ACA News and Publications

A complete archive of our ACA news and publications.

ACA Pathways: IRS Issues Pay or Play Enforcement Guidance

November 10, 2017 – The Internal Revenue Service (IRS) recently updated its Questions and Answers (Q&As) on the employer shared responsibility rules under the Affordable Care Act (ACA) to include information on enforcement. Read more

ACA Pathways: President Trump Signs Executive Order Designed To Revamp ACA Rules

October 13, 2017 – On Oct. 12, 2017, President Donald Trump signed an executive order intended to change certain rules under the Affordable Care Act (ACA). The order would relax regulations on association health plans, which could allow individuals and small businesses to purchase health insurance policies across state lines and avoid certain ACA requirements. Read more

ACA Pathways: 2017 Employer Reporting Finalized

October 11, 2017 – On September 28, 2017, the Internal Revenue Service (IRS) released final 2017 forms for reporting under Internal Revenue Code (Code) Sections 6055 and 6056. Final instructions for 2017 were released in early October. Read more

ACA Pathways: Contraceptive Coverage Requirement Scaled Back, HIPAA Certification Rules Withdrawn

October 09, 2017 – On October 6, 2017, the Trump Administration issued new rules that will allow more employers to opt out of providing no-cost birth control to women by claiming religious or moral objections. Read more

ACA Pathways: Play or Pay Mandates, Employer Reporting, and Health Insurance Fee

August 16, 2017 – One consequence of this year's several attempts to repeal and/or replace the Affordable Care Act (ACA), is that it has generated much confusion as to whether the ACA individual and employer mandates and related reporting requirements continue to apply. Read more

ACA Pathways: Efforts To Replace and Repeal ACA Fall Short In U.S. Senate

July 31, 2017 – Early on the morning of July 28th, members of the U.S. Senate voted 49-51 to reject a "skinny" version of a bill to repeal and replace the Affordable Care Act (ACA), called the Health Care Freedom Act. Read more

ACA Pathways: Attention Self-insured Plan Sponsors: PCORI Fee Payment Deadline Is Fast Approaching.

June 27, 2017 – The Affordable Care Act (ACA) contains several temporary annual fees and payments that apply to group health plans and insurers. One such fee, the annual Patient-Centered Outcomes Research Institute (PCORI) Fee is due by July 31, 2017. Read more

ACA Pathways: 2018 Play or Pay Affordability Percentage Released

May 12, 2017 – The IRS recently announced that the affordability percentage for 2018 plan years has decreased to 9.56% from 9.69% for 2017 plan years. Read more

ACA Pathways: ACA Replacement Bill Passed by U.S. House of Representatives; Advances to the Senate

May 05, 2017 – On Thursday, May 4th, after seven years of debate, and weeks of scrambling to secure the votes needed for passage, the U.S. House of Representatives finally passed its latest version of the American Health Care Act of 2017 (AHCA), the signature legislation to repeal and replace the Affordable Care Act (ACA). Read more

ACA Pathways: Market Stabilization Final Rule Issued

April 19, 2017 - On April 14, 2017, the Department of Health and Human Services (HHS) issued a market stabilization final rule under the Affordable Care Act (ACA). The final rule includes new reforms intended to help lower premiums, stabilize the individual and small group health insurance markets and increase choices for the 2018 plan year. Read more

ACA Pathways: Obamacare Remains Law of the Land (For Now)

March 27, 2017 - On Friday March 24, 2017, House Speaker Paul Ryan pulled the plug on the American Health Care Act, the Republican-sponsored legislation that would partially repeal and replace the Affordable Care Act (ACA), after conceding he did not have enough votes to ensure the bill's passage before the whole House of Representatives. Read more

ACA Pathways: ACA Repeal Starts Now... What You Need To Know

March 09, 2017 - Earlier this week, Republican leadership in the U.S. House of Representatives issued two bills to repeal and replace the Affordable Care Act (ACA) through the budget reconciliation process. These bills, which were issued by the Ways and Means Committee and the Energy and Commerce Committee, are collectively known as the American Health Care Act." Read more

ACA Pathways: ACA Repeal Efforts Off to a Blazing Start

January 24, 2017 - Within hours after being sworn in as President of the United States, on January 20, 2017, Donald Trump issued his first Executive Order, directing the Secretary of Health and Human Services (HHS) and others in the federal government with authorities and responsibilities under the Affordable Care Act (ACA) to take steps to undo the ACA to the "maximum extent permitted by law." Read more


