Compliance – ACA & Other

At the center of the challenge is the Appropriations Clause of the Constitution.  Article I, Section 9, Clause 7 says, “No money shall be drawn from the Treasury, but in consequence of appropriations made by law.”

The lawsuit filed argues the administration is spending billions of dollars without the necessary appropriations from Congress.

The suit filed involves the fundamental question of executive power and Congress’s power of the purse. The issue is a provision of the health care law that requires insurance companies to reduce co-payments, deductibles and other out-of-pocket costs. The federal government reimburses insurers for the “cost-sharing reductions.” This type of assistance is different from the subsidies upheld by the Supreme Court last week. The subsidies, tax credits, help people pay insurance premiums.

The lawsuit challenges the Obama administration saying they did not receive, but needed, an appropriation to make these payments to insurance companies. Thus, President Obama requested the money as part of the budget he sent to Congress in April 2013, but Congress did approve the request. The administration began making the payments in early 2014, using money from a separate account established for tax refunds and tax credits.

In their lawsuit, House Republicans say, “Congress has not, and never has, appropriated any funds” for the cost-sharing reductions. The Obama administration argues that the House does not have standing to sue because its members have not suffered a concrete injury or specific harm. The case is “a generalized institutional dispute between the executive branch and one chamber of the legislative branch,” the Justice Department said.

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

UnitedhealthCare has provided two videos covering the basics of IRS section 6055 and section 6056 reporting to help give a better understanding of what the reporting is and what is required of employers, both fully insured and self-funded.

Section 6055 reporting supports the individual mandate.  It is the required reporting to the Internal Revenue Service of information relating to covered individuals that have been provided minimum essential coverage by health insurance issuers, certain employers and other entities that provide minimum essential coverage.

Section 6056 reporting supports the employer mandate. It is the required reporting to the IRS of information relating to offers of health insurance coverage by employers that sponsor group health plans.

Specifically, the videos cover:

• What are sections 6055 and 6056 reporting (click to view videos)
• When the provision becomes effective
• When reporting needs to be done
• Who is responsible to report
• UnitedHealthcare’s approach to supporting fully insured and self-funded groups

All content for this Blog was provided by UnitedhealthCare.

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

The ACA forms chart is voluntary for employers that wish to file in 2015 for 2014. The return and transmittal forms are to be filed with the IRS on or before February 28 (March 31 if filed electronically) of the year following the calendar year of coverage.

Here’s the IRS link for complete instructions.
http://tinyurl.com/mgzhyoc

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

The employer mandate tree easily breaks down what we see today and the changes taking place next year.

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

HHS recently finalized regulations to verify the annual out-of-pocket maximums for an individual in 2016 are limited to the annual limit for self-only coverage. This applies to all individuals, including each individual under family coverage. The regulation provides that the embedded out-of-pocket limit applies to all plans.

This embedded rule means that plans (including self-funded plans) will now have to have embedded out-of-pocket limits for each individual covered under family coverage. For example, using the 2016 limits, if a family plan has an annual out-of-pocket limit of $12,000 and one family member incurs an expense of $25,000, that family member would be responsible for expenses up to $6,850 (the self-only out-of-pocket limit), and the remaining $18,150 would be paid in full by the plan. Additional expenses incurred by that family member would be paid by the plan with no cost sharing for the remainder of the plan year.

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.