Court Ruling on Anti-Discrimination Regulations

A U.S. District Court judge has issued a nationwide preliminary injunction prohibiting the U.S. Department of Health and Human Services (HHS) from enforcing certain provisions of the rules in Section 1557 of the Affordable Care Act (ACA).

The plaintiffs, eight states1 and three private entities2, argued the rules extending anti-discrimination protections to transgender individuals and allegedly requiring the performing of and coverage of pregnancy terminations conflict with their beliefs. The federal government argued that the rules do not mandate any particular procedure, rather the rules require only that covered entities provide nondiscriminatory health services and health insurance in a nondiscriminatory manner.

Court ruling

On Dec. 31, 2016, the preliminary injunction was issued after the judge determined that the federal government exceeded its authority with rules that extended anti-discrimination protections to transgender individuals and that the rules likely violated certain laws, including religious freedom protections for the private entities regarding pregnancy terminations. Other provisions of the anti-discrimination rules issued under Section 1557 of the ACA were not affected by the preliminary injunction.

More on the ACA’s anti-discrimination regulations

The U.S. Office for Civil Rights issued anti-discrimination rules under the ACA’s Section 1557 that prohibit covered entities from discriminating in the provision of a health program or activity based on race, color, national origin, sex, age or disability.

Section 1557 rules apply to the following “covered entities”:

  • health plans, insurers, hospitals, doctors and other medical providers that receive federal funding from HHS, including Medicaid and Medicare Parts A, C and D payment (prescription-drug subsidies) but not Medicare Part B;
  • qualified health plans offered on either state or federal Health Insurance Marketplaces, also known as exchanges; and
  • all of a health insurance issuer’s operations, including the issuer’s third-party administrator services or ASO services, if an issuer receives federal financial assistance from HHS.

A covered entity that does not comply with Section 1557 may face:

  • enforcement mechanisms under federal law that ultimately may result in loss of federal funding, and
  • lawsuits from individuals, with the potential for compensatory damages.

Moving forward

Clients should consult with their attorney regarding compliance with Section 1557 rules before making any changes to their previously decided course of action.

For more information on Section 1557 rules, follow this link.

1Plaintiffs include eight states: Arizona, Kansas, Kentucky, Louisiana, Mississippi, Nebraska, Texas and Wisconsin.

2Plaintiffs also include three religiously affiliated private entities: Franciscan Alliance, Inc., its wholly owned entity Specialty Physicians of Illinois, LLC, and the Christian Medical & Dental Society.

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Filed under Healthcare reform, Section 1557

Deadlines Approaching for 6055 and 6056 Reporting

Deadlines for IRS Sections 6055 and 6056 reporting are approaching. Employers must provide a statement to the primary covered individual by March 2, 2017, and file paper returns by February 28, 2017, or electronic returns by March 31, 2017. Starmark® is providing a spreadsheet, available in the Document Center the week of January 9, 2017, that includes Social Security numbers we have on file for employees and dependents. For help with completing the forms or filing with the IRS, see your accountant, tax advisor and/or payroll services company.

Reminder: The ACA Reinsurance Assessment Fee will not be assessed for the 2017 benefit year; therefore, if you previously chose the option to have Starmark collect a monthly contribution fee, it is no longer included on your monthly bill.

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Changes Proposed for Form 5500

Federal agencies are proposing changes to improve Form 5500 Annual Return/Report. If adopted, the changes would generally apply for plan years beginning on or after Jan. 1, 2019.

View this flyer to learn what these proposed revisions are intended to do and what plans would be affected.

 

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Transitional Reinsurance Deadline Approaching

Employers must submit the 2016 Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form and schedule payment no later than Nov. 15, 2016 on Pay.gov.

In 2016, the fee is $27 per average covered life. The first installment of $21.60 per average covered life is due no later than Jan. 17, 2017, and the second installment of $5.40 per average covered life is due no later than Nov. 15, 2017. Plan sponsors can also pay the fee in full by the deadline of the first installment.

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Filed under Healthcare reform, Reinsurance Fee

April 2017 Edition of the SBC Template and Supporting Documents

Health plans and issuers that maintain an annual open enrollment period will be required to use the April 2017 edition of the SBC template and associated documents beginning on the first day of the first open enrollment period that begins on or after April 1, 2017, for plan years beginning on or after that date. For plans and issuers that do not use an annual open enrollment period, this SBC template and associated documents are required beginning on the first day of the first plan year that begins on or after April 1, 2017.

In addition, the Center for Consumer Information & Insurance Oversight (CCIIO) has temporarily suspended the completion of a new third coverage example for a simple fracture for the 2017 Summary of Benefits and Coverage (SBC).

Until further notice, self-funded plans and insurers should enter default values of “$0” on the Plans and Benefit template for each field for this coverage example, according to the CCIIO, which is part of the Centers for Medicare and Medicaid Services.

Self-funded plans and insurers may continue to use the Coverage Example Calculator approved for plan year 2016 to calculate data for the two other SBC coverage examples: “Having a Baby” and “Managing Diabetes.”

For more information on SBCs, follow this link.

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Filed under Healthcare reform, SBC

Regulations on Section 1557 Prohibit Discrimination

The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) published a final rule implementing Section 1557 of the ACA prohibiting “covered entities” from discriminating in the provision of a health program or activity based on race, color, national origin, sex, age or disability.

The regulations require covered entity’s anti-discrimination notice and taglines be published by October 16, 2016, and health benefit plan documents be amended when renewed on and after January 1, 2017.

Who Is a Covered Entity?

A covered entity may include doctors, hospitals, health plans and other medical providers that receive federal financial assistance from HHS. Examples of federal financial assistance include Medicaid and Medicare Parts A, C and D payments (including prescription drug subsidies).

View a flyer, Navigating Anti-Discrimination Regulations, to learn more. Or for additional reference materials, go to the HHS website.

Starmark® will send potentially affected employers (determined by SIC codes), beginning with effective dates of October 15, 2016, the Notice Regarding Section 1557 of the Affordable Care Act form. Employers who receive this form must complete it and return it to Starmark.

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Filed under Healthcare reform, Section 1557

ACA Reinsurance Assessment Fee – Important Filing and Payment Dates

Sponsors of self-funded health benefit plans are responsible for filing and paying the ACA Reinsurance Assessment Fee. To assist with the filing, Starmark® will calculate the average number of lives covered under the sponsor’s plan and will mail the information to the sponsor mid-October.

To file, sponsors must go to http://www.pay.gov and complete the ACA Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form online no later than November 15, 2016. If they are making the payment in one lump sum, the payment must be remitted no later than January 17, 2017, at http://www.pay.gov; or if making the payment in two installments, they must pay the first installment by January 17, 2017, and the second installment no later than November 15, 2017, at http://www.pay.gov.

 

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Filed under Healthcare reform, Reinsurance Fee