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.
The Department of the Treasury, Department of Labor, and Department of Health and Human Services released their proposed rule regarding health reimbursement arrangements (HRAs) and other account-based group health plans. The proposed rule’s goal is to expand the flexibility and use of HRAs to provide individuals with additional options to obtain quality, affordable healthcare. According to the Departments, these changes will facilitate a more efficient healthcare system by increasing employees’ consumer choice and promoting healthcare market competition by adding employer options. Request this Advisor to learn how these proposed rules will affect your business.
Employers often have questions about benefits they must maintain for employees who go on leave. Whether an employer must maintain a particular benefit will depend on a variety of factors, including the type of leave, the employer’s written policy, and federal and state laws. Request this Advisor for a chart of common types of leave under federal laws.
Employers that do not meet the requirements of the ACA need to be concerned about several potential penalties. Two significant penalties include the excise tax and the penalties that larger employers must pay if they do not meet their employer shared responsibility / play-or-pay obligations.
The Consolidated Omnibus Budget Reconciliation Act (COBRA) requires certain group health plans to make continuation coverage available to certain individuals who would otherwise lose group health plan coverage due to a qualifying event. Employers who go through business reorganizations, such as mergers and acquisitions (M&A), will need to know whether COBRA continuation coverage must be offered and whether the group health plan of the seller or buyer must provide COBRA continuation coverage.
Short-term, limited-duration insurance is a type of health insurance coverage designed to fill temporary gaps in coverage when an individual is transitioning from one plan or coverage to another plan or coverage. Request this Advisor to learn how the final rule will provide consumers with more affordable options for health coverage.
A plan sponsor’s requirements under federal law will vary depending on factors such as group health plan design, size, grandfathered status, and whether the plan is fully insured or self-funded. Request this helpful list of the main federal requirements that apply when a plan is fully insured and when a plan is self-funded, including plan documents and notices, the ACA, and government filings.
The Department of Labor issued a final rule that broadens the definition of “employer” and the provisions under which an employer group or association may be treated as an “employer” sponsor of a single multiple-employer employee welfare benefit plan and group health plan under Title I of the Employee Retirement Income Security Act (ERISA) that goes into effect August 20, 2018. Want to be sure you’re adequately informed?
Beginning in late 2017, the IRS started sending Letter 226-J to multiple large employers who were required to offer health coverage to fulltime employees in calendar year 2015. What is Letter 226-J, and how should your clients respond?
Under the 21st Century Cures Act, certain small employers may reimburse individual health coverage premiums up to a dollar limit through HRAs called "Qualified Small Employer Health Reimbursement Arrangements" (QSE HRAs). This Compliance Advisor covers frequently asked questions on the implementation and administration of QSE HRAs.
This Compliance Advisor reviews how employers typically set premiums for employees as well as contribution structures for different groups of employees. It also reviews the definitions of highly compensated and key employees for nondiscrimination purposes, as well as the consequences of violating HIPAA nondiscrimination rules and failing section 125 or 105(h) nondiscrimination tests.
This ACA Advisor reviews the 2017 draft forms and instructions and supplies an at-a-glance chart of all reporting requirements, as well as information on penalties for failure to file, 6055 requirements and instructions for certain boxes/lines on 1095C.
A health flexible spending account (FSA) is a pre-tax account used to pay for out-of-pocket health care costs for a participant as well as a participant's spouse and eligible dependents. This Compliance Advisor reviews rules related to eligibility, contributions, covered expenses and reimbursement under FSAs.
A dependent care flexible spending account (DCFSA) is a pre-tax benefit account used to pay for eligible dependent care services. This Compliance Advisor reviews which expenses are eligible for reimbursement under DCFSAs as well as rules related to qualifying individuals, contributions, and reimbursement amounts.
This Compliance Advisor explains the various rules governing the COBRA payment process, including grace periods, notification, premium payment methods, third party payments, and treatment of insignificant shortfalls.
This Compliance Advisor helps employers calculate COBRA premiums in several scenarios including multi-rate structures and single-rate structures with fully insured plans, methods to use for self funded plans, as well as premium calculation with Health FSAs and HRAs.
Government and church plans do not need to comply with ERISA. This Compliance Advisor helps employers understand the definition of a church plan and the three-factor test that determines if a plan meets ERISA's "church plan" exception.
The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires group health plans to provide notices to covered employees and their families explaining their COBRA rights when certain events occur. This Compliance Advisor reviews the different timeframes and requirements for initial, qualifying event, election, early termination and unavailability notices under COBRA (as well as special rules for multiemployer plans).
This Compliance Advisor covers the five circumstances when the COBRA coverage period may be extended beyond the typical 18 or 36 months.
The Consolidated Omnibus Budget Reconciliation Act of 1985 (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 Advisor focuses on the seven triggering events that could cause an employee, the employee's spouse or dependent children to lose coverage and become eligible for COBRA continuation coverage.
The Section 125 cafeteria plan regulations and the Patient Protection and Affordable Care Act (ACA) require employers to take certain actions when an employee reduces hours. This Compliance Advisor answers the top three most common questions about coverage requirements.
This Compliance Advisor provides extensive guidance on the nondiscrimination tests required for self-insured medical reimbursement plans, including the purpose and types of testing, who is defined as a highly compensated individual, how the tests are applied, when to test, and what to do if you fail the test (including excess reimbursement examples).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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?
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.