MARKET STABILIZATION PROPOSED RULE ISSUED

OVERVIEW

On Feb. 15, 2017, the Department of Health and Human Services (HHS) issued a market stabilization proposed rule under the Affordable Care Act (ACA). The proposed rule includes new reforms intended to stabilize the individual and small group health insurance markets for the 2018 plan year.

Specifically, the rule proposes a variety of policy and operational changes to existing standards to stabilize the Exchanges, including changes to the annual open enrollment period and special enrollment periods.

ACTION STEPS

The proposed rule does not directly impact plans in the large group market. Instead, the proposed rule aims to stabilize the individual and small group health insurance markets in light of pending changes that may be made to the ACA.

If finalized, the changes made under the rule are proposed to be effective for the 2018 plan year.

Overview of the Proposed Rule

The market stabilization proposed rule for 2018 includes new reforms that are aimed at stabilizing the individual and small group health insurance markets. Specifically, this proposed rule would make changes to:

  • Special enrollment periods;
  • The annual open enrollment period;
  • Guaranteed availability;
  • Network adequacy rules;
  • Essential community providers; and
  • Actuarial value requirements.

The proposed rule also announces upcoming changes to the qualified health plan (QHP) certification timeline.

Open Enrollment Period for 2018

The rule proposes to shorten the upcoming annual open enrollment period for the individual market (for the 2018 plan year). Under a previous final rule, HHS established an open enrollment period for the 2018 plan year that runs from Nov. 1, 2017, through Jan. 31, 2018. However, that final rule sets a shortened open enrollment period for the 2019 and later plan years.

Under the proposed rule, this shortened open enrollment period would apply beginning with the 2018 plan year. Therefore, for the 2018 plan year, the open enrollment period would run from Nov. 1, 2017, through Dec. 15, 2017. This proposed change is intended to align the Exchanges with the employer-sponsored insurance market and Medicare, and help lower prices by reducing adverse selection.

Special Enrollment Period Pre-enrollment Verification

The proposed rule would expand pre-enrollment verification of eligibility to individuals who newly enroll through special enrollment periods (SEPs) in Exchanges using the federal platform. Previously, HHS allowed individuals to self-attest eligibility for most SEPs—and to enroll in coverage without further verification of eligibility—in an effort to minimize barriers for individuals to obtain coverage. However, this practice led to abuses of SEPs, allowing individuals to enroll in coverage that they would not otherwise qualify for.

To curb these abuses, the proposed rule would require HHS to conduct pre-enrollment verification of eligibility for all categories of SEPs for all new consumers in all Exchanges using the www.HealthCare.gov platform. According to HHS, this proposed change would help make sure that SEPs are available to all who are eligible for them, but will require individuals to submit supporting documentation—a common practice in the employer health insurance market. This is intended to help place downward pressure on premiums, curb abuses and encourage year-round enrollment.

Guaranteed Availability

The rule also proposes to address potential abuses of the ACA’s “guaranteed availability” rules, which require insurers to offer coverage to any eligible consumer who applies for coverage. HHS has previously interpreted this requirement to mean that an insurer cannot refuse enrollment to an individual even in cases where the individual has failed to pay outstanding premiums for any prior coverage. According to HHS, issuers have complained that some individuals are taking advantage of this provision by, for example, declining to make premium payments for coverage at the end of a benefit year, and then enrolling in new coverage for the next year, thereby avoiding having to pay outstanding premiums for the previous year’s coverage.

The proposed rule would attempt to curb these abuses by allowing an issuer to collect premiums for prior unpaid coverage before enrolling a patient in the next year’s plan with the same issuer. This is intended to incentivize patients to avoid coverage lapses.

Determining the Level of Coverage

The ACA requires QHPs offered through an Exchange to meet certain levels of actuarial value, referred to as “metal levels.” HHS regulations have allowed for a “de minimis” variation in the actuarial valuations used in determining the level of coverage of a plan to account for differences in actuarial estimates.