2016

ACA Pathways: ACA Forms 1095-B And 1095-C Disclosure Deadlines Extended

November 30, 2016 - The Internal Revenue Service (IRS) has released Notice 2016-70 extending the due date for insurers, self-insured employers, other providers of minimum essential coverage and applicable large employers to provide Form 1095-B ("Health Coverage") and/or Form 1095-C ( "Employer Provided Health Insurance Offer and Coverage") to applicable individuals, from January 31, 2017 to March 2, 2017. Read more

ACA Pathways: Attention Self-insured Plan Sponsors - Transitional Reinsurance Fee Deadline Fast Approaching

November 01, 2016 - Entities that are required to contribute to the Affordable Care Act (ACA)'s transitional reinsurance fee program (Contributing Entities) must submit their ACA Transitional Reinsurance Program Annual Enrollment Contributions form and supporting documentation for the 2016 benefit year to the Department of Health and Human Services (HHS) no later than November 15, 2016. Read more

ACA Pathways: IRS Finalizes 2016 Forms for ACA Reporting

October 06, 2016 - The Internal Revenue Service (IRS) has recently released final forms and instructions for reporting under Internal Revenue Code (Code) Sections 6055 and 6056. Read more

ACA Pathways: Proposed Regulations Address Implications Of Cash Opt-out Payments To Employees

July 27, 2016 - The Internal Revenue Service (IRS) recently issued proposed regulations relating to the health insurance premium tax credit (subsidy) and the individual shared responsibility penalty under the Affordable Care Act (ACA). Read more

ACA Pathways: Attention Self-Insured Plan Sponsors: PCORI Fee Payment Deadline Fast Approaching

July 06, 2016 - The Affordable Care Act (ACA) contains several temporary annual fees and payments that apply to group health plans and insurers. One such fee, the annual Patient-Centered Outcomes Research Institute (PCORI) Fee is due by July 31, 2016. The PCORI Fee is imposed on plan sponsors of applicable self-insured health plans and issuers of specified health insurance policies. This means that employers who sponsor self-funded plans are responsible for paying this fee, as are insurers of most fully insured policies. Read more

ACA Pathways: One-Year Moratorium For Health Insurance Provider Fee

April 19, 2016 - Section 9010 of the Affordable Care Act (ACA) charges a fee to each covered entity engaged in the business of providing health insurance. This is known as the Health Insurance Provider Fee ("Fee"). The Consolidated Appropriations Act of 2016, passed late last year, suspended collection of this Fee for the 2016 calendar year and due in 2017 ("2017 Fee Year"). As a result, health insurance issuers are not required to pay the Fee in 2017. Read more

ACA Pathways: Final SBC Template Released for 2017

April 11, 2016 – On April 6, 2016, the Departments of Labor (DOL) and Health and Human Services (HHS) issued the final revised template and related materials for use in preparing the summary of benefits and coverage (SBC) document. The SBC provides concise, simple and consistent information about health plan benefits and coverage. It is intended to help health plan consumers better understand the coverage they have and to help make easy comparisons of different options when shopping for new coverage. Read more


2015

ACA Pathways: IRS Delays ACA Employer Reporting and Disclosure Requirements and Addresses Certain Issues Related to Employer Provided Health Coverage

December 28, 2015 – On December 28, 2015, the Internal Revenue Service (IRS) released Notice 2016-4, extending the due dates for the 2015 information reporting requirements (both furnishing to individuals and filing with the IRS) for insurers, self-insuring employers, and certain other providers of minimum essential coverage under section 6055 of the Internal Revenue Code (Code).... Read more

ACA Pathways: Cadillac Tax Effective Date Delayed

December 22, 2015 – President Obama has signed a federal budget bill for 2016 into law that makes significant changes to three tax provisions under the Affordable Care Act (ACA), effective December 18, 2015, the date of the bill's enactment.... Read more

ACA Pathways: Final Rules Issued on Coverage of Contraceptive Services Under ACA

July 15, 2015 - On July 10, 2015, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (collectively, the Departments) jointly released final regulations on the Affordable Care Act (ACA)’s women’s preventive care coverage requirement... Read more

ACA Pathways: Attention Self-Insured Plan Sponsors: PCORI Fee Payment Deadline Fast Approaching

