Wagner Header

The Wagner Law Group Description 

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 19 attorneys engaged exclusively in employee benefits, estate planning and employment law. Five 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


Massachusetts Office 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110

Florida Office 

Tel: (561) 293-3590
Fax: (561) 293-3591
7121 Fairway Drive
Suite 203
Palm Beach Gardens, FL 33418


New York Office

Tel: (716) 650-5987

Fax: (716) 633-0301

333 International Drive

Suite B-4

Williamsville, NY 14221


San Francisco Office

Tel: (415) 625-0002

Fax: (415) 829-4385

315 Montgomery Street

Suite 902

San Francisco, CA 94104







August 16, 2012 

 State and Federal Law Alert




Changes to Fair Share Contribution Test




Recent legislation has eased the requirements for passing the Fair Share Contribution test.


Under the Massachusetts Health Care Reform Act, employers with the equivalent of 11 or more full time Massachusetts employees that fail to make a "fair and reasonable" contribution towards the cost of group health care coverage must pay a quarterly "Fair Share Contribution" of $73.75 per full time employee. To be exempt from the payment, a smaller employer has to pass either the 25% participation test (25% of its full time employees must be covered by the employer's plan) or the 33% contribution test (the employer must pay 33% of the cost of employee-only coverage and offer the coverage within 90 days of the date of hire). Employers with more than 50 employees must pass both tests or cover at least 75% of their full time employees.


Under the new legislation, the Fair Share Contribution rules will only apply to employers that employ the equivalent of 21 or more full time employees. Also, when calculating whether 25% or 75% of its full time employees participate in the employer's plan, the employer may disregard any employee who has qualifying health insurance coverage from a spouse, parent, veteran's plan, Medicare or a "plan or plans due to disability or retirement." This second rule will ease the requirements for employers that have employees who chose to be covered under another plan.


Unfortunately, the new rules are not effective until July 1, 2013.





SBCs Not Required for Medicare

Advantage Plans


The Departments of Labor, Health and Human Services and the Internal Revenue Service, recently issued "FAQs About Affordable Care Act Implementation, Part X." FAQ Part X provides additional clarification on the uniform explanation of benefits and coverage ("Summary of Benefits and Coverage" or "SBC") that group health plans (including grandfathered plans) must provide to plan participants and beneficiaries pursuant to the Patient Protection and Affordable Care Act ("PPACA").


Under Part X, the agencies clarify that the SBC disclosure requirements do not apply to Medicare Advantage Plans that are offered as one of several benefit packages by a sponsoring employer.


Medicare Advantage Plans, which operate like an HMO or PPO, are offered by private companies and are approved by Medicare as another option for Medicare recipients. Sometimes called "Part C" or "MA Plans," Medicare Advantage Plans provide all of the Part A (Hospital Insurance) and Part B (Medical Insurance) coverage offered under original Medicare, plus some extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Many also include prescription drug coverage (Medicare Part D).  Medicare pays a fixed, monthly amount to the companies offering Medicare Advantage Plans. And, while the companies must follow rules set by Medicare, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how services are delivered (such as referrals to specialists).


Because Medicare Advantage plans are Medicare benefits, the agencies concluded that they are not health insurance coverage for the purposes of SBCs and Medicare Advantage organizations are, therefore, not required to provide an SBC with respect to these benefits.





This Newsletter is protected by copyright. Material appearing herein may be reproduced with appropriate credit.


Pursuant to Internal Revenue Service Circular 230, we hereby inform you that any advice set forth herein with respect to US federal tax issues is not intended or written by The Wagner Law Group to be used and cannot be used, by you or any taxpayer, for the purpose of avoiding penalties that may be imposed on you or any other person under the Internal Revenue Code.


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.