2015 Compliance Checklist

The Affordable Care Act (ACA) has made a number of significant changes to group health plans since the law was enacted over four years ago. Many of these key reforms became effective in 2014, including health plan design changes, increased wellness program incentives and reinsurance fees.

Additional reforms take effect in 2015 for employers sponsoring group health plans. In 2015, the most significant ACA development impacting employers is the shared responsibility penalty and related reporting requirements for applicable large employers. To prepare for 2015, employers should review upcoming requirements and develop a compliance strategy.

This Legislative Brief provides a health care reform compliance checklist for 2015. Please contact Clark & Associates of Nevada, Inc. for assistance or if you have questions about changes that were required in previous years.

Download the PDF version of the 2015 Compliance Checklist.

Employer Reporting of Health Coverage: Code Sections 6055 & 6056

The Affordable Care Act (ACA) created new reporting requirements under Internal Revenue Code (Code) Sections 6055 and 6056. Under these new reporting rules, certain employers must provide information to the IRS about the health plan coverage they offer (or do not offer) to their employees.

On July 24, 2014, the Internal Revenue Service (IRS) released draft versions of the following forms that employers will use to report under Sections 6055 and 6056:

  1. Form 1094-B: Transmittal of Health Coverage Information Returns;
  2. Form 1095-B: Health Coverage;
  3. Form 1094-C: Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Return; and
  4. Form 1095-C: Employer-Provided Health Insurance Offer and Coverage.

Forms 1094-C and 1095-C will be used by applicable large employers (ALEs) that are reporting under Code Section 6056. Forms 1094-B and 1095-B will generally be used by entities reporting as health insurance issuers or carriers, sponsors of self-insured group health plans that are not reporting as ALEs, sponsors of multiemployer plans and providers of government-sponsored coverage under Section 6055. However, a reporting entity that is reporting under Section 6055 as an ALE will file under a combined reporting method, using Forms 1094-C and 1095-C.

According to the IRS, these draft forms are intended to help stakeholders (including employers, tax professionals and software providers) prepare for these new reporting provisions.

These forms are draft versions only, and should not be filed with the IRS. In addition, these draft forms should not be relied upon for filing. The IRS may make changes to the forms prior to releasing final versions.

Read more here: Health Care Reform Bulletin

Know Your Benefits: Preventive Care

According to the U.S. Centers for Disease Control and Prevention (CDC), 7 out of 10 Americans die each year from chronic diseases, many of which are preventable. When preventive care is used and illnesses and diseases are caught early enough, individuals can avoid or better control their health problems.

But what exactly is preventive care?

Preventive care is a type of health care whose purpose is to shift the focus of health care from treating sickness to maintaining wellness and good health. Preventive care occurs before you feel sick or notice any symptoms and is designed to prevent or delay the onset of illness and disease. The CDC asserts that treatment for chronic diseases works best when they are detected early.

Read the full article to learn more about preventive care.

Supreme Court Rejects Contraceptive Mandate for Some Companies

On June 30, 2014, the U.S. Supreme Court issued its ruling in two related cases challenging the Affordable Care Act’s (ACA) contraceptive coverage mandate. In these cases, three closely held for-profit corporations—Hobby Lobby Stores, Mardel and Conestoga Wood Specialties—argued that they should not be required to comply with the contraceptive mandate, because covering certain types of contraceptives under their health plans violates their sincere religious beliefs.

Read the Health Care Reform Bulletin for more details.

Final Rule Released on ACA Waiting and Orientation Periods

The Affordable Care Act (ACA) provides that group plans or health insurance issuers offering group health insurance coverage may not apply any waiting period that exceeds 90 days.

On June 23, 2014, the Departments of the Treasury, Labor and Health and Human Services (the Departments) released final regulations clarifying the maximum allowed length of any “reasonable and bona fide employment-based orientation period” as it relates to the waiting period limit.

The final regulations apply to group health plans and group health insurance issuers for plan years beginning on or after Jan. 1, 2015. Until then, employers can comply with the proposed regulations issued earlier this year.