July 8, 2015 - The Affordable Care Act (ACA) contains several temporary annual fees and payments that apply to group health plans and insurers... Read more

ACA Pathways: Supreme Court Hands Victory for ACA Subsidies in the Federal Marketplaces

June 25, 2015 - Today, the Supreme Court, in a 6-3 decision, upheld the availability of subsidies in all States, including those with Federally- facilitated health insurance Marketplaces... Read more

ACA Pathways: Additional Guidance Released Regarding ACA’s Preventive Services Coverage Requirement

May 14, 2015 - The Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (collectively, the Departments) have jointly released additional Frequently Asked Questions (FAQs) to assist in the implementation of the preventive services coverage requirement under the Affordable Care Act (ACA)... Read more

ACA Pathways: IRS Provides Additional Guidance Regarding Plans Violating ACA Market Reforms

February 20, 2015 - Internal Revenue Code (“Code”) Section 4980D assesses an excise tax of up to $100 per day for each employee for a group health plan’s failure to satisfy market reforms under the Affordable Care Act (“ACA”). Read more

ACA Pathways: IRS Releases Final ACA Employer Reporting Forms and Instructions

February 13, 2015 - The Affordable Care Act (ACA) created new reporting requirements under Internal Revenue Code Sections 6055 and 6056. Under these new reporting rules, certain employers must provide information to the IRS about the health plan coverage they offer (or do not offer) to their employees. Read more


2014

ACA Pathways: HHS Proposes Benefit and Payment Parameters for 2016

December 4, 2014 - On November 21, 2014, the Department of Health and Human Services (HHS) released its 2016 Notice of Benefit and Payment Parameters Proposed Rule. The proposed rule describes benefit and payment parameters applicable to the 2016 benefit year, including standards relating to... Read more

ACA Pathways: Departments Issue Additional Guidance on Premium Reimbursement Arrangements

November 13, 2014 - On November 6, 2014, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (collectively, the Departments) issued additional guidance in the form of Frequently Asked Questions (FAQs) to assist in the implementation of the Affordable Care Act (ACA). Read more

ACA Pathways: IRS Expands Rules for Cafeteria Plan Mid-year Election Changes

September 22, 2014 - On September 18, 2014, the Internal Revenue Service, in conjunction with the Department of the Treasury (collectively IRS) issued Notice 2014-55, providing two additional opportunities for employees and their dependents to drop their coverage mid-year under their employer group health plan to enroll in a qualified health plan through a Health Insurance Exchange (Marketplace). Read more

ACA Pathways: Draft Instructions and Forms for Employer Reporting of Health Coverage Released

September 16, 2014 - The Affordable Care Act (ACA) created new reporting requirements under Internal Revenue Code (Code) Sections 6055 and 6056. Under these new reporting rules, certain employers must provide information to the IRS about the health plan coverage they offer (or do not offer) to their employees to assist it in administering ACA’s employer and individual mandates. Read more

ACA Pathways: Attention Self-insured Plan Sponsors - PCORI Fee Payment Deadline Fast Approaching

July 10, 2014 - The Affordable Care Act (ACA) contains several temporary annual fees and payments that apply to group health plans and insurers. One such fee, the annual Patient-Centered Outcomes Research Institute (PCORI) Fee is due by July 31, 2014. The PCORI Fee is imposed on plan sponsors of applicable self-insured health plans and issuers of specified health insurance policies. This means that employers who sponsor self-funded plans are responsible for paying this fee, as are insurers of most fully insured policies. Read more

ACA Pathways: Supreme Court Rejects Contraceptive Mandate for Some Companies

July 02, 2014 - On June 30, 2014, the U.S. Supreme Court ruled that the Affordable Care Act (ACA)'s contraceptive mandate, as applied to closely held corporations with sincere religious objections, violates the Religious Freedom Restoration Act (RFRA). Read more

ACA Pathways: Final Rule Released on ACA Waiting and Orientation Periods

June 25, 2014 - The Affordable Care Act (ACA) provides that group plans or health insurance issuer offering group health insurance coverage may not apply any waiting period that exceeds 90 days. Read more

ACA Pathways: Special Enrollment Events for Marketplace Coverage

June 10, 2014 - Under the Affordable Care Act (ACA), individuals that need health coverage who want to enroll in a health plan offered through Covered California (CoveredCA), California's health care marketplace, generally must do so during CoveredCA's annual open enrollment period. For 2014 coverage, the open enrollment period ended on March 31, 2014. The 2015 open enrollment period will not begin until November 15, 2014 (and will run through February 15, 2015). Read more

