Two federal appeals courts issued conflicting rulings on a key provision of the Patient Protection and Affordable Care Act (PPACA) relating to the availability of premium tax credits and cost-sharing subsidies on the federally facilitated exchanges. First, the U.S. Court of Appeals for the D.C. Circuit, in Halbig v. Burwell, overturned this provision, stating that PPACA does not authorize the Internal Revenue Service (IRS) to provide premium tax credits and cost-sharing subsidies for insurance purchased on the federally facilitated exchanges (as the law does for insurance purchased on state-established exchanges). Shortly thereafter, the U.S. Court of Appeals for the Fourth Circuit, in King v. Burwell, upheld the same PPACA provision, stating that PPACA does authorize the IRS to provide premium tax credits and cost-sharing subsidies on federally facilitated exchanges. Parties in both cases plan to appeal the rulings, and the cases appear to be headed to the U.S. Supreme Court, particularly with the circuit split.
Under health care reform (PPACA), a new nonprofit corporation was established, the Patient Centered Outcomes Research Institute (PCOR). This corporation will be funded in part by PCOR/CER (comparative effectiveness research) fees paid by certain health insurance issuers or plan sponsors of applicable self-insured health plans. Please note that Health reimbursement Arrangements (HRA) are categorized as a self-insured health plans unless, in rare occasions, it is determined to be an excepted benefit (i.e. for vision and dental expenses only) and are therefore subject to this fee.
On May 2, 2014, the Centers for Medicare and Medicaid Services (part of HHS) issued a bulletin to deal with Special Enrollment Periods (SEPs).
HHS is concerned that former Model COBRA Continuation Coverage Election Notices (Model Election Notices) published by the Department of Labor and other documents provided by employers did not address, or did not sufficiently address, Marketplace options for persons eligible for COBRA.
The concern? Persons eligible for COBRA and their qualified beneficiaries may have had insufficient information to understand that they cannot voluntarily drop COBRA and enroll in the Marketplace outside of Marketplace open enrollment.
As a result, in accordance with 45 CFR 155.420(d)(9), HHS is providing an additional special enrollment period based on exceptional circumstances so that persons eligible for COBRA and COBRA beneficiaries are able to select Qualified Health Plans (QHPs) in the Federally Facilitated Marketplace (www.healthcare.gov).
On May 2, 2014, EBSA released an advanced copy of proposed rulemaking, which will be published in the May 7, 2014, Federal Register. The guidance amends notice requirements for COBRA so as to better align PPACA and COBRA notice requirements and to add information relating to special enrollment rights in the state health insurance exchanges.
On April 21, 2014, CMS issued guidance, in the form of a frequently asked question (FAQ), clarifying how COBRA coverage impacts an individual's eligibility to enroll in the exchange and to receive a premium tax credit. As background, the open enrollment period for almost all exchanges ended March 31, 2014. Individuals may only enroll in the exchange midyear if they qualify for a special enrollment period due to a qualifying event. The FAQ clarifies that during the open enrollment period for the exchange, an individual who has voluntarily terminated his/her COBRA coverage (i.e., COBRA coverage has not been exhausted) will be eligible to enroll in a qualified health plan through the exchange.
San Francisco recently took a major step in helping both its hard-working citizens and the environment. On March 26, 2014, the SB 1339 Bay Area Commuter Benefits Program became official. Now the Bay Area Air District and the Metropolitan Transportation Commission (MTC) will be working together with their regional Bay Area commuter policy, which mandates that all employers with 50 or more full-time employees, offer commuter benefits to both full-time workers and those that work at least 20 hours a week. Employers have until September 30, 2014, to comply with the SB 1339 Bay Area Commuter Benefits Program.
Achieving lower commuting costs and climate protection without raising taxes.
March 26, 2014 - (Boston, MA) Today, the Metropolitan Transportation Commission approved Regulation 14 Rule 1 of the Bay Area Air Quality Management District, which requires a commuter benefit program to be in place for all employers that have 50 or more full-time employees in the nine-county Bay Area. This regulation is a result of SB 1339, which was signed into law by Governor Brown, requiring a pilot project to be in effect until January 2017. According to the text of the bill, SB 1339, the state believes that by requiring large employers to offer commuter benefit programs, it will encourage greater use of mass transit and vanpools. For those employees who already commute to work using mass transit, it will offer them significant tax savings. Participating employers will also reduce their tax burden. Employers will have until September 30, 2014, to comply with this regulation.
How employers can stay competitive… and retain talent
“Uncertainty” is not likely to warm the hearts of many CFOs and Finance VPs, and perhaps no aspect of corporate administration has a higher level of uncertainty than healthcare and benefits. As with pension plans, the administration of defined benefit health plans is best suited to those with a defiantly optimistic view of business trends or to companies certain that they will experience year-over-year gains to fund defined benefits indefinitely.
Qualified Transportation Fringe Benefits. For 2014, the monthly limit on the amount that may be excluded from an employee’s income for qualified parking benefits is $250 (a $5 increase from the 2013 limit of $245). The combined monthly limit for transit passes and vanpooling expenses for 2014 is $130 (a $115 decrease from the 2013 limit). [EBIA Comment: The substantial decrease is due to expiration of the temporary “rule of parity” that made the combined limit for transit and vanpooling the same as the parking limit for 2012 and 2013. Whether Congress will eventually extend the rule of parity to 2014 is uncertain.]
Moments ago, the Department of Treasury issued a press release and informational fact sheet announcing a major policy change relating to flexible spending accounts (FSAs) that has many positive implications for all FSA constituents – including administrators, employers and participants. The Department of Treasury has modified its FSA “use-it-or-lose-it” provision to allow a limited rollover of FSA funds.
On Friday, September 13, 2013 Treasury published Notice 2013-54 (Notice) which preserves all Health Reimbursement Arrangements (HRAs) that are integrated with an underlying group health plan but eliminates an employer's ability to use a stand-alone or other tax-favored arrangements, including Premium Reimbursement Arrangements or cafeteria plans, to help employees pay for individual health policies on a tax-free basis. In addition, the Notice addresses a number of specific topics related to flexible spending accounts (FSAs) and HRAs. As such, this Alert is the first of two covering Notice 2013-54 which spells out requirements for HRAs offered starting January 1, 2014. Treasury and IRS Notice 2013-54
On Friday, September 13, 2013 Treasury published Notice 2013-54 (Notice) which preserves all Health Flexible Spending Accounts (health FSAs) that are considered excepted benefits but eliminates an employer’s ability to use a stand-alone health FSA or other tax-favored arrangements, including Premium Reimbursement Arrangements or Health Reimbursement Arrangements (HRAs), to help employees pay for individual health policies on a tax-free basis. In addition, the Notice addresses a number of specific topics related to FSAs and HRAs. As such, this Alert is the second of two.
Health Savings Accounts are an integral component of the Consumer Directed HealthCare strategy. As HSAs gain mainstream acceptance in the marketplace it’s imperative that employers adopt an HSA solution that integrates with their core benefits offerings. Maintaining separation between the HSA and the underlying HDHP health plan will help avoid unnecessary disruption when the inevitable change of medical carrier occurs.
On May 8, 2013, the Employee Benefits Security Administration of the U.S. Department of Labor (“DOL”) issued Technical Release No. 2013-02 (“Release”) providing important guidance under the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (“Affordable Care Act”), with regard to the requirement that employers provide notices to their employees of the existence of the Health Insurance Marketplace (“Marketplace”), previously referred to as the “Exchange.”