February 5, 2016
Employee Benefits & Executive Compensation
Self-Funded Plan Subrogation
The U.S. Supreme Court has held that self-insured health plan may not exercise reimbursement rights against a plan participant after settlement proceeds recovered by the participant from a third party have been spent or otherwise “dissipated.” The court concluded that the equitable remedies available under ERISA did not include a right to obtain payment from the participant after the settlement dollars were no longer in an identifiable fund.
January 29, 2016
Employee Benefits & Executive Compensation
IRS publishes booklet on reporting “minimum essential” group health plan coverage provided to individuals
The IRS issued a January 2016 version of Publication 5215 in the form of a two-page booklet, which summarized how employers, insurers, and other similar plan sponsors should report “minimum essential” group health plan coverage provided to individuals using Form 1095-B. The booklet covered only ACA reporting requirements under Form 1095-B; it did not address Form 1095-C for which large employers could report minimum essential coverage concurrently with the offers of coverage made to full-time employees. The booklet directed taxpayers to the IRS ACA web page for employer-specific information and forms, recent guidance concerning extended deadlines, current instructions, and updated Q&A guidance.
January 22, 2016
Employee Benefits & Executive Compensation
Wellness program survives ADA challenge
A federal judge in Wisconsin denied the EEOC’s challenge to a wellness program maintained by Flambeau, Inc. The wellness program required employees to complete a health risk assessment and a biometric screening as a condition to obtaining coverage under the employer’s group health plan. The EEOC alleged that the program violated the ADA’s prohibition against involuntary medical examinations and disability-related inquires. But, following the rationale in Seff v. Broward County, 691 F.3d 1221 (11th Cir. 2012), the court concluded that the ADA’s underwriting safe harbor applied to the wellness program, so the program did not violate the ADA.
January 15, 2016
Employee Benefits & Executive Compensation
In Notice 2015-87, the IRS presents 26 questions and answers about a broad array of topics impacting employer-sponsored health benefit programs. The Notice begins with health reimbursement arrangements (HRAs) and builds upon several existing sources of guidance relating to integration with other group health plans and employer reimbursement of premium expenses. Other highlights include the application of various fringe benefits to the adjusted 9.5% affordability threshold, clarification of COBRA continuation coverage related to unused health flexible spending arrangement (health FSA) funds and permissible conditions on carryover amounts. There is some elaboration on penalty relief for employers who make a good faith effort to comply with the ACA reporting requirements of Forms 1094 and 1095, at least with respect to offers of coverage made during 2015.
January 8, 2016
Employee Benefits & Executive Compensation
Form 1095 Reporting Delay
Large and small employers who are required to report group health plan coverage on Forms 1094 and 1095 will have a short reprieve in early 2016, according to IRS Notice 2016-4. Individual statements to plan participants reported on Form 1095-B or 1095-C were originally due by February 1, 2016, but the deadline has been extended to March 31, 2016. The deadline for transmittal forms reported to the IRS on Form 1094-B or 1094-C (and the accompanying Forms 1095) been extended to June 30, 2016 (if filing electronically) and to May 31, 2016 (if filing in hardcopy).
December 18, 2015
Employee Benefits & Executive Compensation
The IRS has released Instructions to Form 8921, Credit for Small Employer Health Insurance Premiums. Since 2013, the tax credit is available only to employers who offer their employees coverage through a Small Business Health Options Program (SHOP) Marketplace (there are exceptions that apply to certain employers in Iowa, Washington, and Wisconsin). In general, only employers who have fewer than 25 full-time equivalent employees, who pay them less than $52,000 average annual wages, and who pay for at least 50% of their health insurance premium will qualify. For employers meeting all of these requirements, the credit amounts to a maximum 50% of premiums paid (35% for tax-exempt employers). The Instructions also contain an impressive 20-page listing of the average small group premiums in each county in each state for tax years beginning in 2015.
Disclaimer:
These employee benefits “Bytes” are prepared on behalf of the American Bar Association Health Law Section, and are part of a weekly “Health Law Byte” e-mail publication that is available to ABA members. The weekly HL Byte publication includes updates from the other ABA Health Law Interest Groups: •Business & Transactions, •eHealth, Privacy & Security, •Employee Benefits & Executive Compensation, •Healthcare Facility Operations, •In-House Counsel Sub-Interest Group, •Healthcare Fraud & Compliance, •Healthcare Litigation & Risk Management, •Life Sciences, •Managed Care & Insurance, •Payment, & Reimbursement, •Physician Issues, •Public Health & Policy, •Tax & Accounting. If you are interested in this and other ABA Health Section benefits please visit: http://www.americanbar.org/groups/health_law.html