The proposed rule would make adjustments to the “de minimis” range used for determining the level of coverage, allowing a variation of -4/+2 percentage points (rather than +/- 2 percentage points) for all non-grandfathered individual and small group market plans that are required to comply with actuarial value. As a result, the proposed rule would provide greater flexibility to issuers in the actuarial value de minimis range to provide patients with more coverage options.

Network Adequacy

The proposed rule would provide greater flexibility to states in the review of QHPs. Under the proposed rule, HHS would defer to the states’ reviews in states with the authority and means to assess issuer network adequacy. According to HHS, states are best positioned to ensure their residents have access to high quality care networks.

Qualified Health Plan Certification Calendar

Finally, the proposed rule announces HHS’ intention to release a revised proposed timeline for the QHP certification and rate review process for the 2018 plan year. The revised timeline would provide issuers with more time to implement proposed changes that are finalized prior to the 2018 coverage year. Therefore, the revised timeline would give issuers flexibility to incorporate benefit changes and maximize the number of coverage options available to patients.

 

Source: U.S. Department of Health and Human Services,
Centers for Medicare & Medicaid Services

Click Here for the full article: Market Stabilization Proposed Rule Issued 2-20-17-1

CONGRESS CLEARS PATH FOR ACA REPEAL

OVERVIEW

On Jan. 13, 2017, the U.S. House of Representatives passed a budget resolution for fiscal year 2017 to begin the process of repealing the Affordable Care Act (ACA).

The budget resolution—which was approved by the U.S. Senate on the preceding day—does not, itself, repeal the ACA. However, any budget reconciliation bill drafted as a result of the resolution is likely to include a number of provisions to repeal—and possibly replace—at least some ACA provisions.

HIGHLIGHTS

  • Congress approved a budget resolution to begin the process of repealing the ACA.
  • The budget resolution will be used to draft budget reconciliation legislation to repeal certain ACA provisions.
  • A full repeal of the ACA cannot be accomplished through the budget reconciliation process.

IMPORTANT DATES

January 13, 2017 – Congress approves a budget resolution for fiscal year 2017, which begins the process of repealing the ACA.

January 27, 2017 – Targeted deadline for drafting a budget reconciliation bill including repeal provisions

ACTION STEPS

This budget resolution is a nonbinding spending blueprint that is used to create federal budget legislation through a process called “reconciliation.” As a result, it does not need presidential approval, and does not become law.

House and Senate committees have targeted Jan. 27, 2017, as the deadline to draft a budget reconciliation bill following the budget resolution, although some have indicated that the process may take longer. Once drafted, a reconciliation bill can be passed by both houses with a simple majority vote.

Overview

Because both the House and Senate have approved the budget resolution, committees from both chambers will now begin the process of drafting repeal legislation. If this legislation is passed in both the Senate and the House by at least a simple majority vote, it would then go to President Donald Trump for approval.

Republicans have given some indication as to what this repeal legislation may include, although many questions still remain. At this time, Republicans have not agreed on a plan to either repeal or replace the ACA.

However, a full repeal of the ACA cannot be accomplished through the budget reconciliation process. A budget reconciliation bill can only address ACA provisions that directly relate to budgetary issues—specifically, federal spending and taxation. A full repeal of the ACA must be introduced as a separate bill that would require 60 votes in the Senate to pass.

ACA Provisions That May Be Affected

Because this repeal is taking place as part of a budget reconciliation, Congress cannot repeal any ACA provisions that are not related to the federal budget (for example, the requirement to cover young adults to age 26 or the prohibition on pre-existing condition exclusions).