ACA Pathways: Agencies Release New Cobra Guidance / Updated Notices

May 12, 2014 - The Departments of Labor (DOL), Health and Human Services (HHS), and Treasury (collectively, the Agencies) recently issued several pieces of guidance regarding COBRA to clarify the impact of the establishment of the Health Insurance Marketplace (Marketplace) under the Affordable Care Act (ACA) that became effective January 1, 2014. Read more

ACA Pathways: HSS Issues Notice of Benefit and Payment Parameters for 2015 Final Rule

March 12, 2014 - On March 5, 2014, the Department of Health and Human Services (HHS) released its 2015 Notice of Benefit and Payment Parameters Final Rule. Read more

ACA Pathways: Final Regulations Implementing Employer And Insurer Reporting Requirements Released

March 11, 2014 - On March 5, 2014, the Internal Revenue Service (IRS) and the U.S. Department of the Treasury finalized the two proposed regulations on the Affordable Care Act (ACA)'s employer and insurer reporting requirements to provide information to the IRS and to covered individuals about the health plan coverage they offer (or do not offer) to their employees. These requirements are found in Internal Revenue Code (Code) sections 6055 and 6056, and are intended to provide the IRS with information to administer other ACA requirements ‐ in particular, the employer and individual mandates. They will also allow individuals to establish verification of their coverage to determine if they will qualify for a premium tax credit in the Health Insurance Marketplace (Marketplace). Read more

ACA Pathways: Final Rule On 90-Day Waiting Period Limitation Requirement Released

February 21, 2014 - For plan years beginning on or after January 1, 2014, the Affordable Care Act (ACA) prohibits group health plans and group health insurance issuers from applying any waiting period that exceeds 90 days. On February 20, 2014, the U.S. Departments of Labor, Treasury, and Health and Human Services (collectively, the "Departments") announced the publication of final regulations under the ACA implementing the 90‐day limit on waiting periods for health coverage. Read more

ACA Pathways: Final Play or Pay Regulations Issued Providing Additional Transitional Relief for Many Employers

February 11, 2014 - On Monday, February 10, 2014, the U.S. Department of the Treasury and the Internal Revenue Service (IRS) issued final regulations implementing the employer responsibility provisions under the Affordable Care Act (ACA), commonly referred to as the "play or pay" mandate, that take effect in 2015. Read more


2013

ACA Pathways: IRS Issues Proposed Rules on Employer Reporting of Health Plan Coverage

September 11, 2013 - On September 5, 2013, the Internal Revenue Service (IRS) released two proposed rules on the Affordable Care Act (ACA)'s requirements for certain employers to provide information to the IRS and to covered individuals about the health plan coverage they offer (or do not offer) to their employees. These reporting requirements, found in Internal Revenue Code sections 6055 and 6056, are intended to provide the IRS with information to administer other ACA requirements - in particular, the employer and individual mandates. Read more

ACA Pathways: IRS Issues Final Rules on Individual Mandate Penalties

September 4, 2013 - Beginning in 2014, the Affordable Care Act (ACA) requires most individuals to obtain acceptable health insurance coverage for themselves and their family members or pay a penalty. This rule is often referred to as the "individual mandate." Individuals may be eligible for an exemption from the penalty in certain circumstances. Read more

ACA Pathways: Agencies Issue Final Regulations on Contraceptive Coverage and Religious Organizations

July 11, 2013 - The Department of Health and Human Services, Department of Labor and Department of U.S. Treasury (collectively, the "Agencies") recently published final rules regarding the requirement under the Patient Protection and Affordable Care Act ("Affordable Care Act") to cover certain contraceptive services. Read more

ACA Pathways: IRS Issues Transitional Relief for 2014 for Employer Reporting of Health Plan Coverage and Employer Shared Responsibility Provisions of The Affordable Care Act

July 10, 2013 - On July 2, 2013, the Treasury Department announced that it will delay enforcement of the Affordable Care Act (ACA)'s employer shared responsibility (play or pay) provisions, as well as provide large employers with an additional year to comply with the health plan reporting requirements under Internal Revenue Code (Code) Sections 6055 and 6056. Read more