Read the Health Care Reform Bulletin for more information about the final rule on ACA waiting and orientation period.

HIPAA Security Risk Assessment (SRA) Tool

The Department of Health and Human Services (HHS), through its Office of the National Coordinator for Health Information Technology (ONC), has developed an interactive Security Risk Assessment Tool (SRA Tool) to assist covered entities in performing and documenting Health Insurance Portability and Accountability Act (HIPAA) security risk assessments.

Although HHS designed the SRA Tool for health care providers in small- to medium-sized offices, it is a helpful resource for all covered entities and business associates to review their implementation of the HIPAA Security Rule.

Learn more about the HIPAA Security Risk Assessment Tool.

Pay or Play: Penalties for Failing to Offer Dependent Coverage

Beginning in 2015, the Affordable Care Act (ACA) generally requires applicable large employers to offer affordable, minimum value health coverage to their full-time employees (and dependents) or pay a penalty. These employer mandate penalties are also known as “shared responsibility” or “pay or play” penalties.

On May 13, 2014, the Internal Revenue Service (IRS) released FAQs addressing consequences under the employer shared responsibility rules for applicable large employers that offer health insurance coverage to all full-time employees, but do not offer dependent coverage.

In general, an employer will potentially be liable for an employer shared responsibility penalty only if a full-time employee:

  • Enrolls in coverage through an Exchange
  • Receives a subsidy to help pay for the Exchange coverage

Whether or not one or more of its full-time employees’ dependents enrolls through an Exchange and receives a subsidy does not affect an employer’s liability.

Read the full Health Care Reform Bulletin to learn more about:

  • Liability for Employer Shared Responsibility Penalties
  • Transition Relief for Offering Dependent Coverage in 2014

Consequences of Reimbursing Individual Insurance Premiums

Affordable Care Act (ACA) reforms that took effect this year may make purchasing health insurance in the individual market more accessible. Due to these reforms and the rising costs of health coverage, some employers have considered helping employees pay for individual health insurance policies instead of offering an employer-sponsored plan.

On May 13, 2014, the Internal Revenue Service (IRS) issued FAQs addressing the consequences for employers that do not establish a health insurance plan for their employees, but instead reimburse employees for premiums they pay for individual health insurance (either inside or outside of an Exchange). These arrangements are known as employer payment plans. Read the full Health Care Reform Bulletin to learn more about:

  • Background on Employer Payment Plans
  • Consequences for Employers

Reporting Requirements for Employers and Health Plans

The Affordable Care Act (ACA) created a number of federal reporting requirements for employers and health plans. The additional reporting is intended to promote transparency with respect to health plan coverage and costs. It will also provide the government with information to administer other ACA mandates, such as the large employer shared responsibility penalty and the individual mandate.

This Health Care Reform Legislative Brief brought to you by Clark and Associates of Nevada provides a summary of the following reporting provisions:

  • Form W-2 reporting
  • Applicable large employer health coverage reporting (Code 6056)
  • Reporting of healthy coverage by health insurance issuers and sponsors of self-insured plans (Code 6055)
  • Transparency in coverage reporting and cost-sharing disclosures
  • Quality of care reporting

Read the full Legislative Brief for more information.

Annual Deductible Limit Repealed for Small Health Plans

On April 1, 2014, President Obama signed the Protecting Access to Medicare Act of 2014 (Act) into law. The Act’s main provisions preserve the pay rate for physicians treating Medicare patients and delay the compliance deadline for converting to the updated International Classification of Diseases codes for at least one year. The Act also eliminates the Affordable Care Act’s (ACA) annual deductible limit that applied to health plans in the small group market. This change is retroactively effective to when the ACA was enacted in March 2010.

Quick Facts

  • For 2014 plan years, small group health plans were subject to annual deductible limits.
  • A new law repeals the ACA’s annual deductible limit, effective retroactively.

Read the full Health Care Reform Bulletin brought to you by Clark and Associates of Nevada to learn more about the repeal of annual deductible limit for small health plans.