However, many of the ACA’s tax and spending provisions are likely to be affected. This may include a number of key ACA provisions, such as:

  • The individual mandate-The ACA’s individual mandate requires most individuals to obtain acceptable health insurance coverage for themselves and their family members or pay a penalty. Because this provision is enforced as a tax, it is a key target for repeal through the budget reconciliation process.
  • The employer shared responsibility rules-The ACA’s employer shared responsibility rules require applicable large employers to offer an acceptable level of health coverage to full-time employees (and their dependents) or pay a penalty. This provision is also enforced as a tax, and therefore, is also a key target for repeal through the budget reconciliation process.
  • Federal Exchange subsidies for low-income individuals-The ACA created health insurance subsidies to help eligible individuals and families purchase health insurance through an Exchange. These subsidies have long been a target for opponents of the ACA, and are currently being challenged in federal court. Therefore, it is likely that the budget reconciliation bill will include provisions affecting these subsidies.

Looking Ahead

Despite Democratic opposition, Republicans have enough votes in both the Senate and the House to pass a budget reconciliation bill to repeal aspects of the ACA. In addition, President Trump has vowed to approve legislation repealing the ACA.

Nevertheless, there is growing concern over the impact that a full or partial repeal of the ACA would have on the American public. Although Republicans have expressed an intent to enact a repeal and replacement simultaneously, members of both parties have concerns over whether that may be possible.

Click Here to download the full article: Congress Clears Path for ACA Repeal 1-18-17

Protecting Your Interests: Understanding Worker’s Compensation Employee and Employer Perspectives

Understanding Workers Compensation

Apart from salaries, employee benefits are the largest employee-related expense most businesses pay. The important thing to understand is that worker’s compensation isn’t a benefit. Under Nevada law, it’s a requirement for all companies with 1 or more employees. More importantly, it was designed to protect the interests of employees and employers equally.

Under the worker’s compensation system, employers are required to purchase insurance that provides benefits to employees who suffer work-related injuries and illnesses. The system creates an equitable compromise between employers and employees. Workers get benefits regardless of who is at fault. In return, employers are largely indemnified from lawsuits by injured or sick employees seeking financial awards for pain and suffering, mental anguish, or other non-direct or immediate conditions.

Benefits to employees in exchange for their forfeiture of rights to sue his or her employer for negligence is the basis of worker’s compensation. The compromise between guaranteed coverage, and the lack of litigious recourse is often referred to as the ‘compensation bargain’. And generally, it’s thought to be a very fair bargain for both sides.

Remunerative damages for pain and suffering, and employer negligence are generally not available in workers’ compensation plans. Negligence is therefore generally a non-issue in such cases. The denial of recourse to abuse claims is an opportunity all employers should be happy about. Monthly premiums for worker’s compensation pale in comparison to upheld claims of employer negligence.

What to Do: The Truly Important Things

Employees injured at work must notify their employers and seek medical treatment immediately. Failure to do so adversely affects the dispensation of benefits. Written notice to employers must be furnished within7 days of an accident or injury. For occupational disease or chronic conditions, the clock starts ticking as soon as it’s realized that the condition was caused by work. Employers will provide their employees with the necessary form to report claims (Form C-1). Delay in giving notice, or failing to report entirely can often lead to the denial of a worker’s compensation claim.

Permanent vs Partial Disability

Workers who are totally disabled will receive two-thirds of their average monthly wages for as long as the disability lasts. Certain injuries, such as total blindness or amputation of both legs, are so severe that they are considered total permanent disabilities. For permanent disability to apply, the injury must be sufficiently extreme as to prevent a worker form obtaining gainful employment ever again.

Temporary Disability

Temporarily disabled workers will be eligible to receive temporary total disability benefits. Temporary total disability payments are two-thirds of average monthly wages with a ceiling maximum. Beneficiaries can continue to receive temporary disability benefits until a doctor declares maximum medical improvement (MMI), meaning that recovery has plateaued and the condition is not likely to improve.

In partial disability situations, an employee’s doctor will make assess a percentage of overall impairment, from 1% to 100%. In such cases, 6% of a worker’s average monthly wage for every 1% of impairment is provided. Accordingly, a disability rating of 50%, will award 30% of an average monthly wage.

What About Denied Claims?

