News & Analysis as of

Plan Sponsors – It’s That Time Of Year Again! Medicare Creditable Coverage Notices Must Be Sent By October 15th

If prescription drug coverage is offered under your group health plan, you must provide an annual notice by October 15th to plan participants (and their dependents) who are Medicare eligible, whether they are active...more

What is Telemedicine? A Cool Benefit or a Hot Mess?

We’ve had numerous inquiries lately about telemedicine benefits. My clients most typically ask either “is this a group health plan?” or “is it just access to another provider?” Clearly, there is much confusion surrounding...more

ACA Reporting Update – 2016 Draft Forms & Instructions Released

Since our last ACA Reporting Update, the extended deadlines to distribute Forms 1095-B and 1095-C to covered individuals and employees and to file the forms with the IRS have passed. The IRS has stated, however, that late...more

Waves of Guidance and Benefit Plan Developments Worth Watching

Notices on Second Round of Privacy and Security Audits are Out, Expat Plans, OON Surgery Center Billing Issues, and New Nondiscrimination Rules for Federal Contractors, New ERISA Civil Monetary Penalties, COBRA Notices and...more

COBRA Notices May Include Additional Information on Exchanges

The Department of Labor (DOL) recently issued an FAQ addressing the inclusion of information about the Health Insurance Exchanges (Marketplace) in COBRA notices. The guidance could be very helpful for employers in directing...more

The ERISA Litigation Newsletter - May 2016

Editor’s Overview - In this issue of Proskauer's ERISA Litigation Newsletter, we review a recent ruling by the Tenth Circuit Court of Appeals concerning the application of controlled group principles to the building...more

Cadillac Tax: A Levy in Limbo

The future of the Cadillac tax, a key cost-control mechanism and federal revenue source enacted as part of the Patient Protection and Affordable Care Act (ACA), is unclear. Though initially set to take effect in 2018,...more

Vague COBRA Notices Could Prove Venomous

A recent class action settlement serves to remind employers that the Consolidated Omnibus Budget Reconciliation Act, commonly referred to as COBRA, has real fangs in the hands of the plaintiffs’ bar. A large financial...more

Beware of Traps for the Unwary in Preparing ACA Information Returns (Part 3)

This is the third and final part of a series on traps for the unwary in preparing information returns required under the Affordable Care Act (ACA). Part one of the series included the information-return deadlines. Part two...more

No Surprises in the Final Rules Issued Under ACA

Final rules have been issued regarding grandfathered plans, pre-existing conditions, rescissions, dollar limits, claims and appeals procedures, and patient protections. These rules, effective on the first day of the plan year...more

Checklist for Group Health Plan Participant Disclosure Requirements

There has been an explosion of participant disclosure requirements for group health plans in recent years. While health care reform created some of these new requirements, many of them became effective years earlier. For busy...more

The Affordable Care Act’s Reporting Requirements for Carriers and Employers (Part 15 of 24): Coding Form 1095-C, Part II for...

As we noted in a previous post, the recently issued final 2015 Instructions for Forms 1094-C and 1095-C changed certain of the rules relating to the reporting for offers of COBRA coverage where the COBRA qualifying event...more

Navigating Legal Issues in Connection with Employer Sponsored On-Site Health Clinics

Employers are increasingly concerned with the high cost of health care and executives in the C-Suite are beginning to take notice. The Affordable Care Act (‘‘ACA’’) required employers who sponsor group health plans to adopt a...more

IRS Releases Final Forms for Health Care Reform Reporting

With required reporting under the Affordable Care Act (ACA) looming, employers should be aware of the latest guidance from the IRS. As a reminder, information reporting requirements apply to all employers who are members of...more

The Affordable Care Act’s Reporting Requirements for Carriers and Employers (Part 10 of 24): IRS Issues Final Form 2015...

The IRS recently issued final instructions for Forms 1094-B and 1095-B and Forms 1094-C and 1095-C . The 2015 Instructions for Forms 1094-B and 1095-B implement a suggestion we made in a previous post relating to the...more

The Affordable Care Act’s Reporting Requirements for Carriers and Employers (Part 7 of 24): Mergers and Acquisitions

When it comes to mergers and acquisitions involving at least one applicable large employer (ALE), the substantive rules governing employer shared responsibility (under Internal Revenue Code § 4980H) and the corresponding...more

The “Cadillac Tax” is Rollin’ In!

When healthcare reform was rolled out in 2010, there was a provision included in the law imposing a tax on healthcare benefits provided to employees that exceed a threshold cost. This tax has been referred to as the...more

Draft 2015 Forms and Instructions for ACA Coverage Offer Information Reporting: Forms 1094-B, 1095-B, 1094-C, 1095-C and 8809

At about the same time as last year, the IRS has released draft ACA coverage information reporting Forms and Instructions to be used early next year. There are many small differences and one HUGE difference. The IRS decided...more

Employee Health Care Plans: Tips for Navigating the Affordable Care Act Requirements

The United States Supreme Court upheld the Affordable Care Act (the "Act") in a recent decision involving the use of the insurance exchanges. Employers are now certain that they must deal with the requirements of the Act...more

Trade Act Reinstates Expired Health Coverage Tax Credit (HCTC)

On July 6, 2015, President Obama signed the Trade Preferences Extension Act of 2015. Among other things, the Trade Act retroactively reinstated the Health Coverage Tax Credit (HCTC), which had previously expired on January...more

Issue 92: IRS Releases Final Employer Reporting Forms and Instructions

As we previously reported in Issue 80, the Affordable Care Act (ACA) requires providers of minimum essential health coverage and applicable large employers to file annual reports with the IRS to report the coverage provided...more

The Big Picture of the Employer Shared Responsibility Tax

Ever since the Treasury Department in early 2014 issued final regulations on the employer shared responsibility tax (ESR tax)1 and the related final reporting regulations (ESR regulations)2 under the Patient Protection and...more

IRS Traded in Your Chevy for a “Cadillac (ac-ac-ac-ac-ac) Tax”: Agency Issues First Guidance on the Implementation Code Section...

On February 23, 2015, the Internal Revenue Service (IRS) issued the first piece of guidance that discusses the excise tax, better known as the “Cadillac Tax,” imposed by Section 4980I of the Internal Revenue Code of 1986, as...more

Employee Benefits Developments - March 2015

The Internal Revenue Service recently issued Notice 2015-16, intending to initiate and inform the process of developing regulatory guidance regarding the excise tax on high-cost employer-sponsored health coverage. The...more

Same-Sex Spouse Has No Standing to Assert COBRA Notice Claim

A New Jersey federal district court held (in an unpublished opinion) that a former plan participant’s same-sex spouse who never enrolled in the benefit plan did not have standing to assert a claim alleging that his spouse’s...more

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