Wednesday, December 30, 2015

IRS Delays 1094/1095 Reporting

 January 31st, 2016 for statements given to employees/individuals and February 29th for transmittal's filed to the IRS (and WAS March 31st if you are filing over 250 employee statements to employees).  Keep in mind, this is the information that the IRS will use to penalize the individual or the employer if they are not offering appropriate and affordable coverage and is used by the individual when preparing their personal tax returns. 

Now, the IRS announced that it will be giving employers additional time.  According to Notice Notice 2016-4, the IRS is delaying filing deadlines to allow employers, insurers and other providers additional time to get information together for the reporting.  The NEW deadlines are:

  • Statements given to employees/individuals is now March 31, 2016 (Two Additional Months)
  • Transmittal's filed to IRS (Paper) is now May 31st, 2016 (Three Additional Months)
  • Transmittal's filed electronically in now June 30th, 2016 (Three Additional Months)

Hope you find this information helpful and Happy New Years!

Wednesday, December 2, 2015

Repeal of the "Cadillac Tax" under ACA

The Cadillac tax is slated to take effect in 2018 for individuals with health insurance plans worth more than $10,200 a year or families with plans worth more than $27,500. That's $850 for an individual plan and includes other things like Employer HSA contributions, Employer HRA Contributions, Wellness plans, pre-tax policies for specific disease or illness plans (Cancer Policy). The tax itself is a 40% non-deductible excise tax on any amount above these thresholds.  Under the tax, those plans that are fully insured, employers calculate and insurers pay the tax, for Self-funded plans, the employers calculate and "the person who administers the plan benefits" pays and under HSA's and HRA's Employers calculate and employers pay.

The tax was included in the law to curb the highly comprehensive, highly expensive health plans as well as help raise funding for the ACA, an estimate 87 Billion over the next ten years.

Now that we are getting closer to point of impact, even democrats are no longer supporting the tax because it's not really a tax on "Cadillac Plans" but many mid-level plans simply because of the rising cost of health care.

"The 'Cadillac Tax' will raise barriers that would deprive patients of needed cancer screenings, diagnostic tests and lifesaving treatment," said Rep. Joe Courtney, D-Conn., who is the sponsor of a House bill to repeal the tax.  "We must repeal this onerous tax before it diminishes the progress we have made since enactment of the ACA."   

Wednesday, October 14, 2015

Repeal of Definition of Small Employer Group back to 1-50 Employees under ACA

On October 8, 2015, the federal government repealed the legislation that had redefined employer groups with 51 to 100 full-time-equivalent employees as small groups for 2016 health insurance coverage.

However, the federal legislation still allows individual states the option to expand the definition of small group from 1 to 100 employees in 2016, which is the definition currently set by the Virginia and District of Columbia legislatures.

Following the federal announcement to repeal the decision to redefine employers with 51-100 employees as small groups, Maryland issued bulletin (15-27) stating that Maryland's definition of small group will align with the federal changes and remain at the 1-50 employee level.

Bulletin 15-27 states, "Since Maryland law has been drafted to follow the federal law, for plan years that begin on or after January 1, 2016, small employers will be those that during the preceding calendar year employed an average of not more than 50 employees.”

Excerpt from Kaiser Foundation Health plan

This is good news as groups over 50 Full-Time and Full Time Equivalents were being pushed down to small group which historically has had higher rates and more ACA mandates.

Friday, July 24, 2015

Insurer Mega Mergers: What It May Mean To You

Not too long ago Coventry was gobbled up by Aetna, then Aetna grabbed Humana and now Anthem making a deal to purchase Cigna.  With these mega-mergers what should we expect?  Will rates rise because we have less competition?  Will, the now, larger insurers decide to merge and move us even closer to a socialist single-payer system?  

Excerpt by Chad Bray, NewYorkTimes 7-24-15....

The health insurer Anthem said on Friday that it had agreed to acquire its rival Cigna for $48.3 billion in a deal that would further concentrate the United States market to just a few major players.The combined company would have estimated revenue of about $115 billion and serve more than 53 million people with medical coverage.A flurry of deals are reshaping the industry. Earlier this month Aetna agreed to acquire Humana, the smallest of the big five insurers, for $37 billion in cash and stock. If both transactions are completed, the number of major health insurers in the United States will shrink to three.Health insurers are seeking to consolidate to gain greater scale to reduce costs and capitalize on growing opportunities in the government and individual markets. A major force has been the Obama administration’shealth care overhaul, which has bolstered revenues. But greater transparency in pricing and less generous funding of government plans have also put profit margins under pressure.
It is possible that regulators in the United States could block some mergers: Antitrust officials at the Justice Department and the Federal Trade Commission have shown an increasing willingness to do so if they believe the alliances could hurt consumers.
Analysts have said that antitrust regulators would probably allow only some deals to go forward, and that they could stop others if they decided that too much power was being concentrated in too few hands.