If a workers’ comp claim is denied, or the insurance company is disputing any portion of a claim, an employee has the right to appeal under Nevada law. A Hearing Officer will hear from both sides and issue a decision in the case. If that decision is disagreeable to either party, another appeal may be filed with an Appeals Officer within 30 days.

At the End of the Day

Worker’s compensation insurance is beyond reasonable given the potential claims it obviates. Perhaps the most intangible of its benefits is the sense of security it affords covered team members. Workers evaluate their employers in the same way employers evaluate them – what are they getting in exchange for their time or money. Knowing they and their families are safe, regardless of what happens on the job, is an incalculable booster to their morale, productivity and retention – all of which save employers great sums of money in the long run.

Lost Life Insurance Policies and Annuities – How to Find Them

A recent finding by Consumer Reports states that each year in this country about $1 Billion of life insurance policy benefits go unclaimed. For a cash-strapped and debt-burdened middle class, that’s quite a sum to leave in the pockets of our nation’s insurers. Fortunately for Nevadans, the Nevada Division of Insurance and the National Association of Insurance Commissioners (NAIC) have teamed up to help consumers find lost insurance policies. Collectively, we Americans forget about and lose a billion dollars of life insurance entitlements each year – a sum greater than the annual GDP of 26 different countries.

The NAIC’s Life Insurance Policy Locator provides nationwide access and assistance with finding a deceased person’s life insurance policy and annuities. This new tool builds on policy locator programs developed separately in several states before this launch.

Meet the State of Nevada Division of Insurance

We typically don’t think about insurance until we need to. Most us have what might be described as a ‘detached’ or ‘decidedly tolerable’ relationship with our insurers to put it in the best light. It’s important to acknowledge the organization that quietly serves to safeguard ordinary Nevadans’ interests and monitor the practices of insurers.

The State of Nevada Division of Insurance, a division of the Nevada Department of Business and Industry, protects the rights of Nevada consumers and regulates Nevada’s $13 billion insurance industry. The Division of Insurance has offices in Carson City and Las Vegas. In 2015, the Division investigated more than 3,200 consumer complaints and recovered nearly $5 million on behalf of consumers. For more information about the Division of Insurance, visit doi.nv.gov or download the Division’s smartphone app NDOI Connect available on the Apple App Store and Google Play.Bottom of Form

Most of us wouldn’t have a clue about how to find a lost policy and claim annuities. The Policy Locator developed by the NAIC simplifies the process for consumers and insurance companies alike, thereby reducing time to payout and avoiding hassle.

The way the locator tool works is by sending out encrypted consumer requests to participating insurers. The insurers then compare inbound requests with policyholder information find matches. These matches are in turn communicated to state insurance departments through the locator tool. Insurance companies then contact beneficiaries or their authorized representatives.

Nevadans can access this tool by visiting the Division’s website at http://doi.nv.gov/Consumers/

Click on the Life Insurance & Annuities tab or use this link:

http://doi.nv.gov/Consumers/Life_Insurance_and_Annuities/Life_Insurance___Annuity_Policy_Locator/

Over the last six years, state insurance regulators investigating unclaimed life insurance benefits have identified and returned $6.75 billion in proceeds to U.S. consumers, so the program is working phenomenally. If you suspect that you’ve lost a policy and are eligible for annuities, please use the resources above to locate and receive the benefits to which you are entitled.

ACA COMPLIANCE BULLETIN

Final 2018 Notice of Benefit and Payment Parameters

On Dec. 16, 2016, the Department of Health and Human Services (HHS) released its Final Notice of Benefit and Payment Parameters for 2018. This rule describes benefit and payment parameters under the Affordable Care Act (ACA), applicable for the 2018 benefit year. Updates standards included in the rule relate to:

  • Annual limitations on cost-sharing
  • The individual mandate’s affordability exemption; and
  • special enrollment periods in the exchange.

The final rule also enhances standards for state-based Exchanges on the federal platform (SBE-FPs) and creates three new sets of six standardized benefit plan options in the Federally Facilitated Exchange (FFE).

