Benefits Blog

1095 Reporting: What in the World Are “Non-Calendar-Year Transition Relief,” “First-Year Relief” and “No Dependent Coverage Transition Relief?”

David LeFevre
ERISA Counsel, Wortham Insurance & Risk Management

Written: December 18, 2015

If you’re using a vendor for 1095 reporting, you may have received other strange questions about how you are complying with the employer shared responsibility (pay-or-play) mandate. (Here's our first blog post on strange 1095 reporting questions.) These questions are often not explained very well, and most times they're not explained at all. Even if you’re not using a vendor, you may have looked at the instructions for Forms 1094-C and 1095-C and wondered about:Non-Calendar-Year Transition ReliefPlan Start MonthFirst Year as ALE Period or First-Year ReliefNo Dependent Coverage Transition Relief.Here's what those references mean.Non-Calendar-Year Transition Relief Way back when the IRS issued some of its first guidance on the employer shared responsibility rules (pay-or-play mandate), it cut non-calendar-year plans a bit of a break. The mandate would kick in with the first plan year beginning on or after January 1, 2014.

David LeFevre
ERISA Counsel, Wortham Insurance & Risk Management

Written: December 18, 2015

If you’re using a vendor for 1095 reporting, you may have received strange questions about how you are complying with the employer shared responsibility rules (a/k/a pay-or-play mandate). These questions are often not explained very well, and many times they're not explained at all. Even if you’re not using a vendor, you may have looked at Form 1094-C and wondered about the four checkboxes on line 22.These questions ask the employer about the following: Qualifying OffersQualifying Offer Transition ReliefSection 4980H Transition ReliefThe 98% Offer MethodThese four bullets merely offer optional (and in most cases largely worthless) safe harbor shortcuts to ACA reporting.

David LeFevre
ERISA Counsel, Wortham Insurance & Risk Management

Written: November 30, 2015

The Department of Labor's Equal Employment Opportunity Commission (EEOC) has been hard at work on financial incentives in employer wellness programs. Its most recent task was to issue a new regulation proposed under the Genetic Information Nondiscrimination Act (GINA). It offers a much-desired clarification of GINA's scope, but it also brings additional complexity—that is, if the regulation applies in the first place. What the Proposed Regulation Does and Does Not AddressThe EEOC's new GINA wellness regulation is very, very narrow in its scope. Among other things, GINA prohibits offering financial inducements (incentives) to acquire an employee’s genetic information. GINA defines "genetic information" to include medical history of an employee’s "family member," which in turn is defined to include, rather curiously, the employee’s spouse.

David LeFevre
ERISA Counsel, Wortham Insurance & Risk Management

Written: November 16, 2015

The federal Department of Labor (DOL) has announced new proposed regulations that, if finalized, will require internal and external claims and appeals procedures very similar to those required of medical claims under the ACA, complete with required use of accredited independent review organizations (IROs). While many employers insure their disability coverages, this regulatory change is not limited to benefits normally referred to as "disability benefits." These regulations affect not only employers with self-insured short-term and long-term disability coverage, but also employers with any benefit change or enhancement that is conditioned on a disability, such as medical continuation coverage for disabled employees or early access to benefits for retirees like healthcare reimbursement arrangements (HRAs) and pension plans.

David LeFevre
ERISA Counsel, Wortham Insurance & Risk Management

Written: October 07, 2015

Do you have the right policies, procedures and documentation in place to prove that your health plan is affordable and provides minimum value and has eligibility provisions that cover all employees deemed full-time under the IRS regulations? Are you sure? What's a Subsidy Notice?Starting some time in 2016 (HHS doesn't know exactly when yet), the CCIIO division of Health and Human Services (HHS) will be implementing a part of the ACA it probably should have implemented a year ago—namely, notifying employers that one of their employees received an "advance premium tax credit" (i.e., subsidized coverage) from a state or federal exchange. These notices were required by Section 1411 of the ACA for the federally-facilitated marketplace and state-based exchanges using the federal platform, but HHS hasn't had the infrastructure in place to send the notices, and until recently building out the infrastructure apparently hasn't been a priority.

Benefits Blog

1095 Reporting: What in the World Are “Non-Calendar-Year Transition Relief,” “First-Year Relief” and “No Dependent Coverage Transition Relief?”

1095 Reporting: What in the World Are “Qualifying Offer Transition Relief,” “4980H Transition Relief” and the "98% Offer Method?”

The Real Skinny on the EEOC's New GINA Wellness Incentive Regulation

Benefits with Disability Provisions Will Need New Claims & Appeals Processes

Get Ready for Subsidy Notices from the Exchanges

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