Employer Mandate Penalties Delayed Until 2015

July 3, 2013 - The Obama Administration has postponed the Affordable Care Act (ACA) employer mandate penalties for one year, until 2015. The Department of the Treasury announced the delay on July 2, 2013, along with a similar delay for information reporting by employers, health insurance issuers and self-funded plan sponsors. Read more

Health Care Reform Update - Covered California Announces Health Plan Offerings for 2014

May 30, 2013 - On May 23, 2013, the State of California health insurance marketplace, known as Covered California, announced its 2014 health care plan offerings and preliminary rates for the individual market.   Read more

Health Care Reform Update: DOL Issues Model Exchange Notice and Updates Cobra Election Notice

May 2013 - Beginning Jan. 1, 2014, individuals and employees of small businesses will have access to insurance coverage through the Affordable Care Act's (ACA) health insurance exchanges (Exchanges). Open enrollment under the Exchanges will begin on Oct. 1, 2013. ACA requires employers to provide all new hires and current employees with a written notice about ACA's Exchanges. Read more

IRS Proposed Regulations: More Guidance to Determine Minimum Value and Affordability Requirements for Wellness Programs, and HRA and HSA Contributions

May 2013 - Proposed regulations by the Department of the Treasury were published on May 3, 2013 that included additional guidance to assist employers in determining whether the health coverage they offer their employees provides "minimum value." Read more

The Pay-or-Play Provisions and Financial Analysis

April 2013 - The "pay-or-play" provisions under Section 4980H of the Internal Revenue Code – as added by the Affordable Care Act (ACA), the law that introduces sweeping health care reform for the nation – become effective as early as January 1, 2014. Read more

Health Care Reform - Exchange Notice Requirements Delayed

January 2013 - The Affordable Care Act (ACA) requires employers to provide all new hires and current employees with a written notice about ACA's health insurance exchanges (Exchanges), effective March 1, 2013. Read more

Summary of Benefits and Coverage (SBC) Questions and Answers

January 2013 - The Summary of Benefits and Coverage (SBC) provision of the Patient Protection and Affordable Care Act is one of the health care reform mandates taking effect in 2013. Here, Burnham Benefits answers critical questions about the provision and gives guidance on SBC compliance, including specific information for California empoyers. For more information, contact your Burnham Benefits representative. Read more


2012

Proposed Reinsurance Fees Will Cost Group Health Plans

December 2012 - The Affordable Care Act (ACA) established three risk‐spreading programs to provide payments to health insurance issuers that cover higher‐risk populations and to more evenly spread the financial risk carried by issuers. These programs, which will be effective in 2014, are a transitional reinsurance program, a temporary risk corridor program and a permanent risk adjustment program. Read more

Understanding the 3.8% Tax

November 2012 - You might expect the kind of information in this Pathways document to be communicated to you by your tax advisor, but as your valued advisor we wanted to be certain that you were made aware of the existence of the new 3.8% tax on particular investment incomes, as well as the 0.9% increase on Medicare tax imposed on high income individuals and households. Read more

Burnham's Guide to Post‐Election Health Care Reform

November 2012 - The polls have closed and the results are in.... Like it or not, health care reform is here to stay. Following the conclusion of the election, many of our clients have approached us and asked "what's next?" or "what do we need to do now to be in compliance?" If you have embraced the wait‐and‐see approach in regard to your health care reform planning, you are not alone. But now, it's time to act. Read more

IRS Issues New Guidance on Employer Penalties

October 2012 - Beginning in 2014, large employers may face penalties if they do not offer any health coverage to full‐time employees, or if they offer health coverage that is unaffordable or does not provide minimum value. The penalty is known as a "shared responsibility payment," and is triggered if one of the employer's full‐time employees receives a premium tax credit or cost sharing reduction for coverage obtained through a health insurance exchange. Read more

Health Care Reform – Important Guidance for Medical Loss Ratio Rebates

August 2012 - The Affordable Care Act's medical loss ratio (MLR) rules mandate that health insurance carriers report how they spend their premium revenue to the Department of Health and Human Services (HHS). In addition, carriers that do not spend at least 80 percent (small group) or 85 percent (large group) of their premium revenue on reimbursement for clinical services and health care quality improvement must provide rebates to consumers beginning in 2012. Read more