Finally, the rule provides additional clarity on the special enrollment periods available through the FFE, and updates the ACA’s current child age rating structure to provide a more gradual transition when individuals move from age 20 to 21.

Click Here for the full document:  Final 2018 Notice of Benefit and Payment Parameters

Broker Insights – The Benefits Market Under President-Elect Trump

Presidential Republican candidate Donald Trump’s victory in the election, along with Republican majorities retained in both the Senate and House of Representatives, will likely have a significant impact on the employee benefits industry, as well as a number of compliance issues over the next four years. This piece provides an overview of some of the changes to come. After hard-fought campaigns by both candidates, Donald Trump was elected the 45th president of the United States on Nov. 8, 2016, and will be inaugurated into office on Jan. 20, 2017. During his campaign, Trump called for a repeal of President Barack Obama’s health care reform legislation, the Affordable Care Act (ACA). In addition, Trump’s victory raises uncertainty over the future of other policies enacted under President Obama.

This Broker Insights piece serves as a high-level summary of some of the changes to come. However, like any election, how and if Trump’s campaigned platforms and promises will be achieved once he takes office remains to be seen. By being aware of the potential changes, though, you can better understand how the Trump administration may impact the employee benefits industry, which allows you to prepare your business and your clients for any potential changes. Please note that this list of potential changes is based on current expert opinion, research and formal statements released by the President-elect and the Republican Party.

This list is not exhaustive and is subject to change without notice as the new administration takes office. Because of the uncertainty, you and your clients should not make any substantial amendments to your benefits plans and be sure to look to Broker Briefcase for the latest updates.

 CLICK HERE for the full document: Benefits-Industry-Under-President-Elect-Trump

FINAL FORMS FOR ACA REPORTING RELEASED

Final Forms for ACA Reporting Released

The Internal Revenue Service (IRS) has released final 2016 forms for reporting under Internal Revenue Code (Code) Sections 6055 and 6056.

  • Forms 1094-B and 1095-B are used by entities reporting under Section 6055, including self-insured plan sponsors that are not applicable large employers (ALEs). Final 2016 versions of these forms and final instructions were released on Sept. 26, 2016.
  • Forms 1094-C and 1095-C are used by ALEs to report under Section 6056, as well as for combined Section 6055 and 6056 reporting by ALEs who sponsor self-insured plans. Final 2016 versions of these forms and final instructions were released on Sept. 30, 2016.

Minor changes were made to the forms, including the addition of two new “Offer of Coverage” codes for use on Form 1095-C.  The instructions also included some clarifications.

ACTION ITEMS

Employers should become familiar with the revisions to the forms. These final forms and instructions can be used for filing with the IRS in early 2017, for coverage in 2016.

Background

The Affordable Care Act (ACA) created new reporting requirements under Code Sections 6055 and 6056. Under these rules, certain employers must provide information to the IRS about the health plan coverage they offer (or do not offer) or provide to their employees. Each reporting entity must annually file all of the following with the IRS:

  • A separate statement (Form 1095-B or Form 1095-C) for each individual who is provided with minimum essential coverage (for providers reporting under Section 6055), or for each full-time employee (for ALEs reporting under Section 6056); and
  • A transmittal form (Form 1094-B or Form 1094-C) for all of the returns filed for a given calendar year.

Entities must also furnish related statements (Forms 1095-B or 1095-C, or a substitute form) to individuals.

Forms must be filed with the IRS no later than February 28 (March 31, if filed electronically) of the year following the calendar year to which the return relates. For calendar year 2016, forms are required to be filed with the IRS by Feb. 28, 2017 (or March 31, 2017, if filing electronically). The individual statements are due on or before January 31 of the year immediately following the calendar year to which the statements relate. Individual statements for the 2016 calendar year must be furnished by Jan. 31, 2017.

