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 irs.gov.........The 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.

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 www.AnthemFacts.com.

 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

Maryland Parental Leave Law for Employers with 15-49 Employees

Beginning October 1, 2014, all Maryland businesses with 15-49 employees will be required to provide six weeks of unpaid leave to an employee upon the birth of their child or the placement of an adopted or foster care child. This new law requires that the employer hold the employee’s job and benefits for up to six weeks or return the employee to an “equivalent position” when the employee returns within the six week leave period. Premiums for benefits may be recovered by the employer if the employee fails to return to work after the leave ends 

This new Maryland law is geared to providing employees who work for smaller employers with a watered-down version of federal Family and Medical Leave Act (FMLA).  Under FMLA employers with 50 or more employees must offer 12 weeks of unpaid leave for a medical condition or to provide care for a family member with a medical condition.   .

Employers may want to draft policy and take necessary steps to comply with the new law.

Group Health Plans That Fail to Cover In-Patient Hospitalization Services

Health plans that are trying to offer a stripped down Minimal Value plan to save costs and avoid penalties need to be careful.  The Fed is cracking down on these types of plans by requiring in-patient hospitalization services as part of the coverage.  Please see below release via IRS Guidewire. 

Group Health Plans That Fail to Cover In-Patient Hospitalization Services

VIA IRS GUIDEWIRE:  

Notice 2014-69 advises employers and other taxpayers that employer-sponsored health plans that fail to provide substantial coverage for in-patient hospitalization services or for physician services do not provide minimum value within the meaning of § 36B and that the IRS, the Treasury Department, and the Department of Health and Human Services (HHS) expect shortly to propose regulations to this effect.  The notice also advises that IRS, Treasury, and HHS are considering whether the continuance tables underlying the Minimum Value Calculator produce valid actuarial results for plans with these designs. Employers offering plans that fail to cover in-patient hospitalization or physician services should exercise caution in relying on the Minimum Value Calculator to demonstrate that these plans provide minimum value for any portion of a taxable year after publication of final regulations.

Notice 2014-69 will appear in IRB 2014-48 dated Nov. 24, 2014.

Parental Leave Law Now In Effect October 1, 2014-FMLA Light

Beginning October 1, 2014, all Maryland businesses with 15-49 employees will be required to provide up to six weeks of unpaid parental leave to an employee upon the birth of their child or the placement of an adopted or foster care child. The Parental Leave Law requires the employer to hold the employee’s job for up to six weeks or return the employee to an “equivalent position” when the employee returns within the six week leave period.  In order to qualify under this law, the employee must have worked for the employer 12 months and a minimum of 1250 hours in the previous 12 months. 

For employers with more than fifty employees, Family and Medical Leave Act (FMLA) already requires those employers grant 12 weeks of unpaid leave for various qualifying family and medical events, the new Maryland law is geared to providing employees who work for smaller employers with a lighter version of FMLA.  One major difference is that the new Maryland law does not cover medical leave (as it is limited to parental leave) and it only provides for six weeks of leave.  As is under FMLA, employee benefits must be maintained by the employer while on leave.  Premiums may be recovered by the employer if the employee fails to return to work after the leave ends

Employers should update employee handbooks and draft Parental Leave Policy that adheres to the new law.

HIPAA-Responsibilities-Frequently Asked Questions

HIPAA is at the forefront of many employers minds. As many are struggling to comply, hopefully some of the following questions and answers from HHS Website will help.  

What Is Health Information Privacy

Answer:

The HIPAA Privacy Rule provides federal protections for individually identifiable health information held by covered entities and their business associates and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of health information needed for patient care and other important purposes. 

The Security Rule specifies a series of administrative, physical, and technical safeguards for covered entities and their business associates to use to assure the confidentiality, integrity, and availability of electronic protected health information.

Who must comply with HIPAA privacy standards?

Answer:

As required by Congress in HIPAA, the Privacy Rule covers:

• Health plans
• Health care clearinghouses
• Health care providers who conduct certain financial and administrative transactions electronically. These electronic transactions are those for which standards have been adopted by the Secretary under HIPAA, such as electronic billing and fund transfers.

These entities (collectively called “covered entities”) are bound by the privacy standards even if they contract with others (called “business associates”) to perform some of their essential functions. The law does not give the Department of Health and Human Services (HHS) the authority to regulate other types of private businesses or public agencies through this regulation. For example, HHS does not have the authority to regulate employers, life insurance companies, or public agencies that deliver social security or welfare benefits. See our business associate section and the frequently asked questions about business associates for a more detailed discussion of the covered entities’ responsibilities when they engage others to perform essential functions or services for them.

I’m an employer that offers a fully insured group health plan for my employees. Is the fully insured group health plan subject to all of the Privacy Rule provisions?

