Producers
The only way for an employer to provide certain benefits tax-free to its employees, such as health, dental or vision insurance, is through a Cafeteria Plan, as defined under Section 125 of the Internal Revenue Code. The only way for an employer to have a Cafeteria Plan is by preparing a written plan document which meets the requirements of Code Section 125. Failure to have a written document, or failure to operate a Cafeteria Plan in accordance with the terms of Code Section 125, disqualifies the plan as a Cafeteria Plan and results in gross income to the participants. In other words, any participant in the plan will lose the tax favorable status of the benefits that he or should would have otherwise received.
The Affordable Care Act (ACA) requires certain entities to report information to the Internal Revenue Service (IRS) relative to health insurance coverage. The reporting is generally completed by insurance companies, government-run Exchanges and applicable large employers. The reporting helps the IRS enforce three key provisions of the ACA:
- Most U.S. citizens and lawfully present residents must have health insurance or pay a penalty. This is referred to as the Individual Mandate. The reporting helps the IRS understand who has health insurance coverage.
Group health plans typically make coverage available to current or former employees and their spouses and children. However, some employers extend coverage to certain groups of non-employees. The most common example would be letting a business owner participate in the plan. Most types of business owners aren’t classified as employees for tax purposes, but rather they are said to be self-employed.
Posted September 26th, 2016 in Producers, Employers, Individuals
The cornerstone of the Affordable Care Act (ACA) is arguably the Health Insurance Marketplaces, also referred to as the Exchanges. Effective 2014, previously uninsurable individuals could start enrolling in a health insurance plan without regard to their medical history, and people who had trouble affording coverage could receive subsidies to reduce their out-of-pocket costs and/or premiums if certain requirements could be met.
Posted September 19th, 2016 in Producers, Employers, Individuals
Employers must provide a written notice on an annual basis to any Medicare-eligible individuals who are covered under a group health plan that includes prescription drug coverage. The notice is required to include information as to whether the prescription drug coverage is considered to be creditable. In other words, is the prescription drug coverage at least as good as the standard Medicare Part D plan?
Today, September 13, 2016, marks the three-year anniversary of the release date for IRS Notice 2013-54, which ironically occurred on Friday the 13th. A few years back, benefits industry leaders thought employers could be deterred from adopting Health Reimbursement Arrangements (HRAs) since much of the guidance made changes to the types of HRAs that could be offered. Below is a snapshot of the (now) permissible types of HRAs.
Posted September 6th, 2016 in Producers, Employers, Individuals
The Affordable Care Act (ACA) continues to evolve. Here are 10 changes expected to take effect in 2017.
Posted August 29th, 2016 in Producers, Employers, Individuals
In 2013 and 2014 the word “exchange” was being used everywhere in the health insurance industry. Now, just a couple of years later, that term isn’t being used as frequently as it was just a couple years prior. Why? For one, the federal government decided the phrase “health insurance marketplace” or “marketplace” was what they would start calling their exchange. The media and general public also seem to associate the word “Obamacare” as being synonymous with the government-run exchanges. Additionally, private exchanges are not experiencing the growth rates that many had projected.
By now, you’ve probably heard about the Employer Mandate on several different occasions. Without reiterating all of the specific details, applicable large employers (ALEs) must offer health insurance coverage to full-time employees that has minimum value and is considered affordable or risk paying penalties.
If you are an employer who offers a group health plan to employees who reside in the following states, then the Department of Labor (DOL) requires you to provide a premium assistance notice to employees who are eligible for the group health plan and who are also eligible (or may become eligible) for Medicaid, including the employees children who are also eligible (or may become eligible) for the Children’s Health Insurance Program (CHIP):
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