Key Changes

The 2016 forms and instructions are largely unchanged from 2015 versions. Most of the changes were made to provide additional clarification, rather than make substantive revisions. However, note the following items:

  • Waivers from Electronic Filing. The 2016 instructions state that reporting entities are encouraged to file Form 8508 requesting a waiver at least 45 days before the due date of the return, but no later than the return’s due date. The instructions also note that the IRS does not process waiver requests until January 1 of the calendar year that the returns are due. The 2015 instructions had indicated that waiver requests had to be filed at least 45 days before the due date of the returns.
  • Reporting Penalties. The 2016 instructions include adjusted penalty amounts for failures to file returns and furnish statements. The adjusted penalty amount is $260 per violation, with an annual maximum of $3,193,000.00 Penalty amounts can be increased or decreased, depending on the situation. Lower annual maximums continue to apply for small businesses.
  • Taxpayer Identification Number (TIN). Both Form 1095-B and Form 1095-C clarified that employers may report a Taxpayer Identification Number (TIN) instead of a Social Security number (SSN) for any covered individuals (except for employees listed in Part I of Form 1095-C).

2016 Final Forms 1094-B/1095-B and Instructions

Form 1094-B was not revised. The following revisions were made to Form 1095-B:

  • The language “Do not attach to your tax return. Keep for your records.” was added under the title of the form for the benefit of recipients.
  • Parts I and IV were updated to reflect that a taxpayer identification number (TIN) may be entered.
  • Line 9 (previously “Small Business Health Options Program (SHOP) Marketplace identifier, if applicable”) is now reserved and will be left blank. This field was previously included on Form 1095-B, but was not required to be completed for 2015.
  • The heading to Part II was revised to read “Information about Certain Employer-Sponsored Coverage” to clarify that Part II will be blank for some individuals with employer-sponsored coverage.

The instructions were revised to more clearly state the rules for reporting in situations where an individual is covered by more than one minimum essential coverage plan or program, such as an employer’s major medical plan and a health reimbursement arrangement (HRA). Separate reporting is not required for the HRA if the employee is also enrolled in a medical plan of the same employer.

The IRS also released additional proposed regulations under Section 6055 to clarify certain aspects of this reporting. Specifically, the Section 6055 proposed regulations:

  • Identify the entities that are responsible for reporting coverage under catastrophic health plans and the Basic Health Program (BHP);
  • Clarify the rules for reporting in situations where an individual is covered by more than one minimum essential coverage plan or program; and
  • Provide additional guidance regarding the reporting of Social Security numbers (SSNs) or other taxpayer identification numbers (TINs), including when truncation is allowed as well as changes to the SSN or TIN solicitation process under Section 6055.

2016 Final Forms 1094-C/1095-C and Instructions

The following changes were made to Form 1094-C:

  • On Line 22, Box B is designated as “Reserved.” For 2015, this box was used to indicate eligibility for the Qualifying Offer Method Transition Relief. This relief is not applicable for 2016.
  • The language “Section 4980H” was inserted before “Full-Time Employee Count for ALE Member” in Part III, Column (b) to remind reporting entitites that the Section 4980H definition of “full-time employee” applies for purposes of this column, not any other definition that an ALE may use for other purposes. The instructions contain clarification and an example illustrating this point.

The following changes were made to Form 1095-C:

  • New Codes 1J and 1K have been added for use on Line 14. The instructions contain information on using these codes:
    • Code 1J can be used if: (1) minimum essential coverage providing minimum value was offered to the employee; (2) minimum essential coverage was conditionally offered to the employee’s spouse; and (3) minimum essential coverage was not offered to the employee’s dependent(s).
    • Code 1K can be used if: (1) minimum essential coverage providing minimum value was offered to the employee; (2) minimum essential coverage was conditionally offered to the employee’s spouse; and (3) minimum essential coverage was offered to the employee’s dependent(s).
  • The heading on Line 15 was revised to read “Employee Required Contribution (see instructions).” The instructions include a new definition of this term, as described below, which is intended to clarify the amount to be entered on this line.
  • The 2015 Form 1095-C included a “Plan Start Month” box, which was optional for 2015, but was expected to be required for 2016 and beyond. The 2016 Form 1095-C provides that the “Plan Start Month” box will remain optional for 2016, but is expected to be mandatory for 2017.
  • Language regarding Part III, Covered Individuals, has been added to clarify that employers should enter information for all individuals enrolled in the self-insured coverage, including the employee.
  • Codes 1I and 2I are no longer applicable and have been reserved.
  • The language “Do not attach to your tax return. Keep for your records.” was inserted under the title of the form to inform the recipient that Form 1095-C should not be submitted with the return.
  • The 2016 Form 1095-C noted that the affordability percentage for employer-sponsored coverage is adjusted each year. Initially set at 9.5 percent, the affordability percentage increased to 9.56 percent for 2015 plan years, and 9.66 percent for 2016 plan years. For more information, visit IRS.gov.