Health Care Reform – U.S. Supreme Court Upholds Constitutionality of Entire Act

June 2012 - As we review today’s U.S. Supreme Court’s landmark decision upholding the constitutionality of the Patient Protection and Affordable Care Act (PPACA) (aka Health Care Reform), that statement from Benjamin Franklin describes the Court’s ruling in a nutshell. On the biggest issue, the constitutionality of the individual mandate, the Court, in upholding the mandate, said that the penalty for not carrying insurance is a tax and therefore falls within Congress’ taxing power. Read more

Health Care Reform: Important Guidance for Non-Calendar Year Health FSA Plans

June 2012 - The Affordable Care Act (ACA) imposes a $2,500 limit on salary reduction contributions to a health flexible spending account (FSA) offered under a cafeteria plan. This limit is applicable to grandfathered and non-grandfathered health FSAs. ACA provides that this change is effective for taxable years beginning after Dec. 31, 2012. The $2,500 limit will be indexed for cost-of-living adjustments for 2014 and later years. Read more

Health Care Reform: Comparative Effectiveness Research Fees

May 2012 - The Affordable Care Act (ACA) created the Patient-Centered Outcomes Research Institute (Institute) to help patients, clinicians, payers and the public make informed health decisions by advancing comparative effectiveness research. The Institute’s research is to be funded, in part, by fees paid by health insurance issuers and sponsors of self-insured health plans. Read more

Health Care Reform: Final Guidance on Summary of Benefits and Coverage (SBC)

February 2012 - The Patient Protection and Affordable Care Act (PPACA) requires health plans and health insurance issuers to provide a summary of benefits and coverage (SBC) to applicants and enrollees. Both non‐grandfathered and grandfathered plans will need to provide the SBC. Read more


2011

Health Care Reform: Preventive Care Guidelines for Women

August 2011 - The Patient Protection and Affordable Care Act (PPACA) requires non-grandfathered health plans to cover preventive health services without imposing cost-sharing requirements for the services. PPACA’s preventive care mandate is generally effective for plan years beginning on or after Sept. 23, 2010. Read more

Cafeteria Plan Amendment – OTC Drugs and Medicines

June 2011 - As previously reported, beginning January 1, 2011, expenses incurred for medicines or drugs may be reimbursed from a health care flexible spending arrangement (FSA), health savings account (HSA), Archer medical savings account (Archer MSA) or health reimbursement arrangement (HRA) only if the medicine or drug requires a prescription, the drug is available over-the-counter but the individual obtains a prescription, or the drug is insulin. Read more

Health Care Reform: Form W‐2 Reporting Requirements Published

April 2011 - The Patient Protection and Affordable Care Act (PPACA) requires employers to report the aggregate cost of employer‐ sponsored group health plan coverage on their employees’ Forms W‐2. The purpose of the reporting requirement is to provide information to employees regarding how much their health coverage costs. Read more

California State Tax Issue – Up to Age 26 Coverage

April 2011 - On April 7, 2011, California Governor Brown signed Assembly Bill (AB 36) which conforms California state law with federal law to allow tax exclusions or deductions for employers providing health care coverage to dependents under age 27. The bill offers relief from imputing state income back to March 30, 2010, which is the date on which federal tax laws changed to waive dependency requirements for children up to age 26. Please see the attached reprint of our November 19, 2010 HCR Pathways which discussed this issue in greater detail. Read more

California State Tax Issue – Up to Age 26 Coverage Will It Stay or Will It Go?

March 2011 - On November 19, 2010, Burnham Benefits addressed the California taxation issue in an HCR Pathways document. As we sit here today, the issue still exists. However, California Assembly Bill 36 (AB36), which will bring state income taxes into line with federal changes under the PPACA, is currently pending and moving through the California legislature at a rapid pace. Read more

Important Health Care Reform Legislative Update - House of Representatives Passes Legislation to Repeal PPACA

January 2011 - On January 19, 2011, members of the House of Representatives passed a bill by a vote of 245‐189 to repeal the health care reform legislation, also known as the Patient Protection and Affordable Care Act (PPACA). Three Democrats joined the House’s 242 Republicans in unanimously supporting the bill. Read more


2010

Delayed Fully‐Insured Group Health Plan Non‐Discrimination Requirement

December 2010 - The health care reform law prohibits fully‐insured group health plans from discriminating in favor of highly compensated individuals. If a fully‐insured plan loses grandfather status, it will have to comply with “rules similar” to the non‐discrimination rules found in Section 105(h) of the Internal Revenue Code applicable to self‐funded plans. Under the law, this requirement took effect on the first day of the first plan year on or after September 23, 2010. Read more

