Industry Articles

HHS Announces Start to Phase 2 of HIPAA Audit Program
On March 21, 2016 the U.S. Department of Health and Human Services' Office for Civil Rights (OCR) announced the start of phase 2 (Phase 2) of the Health Insurance Portability and Accountability Act (HIPAA) Audit Program. Phase 2 will consist of more than 200 desk and onsite audits of both covered entities and business associates to determine their compliance with HIPAA's Privacy, Security, and Breach Notification rules. By contrast, the Phase 1 pilot audit program conducted in 2011 and 2012 targeted only covered entities and involved just 115 audits.

Anthem Announces Definitive Agreement to Acquire Cigna Corporation
July 24, 2015 - Earlier today, Anthem's parent company announced that it has entered into a definitive agreement with Cigna Corporation. The combined company will be an industry leader with enhanced diversification and capabilities to advance the transformation of health care delivery for consumers. Following the transaction, Anthem will have more than $115 billion in pro forma annual revenues, based on the most recent 2015 outlooks publicly reported by both companies and will gain meaningful diversification covering approximately 53 million medical members with well positioned commercial, government, consumer, specialty and international franchises. To continue reading the official press release, view the attached PDF.

U.S. Supreme Court Finds A Constitutional Right to Same-Sex Marriage
In a 5-4 holding released Friday, June 26, the United States Supreme Court found in Obergefell v. Hodges that state prohibitions on same-sex marriage violate the Equal Protection and Due Process clauses of the Fourteenth Amendment to the U.S. Constitution. In short, this means that every state must allow same-sex couples to marry and must recognize same-sex marriages performed in other states. The decision invalidates any existing state bans on same-sex marriage.

Employee Benefits and Same-Sex Marriage
Same-sex marriage is effectively legal for federal benefits law purposes and now legal in a majority of states, largely as a result of the U.S. Supreme Court declining to review appeals of lower courts decisions banning state mini-DOMA laws as a violation of equal protection principles. Benefits and human resources professionals operating companies in the 30 states (and DC) that recognize same-sex marriage all have the same question: what does this mean for their employee benefits plans?

HPID Reminder: Health Plans Required to Register by November 5, 2014
As part of the Affordable Care Act's (ACA) Administrative Simplification provision, all controlling health plans (defined below) must obtain a 10-digit numeric identifier known as a Health Plan Identifier, or HPID. The HPID is part of a project that federal agencies, health insurers and health care provider groups have been working on for years, as final rules for the HPID requirement were published in the Federal Register on September 5, 2012 (77 FR 54719) (the Final Rules).

IRS to Amend Cafeteria Plan Regulations to Facilitate Enrollment in Marketplace Coverage
On Thursday, September 18, 2014, the Internal Revenue Service (IRS) released Notice 2014-55, which expands the cafeteria plan "change in status" rules to allow plans to offer employees an option to revoke their elections for employer-sponsored health coverage to purchase a qualified health plan through a Health Insurance Marketplace (Marketplace). The notice is effective immediately and will appear in IRB 2014-41, to be published Oct. 6, 2014.

IRS Increases 9.5% Affordability Threshold - Or Did It?
On July 24, 2014, the Internal Revenue Service (IRS) released three Revenue Procedures (2014-46, 2014-37, and 2014-41), which provide guidance to individuals on their obligation to maintain minimum essential coverage (MEC) under the Affordable Care Act ACA) so-called individual mandate. It has been widely reported that the IRS has increased the affordability percentage. This is not necessarily true.

IRS Releases Draft ACA Reporting Forms for Employers and Insurance Issuers
IRS Releases Draft ACA Reporting Forms for Employers and Insurance Issuers On Thursday, July 24, 2014, the Internal Revenue Service (IRS) released draft forms that applicable large employers and health insurance issuers will use to report information regarding health coverage, as required under the Affordable Care Act (ACA) starting in 2015. (The first reporting will be due in the first quarter of 2016, reflecting the 2015 calendar year.)

High Stakes Decisions on the Affordable Care Act Come Out For and Against the Administration
July 22, 2014 marked a day when two different federal courts came out on opposite sides of the same question. In the morning, the U.S. Court of Appeals for the DC Circuit dealt a serious blow to the Obama Administration with a decision that called into question the structural integrity of the "pay-or-play" mandates under the Affordable Care Act ("ACA"). Later in the day, the U.S. Court of Appeals for the Fourth Circuit, sitting down the road in Richmond, came out on the other side of the question. See below PDF for full reform alert.

