News & Analysis as of

Health Insurance Patient Protection and Affordable Care Act (PPACA) Self-Insured Health Plans

Hall Benefits Law

Court Orders Claims Reprocessing After Finding TPA Illegally Excluded Gender-Affirming Care in Violation of ACA Section 1557

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A federal district court has awarded injunctive relief, including claims processing, after finding that an insurer acting as a third-party administrator (TPA) for a self-insured plan violated Section 1557 of the Affordable...more

Woodruff Sawyer

Compliance Alert: Reminder PCORI Fees Due By July 31, 2023

Woodruff Sawyer on

Employers that sponsor self-insured group health plans, including health reimbursement arrangements (HRAs) should keep in mind the upcoming July 31, 2023 deadline for paying fees that fund the Patient-Centered Outcomes...more

Troutman Pepper

COVID-19 Employee Benefits: FAQs for Employers Focus on Health and Welfare Benefit Plans

Troutman Pepper on

It is hard to find a sector of the American workforce that has not been affected by the COVID-19 emergency. Employees are being asked to work from home if they are able, businesses are being forced to close, and employers are...more

Holland & Hart - The Benefits Dial

You’ve Got Another PCORI Fee Coming!: Congress revives the PCORI fee and filing obligations

In the wee hours of December 2019, Congress revived the PCORI fee and filing obligations of employer sponsors of self-insured group health plans. In accordance with the requirements of the Affordable Care Act, employer...more

Snell & Wilmer

Congress Giveth and They Taketh Away — Recent Health Plan Changes

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In enacting the Further Consolidated Appropriations Act, 2020, (the “Act”), Congress, among other changes, enacted the following key changes affecting employer group health plans...more

Burr & Forman

PCORI Fee Resurrected

Burr & Forman on

In the summer of 2019, I wrote a short blog on the death of the PCORI fee — Ding, Dong, the PCORI Fee is Dead!. When enacted as part of the Affordable Care Act, the fee was set to expire with plan/policy years ending after...more

Jones Day

Direct Contracting 101: Collaborations Between Employers and Health Care Providers

Jones Day on

As employers continue to encounter escalating health care costs, many are exploring the "direct contracting" option, which allows for direct service and pricing negotiations with health care providers. While the direct...more

Davis Wright Tremaine LLP

Update #8: American Health Care Act Passed by House May Revive Annual and Lifetime Limits in Self-Insured Employer Plans

On May 4, the House Republicans narrowly passed the American Health Care Act (AHCA). Except for effective dates, the provisions impacting employers were generally unchanged. One major change to the original bill is that...more

Bass, Berry & Sims PLC

Reminder: November 15 Transitional Reinsurance Program Filing Deadline is Fast Approaching

Bass, Berry & Sims PLC on

To help stabilize the individual insurance market, Section 1341 of the Affordable Care Act introduced the Transitional Reinsurance Program (TRP), which includes the collection of a TRP fee from “contributing entities” for...more

BCLP

Deadline Reminder for Employers and Providers: Electronically File Information Returns with IRS by June 30

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Self-insured employers, applicable large employers and health coverage providers are reminded that the June 30 deadline to electronically file information returns with the IRS is approaching. The deadline to provide...more

Manatt, Phelps & Phillips, LLP

Manatt on Health Reform: Weekly Highlights - March 2016

HHS approves waiver extending Medicaid coverage to Flint residents impacted by the water crisis; SCOTUS rules that states cannot require self-insured health plans to provide claims data; and seven insurers sign on to...more

BCLP

Health Coverage Providers: Deadlines for Health Coverage Providers to Report Minimum Essential Coverage are Approaching

BCLP on

Who Must Report? If you are a health insurance issuer, self-insured employer, or other entity that providedminimum essential coverage (MEC) during calendar year 2015, including a state government providing Medicaid or...more

Locke Lord LLP

New Texas Medical Stop-Loss Rules Drafted by Texas Department of Insurance

Locke Lord LLP on

Within an environment of increased federal and state regulatory emphasis on health insurance related issues arising due to the passage by the U.S. Congress of the Patient Protection and Affordable Care Act of 2010, the Texas...more

McDermott Will & Emery

IRS Adjusted ACA Fee Amounts for the 2015/2016 Policy or Plan Years and Additional Payment Options

McDermott Will & Emery on

The Patient-Centered Outcomes Research Institute (PCORI) fee was established under the Affordable Care Act (ACA) to advance comparative clinical effectiveness research. The PCORI fee is assessed on issuers of health insurance...more

Balch & Bingham LLP

PCORI Fee Inflation Adjustment

Balch & Bingham LLP on

In Notice 2015-60 (October 9, 2015), the IRS announced that the PCORI fee will rise to $2.17 per covered life for plan years ending on or after October 1, 2015 and before October 1, 2016. For plan years ending on or after...more

Balch & Bingham LLP

Final 2015 Forms 1094-B, 1095-B, 1094-C, 1095-C and Instructions

Balch & Bingham LLP on

On September 16, 2015, the IRS finalized these ACA coverage reporting Forms and Instructions... We report here, with minimal analysis, changes that we recognized on first comparison to the 2015 Draft Forms and Instructions....more

Tucker Arensberg, P.C.

The “Cadillac Tax” is Rollin’ In!

Tucker Arensberg, P.C. on

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

McAfee & Taft

The ACA’s Toyota tax

McAfee & Taft on

For several years now, employers have spent a great deal of time focusing on the Affordable Care Act’s (ACA) play-or-pay mandate. Numerous articles have been written and numerous educational seminars have been given...more

Best Best & Krieger LLP

BEST IN LAW: Employers need to heed Obamacare Reporting Rules

Compliance with reporting obligations is always important for any employer, but the employer reporting requirements under the Affordable Care Act pack a significant penalty that makes compliance particularly important. ...more

Mintz - Employment, Labor & Benefits...

ACA Countdown to Compliance - 52 Week Series For Employers

In this volume, we have collected the 52 weekly blog posts that comprise the series entitled, The Affordable Care Act—Countdown to Compliance for Employers. The series appeared in the Mintz Levin Employment Matters Blog...more

McDermott Will & Emery

IRS Publishes Final Forms and Instructions on Information Reporting Under the Affordable Care Act

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The Internal Revenue Service (IRS) published final forms and instructions addressing information reporting requirements applicable to employers and insurers under Internal Revenue Code Sections 6055 and 6056. The reporting...more

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