To provide employers sufficient time to expand their health plans to add dependent coverage, the proposed regulations provided that any employer that takes steps during its plan year toward satisfying the dependent coverage requirement will not be liable for any employer shared responsibility penalty solely on account of a failure to offer coverage to the dependents for that plan year. Under the regulations, this relief is extended to plan years that begin in It applies to employers for the plan year with respect to plans under which:.
The relief is not available if the employer had offered dependent coverage during either of those plan years and later dropped that off of coverage. If coverage was offered to some, but not all, dependents during the or plan year, the relief as extended applies only with respect to dependents who were not offered coverage at any time during the or plan year. In addition, the relief is available only of the employer take steps during the or plan year or both to extend coverage under the plan to dependents not offered coverage during the or year or both.
The proposed regulations included transition relief for purposes of determining full-time employee status in The final regulations extend this transition relief to apply, on a one-time basis in preparing for , for employers using the look-back measurement method to determine full-time status. Thus, for purposes of stability periods beginning in , employers may adopt a transition measurement period that:.
This transition guidance applies to a stability period beginning through the end of that stability period including any portion of the stability period falling in , and applies to individuals who are employees as of the first day of the transition measurement period. For employees hired during or after the transition measurement period, the general rules for new employees under the look-back measurement method apply. For more information on the employer shared responsibility regulations, see the most recent IRS Questions and Answers.
Get the latest healthcare compliance, business insurance and personal insurance news in your inbox. She works closely with Employee Benefits Consultants and Account Executives to provide clients with the tools and information to remain compliant. Judy provides timely education, guidance and conveys the requirements and intricacies of new legislation in a practical fashion. Employers, of course, will be thrilled to be spared the mandate for one more year. Democratic politicians, similarly, will be glad to have this not hanging over their heads for the mid-term election.
The wild-card is left-wing activists. The employer mandate is bad policy and should be eliminated.
But the unilateral way the WH is doing it isn't good. Health wonks of every persuasion, myself included, have long argued that the original sin of the U. If you like Obamacare, and you want it to work, you don't need the employer mandate. The heavily Democratic legislature overrode his veto. Even if the Obama administration's delay lasts for only one year, that delay will give firms time to restructure their businesses to avoid offering costly coverage, leading to an expansion of the individual insurance market and a shrinkage of the employer-sponsored market.
Remember that the administration is not delaying the individual mandate, which requires most Americans to buy health coverage or face a fine.
But delaying the employer mandate could lead, ultimately, to its repeal, which would do much to transition our insurance market from an employer-sponsored one to an individually-purchased one. Indeed, earlier this year, a bill to do just that was introduced by Rep. Charles Boustany R. Lamar Alexander R. Orrin Hatch R. Over the past several months, the Administration has been engaging in a dialogue with businesses - many of which already provide health coverage for their workers - about the new employer and insurer reporting requirements under the Affordable Care Act ACA.
The Administration is announcing that it will provide an additional year before the ACA mandatory employer and insurer reporting requirements begin. Here is some additional detail. Once these rules have been issued, the Administration will work with employers, insurers, and other reporting entities to strongly encourage them to voluntarily implement this information reporting in , in preparation for the full application of the provisions in We recognize that this transition relief will make it impractical to determine which employers owe shared responsibility payments under section H for During this transition period, we strongly encourage employers to maintain or expand health coverage.
It should be repealed. Taxpayers with coverage through the FFM may also be able to find a copy of the A at their healthcare.
The information on the A is necessary for taxpayers to be able to complete the form to reconcile the tax credits they received with those to which they were entitled. Individuals who were not insured at all for the entire year, for example, will not receive one of these forms.
Only individuals who worked for large self-insured employers will receive a C. It is also possible that a taxpayer might receive more than one of the forms; for example a person who changed employers or changed from employer to marketplace coverage over the course of the year might receive multiple or different forms. The fact that an individual receives a B or C does not necessarily mean that the individual must file a tax return. An individual who received a A, however, will in most instances have to file a tax return to reconcile advance premium tax credits received with premium tax credits actually owed.
None of the information forms are filed with the tax return.
But taxpayers should hold onto all of them for their records as is true with any important tax document. This document in fact includes two reports. The first report consists of a compliance review focused on policies and procedures and operational testing for 23 insurers in 15 federally facilitated states.
It addresses vehement complaints from employer groups about the administrative burden of reporting requirements, though it may also affect coverage provided to some workers. Andi Parkinson. A final working paper focuses on the effect of the ACA coverage expansion on part-time work and retirement decisions among older workers. However, the published work, of necessity, used only early years of data, so additional research is needed to follow up on these studies. Kumar Shray. The final rule clarifies that the initial measurement period need not be based on calendar months, although the stability period must be based on calendar months. Crnc Navidad.
The second report summarizes reviews of 1, notices regarding the renewal or discontinuance of a product including qualified health plans sent out by 42 insurers in the federally facilitated marketplace FFM. The compliance review examined compliance with regulatory requirements in 13 areas: casework review policies, issuer oversight of affiliated agent and broker compliance, delegated and downstream entities, enrollment periods for qualified individuals, enrollment process for qualified individuals, marketing and benefit design, health plan applications and notices, record retention, network adequacy standards, qualified health plan issuer participation standards, rating variations, termination of coverage for qualified individuals, and compliance plans.
The review classified results with respect to each subject area for each insurer into four categories: no policy or procedure; policy not in effect; incomplete policy; and failure of operational testing, which is to say processes or documentation did not fully reflect policies in effect. During and insurers in the FFM were subject to a good faith enforcement policy, focused on education rather than enforcement so there is no indication that enforcement actions were taken against any of the insurers.
The compliance reviews were began in April of and included nine on-site reviews and 14 desk reviews. They are thus more than a year old and were conducted at a time when insurers were still struggling with a multitude of new requirements. They are unlikely to reflect the current state of compliance. The reviews were very focused on documentation and data. The results of the reviews will be used for insurer education and technical assistance, updating regulations and guidances, updating compliance protocols, and policy and operations.
They will also help insurers achieve better regulatory compliance.
The most widespread problems were identified with respect to oversight of agents and brokers, where 19 of the 23 insurers did not have policies or procedures in effect to identify that affiliated agents and brokers had completed all FFM registration requirements prior to being compensated for enrollments. Thirty-nine percent of insurers had incomplete still in draft form policies with respect to some agent and broker issues, 17 percent had policies that were not in effect, and 78 percent had operational issues identified by testing or review of insurer procedures.
By contrast, only two of 23 insurers had incomplete marketing non-discrimination policies or policies not yet in effect. All insurers had policies in place with respect to taglines for people with disabilities or language access problems, but 16 of 23 insurers had operational issues, that is they had not actually included the taglines in their notices.
CMS found multiple problems with respect to lack of policies and procedures, incomplete policies and procedures, and policies not in effect with respect to FFM-specific enrollment policies, policies for processing and reconciling premium tax credit and cost-sharing reduction payments, and policies for accepting payments from third-party organizations. CMS found only one instance where an insurer had failed to report a security breach.
Network adequacy review focused on provider directories and on policies for access to out-of-network providers. Here 48 percent did not have policies in effect for the entire year, 39 percent had incomplete policies, 13 percent lacked out-of-network policies, and 30 percent had operational findings, including findings of provider directory deficiencies.
The separate notice review report examined the notices that insurers must send out when they renew or discontinue coverage. It focused on the general format and content of notices, the timeliness of notices, the accuracy of identification of the notice of recipient, and evaluation of the deductible, maximum out-of-pocket, and cost-sharing changes for eight benefit types communicated in notices.