Forms and Additional Guidance Now Available on Small Business Health Care Tax Credit

December 2010 - The Internal Revenue Service has released final guidance for small employers eligible to claim the new small business health care tax credit for the 2010 tax year. Read more

California and Federal Taxation Issues – Up to Age 26 Coverage

November 2010 - To determine how to treat the value of health coverage for the dependents of employees—and whether to include the value of that coverage in the employee’s gross income—employers and taxpayers need to consider whether the dependent qualifies as a dependent under Section 152 of the Internal Revenue Code. This is true under both federal and California law. Except for the treatment of certain domestic partner relationships, California and federal law generally follow the same rules on the tax treatment of dependent coverage. Read more

Reimbursement Changes for Over‐the‐Counter Drugs

September 2010 - The Patient Protection and Affordable Care Act (PPACA) changed the requirements related to reimbursements for over‐the‐counter (OTC) drugs. These changes affect health FSAs, HRAs, HSAs and Archer MSAs, which will need a prescription to reimburse the costs of OTC drugs purchased after December 31, 2010. Read more

Financial Implications of Health Care Reform

September 2010 - Under the Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care and Education Reconciliation Act, employers will soon have to make changes to their health plans that will most likely have financial implications. This article analyzes the financial implications of some of the provisions and offers employers some recommendations to consider as they adapt to the changes ushered in by the new law. Read more

Health Care Reform for Small Employers – Small Business Employer Tax Credit

August 2010 - Under the recently enacted health care reform law, many small businesses and tax‐exempt organizations that provide health insurance coverage to their employees now qualify for a special tax credit. Read more

Health Care Reform – Additional Provisions Affecting Small Employers

August 2010 - In addition to the health care reform provisions affecting all employers, there are some additional provisions that specifically affect small employers. The definition of “small employer” differs for each of these provisions. Please see below for the respective provisions and whether or not they affect you based on your company size. Read more

Health Care Reform ‐ Preventive Health Services Coverage Guidelines

August 2010 - The Patient Protection and Affordable Care Act requires new health plans to cover preventive health services without imposing cost‐sharing requirements for the services. On July 14, 2010, the Departments of Health and Human Services (HHS), Labor and Treasury issued interim final rules relating to coverage of preventive services. This requirement is generally effective for plan years beginning on or after September 23, 2010 and does not apply to grandfathered health plans. Read more

Health Care Reform – Interim Final Rules on New Appeals Process

August 2010 - Under the Patient Protection and Affordable Care Act, a non-grandfathered group health plan must adopt an improved internal claims and appeals process and follow minimum requirements for external review. On July 23, 2010, interim final regulations were issued implementing these requirements (the Interim Final Rule). The appeals process rules are effective for plan years beginning on or after September 23, 2010. Comments on the Interim Final Rule are being accepted until September 21, 2010. Read more

Health Care Reform: Grandfathering Rules Clarified

July 2010 - The health care reform law passed earlier this year brings many changes to employers and health plans. The extent of the impact will depend, in part, on whether you maintained a health care plan on March 23, 2010, the date the primary legislation was enacted. If your company sponsored a plan on that date, it is considered a “grandfathered” plan. Grandfathered plans are exempt from certain health care reform requirements, such as no cost‐sharing for preventive care and other patient protections. Read more

Health Care Reform: Burnham Benefits Interviewed on Critical Mass for Business Internet Radio Show

July 2010 - On July 6, 2010, Ed Bray, Burnham Benefits’ Director of Compliance, had the opportunity to be interviewed regarding health care reform’s impact on employers on the Critical Mass for Business Radio Show on OC Talk Radio.net. Read more

Health Care Reform Update: Part II

April 2010 - With the passing of this legislation comes many questions and uncertainties regarding the components and the implementation timeline. Burnham Benefits is committed to ensuring that you are kept up‐to‐date with reform developments and aware of any potential impact that this legislation may bring. This Health Care Reform Legislative Update Part II provides a timeline of the mandates that affect employers and group health plans with key reform provisions as we know them today. Read more

Special Edition Health Care Reform Legislation

March 2010 - As always Burnham Benefits strives to keep our clients informed of pertinent legislative updates. However, as health care reform is one of the largest legislative changes to hit our country, we anticipate there will be updates on a daily basis. We commit to keeping you informed without inundating you with information. Read more