Answer:

The Privacy Rule recognizes that certain fully insured group health plans may not need to satisfy all of the requirements of the Privacy Rule since these responsibilities will be carried out by the health insurance issuer or HMO with which the group health plan has contracted for coverage of its members. In particular, a fully insured group health plan that does not create or receive protected health information other than summary health information (see definition at 45 CFR 164.504(a) (GPO)) and enrollment or disenrollment information is not required to have or provide a notice of privacy practices. See 45 CFR 164.520(a)(2) (GPO).

Moreover, these group health plans are exempt from most of the administrative responsibilities under the Privacy Rule. See 45 CFR 164.530(k). These health plans are still required, however, to refrain from intimidating or retaliatory acts (45 CFR 164.530(g) (GPO)), and from requiring an individual to waive their privacy rights (45 CFR 164.530(h) (GPO)). The documentation requirements at 45 CFR 164.530(j) apply to these group health plans only to the extent of amendments, if any, made to the plan documents for the sharing of information with the plan sponsor under 45 CFR 164.504(f) (GPO). Additional information about the Privacy Rule, including guidance and technical assistance materials is available through the Department of Health and Human Services Office for Civil Rights Web site.

Must all small health plans comply with the Privacy Rule?

Answer:

No. Certain plans are specifically excluded from having to comply with the HIPAA Administrative Simplification requirements, including the Privacy Rule. See 45 CFR 160.103 (GPO). An employee welfare benefit plan that has less than 50 participants and is administered by the employer that establishes and maintains the plan is not a HIPAA covered entity. These plans, therefore, are not subject to the Privacy Rule. For additional information regarding compliance with the Privacy Rule, see the Office for Civil Rights Web site.

Are the following types of insurance covered under HIPAA: long/short term disability; workers' compensation; automobile liability that includes coverage for medical payments?

Answer:

No, the listed types of policies are not health plans. The HIPAA Administrative Simplification regulations specifically exclude from the definition of a “health plan” any policy, plan, or program to the extent that it provides, or pays for the cost of, excepted benefits, which are listed in section 2791(c)(1) of the Public Health Service Act, 42 U.S.C. 300gg-91(c)(1). See 45 CFR 160.103. As described in the statute, excepted benefits are one or more (or any combination thereof) of the following policies, plans or programs:

• Coverage only for accident, or disability income insurance, or any combination thereof.
• Coverage issued as a supplement to liability insurance.
• Liability insurance, including general liability insurance and automobile liability insurance.
• Workers’ compensation or similar insurance.
• Automobile medical payment insurance.
• Credit-only insurance.
• Coverage for on-site medical clinics
• Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.

What Is Protected Health Information (PHI)?

Answer:

The Privacy Rule defines PHI as individually identifiable health information, held or maintained by a covered entity or its business associates acting for the covered entity, that is transmitted or maintained in any form or medium (including the individually identifiable health information of non-U.S. citizens). This includes identifiable demographic and other information relating to the past, present, or future physical or mental health or condition of an individual, or the provision or payment of health care to an individual that is created or received by a health care provider, health plan, employer, or health care clearinghouse. For purposes of the Privacy Rule, genetic information is considered to be health information.

For Covered Entities and Business Associates

The HIPAA Rules apply to covered entities and business associates.  

Individuals, organizations, and agencies that meet the definition of a covered entity under HIPAA must comply with the Rules' requirements to protect the privacy and security of health information and must provide individuals with certain rights with respect to their health information. If a covered entity engages a business associate to help it carry out its health care activities and functions, the covered entity must have a written business associate contract or other arrangement with the business associate that establishes specifically what the business associate has been engaged to do and requires the business associate to comply with the Rules’ requirements to protect the privacy and security of protected health information. In addition to these contractual obligations, business associates are directly liable for compliance with certain provisions of the HIPAA Rules.

If an entity  does not meet the definition of a covered entity or business associate, it does not have to comply with the HIPAA Rules.  See definitions of “business associate” and “covered entity” at 45 CFR 160.103.

COURT BARS PPACA AID FOR FEDERAL EXCHANGE SHOPPERS

By Andrew Zajac
July 22 (Bloomberg)

President Barack Obama’s health care overhaul suffered a potentially crippling blow as a U.S. appeals court ruled the government can’t give financial assistance to anyone buying
coverage on the insurance marketplace run by federal authorities.  

The decision, if it withstands appeals, may deprive more than half the people who signed up for the Patient Protection and Affordable Care Act the tax credits they need to buy a health plan.

The way PPACA is written makes clear that the subsidy is available only to people who
bought plans on state-run exchanges, a three-judge panel in Washington ruled today.

Only 14 states have opted to set up their own marketplaces, making delivery of tax credits via
the federal exchange crucial to meeting Obamacare’s goal of broadening health-care coverage
in the U.S.

“A very large share of people need the subsidies,” said Robert Blendon, a professor of health
policy at the Harvard School of Public Health in Boston.

If the ruling isn’t overturned, “it basically would significantly cripple the law,” Blendon said in an
interview before the ruling.