioners.

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Reporting and Plan Documents under ERISA and Cafeteria Plan Rules

For many years, most of ERISA's requirements applied to pension plans. However, in recent years that has changed, and group plans (called "welfare benefit plans" by ERISA and the DOL) now must meet a number of requirements. Also, while cafeteria plans are not ERISA plans, many of the component benefit plans offered through a cafeteria plan are subject to ERISA. This can create confusion for plan sponsors when they determine what ERISA obligations they have in relation to their cafeteria plan, as well as to their individual offerings. This new UBA ACA Advisor can help emplyers understand the interplay between ERISA and cafeteria plans and the reporting and plan document requirements under both.

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Cafeteria Plans: Participant Contributions

Cafeteria plans, or plans governed by IRS Code Section 125, allow employers to help employees pay for expenses such as health insurance with pre-tax dollars. Employees are given a choice between a taxable benefit (cash) and two or more specified pre-tax qualified benefits, for example, health insurance. Employees are given the opportunity to select the benefits they want, just like an individual standing in the cafeteria line at lunch. This new guide from UBA can help employers understand participant contributions and what to do when a participant is unable to pay their required contribution.

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Perfect Attendance! How to Handle Leaves of Absence under the ACA

Leaves of absence can make it difficult for an employer to determine if or how an employee counts toward the applicable large employer (ALE) threshold of 100, as well as determining if an employee is considered full time and must be offered coverage. This ACA Advisor defines service hours, exceptions, methods for counting hours, FMLA, USERRA, and jury duty, unpaid leave, layoffs, disability, conveying policies, determining ALE status, and crediting hours to employees.

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Mid-Size Employers; Transition Relief and Community Rating

If a mid-size employer has a non-calendar-year plan and can meet certain transitional rules, it can delay offering health benefits until the start of its 2016 plan year. They must meet certain maintenance requirements to qualify for transition relief. These employers must also be cognizant of non-calendar year transition relief requirements, transitional rules related to community rating and what happens when transition relief policies clash.

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HRAs, HSAs, and Health FSAs - What's the Difference?

Health reimbursement arrangements (HRAs), health savings accounts (HSAs) and health care flexible spending accounts (HFSAs) are generally referred to as account-based plans. To help determine the best option for your particular situation, this comprehensive chart compares eligibility criteria, contribution rules, reimbursement rules, reporting requirements, privacy requirements, applicable fees, non-discrimination rules and other characteristics of these types of accounts.

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Frequently Asked Questions about the Transitional Reinsurance Fee (TRF)

The transitional reinsurance fee (TRF) applies to fully insured and self-funded major medical plans for 2014, 2015, and 2016. The purpose of the fee is to provide funds to help stabilize premiums in the individual insurance market in view of uncertainty about how the Affordable Care Act (ACA) would affect claims experience. While insurers are responsible for reporting and paying the fee on the policies they issue, the fee will generally be passed on to the employer. Request UBA's "Frequently Asked Questions about the Transitional Reinsurance Fee (TRF)" for the answers to nearly 30 questions about filing, due dates, calculation methods, payment, submission and more.

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Comparison of PCORI and TRF

Many employers are gearing up to comply with the new fees under the Affordable Care Act (ACA). UBA offers a comparison of the Patient-Centered Outcomes/Comparative Effectiveness (PCORI) Fee and the Transitional Reinsurance Fee that gives a side-by-side comparison of each, including start and end dates, reporting methods, fee due dates, exclusions, calculation methods and more.

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IRS Issues Final Regulations on Employer Shared Responsibility (Play or Pay)

On February 10, 2014, the IRS issued final regulations on the employer-shared responsibility requirements, often known as “play or pay.” This is the requirement that large employers offer adequate coverage to their full-time employees or pay penalties. The final regulations follow the proposed regulations (which were issued in January 2013) in many respects, but also contain some surprises. UBA has developed an analysis of the final regulations for employers.

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Excepted Benefits - Limited Scope Dental, Vision; EAPs

On September 26, 2014, the U.S. Department of Health and Human Services (HHS), the Internal Revenue Service (IRS), and the Department of Labor (DOL) released final regulations that explain when dental and vision plans and employee assistance plans (EAPs) will be considered “excepted benefits.” Excepted benefits are health benefits that are limited enough in scope to be exempt from many of the requirements of the Patient Protection and Affordable Care Act (ACA), such as annual dollar limits, reporting on W-2s, and various fees.

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Group Health Plans

ACA brings numerous responsibilities and options to employers. Below is a summary of the ACA provisions that apply to group health plans and whether the provision applies to Self-funded plans, Small Group Insurance Plans, or Large Group Insurance Plans.

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Frequently Asked Questions about the Health Marketplace

The health marketplaces (which are also called the exchange) are scheduled to open Jan.1, 2014. Most Americans will be eligible to enroll in the marketplace, and many will be eligible for assistance paying the premium. Each state will have its own marketplace. About one-third of the states will run the marketplace themselves and the federal government will run the marketplace on behalf of the state in the remaining two-thirds of the states.

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An ACA Guide for Employees: Preparing for 2014

The Affordable Care Act (ACA) is complicated, and employees will need to understand their responsibility to purchase coverage under the new law. This guide helps employers educate their employees on the law and navigate the options available to them, particularly in regard to health insurance exchanges.

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ACA Compliance and Decision Guide for Small and Large Employers

To help employers make "pay or play" decisions under ACA, UBA has developed a series of decision support tools. To download an executive summary for employers of all sizes, click here. Or, request a more detailed decision guide with significantly expanded content specifically for small (fewer than 50 employees), or large (more than 50 employees) employers.

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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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HORAN Creates New Executive Leadership Positions to Support Rapid Growth and Expansion
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