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The Wagner Law Group

The Wagner Law Group, A Professional Corporation, is a nationally recognized ERISA & employee benefits, estate planning, employment, labor & human resources practice. 


Established 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.





Contact Info

The Wagner Law Group


  Integrity | Excellence



Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110

Palm Beach Gardens 

Tel: (561) 293-3590
Fax: (561) 293-3591
7108 Fairway Drive
Suite 125
Palm Beach Gardens, FL 33418



Tel: (813) 603-2959

Fax: (813) 603-2961

101 East Kennedy Boulevard

Suite 2140
Tampa, FL  33602 


San Francisco

Tel: (415) 625-0002

Fax: (415) 358-8300

300 Montgomery Street

Suite 600

San Francisco, CA 94104


St. Louis

Tel: (314) 236-0065

Fax: (314) 236-5743
100 South 4th Street, Suite 550
St. Louis, MO  63102 







January 5, 2017


 Health and Welfare Law Alert




   Agencies Release ACA FAQs XXXV






DOL, HHS 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 ("QSEHRAs").


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.


ACA 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").


In 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.


HIPAA 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 available.


Preventive 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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This Newsletter is provided for information purposes by The Wagner Law Group to clients and others who may be interested in the subject matter, and may not be relied upon as specific legal advice.  This material is not to be construed as legal advice or legal opinions on specific facts. Under the Rules of the Supreme Judicial Court of Massachusetts, this material may be considered advertising.