The instructions for Forms 1094-C and 1095-C also contain the following clarifications or revisions:

  • Transition Relief. Several forms of transition relief were available to ALEs for 2015 under Sections 4980H and 6056, but only limited transition relief continues to apply in 2016. References to transition relief that applied only in calendar year 2015 have been removed. Descriptions of the remaining forms of transition relief have been amended to clarify for which months in 2016 the transition relief applies.
  • Aggregated ALE Groups. The instructions contain additional information on filing by ALEs that are part of an Aggregated ALE Group, including clarification that each member of the group must file regarding its own full-time employees. The instructions also include information and an example on filing related to employees who work for more than one member of an Aggregated ALE Group.
  • Authoritative Transmittal. ALEs must designate one Form 1094-C as the Authoritative Transmittal. The instructions include information and examples on the Authoritative Transmittal requirements.
  • Qualifying Offer Method. The instructions clarify that ALEs using the Qualifying Offer Method may, but are not required to, enter a safe harbor code on Line 16 when Code 1A is entered on Line 14. A Qualifying Offer is, by definition, treated as an offer that falls within an affordability safe harbor even if no code is entered on Line 16.
  • COBRA and other Post-employment Coverage. Clarifying language has been added on how to report offers of COBRA and other post-employment (non-COBRA) coverage. Offers of COBRA or other post-employment coverage to former employees (and their family members) should not be entered as offers of coverage on Line 14. However, an offer of COBRA coverage to an employee who remains employed should be entered as an offer of coverage.
  • The instructions state that references to 9.5 percent related to the coverage affordability calculation are applied as indexed for purposes of the premium tax credit. The percentage, as adjusted, is 9.56 percent for 2015, 9.66 percent for 2016 and 9.69 percent for 2017.
  • Employee Required Contribution. The instructions include a new definition of this term, which is intended to clarify the amount to be entered on Line 15 of Form 1095-C. The “Employee Required Contribution” is the employee’s share of the monthly cost for the lowest-cost self-only minimum essential coverage providing minimum value that is offered to the employee by the ALE. The instructions clarify that the employee share is the portion of the monthly cost that would be paid by the employee for self-only coverage, whether paid through salary reduction or otherwise, and include information for calculating this amount.
  • Substitute Statements. The instructions clarify that substitute statements furnished to individuals may be in portrait format. However, substitute returns filed with the IRS on paper must be printed in landscape format.
  • Code 1G. The instructions clarify that Code 1G applies for the entire year or not at all. Therefore, if Code 1G applies, an ALE must enter Code 1G on Line 14 of Form 1095-C in the “All 12 Months” column, or in each separate monthly box (for all 12 months).
  • Code 2C. The instructions clarify that Code 2C should not be entered on Line 16 of Form 1095-C for any month in which the employee enrolled in coverage that was not minimum essential coverage.
  • Affordability Safe Harbor Codes. The instructions clarify that an affordability safe harbor code (Code 2F, 2G or 2H) should not be entered on Line 16 of Form 1095-C for any month that the ALE did not offer minimum essential coverage to at least 95 percent of its full-time employees and their dependents (that is, any month for which the ALE checked the “No” box in column (a), Minimum Essential Coverage Offer Indicator, on Form 1094-C, Part III).