No Pay-or-Play Penalty in States with a Federal Exchange?
The U.S. Court of Appeals for the DC Circuit has dealt a serious blow to the Obama Administration today with a decision that calls into question the structural integrity of the "pay-or-play" mandates under the Affordable Care Act ("ACA"). See below PDF for full reform alert.

Final Regulations on Orientation Periods Released
The Departments of Labor, Treasury, and Health and Human Services released final regulations ("Final Regulations") clarifying the relationship between a group health plan's eligibility criteria and the Affordable Care Act's (ACA) 90-day limit on waiting periods. Specifically, the Final Regulations (published in the June 25 Federal Register) address an employer's ability to require new employees to satisfy a "reasonable and bona fide employment-based orientation period" before starting a group health plan's waiting period. Please see below PDF to read the full article.

New Solutions Called for as the ACA Threatens to Boost Workers' Compensation Costs
We all know that the Affordable Care Act (ACA), as it continues to roll out, has been complicated for Employers. With the change also comes the opportunity to rethink their approach to managing claims, on both the medical and the workers' compensation side. By creating a culture that places a high value on injury prevention, employers can take the important step of moving beyond managing claims to managing risk. Among the least understood and seldom discussed consequences for employers is the possible relationship between the rollout of the ACA and workers' compensation claims. MMA has authored a white paper addressing this topic and introduces some thought provoking ideas.

Final Rule Implementing Mental Health Parity Requirements

Changes to the "Use-or-Lose" Rule for Health FSAs
On Oct. 31, 2013, the Internal Revenue Service (IRS) released Notice 2013-71 (Notice), which relaxes the "use-or-lose" rule for health FSAs. Under the relaxed rule, employers will now be able to allow participants to carry over up to $500 in unused funds into the next year. This modification applies only if the plan does not also incorporate the grace period rule.

The FMLA - 20th Birthday Brings Change

Final Rules Issued on HIPAA Privacy and Security Protections

IRS Guidance on Tax-Free Coverage for Children under Age 27

As a result of changes made by the recently enacted Affordable Care Act, health coverage provided for an employee's children under the age of 27 is now generally tax-free to the employee, effective March 30, 2010.


The Internal Revenue Service announced on April 27, 2010 that these changes immediately allow employers with cafeteria plans – plans that allow employees to choose from a menu of tax-free benefit options and cash or taxable benefits – to permit employees to begin making pretax contributions to pay for this expanded benefit.

Please see the attached legislative brief for additional guidance regarding this IRS Notice.

COBRA Extension Through May

The HIRE Act
On March 18, 2010, President Obama signed into law the Hiring Incentives to Restore Employment Act (HIRE Act).  The HIRE Act was enacted to help foster job growth through immediate tax incentives to employers who hire formerly unemployed or part-time workers. 
The HIRE Act offers tax breaks to covered employers for hiring qualified individuals in 2010; on or after February 3, 2010 but before January 1, 2011.  The HIRE Act defines qualified individuals as:
-        an employee that provides the employer with a signed affidavit certifying that he or she was unemployed during the 60 days before beginning work or, alternatively, worked fewer than a total of 40 hours for someone else during the 60-day period (the IRS is currently developing a form employees can use to make the required statement)
-        was not hired to replace another employee, unless such employee voluntarily quit or was terminated for cause
-      is not a family member
The HIRE Act provides employers with incentives to retain employees for at least one year and applies to both for-profit and not-for-profit private sector employers of any size, as well as public higher education institutions.

COBRA Extension Through March

The American Recovery and Reinvestment Act of 2009 (ARRA) provided a temporary subsidy for the cost of COBRA continuation health coverage. The COBRA premium subsidy was extended for the first time in December 2009. On March 2, 2010, the Temporary Extension Act of 2010 extended the eligibility period for the subsidy again. The Temporary Extension Act also clarifies some questions regarding the subsidy and provides premium subsidy eligibility  for individuals who experienced a reduction in hours of employment before their involuntary termination.

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