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IRS Offers Help with ‘Pay or Play’ Proposal

The IRS kicked off 2013 with a little relief for some employers under the Patient Protection and Affordable Care Act (PPACA). The proposed guidance eases some of the penalties for larger employers who fail to provide adequate health care coverage for all their full-time employees. The PPACA “pay or play” penalty will not apply as long as the employer covers at least 95% of their full-time employees and their dependents up to age 26. The proposed guidance clears up questions that have lingered since the inception of the law in 2010. While the “pay or play” penalty doesn’t go into…

IRS Proposes Regulations on Employer Penalty

The Internal Revenue Service has released proposed regulations on the health care reform employer “shared responsibility” penalty provision. This is the penalty on “large” employers (those with at least 50 full-time or full-time equivalent employees) that do not provide affordable minimum essential coverage for full-time employees and their dependents and have at least one full-time employee who receives subsidized Exchange coverage (new Internal Revenue Code section 4980H, enacted as part of the Patient Protection and Affordable Care Act of 2010 as amended by the Health Care and Education Reconciliation Act of 2010). The IRS also posted on its website a…

DOL Begins Auditing Group Health Plans

Employers that have had their group health plans audited by the Employee Benefits Security Administration (EBSA, the arm of the U.S. Department of Labor that enforces Title I of ERISA) are aware of the broad nature of the document requests and compliance reviews carried out under these audits. The EBSA has updated its audit protocols to include a review of plans’ compliance with the Patient Protection and Affordable Care Act (PPACA), the Genetic Information Nondiscrimination Act (GINA), and wellness programs, in addition to the laundry list of other federal benefits laws pertaining to group health plans. An uptick in PPACA enforcement appears…

Rules May Create Win-Win for Firms, Workers

New proposed federal regulations on wellness programs may deliver a healthy shot in the arm for employer-sponsored initiatives. Just before Thanksgiving, the federal government released a flurry of guidance regarding the PPACA. One set of proposed rules defines the value of wellness program incentives. The proposed rules would increase the maximum reward or penalty for wellness incentives from 20% of the total cost of the coverage to 30% beginning in 2014. They also would increase the ceiling on rewards for tobacco cessation programs to 50 percent of the cost of coverage. These richer incentives likely would encourage more employees to…

IRS Issues Three Proposed Regulations Addressing Open Issues Under PPACA

The following is a summary of proposed regulations. Some or all of the provisions may change when final rules are issued. On Nov. 20, 2012, the Department of Health and Human Services issued three sets of proposed rules that provide some of the needed details on how PPACA will probably unfold.  The proposed rules address: Wellness programs under PPACA Essential health benefits and determining actuarial value Health insurance market reforms All three rules are still in the “proposed” stage, which means that there may – and likely will – be changes when the final rules are issued.  There is a 30-day public…