Thursday, May 21, 2015

1.1 Million Carefirst Members In D.C-Data Breach

As many as 1.1 million Washington, D.C., BlueCross BlueShield members may have had their information accessed in a cyber-breach that occurred in June of 2014.
CareFirst BlueCross BlueShield announced Wednesday it had been the target of a "sophisticated cyberattack," the company said in a release.
The attackers could have potentially acquired members' names, birth dates, email addresses and subscriber identification numbers.
However, CareFirst said its user names must be used in conjunction with a member-created password to gain access to underlying member data on the website.
The database that was breached did not include these passwords, which were encrypted and stored in a separate system as a safeguard against such attacks.
That means the attackers did not have access to member Social Security numbers, medical claims, employment, credit card, or financial information, CareFirst said.
The company is blocking member access to the accounts that might have been compromised, and is asking members to create new user names and passwords for them.
The attack came to light when CareFirst hired Mandiant, the cyber-forensics unit of computer security company FireEye, to review its security in the wake of recent cyber attacks on other health insurers.
"The intrusion was orchestrated by a sophisticated threat actor that we have seen specifically target the health care industry over the past year," said Charles Carmakal, managing director of Mandiant.
The fact that the health care company's members are primarily based in Northern Virginia, Maryland and Washington D.C. is not lost on people in the security community.
"Obviously, we know what's there," said Rick Holland with Forrester Research, contemplating the heavy concentration of government, military and contractors in the region.
There has been speculation that previous health care computer breaches could also be linked to China, including those at AnthemPremera and Community Health System.
Industrial spying by China is well known. On Tuesday federal prosecutors made public charges against a Chinese espionage ring that included two professors who studied together at the University of Southern California. The ring stole trade secrets and gave them to Chinese companies.
 Elizabeth Weise, USATODAY6:31 p.m. EDT May 20, 2015

Wednesday, March 25, 2015

Some Of Your Employees Are Going To Be In Shock When They File Their Taxes

Shock Number One

Normally the health exchanges have an annual open enrollment period from November 15th to February 15th each year.  You probably heard that this has been expanded this year because so many people didn't know that if they couldn't prove they had health insurance they were going to pay a penalty(Tax).  The penalty for this year is $95 per person (half for kids) or 1.5% of your gross income over the Federal Filing Limit, whichever is greater.  For 2015 it goes to $325 (half for kids) per person or 2% of gross income over the Federal Filing Limit and in 2016 $695 per person (half for kids) and 2.5% of gross income over the Federal Filing Limit (whichever is greater).  These are going to be significant penalties.

Shock Number Two

You as an employer offer affordable minimal essential coverage to your employee.  Most, if not all, of my clients do.  The coverage must at least be comparable to a bronze plan and can't cost the employee any more than 9.5% of their W-2 Income.  Here is where the shock comes in.  You have an employee that hears that they are going to get a penalty or thinks the cost under the employer plan is too expensive.  They now decide to go check out the exchange and see what that's all about.  They sign up for coverage and get a nice subsidy based on their income.  In this case lets say they are an individual and get a $250 subsidy per month to help pay for their coverage.  Here is the problem, if your employee is offered affordable, minimal essential coverage at work, they aren't eligible for a subsidy on the exchange and will have to pay back all of those subsidy dollars.  In this case $3,000.  

Please let your employees know that they should not go to the exchange to get coverage with a subsidy for themselves unless they have have written proof from an exchange representative that they are eligible.  However, they may be eligible for subsidy's for their spouses and children as those coverages when added to their individual coverage may be unaffordable as most employers help pay for the cost of the individual not the spouses or dependents.

If your employees are eligible for Medical Assistance this is considered affordable minimal essential coverage and is allowed even if the employer offers affordable minimal essential coverage.

Please keep in mind that the IRS requires all employers to report to the IRS what employees have what coverage every year.  For employers under 50 lives, this is done at the carrier level.  

If you have any questions regarding this information please feel free to contact me at 410-239-5009.

Thursday, March 19, 2015

IRS Request To Verify Identity

WASHINGTON – The Internal Revenue Service today reminded taxpayers who receive requests from the IRS to verify their identities that the Identity Verification Service website,, offers the fastest, easiest way to complete the task.

