The Wagner Law Group
Wagner Law Group, A Professional Corporation, is a nationally
recognized ERISA & employee benefits, estate planning,
employment, labor & human resources practice.
in 1996, The Wagner Law Group has 26 attorneys engaged
exclusively in employee benefits, estate planning and
employment law. Six of our attorneys are AV rated by
Martindale-Hubbell as having very high to preeminent legal abilities
and ethical standards. The firm is among the largest ERISA boutiques
in the country. Our practice is national in scope, with clients in
more than 40 states and several foreign countries.
Wagner Law Group
Fax: (561) 293-3591
7108 Fairway Drive
Palm Beach Gardens, FL 33418
East Kennedy Boulevard
Tampa, FL 33602
Francisco, CA 94104
100 South 4th Street, Suite 550
St. Louis, MO 63102
January 5, 2017
Health and Welfare Law
ACA FAQs XXXV
and IRS have released FAQs About Affordable Care Act Implementation
Part XXXV ("FAQs XXXV"). Specifically, FAQs XXXV addresses
compliance with HIPAA's special enrollment rights, coverage of
preventive services under the Affordable Care Act ("ACA")
and Qualified Small Employer Health Reimbursement Arrangements
Background. HIPAA requires employers who sponsor group
health plans to offer special enrollment (i.e., mid-year
enrollment) opportunities to employees who do not enroll in coverage
when first eligible but who subsequently lose other coverage or
experience events such as acquiring a new spouse or dependent.
requires non-grandfathered group health plans to cover certain
preventive services without imposing any cost-sharing requirements on
participants. The ACA's preventive services requirements are
developed, in part, based on recommendations from the Health
Resources and Services Administration ("HRSA").
addition, the ACA prevents employers from offering stand-alone HRAs
because the arrangements do not satisfy many of the ACA's market
reforms, including the requirement to provide first-dollar coverage
of preventive services and the prohibition on lifetime and annual
limits. Following the ACA's enactment, the IRS released guidance (IRS
Notice 2013-54) that reiterated this prohibition and imposed an
excise tax of up to $36,500 for failures to comply with this rule.
Special Enrollment Rules.
FAQs XXXV confirm that an employee is eligible for special enrollment
if he or she: (i) is otherwise currently eligible for coverage under
the employer's group health plan; (ii) had other coverage in effect
when the employer's group health plan coverage was previously
offered; and (iii) subsequently lost that other coverage. However,
FAQs XXXV provide that the special enrollment events also include a
loss of eligibility for individual insurance coverage, regardless of
whether that coverage is purchased through a Marketplace and
regardless of whether other individual insurance coverage is
Services. FAQs XXXV confirm
that updated HRSA recommendations for women's preventive services
will apply for plan years beginning on or after December 20, 2017.
The updated guidelines address several women's health services,
including breast cancer screening, cervical cancer screening,
gestational diabetes, breastfeeding services and supplies, along with
well-women preventive visits. Plans will also be required to cover
all 18 of the FDA-approved contraceptive methods.
QSEHRAs. The 21st Century Cures Act (the "Act")
permits certain small employers that do not offer any group health
plan to their employees to offer QSEHRAs to employees that can be
used to pay individual health insurance premiums. While the Act does
not repeal the ACA's prohibition on employers offering stand-alone
HRAs, it does create a new type of tax-free benefit: QSEHRAs. (See
the 12/15/16 Alert for more information on the eligibility
requirements for small employers to offer QSEHRAs.) FAQs XXXV confirm
that small employers that meet the eligibility requirements
applicable to QSEHRAs may begin offering the arrangements to
employees in 2017.
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