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California Repeals 60-Day Limit on Health Insurance Waiting Periods

Under the Patient Protection and Affordable Care Act (ACA), a “waiting period” is defined as the period that must pass before coverage for an individual who is otherwise eligible to enroll under the terms of a group health plan can become effective. The ACA prohibits group health plans and group health insurance issuers from imposing a waiting period that exceeds 90 days after an employee is otherwise eligible for health coverage. Generally, an individual is “eligible” to enroll in a health plan if he or she has met the plan’s substantive eligibility conditions,...

Need Help Finding Your Plan's Missing Participants?

The Department of Labor (DOL) recently issued a new Field Assistance Bulletin (FAB 2014-01) that provides guidance regarding the steps a plan administrator should take to fulfill his or her fiduciary duty to locate and distribute account balances to missing participants in terminated defined contribution plans.  FAB 2014-01 replaces the 10-year-old Field Assistance Bulletin 2004-02 (FAB 2004-02).  Since FAB 2004-02, many changes have occurred that warranted updated guidance.  These changes include the discontinuance of the letter-forwarding services by the Internal Revenue...

The Department of Health & Human Services Clarifies Applicability of Certain Provisions of the Affordable Care Act to Health Insurance Issuers in Puerto Rico

The Affordable Care Act ("ACA") and its regulations have been incorporated into the Puerto Rico Health Insurance Code, as amended, and guidance has been issued by the Office of the Insurance Commissioner to such effect.  The Department of Health & Human Services, however, has recently clarified that the following requirements imposed under the ACA, will not apply to individual or group health insurance in the U.S. territories, including Puerto Rico: (i) guaranteed availability; (ii) community rating; (iii) single risk pool; (iv) rate review; (v) medical loss ratio; and (vii...

IRS Issues Draft ACA Reporting Forms

On July 24, 2014, the Internal Revenue Service (IRS) released draft forms that employers will use to report on health coverage that they offer to their employees. In March, the IRS issued final rules implementing the health coverage reporting requirements under the Affordable Care Act (ACA).  The information reporting requirements become effective for the 2015 tax year. Section 6056 of the Internal Revenue Code, as added by the ACA, requires “applicable large employers” to provide information to the IRS about the type of health coverage offered to their full-time...

Circuits Split Regarding Validity of Federal Subsidies of Health Insurance Purchased on Federally-Established Exchanges

Two federal appeals courts have issued opposing decisions regarding whether the IRS has the authority under the Affordable Care Act (“ACA”) to extend federal tax subsidies to individuals who obtain health insurance coverage through a federal Marketplace (also known as an Exchange).Pursuant to the requirements of the statute, there is a Marketplace in each state where individuals can purchase healthcare coverage.  Under the ACA, the Marketplace can either be established by a state or the federal government. The federal government now runs the insurance Marketplaces in the 36...


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Format: 2014-08-22
Format: 2014-08-22