Additional Resources

The 2015 versions of these forms are also available on the IRS website:

These forms must have been furnished to individuals no later than March 31, 2016. Reporting entities must have filed these forms with the IRS no later than May 31, 2016 (or June 30, 2016, if filing electronically). The IRS announced that information returns under Sections 6055 and 6056 may continue to be filed after the filing deadline (both on paper and electronically). Employers that missed the June 30, 2016, deadline should continue to make efforts to file their returns as soon as possible.

The IRS will not assess penalties for late filing on reporting entities that have made legitimate efforts to file information returns, if they continue to make efforts and complete the process as soon as possible. In addition, penalties may be waived in some cases, for reasonable cause.

The IRS also previously released:

More Information

Please contact Clark & Associates of Nevada, Inc. for more information on reporting under Code Sections 6055 and 6056.

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What You Need to Know About Form 1095-C

If, at any time in 2015, you were a full-time employee of a large organization (usually a company that has 50 or more full-time people in their employ), you may receive a new tax form, Form 1095-C, early in 2016. Part-time employees of large organizations who work less than 30 hours per week may also receive this form. This form may be sent via email or post, or simply hand-delivered to you at work.

Why am I getting this new tax form?
Because Form 1095-C provides proof of health insurance coverage offered to you (and your family, as an extension) by your employer in 2015. If you had purchased health insurance coverage through the Health Insurance Marketplace and wish to claim premium tax credit, this kind of information will help determine whether you are eligible.

What kind of information is on the form?
Form 1095-C is divided into three parts:

  • Part I – This section contains employee and employer identifying information, like the employer’s address and EIN, the employee’s Social Security number, etc.
  • Part II – This section determines whether coverage was offered to you and your dependents, and also indicates the lowest monthly premium for self-only coverage that was offered to you in the past year.
  • Part III – This section lists the people in your household that were covered by health insurance and the periods they were covered. This part will only be completed if your employer’s insurance coverage wasn’t provided through an insurance company.

IMPORTANT: Save your Form 1095-C. This provides key information about your health insurance coverage; it will also help you fill out your tax return.

What if I switched jobs or didn’t enroll in my employer’s insurance?
If you were employed full-time by a large organization in 2015, you will be provided with a Form 1095-C regardless of whether you were offered health insurance coverage or if you elected to enroll in the benefits through your employer. If you worked full-time for several large employers in the past year, you will receive a Form 1095-C from each of them.

Will I need to file this form with my tax return?
No, you don’t need to. But, as mentioned earlier, it is beneficial to save this new tax form, because it provides information that can help you complete your income tax return for the year. The Internal Revenue Service (IRS) will receive its own copy for filing and comparison purposes.

It’s important to note that the form you receive may vary based on the status of your employment and the type of insurance your employer offers.

Download the full Employee Benefits Bulletin. If you would like to learn more about Form 1095-C or if you have any questions about Nevada health insurance options, contact Clark and Associates today!

Reasons to Get Health Insurance for Your Small Business Employees [Infographic]

As a business owner, you know how important it is to keep your employees happy, healthy, and productive. One way of doing that is to offer comprehensive health coverage. If you’re a small business owner in Nevada, you aren’t mandated to provide small business health insurance, but it may be worth your while to do so. Offering health insurance can help you attract and retain the best talent. Additionally, it can also help you save money on health care costs, since insurance providers can negotiate fees with hospitals, doctors, and other health care providers. Contrary to popular belief, small business health insurance in Nevada isn’t a waste of money. If your employees are happy and healthy, they are more productive. The more productive they are, the better for your bottom line.

Need more reasons to purchase health insurance for your small business employees? Check out this infographic. For more information or to get a quote, contact Clark & Associates today.

Nevada Small Business Health Insurance Infographic

Download “Small Business Health Insurance: Reasons to Buy Health Coverage for Your Employees” [Infographic]