Taxpayers may receive a letter when the IRS stops suspicious tax returns that have indications of being identity theft but contains a real taxpayer’s name and/or Social Security number. Only those taxpayers receiving Letter 5071C should access

The website will ask a series of questions that only the real taxpayer can answer.

Once the identity is verified, the taxpayers can confirm whether or not they filed the return in question. If they did not file the return, the IRS can take steps at that time to assist them. If they did file the return, it will take approximately six weeks to process it and issue a refund.

Letter 5071C is mailed through the U.S. Postal Service to the address on the return. It asks taxpayers to verify their identities in order for the IRS to complete processing of the returns if the taxpayers did file it or reject the returns if the taxpayers did not file it. The IRS does not request such information via email, nor will the IRS call a taxpayer directly to ask this information without you receiving a letter first. The letter number can be found in the upper corner of the page.

The letter gives taxpayers two options to contact the IRS and confirm whether or not they filed the return. Taxpayers may use the site or call a toll-free number on the letter. Because of the high-volume on the toll-free numbers, the IRS-sponsored website,, is the safest, fastest option for taxpayers with web access.

Taxpayers should have available their prior year tax return and their current year tax return, if they filed one, including supporting documents, such as Forms W-2 and 1099 and Schedules A and C.

Taxpayers also may access through by going to Understanding Your 5071C Letter or the Understanding Your IRS Notice or Letter page. The tool is also available in Spanish. Taxpayers should always be aware of tax scams, efforts to solicit personally identifiable information and IRS impersonations. However, is a secure, IRS-supported site that allows taxpayers to verify their identities quickly and safely. is the official IRS website. Always look for a URL ending with “.gov” – not “.com,” “.org,” “.net,” or other nongovernmental URLs.

From the IRS, March 18, 2015

Wednesday, February 25, 2015

Who Reports What to the IRS and Employees under Section 6055 of the ACA?

Beginning this year and filing in 2016, employers, insurers and the insurance marketplace will be required to file forms to employees and/or the IRS indicating who had health insurance coverage and when during 2015.  The filing deadline for employers is January 31st, 2016 for statements given to employees/individuals and February 29th for transmittal's filed to the IRS (March 30th if you are filing over 250 employee statements to employees).  This is the information that the IRS will use to penalize the individual or the employer if they are not offering appropriate and affordable coverage and is used by the individual when preparing their personal tax returns.  

The big question is:  Are you as an employer responsible for filing these forms?

From Affordable Care Act added section 6055 to the Internal Revenue Code, which provides that every provider of minimum essential coverage will report coverage information by filing an information return with the IRS and furnishing a statement to individuals.

The answer is: yes and no  

If you have less that 50 full time equivalent employees and fully-insured then the health insurance carrier is responsible for the transmittal that is sent to the IRS (Form 1094B) and the Statement that is sent to the individual employee for their taxes (1094C).

If you have less than 50 full time equivelant employees and are self-insured, the employer is responsible for filing the Transmittal to the IRS (Form 1095B) and the  Statement to the employee (1095C)

If you are fully-insured or self-insured with over 50 full time equivalent employees then the employer is responsible for filing the Transmittal to the IRS (Form 1095B) and the Statement to the employee (1095C).

As a side-note, people with individual coverage directly with an insurance carrier or through the exchanges will receive a statement on form 1095A from either the Insurance Marketplace (Exchange) or from the Carriers.

Friday, February 6, 2015

Anthem Data Breach and Suspicious Voice Mail Alert

Anthem Data Breach and Suspicious Voice Mail Alert 

1. CareFirst BlueCross Blue Shield statement regarding Anthem data breach: CareFirst has been made aware by Anthem (like CareFirst, a Blue Cross Blue Shield company) of a cyberattack on Anthem’s information technology system and a resulting data breach. It is unknown at this time the extent to which the data breach may affect members of other Blue Cross Blue Shield plans. CareFirst is working with Anthem and the Blue Cross and Blue Shield Association as the breach is investigated, and will provide information as warranted about the breach and any impact on CareFirst members. Further information about the data breach may be found at

 2. Report of suspicious voice mails claiming to be from CareFirst: CareFirst has been informed that some members have received voice messages claiming to be from CareFirst, and asking the member to call back to a given phone number. That number connects the member to a company that offers information on vacation packages. CareFirst BlueCross BlueShield is not sponsoring or making these calls and is investigating this matter. 

Carefirst Blue Cross Blue Shield
February 5, 2015